Acta Ortopedica Brasileira最新文献

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.

Musculoskeletal injuries in the lower quarter during surfing are primarily associated with the sport's fundamental movements. This movements occur when the surfer is standing on the board, riding the wave. The injuries are typically acute, with severity and complexity varying according to the surfer's skill level and maneuvers performed. The objective of the present study was to conduct an integrative review of studies related to the musculoskeletal assessment of the lower quarter, focusing on physical examinations and functional tests applicable to surfers. This integrative review was carried out through a literature review, evaluating and analyzing papers from national and international journals indexed in the scientific databases Scielo and PubMed. The developement and analysis involved a panel of experts in the field of medicine and surfing health composed of physical educators, physiotherapists and sports doctors. This guideline aims to complement the information presented in the upper quarter article, emphasizing the prevalence of musculoskeletal injuries in the lower quarter among surfers and guiding outpatient assessments. It considers the specificities of surfing and the biomechanical movements involved. Level of Evidence III; Expert opinion.

In persistent and debilitating cases of spondylolisthesis, surgical correction is usually indicated, and the surgeon may opt for spinal fusion or dynamic stabilization techniques, such as lumbar facet arthroplasty (LFA). However, LFA is an emerging technique that requires more research to fully understand its effectiveness and safety. To summarize the scientific evidence related to LFA in the surgical correction of spondylolisthesis. The database chosen to papers selection was PUBMED, based on the following search string: ((lumbar[title/abstract] AND facet[title/abstract] AND arthroplasty[title/abstract]) OR tops[title /abstract]) AND spondylolisthesis[title/abstract], including studies published in the last 10 years. Results: Initially, 9 papers were identified that met the previously established search strategy. After reading the titles and abstracts, 1 text was excluded because it did not deal with the application of LFA in spondylolisthesis, leaving 8 studies for review. Significant clinical improvement, maintenance of radiological stability and low complication rates were consistently observed with the use of LFA. Furthermore, economic analyzes indicated that the TOPS System is a cost-effective and economically dominant option compared to conventional approaches such as TLIF. These findings suggest that the TOPS system may be a viable and advantageous alternative for patients with degenerative spondylolisthesis, offering not only clinical but also long-term economic benefits. Level of Evidence IV; Descriptive Studies .

There is a reduction in the workload of medical residency in orthopedics and a perception that residents can improve their surgical skills without the need to expose patients to risks. Arthroscopies are among the most frequent surgeries in orthopedics and can be trained in a Virtual Reality environment. Our objective is to evaluate the ability of Virtual Reality to develop arthroscopic skills in medical students and orthopedic residents. We conducted the search on Pubmed, Scopus, Embase, and Web of Science platforms. Excluding duplicates, 521 articles remained. We use the Rayyan application to exclude articles outside the scope of the study, and three randomized articles that evaluated the arthroscopic performance of medical students or orthopedic residents with and without training in virtual reality were selected. Regarding time, a tendency towards a decrease in arthroscopic execution time was observed by individuals who trained in VR simulators. Regarding surgical skill, a significant improvement in arthroscopic execution was observed by individuals who trained in VR simulators. Virtual Reality simulators proved effective in developing arthroscopic surgical skills and were an effective alternative in training students and residents. Level of Evidence I; Systematic Review and Metanalyses .