Revista Brasileira de Ortopedia最新文献

Intra-articular calcaneal fractures are significant injuries to the locomotor system, often leading to lifelong impairments in foot mechanics with substantial occupational, social, and financial repercussions. The initial imaging diagnosis relies on radiography; however, computed tomography is crucial for understanding the three-dimensional anatomy of the fracture and facilitating surgical planning. The treatment of intra-articular calcaneal fractures remains a subject of debate, with literature supporting diverse approaches for similar fracture types. Currently, the gold standard for managing subtalar joint fractures is surgical intervention. Among the two most common techniques, the extended lateral and the sinus tarsi approaches yield comparable functional outcomes, though the latter is associated with fewer complications. The present article discusses the diagnosis, classification, and treatment of intra-articular calcaneal fractures, focusing on the sinus tarsi and extended lateral "L" approaches, as well as the fixation techniques applicable to each fracture type.

The tourniquet (TNQ) interrupts blood flow to a given anatomical segment and has critical applications in orthopedic surgeries by providing a blood-free operating field. The risks and complications attributed to its use are increased pain, reperfusion injury, edema, deep venous thrombosis, and peripheral nerve injury. The main recommendations for TNQ use and to reduce the occurrence of complications include adequate limb padding; TNQ inflation to pressures of 50 mmHg and 100 mmHg above the perfusion pressure for the upper and lower limbs respectively; avoid TNQ use in children and patients with cachexia, lupus, and coagulopathy; avoid keeping the device inflated for more than 2 hours; and have a trained team alert to deflation, which is characterized by the possibility of bleeding, pulmonary embolism, and myonephropathic metabolic syndrome. The present update article summarizes the best evidence on TNQ use in orthopedic surgeries and proposes a protocol for its safe use.

Objective: To describe the prevalence of preoperative malnutrition in individuals undergoing primary TKA and to assess its association with age, sex, body mass index (BMI), and comorbidities, as well as the risk of prolonged postsurgical hospitalization, early prosthetic joint infection (PJI), or readmission.

Methods: We conducted a cohort study of TKAs performed between 2014 and 2016. Preoperative malnutrition was defined as a total lymphocyte count < 1,500 cells/mm ³ , a serum albumin concentration < 3.5 g/dL, or a transferrin concentration < 200 mg/dL within the six months before surgery.

Results: Out of the 2080 TKAs performed, 1099 had valid lymphometry, albumin, and transferrin data and were included in the analysis. The prevalence of malnutrition was 17.7%. Independent factors associated with a higher prevalence of malnutrition were age (OR = 1.03; 95% CI = (1.01-1.05)), anemia (1.55 (1.05-2.28)), low weight (3.13 (1.50-6.50)), and normal weight (1.85 (1.21-2.82)). Diabetes mellitus was inversely associated with malnutrition (0.60 (0.38-0.96)). Early PJI was diagnosed in 18 (1.6%) participants. There was no statistically significant and independent association between malnutrition and postsurgical complications.

Conclusion: Altered lymphocyte count, serum albumin, and transferrin levels is common among individuals undergoing TKA, particularly in older patients, those with anemia, and individuals with normal or low weight. Future studies with larger sample sizes are needed to better assess the relationship between malnutrition and adverse outcomes following TKA.

Objective: Describe the prevalence of preoperative malnutrition in individuals undergoing primary TKA and to assess its association with age, sex, body mass index (BMI), and comorbidities, as well as the risk of prolonged postsurgical hospitalization, early prosthetic joint infection (PJI), or readmission.

Methods: We conducted a cohort study of TKAs performed between 2014 and 2016. Preoperative malnutrition was defined as a total lymphocyte count < 1,500 cells/mm ³ , a serum albumin concentration < 3.5 g/dL, or a transferrin concentration < 200 mg/dL within the six months before surgery.

Results: Out of the 2080 TKAs performed, 1099 had valid lymphometry, albumin, and transferrin data and were included in the analysis. The prevalence of malnutrition was 17.7%. Independent factors associated with a higher prevalence of malnutrition were age (OR = 1.03; 95% CI = (1.01-1.05)), anemia (1.55 (1.05-2.28)), low weight (3.13 (1.50-6.50)), and normal weight (1.85 (1.21-2.82)). Diabetes mellitus was inversely associated with malnutrition (0.60 (0.38-0.96)). Early PJI was diagnosed in 18 (1.6%) participants. There was no statistically significant and independent association between malnutrition and postsurgical complications.

Conclusion: Altered lymphocyte count, serum albumin, and transferrin levels is common among individuals undergoing TKA, particularly in older patients, those with anemia, and individuals with normal or low weight. Future studies with larger sample sizes are needed to better assess the relationship between malnutrition and adverse outcomes following TKA.

Objective: To analyze the anatomy of the perforating vessels irrigating the skin of the medial aspect of the thigh and originating from the secondary vascular pedicle of the gracilis muscle.

Methods: We dissected 33 thighs from cadavers of both sexes to record and analyze the characteristics of the blood vessels irrigating the gracilis muscle in the middle third of the thigh.

Results: All thighs (100%) had a secondary vascular pedicle in the intermuscular septum between the gracilis and vastus medialis/sartorius muscles, with branches irrigating the overlying skin on the medial aspect. The pedicle presented an arterial diameter ranging from 1.3 to 4.6 mm (mean: 2.3 mm) and a length ranging from 28 to 84 mm (mean: 50.6 mm). In 87.8% of the cases, the pedicle irrigated the gracilis muscle and presented vessels to the overlying skin.

