Acta Ortopedica Brasileira最新文献

Objectives: evaluate the anatomical characteristics and variations of the anterior interosseous nerve (AIN) and define the feasibility of transferring the pronator quadratus branch (PQB) to the posterior interosseous nerve (PIN) without tension.

Materials and methods: Fifty upper limbs of 25 male adult cadavers were dissected, 20 were prepared and five were fresh cadavers.

Results: The AIN originated from the median nerve in an average of 5.2 cm distal to the intercondylar line. In 29 limbs, it originated from the posterior fascicles of the median nerve, while in 21 specimens, from the posterolateral fascicles. In 2 specimens, two branches for the AIN were present. The PIN was studied in 30 limbs, we identified its origin in the radial nerve in all limbs. In 23 limbs, the branches to the supinator muscle originated from the PIN proximally to the Fröhse arcade, in 7 members distally.

Conclusion: The PQB was reliably present in all dissected forearms and presented variations only in its diameter. The PQB could be transferred to PIN without tension in all specimens even with full range of motion of the forearm. Level of Evidence IV; Case Series.

Objective: To analyze the clinical and epidemiological profile of patients with neck pain, assessing risk factors, comorbidities, and the need for therapeutic interventions, as well as the impact of magnetic resonance imaging (MRI) on case management.

Methods: This is a cross-sectional study involving 435 patients treated at the Emergency Department of the Instituto Ortopédico de Goiânia (IOG) between July and December 2023. Sociodemographic, clinical, and risk factor variables were analyzed based on data collected from electronic medical records. Statistical analysis included association tests with a significance level of 5% (p<0.05).

Results: A high prevalence of sedentary lifestyle (94.59%) and prolonged work exposure (78.38%) was observed. Most patients required medication (94.59%), while 63.96% underwent additional clinical interventions. Statistically significant associations were identified between sex, occupational factors, and lesions detected by MRI. The average time to diagnosis was 4.2 months.

Conclusion: Neck pain is strongly associated with modifiable risk factors such as sedentary behavior and occupational overload, highlighting the importance of preventive strategies and individualized therapeutic approaches. MRI played a key role in diagnosis and treatment planning. Level of Evidence III; Study of Non-Consecutive Patients; No Uniformly Applied "Gold" Reference Standard .

Objectives: To evaluate in vitro the bone graft preparations sterilization (BG) by freezing, gamma irradiation and ethylene oxide and compare in vivo their osseointegration in Wistar rat femurs.

Method: This basic controlled experimental study carried out in two phases, in vitro. First, in vitro, it was evaluated the sterilization of bone allografts exposed to S. aureus, A. baumanii, M. tuberculosis and C. albicans. In the second phase, in vivo, bone allografts osteointegration was compared in thirty-two Wistar rats, separated into four groups. In the control group (CG), fenestrations were carried out in the femur and not given a graft. Other groups received bone allografts prepared by freezing to -70ºC, ethylene oxide and 25KGy gamma irradiation. After thirty days, femurs were histologically evaluated by Hematoxylin-Eosin and Alcian Blue colorations and the Fisher's Exact test was used with p≤0.05.

Results: In the in vitro study was observed lower level of decontamination by freezing method (26.6±21.09%) meanwhile and the other methods being 100% efficient. In the in vivo study, we observed no significant differences between the inflammatory reaction, mineralization and osteointegration. The percentage of proteoglycans was higher in the Gamma Irradiation Group and Ethylene Oxide Group. However, there were no significant differences. In the Frozen Graft Group, there was an absence in 37.5% of proteoglycans.

Conclusion: The preparation of the bone allografts by freezing is less effective than the other methods and there were no differences in the osteointegration of the bone allografts in rat femurs.

