Acta Ortopedica Brasileira最新文献

Objective: To identify and analyze the geographical distribution, surgical volume, and population adequacy of Orthopedic Oncology Centers (OOCs) within the Brazilian Unified Health System (SUS).

Methods: We evaluated 11,139 procedures recorded in Hospitalization Authorizations (AIHs) between 2008 and 2019, including "hemipelvectomy in oncology" and "resection of bone tumors with replacement or reconstruction." Hospitals performing both procedures and at least three hemipelvectomies during this period were classified as OOCs.

Results: A total of 58 OOCs were identified in 18 states, accounting for 79.5% of all procedures. Most patients (93.7%) were treated in their home state. High-Volume Centers (HVCs) performed 95% of the surgeries, while Low-Volume Centers (LVCs) were responsible for only 5%. The Northeast region concentrated 39.1% of procedures, while the South had the highest number of OOCs per population.

Conclusion: The geographical distribution of OOCs in Brazil is relatively adequate; however, procedures are highly concentrated in a few high-volume centers. This centralization may be associated with better clinical outcomes, reinforcing the need for policies that encourage specialized treatment in reference units. Level of Evidence III; Cross-Sectional Observational Study .

To evaluate the efficacy of bioabsorbable interbody cages in comparison with conventional techniques in animal models, with emphasis on the impact of follow-up time on developments. A systematic review and meta-analysis was performed including 11 studies on the use of bioabsorbable cages in comparison with conventional techniques. The odds ratio (OR) was calculated for range of motion (ROM), and heterogeneity was assessed by Cochran's Q test. Descriptive statistical analyses and hypothesis tests were performed to evaluate the parameters of fusion rate, intervertebral disc height and ROM. The 11 studies included totaled 244 animals. The analysis revealed a cumulative OR of 1.70 for ROM and fusion rate in the first four months of follow-up. No significant differences were found in height parameters in the study follow-ups. Heterogeneity among studies was low, indicating consistency in the results. The analysis suggests that bioabsorbable cages have advantages in periods of less than four months, and that there is no inferiority in the results in follow-up periods longer than four months in terms of fusion rate, ROM and intervertebral height in long-term experimental studies, and further research is needed to determine their clinical applicability. Level of Evidence ll; Systematic meta-analytical review of non-randomized controlled clinical studies whose results were homogeneous .

Objective: This study aimed to evaluate the use of ultrasonography (USG) compared to radiography in identifying callus formation and fracture healing in hand bones (metacarpals and phalanges).

Methods: A prospective observational study was conducted with patients who sustained metacarpal and phalangeal fractures and were followed in the hand and microsurgery clinic of a philanthropic hospital in São Paulo between July 2023 and April 2024. Fractures were treated either conservatively or surgically with Kirschner wire fixation. Callus formation was monitored using serial weekly USG and radiographic examinations. Follow-up ended when bone healing was confirmed by both methods.

Results: There was a difference in the mean time of callus appearance between ultrasonographic and radiographic evaluations for all analyzed variables.

Conclusion: Ultrasonographic callus formation preceded radiographic callus appearance by approximately 18.2 days across all variables studied, suggesting that USG is a useful and alternative tool for the early diagnosis of bone healing in phalangeal and metacarpal fractures. Level of Evidence II; Prospective Observational Study .

The Achilles tendon, though the strongest in the human body, is the most commonly ruptured and frequently affected by tendinopathy, particularly in athletes. Achilles tendinopathy (AT) impacts approximately 8% of sports participants, with a lifetime incidence of over 50% in runners. Characterized by pain and tenderness, AT significantly compromises quality of life and functional performance. This narrative review explores biomechanical factors contributing to AT, focusing on both kinematic and kinetic parameters and their clinical relevance, providing a review of AT biomechanics literature, nonoperative interventions, and exercises targeting specific biomechanical risks. Studies have linked abnormal motion to AT. Key biomechanical factors include decreased plantar flexion strength, reduced gluteus medius and maximus activity, decreased peak ankle dorsiflexion, altered peak knee flexion, and decreased forward progression of the center of force, which may increase mechanical load and microtrauma, ultimately resulting in tendon damage. The effectiveness of various interventions was examined, emphasizing the integration of specific exercises aimed at addressing distinct biomechanical deficits. Effective management of AT requires addressing strength deficits and biomechanical abnormalities. Traditional rehabilitation protocols focus on strengthening but often neglect critical biomechanical issues. This review highlights the importance of incorporating specific exercises targeting kinematic and kinetic deficiencies. Level of Evidence V; Expert Opinion .

