A Novel Ligamentous Complex in the Anteromedial Region of the Knee: A Cadaveric Study.

Background: The medial knee structures have a primary role in stabilizing valgus and rotational stress, which makes them important in assessing the ligament-injured knee globally and choosing the most adequate treatment. Purpose: To conduct a layer-by-layer dissection of the knee's anteromedial side and provide a qualitative and quantitative description of the anatomy and histology of a ligament in the anteromedial region of the knee, which we have termed the anterior oblique ligament (AOL). Also, to describe the AOL relationship with what we have termed the medial cross-a ligament complex that stabilizes the medial pivot. Study Design: Descriptive laboratory study. Methods: A total of 35 fresh-frozen knees from transfemoral amputations that were exclusively performed for vascular reasons were dissected. Structures were identified after meticulous dissection, respecting the same protocol, measured with a digital caliper rule, and histologically studied for data. Results: The AOL was found in all dissected knees, with a mean length of 31.47 ± 5.06 mm. This structure presented a ligament histology with densely organized collagen fibrils. The medial cross was represented by the superficial medial collateral ligament, AOL (anterior region), and posterior oblique ligament. Conclusion: This study demonstrated the presence of a ligament in the anteromedial region of the knee, termed the AOL. This structure was in the anterior part of a ligament complex-the medial cross. Clinical Relevance: Studying and revisiting the medial compartment can provide important information for understanding joint instability and promoting better results in ligament reconstructions.

Comparison of Locked Plates and Blade Plates for Varus Osteotomy of the Proximal Femur by the Finite Element Method.

Objective: The present study compared the difference in load and pressure distribution behavior of the blade plate and locked plate for varus osteotomy of the proximal femur per the finite element method. Methods: Modeling was performed by scanning a medium-sized left femur with medial valgus deformity made of polyurethane. Results: The stiffness of the locked plate is higher compared with that of the blade plate. However, this difference was not significant. In addition, the locked plate has proximal locking screws to ensure that the bending moments on the screws are smaller during loading. Conclusion: In summary, both plates are well-established and effective. However, the study using the finite element method plays a fundamental role in understanding the load and pressure distribution of the implant. Moreover, it opens up new possibilities for further studies, including surgical proposals and customized implant materials.

Spondylolysis and Spondylolisthesis in Athletes.

This article is an update on spondylolysis and spondylolisthesis in athletes, from diagnosis to treatment, based on our service experience and a literature review.

Developmental Dysplasia of the Hip - Part 1.

Developmental dysplasia of the hip (DDH) is a condition characterized by changes in joint formation within the last months of intrauterine life or the first months after birth. Developmental dysplasia of the hip presentation ranges from femoroacetabular instability to several stages of dysplasia up to complete dislocation. Early diagnosis is essential for successful treatment. Clinical screening, including appropriate maneuvers, is critical in newborns and subsequent examinations during the growth of the child. Infants with suspected DDH must undergo an ultrasound screening, especially those with a breech presentation at delivery or a family history of the condition. A hip ultrasound within the first months, followed by pelvic radiograph at 4 or 6 months, determines the diagnosis and helps follow-up. Treatment consists of concentric reduction and hip maintenance and stabilization with joint remodeling. The initial choices are flexion/abduction orthoses; older children may require a spica cast after closed reduction, with or without tenotomy. An open reduction also can be indicated. After 18 months, the choices include pelvic osteotomies with capsuloplasty and, eventually, acetabular and femoral osteotomies. The follow-up of treated children must continue throughout their growth due to the potential risk of late dysplasia.

TREATMENT OF OSTEOGENESIS IMPERFECTA USING THE FASSIER-DUVAL TELESCOPIC ROD.

