Acta Ortopedica Brasileira最新文献

Objective: This study introduces a novel approach by proposing a dressing impregnated with vancomycin and chlorhexidine for postoperative care, specifically targeting patients undergoing orthopedic surgeries.

Methods: The research design involved a pilot study with a randomized control group, aiming to evaluate the efficacy and safety of vancomycin with a chlorhexidine dressing (Evidence Level I). Participants received vancomycin and CHG impregnated dressing or non-impregnated dressing during the period from March 2023 to October 2023 in trauma-related surgery in the lower limbs. The sample size was based on convenience, considering the pilot study; even though it was randomized and blinded, this study was not a clinical trial.

Results: A total of 12 patients used an impregnated dressing, and nine used the same dressing without impregnation. Despite limitations, including the small sample size and single-center study location, our findings demonstrate the safety of the impregnated dressing in trauma surgeries, indicating potential applicability in broader surgical contexts.

Conclusion: In conclusion, this study contributes to the discourse on preventive strategies for SSIs, presenting a pioneering approach with the use of vancomycin and chlorhexidine-impregnated dressings. Future research endeavors, incorporating larger-scale studies and addressing study limitations, are crucial for advancing the understanding and implementation of effective postoperative care strategies. Level of Evidence I; Case-control study.

In Brazil, surfing has gained popularity in recent decades, driven by beautiful beaches, good wave conditions and the spirit of adventure that permeates Brazilian culture, but also increasing the risk of injuries. During surfing, the surfer spends most of the time lying prone on the board while paddling, placing heavy demands on the musculoskeletal system in the cervical and lumbar spine, as well as in the shoulder region, which are important points for complaints of chronic injuries among surfers. The objective of the present study was to update musculoskeletal assessment of the upper quarter, related to physical examination and functional tests that can be applied to surfers. This is an update study based on an integrative review through a bibliographical survey in which national and international journals indexed in the scientific databases Scielo and PubMed were evaluated, developed and analyzed by a group of experts in the area of surf medicine and health composed of physical educator, physiotherapists and sports doctors. This guideline study compiled important information regarding the prevalence of upper quarter musculoskeletal injuries in surfers, guiding the surfer's outpatient assessment, considering the specificity of the sport and biomechanical gesture involved. Level of Evidence III; Expert opinion.

Objective: To evaluate patients with post-osteosynthesis infection (POI) in the appendicular skeleton, in a tertiary hospital, and to develop a care protocol for case management, based on cohort data and agreement between attending physicians.

Method: primary, observational, retrospective and comparative study, evaluating cases of POI, from 2014 to 2019, assisted by the service. The outcomes analyzed were length of stay, readmission, fracture site, etiological agent, antibiotic therapy, number of surgeries and clinical outcome after one year (cure or failure, these considered recurrence, amputation or death). Based on this data, a protocol for diagnosing and treating POI was proposed to the institution's orthopedists, with responses assessed in terms of the content validity coefficient, in order to grade compliance with the protocol.

Results: sample of 27 participants, mostly male, with infection in the lower limbs (77.8%), who underwent an average of two surgeries. The average length of stay was 48 days. The median duration of antibiotic therapy was 34 days. Patients with cure criteria used a greater amount of antibiotics compared to other cases (p<0.05). The responses of orthopedists to the management protocol for these cases reached a concordance of 0.91.

Conclusion: The profile of patients and therapy to POI was similar to the literature and supported the development of the care protocol, with high agreement among developers. Level of Evidence III; Observational, Retrospective and Comparative Study.

Introduction: Pelvic dissociation is a complex condition with a high rate of surgical complications and no established standard treatment. Surgery aims to preserve limb function by restoring bone structure and hip biomechanics. Conventional orthopaedic implants are made from materials such as stainless steel, cobalt-chrome or titanium. High-porosity implants have been introduced to improve the durability of hip arthroplasty.

Objective: To evaluate osseointegration after revision total hip arthroplasty in cases of pelvic dissociation.