To compare the clinical outcomes of children with forearm bone fractures undergoing surgical treatment with intramedullary fixation with TEN rods and Kirschner wires. A systematic review of the literature was carried out, conducting a search for data in the Pubmed/Medline, Science Direct and Scielo databases. The quality of the trials was assessed by the MINORS tool and the meta-analysis of the studies was performed using the R software (version 4.4.0). 16 studies were selected, representing 1,075 patients, with a predominance of males, where the mean age range varied from 8.32 to 14.2 years. Applying the MINORS Scale, the quality of the studies was good (≥ 11). The meta-analysis of the studies revealed a statistically significant increase in the risk of adverse events in the experimental group compared to the control group, with a risk ratio (RR) of 1.35 (95% CI: 1.03 to 1.76). The combined mean difference (raw mean) between the experimental group and the control group was -12.42 minutes (95% CI: -13.75 to -11.10) in the fixed-effect model, indicating a significant reduction in surgical time for the experimental group. In the random-effect model, the mean difference was -21.62 minutes (95% CI: -33.30 to -9.94). Regarding fracture consolidation time, the fixed-effect model indicated a raw mean difference of 0.99 (95% CI: 0.61 to 1.36). Furthermore, heterogeneity was moderate to high, with an I² of 73% (p < 0.01). Intramedullary fixation with TEN nails and Kirschner wires presents a diversity of clinical outcomes and complications. The systematic review highlighted the importance of choosing the appropriate treatment method, considering the patient characteristics and the nature of the fracture. Level of Evidence II; Systematic Review .

The calcaneal tendon is the strongest tendon in the human body, and therefore the most commonly injured in the lower limbs. The aim of this study is to present a rehabilitation protocol, based on the literature, according to the physiology of tissue regeneration in the postoperative period of acute rupture of the calcaneal tendon, carried out through a bibliographic survey of the last 20 years and proposed by the Physiotherapy Service of the Institute of Orthopaedics and Traumatology of the Hospital das Clínicas of the University of São Paulo. The findings demonstrated that, despite the differences in surgical techniques, the proposed rehabilitation protocol presents minimal risk of damage to the surgical site. Level of Evidence III; Systematic Review .

Objective: In chronic hand flexor tendon reconstruction with tendon grafts, the challenge is to obtain the best resistance and tension of the suture that allows early active mobility. This experimental study of tension relaxation aims to investigate whether prior preconditioning of the tendon graft could assist to identify the ideal tendon graft tension in these reconstructions.

Methods: The porcine flexor tendons were subjected to the tension relaxation test, with three test cycles each with up to 50 N of tension and relaxation for 300 seconds. Measured: maximum force (N), maximum tension (Mpa) and maximum deformation.

Results: After the peak tension of 50 N, the following was observed: maximum deformation, with an average tendon elongation of 2.3 mm; average residual tendon elongation of 0.6 mm; demonstrating the viscoelastic spring characteristic of porcine tendons.

Conclusion: We recommend performing intraoperative preconditioning of the tendon graft with loads close to active grip strength (50 N to 70 N). If it is impossible to perform preconditioning, the suture can be placed 17 degrees of flexion of the proximal interphalangeal joint above the cascade flexion of fingers, compensating for tendon elongation under a load of 50 N. Level of Evidence III; Experimental .

