Osteosynthesis of femoral neck fractures: two or three screws?

OBJECTIVES: To evaluate the efficacy of osteosynthesis on femoral neck fractures using two instead of three screws. METHODS: Thirtynine fractures were retrospectively evaluated, divided into groups in which two screws were used in parallel (n = 28) or three screws (n =11) in an inverted triangle configuration (in accordance with the AO technique). The patients were then followed up until reaching the outcome of either consolidation or failure. RESULTS: In the group in which two screws were used, consolidation was observed in 23 of the 28 fractures (82%). In the group in which three screws were used, consolidation was observed in 6 of the 11 fractures (55%). There was no statistically significant difference between these percentages. CONCLUSION: There was no difference in the prognosis for these fractures when treated using two screws in parallel or three screws in an inverted triangle in accordance with the AO technique. Further studies are needed in order to establish a definitive conclusion.OBJETIVOS: Avaliar a eficácia da osteossíntese de fraturas do colo femoral com dois em vez de três parafusos. MÉTODOS: Avaliadas, retrospectivamente, 39 fraturas, divididas em grupos nos quais foram utilizados dois (n = 28) parafusos paralelos e três parafusos (n = 11) na configuração de triângulo invertido segundo a técnica AO. Os pacientes foram acompanhados até o desfecho: consolidação ou falha. RESULTADOS: No grupo em que se utilizou dois parafusos, observamos consolidação em 23 das 28 fraturas (82%). No grupo de três parafusos observou-se consolidação em seis das 11 fraturas (55%). Não houve diferença estatística entre os valores obtidos. CONCLUSÃO: Não houve diferença no prognóstico dessas fraturas quando tratadas com dois parafusos paralelos ou três parafusos em triângulo invertido segundo a técnica AO-ASIF. Mais estudos são necessários para estabelecer conclusão definitiva.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Grupo de Patologias do Quadril AdultoUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Programa de Patologias do Quadril AdultoUNIFESP, EPM, Grupo de Patologias do Quadril AdultoUNIFESP, EPM, Programa de Patologias do Quadril AdultoSciEL

Pre- and Post-Surgery analysis of functional capacity and quality of life of patienst with Osteoarthritis submitted to Total Hip Artroplasty

OBJECTIVE: To evaluate the functional capacity of the hip articulation and the quality of life of patients with osteoarthritis submitted to total artroplasty. METHODS: 12 patients were assessed through the questionnaire Harris Hip Score (modified/scale of 0-95 points) and goniometry in the pre- and post-surgery of total hip artroplasty. RESULTS: The pre-surgery questionnaire score was 39.7 and in the post-surgery the average score reached 74.1 points (p = 0.000001). The range of motion of the hip was incomplete in all the movement arches in the pre-surgery, but in the post-surgery this value increased significantly in flexion (p = 0.007), extension (p = 0.02), abduction (p = 0.001, medial rotation (p = 0.0002) and lateral rotation (p = 0.01); only the aduction movement was not significantly increased (p = 0.08). CONCLUSIONS: Total hip artroplasty reliefs patients pain, improves daily life activities and increases the hip range of motion; patients, however, relate fear and insecurity in the accomplishment of those activities.OBJETIVO: avaliar a capacidade funcional da articulação do quadril e a qualidade de vida de pacientes portadores de osteoartrose submetidos à artroplastia total. MÉTODOS: foram avaliados 12 pacientes através do questionário Harris Hip Score (modificado/ escala de 0-95 pontos) e goniometria no pré e pós-operatório de artroplastia total de quadril. RESULTADOS: a amplitude de movimento mostrou-se incompleta em todos os arcos de movimento no pré-operatório. No pós-operatório os valores aumentaram significativamente na flexão (p=0,007), extensão (p=0,02), abdução (p=0,001), rotação medial (p=0,0002) e lateral (p=0,01), apenas o aumento do movimento de adução de quadril não foi significativo (p=0,08). A medida do escore obtido através do questionário no pré-operatório foi 39,7 pontos e no pós-operatório 74,1 pontos (P<0,000001). CONCLUSÕES: a artroplastia total do quadril proporciona ao paciente alívio da dor, melhora na realização das atividades da vida diária e aumento da amplitude do movimento articular do quadril. Os pacientes, porém, relatam medo e insegurança na realização dessas atividades.Universidade de FrancaUniversidade de Franca departamento de fisioterapia geriátricaUNIFESP-EPM Departamento de ortopedia e traumatologiaUNIFESP, EPM, Depto. de ortopedia e traumatologiaSciEL

