Acta Ortopedica Brasileira最新文献

Objective: To assess the incidence and characteristics of injuries that occurred during the 2021 season of the Paulista Soccer Championship during the coronavirus disease 2019 pandemic and to compare these characteristics before and after the championship interruption.

Methods: A prospective study was conducted using an electronic form developed by the Medical Committee of the Paulista Soccer Federation. The results were sent by the team physicians of Series A1 after each round of the Paulista Soccer Championship.

Results: Series A1 presented 7.2 injuries per 1,000h of game time. Most injuries occurred within 31-45 min of the match, with muscle injuries being the most frequent and the lower limbs the most affected. Only 10% of injuries required surgery. The strikers were the most affected players and most injuries occurred in penalty-free movements. There was no statistical difference between pre- and post-interruption of the championship due to the pandemic.

Conclusion: The incidence of injuries per 1,000h was below the average reported in the literature. Most injuries occurred in the lower limbs; muscle sprains were the most common type of injury, followed by sprains and fractures. MRI was the most commonly requested examination; and most injuries were classified as moderate. Overall, 10% of the injuries were treated surgically. There was no difference between pre- and post-championship interruption. Level of evidence VI, Descriptive epidemiology study.

Objective: To evaluate the epidemiological profile of patients diagnosed with ankle fracture admitted to a tertiary hospital.

Methods: Retrospective Cross-Sectional Observational Study.

Inclusion criteria: Individuals aged ≥18 (eighteen) years, diagnosed with ankle fracture, who underwent surgical and/or conservative treatment at a tertiary hospital in the city of São Paulo.

Exclusion criteria: Medical records with incomplete data, patients transferred to other hospital services.

Results: There was a higher prevalence of: mechanism of trauma due to motorcycle accidents (27.9%), surgical treatment (92.7%), with a higher frequency of use of plates and screws (68.5%). The most common type of fracture were bimalleolar and trimalleolar (23.8%; 20.5%), classified as AO44B2 and AO44B3, both with 17.8%.

Conclusion: Ankle fractures in this study were predominantly seen in male patients, aged from 30 to 39 years, with the main mechanism of injury being a motorcycle accident. There was a correlation between mechanism of injury and fracture classification , with the most common being types 44B2 and 44B3, and the use of an external fixator in 9.1% of cases. The death rate was significant when related to associated injuries, in polyfractured patients. Level of Evidence II, Retrospective study.

Objective: Soccer shows a high incidence of injuries and its cause is multifactorial. The impacts of the coronavirus pandemic are unknown. This study aims to evaluate the incidence of injuries in the 2023 Campeonato Paulista de Futebol (São Paulo Soccer Championship) and compare it to the championships prior to the pandemic.

Methods: This study was conducted by collecting data on injuries among players in the A1 Series of the 2023 São Paulo Soccer Championship. Injuries were recorded by each team's medical staff via an online questionnaire. The variables included: Type of Field, Weather, Temperature, Distance, Home Advantage, Age, Type and Location of Injury. The primary outcome is to evaluate the incidence of injuries, and the secondary outcomes are to analyze the relationship between the described variables, the observed incidence, and the comparison of data obtained from 2016 to 2019.

Results: In 2023, 76 injuries were recorded, an incidence of 22.1 injuries/1,000h. Muscle injuries (46.1%) and sprains (18.4%) were the most common. From 2016 to 2019, there was a decrease in the incidence of injuries per 1,000h, respectively: 24.2; 17.6; 14 and 10.5.

Conclusion: the incidence in 2023 was 22.1 injuries/1,000h, which points to an increase compared to the pre-pandemic period. Level of Evidence II, Comparative Prospective Study.

Objective: To evaluate the prevalence of shoulder pain, level of functional performance, and morphological involvement of the rotator cuff on ultrasound in morbidly obese patients.

Methods: The study included 54 morbidly obese patients receiving follow-up care in a bariatric surgery outpatient clinic, which were compared with a control group consisting of 49 participants. Presence of shoulder pain, shoulder functional performance, ultrasound of the rotator cuff and blood tests were the parameters evaluated.

Results: The obese group showed a greater incidence of shoulder pain (p < 0.0001; OR: 17.5), lower functional performance according to UCLA (p < 0.0001; OR: 7.5) and DASH scales (p < 0.0001) and a greater incidence of pathological ultrasound and c-reactive protein test changes (p < 0.0001).

Conclusions: These findings suggest that being overweight is an important exacerbating factor for shoulder pain, lower shoulder functional performance and pathological changes of the rotator cuff and c-reactive protein test. Level of Evidence II, Cross-sectional study.

Objective: To analyze the satisfaction of patients who underwent hand surgical treatment with the wide-awake local anesthesia no tourniquet (WALANT) anesthesia technique.

Methods: This is a cross-sectional study on the satisfaction of patients who underwent hand surgical treatment with the WALANT technique. These patients were treated at the Hand and Microsurgery outpatient clinic of a public hospital from March 2020 to March 2022. They were assessed by the modified Heidelberg questionnaire.

Results: The overall average of satisfaction totaled 3.27 (maximum value 4, SD 0.52, p-value 0.04), representing a good result. Patients' profile characteristics showed no statistically significant differences.

Conclusion: The efficiency of WALANT technique stemmed from the high satisfaction rate of patients undergoing minor surgeries, justifying its use as a routine option in outpatient surgeries in the public system. Level of evidence III, Retrospective comparative study.