Method: A descriptive observational study carried out at the Hospital das Clínicas of the Federal University of Goiás and at the Orthopedics and Traumatology Clinic (COT) in Goiânia. Data was collected from the medical records of patients who underwent total hip arthroplasty between 2012 and 2020, using titanium or tantalum implants, both high-porosity materials.

Results: The study included 26 patients, 53.8% female and 46.2% male. The majority (34.6%) were aged between 60 and 69. Of the patients, 53.8% used titanium implants and 46.2% tantalum. After surgery, 38.5% had a Harris Hip Score between 70 and 80, with 61.5% of patients showing osseointegration in less than six months.

Conclusion: Tantalum, due to its high porosity, was effective in treating patients with pelvic dissociation undergoing revision total hip arthroplasty. Level Of Evidence lV; Descriptive Observational Study .

Objective: To evaluate trends in corrective surgery for hallux valgus in Brazil, focusing on minimally invasive techniques, regardless of generation.

Methods: Information was obtained through a questionnaire, using the "Survey" tool, to foot and ankle orthopedists; conducted by the Orthopedics and Traumatology Service of IAMSPE. Outcomes were measured and evaluated through tables and incidence. Data from 54 orthopedic doctors were evaluated, regardless of the surgical technique used to correct hallux valgus.

Results: A trend toward preference for the minimally invasive technique was observed, due to better clinical outcomes and early rehabilitation.

Conclusion: There is a need for further study and in-depth analysis of the minimally invasive technique for the treatment of hallux valgus, considering that this has become the main method of choice for the treatment of this condition. Level of Evidence IV; Case Series .

Objective: To make a comparative analysis of patients with scaphoid pseudarthrosis operated with screw and corticocancellous graft and patients operated with plate and cancellous graft only, in regards to consolidation, carpal stability and limb functionality.

Methods: non-randomized retrospective cohort study. Nineteen patients with scaphoid pseudarthrosis without advanced collapse were included in the study, of which 9 patients operated with screw and corticocancellous graft (Group A) and 10 operated with plate using cancellous graft (Group B). The following were evaluated preoperatively and 12 weeks postoperatively: functional recovery using the visual analogue scale, range of motion, grip strength, digital pinch strength, DASH and MAYO wrist score functional scales. To assess carpal instability, the scapholunate and radiolunate angles were assessed on radiographs and the interscaphoid angle on CT. And the bone consolidation rate was assessed with CT in the 8th postoperative week.

Results: group A with 90% and B with 100% consolidation rate, however the latter with a longer average time for consolidation - 9.7 weeks (p = 0.002). Improvement in pain intensity was achieved in both groups (p = 0.03). Increased pinch strength (p=0.04) and grip strength in group B and decreased in group A. The range of motion was superior in group B, with loss of ulnar deviation (p=0.02) and radial deviation (p=0.007) in group A. Regarding the MAYO wrist score, there was loss of function in group A and an increase in group B (p=0.007). There was correction of the scapholunate angle in both groups (p=0.03), with no difference between them.

Conclusions: Patients in group B had better recovery of range of motion, pinch and grip strength, and better functionality according to the MAYO wrist score. Level of Evidence III; Study with an Almost-Experimental Design as a Non-Randomized Study with a Single Pre- and Post-Test Group. (Non-Randomized Retrospective Cohort).

Objective: To identify and review national and international articles that address the impacts on quality of life and the main clinical-functional outcomes of patients undergoing rotator cuff arthroplasty technique.

Methods: A systematic literature search was conducted using the databases Lilacs, MedLine, Pubmed, Scielo, BVS and Cochrane, published in the last 05 years.

Results: 623 articles were found, with 575 excluded after temporal screening, title and abstract reading. For initial registration purposes, 48 studies were selected, of which 12 were excluded for being duplicates. Of the remaining 36 studies, 31 were excluded for not meeting the inclusion criteria, resulting in 05 studies that composed the synthesized data. All classified as Evidence Level I by AHRQ.