Objectives: This study aimed to assess the treatment of patients with Osteogenesis Imperfecta (OI) operated on with a telescopic Fassier-Duval (FD) rod in a querterenario hospital from 2010 to 2020. Methods: We analyzed indication for surgical treatment, causes of reoperation, complications and the effectiveness of telescoping rod. Results: The results were compared with the literature and with the same parameters from a previous study which a different telescopic rod developed by the same authors. This was a retrospective study based on the analysis of digital and radiographic clinical records. Fifteen patients with 21 FD rods were evaluated, most were used on the femur (18 rods or 85.7%), eight patients were female (53.3%), with a mean age of 10.47 (3.92 to 16.44) years, most of whom had type III Sillence (46.7%), with a mean follow-up of 5.22 (1.43 to 7.02) years. Seven rods (33.3%) had complications. The main indication was for fracture (57.1%). Regarding the ability to telescope, we observed that 15 rods (71.4%) followed the child's growth. Conclusion: We had good results using FD rods, similar to the data found in the literature and the data obtained with our rod. Level of Evidence III,Retrospective comparative study .

Objetivos: O objetivo deste estudo foi avaliar o tratamento de pacientes com Osteogênese Imperfeita (OI) operados com a haste telescopada de Fassier-Duval (FD) num hospital quaternário no período de 2010 a 2020. Métodos: Analisamos a indicação cirúrgica do tratamento, as causas de revisão, suas complicações e a eficácia na telescopagem da haste. Resultados: Os resultados foram comparados com a literatura e com os mesmos parâmetros de um artigo anterior no qual foi utilizada uma haste telescopada desenvolvida pelo nosso grupo. O estudo foi retrospectivo baseado na análise dos prontuários clínicos digitais e radiográficos dos pacientes. Quinze pacientes com 21 hastes de FD foram avaliados, sendo a maioria no fêmur (85,7%), oito pacientes eram do sexo feminino (53,3%), com média de 10,47 (3,92 a 16,44) anos, a maioria do tipo III de Sillence (46,7%), com tempo de seguimento médio de 5,22 (1,43 a 7,02) anos. Deste total, sete hastes (33,3%) apresentaram complicações. A principal indicação cirúrgica foram fraturas (57,1%). Em relação à telescopagem, observamos que 15 hastes (71,4%) acompanharam o crescimento da criança. Conclusão: No presente estudo verificamos bons resultados com as hastes de FD, à semelhança dos dados encontrados na literatura e dos dados encontrados com a haste do nosso serviço. Nível de Evidência III; Estudo retrospectivo comparativo .

Depression fractures of the posterolateral tibial plateau: Treatment by lateral femoral epicondyle osteotomy approach.

OBJECTIVE: The best surgical exposure and fixation method for fractures affecting the posterolateral corner of the tibial plateau remain debatable. This study describes a surgical approach to treat lateral depressions of the posterolateral tibial plateau with or without rim involvement by osteotomy of the lateral femoral epicondyle associated with osteosynthesis with a one-third tubular horizontal belt plate to stabilize the fracture fragment. METHOD: We evaluated 13 patients with fractures of the tibial plateau affecting the posterolateral region. Assessments included the degree of the depression (in millimeters), quality of the reduction, complications, and function. RESULTS: All fractures and osteotomies consolidated. The patients had a mean age of 48 years and were mostly men (n=8). Regarding the quality of the reduction, the mean reduction obtained was 15.8 mm, and 8 patients achieved anatomical reduction. The mean (± standard deviation) Knee Society Score was 92±13 (range 65-100), and the mean Function Score was 95±9.6 (range 70-100). The mean Lysholm Knee Score was 92±11.7 (range 66-100), and the mean International Knee Documentation Committee Score was 85±12.6 (range 63-100). All these scores reflect good results. None of the patients developed superficial or deep infection or presented healing disorders. Sensitive or motor complications of the fibular nerve were not observed. CONCLUSIONS: In this series of patients with depression fractures of the posterolateral tibial plateau, a surgical approach through osteotomy of the lateral femoral epicondyle allowed direct reduction and stable osteosynthesis of the fractures without functional impairment.

Growth modulation for angular knee deformities: a practical guideline.

PURPOSE OF REVIEW: This study aimed to review the established concepts and advances related to growth modulation for treating knee angular deformities. Although they are considered well tolerated procedures, careful indications and accurate techniques are necessary to ensure good results. RECENT FINDINGS: In addition to general clinical and radiographic evaluations, new tools such as two-dimensional low-dose radiography and gait analysis have been used to clarify angular and torsional combinations and the impact of mild angulations on the knee joint. Temporary epiphysiodesis is commonly the choice, and it can be performed with different implants such as staples, tension band plates (TBP), percutaneous transphyseal screws (PETS), sutures, and screws. SUMMARY: Considering its principles, TBP has been preferred for younger children. Cost can be a limitation, and research for alternative implants such as screws and nonabsorbable sutures indicate they might be an alternative in the future. In adolescents, PETS becomes an attractive alternative; however, its reversible character has been controversial, and further studies are needed to establish limits in younger patients.

