Fatores associados à quedas e fraturas no paciente idoso/ Factors associated with falls and fractures in elderly patients

Objetivo: analisar e identificar os fatores mais incidentes nos idosos internados com fraturas. Metodologia: estudo transversal retrospectivo realizado através de entrevista com 47 idosos de maio a dezembro de 2019 que responderam o questionário com informações sobre sexo, idade, tipo de trauma, local da fratura, hábitos de vida, morbidades, acuidade visual, grau de dependência e aspectos habitacionais. Resultados: A média de idade foi 75,45, com predominância de mulheres (63,82%). A maioria dos pacientes realizaram cirurgia e o trauma prevalente foi queda (87,23%). O osso mais acometido foi o fêmur (24 casos). As morbidades predominantes foram a osteoporose (40,42%) e hipertensão arterial (45,31%). Grande parte dos entrevistados referiu má acuidade visual (74,46%), tabagismo (44,68%), etilismo (25,53%), sedentarismo (45,31%) e apresentam algum grau de dependência (31,91%). Conclusão: Com base nos dados obtidos, foi possível observar a relação entre a incidência de queda e fratura no idoso. O estudo mostrou importante a identificação do índice de quedas e dos fatores comumente encontrados, o que aponta a relevância da implementação de medidas preventivas e conscientização sobre a casuística e as comorbidades relacionadas à queda e fratura de idosos, com intuito de reduzir os índices de fraturas e melhorar a qualidade de vida dessa população

COST ANALYSIS OF MOTORCYCLE ACCIDENT VICTIMS AT A UNIVERSITY HOSPITAL: PERSPECTIVES FROM 2017 AND 2020

ABSTRACT Introduction: Motorcycle accidents constitute a public health problem that affects public and private health services due to the expenses of the victim's treatment and rehabilitation. Objective: Evaluate the impact of motorcycle accident costs in a university hospital in 2020. Method: Comparative analysis of the costs of motorcycle accident patients in 2020 and 2017. Results: Among 151 patients included in the study, the average cost was U$3,083.54, and the average days of hospitalization were 5.3 days. The patient with the highest cost to the hospital spent U$22,504.05, and the patient with the lowest cost spent U$356.72. The longest stay among these patients was 41 days, and the shortest was one day. The average cost per patient per day for the entire sample was U$581.80. Conclusion: The formulation and application of strategies that promote the reduction of motorcycle accidents in the city of Campinas are necessary. Level of evidence II, Retrospective study

Relação entre Índice de Massa Corporal e localização anatômica das lesões relacionadas à corrida em corredores amadores / Relationship between Body Mass Index and anatomical location of injuries related to running in amateur runners

Objetivo: Analisar a relação entre Índice de Massa Corporal e localização anatômica das lesões em membros inferiores de corredores amadores avaliados em um serviço privado de ortopedia e fisioterapia.Método: Estudo epidemiológico retrospectivo transversal realizado através da análise de cento e vinte (120) prontuários de corredores que fizeram avaliação de corrida em uma clínica de ortopedia e fisioterapia de Campinas (SP) no período de 2017 a 2018.Resultados: Do total de corredores avaliados, 64% estavam adequados ao peso, 33% tinham sobrepeso e 3% eram obesos. A localização anatômica afetada mais prevalente foi o joelho (47%). No grupo adequado ao peso, com sobrepeso e obeso a lesão mais prevalente foi no joelho (48%, 40% e 100%, respectivamente).Conclusão: Corredores com diferentes Índice de Massa corporal tiveram distribuições distintas quanto ao local da lesão nos membros inferiores. O joelho é o principal local de acometimento de lesões relacionadas à corrida de rua em corredores amadores, independentemente do Índice de Massa Corporal.

Utility of Quantitative Ultrasound of the Calcaneus in Diagnosing Osteoporosis in Spinal Cord Injury Patients

Bittar CK, Cliquet A Jr, dos Santos Floter M: Utility of quantitative ultrasound of the calcaneus in diagnosing osteoporosis in spinal cord injury patients. Am J Phys Med Rehabil 2011;90:477-481. Objective: The aim of this study was to assess the utility of quantitative ultrasound of the calcaneus in diagnosing osteoporosis in spinal cord injury patients in a Brazilian Teaching Hospital. Design: This is a diagnostic test criterion standard comparison study. Between January 2008 and October 2009, the bone density of 15 spinal cord injury patients was assessed for analysis before beginning rehabilitation using muscle stimulation. The bone density was assessed using bone densitometry examination (DEXA) and ultrasound examination of the calcaneus (QUS). The measurements acquired using QUS and DEXA were compared between patients with spinal cord injury and a control group of ten healthy individuals. Results: The T-score values for femoral neck using DEXA (P < 0.0022) and those using QUS of the calcaneus (P < 0.0005) differed significantly between the groups, and the means in the normal subjects were higher than those in spinal cord injury patients who would receive electrical stimulation. In spinal cord injury patients, the significant differences were found between the QUS T-score for calcaneus and the DEXA scores for the lumbar spine and femoral neck. Conclusions: Because of the low level of mechanical stress on the calcaneus, the results of the QUS could not be correlated with the DEXA results for diagnosing osteoporosis. Therefore, QUS seems to be not a good choice for diagnosis and follow-up.90647748