Conclusion: Based on the data found, we conclude that it is feasible to obtain a reliable flap from the medial aspect of the middle third of the thigh.

Objective: To analyze the anatomy of the perforating vessels irrigating the skin of the medial aspect of the thigh and originating from the secondary vascular pedicle of the gracilis muscle.

Methods: We dissected 33 thighs from cadavers of both sexes to record and analyze the characteristics of the blood vessels irrigating the gracilis muscle in the middle third of the thigh.

Results: All thighs (100%) had a secondary vascular pedicle in the intermuscular septum between the gracilis and vastus medialis/sartorius muscles, with branches irrigating the overlying skin on the medial aspect. The pedicle presented an arterial diameter ranging from 1.3 to 4.6 mm (mean: 2.3 mm) and a length ranging from 28 to 84 mm (mean: 50.6 mm). In 87.8% of the cases, the pedicle irrigated the gracilis muscle and presented vessels to the overlying skin.

Conclusion: Based on the data found, we conclude that it is feasible to obtain a reliable flap from the medial aspect of the middle third of the thigh.

A lesão de Hill-Sachs é uma condição frequentemente associada à instabilidade anterior do ombro, que desempenha um papel crucial nos resultados de seu tratamento The Hill-Sachs lesion is a condition frequently associated with anterior shoulder instability, which plays a crucial role in the outcomes of its treatment. It is characterized by a posterior compressive fracture in the humeral head caused by an impingement against the anterior rim of the glenoid cavity during dislocation. A thorough understanding of this lesion is essential to support clinical decisions and choose the most appropriate treatment. Advances in imaging modalities, such as magnetic resonance imaging and computed tomography, enabled lesion identification with greater precision and its classification per depth, location, and volume, resulting in a detailed assessment of its role in shoulder instability. The present article reviews the main classifications, diagnostic methods, and treatment options to provide orthopedists with a comprehensive and updated view of the strategies to promote better functional outcomes and minimize the risk of instability recurrence.

Low back pain is a common complaint. This syndrome comprehends different underlying mechanisms, which are difficult to differentiate in a timely manner only through semiotic, laboratory, and imaging resources available in an emergency setting. Such circumstances make practitioners prone to an initial symptomatic approach in the form of medications (non-steroid anti-inflammatory drugs, analgesics, muscle relaxants) or local procedures (local heat, massage). Peripheral neurotrophic substances, such as pyrimidine nucleotides (uridine triphosphate and cytidine monophosphate) combined with vitamin B12 (hydroxocobalamin), have been used as anabolic precursors able to provide spinal nerve roots with triggering elements useful for nerve and glial cells regeneration, once a likely spinal compression mechanism is contained. The authors performed a systematic review and meta-analysis with the above combination with the aim of better determining its role in low back pain management.

Low back pain is a common complaint. This syndrome comprehends different underlying mechanisms, which are difficult to differentiate in a timely manner only through semiotic, laboratory, and imaging resources available in an emergency setting. Such circumstances make practitioners prone to an initial symptomatic approach in the form of medications (non-steroid anti-inflammatory drugs, analgesics, muscle relaxants) or local procedures (local heat, massage). Peripheral neurotrophic substances, such as pyrimidine nucleotides (uridine triphosphate and cytidine monophosphate) combined with vitamin B12 (hydroxocobalamin), have been used as anabolic precursors able to provide spinal nerve roots with triggering elements useful for nerve and glial cells regeneration, once a likely spinal compression mechanism is contained. The authors performed a systematic review and meta-analysis with the above combination with the aim of better determining its role in low back pain management.

Objective: To retrospectively compare the impact of using neoadjuvant denosumab for Campanacci grade-III giant cell tumor (GCT) of the proximal femur involving the hip joint.

Methods: We retrospectively reviewed 18 cases of Campanacci grade-III GCT of the proximal femur receiving surgery between January 2014 and December 2019 from our hospital. One group of 10 patients received weekly neoadjuvant denosumab 120 mg for 4 weeks, while the other group of 8 patients did not receive denosumab before surgery. Two patients were subjected to intralesional curettage while the others received resection and hip arthroplasty. Comparisons were made using unpaired t -test and Fisher's exact test. Functional outcomes were assessed by revised Musculoskeletal Tumor Society (MSTS) score and Harris Hip Score (HHS) at 6 weeks, 6 months, and 12 months of follow-up, as well as incidence of recurrence.

Results: The comparison of the mean MSTS scores of the denosumab and non-denosumab groups was as follows: 24.0 ± 6.5 versus 20.0 ± 6.0 ( p  = 0.04) at 6 weeks respectively; 26.0 ± 5.0 versus 23.0 ± 0.67 ( p  = 0.04) at 6 months respectively; and 28.8 ± 1.7 versus 29.5 ± 0.33 ( p  = 0.35) at 12 months respectively. The comparison of HHSs between the denosumab and non-denosumab groups was as follows: 61.02 ± 7.36 versus 48.52 ± 3.97 ( p  = 0.03) at 6 weeks respectively; 81.1 ± 2.97 versus 79.15 ± 3.24 ( p  = 0.82) at 6 months respectively; and 89.84 ± 3.75 versus 90.05 ± 3.00 ( p  = 0.38) at 12 months respectively. There was no recurrence.

Conclusion: Denosumab was clinically effective in improving the short-term functional outcomes, but long-term functional outcomes remained similar between the groups. We did not find an increased recurrence rate in the denosumab group.