Acta Ortopedica Brasileira最新文献

Objective: To report on the experience and impressions of the Brazilian orthopedic trauma surgeons attending the Leadership Development Program (LDP) hosted by the Sociedade Brasileira do Trauma Ortopédico (SBTO) in Sao Paulo, Brazil on November 4, 2022.

Methods: Forty-eight orthopedic trauma surgeons from five different regions throughout Brazil were provided a link to complete The Big Five Test, a validated online personality assessment. The questionnaire was available in Portuguese and was intended to provide a background on individual personality traits and their influence on interpersonal interactions. The LDP integrated content from literature reviews specific to Latin America, established leadership programs from leading business schools, and various subject matter experts. Prior to the start of the LDP, participants received a pre-course survey evaluating demographic information, a needs assessment, and the prioritization of leadership topics utilizing a 5-point Likert-scale. Attendees participated in the one-day, interactive LDP focusing on the fundamental principles of leadership development, communication, personal development, emotional intelligence and negotiation. Following the LDP, a post-course evaluation was administered to determine the participants' overall experience, and suggestions for LDP improvement.

Results: Forty-one of the forty-eight course participants completed the pre-course evaluation, whereas forty-six of the forty-eight participants completed the post-course evaluations. Overwhelmingly, the lack of opportunity was most prevalently reported as the main obstacle to attending a leadership course, as cited by 56% of respondents.

Conclusion: Expanding the accessibility, diversity, and customizability of leadership programs can facilitate the development of personal tools needed to move healthcare forward. Critical topics include emotional intelligence and other differentiating leadership qualities that distinguish true transformational and servant leaders. Advancing leadership skills can stimulate networking, expose learners to experiential learning styles, inspire others to create positive change, and engender creative solutions for systematic improvements and health outcomes. Level of Evidence III; Individual Case-Control Studies.

Objective: Evaluate whether the experience of the surgeon could reduce Ponseti treatment time, and a number of cast changes, and the evolution of the Pirani Score.

Methods: 2 reference centers were evaluated. At Institution 1, 254 patients with idiopathic clubfoot (403 feet) were included, and at Institution 2, 32 patients (51 feet). At institution 1 (mentor), 3 intervals of 5 years each were analyzed. At the Institution 2 (trainee), 1 interval of 5 years was analyzed.

Results: Patients treated by the mentor had fewer casts compared with the trainee (p < 0.001). At Institution 1, the three mentor intervals showed differences in the number of casts (p < 0.05). A statistically significant difference was observed only in the first mentor interval (2000 to 2005, average of 3.47 casts) compared with the 2 other intervals (2005 to 2010; average of 2.6 casts and 2011 to 2015; average of 2.79 casts; p < 0.0001). Pirani score decreases the most until the third clinic visit.

Conclusion: The mentor's greater expertise was associated with fewer casts and shorter time to obtain correction in isolated clubfoot, especially right after the first 5 years of practice. Progression of the Pirani score in both institutions occurs between the first and the third casts. Level of Evidence III; Therapeutic Study, Retrospective Comparative Study.

Objective: The objective of this study was to evaluate the impact of drainage tube placement on postoperative pain, recovery, and opioid consumption within a 72-hour period following unicompartmental knee arthroplasty (UKA).

Methods: Patients with medial knee osteoarthritis who underwent UKA from January 2019 to August 2020 were enrolled in the study and divided into two groups based on whether they received a drain postoperatively.

Results: The drainage group had significantly lower VAS scores on day 1, day 2, and day 3, in addition to significantly smaller changes in the circumference of the knee joint within 3 days postoperatively (P <0.05). The ROM in the drainage group significantly increased at 3 days and 1 month post-surgery, with a statistically significant difference in morphine consumption between the two groups at 3 days (P<0.05). The incidence of postoperative nausea and vomiting (5 cases) and wound bleeding (1 case) was lower in the drainage group compared to the non-drainage group (P<0.05).

Conclusions: The placement of a drainage tube in UKA may reduce the swelling of knee joint and pain, which not only reduces the use of Opioid but also facilitates early functional activities of the knee joint. Level of Evidence III; Retrospective Comparative Study.

