Acta Ortopedica Brasileira最新文献

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.

Objective: To clarify whether work-related factors influence the return to work after CTS surgery.

Methods: Descriptive observational study that included 56 patients who underwent CTS surgery. The variables studied were profession, employment status, time off work after surgery, reason for returning to work, stress level, leave granted by the National Institute of Social Security (INSS), change in job function, and level of work effort.

Results: The average time to return to work was 39.8 days (SD: 22.3). Self-employed individuals returned to work 6.5 days (SD: 22.3) earlier than salaried employees with a formal contract, who returned in 43.8 days (SD: 23.9; p=0.49). Most patients were on leave granted by the INSS, with an average of 47.8 days (SD: 23; p=0.003). Patients who had surgery on their left upper limb returned to work one week earlier than those who had surgery on their right (p=0.025).

Conclusion: Coverage by INSS are associated with a delay of approximately two weeks in return to work compared to patients without this coverage. Level of Evidence II; Retrospective ^f Study.

Objective: To evaluate clinical and radiological outcomes of the arthroscopic Latarjet procedure with cortical buttons for traumatic anterior shoulder instability.

Methods: Retrospective case series of medical reports and imaging studies of patients operated between April 2016 and September 2019 at a single hospital. Primary outcome was the Rowe score 24 months after surgery (MCID of 9.7 points). Secondary outcomes were the VAS, Rowe scores at other follow-up points, recurrence of instability, complications and tomographic evaluation of arthritis and graft healing, resorption and positioning.

Results: 46 shoulders were evaluated. At 24 months, mean Rowe score increased from 34.4 ± 11.4 to 90.1 ± 12.2 (p<0.001) and VAS from 6.1 ± 2.0 to 1.2 ± 1.9 (p<0.001). Every patient achieved MCID. Over 90% of grafts were well positioned and approximately 85% of them healed. There was no redislocation and only one (2.2%) subluxation. There were complications in six patients (13%), and no reoperation was needed.

Conclusion: At short-term, arthroscopic Latarjet procedure with cortical buttons provides good clinical outcomes, significant pain reduction and low recurrence rate. Graft healing and positioning were adequate. Complications were minor, with no reoperation needed. Level of Evidence IV; Case Series.

Rocker sole footwear can be indicated as a treatment for forefoot load distribution disorders, such as diabetic ulcers, metatarsalgia, and hallux rigidus, among others, with favorable clinical outcomes. Pressure analysis studies on rocker sole footwear highlight results that explain their clinical benefits for forefoot conditions. There is insufficient data in the literature to understand the changes in foot mobility and anatomy caused by rocker sole footwear. This study proposes a methodology using weight-bearing computed tomography (WBCT) to evaluate the anatomical alterations in the forefoot associated with rocker sole footwear. The goal is to investigate morphological changes in the forefoot that explain the clinically established kinetic and kinematic effects of such footwear. Biomechanical analysis potentially enhances the understanding of kinetic and kinematic findings without the bias of rocker sole position or magnitude changes. Level of Evidence V; Expert Opinion.

Objective: To evaluate whether NPWT in delayed coverage of Gustilo-Anderson Type IIIB open tibial fractures reduces the complication rate, including deep infection, nonunion, and amputation.

Methods: Retrospective case series including patients with Gustilo-Anderson Type IIIB open tibial shaft fractures treated between January 2014 and December 2017 with NPWT. The outcome measures were incidence of deep infection, nonunion, and amputation. Analysis of time to coverage (within 7 days vs. after 7 days) and type of soft tissue coverage.

Results: 26 patients with open tibial shaft fractures, predominantly male (96.2%), mean age 33.4 ± 13.9 years. Seven patients (26.9%) received coverage within 7 days; 19 patients (73.1%) received delayed coverage. The flap types were Myocutaneous (42.3%), microsurgical (34.6%), fasciocutaneous (23.1%). The overall infection rate was 50%, no significant difference between early (57.1%) and delayed (47.4%) coverage groups (p > 0.999). No amputations in the early coverage group; 2 (10.5%) in the delayed coverage group. Nonunion rates were 42.9% (early) and 36.8% (delayed). Overall complication rate: 85.7% (early) vs. 57.9% (delayed) (p = 0.357).

Conclusion: NPWT may exert a protective effect in cases of delayed coverage by isolating the wound and promoting healing. Level of Evidence III; Retrospective ^f study.

Objective: To evaluate the economic and environmental impacts of telemedicine use and the correlation of socioeconomic variables with telemedicine preference in patients with hip pathologies at a tertiary referral center in São Paulo, Brazil.

Methods: A cross-sectional study (January-June 2024) analyzed telemedicine patients, collecting data on preferences, socioeconomic profile, travel, and costs (transport and food). Avoided distance, time, and pollutant emissions were calculated using Google Maps and emission factors. The preference for telemedicine was correlated with socioeconomic data. Statistical analyses used Wilcoxon, chi-square, and logistic regression tests.

Results: 148 patients were included, of whom 77.7% preferred telemedicine. The mean round-trip distance avoided was 168.84 km, and the mean time saved was 223.97 minutes. Estimated out-of-pocket savings were USD 12.62 for public transport users and USD 28.95 for private car users. Telemedicine also reduced emissions by approximately seven metric tons of carbon dioxide in total. Higher income was positively associated with telemedicine preference (p=0.0283); other variables showed no significant associations.

Conclusion: Telemedicine reduced time, costs, and emissions, improving access. Preference was higher among wealthier patients, indicating barriers for low-income groups. Further studies should explore low adherence among socioeconomically disadvantaged populations. Level of Evidence IV; Economic and Decision Analysis.

Mucopolysaccharidoses (MPS) are lysosomal storage diseases characterized by the improper accumulation of glycosaminoglycans due to genetic deficiencies in specific enzymes. This accumulation leads to progressive cellular and tissue dysfunction, affecting multiple systems, particularly the musculoskeletal system, resulting in multiple dysostoses with deformities in the spine, thorax, and limbs. Clinically, MPS manifests as recurrent respiratory infections, sleep apnea, severe cardiac lesions, and hydrocephalus, among other symptoms. Bone and joint alterations markedly impair motor function and the quality of life of patients. However, early diagnosis can be achieved by identifying osteoarticular signs, which are crucial for the immediate initiation of treatment. Despite the well-pronounced skeletal manifestations, there is a lack of recognition among specialists, indicating the need for detailed reviews for medical professionals, especially orthopedists, radiologists, pediatricians, and geneticists. This study aims to highlight the orthopedic alterations of MPS, emphasizing their radiographic aspects, which are essential for suspicion, differential diagnosis, and correct identification, contributing to better management of these diseases. Level of Evidence V; Review Article.

Objective: To compare the efficacy of 2D fluoroscopy with intraoperative computed tomography (CT) in detecting intra-articular screws that extend beyond the dorsal cortex in distal radius fractures.

Methods: Prospective study of 10 patients undergoing osteosynthesis of distal radius fractures, evaluating the accuracy of 2D fluoroscopy and intraoperative CT.

Results: 2D fluoroscopy did not identify inadequate positioning, while intraoperative CT detected 20% of intra-articular screws and 60% of screws going beyond the dorsal cortex.

Conclusion: Intraoperative CT is more effective in detecting inadequate positioning of the synthesis material and may prevent future complications. Level of Evidence III; Prospective ^d comparative study ^e.