Developmental Dysplasia of the Hip - Part 1 / Displasia do desenvolvimento do quadril - Parte 1

Abstract Developmental dysplasia of the hip (DDH) is a condition characterized by changes in joint formation within the last months of intrauterine life or the first months after birth. Developmental dysplasia of the hip presentation ranges from femoroacetabular instability to several stages of dysplasia up to complete dislocation. Early diagnosis is essential for successful treatment. Clinical screening, including appropriate maneuvers, is critical in newborns and subsequent examinations during the growth of the child. Infants with suspected DDH must undergo an ultrasound screening, especially those with a breech presentation at delivery or a family history of the condition. A hip ultrasound within the first months, followed by pelvic radiograph at 4 or 6 months, determines the diagnosis and helps follow-up. Treatment consists of concentric reduction and hip maintenance and stabilization with joint remodeling. The initial choices are flexion/abduction orthoses; older children may require a spica cast after closed reduction, with or without tenotomy. An open reduction also can be indicated. After 18 months, the choices include pelvic osteotomies with capsuloplasty and, eventually, acetabular and femoral osteotomies. The follow-up of treated children must continue throughout their growth due to the potential risk of late dysplasia.

Resumo O termo displasia do desenvolvimento quadril (DDQ) refere-se à condição na qual a articulação sofre alterações na sua formação durante os últimos meses da vida intrauterina ou nos primeiros meses após o nascimento. No espectro de apresentação, varia desde a instabilidade femuroacetabular, passando por estádios de displasia até a completa luxação. O diagnóstico precoce é fundamental para o sucesso do tratamento. A triagem através do exame clínico incluindo manobras apropriadas é imprescindível nos recém-nascidos e nas avaliações subsequentes durante o crescimento da criança. O rastreamento ultrassonográfico é indicado nos bebês sob suspeita clínica e muito mais recomendável naqueles que tiveram apresentação pélvica para o parto ou que tenham antecedentes familiares. A ultrassonografia do quadril nos primeiros meses seguida da radiografia da bacia após o 4° ou 6° mês de vida são os exames que determinam o diagnóstico e auxiliam o seguimento. O tratamento está baseado na obtenção de uma redução concêntrica e na manutenção e estabilização do quadril, propiciando a remodelação articular. Inicialmente, as órteses de flexão/abdução são a escolha; em crianças maiores pode ser necessário o uso de gesso após redução incruenta com ou sem tenotomia; redução aberta pode ser indicada e após os 18 meses as osteotomias pélvicas associadas a capsuloplastia e eventuais osteotomias acetabular e femoral. Crianças tratadas devem ser acompanhadas durante todo o seu crescimento pelo eventual risco de displasias tardias.

Treatment of osteogenesis imperfecta using the fassier-duval telescopic rod / Tratamento da osteogênese imperfeita com a haste telescópica fassier-duval

ABSTRACT Objectives: This study aimed to assess the treatment of patients with Osteogenesis Imperfecta (OI) operated on with a telescopic Fassier-Duval (FD) rod in a querterenario hospital from 2010 to 2020. Methods: We analyzed indication for surgical treatment, causes of reoperation, complications and the effectiveness of telescoping rod. Results: The results were compared with the literature and with the same parameters from a previous study which a different telescopic rod developed by the same authors. This was a retrospective study based on the analysis of digital and radiographic clinical records. Fifteen patients with 21 FD rods were evaluated, most were used on the femur (18 rods or 85.7%), eight patients were female (53.3%), with a mean age of 10.47 (3.92 to 16.44) years, most of whom had type III Sillence (46.7%), with a mean follow-up of 5.22 (1.43 to 7.02) years. Seven rods (33.3%) had complications. The main indication was for fracture (57.1%). Regarding the ability to telescope, we observed that 15 rods (71.4%) followed the child's growth. Conclusion: We had good results using FD rods, similar to the data found in the literature and the data obtained with our rod. Level of Evidence III,Retrospective comparative study .

