Acta Ortopedica Brasileira最新文献

Objective: This study aimed to evaluate the surgical treatment of diaphyseal femur fractures in polytraumatized children, considering consolidation rate, complications, and function as outcomes of interest.

Methods: This is a quantitative, cross-sectional, and retrospective study of medical records of patients treated from 2012 to 2021. The 39 patients (41 femurs) were divided into four groups according to the method of osteosynthesis. We used the IBM SPSS Statistics software, version 20 (SPSS Inc, Chicago, IL), and performed Chi-square, Fisher, Kruskal-Wallis, and Shapiro-Wilk tests with a significance level of 5%.

Results: We observed six complications among patients. Functional outcomes were satisfactory in 40 cases (97.6%) and unsatisfactory in one case (2.40%) according to the adopted criteria. We found one case (2.40%) of non-union and one case (2.40%) of malunion, whereas 39 cases (95.20%) achieved full consolidation.

Conclusions: Flexible intramedullary nails and external fixators are the preferred options for patients aged 5 to 10 years. Intramedullary nails, plates, or external fixators are prioritized for patients over 11 years old. The type and pattern of fractures were considered relevant for treatment selection. Level of evidence III, Therapeutic study - Investigation of outcomes and treatment. Comparative retrospective study.

Objetive: This study aims to analyze the learning curves in performing the arthroscopic Latarjet surgery.

Methods: This was an observational, retrospective, single-center study. All cases of arthroscopic Latarjet performed in this institution from 2016 to 2021 were included. The data analyzed were surgical time (of the chief surgeon alone and the group of surgeons), complications, and time until the return to sports activities. Technical observations about the learning process were also reported.

Results: In total, 50 consecutive cases were included (93% retention of the initial sample identified at the institution). The decrease in surgical time was presented logarithmically and showed a decrease in time both for the individualized analysis of the senior surgeon (r = -0.67, p < 0.001) and for the surgical group (r = -0.476, p < 0.001). Mean operating time (and standard deviation) dropped from 235 minutes (73) in the first 10 cases to 156 minutes (34) for the subsequent cases (p < 0.001). In the first 20 cases, five intercurrences were recorded and three reoperations were performed, whereas subsequent cases presented only one intercurrence requiring surgical intervention (p = 0.032). The median time to return to sport was nine months for the first 20 cases versus six months for subsequent cases (p = 0.001).

Conclusion: The learning curve for the arthroscopic Latarjet procedure showed a progressive decrease in operative time, complications, and time to return to sports activities. This suggests that the surgeon developed the necessary skills and confidence to reach a plateau of expertise to perform the surgical procedure. Level of evidence IV, Observational retrospective.

Objective: To establish the epidemiological profile of shoulder injuries suffered by surfers, through the injury proportion rate, type, mechanism and/or severity, caused by surfing.

Methods: This systematic review was conducted and written in accordance with the guidelines for systematic reviews- PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The bibliographic research was carried out between January 2020 and January 2022 in journals indexed in the Web of Science, SPORTDiscus, PubMed, Scopus, Cochrane and Embase databases. Data were analyzed in RStudio, and the methodological quality of the studies was assessed.

Results: Ten studies were included, all of which were retrospective in cross-sectional design and had an average methodological quality of 75%. The meta-analysis showed an injury incidence rate of 14.88%. Odds ratio analysis showed that injuries of joint origin are 7.26 times significantly higher in individuals with shoulder injuries, and injuries of bone origin and skin injuries had reduced odds of 70% and 89%, respectively. The most common mechanism of injury was the movement of paddling (57,68%), with the average prevalence of acute injuries being 31.53% and chronic injuries being 68.47%.

Conclusion: There was a scarcity and/or variation in the categorization of data regarding injuries in the shoulder region resulting from surfing, with injuries of joint and musculotendinous origin being frequent; and rowing, the most overloading factor. Level of evidence II, Systematic Review.

