Acta Ortopedica Brasileira最新文献

Trauma configures the main cause of spinal cord injuries. Patients with traumatic spinal cord injury often develop severe and debilitating outcomes that require multidisciplinary care to adapt patients to their new reality. Heterotopic ossification (HO) is one of the frequent comorbidities in these patients but it still lacks well-established treatments or a gold standard one. Thus, this systematic review aimed to search the current literature for HO treatment and prevention. This study was conducted following PRISMA recommendations (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) and searches were conducted in three databases (PubMed, Embase, and Web of Science). A total of 193 articles were found in an initial search. After screening following the established criteria, eight articles were included in this review; of these, two reported prevention and the others, treatments. Based on data analysis, the use of non-steroidal anti-inflammatory drugs in the acute post-traumatic period proved to be the best method of prevention. In cases of mature HO or accompanied by ankylosis, surgical resection proved to be the most effective treatment despite the high rate of postoperative infections. Level of Evidence III, Systematic Review.

Objective: Evaluate the stability provided by two flexible intramedullary nails (FINs) in a simulation of fractures at the proximal levels in pediatric femur models.

Methods: Two FINs were inserted in 18 synthetic models of pediatric femurs. Fractures were simulated at one of three levels, and the models were divided into the following groups (n=6): diaphysis (control), subtrochanteric and trochanteric. Flex-compression tests were performed with force up to 85 N. Relative stiffness and the average deformation was obtained. Torsion tests were performed by rotating the proximal fragment until 20°, to obtain the average torque.

Results: At flex-compression, the set's average relative stiffness and average deformations were: 54.360x10³ N/m and 1.645 mm in the control group, respectively. In the subtrochanteric group, the relative stiffness was 31.415x10³ N/m (-42.2%) and the deformation was 2.424 mm (+47.3%) (p<0.05). For the trochanteric group, the relative stiffness was 30.912x10³ N/m (+43.1%) and the deformation was 2.508 mm (+52.4%) (p<0.05). In torsion, the average torque was 1.410 Nm in the control group; 1.116 Nm in the subtrochanteric group (-20.8%), and 2.194 Nm in the trochanteric group (+55.6%) (p<0.05).

Conclusion: FINs do not seem to be biomechanically competent for the treatment of proximal femoral fractures. Level of Evidence I; Therapeutic Studies - Investigating the results of treatment.

Objective: To evaluate the knowledge about scoliosis in teachers of municipal public schools.

Methods: In total, 126 professionals were interviewed using a standard questionnaire containing issues related to scoliosis.

Results: 31% of interviewees did not know what scoliosis is. Of those who knew 89.65% were partially correct about the definition. Of those who claimed to know how the scoliosis diagnosis is made, only 25.58% were completely correct. When questioned about the Adams test, 84.9% did not know it. Among the interviewees, 57.9% answered that it is impossible to identify scoliosis by a simple examination of their students and, off these, 86.3% stated the lack of knowledge about the subject; and 92.1% considered that training for the diagnosis and early identification of scoliosis in students.

Conclusion: This study holds social impact since the interviewed teachers were not knowledgeable about the subject and had difficulty in providing a definition of the condition and in how to proceed with the investigation. Continuous education activities and the inclusion of this subject on the curricula of teacher education programs would improve the early diagnosis and treatment of scoliosis, with high success rates. Level of Evidence IV, Economic and Decision Analyses.

In the current scenario of medical education, a trend of using models and simulators to train operational skills, especially in the practice of basic orthopedic techniques, is growing. This form of teaching allows academics to maximize learning opportunities and contributes to improving the quality of care for their future patients. However, the realistic simulation has high costs as a major limitation.

Objective: To develop a low-cost orthopedic simulator for practicing pediatric forearm reduction skills in the preclinical setting.

Methods: A model of an arm and forearm with a fracture in the middle third was developed. Orthopedists, residents, and medical students evaluated the simulator's ability to reproduce fracture reduction.

