Acta Ortopedica Brasileira最新文献

Objective: To describe the clinical and radiological parameters of spine malignant tumors.

Methods: This is a therapeutic study of the descriptive retrospective type. Clinical evaluation included age, sex, tumor lesions, treatments, surgical procedures, and complications. The radiological evaluation analyzed radiographic exams, computed tomographies, and MRIs, focusing on morpho-pathological characteristics and the treatments employed.

Results: Among the 236 patients evaluated, the majority were female, aged 6 to 91 years. The main complaint reported was low back pain. The most commonly used surgical approach was the posterior access, including pedicle fixation and decompression of the spinal canal. The most prevalent complication observed was infection. The majority of patients had primary breast tumors. The predominantly affected segment of the spine was the thoracic. Upon analyzing the portions of the spine affected, it was observed that the posterior arch portion was the most commonly affected.

Conclusion: The clinical and radiological presentation of patients with metastatic lesions in the spine in our sample was similar to reports in the literature. Surgical outcomes aligned with previous expectations. Initial symptoms were noted, varying intervals between symptoms, diagnosis, and treatment. Level of Evidence III; Comparative Retrospective Study.

Rotator cuff injury is the most frequent etiology of shoulder pain, with 24% of these injuries involving the subscapular tendon.

Objective: To correlate the findings of three clinical tests (Gerber test, Belly Press test, and Bear Hug test) with Magnetic Resonance Imaging (MRI) and arthroscopic findings of subscapular lesions.

Methods: Prospective cross-sectional study, from November 2023 to March 2024, with 50 patients with rotator cuff injury, evaluating sensitivity, specificity, and accuracy among clinical tests, MRI, and arthroscopic findings.

Results: 50 patients formed the sample, with 29 (58%) men and 21 (42%) women aged 42 to 86 years. We found a specificity of 88% and an accuracy of 54% in MRI. Regarding the Gerber test, the Belly Press test, and the Bear Hug test, the sensitivity was 64%, 64%, and 76%, with specificity of 75% for the Gerber and Belly Press tests and accuracy of 74% for the Bear Hug test.

Conclusion: We concluded that the Bear Hug test showed higher sensitivity and accuracy in detecting subscapular tendon lesions, with MRI being the most specific method. Level of Evidence II; Prospective Study.

Objective: To assess the feasibility of the entire micro fragmented adipose tissue knee injection procedure under local anesthesia. From the subcutaneous harvesting and microfragmentation process to the intrarticular knee injection.

Methods: A patient with bilateral knee osteoarthritis underwent adipose tissue harvesting and bilateral intra-articular micro fragmented adipose tissue knee injection under local anesthesia. Patient-related outcomes were collected before the procedure, 12 months, and 24 months follow-up. Womac, Koos, and VAS were recorded.

Results: The visual analog scale, KOOS questionnaire, and WOMAC score all improved in the 12- and 24-month follow-ups.

Conclusion: Adipose tissue harvesting and micro fragmented adipose tissue knee injection are procedures that can be performed under local anesthesia and have good patient report outcomes. Level of Evidence IV; Therapeutic Study.

Objective: This study aimed to evaluate the profile of patients diagnosed with giant cell tumors treated at the Ophir Loyola Hospital.

Method: An analytical study in the form of a retrospective cohort, conducted through a review of patient medical records and imaging exams of individuals treated at the hospital between January 1, 2020, and December 31, 2021.

Result: A total of 19 patients were evaluated, with an average time of 10.5 months between diagnostic suspicion and the first consultation with the Orthopedic Oncology team.

Conclusion: Among the patients studied, 73% were presented with advanced-stage disease, requiring aggressive surgical treatment with wide resection and replacement with an endoprosthesis. Level of Evidence II; Retrospective Prognostic Study.

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: 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: 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.