Conclusions: The results of this study suggest that individuals with rotator cuff injuries can benefit from the Reverse Shoulder Arthroplasty technique for rotator cuff treatment, where it can be observed that patients undergoing RSA had significant improvement in functional capacity and quality of life, showing improvements in both physical and emotional aspects and functional independence. Level of Evidence III; Systematic Review .

Rotator cuff injuries occur due to overuse of the shoulder joint, trauma or age-related degeneration, and are aggravated by subacromial lesions and anatomical factors. Symptoms include persistent pain, reduced range of motion and muscle weakness, compromising patients' quality of life. Treatment can be conservative or surgical, and platelet-rich plasma (PRP) has emerged as an alternative to speed up healing and reduce inflammation. The objective was to review the literature on the use of PRP in the treatment of rotator cuff injuries. Clinical trials published in the last 5 years and available in the PUBMED database were selected, based on the following search strategy: (platelet[title] AND rich[title] AND plasma[title]) AND (rotator[title] AND cuff[title]). The 13 studies that responded to the initial search were included in the sample that made up this review. PRP has been shown to be a promising alternative for treating rotator cuff injuries, especially in terms of short-term pain and function. However, its long-term efficacy and its comparison with corticosteroids are still a matter of debate. Therefore, the choice of treatment should be personalized, taking into account the characteristics and goals of each patient. Level of Evidence IV; Evidence from Descriptive (Non-Experimental) Studies or with a Qualitative Approach.

Objectives: To assess the accuracy of incisional biopsies (IB) and needle biopsies (NB) in soft-tissue tumors treated at a Brazilian center of reference, as well as the variables related to the demographic profile and treatment established.

Methods: A retrospective, descriptive and observational study was conducted with patients with malignant soft tissue tumoral lesions, of indeterminate and intermediary malignancy, subjected to IB or NB at the institution from January 2010 to December 2019.

Results: 114 biopsies were performed in soft-tissue tumors of malignant lesions, of indeterminate and intermediary malignancy; of these 90 biopsies, 61 (67.7%) were IB and 29 (25.4%) were NB. It was necessary to perform a new collection in 5 cases among the NB (17.2%) and 1 case among the IB (1.6%). The IB accuracy was 83.6, while NB was 62.1. Of the 18 patients subjected to surgical treatment with radical margin, 7 were initially subjected to NB (36.8%) and 9 to IB (17.3%).

Conclusion: Despite the advantages inherent to the percutaneous procedure of NB, IB must still be considered a diagnostic option in soft tissue tumors with high heterogeneity and degree of necrosis. Level of Evidence III; Diagnostic Studies - Investigating a Diagnostic Test .

Objective: This study aimed to analyze the epidemiological profile of child abuse cases treated at Hospital Geral de Pirajussara, São Paulo, and to understand the characteristics of associated injuries.

Methods: A retrospective cross-sectional study was conducted by reviewing medical records of patients suspected of abuse, aged 18 years or younger, from January 2012 to December 2022. Data on sex, age, trauma mechanism, presence of fractures, and outcomes were analyzed.

Results: A total of 58 records were included. Most cases involved adolescents (50%, n=29). The most common abuse mechanism was physical force (36.21%, n=21), followed by direct trauma by object (13.79%, n=8). Fractures were present in 41.38% of cases (n=24), with skull and facial fractures being the most frequent (33.33%, n=7). Brain injuries were the most common associated injuries (42.42%, n=14). Most cases (77.59%, n=45) were discharged with an average hospital stay of 9 days.

Conclusions: Abuse is prevalent among young children under 1 year and adolescents (13-18 years). Identified patterns of injuries and abuse mechanisms highlight the need for stringent screening and management protocols. Continuous training and vigilance are crucial for effective prevention and intervention. Level of Evidence III; Cross-Sectional Retrospective Study.