RESUMO Objetivos: O objetivo deste estudo foi avaliar o tratamento de pacientes com Osteogênese Imperfeita (OI) operados com a haste telescopada de Fassier-Duval (FD) num hospital quaternário no período de 2010 a 2020. Métodos: Analisamos a indicação cirúrgica do tratamento, as causas de revisão, suas complicações e a eficácia na telescopagem da haste. Resultados: Os resultados foram comparados com a literatura e com os mesmos parâmetros de um artigo anterior no qual foi utilizada uma haste telescopada desenvolvida pelo nosso grupo. O estudo foi retrospectivo baseado na análise dos prontuários clínicos digitais e radiográficos dos pacientes. Quinze pacientes com 21 hastes de FD foram avaliados, sendo a maioria no fêmur (85,7%), oito pacientes eram do sexo feminino (53,3%), com média de 10,47 (3,92 a 16,44) anos, a maioria do tipo III de Sillence (46,7%), com tempo de seguimento médio de 5,22 (1,43 a 7,02) anos. Deste total, sete hastes (33,3%) apresentaram complicações. A principal indicação cirúrgica foram fraturas (57,1%). Em relação à telescopagem, observamos que 15 hastes (71,4%) acompanharam o crescimento da criança. Conclusão: No presente estudo verificamos bons resultados com as hastes de FD, à semelhança dos dados encontrados na literatura e dos dados encontrados com a haste do nosso serviço. Nível de Evidência III; Estudo retrospectivo comparativo .

Percutaneous hemiepiphysiodesis using transphyseal screws for adolescent tibia vara.

Hemiepiphysiodesis around the knee is becoming the mainstay procedure in adolescents for a wide range of aetiological deformities, when considering adolescent tibia vara (ATV), the published series have variable results. The purpose of this study was to review our experience with the percutaneous transphyseal screw (PETS) in these patients followed until bone maturity. We analysed the charts from 13 patients (20 knees) that underwent lateral tibial hemiepiphysiodesis using PETS. The radiographs were accessed before surgery, at implant removal, when occurred, and at the final follow-up. The clinical evaluation noted if there were complaints regarding pain or range of motion, and the radiographic assessment included: the femorotibial angle, the mechanical axis zone, the anatomic lateral distal femoral angle, and medial mechanical proximal tibial angle. There was one overcorrection, and after the screw removal (14 knees), rebound was observed in two knees modifying the result from excellent to good in all three knees. No bone bars and no implant breakage were observed. At the last appointment, all patients had normal knee range of motion, and two patients had unilateral alignment complaints, one of whom referred to occasional pain. Overall, the surgery was excellent in 12 knees (60%), good in six knees (30%), and poor in two knees (10%). This technique is indicated to be well tolerated and effective for treating ATV. When a complete correction cannot be obtained, in our opinion, it is advantageous to at least stabilise the deformity and postpone osteotomies until after skeletal maturity. Level of Evidence: Level IV - Case Series, Therapeutic Study.

Knee anteromedial compartment dissection: Final results and anterior oblique ligament description.

The anteromedial region of the knee is little explored in the literature and may play an important role in anteromedial rotatory instability. The purpose of this study is to describe a ligamentous structure in the anteromedial region of the knee identified in a series of anatomical dissections of cadaveric specimens. Twenty-one cadaveric knees were dissected to study the medial compartment. Exclusion criteria were signs of trauma, previous surgery, signs of osteoarthritis, and poor preservation state. The main structures of this region were identified during medial dissection. After releasing the superficial medial collateral ligament of the tibia, the anterior oblique ligament (AOL) was isolated. The morphology of the structure and its relationship with known anatomical parameters were determined. For the statistical analysis, the means and standard deviations were calculated for continuous variables. A 95% confidence interval was defined as significant. Student's t-tests were used for continuous variables. After dissection, a distinct ligamentous structure (AOL) was found in the medial region of the knee. This structure was found in 100% of the cases, was located extracapsularly and originated in the anterior aspect of the medial epicondyle, running obliquely toward the tibia. When crossing the joint, the ligament presented a fan-shaped opening, exhibiting a larger area at the tibial insertion. The AOL had a mean thickness of 6.83 ± 1.51 mm at its femoral origin and 13.39 ± 2.64 at its tibial insertion. It had a significantly (p = 0.0001) longer mean length with the knee at 90° of flexion (35.27 ± 6.59 mm) than with the knee in total extension (27.89 ± 5.46 mm), indicating that the ligament is tensioned in flexion. A new structure was identified in the anteromedial compartment of the knee with a ligamentous appearance. Further studies are necessary to identify its importance on knee stability. This study demonstrates the anatomy of a new medial structure of the knee. As a result, there will be a better understanding of the stability of the knee.