Results: The simulator had a significantly lower cost than the others in the literature. The participants agreed that the model had a good performance, and that the manipulation was consistent with the reality of reducing closed pediatric forearm fracture.

Conclusion: The results suggest that this model can be used to teach orthopedic residents and medical students the skill of closed reduction of fractures in the middle third of the forearm. Level of Evidence III, Case Control Study.

Introduction: Soft tissue undifferentiated pleomorphic sarcoma (UPS) in extremities is considered a rare neoplasm, corresponding to 5% of soft tissue sarcomas (STS) today. The objective was to evaluate prognostic factors related to death, local recurrence (LR), and impact on survival rates.

Methods: A retrospective study including 42 patients with UPS in extremities treated surgically in a single center. Comparisons were made between demographic data, characteristics of the neoplasia, and treatment. Between the variables with statistical significance, logistic regression analysis was used. Survival rates were evaluated using Kaplan-Meier plots. To compare the effect of variables on survival rates, the Log-Rank test was used.

Results: Age group of patients was from 25 to 85 years (mean 58 years), with a mean follow-up of 29.6 months. The variables with the highest effect on survival rates were sizes larger than 15 cm (T4) with p = 0.01, presence of metastatic lesions, and prognostic stage IV according to the American Joint Committee of Cancer (AJCC) with p < 0.001. The mean survival was 25.9 months. Metastasis and stage IV of AJCC were associated with a reduction in patient survival (17.8 months) with Log-Rank test p < 0.001. Conclusion: The main factors of poor prognosis related to mortality and reduction of survival of UPS in extremities were metastatic lesions and stage IV of AJCC. Level of Evidence III, Retrospective Study.

Objectives: Analyze the epidemiological profile of patients with traumatic spinal fractures treated at Mário Covas State Hospital between 2015 and 2020.

Methodology: This is an epidemiological, descriptive, retrospective, quantitative, comparative, medical records review-type study. Data collection was carried out between May and June 2022 at the Mário Covas State Hospital, the following characteristics being evaluated: age, sex, lesion topography, trauma mechanism, origin and treatment.

Results: Data from 252 patients with traumatic spinal fractures were analyzed. The mean age of patients was 48.7 years, 74.7% were male. The mechanism of trauma from falls from a height and the topography of the lumbar vertebrae have a highly significant trend. The most affected vertebrae are lumbar L1, thoracic T12 and cervical C6. The crossing of the age group with the male sex is higher than expected in those over 60 years of age. The crossing of the age group with the trauma mechanism is higher than expected, between 20 and 39 years.

Conclusion: There are few published works on the epidemiology of traumatic fractures of the spine, which points to the need for further studies on the subject. Level of Evidence III; Retrospective comparative study.

Objective: Describe the national scenario of the orthopedics and traumatology Medical Residency Program (MRP) in 2020/2021, showing the distribution of vacancies by states and regions of Brazil, the number of residents and the percentage of agreement between the accredited services that offer the program by the Brazilian Society of Orthopedics and Traumatology (SBOT) and by the National Commission for Medical Residency linked to the Ministry of Education (CNRM/MEC).

Methods: This is a descriptive, cross-sectional study. Data from the CNRM and SBOT system referring to residents attending orthopedics and traumatology Programs in 2020/2021 were analyzed.

Results: In the analyzed period, there were 2.325 medical residents in orthopedics and traumatology in vacancies authorized by the CNRM/MEC in Brazil. The southeast region was predominant, with 57.2% of vacancies, totaling 1.331 residents. Compared to other regions, the south region with 16.9% (392), the northeast with 15.1% (351), the midwest with 7.7% (180), and the north with 3.1% (71). In addition, there was an accreditation agreement of 53.8% in evaluating services between the SBOT and CNRM, with distinctions among the states.