Degenerative spine diseases are a common cause of low back pain and neurological dysfunction, often associated with aging, and may require surgical interventions when conservative treatment is ineffective. This study aims to evaluate the risks and benefits of minimally invasive spinal fusion surgery (MIS) compared to open surgery (OS) for the treatment of these conditions. Through a systematic review, 83 studies were analyzed, of which 10 were included in the meta-analysis. The methodology followed PRISMA guidelines, with searches in PubMed, Scopus, Web of Science, Medline Ovid, and SciELO databases. The results indicate that MIS offers several advantages over OS, including lower intraoperative blood loss, reduced postoperative pain, shorter hospital stay, and lower incidence of complications, without compromising bone fusion rates. These findings suggest that MIS is an effective and potentially superior alternative to OS, with significant benefits for patient recovery. However, specialized training is required to ensure the safety and efficacy of the procedure. Level of Evidence l; Systematic review.

Objective: To analyze the feasibility and patient satisfaction of using the WALANT technique in treating low-complexity hand and wrist surgical conditions.

Methods: A prospective pilot study conducted in a tertiary hospital, including individuals aged ≥18 years, ASA I or II, undergoing low-complexity procedures lasting <1 hour. Those with contraindications to local anesthesia or clinical conditions that could affect the study data were excluded. Participants received WALANT anesthesia. Demographic and clinical data were collected, and the Numerical Pain Scale measured pain.

Results: Twenty-one participants who underwent 23 surgical procedures were analyzed. 69.6% were women, a mean age of 49.6 ± 15.6 years, and 73.9% were ASA II. During the procedures, 86.5% reported tolerable pain only once, attributed to the needle puncture of the skin (mean of 2.0 ± 1.7 on a scale of 0-10). Only 5% reported that the pain of anesthesia was greater than that of contralateral venous access. Intraoperative bleeding was tolerable.

Conclusion: The WALANT technique showed sufficient anesthetic and vasoconstrictor efficacy for most low-complexity hand and wrist surgeries and ensured patient comfort even without sedation. Level of Evidence IV; Case Series .

Objective: This retrospective study investigated the waiting time for surgery in patients with severe subaxial cervical fractures at Santa Casa de Misericórdia de São Paulo, as well as identifying the main causes of surgical delays.

Methods: The research was quantitative and retrospective, utilizing medical records of patients operated on between January 2015 and June 2023. Variables analyzed included age, gender, trauma mechanism, fracture classification, neurological status, waiting time until surgery, and causes of delay. Data were initially collected using physical forms and then migrated to electronic platforms (SurveyMonkey^® and Red Cap^®) for detailed statistical analysis.

Results: The study included 36 patients, with a significant predominance of men (86.1%) and an average age of 44.97 years. Falls were the most common trauma mechanism (44.4%), followed by automobile accidents (27.8%). Most fractures occurred at the C4/C5 (16.7%) and C5/C6 (13.9%) levels. The most frequent AO type classification was type C (47.2%). The average waiting time for surgery was 9.28 days, with the main cause of delay being the availability of the operating room (66.7%).

Conclusion: The results indicate that cervical fractures have a significant impact on young adults, predominantly men, often associated with falls and automobile accidents. Early identification and timely surgical intervention are crucial to minimize complications and improve neurological outcomes. Strategies to reduce surgical waiting times, such as improvements in hospital resource management, are essential to optimize the treatment of these injuries. Level of Evidence III; Retrospective Cohort Study.

Objective: the main objective of the study was to evaluate a screening protocol for performing total knee arthroplasty (TKA) without postoperative admission to an intensive care unit (ICU). The secondary objective was to evaluate the postoperative blood transfusion rate.

Method: between January 2020 and December 2021, 270 TKA were performed, following a clinical protocol: age up to 75 years, body mass index up to 35 kg/m2, ASA score classification I or II, non-smoker, without history of ischemic disease (coronary or cerebral), creatinine clearance greater than 60 mL/min, hemoglobin greater than 12 g/dL and osteoarthritis with deformity treatable with primary prosthesis (fixed or rotating base). The need for conversion to ICU and the blood transfusion rate were assessed.

