Acta Ortopedica Brasileira最新文献

Objective: The aim of this study was to evaluate capsulolabral repair in athletes with traumatic anterior glenohumeral instability using magnetic resonance imaging (MRI) and correlate it with clinical and epidemiological data.

Method: A prospective therapeutic clinical study was conducted with 36 athletes undergoing surgical treatment. MRI was performed preoperatively and in the third month postoperatively. The morphology, height, angulation, integrity and density of the repaired capsulolabral tissue were evaluated. Linear and logistic regression models were applied.

Results: A total of 36 athletes were evaluated (mean age 29.64 ± 9.08 years). For all numerical variables (morphology, integrity, angles and heights) the differences were statistically significant, except for the coronal angle and homogeneity. Longer time to surgery or multiple dislocations reduced the improvement in morphology. There were no new episodes of dislocation. In the 3-month radiological evaluation, the integrity of the labrum was present in 97% of the patients, however, all patients still had a heterogeneous labrum.

Conclusion: There are statistically significant differences between the morphology, height and angulation of the labrum between the pre- and postoperative periods of patients operated on for glenohumeral instability. Although the 3-month MRI showed integrity of the labrum in almost all athletes, this tissue still presented altered density even with satisfactory clinical results. Level of Evidence III; Prospective Study.

Introduction: Lower back disorders are prevalent and a significant reason for emergency care visits. In 2020, 619 million people experienced low back pain, expected to rise to 843 million by 2050. A common cause is the presence of a lumbosacral transitional vertebra (LSTV). Objectives: This study evaluates the prevalence of Bertolotti Syndrome in patients with low back pain in an emergency setting and assesses interobserver reliability of LSTV classifications.

Methods: A retrospective analysis of 1023 lumbar spine radiographs from patients presenting with low back pain from 2018 to 2020 was conducted. After exclusions, 469 radiographs were analyzed. Two orthopedists classified LSTVs using Tini and Castellvi's systems. Statistical analyses included the Kappa agreement index, two-proportion Z test, confidence interval for the mean, and p-value calculations.

Results: The prevalence of Bertolotti Syndrome was 62.5% for observer A and 61.6% for observer B. Type I LSTV was the most common, with over 70% of cases, followed by type III at over 15%. The most frequent morphology was bilateral involvement of the transverse process, with more than 50% of cases exhibiting IB morphology according to both classifications.

Conclusion: This study found a high incidence of Bertolotti Syndrome (over 60%) in patients with low back pain seeking emergency care, suggesting that LSTV should be more frequently considered in differential diagnoses. Improved recognition of LSTV could lead to better management strategies for low back pain associated with this congenital anomaly. Level of Evidence III; Retrospective Cohort Study.

Objective: To evaluate the clinical outcomes of surgical treatment by wrist triangular fibrocartilage complex (TFCC) lesions videoarthroscopy (VA) and analyze the correlation between magnetic resonance imaging (MRI) and intraoperative VA findings.

Methods: Cross-sectional study of 28 patients undergoing VA from February 2021 to September 2023, selected by predefined inclusion/exclusion criteria. The mean age was 39.6 years (range: 20-58), with a mean follow-up of 13.6 months (6-20). Twelve surgeries (42.9%) were on the right wrist and sixteen (57.1%) on the left. Functional assessment used the 11-item Quick-Dash questionnaire.

Results: Quick-Dash scores were excellent in 18 cases (64.3%), good in 7 (25.0%), and satisfactory in 3 (10.7%). MRI identified 4 (14.3%) extensive and 24 (85.7%) partial tears, while VA confirmed 2 (7.1%) extensive and 26 (92.9%) partial tears. Concordance between MRI and VA was found in 26 cases (92.9%).

Conclusion: Surgical treatment by VA resulted in predominantly excellent functional outcomes. There was high agreement between MRI and VA findings, indicating good sensitivity and specificity. Level of Evidence IV; Case Series.

Objective: To create, through anatomical dissections, a map of the location of the Martin-Gruber anastomosis (MGA) in the forearms of cadavers.

Methods: One hundred forearms from 50 adult cadavers were used in this study. Dissection was performed through a median incision in the forearm and distal third of the arm. Lines between the humeral epicondyles (interepicondylar) and between the styloid processes of the radius and ulna (interstyloidea) were used as reference points for the topographic location of the anastomoses, and the forearms were divided into proximal, middle and distal thirds.

Results: MGA was present in 27 forearms (27%). In four limbs (14.8%) the nerve fascicles originated from the median nerve proximal to the interepicondylar line. In two limbs (7.4%), at the level of the interepicondylar line and, in 21 of these (77.7%), they were found distal to this line. In 17 limbs (62.9%), the anastomosis occurred in the proximal third of the forearm, in eight limbs (29.6%), the anastomosis occurred in the middle third of the forearm and, in two limbs (7.4%), the anastomosis occurred with the ulnar nerve it occurred in the distal third of the forearm.

Conclusion: Despite the great variation in their location, most anastomoses were found distal to the interepicondylar line, especially in the proximal third of the forearm. Level of Evidence IV; Case Series.

Objective: To evaluate the epidemiological profile and waiting time for osteosynthesis in patients admitted due to intertrochanteric fracture in a public hospital in the Federal District of Brazil.

Methods: This observational, descriptive, and retrospective study involved patients over 18 years old with intertrochanteric fractures between June and December 2023. Demographic, clinical data, and information about waiting time for osteosynthesis were collected. Analyses were performed using descriptive statistics and logistic regression.

Results: The majority of patients (61.4%) were female, with a mean age of 74 years. The average time between fracture and care was 3.4 days, and from fracture to osteosynthesis was 22.7 days. The mortality rate was 6.8%, with higher prevalence in elderly women with comorbidities.

