Surgical hip dislocation with relative femoral neck lengthening and retinacular soft-tissue flap for sequela of Legg-Calve-Perthes disease.

OBJECTIVE Correction of post-LCP (Legg-Calve-Perthes) morphology using surgical hip dislocation with retinacular flap and relative femoral neck lengthening for impingent correction reduces the risk of early arthritis and improves the survival of the native hip joint. INDICATIONS Typical post-LCP deformity with external and internal hip impingement due to aspherical enlarged femoral head and shortened femoral neck with high riding trochanter major without advanced osteoarthritis (Tönnis classification ≤ 1) in the younger patient (age < 50 years). CONTRAINDICATIONS Advanced global osteoarthritis (Tönnis classification ≥ 2). SURGICAL TECHNIQUE By performing surgical hip dislocation, full access to the hip joint is gained which allows intra-articular corrections like cartilage and labral repair. Relative femoral neck lengthening involves osteotomy and distalization of the greater trochanter with reduction of the base of the femoral neck, while maintaining vascular perfusion of the femoral head by creation of a retinacular soft-tissue flap. POSTOPERATIVE MANAGEMENT Immediate postoperative mobilization on a passive motion device to prevent capsular adhesions. Patients mobilized with partial weight bearing of 15 kg with the use of crutches for at least 8 weeks. RESULTS In all, 81 hips with symptomatic deformity of the femoral head after healed LCP disease were treated with surgical hip dislocation and offset correction between 1997 and 2020. The mean age at operation was 23 years; mean follow-up was 9 years; 11 hips were converted to total hip arthroplasty and 1 patient died 1 year after the operation. The other 67 hips showed no or minor progression of arthrosis. Complications were 2 subluxations due to instability and 1 pseudarthrosis of the lesser trochanter; no hip developed avascular necrosis

Development of acetabular retroversion in LCPD hips-an observational radiographic study from early stage to healing.

BACKGROUND Acetabular retroversion is observed frequently in healed Legg-Calvé-Perthes disease (LCPD). Currently, it is unknown at which stage and with what prevalence retroversion occurs because in non-ossified hips, retroversion cannot be measured with standard radiographic parameters. METHODS In a retrospective, observational study; we examined pelvic radiographs in children with LCPD the time point of occurrence of acetabular retroversion and calculated predictive factors for retroversion. Between 2004 and 2017, we included 55 children with a mean age of 5.7 ± 2.4 years at diagnosis. The mean radiographic follow-up was 7.0 ± 4.4 years. We used two new radiographic parameters which allow assessment of acetabular version in non-ossified hips: the pelvic width index and the ilioischial angle. They are based on the fact that the pelvic morphology differs depending on the acetabular version. These parameters were compared among the four Waldenström stages and to the contralateral side. Logistic regression analysis was performed to determine predictive factors for acetabular retroversion. RESULTS Both parameters differed significantly among the stages of Waldenström (p < 0.003 und 0.038, respectively). A more retroverted acetabulum was found in stage II and III (prevalence ranging from 54 to 56%) compared to stage I and IV (prevalence ranging from 23 to 39%). In hips of the contralateral side without LCPD, the prevalence of acetabular retroversion was 0% in all stages for both parameters. Predictive factors for retroversion were younger age at stage II and IV, collapse of the lateral pillar in stage II or a non-dysplastic hip. CONCLUSIONS This is the first study evaluating acetabular version in children with LCPD from early stage to healing. In the developing hip, LCPD may result in acetabular retroversion and is most prevalent in the fragmentation (stage II) and early healing stage (stage III). Partial correction of acetabular retroversion can occur after healing. This has a potential clinical impact on the timing and type of surgical correction, especially in pelvic osteotomies for correction of acetabular version. LEVEL OF EVIDENCE Level III, retrospective observational study

Demographic Changes in Pelvic Fracture Patterns at a Swiss Academic Trauma Center from 2007 to 2017.

