Acta Ortopedica Brasileira最新文献

Objective: To describe the clinical and imaging characteristics of chondroblastoma and identify possible factors related to joint complications.

Method: This retrospective cohort study was carried out with data from the medical records of 23 patients diagnosed with chondroblastoma, subjecting them to statistical analyses.

Result: In total, 19 patients were included, 12 (63.2%) of which were mean with a mean age of 13.6±3.5 year. The relation with the local dimension equaled 57.9%, higher in the apophysis of the greater trochanter: 95.2% (p<0.001). Based on imaging, 15.8% patients had an open physis; 55.6%, no damaged physeal line; 42.1%, cortical rupture; 21.1%, secondary aneurysmal bone cyst; 26.7%, violated cartilage; and all cases, medullary edema. 15.8% of cases showed local recurrence and no metastasis. Moreover, 46.7% of patients had relevant secondary osteoarthritis related to the aggressiveness of the tumor according to the Enneking classification (p= 0.041).

Conclusion: The clinical outcome of chondroblastoma show no relation to age, sex, location, physeal status, or presence of calcifications or secondary aneurysmal bone cyst. Progression to secondary osteoarthritis configured the most frequent non-oncological complication and showed a direct relation with the severity of the chondroblastoma. Level of Evidence IV, Case Series.

Introduction: Legg-Calvé-Perthes disease is a major cause of hip joint deformities in children. Currently, experimental research is directed at investigating biological therapies, including the use of human dental pulp stem cells (hDPSC), which have not yet been studied for this purpose in swine models. This study aimed to evaluate whether local injection of hDPSC induces bone mineralization in the proximal femoral epiphysis in an experimental model of avascular necrosis of the femoral head in immature pigs.

Methods: Ten immature pigs underwent surgery to induce osteonecrosis of the proximal femoral epiphysis on the right side. In the intervention group (IG), hDPSC injections were performed immediately after osteonecrosis induction, and in the control group (CG), no additional procedure was performed. Left hips were used as controls. After 8 weeks, all animals were euthanized, and macroscopic, radiographic, and histological evaluations were performed.

Results: Bone mineralization was greater in the right hips of the IG compared to the CG (p = 0.0356), with an average mineralization index increase of 77.78% after hDPSC injection. Radiographic evaluation of the epiphyseal index showed a greater collapse in the right IG hips compared to the right CG hips (p < 0.001) and macroscopic evaluation showed a higher chance of the femoral head being flat (p = 0,049).

Conclusion: The injection of hDPSC into the proximal femoral epiphysis with induced osteonecrosis increases bone mineralization in immature pigs, but these treated hips show more deformity compared to the untreated hips. Level of Evidence IV, Case Series .

Objective: compare a face-to-face exercise program (face-to-face group [FG]) to telerehabilitation (telerehabilitation group [TG]), in patients undergoing total hip arthroplasty (THA).

Methodology: randomized clinical trial with 24 participants: 14 in the FG, which held weekly exercise sessions with face-to-face supervision in the clinic; and 10 in the TG, which performed exercises at home, with guidance from the booklet and weekly calls from the researchers. All participants underwent 6 weeks of intervention and were evaluated, by a blinded evaluator, in the pre- and post-intervention moments for: pain; kinesiophobia; functional; joint range of motion (ROM); and peak muscle torque (PT).

Results: post-intervention only the TG (p = 0.018; d = 1,744) showed improvement in the results of the TUG, however both TG (p = 0.043; d = 1,876) and FG (p = 0.002; d = 1,854) showed improvement in the HHS results.

Conclusion: telerehabilitation proved to be as effective as face-to-face rehabilitation in improving PT, ROM and functional capacity of patients in the initial stage of THA rehabilitation. It can be considered a low-cost and easy access alternative in this post-operative phase. Level of Evidence I, Randomized control trial.

Objective: To evaluate classification use based on the assessment of agreement in trochanteric fractures between different observers through a simple proposal of bimodal classification.

Methodology: A total of 50 radiographic images of femur trochanteric fractures were selected and classified by 22 evaluators, 10 traumatologists and 12 residents, as STABLE or UNSTABLE. The assessment of reproducibility was done using the kappa statistical index. After the evaluation, the groups were isolated and submitted to the ANOVA test with Bonferroni correction to evaluate the statistical differences between them.

Results: When evaluated by the kappa index, the results of the 50 fractures assessed by the 22 evaluators were k = 0.272. The reproducibility of the classification proposal was considered statistically weak.

Conclusion: Based on this study, it is recommended that the classifications be extensively tested and reach a minimum level of interobserver reproducibility (kappa > 0.8). It is suggested that classifications that do not achieve this result be improved or abandoned. Level of evidence II, Prospective study.

Objective: To evaluate the survival and complications associated with unconventional stent reconstructions for bone and soft tissue tumors.

Methods: We retrospectively extracted data from the ICESP (Instituto do Cancer do Estado de São Paulo) registry system to evaluate postoperative complications, including thrombosis, amputation, infection, tumor recurrence, and death. We also assessed time until complications and reoperations, as well as survival.

Results: We evaluated 108 patients who underwent unconventional stent reconstruction surgeries for bone tumors. There were significant associations between smoking and tumor recurrence, and between type of cancer, patient functionality, hypertension, and the occurrence of postoperative complications, presence of comorbidities, and death after surgery. Patients with soft tissue tumors and those unable to perform normal activities were at risk of earlier complications.

