Revista Brasileira de Ortopedia (English Edition)最新文献

Objective

The aim of this study is to analyze the accuracy of the two classification systems for open fractures most commonly used in current medical practice, Gustilo and Tscherne, as predictors of infection.

Methods

A retrospective observational study was performed, including 121 patients suffering from open fracture of the appendicular skeleton treated at an emergency hospital. The fractures were classified according to Gustilo and Tscherne systems during the initial treatment, and ratings were subsequently confirmed or rectified during hospitalization. Sensitivity, specificity, positive and negative predictive values, and accuracy were calculated according to each classification adopted.

Results

The results of this study demonstrated that both classifications of Gustilo and Tscherne are associated with the clinical outcome of infection in open fractures. The Gustilo classification achieved sensitivity of 76.7%, specificity of 53.8%, and accuracy of 59.5%. Tscherne's classification had a sensitivity of 56.7%, specificity 82.4%, and accuracy of 76.1%.

Conclusion

The Tscherne system showed better accuracy, including specificity as a predictor of infection in open fractures, when compared with the Gustilo system.

Biapical femoral deformities are challenging to treat. In order to correct concomitant metaphyseal and diaphyseal deformities of the femur, the authors propose a double femoral controlled osteotomy with combined internal fixation, consisting of a Puddu plate and an intramedullary nail. The method was described in two patients. Results were analyzed using a visual analog scale (VAS), the Lysholm score, and SF-36. No complications were found. Complete consolidation of the osteotomies and radiographic alignment correction were achieved. Results were obtained with a minimum follow-up of 66 months. Both patients had improved for pain (VAS from 60 to 40 and from 50 to 20 at reassessment), function (Lysholm score from 78 to 93 and from 55 to 73) and quality of life (SF-36, both mental – from 40.7 to 57.1 in case one and from 24.7 to 59.7 in case two – and physical – from 27.7 to 45.6 and from 28.2 to 46.8). The authors have found that this technique is a reliable, accurate, and reproducible solution for biapical deformities of the femur.

Objective

To evaluate patients diagnosed with posterior four-part fracture-dislocations of the proximal humerus, that were surgically treated with osteosynthesis, regarding their clinical and functional outcomes.

Methods

A prospective observational study of eight patients from the same hospital institution in the interior of São Paulo State (Brazil), through individual interviews using the UCLA, DASH, and Constant international scores. The active movements included in the scores plus the range of motion of the affected and non-affected limb were measured. The affected shoulder's radiographs were requested to verify bone conditions and the fixation of the osteosynthesis.

Results

The rating of eight patients by the international scores indicated that seven of the eight patients presented good clinical and functional evolution of the affected limb; this represents 87.5% of the evaluated individuals.

Conclusion

Surgical treatment with osteosynthesis performed during the acute period (<four weeks) leads to good results in most cases.

Objective

To evaluate the neurotrophin mRNA expression and axon count in the median nerve of Wistar rats submitted to neural mobilization (NM) after nerve compression.

Methods

Eighteen animals were randomly divided into G1 (nerve compression only), G2 (NM for 1 min), and G3 (NM for 3 min). For NM, the animals were anesthetized and the right scapula received the mobilization, adapted as indicated for humans, on alternate days, from the third to the 13th postoperative (PO) day, totaling six days of therapy. On the 14th PO day, animals were anesthetized and euthanized. Fragments of the median nerve, distal to the compression procedure, were removed for histomorphometric analysis and expression of neurotrophins, nerve growth factor (NGF), and brain-derived neurotrophic factor (BDNF) by RT-PCR.

Results

Histomorphometric analysis revealed differences in the number of axons in the injured side, which was significantly lower in the injured limb nerve compared to the control limb, whereas the RT-PCR analysis showed no significant differences in the expression of NGF or BDNF.

Conclusion

NM treatment did not affect median nerve regeneration, which maintained normal recovery rates.

Objective

The current study aims at a functional analysis of trans-olecranon lateral pinning for displaced supracondylar fracture of the humerus (SCFH) in children.

Methods

A prospective study of 48 children (30 males, 18 females; mean age: 7.4 years) with displaced SCFH was treated at this institution with modified technique from March 2011 to September 2014. Cases were selected on the basis of inclusion criteria. The functional outcome was assessed clinically by modified Flynn's criteria along with achievement of full range of motion.

