Fratura da região distal da clavícula em crianças

ResumoObjetivoAnalisar as fraturas da região distal da clavícula em pacientes pediátricos.MétodosForam observados dez pacientes entre cinco a 11 anos com média de 7,3 anos. Nove pacientes foram tratados conservadoramente e um cirurgicamente. As fraturas foram classificadas segundo a classificação de Nenopoulos.ResultadosTodas as fraturas consolidaram sem complicações. O tratamento conservador foi usado em nove pacientes, três do grupo IIIb; três IIb; dois IIa e um IV. O único paciente tratado cirurgicamente foi uma paciente do gênero feminino de 11 anos com fratura do grupo IV.ConclusãoA indicação do tratamento para as fraturas distais da clavícula em crianças deve ser baseada na idade do paciente e no desvio dos fragmentos.AbstractObjectiveTo analyze fractures of the distal clavicle region in pediatric patients.MethodsTen patients between the ages of five to eleven years (mean of 7.3 years) were observed. Nine patients were treated conservatively and one surgically. All the fractures were classified using the Nenopoulos classification system.ResultsAll the fractures consolidated without complications. Conservative treatment was used for nine patients, of whom three were in group IIIB, three IIb, two IIa and one IV. The only patient who was treated surgically was a female patient of eleven years of age with a group IV fracture.ConclusionThe treatment indication for distal fractures of the clavicle in children should be based on the patient's age and the displacement of the fragments

SAFE LOCALIZATION FOR PLACEMENT OF PERCUTANEOUS PINS IN THE CALCANEUS

ABSTRACTObjective: To determine the areas presenting risk in six zones of the calcaneus, and to quantify the risks of injury to the anatomical structures (artery, vein, nerve and tendon). Method: Fifty-three calcanei from cadavers were used, divided into three zones and each subdivided in two areas (upper and lower) by means of a longitudinal line through the calcaneus. The risk of injury to the anatomical structures in relation to each Kirschner wire was determined using a graded system according to the Licht classification. The total risk of injury to the anatomical structures through placement of more than one wire was quantified using the additive law of probabilities and the product law for independent events. Results: The injury risk calculation according to the Licht classification showed that the highest risk of injury to the artery or vein was in zone IA (43%), in relation to injuries to nerves and tendons (13% and 0%, respectively). Conclusion: This study made it possible to identify the most vulnerable anatomical structures and quantify the risk of injury to the calcaneus

Recommendations for avoiding knee pain after intramedullary nailing of tibial shaft fractures

<p>Abstract</p> <p>Background</p> <p>The objective of this study is to analyze the proximal tibiofibular joint in patients with knee pain after treatment of tibial shaft fractures with locked intramedullary nail.</p> <p>Findings</p> <p>The proximal tibiofibular joint was analyzed in 30 patients, who reported knee pain after tibial nailing, and standard radiograph and computed tomography were performed to examine the proximal third of the tibia. Twenty patients (68.9%) presented the proximal screw crossing the proximal tibiofibular joint and 13 (44.8%) had already removed the nail and/or screw. Four patients (13.7%) reported complaint of knee pain. However, the screw did not reach the proximal tibiofibular joint. Five patients (17.2%) complained of knee pain although the screw toward the joint did not affect the proximal tibiofibular joint.</p> <p>Conclusion</p> <p>When using nails with oblique proximal lock, surgeons should be careful not to cause injury in the proximal tibiofibular joint, what may be one of the causes of knee pain. Thus, the authors suggest postoperative evaluation performing computed tomography when there is complaint of pain.</p

Avaliação do índice de massa corporal como fator prognóstico na osteoartrose do joelho

ResumoObjetivoAvaliar a relação do índice de massa corporal (IMC) do paciente com o grau de gravidade radiográfica da osteoartrose do joelho.MétodoForam avaliados, de forma prospectiva, 117 pacientes portadores de gonartrose. Os pacientes tiveram seus índices de massa corporal calculados e a artrose do joelho foi classificada segundo os critérios de Ahlbäck modificados. Usou‐se a Anova de Kruskal‐Wallis para avaliar a relação entre essas duas variáveis.ResultadosO grupo classificado como grau V de Ahlbäck apresentou um IMC significativamente maior do que os demais.ConclusãoExiste relação direta entre o IMC e o grau de gravidade radiográfico da gonartrose. A obesidade parece estar diretamente relacionada à progressão da osteoartrose do joelho.AbstractObjectiveTo evaluate the relationship between patients’ body mass index (BMI) and the degree of radiographic severity of knee osteoarthrosis.Method117 patients with gonarthrosis were evaluated prospectively. The patients’ BMI was calculated and their knee arthrosis was classified in accordance with the modified Ahlbäck criteria. Kruskal‐Wallis analysis of variance (ANOVA) was used to evaluate the relationship between these two variables.ResultsThe group classified as Ahlbäck grade V had significantly higher BMI than the others.ConclusionThere is a direct relationship between BMI and the degree of radiographic severity of gonarthrosis. Obesity appears to be directly related to the progression of knee osteoarthrosis