Conclusions: The study demonstrates that a prolonged time between fracture and osteosynthesis is associated with worse clinical outcomes, particularly in elderly patients with comorbidities. Optimizing the waiting time for surgery is essential to reduce morbidity and mortality and improve patient recovery. Level of Evidence IV; Observational, Descriptive, and Retrospective Study.

Objective: To assess the risk factors associated with mortality in elderly patients with proximal femoral fractures up to one year after the fracture.

Method: This was a prospective cohort study of patients aged 60 or older diagnosed with a proximal femoral fracture at a referral hospital in Belém, PA.

Results: 395 patients were assessed. The risk factors age≥83 years (p<0.0010), fracture-surgery time ≥ 3 days (p=0.0034), hemoglobin < 9g/dL (p<0.027), leukocytosis (p<0.00001) and pulmonary infection (p<0.0001) were statistically significant in mortality up to 12 months after the fracture.

Conclusion: It was observed that in the first year after fracture, gender, type of fracture and comorbidities were not determining factors in mortality. In this series, the mortality rate was 20.75% one year after the fracture, with pulmonary sepsis being the most frequent cause of death. Level of Evidence II; Cohort Study.

Objective: To expand existing knowledge on gait parameters in a healthy population using a baropodometer and to ensure the reliability of the equipment.

Methods: A cross-sectional study was conducted with fifty healthy adults aged 24 to 65 years. Parameters were collected from both sides over at least five valid steps. The Wilcoxon test was performed, and the Intraclass Correlation Coefficient (ICC) for static and dynamic measurements was obtained with 95% confidence and a p-value of 0.005.

Results: The platform's reliability exceeded 0.7 for all parameters, both in static and dynamic analysis. All parameters showed a difference of less than 10% compared to the mean estimate across the five tests performed.

Discussion: The platform's reliability showed moderate to high ICC values, indicating that, under similar hardware and software conditions, platforms from different manufacturers may produce comparable results. The ICC for PTI was lower than that of the other variables, possibly due to physiological differences in posture, which affect gait speed.

Conclusion: The HS Tecnology manufacturer's baropodometer is a reliable tool for gait analysis in barefoot healthy individuals. Level of Evidence III; Cross-Sectional Study.

Objective: To analyze cases with clinical suspicion of patellar abnormalities, before ossification of the patella and to characterize the spectrum of abnormalities of the cartilaginous infantile patella by ultrasonography.

Methods: Retrospective study using the keyword "patella" in ultrasonography reports in the Radiology Information System (RIS). The main researcher performed patellar measurements in the group of patients and in a control group (9 patients) without clinical or ultrasonography abnormalities.

Results: Twelve patients with suspected patellar abnormalities were identified, with a mean age of 9 months and 4 days (±1.9 years), 75% male.

Findings: dislocation or subluxation associated with patellar hypoplasia (7 knees), low lying patella and patellar hypoplasia (2), unilateral patellar agenesis (1), bilateral patellar agenesis (1), patellar instability in dynamic assessment and absence of patellar morphological changes (1). In two patients, ultrasonography was negative. The craniocaudal diameter of the hypoplastic patellas measured 0.94 cm ± 0.24 cm and in the control group 1.24 cm and ±0.12 cm (p<0.01). The Insall-Salvati index adapted for ultrasonography measured 0.63±0.07 for the low lying patella and 0.93±0.16 in the control group (p=0.004).

Conclusions: Ultrasonography was useful to characterize abnormalities of the cartilaginous patella, and the most frequent findings were instability and hypoplasia. Level of Evidence IV; Case Series.

To analyze and compare two surgical treatment methods for tibial stress fractures: intramedullary nailing and tension plate, taking into account functional outcomes and postoperative results. This systematic review was conducted and written in accordance with the guidelines for systematic reviews - PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The bibliographic search was carried out between January and September 2024 in journals indexed in the PubMed, Lilacs, Cochrane and Embase databases. Ten studies were selected. Among them, five were case reports, four were case series, and one was a retrospective cohort study. Intramedullary nailing offers good stabilization and a gradual return to sports activities, but it can cause complications such as knee pain and additional fractures. The anterior tension plate, on the other hand, provides effective stabilization with less anterior knee pain and faster healing times, but it is more invasive and may require implant removal and intensive rehabilitation. The choice between intramedullary nailing and tension plate should be based on a detailed assessment of the individual characteristics of the patient, the nature of the fracture, and the potential risks associated with each technique. Level of Evidence IIA; Systematic Review of Cohort Studies.

Introduction: The incidence of bone metastases has increased in recent years, driven by population aging and the efficacy of treatments for visceral-origin cancers. Bone metastasis ranks as the third most common type, with approximately one-third located in the proximal femur. Prosthetic hip replacement is a key treatment option, enabling immediate weight-bearing and resumption of patients' normal activities.

Objective: This study aims to develop an algorithm to encourage early ambulation in patients undergoing hip arthroplasty with non-conventional endoprostheses, targeting improved recovery and minimized complications.

Method: The algorithm was designed by the multidisciplinary team of the Orthopedic Oncology Service at Irmandade da Santa Casa de São Paulo. It focuses on promoting early ambulation for hospital discharge, incorporating specific patient-guided milestones to ensure safe mobility progression while respecting clinical conditions.

Results: The mean time to sitting position was 1.64 ± 0.66 days, while ambulation was initiated at 3 ± 0.42 days.

Conclusion: The implementation of the algorithm demonstrated its efficacy in inpatient rehabilitation through personalized milestones. This approach promotes early ambulation and enhances patient confidence in mobility. Level of Evidence VI; Case series.