Objectives: to identify oncological-orthopedic studies published in Acta Ortopédica Brasileira over three decades; to classify them according to the type and level of evidence (LE); to observe the inter-rater agreement in the classification of studies; to analyze the studies retrospectively, according to levels of evidence; and to outline the evolution of the evidence in the study period.

Methods: Descriptive analyses were performed with absolute and relative frequencies of studies published between 1993 and 2022. Inter-rater agreement was analyzed by percentage of agreement and Kappa statistic (95%CI). The interpretation of the magnitude of the agreement was performed according to Landis & Koch. The association between classifications and publication period was analyzed using Fisher's exact test. The analyses were performed using the R program (significance of 5%).

Results: 69/1349 papers were selected; there was a significant association between type of study, statistical methodology, and LE with publication period (p < 0.05); inter-rater agreement regarding LE was 92.8%.

Conclusions: Oncological-orthopedic studies accounted for 5.1% of all published papers. Regarding the LE, 80% were NE IV and V studies, despite the evolution observed between the first and last decade (decrease in LE V studies and increase in LE II, III and IV). Level of Evidence III, Retrospective Comparative Study.

Objective: This study aims to describe a kinematic gait assessment protocol and identify its main alterations in individuals with cervical spondylotic myelopathy (CSM) compared to healthy patients.

Methods: In total, 14 patients diagnosed with CSM were enrolled and submitted to a three-dimensional gait analysis. The movement of patients was captured with infrared emission cameras that identified tracking markers placed on the lower limbs. Reference positions were used, and the patients walked along a rubberized walkway. The Gait Profile Score (GPS) and Movement Analysis Profile (MAP) were used to analyze variables. Results were subjected to a Student's t-test at 95% confidence interval. The R Core Team (2016) software was used for statistical analysis, graphically comparing the study results with data from healthy patients.

Results: When comparing the kinematic data bilaterally, no statistical differences were found. However, graphical analysis showed changes in the gait of patients with CSM compared to healthy individuals. There were differences in all movements, with a more significant discrepancy in hip and knee flexion and extension, dorsiflexion and plantar flexion, and internal and external hip rotation.

Conclusion: We describe a protocol for gait kinematics assessment using GPS and MAP, and we presented the differences in gait kinematics in patients with CSM compared to healthy individuals. Level of Evidence II, Prospective study.

Objective: To compare the prevalence of smokers among patients with chronic low back pain, in the presence and absence of Modic changes, also the correlation between smoking history and progression of the Modic scale.

Methods: Observational study, case-control type, with the inclusion of 340 vertebral segments in a total of 68 patients, separated into groups: with Modic (case group) and without Modic (control group). The odds ratio between the groups was verified using the Chi-Square test. Degree of correlation between smoking history (packs/year) and the degree of disc degeneration using Max-Modic and Sum-Modic, using Spearman's non-parametric test.

Results: The Modic group (MG) was 54% female and 46% male, with an average smoking history of 13.84 pack-years and an average of 1.42 altered segments per patient.

Conclusion: An increased risk for Modic changes was found among smoking patients (odds ratio [OR] 4.09; 95% CI, 1.26-12.31; p < 0.01) and significant correlation between Max-Modic, sum-Modic and smoking history. Level of Evidence III, Retrospective comparative study.

Objective: To evaluate the pregabalins adjuvant effect in patients with carpal tunnel syndrome (CTS) surgically treated, analyzing postoperative pain and the incidence of complex regional pain syndrome (CRPS).

Methods: Outpatient surgical candidates with CTS were selected and followed for 12 months, divided into three groups. The Control Group received a placebo, the Pregabalin 75 mg Group received a daily dose, and the Pregabalin 150 mg Group received a daily dose of the medication. Patient progress was evaluated using the visual analog scale (VAS) for pain and the DN4 neuropathic pain score before surgery, one month and three months after.