Conclusion: Type of cancer, patient functionality, presence of comorbidities, stent location, and exposure to chemotherapy or radiotherapy are important risk factors associated with complications and survival after unconventional stent reconstruction surgeries. Level of Evidence IV, case series, retrospective study.

Introduction: Osteoporosis impacts public health because of its high morbidity and mortality in older adults and high costs to public funds.

Objectives: Analysis of the epidemiological profile, temporal distribution, deaths, and period from low-impact proximal femoral neck fracture to management in older adults people treated at a Tertiary Hospital.

Methods: Cross-sectional, descriptive and retrospective study that analyzed 133 medical records involving fractures of the proximal femoral neck due to low-energy trauma from 2017 to 2020. Statistical analysis using the chi-square test, Student's t-test and Fisher's exact test.

Results: Of the 133 medical records, there was a predominance of females (p < 0.01) with 93 (69.92%). As for age, the average is 79.87±8.23, median 81 years and range from 61-99 years. The months of May, June, and August were dominant (p > 0.05), 15 (11.28%), 10 (7.52%), and 21 (15.79%), respectively. The most common spot (p < 0.001) was the transtrochanteric region 105 (78.95%). In four years, the number of deaths was: 5(20.83%) in 2017, 4(23.53%) in 2018, 8(33.33%) in 2019, 7(10.29%) in 2020,with no significant changes regarding sex (p > 0.05).

Conclusion: Most data were consistent with the literature. However, two differ, the transtrochanteric fracture and mortality in 2020. The decrease in deaths in 2020 is mainly due to the new surgery protocol within 48 hours of the fracture. Level Of Evidence IV, Case Series.

Objective: To evaluate the preferences of shoulder and elbow surgeons from the Brazilian Society of Shoulder and Elbow Surgery to treat rotator cuff injuries, glenohumeral instability, and acromioclavicular dislocations considering a current and an ideal scenarios.

Methods: A nationwide survey included 314 specialists who answered a 20-question questionnaire on treating shoulder pathologies.

Results: This study included 314 specialists. Most (96%) perform rotator cuff repair arthroscopically and 74% use metallic anchors as a fixation method. In open surgery, most specialists reported using anchors (75%) instead of transosseous sutures. In treating glenohumeral instability via arthroscopic Bankart repair, 86% used three or more fixation anchors and 87%, bioabsorbable anchors. In Latarjet cases, 57% used cannulated screws. In treating acute acromioclavicular dislocations, 88% used the open route. Regarding fixation, 70% chose high-resistance wires; 65%, anchors; and 61%, Kirschner wires.

Conclusion: The current Brazilian scenario has limited availability of ideal instruments and materials so specialists can treat shoulder pathologies. However, specialists' preferences agree with the latest medical literature. Level of evidence V, Expert opinion.

Objective: To radiographically evaluate the postoperative results of AO 2R3C3 type distal radius fractures treated using the spanning plate technique, associated or not with other fixation methods.

Methods: Retrospective observational study that evaluated 14 patients, aged 29 to 80 years, who underwent osteosynthesis, from November 2021 to June 2022. For radiographic measurement, the following parameters were defined: ulnar variance, volar inclination, radial inclination and step articulate.

Results: The mean value of radial inclination was 13.70 degrees, volar inclination was 0.85 degrees, ulnar variance was 0.60mm and joint step was 0.78mm.

Conclusion: Fixation using spanning plate is an excellent alternative in the management of complex fractures of the distal radius. Level of Evidence IV, Case Series.

Introduction: ChatGPT, an advanced Artificial Intelligence model specialized in natural language processing, shows remarkable abilities, achieving high scores in certification exams in various specialties. This study aims to evaluate ChatGPT's performance in multiple-choice tests applied to obtain specialist certification in Orthopedics and Traumatology.

Methods: We used ChatGPT 4.0 to answer 100 questions from the first phase of the Título de Especialista em Ortopedia e Traumatologia 2022 (TEOT) (Specialist in Orthopedics and Traumatology Test). We excluded non-text-based questions. Each question was entered individually into ChatGPT, with a new session initiated for each question. Performance was evaluated regarding number of words and questions' taxonomic classification.

Results: Of the 95 questions analyzed, ChatGPT answered 61.05% correctly and 38.95% incorrectly. There was no statistically significant difference regarding number of words, and ChatGPT's performance did not vary according to taxonomic level.

Conclusion: ChatGPT demonstrated vast knowledge in Orthopedics, with acceptable performance in the TEOT exam. Results suggest ChatGPT's an educational and clinical resource in Orthopedics, but needs future progress and human supervision for its effective application. Level of evidence IV, Case series.

Objective: This original article aimed to develop a digital protocol for the conceptual design and validation of Ankle-Foot Orthoses (AFO) using 3D mapping technologies.

Methods: A scanned model of the ankle-foot complex of a 12-year-old child with a drop foot was utilized, along with a generic AFO model from a Computer-Aided Design environment. Autodesk Meshmixer and Fusion software were employed for conceptual design and static load analysis.

Results: The static load analysis using the Von Mises failure criterion on the AFO model with ABS material demonstrated structural integrity under critical loading conditions. The digital protocol facilitated the design of a functional and patient-specific AFO orthosis.

Conclusions: The study successfully established a digital workflow for AFO design and validation, showcasing the potential of 3D technologies in creating customized orthoses for lower limb rehabilitation. Level of Evidence IV; Descriptive Study.