Revista Brasileira de Ortopedia最新文献

Objective  To perform a radiographic assessment of the quality of supracondylar fracture fixation by identifying the factors that have contributed to inadequate reduction and increased the chance of reduction loss during outpatient follow-up. The variables analyzed were as follows: fracture line, initial displacement, time of day the surgery was performed, and chosen fixation technique. Methods  Review of electronic medical records and radiographic evaluation of supracondylar fractures operated from January 2017 to December 2022. The radiograph assessment was based on the Baumann angle and the anterior humeral line. Determination of fixation quality was based on the number of cortices, crossing site, and wire divergence. Results  We evaluated 194 cases, and postoperative reduction was poor in 17% of the subjects. Reduction loss occurred in 39 cases (20.10%), and 19 (48.7%) of these patients presented insufficient fixation ( p  = 0.002). Among the cases operated during the day, 12.5% lost the reduction compared with 32% of the patients who underwent surgery at night and early in the morning ( p  = 0.001). Conclusion  Reduction quality and postoperative fixation loss were closely related to technical errors and the time of day the surgery was performed.

Proximal humerus fractures account for approximately 3 to 5% of all pediatric-adolescent fractures, with a higher incidence observed in older children, particularly between the ages of 10 and 15 years. Non-displaced or minimally displaced fractures can often be treated conservatively. However, the management of displaced or unstable proximal humerus fractures in adolescents may involve surgical intervention, with closed reduction and percutaneous pinning (CRPP) being commonly employed techniques. Closed reduction and percutaneous pinning is not without its challenges and potential difficulties. This article aims to describe a technique that can facilitate CRPP and minimize complications associated with this surgical approach.

Osteochondral injuries in the knee are uncommon in the immature skeleton and are usually related to sporting activities. Fixation is required depending on the size and location of the fragment. The standard technique is open reduction and internal fixation with metal screws, which are removed in a second procedure after consolidation. As an alternative to reduce risk and morbidity, fixation of the osteochondral fragment may use autologous bone picks. This study reports the execution of this surgical technique on a 13-year-old patient who injured his right knee during a soccer match.

Objective  This study aims to compare the proximal femoral bone density changes in follow-up X-ray imaging and the proximal filling ratios of stems between anatomical and double-tapered wedge stem designs. Methods  Patients aged between 18 and 80 years who received primary total hip arthroplasty using both types of stems between 2017 and 2019 and had follow-up tests for up to a year were included in the study. Canal filling ratios at 3 levels (lesser trochanter [LT], 2 cm above LT, and 7 cm below LT) using the optimal densitometry method. Femoral bone density changes were measured using the Gruen zoning method. Results  A total of 92 patients (76% female and 24% male) met the inclusion criteria for this study. The mean age was 53.86 ± 13.00 years. The canal filling ratio in the double-tapered wedge group (Accolade II) was significantly higher than that in the anatomical stem group (ABGII) ( p  < 0.001, p  < 0.001, and p  = 0.013) for all levels of measurement. No significant difference was observed between both types of stems in femoral bone density changes in zones 1 and 4. However, there were significant differences in femoral bone change, with bone loss being higher in the anatomical stem group in zone 7 (-25% versus -17%; p  = 0.010). Conclusion  Double-tapered wedge stem had a significantly higher canal filling ratio than the anatomical stem at all levels but had less femoral bone density loss in the follow-up postoperative imaging in zone 7. Furthermore, in zones 1 and 4, there was no significant difference in femoral bone density loss.