The collection of clinical data is an essential step for the development of any scientific research. Online digital data collection can optimize this step.

Objective: To compare the response rate and the accuracy of the clinical data collection date through the online and physical digital questionnaire in orthopedic patients.

Methods: Comparative study, level III of evidence, with forty patients who had ankle sprains were evaluated, followed up for a period of 12 weeks with the application of physical and digital Visual Analogue Scale, Foot Function Index and Cumberland Ankle Instability Tool questionnaires, and data were collected about the moment of collection of each questionnaire.

Results: We obtained a response rate of 83.3% in the digital collection group and 60% in the physical collection group (p < 0.05), and the response rate in the digital collection group was higher at all times of collection (3, 6 and 12 weeks). Analysis of the time of collection shows greater variability in the larger physical collection group at all times of the study (2.8 vs 1.5; 4.0 vs 2.4; 8.6 vs 1.5).

Conclusion: Digital data collection is effective for obtaining clinical data in patients with ankle sprains. Level of Evidence III, Comparative, Prospective, Longitudinal Study in Parallel Groups.

Objective: To evaluate the epidemiological and clinical characteristics of low back pain (LBP) in adult professional soccer players.

Methods: Systematic review and meta-analysis.

Results: The review included 44 studies. The pooled prevalence of LBP during ≤ 1 season was 1% (95%CI = 0-4%) in men. The pooled point prevalence of LBP was 25% (95%CI = 16-36%) in men and 28% (95%CI = 20-37%) in women. The pooled past-year prevalence of LBP was 34% (95%CI = 24-44%) in men. The pooled lifetime prevalence of LBP was 32% (95%CI = 25-39%) in men and 50% (95%CI = 32-69%) in women. The pooled frequency of LBP/total number of injuries was 2% (95%CI = 1-3%) in men and 4% (95%CI = 2-5%) in women. The pooled incidence rate of LBP/1,000 player-hours of exposure was 0.30 (95%CI = 0.17- 0.53) in men and 0.32 (95%CI = 0.06 -1.87) in women. The recurrence of LBP ranged from 3% to 63% in men. The intensity of LBP ranged from 1.68 (2.39) to 4.87 (2.14) points on a 0-10 scale (minimum = 0 and maximum = 8 points). The severity of LBP (days absent from professional activities due to pain) ranged from 2 (0) to 10 (19) days (minimum = 1 and maximum = 28 days).

Conclusion: Adult elite soccer players have a substantial prevalence of LBP. The frequency and incidence of LBP (compared with other conditions and sports) seems to be low. Estimates of the recurrence, intensity, and severity of LBP are uncertain. Level of Evidence II, Systematic Review of Level II Studies.

Objective: To describe a protocol of obtention of mesenchymal stem cells and to report their use as a biological adjuvant in three patients undergoing arthroscopic rotator cuff repair.

Methods: Case series of patients who underwent arthroscopic repair of isolated full-thickness supraspinatus tear using mesenchymal stem cells obtained from the bone marrow as a biological adjuvant. All patients were operated on at the same institution, by a surgeon with 13 years of experience. The cells were applied at the end of the procedure, at the tendon-bone interface, at an approximate concentration of 2,000,000 mesenchymal cells/mm³ and a total volume of 5 ml.

Results: All patients improved with the procedure, with one excellent and two good results. All cases overcame the minimally important clinical difference. All cases reached tendon healing, without partial or complete re-tears. We observed no complications.

Conclusion: Arthroscopic rotator cuff repair with added mesenchymal cells obtained from bone marrow and submitted to a cell expansion process led to good functional results and healing in all cases in the sample, with no complications. Level of Evidence IV, Case Series.

Introduction: The genu recurvatum is characterized by a hyperextension deformity of the knee in the sagittal plane. Among its causes are conditions such as arthrogryposis, cerebral palsy, poliomyelitis, sequelae of tibial tuberosity fracture and some syndromes with generalized joint hypermobility. Treatment of this deformity can be challenging and, to date, aggressive methods such as femur or tibial osteotomies are the most used for its correction.