BACKGROUND Increasing life expectancy has led to higher incidence of fragility fractures of the pelvis. These demographic changes may have a direct impact on fracture patterns. The goal was (1) to evaluate demographical trends in patients with pelvic ring injuries at a tertiary Swiss trauma center and (2) to analyze the influence on fracture patterns. METHODS We performed a retrospective cross-sectional study including 958 patients (mean age 57 ± 21 years, 48% women) with a pelvic ring injury between 2007 and 2017. Fractures were classified according to Tile, Young and Burgess or Rommens and Hofmann (fragility fractures) using conventional and CT imaging. Low-energy fractures were defined as fractures resulting from fall from standing height or less. Fracture classifications, age, gender, injury severity score (ISS) and trauma mechanism were compared using analysis of variance (ANOVA) or chi-square test. Cluster analysis was performed to identify groups with similarities in fracture patterns and demographic parameters. RESULTS From 2007 to 2017, the frequency of pelvic ring injuries increased by 115% (increase per decade), mean age increased by 15% (p = 0.031). A trimodal age distribution was found; highest increase for fractures occurred in the 'older' (265%) patient group. Low-energy fracture was the most common trauma mechanism (43% of all fractures, an increase of 249%). Changes in fracture pattern showed a disproportioned increase of 'lateral compression (LC)' fractures (LC type 1 in 64%) or partially stable fracture (B2: with 39%). In patient aged over 65 years, the strongest increase was found for 'non-displaced posterior' fractures with an overall prevalence of 62%. Five clusters were found with the most frequent cluster representing 'older female patients with low-energy fracture (LC, Tile type B)' in 30%. CONCLUSION The current results corroborate the trend of increasing frequency of fragility fractures in an aging society. The demographic shift has a direct impact on fracture pattern with a disproportionate increase in partially stable compression fracture of the pelvis. LEVEL OF EVIDENCE Level III

Estudo sobre a satisfação dos sócios do Sport Club Internacional sob a modalidade sócio contribuinte Campeão do Mundo

Neste trabalho analisa-se a satisfação dos sócios do Sport Club Internacional sob a modalidade Sócio Contribuinte Campeão do Mundo. A concepção desse estudo de caso foi proporcionar conhecimento sobre o nível de satisfação do associado em distintas dimensões de avaliação, acreditando que se possa contribuir na manutenção de um relacionamento duradouro entre o associado e o clube. Para isto, foi utilizado um método híbrido, composto de uma etapa qualitativa e outra quantitativa. Em ambas foram utilizadas ferramentas da Internet para coleta de dados. A qualitativa proporcionou, através de entrevistas em profundidade, a identificação de dimensões para mensurar a satisfação e a elaboração de um questionário. Já na quantitativa utilizou-se o instrumento de coleta de dados produzido na etapa anterior para obter as respostas da amostra estatisticamente representativa de associados do Clube. Os resultados dessa última etapa mostraram os níveis de satisfação em cada dimensão, sinalizando possíveis pontos que merecem uma atenção maior do clube e quais foram melhor avaliados pelo associado

Estrutura de avaliação da qualidade percebida e desempenho em serviços administrativos de instituição de ensino superior