Localization of the tibial entry point

OBJETIVE: To assess, through a questionnaire, the intramedullary nail entry point in the proximal aspect of the tibia. Me-thods: 230 attendees who treat tibial fractures were interviewed. The questionnaire was created with three sections that could be answered with Yes or No answers and a fourth section that had two figures representing anteroposterior (AP) and lateral view x-rays that could be answered with a format A, B or C. RESULTS: The most frequent reason was ease of access (67.8%), followed by the better nail insertion access (60.9%) and the third one was to prevent knee pain (27.4%). Reasons for choosing access so as to prevent knee pain and prevent tendinitis had a significant relationship with points A and C of the schematic figure in the AP x-ray, especially C (medial tibial crest). No significant difference was observed between types of access to the patellar ligament in the schematic figure of the AP and lateral x-ray among age groups. CONCLUSION: The greater the age, the larger the proportion choosing the question avoid valgus deformity. Reasons from a medical (practical) perspective were related to the type of access in the transpatellar ligament, while reasons from a patient (functional) perspective were related to medial parapatellar access. Transpatellar access was chosen by most participants (66.5%).OBJETIVO: Verificar, através de um questionário, o ponto de entrada da haste intramedular na região proximal da tíbia. Métodos: 230 participantes que tratam fraturas da tíbia foram entrevistados. O questionário foi formulado com três segmentos que poderiam ser respondidos com um formato sim ou não e um quarto, com duas figuras que representavam uma radiografia em anteroposterior (AP) e lateral que poderiam ser respondidas com um formato A, B ou C. RESULTADOS: A razão mais frequente foi a facilidade de acesso (67,8%), seguida do melhor acesso para inserção da haste (60,9%) e em terceiro prevenir a dor no joelho (27,4%). Existiu relação significativa entre as razões de escolha do acesso como prevenir dor no joelho e evitar tendinites com os pontos A e C da figura esquemática de radiografia em AP, principalmente o ponto C (crista tibial medial). Observou-se que não existiu diferença significativa nos tipos de acesso em relação ao ligamento patelar, nas figuras esquemáticas de radiografia em AP e perfil entre as faixas etárias. CONCLUSÃO: Observou-se que quanto maior a faixa etária maior a proporção de escolher a pergunta evitar deformidade em valgo. As razões de aspecto médico (prático) foram relacionadas com o tipo de acesso no ligamento transpatelar, enquanto que as razões de aspecto paciente (funcional) foram relacionadas com o acesso parapatelar medial. O acesso transpatelar foi escolhido pela maioria dos participantes (66,5%).Universidade Federal de São Paulo (UNIFESP)Hospital Santa TeresaUniversidade Federal do Rio de Janeiro Faculdade de Medicina Departamento de Ortopedia e TraumatologiaHospital de IpanemaSanta Casa de São Paulo Faculdade de Ciências MedicasSanta Casa de São Paulo da Faculdade de CiênciasUNIFESPSciEL

Bilateral stress fracture of femoral neck in non-athlete – case report

AbstractBilateral stress fracture of femoral neck in healthy young patients is an extremely rare entity, whose diagnostic and treatment represent a major challenge. Patients with history of hip pain, even non-athletes or military recruits, should be analyzed to achieve an early diagnosis and prevent possible complications from the surgical treatment. This report describes a 43-year-old male patient, non-athlete, without previous diseases, who developed bilateral stress fracture of femoral neck without displacement. He had a late diagnosis; bilateral osteosynthesis was made using cannulated screws. Although the diagnosis was delayed in this case, the study highlights the importance of the diagnosis of stress fracture, regardless of the activity level of the patients, for the success of the treatment

Study of the tibial rotational deviation

OBJECTIVE: to evaluate the postoperative rotational deviation of diaphyseal tibial fractures in patients treated with non-reamed, interlocking intramedullary nailing and bridge plate, using computerized tomography for measurement. METHOD: one hundred and thirteen patients with diaphyseal tibial fractures were treated; 42 fractures were treated with non-reamed, interlocking intramedullary nailing, and 71 fractures were treated with bridge plate. Tibial rotation measurements were obtained by using the CT scan. All of the fractures were classified by the AO scale, by their presentation (closed and open) and the percentage of deviation on internal and external rotation. RESULTS: no significant difference in tibial rotation was found as a function of fracture location, internal or external rotation, and types A or B of fractures. However, in the case of type C fractures and open fractures, the treatment with non-reamed, interlocking intramedullary nailing resulted in a much smaller rotation in comparison to the treatment with bridge plate (p = 0.028 and p = 0.05, respectively). CONCLUSIONS: rotational deviations, regardless of the location of the diaphyseal tibial fractures, are associated to the trauma energy, thus presenting a greater challenge to control it by using the bridge plate.OBJETIVO: avaliar o desvio rotacional pós-operatório das fraturas diafisárias da tíbia de pacientes tratadas com haste intramedular bloqueada não-fresada e placa em ponte, utilizando a tomografia computadorizada. MÉTODOS: foram tratados 113 pacientes com fraturas diafisárias da tíbia, sendo que em 42 fraturas os autores utilizaram haste intramedular bloqueada e em 71 foram utilizadas placa em ponte. O método tomográfico utilizado ara se obter as medidas da rotação tibial. Foi empregada a classificação AO das fraturas; à exposição: fechadas e expostas e a percentagem de desvios em rotação interna e externa. RESULTADOS: foi demonstrado não haver diferença significativa de rotação tibial nos seguintes parâmetros analisados: localização, rotação interna ou externa e nos tipos A e B da classificação AO. Porém, nas fraturas do tipo C e nas fraturas expostas, a haste intramedular bloqueada apresentou diferença rotacional significativamente menor (p = 0,028) e (p = 0,05), quando comparada à placa em ponte. CONCLUSÃO: independente da localização das fraturas diafisárias da tíbia, os desvios rotacionais estão relacionados à energia do trauma, apresentando uma maior dificuldade de controle com a técnica placa em ponte.Hospital Santa Teresa Prof. Dr. Donato D'Ângelo Serviço de Ortopedia e TraumatologiaUFRJ Faculdade de MedicinaHospital de IpanemaUNIFESP-EPM Departamento de Ortopedia e TraumatologiaUNIFESP, EPM, Depto. de Ortopedia e TraumatologiaSciEL

