Qual a melhor incidência radiográfica para avaliar o desvio das fraturas tipo die-punch? Estudo em cadáver

OBJETIVO: Avaliar qual a melhor incidência radiográfica para diagnosticar os desvios da fratura tipo die-punch da extremidade distal do rádio. MÉTODOS: Utilizou-se um rádio do Banco de Tecidos Salvador Arena. Após limpeza e retirada de partes moles, realizou-se osteotomia da região dorsoulnar da superfície articular com microsserra, osteótomo e martelo. Fixou-se o fragmento distal com fita adesiva, nos degraus articulares de 1, 2, 3 e 5mm. A peça foi submetida a radiografias nas incidências frente, perfil, oblíqua semipronada, oblíqua semissupinada e tangencial (75º com o plano da mesa). Em uma segunda etapa, avaliou-se o desvio da fratura em cada radiografia, com auxílio do software AutoCAD 2010®. RESULTADOS: A incidência tangencial foi a melhor para identificar os desvios de 1 e 3mm e a segunda melhor nos desvios de 2 e 5mm. No desvio de 2mm a melhor incidência foi a oblíqua semipronada e no de 5mm a oblíqua semissupinada, sendo que não se consegue identificar os desvios de 1 e 2mm na oblíqua semissupinada. CONCLUSÃO: A incidência tangencial foi superior na avaliação do degrau articular de 1mm e 3mm e a segunda melhor quando houve degrau de 2mm e 5mm.OBJECTIVE: the aim of this study is try to show the best view for distal radius fractures so called die-punch fractures. METHODS: There has been used a human cadaver radius bone from the Salvador Arena Tissue Bank. This bone was cleaned up after removing the soft tissues and osteotomies created displaced lunate fossa fractures of 0, 1, 2, 3 and 5 mm. We have fixed this fragment with adhesive tape. Then the joint deviation were significantly increased with step-offs of 1 mm. Radiographs were then taken into 5 different positions: postero-anterior view, lateral view, oblique views and tangencial view for each of the deviations. The resulting lunate fossa depression in each X-ray film was analyzed by the AutoCAD 2010® software. RESULTS: The tangencial view was the best one to see the 1mm and 3mm bone degrees and the second one view to see the 2mm and 5 mm degrees. The pronated oblique view was the best to see the 2mm degrees and the oblique supinated view wasn't able to see the degrees between 1 and 2mm. CONCLUSION: The tangencial view was the best one to see the 1mm and 3mm bone degrees and the second one view to see the 2mm and 5 mm degrees

What is the real angle of deviation of metacarpal neck fractures on oblique views? A radiographic study

OBJECTIVE: The aim of this study was to establish an indirect, easy-to-use, predictable and safe means of obtaining the true degree of displacement of fractures of the neck of the fifth metacarpal bone, through oblique radiographic views. METHODS: An anatomical specimen from the fifth human metacarpal was dissected and subjected to ostectomy in the neck region. A 1-mm Kirschner wire was fixed to the base of the fifth metacarpal bone, perpendicular to the longitudinal axis of the bone and parallel to the ground. Another six Kirschner wires of the same diameter were bent over and attached to the ostectomized bone to simulate fracture displacement. Axial rotation of the metacarpus was used to create oblique radiographic views. Radiographic images were generated with different angles and at several degrees of rotation of the bone. RESULTS: We deduced a mathematical formula that showed the true displacement of fractures of the neck of the fifth metacarpal bone by means of oblique radiographs. CONCLUSIONS: Oblique radiographs at 30° of supination provided the best view of the bone and least variation from the real value of the displacement of fractures of the fifth metacarpal bone. The mathematical formula deduced was concordant with the experimental model used

Avaliação da função do membro superior nos pacientes com paralisia obstétrica após cirurgia de Sever-L'Episcopo modificada Evaluation of upper-limb function in patients with obstetric palsy after modified Sever-L'Episcopo procedure

OBJETIVO: Avaliar a função do membro superior acometido, por meio do escore de Mallet, nos pacientes com contratura em rotação medial do ombro submetidos à cirurgia de Sever-L'Episcopo modificada, e correlacionar a evolução com a idade e com o tempo de seguimento pós-operatório. MÉTODOS: Dezesseis pacientes foram avaliados, sendo comparadas as medidas pré e pós-operatórias do escore de Mallet, e correlacionada a diferença entre esses valores com a idade no momento da cirurgia e tempo de seguimento. RESULTADO: Observou-se melhora do escore de Mallet pós-operatório estatisticamente significante, enquanto a correlação da diferença dos valores do escore com a idade e o tempo de seguimento não foram estatisticamente significantes. CONCLUSÃO: A cirurgia de Sever-L'Episcopo modificada proporcionou melhora da função do membro superior, de acordo com o escore de Mallet. Não houve relação entre a idade e o tempo de seguimento com a função do membro.OBJECTIVE: To evaluate upper-limb function by means of the Mallet score, in patients with medial rotation contracture of the shoulder who underwent the modified Sever-L'Episcopo procedure, and to correlate evolution with age and length of postoperative follow-up. METHODS: Sixteen patients were assessed by comparing the pre and postoperative Mallet scores and correlating the differences between these scores with age at the time of surgery and length of follow-up. RESULTS: A statistically significant improvement in the postoperative Mallet score was observed. The correlations of the differences in scores with age and length of follow-up were not statistically significant. CONCLUSION: The modified Sever-L'Episcopo procedure led to improved upper-limb function according to the Mallet score. Limb function did not present correlations with age or length of follow-up

Estudo por imagem da articulação carpometacarpal do polegar Imaging study of the carpometacarpal joint of the thumb

Santa Casa de Misericórdia de São Paulo Serviço de Diagnóstico por ImagemUniversidade Federal de São Paulo (UNIFESP) Departamento de Diagnóstico por ImagemSanta Casa de Misericórdia de São Paulo Departamento de Ortopedia e TraumatologiaUNIFESPUNIFESP, Depto. de Diagnóstico por ImagemUNIFESPSciEL

Relationship of age and type of obstetric brachial plexus paralysis in forearm pronosupination

ABSTRACT Objective: To evaluate the arc of forearm pronosupination of patients with sequelae of birth paralysis and correlate with these variables. Methods: 32 children aged between 4 and 14 years with total or partial lesions of the , brachial plexus were evaluated; measurements of pronation and supination, active and passive, were made, both on the injured side and the unaffected side. Results: A statistically significant difference was observed between the injured side and the normal side, but there was no difference between the groups regarding age or type of injury. Conclusion: The age and type of injury did not impact on the limitation of the forearm pronosupination in children with sequelae of birth paralysis

PROPOSAL TOMOGRAPHIC CLASSIFICATION FOR INTRA-ARTICULAR DISTAL RADIUS FRACTURES

<div><p>ABSTRACT Objective: The objective of this study was to present a proposal tomographic classification for intra-articular distal radius fractures. Methods: This descriptive study was based on observing tomographic images from 74 patients with distal radius fractures. The cases were grouped by similarity according to the presence of several parameters which determine fracture complexity; the results of the descriptive analysis were transcribed as tomographic classification. Results: The proposal tomographic classification for intra-articular distal radius fractures comprised three major groups and nine sub-groups, which are organized by increasing severity according to the presence of spacing between articular fragments, angulation, loss of radial height, cortical depression, and associated dislocation. Conclusion: This proposal tomographic classification for intra-articular distal radius fractures can help professionals indicate therapeutic options. Level of Evidence IV; Case series.</p></div