Revista Brasileira de Ortopedia最新文献

Objective: To provide a comprehensive depiction of the anatomy of the upper trunk and its distal trifurcation through the dissection of brachial plexuses obtained from adult cadavers.

Methods: We dissected 40 brachial plexuses from adult cadavers preserved using a unique formalin-based technique developed and used by the Anatomy Department of our institution. Bilateral dissection was performed on 20 cadavers placed in the dorsal decubitus position with accurate arm adduction. While the primary focus was on the upper trunk's anatomy, a thorough exploration of the entire brachial plexus was achieved through an extended incision.

Results: The posterior division of the upper trunk was consistently located between the suprascapular nerve and the anterior division. In 22 (55%) of the dissected brachial plexuses, the suprascapular nerve originated from the proximal region of the posterior division of the upper trunk, immediately after its bifurcation. For the remaining 18 (45%), the suprascapular nerve originated directly from the upper trunk.

Conclusion: The distal trifurcation of the upper trunk of the brachial plexus includes the suprascapular nerve and the posterior and anterior divisions of the upper trunk.

Objective: To evaluate the effectiveness of using a graft for reinforcement in rotator cuff repair compared to no use, as well as the effectiveness of different types of grafts, considering healing and shoulder function as primary outcomes, through a systematic review and meta-analysis of randomized controlled trials (RCTs).

Methods: We will conduct a systematic review of RCTs following the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions and of the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols (PRISMA-P) statement. Only RCTs with adult participants comparing repair with a reinforcing graft versus the standard repair, or comparing different types of grafts, will be included. An electronic search will be conducted in the MEDLINE (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and SciELO databases, as well as gray literature. Data management and extraction will be performed using a standardized form that will assess the characteristics of the studies, participants, and intervention, as well as the outcomes and methodological domains. The primary outcomes will be healing and shoulder functional assessment, and the secondary outcomes, pain, range of motion, adverse events, complications, quality of life, and cost-effectiveness. Risk of bias will be assessed with the Risk of Bias, version 2.0 (RoB 2.0), and the certainty of evidence, through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Descriptive, subgroup, and sensitivity analyses will be performed when applicable.

Conclusion: The review is expected to consolidate evidence on the effectiveness of using a graft for reinforcement in rotator cuff repair. It has been registered in the International Prospective Register of Systematic Reviews (PROSPERO) under number 1106892.

Objective: To analyze the use of the groin flap in the treatment of traumatic injuries that are not very extensive, with tissue loss in the wrist and hand region.

Methods: We performed 14 flaps from the inguinal region to reconstruct traumatic hand injuries. The age of the sample ranged from 21 to 56 years, and all patients were male.

Results: Complete flap survival was recorded in all limbs. In seven patients, there were complications: in two, partial necrosis, for which flap debridement was necessary, and the area was covered with a skin graft. In four cases, marginal necrosis occurred, which later healed spontaneously. Partial loosening at the receiving area was observed in one case in the first week, requiring complete suturing.

Conclusion: Even with the advent of microsurgical techniques, the groin flap remains a good and safe method to repair hand injuries with tissue loss, with or without loss of bone tissue.

Objective: To analyze the use of the groin flap in the treatment of traumatic injuries that are not very extensive, with tissue loss in the wrist and hand region.

Methods: We performed 14 flaps from the inguinal region to reconstruct traumatic hand injuries. The age of the sample ranged from 21 to 56 years, and all patients were male.

Results: Complete flap survival was recorded in all limbs. In seven patients, there were complications: in two, partial necrosis, for which flap debridement was necessary, and the area was covered with a skin graft. In four cases, marginal necrosis occurred, which later healed spontaneously. Partial loosening at the receiving area was observed in one case in the first week, requiring complete suturing.

Conclusion: Even with the advent of microsurgical techniques, the groin flap remains a good and safe method to repair hand injuries with tissue loss, with or without loss of bone tissue.

Objective: Implant removal is a common practice in pediatric orthopedics, despite its risks. The present study aims to evaluate postoperative complications following implant removal in pediatric patients, correlating them with epidemiological factors.

Methods: Retrospective cross-sectional study, conducted in a tertiary hospital, with analysis of medical records and imaging exams from February 2021 to June 2024. Medical records of patients under 18-years-old who were followed up until outpatient discharge were evaluated. The research included age, sex, type of implant, indication for insertion and removal, time to implant removal, and postoperative complications, which were classified according to Clavien-Dindo.

Results: A total of 202 medical records were analyzed. Implant removal was more common in boys, with a mean age of 12 years, and the mean time to removal was 16 months. The main reason for placement was orthopedic trauma, and for removal, bone consolidation. The complication rate was 10% (n = 22). Plate removal had the highest complication rate (15%), followed by isolated screws (14%), external fixators (12%), flexible nails (10%), and Kirschner wires (8%). The main complications were unsuccessful removal (45.5%), superficial infection (36.5%), refractures (9%), and movement limitation (9%). The Clavien-Dindo classification revealed 45.45% type I complications, 40.9% type II complications, and 13.6% type IIIa complications.