Results

All 48 children with a mean follow up of 20 months (range: 6–26 months) were assessed. All fractures united well. With modified Flynn's criteria, results were excellent in 40 children (83.3%), good in six children (12.5%), and fair in two children (4.2%). There were no poor results. Preoperative nerve palsies seen in four children recovered at ten weeks. Full range of motion was achieved on an average of 20 days after K-wire removal and no new post-operative nerve palsies were noted.

Conclusion

The modified trans-olecranon fossa four-cortex purchase (TOF-FCP) technique was promising in all cases of unstable SCFH without the complications of loss of reduction or iatrogenic ulnar nerve injury. This technique is simple, safe, and reproducible, with good clinical results in this type of fracture.

Objective

To evaluate whether the change in the CE angle of Wiberg and the acetabular index after Ganz periacetabular osteotomy is statistically significant.

Methods

The pre- and postoperative CE angle of Wiberg and acetabular index of 14 hips operated at a tertiary hospital in Curitiba, Paraná, Brazil were evaluated.

Results

The postoperative measurements showed significant differences in relation to the preoperative period. There was a significant reduction in the CE angle of Wiberg in the postoperative period, as well as in the acetabular index. These differences were statistically significant for both the right and left sides.

Conclusion

The radiographic evaluation of patients submitted to Ganz periacetabular osteotomy presented some statistically significant results; however, a larger sample is still necessary.

Objectives

Evaluate the incidence of digital infarction and tissue necrosis using local anesthesia with 1% lidocaine and 1:100,000 epinephrine in wrist, hand, and fingers surgeries, without a tourniquet, without sedation, and without an anesthesiologist.

Methods

Patients with wrist, hand, and fingers disorders prospectively underwent surgery under local anesthesia with 1% lidocaine and 1:100,000 epinephrine. The primary outcomes evaluated were the presence of digital infarction and tissue loss due to necrosis. As secondary outcomes, the need for the use of sedatives, tourniquet, anesthesiologist assistance, or surgery suspension were evaluated.

Results

Fifty-three wrists, 307 hands, and 128 fingers were anesthetized with lidocaine and epinephrine without any complications related to epinephrine. There was no patient that presented with any of the primary or secondary outcomes.

Conclusions

Wrist, hand, and fingers surgeries can be safely performed with local anesthesia with 1% lidocaine and 1:100,000 epinephrine, without sedation, without a tourniquet, and without an anesthesiologist.

Objective

To analyze magnetic resonance imaging (MRI) of the elbow area to quantify the presence of the anconeus epitrochlearis muscle.

Methods

A total of 232 exams were analyzed; 218 were included, of which 141 were of men and 77, women.

Results

Presence of the muscle was observed in 29 cases (13.3%), demonstrating that the presence of this muscle on images does not have a statistical correlation with the gender or age of the individual.

Conclusion

The prevalence of the anconeus epitrochlearis muscle is variable, without a pattern of normality.

Objective

To analyze, from the immunohistochemical perspective, the effects of hyaluronic acid of different molecular weights in an experimental model of osteoarthritis in rabbits.

Methods

Forty-four male California rabbits were randomly assigned to three different groups (PR, S, and P) and submitted to the resection of the anterior cruciate ligament of the right knee. Three weeks after the surgical procedure, three intra-articular weekly injections were carried out with low-molecular-weight native hyaluronic acid (Hyalgan®) to PR group, high molecular weight branched chain hyaluronic acid (Synvisc®) to group S, and saline solution 0.9% to group P. All animals were sacrificed 12 weeks after the surgical procedure, and the tibial plateaus of the infiltrated knees were then dissected. Histological sections of cartilage from the tibial plateau support areas were stained with immunohistochemical markers in order to investigate the amount of metalloproteases (MMPs 3 and 13) and their inhibitors (TIMPs 1 and 3). The staining intensity was quantified on a Zeiss Imager.Z2 Metasystems microscope and analyzed by Metafer4 Msearch software.

Results

The chondroprotective effect of the hyaluronic acids used in the study was demonstrated when compared to the control group. However, the comparison between them presented no significant statistical difference regarding chondroprotection.

Conclusion

The injection of saline solution demonstrated signs of OA development, while adding native hyaluronic acid of low molecular weight (Hyalgan®) and hyaluronic acid of high molecular weight (Synvisc®) protected the articular cartilage in this model of OA.