The classification of knee osteoarthritis allows assessment of disease severity and may be useful in guiding treatment decisions. One of the most widely used systems for this purpose is the Ahlbäck classification. This study aimed to compare the original description of the Ahlbäck classification with how it has been reported and cited by other authors in subsequent publications. We conducted a search in the PubMed, Embase, and Cochrane databases for articles containing exclusively the terms "knee", "osteoarthritis", "osteoarthrosis", and "Ahlbäck classification". After applying the inclusion and exclusion criteria, 64 articles remained. These articles were analyzed in two aspects: the description of the Ahlbäck classification (categorized as correct, partially correct, or incorrect) and the accuracy of the reference citation (correctly or incorrectly cited). Only 10 articles (15.6%) correctly described the Ahlbäck classification and cited the original source properly. In contrast, 37 publications (58.4%) contained errors both in the description of the classification and the citation. Conversely, 37 publications (58.4%) contained errors both in the description of the classification and in the bibliographic reference. The proportion of articles that accurately described and cited the Ahlbäck classification was markedly low, comprising only 15.6% of those included in this systematic review. Level of Evidence III; Systematic Review .

To explore the effect of calcium supplementation on the risk of fractures at various sites in older adults based on randomized controlled trials (RCTs). PubMed, Embase, and the Cochrane Library were systematically searched for eligible RCTs from their inception until May 2023. The included trials investigated the effect of calcium supplementation on the risk of fracture in individuals aged 50 years or above, regardless of the use or nonuse of vitamin D. The primary and secondary outcome measures were total, vertebral, nonvertebral, and hip fractures. Twenty-three RCTs involving 70,837 individuals were enrolled. Calcium supplementation demonstrated a significant reduction in the risk of total (RR: 0.93; 95% CI: 0.88-0.99; P=0.019) and nonvertebral (RR: 0.93; 95% CI: 0.87-0.99; P=0.023) fractures. No significant differences were observed in vertebral (RR: 0.87; 95% CI: 0.75-1.01; P=0.074) and hip (RR: 0.90; 95% CI: 0.73-1.12; P=0.355) fractures between calcium and placebo or no treatment. Calcium dose influenced total fracture risk (P=0.008), while history of fracture (P=0.044), calcium dose (P=0.041), and follow-up duration (P=0.031) affected nonvertebral fracture risk. Follow-up duration impacted hip fracture risk (P=0.001). Calcium supplementation can significantly affect the risk of fracture, particularly nonvertebral fractures, in older adults. Level of Evidence I; Therapeutic Studies - Investigating the Results of Treatment.

Total hip arthroplasty (THA) is a complex surgery and is indicated for the treatment of degenerative diseases such as osteoarthritis, rheumatoid arthritis and osteonecrosis, as well as femoral neck fractures. This procedure aims to restore mobility, relieve pain and improve patients' quality of life. However, infections, especially periprosthetic joint infection (PJI), are serious complications that can compromise the success of the surgery. To identify risk factors, as well as methods of preventing and treating infections in THA. An integrative literature review was carried out, selecting clinical trials published in the last 10 years that addressed the proposed topic, using the following search strategy in the PUBMED database: hip[title] AND arthroplasty[title] AND infec*[title]. The analysis involved reading and discussing 12 articles, which addressed different aspects of infection prevention and management in THA. Although some interventions, such as collagen sponges with gentamicin and triclosan-coated sutures, have not significantly reduced the incidence of infections, others, such as closed incisional negative pressure therapy (ciNPWT) and washing with diluted betadine, have shown promise in certain contexts. Diagnostic accuracy, especially for coagulase-negative staphylococci, still presents challenges, highlighting the need for advances in diagnostic and therapeutic methods. Thus, despite advances, the prevention and management of infections in THA still require improvement, and interventions must be carefully evaluated to ensure the effectiveness and safety of the procedure. Level of Evidence IV; Evidence from Descriptive (non-experimental) or Qualitative Studies .