O objetivo geral deste trabalho foi construir e aplicar uma estrutura de avaliação da qualidade percebida dos serviços administrativos prestados por servidores técnicos-administrativos em uma Instituição Federal de Ensino Superior (IFES). Para isto, o trabalho se dispôs a: i) levantar um conjunto de atributos e dimensões de qualidade percebida para os serviços administrativos prestados pelos técnicos-administrativos em uma IFES; ii) construir um instrumento de avaliação da qualidade percebida dos serviços administrativos prestados por técnicos-administrativos de uma IFES; iii) analisar gaps de qualidade percebida em serviços administrativos de uma IFES, usando a abordagem IPA (Importance-Performance Analysis), sob a perspectiva de docentes, técnicos-administrativos e discentes; e iv) identificar atributos críticos de qualidade e sua relação com os instrumentos de avaliação de desempenho e de planejamento estratégico na IFES em estudo. Entre as contribuições teóricas deste trabalho estão: i) uma estrutura de atributos para avaliação da qualidade dos serviços administrativos segundo importância e desempenho; e ii) um procedimento metodológico que abrange a hierarquização atributos, a analise dos gaps entre importância e percepção de desempenho, a elaboração e a interpretação da matriz de importância-desempenho. Já as principais contribuições práticas foram: i) a proposta de aperfeiçoamento de instrumentos de avaliação e controle existentes no âmbito da universidade; e ii) a aproximação ao usuário final do serviço, conhecendo sua percepção de qualidade e aspectos valorizados. Assim, ao adotar os procedimentos propostos neste estudo, entende-se que a Universidade estaria promovendo melhorias significativas nos serviços administrativos e avançando na busca pela excelência e qualidade.This study aims to build and apply a structure of evaluation of the perceived quality of administrative services provided by the administrative staff in Higher Education Federal Institutions (HEFI). For this, the work is organized to i) create a set of attributes and dimensions of perceived quality of administrative services provided by administrative staff in a HEFI; ii) build perceived quality assessment instrument of the administrative services provided by HEFI's administrative staff; iii) analyze perceived quality gaps in administrative services of an HEFIs, using the IPA (Importance-Performance Analysis) approach, from the perspective of teachers, administrative staff, and student; and iv) identify critical attributes of quality and their relationship with instruments of performance and strategic planning in the IFES under study. Among the theoretical contributions of this work are i) an attribute structure to evaluate the quality of administrative services according to importance and performance; and ii) a methodological procedure that includes hierarchical attributes, gap analysis between importance and perception of performance, elaboration and interpretation of the importance-performance matrix. The main practical contributions were i) the proposal to improve existing evaluation and control instruments within the university; and ii) the approach to the end user of the service, knowing its perception of quality and evaluated aspects. Thus, when adopting the procedures proposed in this study, it is understood that the University would be promoting significant improvements in administrative services and advancing in the quest for excellence and quality

Estudo sobre a satisfação dos sócios do Sport Club Internacional sob a modalidade sócio contribuinte Campeão do Mundo

Neste trabalho analisa-se a satisfação dos sócios do Sport Club Internacional sob a modalidade Sócio Contribuinte Campeão do Mundo. A concepção desse estudo de caso foi proporcionar conhecimento sobre o nível de satisfação do associado em distintas dimensões de avaliação, acreditando que se possa contribuir na manutenção de um relacionamento duradouro entre o associado e o clube. Para isto, foi utilizado um método híbrido, composto de uma etapa qualitativa e outra quantitativa. Em ambas foram utilizadas ferramentas da Internet para coleta de dados. A qualitativa proporcionou, através de entrevistas em profundidade, a identificação de dimensões para mensurar a satisfação e a elaboração de um questionário. Já na quantitativa utilizou-se o instrumento de coleta de dados produzido na etapa anterior para obter as respostas da amostra estatisticamente representativa de associados do Clube. Os resultados dessa última etapa mostraram os níveis de satisfação em cada dimensão, sinalizando possíveis pontos que merecem uma atenção maior do clube e quais foram melhor avaliados pelo associado

Tolkien et les Inklings

L’œuvre de Tolkien (1892-1973), située au carrefour de questions littéraires, génériques, critiques et théoriques, permet de croiser des interrogations qui possèdent une valeur exemplaire, en particulier à l’égard des relations entre la littérature et les imaginaires. Cette œuvre permet aussi de questionner les rapports qui se sont tissés avec ses premiers lecteurs du groupe des Inklings et la critique. Elle invite à s'intéresser à l’intéraction entre la réception par le grand public et les interprétations des critiques