Acta Ortopedica Brasileira最新文献

Objective: to evaluate the strength of the intrinsic foot muscles in diabetic patients with and without diabetic peripheral neuropathy, compared to healthy controls.

Methods: a prospective experimental study was conducted with 63 patients divided into three groups: diabetics with peripheral neuropathy (20), diabetics without neuropathy (23), and healthy controls (20). Muscle strength was measured using a digital handheld dynamometer, assessing plantar flexion of the hallux and toes in two positions (neutral and maximum plantar flexion). Statistical analyses were performed using R software, with α=0.05 and β=0.2.

Results: the groups had a mean age of 66 years. Variables with statistically significant differences (p < 0.05) included Right Hallux - Neutral Position, All Toes (Right) - Neutral Position, All Toes (Right) - Plantar Flexion, and Left Toes - Plantar Flexion. Diabetic patients with neuropathy showed lower medians and interquartile ranges in these variables, indicating reduced muscle strength compared to controls.

Conclusions: this study explored the strength of the intrinsic foot muscles in diabetic patients, using dynamometry as an assessment tool. Although no conclusive evidence was found, it is suggested that dynamometry may be useful in the early detection of muscle weakness in diabetic neuropathy. Expanding the study with a larger sample and more data is necessary to validate and refine the preliminary conclusions, contributing to the monitoring of muscle deterioration and the effectiveness of treatments. Level of Evidence II; Prospective^d comparative study^e .

Objective: To describe the biomechanical outcomes of five different fixation models, namely: tension band wiring (TB), anterior star-shaped locking plate (PS), lateral orthogonal locking plates (LP), and two additional models using BT and LP combined with a circumferential cerclage wire around the patella, referred to as BTO and PSO, respectively, in a comminuted patellar fracture (AO34C3).

Methods: This study analyzed, using the finite element method (FEM), the following variables: total displacement, fragment displacement, maximum and minimum principal stresses, and total and localized von Mises stresses, under loading conditions of 1,500 N (R1) and 3,000 N (R2).

Results: Results were presented as absolute values and percentiles, as well as through observational analysis of individual stress distributions. From a biomechanical perspective, critical results in both absolute and percentile values were observed for most variables in the TB group compared with the PS and LP groups. While maximum and minimum principal stresses were similar among groups, differences in intensity and location were found for total and localized von Mises stresses. In addition, the inferior pole of the patella exhibited critical stress conditions across all groups.

Conclusions: Tension band wiring demonstrated inferior outcomes compared with locking plates. Biomechanical benefits were observed with the use of two orthogonal locking plates compared with an anterior locking plate; however, both constructs still showed deficiencies in stabilizing the distal pole of the patella. Level of Evidence II; Prospective Study.

Objective: this study analyzed patients with soft tissue sarcoma treated by non-orthopedic oncologists, evaluating their epidemiological profile, staging, and therapeutic challenges.

Method: an analytical study in the form of a retrospective cohort, conducted through a review of medical records of patients treated at the hospital from January 1, 2011, to December 31, 2021.

Results: a total of 61 patients were included, mostly male (55.7%), with a mean age of 42.8 years. The most frequent histological subtypes were synovial sarcoma (29.5%) and undifferentiated pleomorphic sarcoma (21.3%), with a predominance of high-grade tumors (75.4%). The majority of cases (77%) underwent resection, but without proper planning, leading to high recurrence rates (77%) and metastases (49.2%), with the lungs being the primary metastatic site. The mortality rate was 47.5%, with an average time to death of 3.1 years.

Conclusion: the findings highlight the need for early diagnosis, specialized treatment, and multidisciplinary management to optimize clinical outcomes for patients. The adoption of standardized protocols in referral centers may reduce inadequate interventions and improve survival and quality of life for patients with soft tissue sarcoma. Level of Evidence III; Retrospective^f comparative study^e .

