Biomechanical evaluation of orthopaedic cement combined with antibiotic and methylene blue

OBJETIVO: O cimento acrílico é utilizado há anos nas cirurgias ortopédicas, especialmente nas artroplastias do joelho, merecendo atenção também quando utilizado com o acréscimo de antibióticos (para tratamento de infecções) ou corantes (para facilitação de uma possível retirada). Neste estudo procurou-se avaliar diferenças mecânicas entre o cimento ortopédico puro e quando misturado com antibiótico e/ou corante. MÉTODOS: Foram utilizados cimento acrílico ortopédico Surgical Simplex®P Stryker, vancomicina em pó e azul de metileno e as misturas submetidas a testes físicos e mecânicos de acordo com a norma ABNT NBR ISO 5833. Avaliou-se: tempo para a formação de massa, capacidade de intrusão, resistência à compressão, resistência ao dobramento (tensão) e temperatura máxima atingida pelas misturas. RESULTADOS: As misturas avaliadas foram aprovadas quanto ao tempo de preparação da mistura, temperatura máxima alcançada, profundidade da intrusão e resistência à compressão. Somente aquela contendo apenas cimento puro foi aprovada no ensaio de flexão. CONCLUSÃO: O acréscimo de vancomicina e/ou azul de metileno ao cimento ortopédico Surgical Simplex®P Stryker reduz a resistência da mistura à flexão, sendo reprovada pela norma ABNT NBR ISO 5833.OBJECTIVE: Acrylic cement has been used for years on orthopaedic surgeries, especially on knee arthroplasties, deserving special attention when added to antibiotics (for treatment of deep bone infections) or stains (to facilitate its removal). The present study was conducted in order to evaluate potential mechanical differences between the orthopaedic cement itself and when this is added to antibiotic and/or stains. METHODS: Surgical bone cement Simplex®P Stryker, vancomycin and methylene blue were used, and the mixtures were submitted to physical and mechanical tests according the ABNT NBR ISO 5833 rule. The parameters studied here were: time for mass formation, intrusion capability, resistance to compression, resistance to flexion and maximum temperature reached by the mixtures. RESULTS: The evaluated mixtures were approved as to mass formation, maximum temperature, intrusion capability and resistance to compression. Only the one containing pure cement was approved on the flexion essay. CONCLUSION: The addition of vancomycin and/or methylene blue to Surgical Simplex®P Stryker bone cement reduces its resistance to flexion, being unacceptable by the ABNT NBR ISO 5833 rule

Orthopedic evaluation of the hands of systemic sclerosis patients and identification of surgical treatment predictive factors

Orientador: Maurício EtchebehereDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: A esclerose sistêmica (ES) é uma doença caracterizada pelo depósito excessivo de colágeno na pele e nos órgãos internos, decorrentes do desequilíbrio na regulação dos sistemas imune, vascular e conjuntivo. As alterações promovidas pela doença podem levar à disfunção das mãos e requerer tratamento cirúrgico. OBJETIVOS: O presente estudo teve por objetivo identificar possíveis fatores preditivos para a intervenção cirúrgica das mãos, a fim de auxiliar o médico assistente no encaminhamento destes pacientes. METODOLOGIA: Foi realizado um estudo observacional transversal em pacientes com esclerose sistêmica e comprometimento das mãos. Foram coletados dados referentes à idade, sexo, tempo de doença, subtipo clínico, grau de espessamento cutâneo, presença de úlceras digitais, calcinose, fenômeno de Raynaud refratário ao tratamento clínico, mobilidade dos dedos, percepção dolorosa, além do preenchimento de questionários de função global (HAQ-DI, SHAQ) e das mãos (escala de Cochin). As variáveis ??foram submetidas à análise descritiva. Casos com e sem indicação cirúrgica foram comparados por meio de análise univariada. Análise multivariada (modelo de regressão logística binária do tipo forward) foi utilizada para identificar as variáveis ??que poderiam predizer o tratamento cirúrgico. As variáveis ??contínuas foram submetidas à análise discriminativa (curvas ROC). RESULTADOS: Cinquenta e um pacientes foram avaliados. Pacientes com úlceras digitais apresentaram 49,5 vezes mais possibilidade de receber indicação cirúrgica (p< 0,000). A elevação de 1 ponto na escala de Cochin aumentou em 7% a chance de indicação cirúrgica (p = 0.024). A presença de úlceras digitais e o aumento da pontuação na escala de Cochin mostraram associação positiva com a indicação de intervenção cirúrgica. As demais variáveis analisadas não apresentaram associação positiva com a indicação de tratamento cirúrgico. CONCLUSÃO: pacientes com úlceras digitais e elevação da pontuação na escala de Cochin devem ser referenciados para avaliação cirúrgica das mãosAbstract: Systemic sclerosis (SSc) is a disease characterized by the excessive deposition of collagen in the skin and internal organs, as a result of imbalance in the regulation of the immune, vascular and connective systems. The changes promoted by the disease can lead to dysfunction of the hands and require surgical treatment. OBJECTIVES: The objective of this study was to identify possible predictive factors for surgical hand intervention in order to assist the attending physician in the referral of these patients. METHODS: A cross-sectional observational study was performed in patients with systemic sclerosis and hand involvement. Data on age, sex, time of disease, clinical subtype, degree of skin thickening, presence of digital ulcers, calcinosis, Raynaud's phenomenon refractory to clinical treatment, finger mobility and pain perception were collected. General health (HAQ-DI and SHAQ) and hand (Cochin scale) function questionnaires were also completed. The variables were submitted to descriptive analysis. Cases with and without surgical indication were compared by means of univariate analysis. Multivariate analysis (forward binary logistic regression model) was used to identify variables that could predict surgical treatment. The continuous variables were submitted to discriminative analysis (ROC curves). RESULTS: Fifty-one patients were evaluated. Patients with digital ulcers were 49.5 times more likely to receive surgical indication (p <0.000). Elevation of 1 point on the Cochin scale increased the chance of surgical indication by 7% (p = 0.024). The presence of digital ulcers and the increase in the Cochin score showed a positive association with the indication of surgical intervention. The other variables analyzed did not present a positive association with the indication of surgical treatment. CONCLUSION: patients with digital ulcers and elevation of the Cochin score should be referred for surgical evaluation of the handsMestradoFisiopatologia CirúrgicaMestre em Ciência