Comparative Clinical Evaluation of Two Techniques of Arthroscopic Treatment of Partial Articular Rotator Cuff Tears.

Objectives To evaluate the clinical results of patients submitted to arthroscopic treatment of partial lesion of the articular part of the rotator cuff by transtendon suture techniques and after completing the lesion and to compare the postoperative recovery time of the two techniques. Method Retrospective study based on the identification of all cases with partial lesion of the articular part of the rotator cuff submitted to arthroscopic treatment from October 1999 to December 2016 at the Shoulder and Elbow Group of our institution. Thirty-nine patients were included and divided into two groups: those who underwent the transtendon technique and those in whom the lesion was completed. The two groups were statistically similar. The respective medical records were analyzed as well as the identification of the applied technique, the postoperative results, and the related complications. The functional evaluation was performed using the score of the University of California at Los Angeles (UCLA). Results There was no statistically relevant difference between the groups, with a mean UCLA score of 32, and no difference in the time required for rehabilitation. Conclusion There was no difference between the clinical outcome of the patients, regardless of the technique used to repair the partial lesions of the articular part of the rotator cuff, with satisfactory results in 93% of the cases.

Comparative Clinical Evaluation of Two Techniques of Arthroscopic Treatment of Partial Articular Rotator Cuff Tears / Avaliação clínica comparativa de duas técnicas no tratamento artroscópico das lesões parciais articulares do manguito rotador

Abstract Objectives To evaluate the clinical results of patients submitted to arthroscopic treatment of partial lesion of the articular part of the rotator cuff by transtendon suture techniques and after completing the lesion and to compare the postoperative recovery time of the two techniques. Method Retrospective study based on the identification of all cases with partial lesion of the articular part of the rotator cuff submitted to arthroscopic treatment from October 1999 to December 2016 at the Shoulder and Elbow Group of our institution. Thirty-nine patients were included and divided intotwo groups: those who underwent the transtendon technique and those in whom the lesion was completed. The two groups were statistically similar. The respective medical records were analyzed as well as the identification of the applied technique, the postoperative results, and the related complications. The functional evaluation was performed using the score of the University of California at Los Angeles (UCLA). Results There was no statistically relevant difference between the groups, with a mean UCLA score of 32, and no difference in the time required for rehabilitation. Conclusion There was no difference between the clinical outcome of the patients, regardless of the technique used to repair the partial lesions of the articular part of the rotator cuff, with satisfactory results in 93% of the cases.

Resumo Objetivos Avaliar os resultados clínicos dos pacientes submetidos ao tratamento artroscópico da lesão parcial da porção articular do manguito rotador pelas técnicas de sutura transtendão e após completada a lesão e comparar o tempo de recuperação pósoperatório das duas técnicas. Método Estudo retrospectivo baseado na identificação de todos os casos com lesão parcial da porção articular do manguito rotador submetidos a tratamento artroscópico no período de outubro de 1999 a dezembro de 2016 pelo Grupo de Ombro e Cotovelo da nossa instituição. Foram incluídos 39 pacientes divididos em 2 grupos: os que foram submetidos à técnica transtendínea e os outros em que a lesão foi completada. Os dois grupos foram estatisticamente semelhantes. Foi realizada a análise dos respectivos prontuários, da identificação da técnica aplicada, dos resultados pós-operatórios e das complicações relacionadas. A avaliação funcional foi realizada através do escore da University of California at Los Angeles (UCLA). Resultados Não houve diferença estatisticamente relevante entre os grupos, com escore UCLA médio de 32, não havendo diferença também no tempo necessário para reabilitação. Conclusão Não houve diferença entre o resultado clínico dos pacientes, independente da técnica empregada para o reparo das lesões parciais da porção articular do manguito rotador com resultados satisfatórios em 93% dos casos.