Is arthrodesis still a good indication for non-inflammatory arthrosis of the wrist?

AbstractObjectiveThe aim of this study was to objectively and subjectively evaluate wrist function after total arthrodesis, among patients with sequelae of non-inflammatory arthritis who were treated with rigid internal fixation using a DCP plate.MethodsThirty-two patients with sequelae of non-inflammatory degenerative arthritis were treated using total arthrodesis of the wrist. Of these, two patients were treated with Kirschner wires and four discontinued the treatment, thus leaving 26 patients. The indication for arthrodesis of the wrist was the presence of intracarpal pathological conditions: eight wrists presented sequelae from fractures of the distal radius; 13 had sequelae from fractures of the scaphoid; and five had sequelae from Kienbock's disease. The cases were evaluated using the visual analogue scale (VAS), the muscle strength test, the Jebsen–Taylor functional test and the Buck-Gramcko test.ResultsIt was observed that there were no significant differences at the level of 5%, in the variables of grip strength, VAS, Jebsen–Taylor functional test or Buck-Gramcko/Lohmann test, between the pathological conditions.ConclusionTotal arthrodesis of the wrist using a plate in the dorsal region was shown to be a safe and efficient technique for patients with different types of pathological arthrosis of the wrist, since it did not cause any important functional incapacity and brought great pain relief

Femoral anteversion and the neck-shaft angle: relationship with hip osteoarthritis

OBJECTIVE: To compare the existence of agreement between measurements of anteversion of the femoral neck and the degrees of osteoarthritis and abnormality of the neck-shaft angle in patients with unilateral idiopathic hip osteoarthritis, among three evaluators. METHODS: Forty- two patients with unilateral hip osteoarthritis were evaluated by means of simple radiography and computed tomography. RESULTS: It was observed that there was no significant variation in femoral anteversion between the diseased and healthy hips. There was strongest agreement between observers 1 and 2 in relation to both the diseased hips (cases) and the healthy hips (controls). Moreover, no significant agreement was found between observers 1 and 3 (p = 0.13) and between observers 2 and 3 (p = 0.12), in relation to the neck-shaft angle of the control hips. CONCLUSION: Although there was no relationship between femoral anteversion and the neck-shaft angle in the patients with unilateral hip osteoarthritis, the present study showed that there was also no relationship with these angular deviations.OBJETIVO: Comparar, entre três avaliadores, a existência de concordância das medidas da anteversão do colo femoral com o grau da osteoartrite e a alteração do ângulo cervicodiafisário em pacientes com osteoartrite idiopática unilateral do quadril. MÉTODOS: Foram avaliados 42 pacientes com osteoartrite unilateral do quadril por meio de radiografia simples e tomografia computadorizada. RESULTADOS: Observou-se que não ocorreu variação significativa na anteversão femoral entre o quadril doente e o sadio. Houve uma concordância mais forte entre os observadores 1 e 2, tanto em relação ao quadril doente (caso) quanto ao sadio (controle). Além disso, não foi verificada concordância significativa entre os observadores 1 e 3 (p = 0,13) e entre 2 e 3 (p = 0,12) em relação ao ângulo cervicodiafisário do quadril controle. CONCLUSÃO: Apesar de não ter ocorrido relação entre a anteversão femoral e o ângulo cervicodiafisário nos pacientes com osteoartrite unilateral do quadril, este estudo demonstrou não haver relação com estes desvios angulares.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaHospital Santa Teresa Serviço de Ortopedia e TraumatologiaHospital Santa Teresa Serviço de Ortopedia e Traumatologia Grupo de QuadrilUFRJ Faculdade de MedicinaINTOINTO Grupo de Pelve e AcetábuloUNIFESP, EPMSciEL