Results: The administration of pregabalin to surgical patients with CTS did not demonstrate significant differences in immediate postoperative pain relief. Additionally, there were no statistically significant variations in the incidence of complications, such as CRPS, among the groups.

Conclusion: This study did not show a significant impact of pregabalin on postoperative pain relief or the reduction of CRPS incidence in patients undergoing surgery for CTS. These results suggest that pregabalin might not be an effective adjuvant in these surgical situations. Level of Evidence II, Comparative prospective study .

Objective: This study reviews the literature and shares clinical experiences, emphasizing its diagnostic relevance in children under 5 years of age.

Method: We examined 169 cases of Legg-Calvé-Perthes disease (LCPD) in patients in this age group. We analyzed medical records and images, observing variables such as age, gender, complaints, treatment, and outcomes.

Results: We studied 20 patients with Meyer's dysplasia, representing 1.4% of LCPD cases in children. The majority were boys (85%) with symptom onset at 38 months. Claudication (25%) and mild pain (40%) were the main complaints. Radiographic findings showed a smaller, granular, or asymmetric nucleus. The average follow-up was 6.4 years, with interventional treatment in 5 cases. Most showed complete reossification and centralization of the femoral head.

Conclusion: Meyer's dysplasia is a rare condition that affects the hip in children under 5 years of age, predominantly in boys. It usually does not require intensive treatment; clinical and radiological follow-up is sufficient. However, it is important to be aware of possible unfavorable progressions, requiring more aggressive treatment to prevent complications. Level of evidence III, Retrospective comparative study.

Objective: To outline the epidemiological profile of tibial fractures treated in a tertiary hospital and explore associations between the characteristics of the fractures and the clinical outcome of postoperative complications.

Methods: Retrospective cross-sectional study involving adult patients diagnosed with tibial fractures who underwent surgical and/or conservative treatment in a tertiary hospital between January 2019 and December 2021. The variables sex, age, mechanism of injury, type and classification of fracture, associated injuries, personal history, length of hospital stay, surgical treatment, post-surgical complications (infections, loss of synthesis material, surgical wound dehiscence) and death.

Results: The sample consisted of 100 individuals, with an average age of 35.8 years, 86% of whom were male, with a higher prevalence of motorcycle accidents. The most common treatment was intramedullary stem, and type C fractures, which are more complex, were more associated with complications.

Conclusion: Given the predominance of motorcycle accidents involving young people, there is a need for intervention in accident prevention policies, aiming to reduce the incidence, as well as the morbidity and mortality, of these individuals and, consequently, to reduce costs to the health system. Level of evidence III, Retrospective Study.

Objective: This study aims to assess cost-effectiveness of caudal epidural block with transforaminal nerve root block in the treatment of degenerative diseases of the lumbar spine.

Methods: A total of 47 patients with lumbar sciatica symptoms were included. Low back pain and leg pain were assessed using the visual analogue scale (VAS), both in the pre-procedure and one week after. The cost-effectiveness and value required to improve each point on the VAS were estimated using addition, division, and rule of three calculations.

Results: For low back pain, scores ranging from 2 to 10 were found before the procedure, with a mean of 7.5 ± 2.14 (95%CI: 6.8-8.1). A week after, these scores ranged from 0 to 10, with a mean of 3.1±2.8 (95%CI: 2.3-4.0; p < 0.0001). Regarding leg pain, scores ranging from 1 to 10 were noted before the procedure, with a mean of 6.8 ± 2.5 (95%CI: 6.1-7.4). A week after, these scores ranged from 0 to 9, with mean of 2.4 ± 2.5 (95%CI: 1.8-3.1; p < 0.0001). The cost of the materials used during the procedure was 214.72 BRL.

Conclusion: Caudal epidural with transforaminal nerve root block were a cost-effective treatment modality for patients with degenerative diseases of the lumbar spine. Level of evidence III, Retrospective cohort study.