Results: 270 patients underwent surgery during the study period and only one required admission to the ICU, giving the screening protocol a positive predictive value of 99.6%. There was no indication for blood transfusion in any case in the sample.

Conclusion: The proposed screening protocol proved to be effective, allowing total knee arthroplasty to be performed without the prior need for ICU bed reservation, blood typing and/or blood products reservation, without compromising patient safety. Level of Evidence IV; Case Series .

Objective: To document the effects of genicular nerve ablation in patients with severe knee osteoarthritis (OAJ) at 1 and 3 months.

Methods: Prospective, randomized, and controlled trial with 35 patients with grade IV knee osteoarthritis according to Kelgren & Lawrence, undergoing genicular nerve ablation with pulsed radiofrequency (PRF) or phenol. Outcomes were assessed at baseline, 1 month, and 3 months using the Numeric Rating Scale (NRS), the Knee Injury and Osteoarthritis Outcome Score (KOOS), the 30-Second Chair Stand Test (TSL30), and the Timed Up and Go (TUG) test.

Results: The groups were similar at baseline. Both groups improved similarly up to 3 months (p<0.001). NRS decreased by an average of 30% from baseline to all subsequent assessments (p<0.05). TUG decreased between baseline and one month post-procedure (p=0.001), while TSL30 increased from baseline to one and three months (p<0.05). The average behavior of patients was equal between groups over the evaluations for all scores (p Interaction > 0.05). None of the scores differed between groups, regardless of the evaluation period (p Group > 0.05).

Conclusions: Genicular nerve ablation in patients with severe OAJ can provide lasting improvements in pain, function, and quality of life. Both methods, phenol and radiofrequency, are effective. Level of Evidence I; Controlled Randomized Clinical Trial .

Objective: The objective of the article was to do a comparative study between Smith & Nephew ® prosthesis with constricted polyethylene against the standard in patients submitted to total knee arthroplasty surgery during a short-term follow-up. The aim was to analyze the survival of the related implants due to the range of movement and radiographic aspect.

Methods: The sample was divided into two different groups: constricted polyethylene and standard polyethylene. A clinical analysis of the patients was carried out, and it was verified whether implant loosening had occurred.

Results: This study evaluated 61 patients in a period of 2 years, 29 in the constricted polyethylene group. The pre-operative deformities were predominantly considered severe. In the postoperative, the tibial-femoral angle varied on average between 5 - 6° of valgus. The total range of movement in the post-operative was above 101° in both groups. One loosened implant in the constricted polyethylene group was observed.

Conclusion: The patients treated with constricted polyethylene had the same range of movement as the control group. There was no significant difference between both groups related to loosened implants in short-term follow-up. Level of evidence III; Retrospective study.

Introduction: There are few studies in Brazil evaluating the quality of life and costs of patients undergoing total hip arthroplasty (THA).

Purpose: (1) To describe the total cost, quality of life and functional scores of patients undergoing THA in a Brazilian private hospital; (2) to determine preoperative factors associated with quality of life and total cost; and (3) to evaluate the association between cost and quality of life.

Methods: Of the 1061 patients included, pre- and peri-operative data, total costs, pre- and post-operative functional scores (HOOS, WOMAC) and quality of life scores (EQ-5D) were collected over 2 years.

Results: EQ-5D, HOOS and WOMAC improved from 0.492, 54.5 and 45.2, respectively, to 0.888, 90 and 5.9 at 1-year follow-up, and 0.892, 90.4 and 4.0 at 2-year follow-up. The average cost was R$43,324.22±11,323. Associations were observed between EQ-5D variation and male sex (RM=1.058; p=0.03) as well as age (RM=0.996; p<0.001). No association was found between total cost and EQ-5D.

Conclusions: The average cost of patients undergoing THA was R$43,324.22. There was an improvement in quality of life and function, an association between quality of life and male sex and age, however no association was found between total cost and quality of life. Level of evidence IV; Case Series.