Ischiofemoral impingement: an etiology of hip pain: case report

An association between hip pain and quadratus femoris muscle abnormality on magnetic resonance imaging (MRI) with concurrent narrowing of the ischiofemoral space has been reported in the recent literature. This raises the possibility that the muscle damage observed is due to ischiofemoral impingement. This diagnosis has been noted in middle-aged females either with or without a history of trauma or surgery, is a rarely described feature. We report here on a 31-year-old woman who presented with non-traumatic hip pain and evidence of narrowing of the ischiofemoral space and edema in the quadratus femoris. Nonsurgical treatment was administered, which relieved her hip pain. The diagnosis of ischiofemoral impingement should be considered in female patients complaining of hip pain without any other evident cause.A associação entre dor no quadril, anormalidade do músculo quadrado femoral na ressonância magnética (RM) e estreitamento do espaço isquiofemoral tem sido relatada na literatura atual, levantando a possibilidade de que essa lesão muscular seja causada pelo impacto isquiofemoral. Tal diagnóstico foi observado em algumas mulheres de meia-idade com ou sem história de trauma ou cirurgia. Os autores relatam aqui uma mulher de 31 anos de idade, que apresentava dor no quadril sem história de trauma, com evidência de estreitamento do espaço isquiofemoral e edema no músculo quadrado femoral. Foi realizado tratamento não cirúrgico com alívio dos sintomas. O diagnóstico de impacto isquiofemoral deve ser considerado em pacientes do sexo feminino com queixa de dor no quadril sem outra causa evidente.Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Grupo de QuadrilUniversidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Departamento de Ortopedia e TraumatologiaHospital IFOR Grupo de QuadrilUNIFESP, EPM, Grupo de QuadrilUNIFESP, EPM, Depto. de Ortopedia e TraumatologiaSciEL

Fractures of the proximal femur: correlation with vitamin D receptor gene polymorphism

Fractures are the feared consequences of osteoporosis and fractures of the proximal femur (FPF) are those that involve the highest morbidity and mortality. Thus far, evaluation of bone mineral density (BMD) is the best way to determine the risk of fracture. Genetic inheritance, in turn, is one of the major determinants of BMD. A correlation between different genotypes of the vitamin D receptor (VDR) and BMD has been recently reported. On this basis, we decided to determine the importance of the determination of VDR genotype in the presence of an osteoporotic FPF in a Brazilian population. We studied three groups: group I consisted of 73 elderly subjects older than 65 years (78.5 ± 7.2 years) hospitalized for nonpathological FPF; group II consisted of 50 individuals older than 65 years (72.9 ± 5.2 years) without FPF and group III consisted of 98 young normal Brazilian individuals aged 32.6 ± 6.6 years (mean ± SD). Analysis of VDR gene polymorphism by restriction fragment length polymorphism (RFLP) was performed by PCR amplification followed by BsmI digestion of DNA isolated from peripheral leukocytes. The genotype distribution in group I was 20.5% BB, 42.5% Bb and 37% bb and did not differ significantly from the values obtained for group II (16% BB, 36% Bb and 48% bb) or for group III (10.2% BB, 47.6% Bb and 41.8% bb). No differences in genotype distribution were observed between sexes or between the young and elderly groups. We conclude that determination of VDR polymorphism is of no practical use for the prediction of FPF. Other nongenetic factors probably start to affect bone mass, the risk to fall and consequently the occurrence of osteoporotic fractures with advancing age.A01Universidade Federal de São Paulo (UNIFESP)Hospital do Servidor Público Estadual de São PauloUNIFESPSciEL

Evaluation of the function and quality of life of patients submitted to girdlestone's resection arthroplasty