Conclusion: Implant removal in pediatric orthopedics is not without complications, with 11% being found in this study. Failure to completely remove the implant, superficial infections, and refractures were the most common. Before the procedure, the risks and benefits involved should be considered and consensus should be reached among family members and surgeons.

Bone defects caused by trauma infections neoplasms and other conditions are commonly treated with autologous grafts which are considered the gold standard due to their osteoinduction osteoconduction and osteogenesis properties. However their use has limitations including limited availability donor-site morbidity and increased surgical time. Alternatively allogeneic grafts xenografts and synthetic bone substitutes including ceramics bioglasses resins and metals have been developed and are often modified with osteoinductive elements such as growth factors and bioinorganic ions. The ideal bone replacement should be biocompatible bioabsorbable mechanically resistant porous and capable of promoting osseointegration. Although synthetic substitutes have advanced they have not yet achieved the effectiveness of autologous grafts especially concerning osteointegration and economic viability. However innovations in molecular biology bone proteins and gene therapies offer promising prospects for the development of new biomaterials. The current article introduces the reader to bone substitutes by presenting a classification of the materials used and the main characteristics of each group.

Objective: To evaluate and quantify the frequency and magnitude of late loss of radiographic parameters following volar locking plate fixation of distal radius fractures.

Methods: The present is a retrospective, cross-sectional study that radiographically analyzed 65 wrists operated on between 2020 and 2024 at a public institution, evaluating postoperative loss of radial height.

Results: The results showed a median loss of 0.60 mm, with 13.8% of patients experiencing losses greater than 2 mm, and 75.4% experiencing lower losses. No evidence was found that sex statistically significantly affects this incidence after the Wald test.

Conclusion: Despite the effectiveness of the volar locking plate in maintaining reduction, loss of radial height still occurs, especially in older patients with more complex fractures. The present study corroborates the use of this osteosynthesis technique, a fundamental tool in the management of complex fractures of the distal third of the radius, to restore and maintain the anatomy of the region.

Bone defects caused by trauma, infections, neoplasms, and other conditions are commonly treated with autologous grafts, which are considered the gold standard due to their osteoinduction, osteoconduction, and osteogenesis properties. However, their use has limitations, including limited availability, donor-site morbidity, and increased surgical time. Alternatively, allogeneic grafts, xenografts, and synthetic bone substitutes, including ceramics, bioglasses, resins, and metals, have been developed and are often modified with osteoinductive elements, such as growth factors and bioinorganic ions. The ideal bone replacement should be biocompatible, bioabsorbable, mechanically resistant, porous, and capable of promoting osseointegration. Although synthetic substitutes have advanced, they have not yet achieved the effectiveness of autologous grafts, especially concerning osteointegration and economic viability. However, innovations in molecular biology, bone proteins, and gene therapies offer promising prospects for the development of new biomaterials. The current article introduces the reader to bone substitutes by presenting a classification of the materials used and the main characteristics of each group.

Objective: To investigate the outcomes of total knee arthroplasty (TKA) when assisted by a robotic arm compared with the conventional approach.

Methods: We conducted a retrospective cohort study including 96 patients who underwent TKA, assigned to either the robotic-assisted (RA) group or a conventional technique (CT) groups. All surgeries were performed without the use of a tourniquet and included administration of intravenous tranexamic acid. Patients were matched based on sex, age, and preoperative hemoglobin (Hb) and hematocrit (Ht) values. Key outcomes evaluated were perioperative blood loss (assessed through changes in Hb and Ht), operative duration, length of hospital stay, and postoperative complications up to 6 months.

Results: There were 34 patients from each group successfully matched for analysis. There were no significant differences between the groups regarding Hb or Ht reduction (RA: Hb -2.27 ± 1.21 g/dL, Ht -6.56 ± 3.43%; vs. CT: Hb -2.00 ± 1.07 g/dL, Ht -5.85 ± 3.26%; p  > 0.05). The mean surgical time was also similar (RA: 108.9 ± 20.8 vs. CT: 111.8 ± 26.2 min; p  = 0.905). Notably, patients in the RA group experienced a shorter hospitalization period (median: 2 vs. 2.5 days; OR = 0.12; 95% CI = 0.03-0.57; p  = 0.008). Incidence of postoperative complications within 6 months did not differ significantly between groups.

Conclusion: Robotic-assisted TKA was not associated with measurable improvements in blood loss, operative time, or postoperative complications. However, it contributed to a reduction in hospital stay compared with the conventional technique.