Revista Brasileira de Ortopedia最新文献

Objective: The present study aimed to compare the accuracy of the Paprosky Classification of Femoral Bone Loss using plain radiographs and two-dimensional computed tomography (2D CT) images with the femoral defect observed intraoperatively by the surgeon.

Methods: There were 14 hip surgeons from the same hospital who classified 80 patients with an indication for revision hip arthroplasty according to Paprosky based on plain radiographs in anteroposterior views of the pelvis and 2D CT images, reconstructed in the axial, coronal, and sagittal planes. We compared this data with the intraoperative findings of femoral bone loss by the same surgeons.

Results: The agreement between the radiographic and CT assessment was excellent for femoral bone defects (94% agreement; κ = 0.95; 0.90-0.99). Individually, the radiograph-based classification agreed with the intraoperative classification in 85% of cases (κ = 0.8; 0.70-0.90). The CT-based one had 86% of agreement (κ = 0.84; 0.75-0.93). There was no statistical difference between the methods.

Conclusion: The use of 2D CT did not show any benefits in recognizing femoral bone loss by the Paprosky classification compared with radiography. Therefore, the significance of 2D images in planning femoral component revision surgery should be questioned, as it is associated with higher financial costs and greater patient exposure to high radiation levels.

Objective: To compare the effectiveness and safety of surgical and injection-based interventions for Dupuytren's disease (DD) using systematic review and network meta-analysis methodology.

Methods: The current protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines and is registered in The International Prospective Register of Systematic Reviews (PROSPERO). Randomized controlled trials involving adult patients with DD treated by surgical (e.g., fasciectomy, fasciotomy) or injection-based interventions (e.g., collagenase, corticosteroids) must be included. A comprehensive search must be conducted across MEDLINE, CENTRAL, EMBASE, LILACS, IBECS, and trial registries, without language or date restrictions. Two reviewers must perform independent screening, data extraction, and risk of bias assessment (RoB2). Primary outcomes must include functional improvement and adverse effects. Secondary outcomes must include recurrence, range of motion, and pain. Data synthesis should involve random-effects pairwise and network meta-analyses, with GRADE used to assess certainty of evidence. Subgroup analyses should explore heterogeneity based on clinical and methodological variables.

Results: This proposal of review aims to generate comparative estimates of effectiveness and safety across all eligible interventions, incorporating both direct and indirect evidence. Functional outcomes must be synthesized using a predefined hierarchy of patient-reported outcome measures (PROMs), and treatments must be ranked based on efficacy and safety profiles.

Conclusion: The present systematic review aims to fill current evidence gaps by comparing all relevant interventions for DD, supporting clinical decision-making through robust synthesis of functional and safety outcomes.

Objective: The present study aimed to compare the accuracy of the Paprosky Classification of Femoral Bone Loss using plain radiographs and two-dimensional computed tomography (2D CT) images with the femoral defect observed intraoperatively by the surgeon.

Methods: There were 14 hip surgeons from the same hospital who classified 80 patients with an indication for revision hip arthroplasty according to Paprosky based on plain radiographs in anteroposterior views of the pelvis and 2D CT images, reconstructed in the axial, coronal, and sagittal planes. We compared this data with the intraoperative findings of femoral bone loss by the same surgeons.

Results: The agreement between the radiographic and CT assessment was excellent for femoral bone defects (94% agreement; κ = 0.95; 0.90-0.99). Individually, the radiograph-based classification agreed with the intraoperative classification in 85% of cases (κ = 0.8; 0.70-0.90). The CT-based one had 86% of agreement (κ = 0.84; 0.75-0.93). There was no statistical difference between the methods.

Conclusion: The use of 2D CT did not show any benefits in recognizing femoral bone loss by the Paprosky classification compared with radiography. Therefore, the significance of 2D images in planning femoral component revision surgery should be questioned, as it is associated with higher financial costs and greater patient exposure to high radiation levels.

Objective: The present study aimed to evaluate the influence of computed tomography (CT) on the preoperative planning of posterior malleolus (PM) fractures of the ankle, comparing its information with that of conventional radiographs and assessing its impact on surgical treatment.

Methods: The study included 81 patients with PM fractures, whose radiological and CT images were analyzed by 33 specialized orthopedic surgeons. The study had two stages, with a radiological assessment on the first, and the second having radiological and CT evaluation. In both stages, we asked surgeons about the PM size, fracture stability, preoperative management, and potential modifications after CT analysis.

Results: Considering only radiographs, 83.5% of the evaluators selected PM fixation. However, CT addition modified this choice in 49.1% of the cases, influencing the surgical access route and the type of osteosynthesis. In 34.7% of cases, CT revealed a larger PM fragment than radiographs, demonstrating that it is superior in evaluating fracture size and morphology.

Conclusion: The surgical planning of ankle fractures with PM involvement should routinely include CT scans for a more precise fracture line assessment and a potential change in the therapeutic decision based on simple radiography alone.

Objective: To compare the effectiveness and safety of surgical and injection-based interventions for Dupuytren's disease (DD) using systematic review and network meta-analysis methodology.

Methods: The current protocol follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines and is registered in The International Prospective Register of Systematic Reviews (PROSPERO). Randomized controlled trials involving adult patients with DD treated by surgical (e.g., fasciectomy, fasciotomy) or injection-based interventions (e.g., collagenase, corticosteroids) must be included. A comprehensive search must be conducted across MEDLINE, CENTRAL, EMBASE, LILACS, IBECS, and trial registries, without language or date restrictions. Two reviewers must perform independent screening, data extraction, and risk of bias assessment (RoB2). Primary outcomes must include functional improvement and adverse effects. Secondary outcomes must include recurrence, range of motion, and pain. Data synthesis should involve random-effects pairwise and network meta-analyses, with GRADE used to assess certainty of evidence. Subgroup analyses should explore heterogeneity based on clinical and methodological variables.