OBJECTIVES: To evaluate function and quality of life of patients submitted to Girdlestone's arthroplasty, and to compare outcomes between unilateral Girdlestone's group with the group with contralateral total hip prosthesis. METHODS: Cross-sectional study where 9 patients were evaluated with unilateral Girdlestone's and 3 with Girdlestone's in one hip and contralateral total hip prosthesis. The evaluation consisted in filling in a generic questionnaire on quality of life SF-36 and a specific questionnaire for hip function Harris Hip Score (HHS). The comparison between groups was made by using the Student's t-test and the Fisher's test. RESULTS: The patients of the unilateral Girdlestone's group presented a higher number of SF-36 domains classified as high, although 77.8% of these showed poor results on the HHS. All patients had a leg-length discrepancy and positive Trendelenburg's test, which led to limping gait in 11 of 12 patients evaluated. Of these, only 6 underwent physiotherapy after surgery. CONCLUSION: Girdlestone's postoperative quality of life and function in a Brazilian population still requires further studies, because these outcomes are indicative of study variables' behavior and cannot be regarded as definite.OBJETIVOS: Avaliar a função e a qualidade de vida dos pacientes pós-artroplastia de Girdlestone e comparar os resultados entre os grupos Girdlestone unilateral e o grupo com prótese total de quadril contralateral. MÉTODOS: estudo transversal no qual foram avaliados 9 pacientes com Girdlestone unilateral e 3 com Girdlestone em um quadril e prótese total no quadril contralateral. A avaliação constitui-se em aplicar o questionário genérico de qualidade de vida SF-36 e um questionário funcional específico para o quadril, Harris Hip Score (HHS). A comparação dos grupos foi realizada usando-se o teste t- Student e o teste de Fisher. RESULTADOS: Os pacientes do grupo Girdlestone unilateral apresentaram maior quantidade de domínios do SF-36 classificados como elevados, embora 77,8% destes tenham obtido resultados ruins no HHS. Todos os pacientes apresentaram o teste de Trendelenburg positivo e discrepância de membros, o que levou à marcha claudicante em 11 dos 12 pacientes avaliados. Destes, apenas 6 submeteram-se a fisioterapia pós-operatória. CONCLUSÃO: A qualidade de vida e a função pós-operatória de Girdlestone, na população brasileira, ainda necessita ser mais pesquisada, pois estes resultados são indicações do comportamento das variáveis de estudo e não podem ser consideradas encerradas.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Ortopedia e TraumatologiaUNIFESP-EPM DOTUNIFESP, EPM, Depto. de Ortopedia e TraumatologiaUNIFESP, EPM DOTSciEL

Sindrome da banda iliotibial proximal: relato de caso

OBJECTIVE:The overuse injuries in the hip joint occur commonly in sports practitioners and currently due to technical advances in diagnostic imaging, especially magnetic resonance imaging (MRI), are often misdiagnosed. Recently, a group of people were reported, all female, with pain and swelling in the pelvic region.T2-weighted MRI showed increased signal in the enthesis of the iliotibial band (ITB) along the lower border of the iliac tubercle. We report a case of a 34 year old woman, non-professional runner, with pain at the iliac crest with no history of trauma and whose MRI was compatible with the proximal iliotibial band syndrome.As lesões por sobrecarga na articulação do quadril ocorrem comumente em praticantes de esporte e atualmente, por causa do avanço das técnicas de diagnóstico por imagem, especialmente a ressonância magnética (RM), são frequentemente diagnosticadas. Recentemente, foi estudado um grupo de pacientes, todos do sexo feminino, com quadro de dor e edema na região do tubérculo ilíaco. A RM ponderada em T2 demonstrava aumento de sinal na êntese da banda iliotibial (BIT) ao longo da margem inferior do tubérculo ilíaco. Relatamos um caso de uma mulher de 34 anos, corredora não profissional, com quadro de dor na crista ilíaca sem história de trauma e cuja RM era compatível com a síndrome da banda iliotibial proximal.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP-EPMUNIFESP-EPM Department of Radiology and Imaging DiagnosticsUNIFESP, EPMUNIFESP, EPM Department of Radiology and Imaging DiagnosticsSciEL

Gluteal pain in athletes: how should it be investigated and treated?

ABSTRACT Gluteal pain is a frequent symptom in athletes, and defining it etiologically is a challenge for orthopedists. In the present study, using an anatomical approach to the posterior region of the pelvis and the proximal femur, divided into four quadrants, systematized investigation is proposed with the aim of optimizing the treatment and accelerating athletes' return to their sport, through correct diagnosis