Objective: The Aneurysmal Bone Cyst (ABC) is a benign yet aggressive bone tumor. This study aimed to evaluate sex, age, tumor location, tumor size, type of treatment (surgical, infiltration, embolization), and recurrence.

Methods: Descriptive and quantitative statistical analyses were applied. The prevalence ratio and 95% confidence interval were calculated for the association between recurrence and sex, age, tumor size, Capanna's classification, and treatment type.

Results: Twenty-three cases of ABCs were included, eleven (47.8%) females and twelve (52.2%) males. The mean age of treated patients was 11.2±1.8 years. Most cysts were located in the lower limbs (56.5%). The mean follow-up time was 42.8±14.01 months. The mean cyst diameter at the beginning of treatment was 5.58± 1.04 cm; of these, 17.4% were up to 3 cm, 43.5% from 3.1 to 6 cm, and 39.1% over 6 cm. Regarding initial treatment, 6 (26%) patients received infiltration, and in total 20 (86.9%) underwent surgery with bone grafting. The overall recurrence rate was 30.4%. No association was identified between recurrence and the variables studied (p ≥ 0.05). The epidemiological data obtained are consistent with pediatric cohorts reported in the literature.

Conclusion: All evaluated methods are suitable for treating aneurysmal bone cysts. Level of Evidence IV; Case Series.

Introduction: Armwrestling is officially recognized in 160 countries affiliated with the World Armwrestling Federation. The movements involve the upper limbs, with emphasis on shoulder rotators, elbow flexors and extensors, and wrist.

Objective: To evaluate the balance of agonist/antagonist forces in shoulder rotation and to verify differences in relation to the normative value of 64% for strength and 66% for power in the ratio between internal and external rotators.

Methods: Seventeen international-level athletes were selected. A Biodex isokinetic dynamometer was used to evaluate the balance in peak torque of agonists and antagonists in shoulder rotation with strength and power tests.

Results: Significant differences were found in the agonist/antagonist ratio in the power tests, with an average of 57% (P-value = 0.001) versus 66% of the normative value, and in the strength test, 58% (P-value = 0.064) versus 64% of the normative value.

Discussion: The muscular strength and power of the subjects were analyzed in relation to normative parameters for internal and external shoulder rotation. The results were significant in relation to the normative values, indicating muscular imbalance in this group of athletes.

Conclusion: The results indicate that the training performed by armwrestlers promotes a greater gain in strength of the internal rotators of the shoulder than their antagonists. Level of Evidence I; Diagnostic criteria previously tested on consecutive patients (with a universally applied "gold standard").

Objective: To assess the prevalence of palmaris longus (PL) tendon agenesis in a population of medical students.

Methods: The presence of the palmaris longus tendon was evaluated using Schaeffer's test, applied bilaterally in 100 medical students, totaling 200 evaluated antimeres. The data were analyzed for unilateral or bilateral presence of the tendon, in relation to gender, laterality (right or left), and the occurrence of agenesis.

Results: Agenesis of the palmaris longus tendon was observed in 32 out of 200 evaluated antimeres (16%). Among female participants, agenesis was identified in 21 antimeres (21%), whereas in males it was observed in 11 antimeres (11%). Tendon absence was more frequent in the left upper limb, regardless of gender.

Conclusion: The prevalence of palmaris longus tendon agenesis in the studied sample was 16%, with a higher frequency among females. Tendon absence was more common on the left side in both genders. Level of Evidence IV; Case series.

Objective: To evaluate demographic aspects, risk factors, trauma mechanisms, and therapeutic outcomes in humeral shaft nonunion.

Methods: Retrospective analyzing of 14 patients treated between 2011 and 2024 at a quaternary hospital. Evaluating Demographic data, fracture characteristics, treatments, and outcomes were descriptively assessed.