Utility of Quantitative Ultrasound of the Calcaneus in Diagnosing Osteoporosis in Spinal Cord Injury Patients

Bittar CK, Cliquet A Jr, dos Santos Floter M: Utility of quantitative ultrasound of the calcaneus in diagnosing osteoporosis in spinal cord injury patients. Am J Phys Med Rehabil 2011;90:477-481. Objective: The aim of this study was to assess the utility of quantitative ultrasound of the calcaneus in diagnosing osteoporosis in spinal cord injury patients in a Brazilian Teaching Hospital. Design: This is a diagnostic test criterion standard comparison study. Between January 2008 and October 2009, the bone density of 15 spinal cord injury patients was assessed for analysis before beginning rehabilitation using muscle stimulation. The bone density was assessed using bone densitometry examination (DEXA) and ultrasound examination of the calcaneus (QUS). The measurements acquired using QUS and DEXA were compared between patients with spinal cord injury and a control group of ten healthy individuals. Results: The T-score values for femoral neck using DEXA (P < 0.0022) and those using QUS of the calcaneus (P < 0.0005) differed significantly between the groups, and the means in the normal subjects were higher than those in spinal cord injury patients who would receive electrical stimulation. In spinal cord injury patients, the significant differences were found between the QUS T-score for calcaneus and the DEXA scores for the lumbar spine and femoral neck. Conclusions: Because of the low level of mechanical stress on the calcaneus, the results of the QUS could not be correlated with the DEXA results for diagnosing osteoporosis. Therefore, QUS seems to be not a good choice for diagnosis and follow-up

Comparative study on three surgical techniques for intra-articular calcaneal fractures: open reduction with internal fixation using a plate, external fixation and minimally invasive surgery

ABSTRACT OBJECTIVE: To evaluate, compare and identify the surgical technique with best results for treating intra-articular calcaneal fractures, taking into account postoperative outcomes, complications and scoring in the Aofas questionnaire. METHODS: This was a retrospective study on 54 patients with fractures of the calcaneus who underwent surgery between 2002 and 2012 by means of the following techniques: (1) open reduction with extended L-shaped lateral incision and fixation with double-H plate of 3.5 mm; (2) open reduction with minimal incision lateral approach and percutaneous fixation with wires and screws; and (3) open reduction with minimal incision lateral approach and fixation with adjustable monoplanar external fixator. RESULTS: Patients treated using a lateral approach, with fixation using a plate had a mean Aofas score of 76 points; those treated through a minimal incision lateral approach with screw and wire fixation had a mean score of 71 points; and those treated through a minimal incision lateral approach with an external fixator had a mean score of 75 points. The three surgical techniques were shown to be effective for treating intra-articular calcaneal fractures, without any evidence that any of the techniques being superior. CONCLUSION: Intra-articular calcaneal fractures are complex and their treatment should be individualized based on patient characteristics, type of fracture and the surgeon's experience with the surgical technique chosen

Functional and clinical results achieved in congenital clubfoot patients treated by Ponseti's technique

ABSTRACT OBJECTIVES: To analyze and evaluate functional and clinical results in patients with congenital clubfoot treated with Ponseti's technique. METHODS: This study evaluated 31 patients diagnosed with 51 congenital clubfeet, treated between April 2006 and September 2011 with Ponseti's technique. The patients who did not achieve an equinus correction with manipulation were treated with Achilles tenotomy. An anterior tibial tendon transfer was performed in patients who maintained residual adduction. All plasters were made by fellows and supervised by Ankle and Foot Chiefs. The technique was performed without the need for physical therapists, orthotics, and plaster technicians. Patients were submitted to pre- and post-treatment examination and evaluated under Pirani's classification. RESULTS: Male patients had an increased incidence and the right side was more affected, while bilateral involvement was observed in 64.5% of the cases. The mean number of cast changes was 5.8, and Achilles tenotomy was necessary in 26 patients. There were significant deformity improvements in 46 of the 51 treated feet (90.2%); Pirani's mean score improved from 5.5 to 3.6 after treatment. CONCLUSION: The Ponseti method was effective in both functional and clinical evaluation of patients, with significant statistical relevance (p = 0.0001), with a success rate of 90.2% and mean improvement in the Pirani's index of 65.5%

Use of the semitendinosus tendon for foot and ankle tendon reconstructions,

Objective:To demonstrate the results obtained from foot and ankle tendon reconstructions using the tendon of the semitendinosus muscle. The clinical results, the patient's degree of satisfaction and complications in the graft donor and recipient areas were evaluated.Methods:This was a retrospective study in which the medical files of 38 patients who underwent this surgical procedure between 2006 and 2010 were surveyed. The functional results from this technique, the complications in the donor and recipient areas and the patients' degree of satisfaction were evaluated.Results:Three patients presented complications in the recipient area (skin necrosis); one patient showed complications in the donor area (pain and insensitivity); and all patients had satisfactory functional results, with complete range of motion.Conclusion:The semitendinosus muscle is a good option for treatments for foot and ankle tendon injuries