Objective: There are several conservative treatment options for adhesive capsulitis (AC), but no previous study combines hydrodilation, corticosteroid injection and joint manipulation under sedation (triple procedure), followed by daily home exercises.

Methods: Patients included were evaluated before the procedure, at 30 days, 3, 6 and 12 months after treatment in prospective cohort. The outcomes used were the ASES, UCLA, SANE, VAS scales and passive range of motion (ROM).

Results: 65 shoulders of 63 patients were included. The mean ASES score progressed from 37.7 ± 17.9 to 94.1 ± 10.3 at 12 months after the procedure (p < 0.001). The mean UCLA went from 15.9 ± 5 to 33.2 ± 2.8 and SANE from 50.4 ± 18.3 to 94.3±9.0. At 12 months, the passive elevation improved from 114°±24° to 176° ± 6°, external rotation in neutral from 29° ± 17° to 72° ± 11° and internal rotation in neutral from 18.6 ± 3.6 points to 9.4 ± 2.4 points. No patient presented a fracture after manipulation.

Conclusions: Treatment with the triple procedure resulted in a statistically and clinically relevant improvement in functional results and gains in shoulder range of motion, with no reports of complications. Level of evidence IV, Prospective study.

Objective: Evaluation of epidemiological data on Idiopathic Scoliosis in patients with different pectus subtypes.

Methods: A medical record analysis of 418 patients with pectus, associated with idiopathic scoliosis above 10°, with research on: subtypes of pectus (Lateral Pectus Carinatum, Inferior Pectus Carinatum, Superior Pectus Carinatum, Broad Pectus Excavatum, and Localized Pectus Excavatum), and characteristics of the scoliotic curve (Cobb angle, laterality, and location).

Results: The mean age was 14.6 years (22° mean Cobb, 52% females and 48% males). The most frequent kind of pectus was Inferior Pectus Carinatum (28%). The left-convex thoracolumbar type was the most frequent. Scoliosis was more severe in thoracic location and females. The main type was LPC (p < 0.05) in those with severe scoliosis. BPE was more present in men (68%), and LPC and SPC in women (p < 0.05). No significant differences were found between the pectus type and the side or location of the scoliosis curve.

Conclusion: Depending on the subtype of pectus, the scoliotic curve presents distinct epidemiology and characteristics. Level of Evidence IV, Case Series - study prognostic.

Objective: Despite the lack of science-based evidence, many specialists and non-specialists consider W-sitting detrimental to children. This systematic review aims to find evidence on W-sitting.

Methods: This review was registered on PROSPERO under the number CRD42022313341. During January 2023, the term "W-sitting" and its variations were searched on the following databases: PubMed, Medline, Embase, PEDro, and Cochrane. Duplicate articles and those that addressed themes other than W-sitting were removed.

Results: This review found 3641 articles, removed 614 duplicates, and excluded 3021 for focusing on subjects other than W-sitting. It included seven studies for analysis, one of which was a narrative review and two were methodologically inadequate cross-sectional to evaluate the causal effect in W-sitting. Another article evaluated muscular activation in adults according to sitting position. The last article found no causal relation between W-sitting and developmental dysplasia of the hip.

Conclusion: This review found no scientific evidence advise against W-sitting in children and no association with hip dysplasia. Moreover, muscular activation remains the same, regardless of the position chosen for sitting. Level of evidence III, review article.

Background: Spinal stenosis refers to the narrowing of the spinal canal which can generate clinical symptoms secondary to the spinal cord injury itself, or even root involvement. The traditional open surgical procedure to correct spinal stenosis is highly traumatic and risky, and with the development of surgical techniques, endoscopic procedures have been widely used in treating said stenosis, achieving good results with minimally invasive management.

Aim: To conduct a literature review regarding endoscopic techniques for correcting spinal stenosis.

Method: This is an integrative literature review that surveyed the PUBMED database using the following search strategy: spinal[title] AND stenosis[title] AND surgery[title]. Only randomized clinical trials published in the last 10 years were included in the sample.

Results: A total of 13 articles were identified that met the previously established search strategy, all of which were included in the review.

Conclusion: The reviewed studies showed that endoscopic surgery to correct spinal stenosis could offer adequate decompression of neural elements, resulting in shorter hospital stays, faster recovery and favorable operative results. Level of Evidence IV, evidence from descriptive (non-experimental) or qualitative studies.

Introduction: The three-dimensional evaluation of patients in the gait laboratory is a diagnostic method that is gaining ground in various orthopedic pathologies and, in the case of ankle fractures, can more accurately detail the degree of joint limitation.

Objective: To present the importance of laboratory gait studies in the postoperative period of ankle fractures associated with syndesmosis ligament injuries, increasing the arsenal for assessing whether the surgical approach and outcome were satisfactory.

Methods: Case series of 13 patients who underwent surgical treatment for ankle fractures associated with syndesmosis injuries, evaluated postoperatively in the gait clinic using the BTS GAITLAB hardware program. Kinetic and kinematic data using a three-dimensional movement system were collected and analyzed.

Results: Alterations were found in the Temporal and Spatial Parameters and in the Statistical Angles of the lower limb joints, comparing the operated limb with the non-operated limb.

Conclusion: The results of the study suggest that, despite subtle variations between the limbs assessed, the program was able to identify these differences in a significant way, demonstrating that gait assessments bring great benefits in understanding biomechanical limitations, and make more effective and individualized rehabilitation protocols possible. Level of evidence IV, Case series.