Results: This proposal of review aims to generate comparative estimates of effectiveness and safety across all eligible interventions, incorporating both direct and indirect evidence. Functional outcomes must be synthesized using a predefined hierarchy of patient-reported outcome measures (PROMs), and treatments were ranked based on efficacy and safety profiles.

Conclusion: This systematic review aims to fill current evidence gaps by comparing all relevant interventions for DD, supporting clinical decision-making through robust synthesis of functional and safety outcomes.

Objective: The present study explores the association between these inflammatory markers and metastasis in osteosarcoma patients.

Methods: We conducted a retrospective analysis of osteosarcoma patients at our center between January 2022 and August 2024. We collected the clinical and laboratory data of the patients, including white blood cell differential count, C-reactive protein (CRP) levels, erythrocyte sedimentation rate (ESR), neutrophil-to-lymphocyte ratio (NLR), alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) levels. Statistical correlation between these markers and metastasis was assessed using the Pearson's Chi-squared test, the Fisher's exact test, and logistic regression.

Results: A total of 40 osteosarcoma patients were included. Elevated levels of neutrophil count ( p  = 0.024; odds ratio [OR] = 12.667; 95%CI = 1.402-114.419), CRP ( p  < 0.001; OR = 17.000; 95%CI = 3.464-83.436), ESR ( p  = 0.009; OR = 19.000; 95%CI = 2.119-170.383), NLR ( p  = 0.006; OR = 7.429; 95%CI = 1.778-31.040), and LDH ( p  = 0.009; OR = 9.333; 95%CI = 2.180-39.962) were significantly associated with the presence of metastasis.

Conclusion: The neutrophil count, ESR, NLR, and the levels of CRP and LDH are significantly associated with metastasis in osteosarcoma, and they may serve as valuable prognostic markers. Future research should focus on elucidating the mechanisms underlying this relationship and exploring therapeutic interventions targeting inflammation to mitigate metastasis.

Injuries to the proximal hamstring muscle complex are common in athletes and range from strains to tendinous and bony avulsions. The lesion mechanism typically involves an eccentric contraction of the hamstring muscles during abrupt hip hyperflexion with the knee in extension. Low-speed injuries occur in high kicks and splits, whereas tendon avulsions are common in high-speed activities, such as running and ballet. Clinically, patients present with pain, subcutaneous hematoma, and, sometimes, a palpable defect. Additional signs include limited knee extension and involvement of the sciatic nerve. Diagnosis relies on ultrasonography, magnetic resonance imaging (MRI), and radiography, and MRI is the standard test. Surgical treatment is indicated for complete avulsions, especially in athletes, to prevent loss of strength and difficulty in returning to sports. In the surgical technique herein described, we perform one or two transverse incisions in the gluteal fold, depending on the tendon retraction, followed by fixation with metal anchors. The postoperative period includes initial restriction, followed by accelerated rehabilitation for return to sports by the twelfth week. Since 2019, the technique has been applied to 13 patients, demonstrating good outcomes, without re-ruptures and a postoperative Tegner score similar to the preoperative one.

Injuries to the proximal hamstring muscle complex are common in athletes and range from strains to tendinous and bony avulsions. The lesion mechanism typically involves an eccentric contraction of the hamstring muscles during abrupt hip hyperflexion with the knee in extension. Low-speed injuries occur in high kicks and splits, whereas tendon avulsions are common in high-speed activities, such as running and ballet. Clinically, patients present with pain, subcutaneous hematoma, and, sometimes, a palpable defect. Additional signs include limited knee extension and involvement of the sciatic nerve. Diagnosis relies on ultrasonography, magnetic resonance imaging (MRI), and radiography, and MRI is the standard test. Surgical treatment is indicated for complete avulsions, especially in athletes, to prevent loss of strength and difficulty in returning to sports. In the surgical technique herein described, we perform one or two transverse incisions in the gluteal fold, depending on the tendon retraction, followed by fixation with metal anchors. The postoperative period includes initial restriction, followed by accelerated rehabilitation for return to sports by the twelfth week. Since 2019, the technique has been applied to 13 patients, demonstrating good outcomes, without re-ruptures and a postoperative Tegner score similar to the preoperative one.

Objective: The present study explores the association between these inflammatory markers and metastasis in osteosarcoma patients.

Methods: We conducted a retrospective analysis of osteosarcoma patients at our center between January 2022 and August 2024. We collected the clinical and laboratory data of the patients, including white blood cell differential count, C-reactive protein (CRP) levels, erythrocyte sedimentation rate (ESR), neutrophil-to-lymphocyte ratio (NLR), alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) levels. Statistical correlation between these markers and metastasis was assessed using the Pearson's Chi-squared test, the Fisher's exact test, and logistic regression.

Results: A total of 40 osteosarcoma patients were included. Elevated levels of neutrophil count ( p  = 0.024; odds ratio [OR] = 12.667; 95%CI = 1.402-114.419), CRP ( p  < 0.001; OR = 17.000; 95%CI = 3.464-83.436), ESR ( p  = 0.009; OR = 19.000; 95%CI = 2.119-170.383), NLR ( p  = 0.006; OR = 7.429; 95%CI = 1.778-31.040), and LDH ( p  = 0.009; OR = 9.333; 95%CI = 2.180-39.962) were significantly associated with the presence of metastasis.

Conclusion: The neutrophil count, ESR, NLR, and the levels of CRP and LDH are significantly associated with metastasis in osteosarcoma, and they may serve as valuable prognostic markers. Future research should focus on elucidating the mechanisms underlying this relationship and exploring therapeutic interventions targeting inflammation to mitigate metastasis.