Avaliação das fraturas da extremidade distal do antebraço pela classificação ao 2018

Distal forearm fractures are among the most common upper limb fractures in all ages, and many classifications have been proposed to describe them. Recently, a new version of AO/OTA classification was proposed. The aim of this study is to use the AO/OTA 2018 classification to report the epidemiology of distal forearm fractures in adults treated at a single center. Methods: A retrospective analysis of the initial radiographs obtained from cases of distal forearm fractures in an orthopedic emergency room at a single tertiary hospital. Results: Three hundred twenty-two cases were studied, aged 50.35 +/- 18.98 years, 55.3% were female and 44.7% were right-sided. Type 2R3A, 2R3B and 2R3C fractures corresponded to 32.3%, 18.0% and 48.4% of the cases, respectively. Distal ulnar fracture was present in 41.9%. There was a correlation between age and sex: 78.3% of the subjects aged under 30 years were male, and 80.6% of those aged over 60 years were female (p <0.001). Conclusion: The most common type of radial fractures was 2R3C, and the most common type of ulna fracture was 2U3A1.1. There was a correlation between age and sex274220222sem informaçãoAs fraturas distais do antebraço são uma das mais comuns do membro superior em todas as idades, e muitas classificações foram propostas para descrevê-las. Atualmente, uma nova versão da classificação AO/OTA foi proposta. O objetivo deste estudo foi utilizar a classificação AO/OTA 2018 para descrever a epidemiologia das fraturas distais do antebraço no adulto tratadas em um único centro. Métodos: Estudo retrospectivo, em que se avaliaram as radiografias obtidas no primeiro atendimento dos casos de fraturas da extremidade distal do antebraço de esqueletos maduros, atendidas no pronto-socorro ortopédico de um único hospital terciário. Resultados: Foram estudados 322 casos, com média da idade de 50,35 ± 18,98 anos, 55,3% do sexo feminino e 44,7% do lado direito. As fraturas do tipo 2R3A, 2R3B e 2R3C corresponderam a 32,3%, 18,0% e 48,4%, respectivamente. A ulna distal foi envolvida em 41,9%. Houve correlação entre a idade e o sexo, de modo que, no grupo etário com idade até 30 anos, 78,3% eram do sexo masculino e, acima dos 60, 80,6% do sexo feminino (p<0,001). Conclusão: As fraturas do tipo 2R3C foram as mais comuns do rádio, e as 2U3A1.1 foram as mais comuns da ulna. Houve correlação entre idade e sexo. Nível de evidência IV, Série de casossem informaçã

Preoperative antibiotic prophylaxis and the incidence of surgical site infections in elective clean soft tissue surgery of the hand and upper limb: a systematic review and meta-analysis