Treatment of femur pseudoarthrosis using wave plate: Evaluation of consolidation and its relationship with graft type.

INTRODUCTION: In the pathogenesis of femoral pseudoarthrosis, the arched shape of the bone is important when determining traction force on the anterolateral plane and posteromedial compression. In plate osteosynthesis, flexion forces affect the implant and can determine its breakdown and osteosynthesis failure. The wave plate seeks to solve the problem by transferring the support to the cortex under the plate or creating the resistance of a leaf spring. OBJECTIVES: To evaluate the bone healing pattern of femoral pseudoarthrosis treated with wave plate and its effectiveness in consolidation. MATERIALS AND METHODS: We retrospectively evaluated 18 patients with femoral pseudoarthrosis treated with wave plate. RESULTS: Three months after surgery, one patient presented healing of pseudoarthrosis, six months after surgery, 16 patients presented healing of pseudoarthrosis and at 12 months, all patients had complete bone healing. Regarding the type of pseudoarthrosis, nine patients had avascular and nine vascular pseudoarthrosis. Fifteen patients had medial cortical failure and three, lateral cortical failure. In all cases, consolidation started where there was bone failure, be it medial or lateral. DISCUSSION: The wave plate technique is well indicated for the existence of cortical bone failure, both in fractures and in pseudoarthrosis. Objective is to stabilize the fragments by transferring and allowing contact between them. The formation of the bone callus occurred in our sample from the region of the bone defect to the region of bone contact, using either a tricortical or cancellous bone graft. The elastic force of the wave and the eccentric distribution of loads in the femur favored the formation of a callus where it was distracted (bone failure) and the location with concentration of movement (proximity between the fragments) was the end of bone healing. CONCLUSION: The wave plate technique was effective in bone healing of femoral pseudoarthrosis, promoting consolidation from the cortical failure to the bone contact zone.

THE EPIDEMIOLOGY OF DEVELOPMENTAL DYSPLASIA OF THE HIP IN MALES.

Developmental Dysplasia of the Hip (DDH) is one of the most common orthopedic hip diseases of the pediatric population. There is a predominance in females and patients with known risk factors. OBJECTIVE: To evaluate the characteristics of DDH in a reference center and compare them with the literature. METHODS: This is a cross-sectional observational study based on the review of medical records and radiographs from which epidemiological data such as laterality, age at diagnosis, acetabular index, radiographic classification and others were collected. RESULTS: A total of 297 medical records were found between May 1974 and June 2009. Of those, 147 patients (216 affected hips) were eligible for the survey. Most of the patients came from the state of São Paulo (91.1%), were born in autumn/winter (66.7%), reported as Caucasians (76.9%), with bilateral involvement (46.9%) and mean age at diagnosis of 22.8 months. CONCLUSION: The most frequent type of DDH was high dislocation (28.7%), and the acetabular index progressively increased with the age. The International Hip Dysplasia Institute classification was found to be more reproducible than Tönnis classification. Delayed diagnosis was associated with the absence of risk factors and with bilaterality. Level of Evidence III, Retrospective comparative study.