Conclusion: The analysis showed differences between regions and states, considering the vacancies of PRM in orthopedics and traumatology and the concordance of evaluations by institutions accredited by MEC and SBOT. It is aim to work together with a view to qualifying and expanding residency programs for the training of specialist physicians, in accordance with the needs of the public health system and adequate medical practice, is necessary. The analysis during the pandemic period, associated with the restructuring of several health services, demonstrates the stability of the specialty in adverse scenarios. Level of evidence II; Economic And Decision Analyzes - Developing an Economic or Decision Model.

Introduction: The aim of our work is to review those patients who underwent prosthetic hip revision surgery in our hospital considered to be patients at high risk of dislocation or recurrent dislocation, and who underwent a double mobility cemented cup (CMD). Analyzing the different ways to place these cups and the clinical results and reluxations.

Material and methods: The 69 cases comprised 34 men and 35 women with a mean age of 77,39 years. The mean follow-up was 4.7536 years. The type of intervention performed varied according to the cause of the intervention, the acetabular bone stock and the state of the primary cup. In the cases in which there was a good fixation of the primary metalback, we opted to carry out a cementation of the cemented DMC into the existing well-fixed metal acetabular shell, this occurred in 23 cases. In the cases where there was loosening of the primary cup but there was a good bone stock, a CMD was cemented into the bone (21 cases). In the cases where there was a Paprosky type III we cemented a DMC to a Bursch-Schneider reinforcement ring together with the placement of a cancellous bone graft (25 cases).

Results: The clinical evaluation at the end of the follow-up, according to the MD Scale, showed the mean value was 16.454 (SD 0.79472), with a survival at the end of the follow-up of 100% of the placed DMC.

Conclusion: The use of cemented DMC is a good solution in the replacement of THA, especially in cases of reluxation or risk of dislocation due to personal or technical predisposing factors. The use of these DMC cemented can be directly to the bone, into the existing well-fixed metal Shell, or cemented to a reinforcing ring, depending on the acetabular defect. Evidence Level III; Comparative Case Series .

Objective: To evaluate the citation of the ligament in the magnetic resonance imaging (MRI) reports and confirm its presence and injury in the images of exams performed in the acute phase retrospectively.

Methods: In total, 103 patients who underwent anterior cruciate ligament (ACL) reconstruction in 2019 were included. The images were reanalyzed by two radiologists.

Results: In the first analysis, only one report mentioned the anterolateral ligament (ALL) and its injury (0.97%). On reanalysis, ALL was visualized in almost all cases (95% and 97%). An injury was found in 53 (51.5%) cases by radiologist A and in 56 (54.4%) cases by radiologist B. The injury was diagnosed by both in 39 (37.9%) cases (p < 0.0001). Radiologists disagreed regarding the injury (Kappa = 0.411).

Conclusion: The reports failed to describe the ligament and diagnose a significant number of injuries. The analysis of conventional resonance images still presents divergences in the diagnosis of ALL injury associated with the ACL among radiologists. Level of Evidence IV, Case Series.

Objective: To predict the risk of osteonecrosis (ON) according to the Neer and Hertel et al. classification for surgically treated proximal humeral fractures after at least one year of follow-up.

Methods: This is a retrospective, cross-sectional, and observational cohort study. A total of 44 patients, 16 (36.36%) men and 28 (63.63%) women, with a mean age of 61.36 years, participated in this study. Lesions were categorized according to Neer and Hertel's classifications, considering the preoperative prognosis for ON. After at least a year of follow-up, patients were reassessed. Data were evaluated using IBM SPSS Statistics^®.

Results: A total of three patients (6.8%) developed osteonecrosis. Comparisons showed no statistically significant difference, but we observed a superior association of osteonecrosis for the Hertel classification than that of Neer.

Conclusion: Both classifications showed a similar ability to identify patients at low risk of developing ON. New studies with a greater number of participants and sample homogeneity may intensify the value of the evaluation of clinical applicability and predictive capacity of the studied classifications with greater significance and correlation. Level of Evidence III, Case Control Study.