Abstract Background Surgical site infections (SSI) are the most frequent early complications of hand surgeries. However, the indications still remain uncertain for antibiotic prophylaxis in elective clean soft tissue surgeries of the hand and upper limb. Therefore, a systematic review of the literature and a meta-analysis was conducted to investigate the impact of antibiotic prophylaxis on the prevention of SSI in these types of surgeries. Methods An electronic search was performed in the following databases: MEDLINE/Pubmed, PMC/Pubmed, Web of Science/Clarivate Analytics, Embase/Elsevier, Scopus/Elsevier, BVS/Lilacs, and the Cochrane Library, with no restrictions regarding publication language or date. The primary outcome of interest was the occurrence of SSI following elective clean soft tissue surgeries of the hand and upper limb according to the administration of preoperative antibiotic prophylaxis and no antibiotic prophylaxis. Surgeries involving simultaneous bone procedures or orthopedic implants were excluded. Study selection and data extraction were conducted independently by two reviewers. RoB 2.0 and ROBINS-I are Cochrane risk-of-bias tool for randomized trials and non-randomized studies of interventions. The magnitude of the intervention effect was estimated using the relative risk (RR). The meta-analysis was performed with the Review Manager and R software tools, using the Mantel–Haenszel random-effects model and a 95% confidence interval (CI). Results with p ≤ 0.05 were considered statistically significant. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Results The initial search yielded 1175 titles, from which 12 articles met the inclusion criteria for the systematic review, and 10 were included in the subsequent meta-analysis. The majority of these studies were nonrandomized intervention trials, exhibiting a moderate risk of bias. According to our review, preoperative antibiotic prophylaxis did not have a statistically significant impact on the incidence of SSI (RR = 1.13, 95% CI 0.91–1.40, p = 0.28). The overall quality of evidence for this outcome was rated as low. Moderate statistical heterogeneity was observed (I 2 = 44%), and the prespecified sensitivity analysis highlighted the consistency of the results. Conclusions While these results were consistent with the findings from individual studies included in this review, it is important to note that, given the threshold of p ≤ 0.05 for statistical significance, no definitive conclusions can be drawn from the quantitative analysis of the data obtained. Level of evidence: Level 2. Trial registration: CRD42023417786

Evaluation of intra- and interobserver reliability of the AO classification for wrist fractures

ABSTRACT Objective: This study evaluated the intraobserver and interobserver reliability of the AO classification for standard radiographs of wrist fractures. Methods: Thirty observers, divided into three groups (orthopedic surgery senior residents, orthopedic surgeons, and hand surgeons) classified 52 wrist fractures, using only simple radiographs. After a period of four weeks, the same observers evaluated the initial 52 radiographs, in a randomized order. The agreement among the observers, the groups, and intraobserver was obtained using the Kappa index. Kappa-values were interpreted as proposed by Landis and Koch. Results: The global interobserver agreement level of the AO classification was considered fair (0.30). The three groups presented fair global interobserver agreement (residents, 0.27; orthopedic surgeons, 0.30; hand surgeons, 0.33). The global intraobserver agreement level was moderated. The hand surgeon group obtained the higher intraobserver agreement level, although only moderate (0.50). The residents group obtained fair levels (0.30), as did the orthopedics surgeon group (0.33). Conclusion: The data obtained suggests fair levels of interobserver agreement and moderate levels of intraobserver agreement for the AO classification for wrist fractures

The evaluation of a home-based program for hands in patients with systemic sclerosis

