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 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.

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: Implant removal is a common practice in pediatric orthopedics, despite its risks. This 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.

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.

Objective: To investigate whether body mass index (BMI) modifies the association be tween bone mineral density (BMD) and intraoperative fracture risk in cementless hemiarthroplasty.

Methods: Between April 2020 and March 2025, 588 patients who received cementless stems and underwent dual-energy X-ray absorptiometry scans within one week postoperatively were included. Patients were stratified by BMI (≥ 18.5 kg/m ² versus < 18.5 kg/m ² ) and young adult mean (YAM) (cutoff: 70%). Fracture risk was compared across groups. Subgroup analyses based on YAM levels and operative parameters were performed in 577 patients with complete data.

Results: In underweight patients (BMI < 18.5 kg/m ² ), lower YAM was associated with higher intraoperative fracture risk ( p  = 0.128), whereas no significant association was observed in patients with BMI ≥ 18.5 kg/m ² ( p  = 0.80). Fracture rates increased with lower YAM: 3.97% (≥ 70%), 5.24% (60-69%), 5.88% (50-59%), 6.58% (< 50%), though not statistically significant. Higher BMI was associated with longer operative time and greater blood loss.

Conclusion: Body mass index modifies the association between BMD and intraoperative fracture risk. Preoperative YAM assessment may help identify underweight patients at higher risk during cementless hemiarthroplasty. Level of Evidence III, therapeutic study.

Objective: To investigate whether body mass index (BMI) modifies the association between bone mineral density (BMD) and intraoperative fracture risk in cementless hemiarthroplasty.

Methods: Between April 2020 and March 2025, 588 patients who received cementless stems and underwent dual-energy X-ray absorptiometry scans within one week postoperatively were included. Patients were stratified by BMI (≥ 18.5 kg/m ² versus < 18.5 kg/m ² ) and young adult mean (YAM) (cutoff: 70%). Fracture risk was compared across groups. Subgroup analyses based on YAM levels and operative parameters were performed in 577 patients with complete data.

Results: In underweight patients (BMI < 18.5 kg/m ² ), lower YAM was associated with higher intraoperative fracture risk ( p  = 0.128), whereas no significant association was observed in patients with BMI ≥ 18.5 kg/m ² ( p  = 0.80). Fracture rates increased with lower YAM: 3.97% (≥ 70%), 5.24% (60-69%), 5.88% (50-59%), 6.58% (< 50%), though not statistically significant. Higher BMI was associated with longer operative time and greater blood loss.

Conclusion: Body mass index modifies the association between BMD and intraoperative fracture risk. Preoperative YAM assessment may help identify underweight patients at higher risk during cementless hemiarthroplasty. Level of Evidence III, therapeutic study.