A displasia do desenvolvimento do quadril (DDQ) é uma das alterações ortopédicas mais frequentes na população pediátrica. Há predominância no sexo feminino e em pacientes com fatores de risco conhecidos. OBJETIVO: Avaliar as características da DDQ no sexo masculino de um grande centro de referência e cotejá-las com a literatura. MÉTODOS: Trata-se de estudo observacional transversal baseado na revisão de prontuários e radiografias de onde foram coletados dados epidemiológicos tais como lateralidade, idade no diagnóstico, índice acetabular, classificação radiográfica e outros. RESULTADOS: Foram encontrados 297 prontuários no período de maio de 1974 a junho de 2009. Destes, 147 pacientes (216 quadris afetados) foram elegíveis para a pesquisa. A maioria dos pacientes era procedente do estado de São Paulo (91,1%), nascidos no outono/inverno (66,7%), autodeclarados caucasianos (76,9%), com acometimento bilateral (46,9%) e idade média no diagnóstico de 22,8 meses. CONCLUSÃO: O tipo de DDQ mais encontrado foi a luxação alta (28,7%); o índice acetabular apresentou-se progressivamente aumentado quanto maior a idade do paciente. A classificação do International Hip Dysplasia Institute mostrou-se mais reprodutível que a Classificação de Tönnis. O atraso no diagnóstico foi associado à ausência de fatores de risco e à bilateralidade. Nível de Evidência III, Estudo retrospectivo comparativo.

The epidemiology of developmental dysplasia of the hip in males / Epidemiologia da displasia do desenvolvimento do quadril no sexo masculino

ABSTRACT Developmental Dysplasia of the Hip (DDH) is one of the most common orthopedic hip diseases of the pediatric population. There is a predominance in females and patients with known risk factors. Objective: To evaluate the characteristics of DDH in a reference center and compare them with the literature. Methods: This is a cross-sectional observational study based on the review of medical records and radiographs from which epidemiological data such as laterality, age at diagnosis, acetabular index, radiographic classification and others were collected. Results: A total of 297 medical records were found between May 1974 and June 2009. Of those, 147 patients (216 affected hips) were eligible for the survey. Most of the patients came from the state of São Paulo (91.1%), were born in autumn/winter (66.7%), reported as Caucasians (76.9%), with bilateral involvement (46.9%) and mean age at diagnosis of 22.8 months. Conclusion: The most frequent type of DDH was high dislocation (28.7%), and the acetabular index progressively increased with the age. The International Hip Dysplasia Institute classification was found to be more reproducible than Tönnis classification. Delayed diagnosis was associated with the absence of risk factors and with bilaterality. Level of Evidence III, Retrospective comparative study.

RESUMO A displasia do desenvolvimento do quadril (DDQ) é uma das alterações ortopédicas mais frequentes na população pediátrica. Há predominância no sexo feminino e em pacientes com fatores de risco conhecidos. Objetivo: Avaliar as características da DDQ no sexo masculino de um grande centro de referência e cotejá-las com a literatura. Métodos: Trata-se de estudo observacional transversal baseado na revisão de prontuários e radiografias de onde foram coletados dados epidemiológicos tais como lateralidade, idade no diagnóstico, índice acetabular, classificação radiográfica e outros. Resultados: Foram encontrados 297 prontuários no período de maio de 1974 a junho de 2009. Destes, 147 pacientes (216 quadris afetados) foram elegíveis para a pesquisa. A maioria dos pacientes era procedente do estado de São Paulo (91,1%), nascidos no outono/inverno (66,7%), autodeclarados caucasianos (76,9%), com acometimento bilateral (46,9%) e idade média no diagnóstico de 22,8 meses. Conclusão: O tipo de DDQ mais encontrado foi a luxação alta (28,7%); o índice acetabular apresentou-se progressivamente aumentado quanto maior a idade do paciente. A classificação do International Hip Dysplasia Institute mostrou-se mais reprodutível que a Classificação de Tönnis. O atraso no diagnóstico foi associado à ausência de fatores de risco e à bilateralidade. Nível de Evidência III, Estudo retrospectivo comparativo.

ANTEGRADE X RETROGRADE NAILING IN FEMORAL FRACTURES: A STUDY ON CONSOLIDATION AND INFECTION.

OBJECTIVE: Osteosynthesis with intramedullary nailing is considered the method of choice to treat diaphyseal femur fractures in adults. The objective of this retrospective study was to evaluate the bone healing time and incidence of infection in patients with diaphyseal femur fractures treated surgically with retrograde and antegrade intramedullary nailing. METHODS: The medical records of 123 patients from two university hospitals dated 2011-2013 were evaluated, with 126 diaphyseal femur fractures having been found. The most frequent treatment was antegrade intramedullary nailing (51%), of which 38% involved reaming (n=25). RESULTS: We found evidence of 92% healed fractures at 12 months postoperatively. Complications included chronic osteomyelitis in one patient and femoral neck fracture in another patient, both after reamed antegrade nailing. Pyoarthritis of the knee associated with osteomyelitis affected two patients after reamed retrograde nailing and one patient after unreamed retrograde nailing. CONCLUSION: We did not observe a significant difference in bone healing rates with the use of reamed or unreamed antegrade or retrograde nailing. Complications included the presence of infection with an incidence similar to that reported in the literature, and of particular significance, unrelated to the type of approach. Level of evidence III, Retrospective comparative study.