This study used a quasi-experimental design where patients were evaluated before and after participation in the self-management program. Hands are commonly affected in systemic sclerosis (SSc). Strategies to maintain or improve hand function are indicated upon diagnosis and throughout the course of the disease. The purpose of this study was to develop and evaluate a home-based program for hands in patients with SSc. A home-based self-management program that consisted of concise instructions about SSc and hand exercises was developed and evaluated in a group of patients with SSc during 8 weeks. Primary outcome measures were hand pain (Visual Analogue Scale) and hand function (Cochin Hand Function Scale). Secondary outcome measures were disability (Scleroderma Health Assessment Questionnaire), finger motion (delta finger-to-palm), grip strength, tip and key pinch strength, Raynaud phenomenon and digital ulcers impact, quality of life (Short Form Health Survey). For comparisons between different times analysis of variance for repeated measures was used. To calculate the effect size (ES), the Cohen's test was performed. To evaluate skin moisturizing and warming habits before and after intervention, the McNemar test was used. Statistical significance was set at P ≤ .05. Twenty-two SSc patients (19 women: 3 men; 16 limited scleroderma: 6 diffuse scleroderma) completed the program. Significant improvements were noted for hand pain (3.97 vs 2.21, ES: 0.69), Cochin Hand Function Scale (19.24 vs 12.48, ES: 0.48), Scleroderma Health Assessment Questionnaire (0.95 vs 0.48, ES: 1.01), delta finger-to-palm (92.86 vs 106.33, ES: 0.40), grip strength (14.43 vs 19, ES: 0.58), tip pinch strength (2.49 vs 4.18, ES: 1.15), key pinch strength (4.01 vs 5.22, ES: 0.76), Raynaud phenomenon impact (0.94 vs 0.47, ES: 0.75), Short Form Health Survey–role physical (47.38 vs 60.14, ES: 0.61), physical functioning (34.62 vs 61.9, ES: 0.18), social functioning (60.71 vs 75.6, ES: 0.64), bodily pain (50.55 vs 63.38, ES: 0.58), vitality (45.95 vs 62, ES: 2.22), mental health (56.62 vs 72.38, ES: 0.84) moisturizing, and cold avoidance habits. Patients considered the program easy to follow with no adverse effects related to exercises. We developed a home based hand care program to be offered to SSc patients. Improvements in hand function, strength, disability, motion, and overall quality of life were independent of age, income, education level, disease duration, and skin score. Our findings support those of other studies that reported the benefits of hand exercises in SSc. Some study limitations include the lack of a control group, the small number of subjects and the short-time follow up. This home-based program for patients with SSc improved hand pain, function, mobility, and strength at the end of 8 weeks. Patient adherence and sustained efficacy is still to be determined331332

The evaluation of a home-based program for hands in patients with systemic sclerosis.

STUDY DESIGN: This study used a quasi-experimental design where patients were evaluated before and after participation in the self-management program. INTRODUCTION: Hands are commonly affected in systemic sclerosis (SSc). Strategies to maintain or improve hand function are indicated upon diagnosis and throughout the course of the disease. PURPOSE OF THE STUDY: The purpose of this study was to develop and evaluate a home-based program for hands in patients with SSc. METHODS: A home-based self-management program that consisted of concise instructions about SSc and hand exercises was developed and evaluated in a group of patients with SSc during 8 weeks. Primary outcome measures were hand pain (Visual Analogue Scale) and hand function (Cochin Hand Function Scale). Secondary outcome measures were disability (Scleroderma Health Assessment Questionnaire), finger motion (delta finger-to-palm), grip strength, tip and key pinch strength, Raynaud phenomenon and digital ulcers impact, quality of life (Short Form Health Survey). For comparisons between different times analysis of variance for repeated measures was used. To calculate the effect size (ES), the Cohen\u27s test was performed. To evaluate skin moisturizing and warming habits before and after intervention, the McNemar test was used. Statistical significance was set at P ≤ .05. RESULTS: Twenty-two SSc patients (19 women: 3 men; 16 limited scleroderma: 6 diffuse scleroderma) completed the program. Significant improvements were noted for hand pain (3.97 vs 2.21, ES: 0.69), Cochin Hand Function Scale (19.24 vs 12.48, ES: 0.48), Scleroderma Health Assessment Questionnaire (0.95 vs 0.48, ES: 1.01), delta finger-to-palm (92.86 vs 106.33, ES: 0.40), grip strength (14.43 vs 19, ES: 0.58), tip pinch strength (2.49 vs 4.18, ES: 1.15), key pinch strength (4.01 vs 5.22, ES: 0.76), Raynaud phenomenon impact (0.94 vs 0.47, ES: 0.75), Short Form Health Survey-role physical (47.38 vs 60.14, ES: 0.61), physical functioning (34.62 vs 61.9, ES: 0.18), social functioning (60.71 vs 75.6, ES: 0.64), bodily pain (50.55 vs 63.38, ES: 0.58), vitality (45.95 vs 62, ES: 2.22), mental health (56.62 vs 72.38, ES: 0.84) moisturizing, and cold avoidance habits. Patients considered the program easy to follow with no adverse effects related to exercises. DISCUSSION: We developed a home based hand care program to be offered to SSc patients. Improvements in hand function, strength, disability, motion, and overall quality of life were independent of age, income, education level, disease duration, and skin score. Our findings support those of other studies that reported the benefits of hand exercises in SSc. Some study limitations include the lack of a control group, the small number of subjects and the short-time follow up. CONCLUSIONS: This home-based program for patients with SSc improved hand pain, function, mobility, and strength at the end of 8 weeks. Patient adherence and sustained efficacy is still to be determined