Results: The average patient's age was 51 years. Half of the patients were involved in domestic accidents, and half in traffic accidents. 58% of fractures occurred in the middle third of the shaft, and 93% were classified as atrophic nonunions. Healing failure was linked to lack of bone contact, implant loosening, and infection. After definitive treatment, 71% achieved union, 21% remained in nonunion. Bone grafting combined with compression was associated with superior outcomes.

Conclusion: Trauma mechanism, AO classification, and comorbidities were not significant predictors of healing. Grafting associated with compression was crucial for union achievement. Level of Evidence IV; Case series.

Objective: To evaluate the regional distribution of hospital admission authorizations (AIH), total and average hospitalization cost (AHC), average length of stay, number of deaths and mortality rate related to oncological-orthopedic procedures funded by the Unified Health System (SUS) between 2015 and 2024, with an emphasis on the impact of the COVID-19 pandemic.

Methods: Ecological study with time series based on data obtained from the SUS Hospital Information System, analyzed by Brazilian regions in the pre-pandemic, pandemic and post-pandemic periods. Regional differences were calculated using ANOVA or Kruskal-Wallis. The impact of the pandemic was analyzed using T-tests and ARIMA with intervention. Statistical analysis was performed in R.

Results: 9,120 AIHs were recorded, mostly in the Southeast (4,375) and South (2,252) regions. Multiple regional variations were found for all the variables evaluated. Only the AHC was impacted - there was an increase in costs per procedure; The other variables maintained the trend after the beginning of the pandemic.

Conclusions: Despite the increase in the AHC, we did not observe significant variation in the number of AIH, ALS, and MR when analyzing the pre-pandemic and pandemic periods, suggesting that there was no direct impact on the performance of the analyzed procedure. Level of Evidence III; Retrospective _f comparative study _e.

Objective: Footvolley is a sport that have been gaining popularity, however, the literature on injuries in this modality is very scarce. Thus, this study aimed to describe the most common locations and types of injuries in professional footvolley athletes and compare the prevalence between male (M) and female (F).

Methods: Observational, cross-sectional study, including the highest-ranked professional athletes in Brazil in the year 2023. The interviews took place during the national professional footvolley championship stages and included questions about sample characteristics, training history and routine, and injuries suffered throughout their career.

Results: A total of 56 athletes, 36 F (26±5 years; 9±4 years of practice), and 20 F (28±6 years; 7±3 years of practice). Of this total, 95% reported some injury caused by playing footvolley, with knee injuries being the most prevalent (M/F=48%; M=44%; F=55%), and muscle pain (myalgia) being the most prevalent type (M/F=38%; M=39%; F=35%; p>0.05). M presented significant differences about M regarding the site of the injury (foot: M=6%; F=25%; p=0.035) and type of injury (intense nonspecific pain: M=28%; F=5%; p=0.040).

Conclusion: Elite footvolley athletes in Brazil presented a high prevalence of injuries, with the most common injuries being in the knees. Level of Evidence IV; Case Series.

Objective: To identify the prevalence and characteristics of CAULs treated at a university center, aiming to improve epidemiological understanding and management of these conditions.

Methods: Study carried out at the Hand Surgery and Microsurgery Service of Hospital São Paulo, UNIFESP, between January 2014 and February 2023. The sample included 296 patients diagnosed with CAULs, whose data were obtained from medical records. Information on sex, type of anomaly, age at first consultation, laterality, time until surgery, number of procedures and consultations were collected. Descriptive statistical analyses and association tests were performed, considering a significance level of 0.05.

Results: It was observed that 61.15% of the patients were from São Paulo, with a higher prevalence of syndactyly (20.3%), followed by preaxial polydactyly (17.9%) and camptodactyly (11.5%). The majority (35.1%) presented bilateral involvement. Conservative treatment was used in 50% of the cases, while surgical intervention, often the only one (34.46%), was necessary in the others.

Conclusion: This study provides an overview of CAULs, with findings that reinforce the predominance of anomalies such as syndactyly and the importance of individualized treatment strategies. Level of Evidence II; Retrospective ^f Study.