Objective: This study aimed to describe a new surgical technique for correcting genu recurvatum.

Methods: This is a prospective clinical study of children who underwent posterior hemiepiphysiodesis of the distal femur with transphyseal screws.

Results: The approach proved to be safe and useful for genu recurvatum deformities, with femoral or articular apex.

Conclusion: This approach shows great potential for correcting genu recurvatum in the developing skeleton, being an excellent alternative to the more aggressive methods currently used to treat this deformity. Level of evidence IV, Case Series.

Objective: To evaluate whether patients older than 60 years admitted for fracture treatment had a history of previous fracture, a diagnosis of osteoporosis, or were under treatment for bone fragility.

Methods: Retrospective study including 100 patients older than 60 years with fracture. Fracture location, bone densitometry within the past two years, previous diagnosis and osteoporosis treatment, and previous fracture within the past five years were assessed. Using Fisher's test, it was evaluated whether there was an association between previous fracture and osteoporosis treatment.

Results: The most prevalent fracture was in the proximal femur (48%). Of the patients, 18% had fracture in the last five years, with 22% of them diagnosed with osteoporosis, and 22% under treatment. Previous fracture in the last five years was not associated with having a diagnosis of osteoporosis, having had bone densitometry, or being under treatment for osteoporosis.

Conclusion: Among patients with previous fracture, only 22% were aware of their diagnosis of osteoporosis, and less than 25% of them were under bone fragility treatment. Previous fracture in the past five years had no association with having a diagnosis of osteoporosis, having had bone densitometry, or being on osteoporosis treatment. Level of Evidence III, Retrospective Study.

Objective: To describe the efficacy of using viscosupplementation in patients with hemophilic arthropathy (HA), on pain, limb functionality, and quality of life.

Methods: A systematic review of the literature was performed following the PRISMA guidelines without limitations of language or year of publication. The search was performed on the following medical databases: PubMed, Cochrane Library, EMBASE, BVS/BIREME, Scopus, Web of Science, EBSCOhost, and PROQUEST in April 2020. The search used the following word: (hemophilia AND joint diseases) OR (haemophilic arthropathy OR hemophilic arthropathy) AND viscosupplementation.

Results: The systematic review identified 127 articles, 10 of which were selected for data extraction and qualitative analysis. The 10 selected articles included 297 joints with HA in 177 hemophilic subjects. Our review showed positive results in alleviating pain and improving functional capacity, and quality of life. No major adverse effects were observed.

Conclusion: There is a lack of scientific evidence regarding viscosupplementation with hyaluronic acid, but the results presented in this research suggest that it is an effective and safe therapeutic option to alleviate pain and improve functional capacity in patients with HA. Level of Evidence II, Systematic Review.

Scoliosis is a pathology with multiple etiologies that leads to aesthetic changes, increased morbidity and, especially, psychological damage.

Objective: This work aims to compare two mindset types (fixed and growth) and assess levels of quality of life in individuals with scoliosis.

Methods: Two questionnaires, Scoliosis Research Society-30 (SRS-30) and Early-Onset Scoliosis-24 Questionnaire (EOSQ-24), associated with the "Health Mindset Scale," were used. We applied the SRS-30 to patients who were independent or whose diagnosis of spinal deformity occurred after the age of 10 years. For patients diagnosed before the age of 10 or who presented dependence due to cognitive impairment, caregivers were subjected to the "Health Mindset Scale" and EOSQ-24 questionnaires.

Results: The sample consisted of 35 patients aged from 4 to 46 years, the majority aged from 15 to 18 years old (42.9%), female (71.4%), and with neuromuscular scoliosis (28.6%). The only significant result (p = 0.060) was the increase in pain/discomfort scores in the EOSQ-24 for a patient with a growth mindset. Lastly, there was no statistical difference between groups, however, in patients with a growth mindset, there was a tendency (p = 0.060) to have a higher pain/discomfort score, assessed via the EOSQ-24 score, reported by the caregiver. Level of Evidence III, Retrospective Comparative Study.