Intrapartum Pubic Symphysis Disruption

During pregnancy, high progesterone and relaxin levels produce physiological ligament relaxation on the pelvis. Therefore, moderate pubic symphysis and sacroiliac joints relaxing provide birth canal widening, thereby facilitating vaginal delivery. Sometimes, functional pain or pelvic instability may occur during pregnancy or puerperium, which is defined as symptomatic pelvic girdle relaxation. In rare cases, a pubic symphysis disruption can occur during the labor, causing severe pain and functional limitations. The early recognition of this injury is crucial to prevent complications and improve clinical and functional outcomes. This study reports an acute symphyseal disruption resulting from childbirth in a primiparous patient who underwent open reduction and internal fixation with plate and screws. After a 6 months follow‑up, the patient presented no pain and satisfactory functional recovery.Keywords: Pelvis, Pelvis fracture, Pregnancy, Pubic symphysis, Pubic symphysis diastasi

Medial Malleolar Fractures: An Anatomic Survey Determining the Ideal Screw Length

Background: Medial malleolar fractures are frequent, and their treatment is familiar to the orthopedic surgeon. Lag screw fixation using partially threaded screws remains the standard treatment method for medial malleolar fractures. However, the literature lacks a defined method for selecting lag screw length, relying more so on the empiric choice of the surgeon.Aim: The aim of this study is to help define the ideal lag screw length for medial melleolar fracture fixation.Materials and Methods: One hundred and sixteen anatomic specimens were included in the study. A transverse cut was performed in the distal third of the tibia, roughly 1 and a half times the distal tibial plafond width from the ankle joint. A coronal cut was then performed using the center of the medial malleolus. Three observers measured the distance between the medial malleolus tip and beginning of the medullary canal in all anatomic specimens. Differences in measurements were statistically  compared, level of (P ≤ 0.05). Interclass correlation coefficient (ICC) significance level was set at P < 0.05.Results: Measurement average was 55 mm between the medial malleolus tip and the medullary canal, with a standard deviation of 10 mm. High concordance (ICC: 0.819) was achieved among all pairs of observers (P < 0.01). The systematic difference among measurements was absent, and random distribution around general measurements was observed. Conclusion: The authors recommend a screw length of no more than 45 mm to optimize the location of the screw threads in the best cancellous bone in an effort to obtain the most compression.Keywords: Ankle, ankle fractures, medial malleolu

Avaliação da qualidade de vida em pacientes com fratura da tíbia Assessment of quality of life in patients with tibia fractures

OBJETIVO: Avaliar o impacto da fratura na qualidade de vida dos pacientes. MÉTODO: Os pacientes foram submetidos a um protocolo de dados clínicos e epidemiológicos, a uma avaliação específica para fraturas da tíbia, o método de Johner e Wruhs, cujo dados foram analisados por um questionário genérico para avaliação da qualidade de vida, o SF-36, o qual foi aplicado pelos autores, com um mínimo de seis meses de pós-operatório. Estes instrumentos foram também estratificados com relação ao retorno ou não dos pacientes a todas as atividades que realizavam antes do acidente. RESULTADOS: Observou-se uma diminuição dos valores de avaliação do questionário SF-36 demonstrada estatisticamente (p<0,05) tanto pelo teste U de Mann-Whitney, entre os itens do SF-36 e retorno ou não às atividades prévias, como com relação ao resultado do SF36 estratificado para a avaliação clínica (Johner e Wruhs), por meio do teste de Kruskal-Wallis. CONCLUSÃO: De acordo com os critérios estabelecidos, e com base nos resultados obtidos, a fratura da tíbia, mesmo com uma boa evolução clínica, promoveu uma piora na qualidade de vida dos pacientes analisados.<br>OBJECTIVE: To evaluate the impact of tibial fractures on patient's quality of life. METHOD: All patients were evaluated by means of a protocol of clinical and epidemiological data. The Johner and Wruhs method was employed to evaluate tibial fractures and the results were compared to those of the SF-36 Health Survey, which was applied by the authors from the sixth month postoperatively. Those methods were applied considering the return of the patients or not to all the activities they used to perform before the accident. RESULTS: We found a statistical significance (p<0.05) showed by Mann- Whitney's U-test between the component of SF-36, and return or not to previous activities. Regarding the results of SF36 and clinical evaluation (Johner and Wruhs), on the Kruskal-Wallis' test, we also found significant correlation. CONCLUSION: According to the established criteria and based on the results, tibial fractures, even with favorable clinical outcomes, result in a diminished quality of life