OBJETIVO: A osteossíntese com haste intramedular é considerada o método de escolha para tratamento das fraturas diafisárias do fêmur em adultos. O objetivo deste estudo retrospectivo foi avaliar o tempo até a consolidação e a incidência de infecção em pacientes com fratura diafisária do fêmur, operados com haste intramedular retrógrada e anterógrada. MÉTODOS: Foram avaliados os prontuários de 123 pacientes de dois hospitais universitários entre os anos de 2011 e 2013, tendo sido encontradas 126 fraturas diafisárias do fêmur. O tratamento mais frequente foi com haste intramedular anterógrada (51%), das quais 38% (n=25) eram fresadas. RESULTADOS: Com 12 meses de pós-operatório, evidenciamos 92% de consolidação. Entre as complicações, observamos um paciente com osteomielite crônica e um com fratura do colo do fêmur, ambos submetidos à haste intramedular anterógrada fresada e pioartrite do joelho, associada à osteomielite em dois pacientes submetidos à haste intramedular retrógrada fresada e em um paciente após a utilização de haste intramedular retrógrada não fresada. CONCLUSÃO: Não observamos diferença significativa entre a taxa de consolidação com o emprego das hastes retrógradas e anterógradas, fresadas ou não fresadas. Dentre as complicações, observamos a presença de infecção em incidência similar à da literatura e particularmente sem relação com a via de acesso escolhida. Nível de evidência III, estudo retrospectivo comparativo.

Difference in Articular Degeneration Depending on the Type of Sport.

Objective To determine whether type-II collagen degradation is determined by the type of sport. Carboxy-terminal telepoptide of type-II collagen (CTX-II), a serum biomarker of collagen degradation, was measured in athletes who play different sports, and was compared with matched controls. Methods The sample size consisted of 70 female participants aged between 18 and 25 years, 15 of whom were members of a soccer team, 10 of a futsal (a variant of association football played on a hard court) team, 10 of a handball team, 18 of a volleyball team, and 7 of a swimming team. A total of 9 age- and sex-matched individuals with sedentary lifestyles were included in the control group. 3-mL blood samples were collected from each participant, and they were analyzed using an enzyme-linked immunosorbent assay (ELISA). Results A comparison of the CTX-II concentrations of the players of different sports with those of the control group resulted in the following p -values: volleyball ( p = 0.21); soccer ( p = 0.91); handball ( p = 0.13); futsal ( p = 0.02); and swimming ( p = 0.0015). Therefore, in the investigated population, futsal represented the highest risk for type-II collagen degradation and, consequently, for articular cartilage degradation, whereas swimming was a protective factor for the articular cartilage. No statistically significant difference was found in the body mass index among the groups. Conclusion Futsal players are exposed to greater articular degradation, while swimmers exhibited less cartilage degradation compared with the control group in the study population, suggesting that strengthening the periarticular muscles and aerobic exercise in low-load environments has a positive effect on the articular cartilage.

Difference in Articular Degeneration Depending on the Type of Sport / Diferença na degeneração articular de acordo com o tipo de esporte

Abstract Objective To determine whether type-II collagen degradation is determined by the type of sport. Carboxy-terminal telepoptide of type-II collagen (CTX-II), a serum biomarker of collagen degradation, was measured in athletes who play different sports, and was compared with matched controls. Methods The sample size consisted of 70 female participants aged between 18 and 25 years, 15 of whom were members of a soccer team, 10 of a futsal (a variant of association football played on a hard court) team, 10 of a handball team, 18 of a volleyball team, and 7 of a swimming team. A total of 9 age- and sex-matched individuals with sedentary lifestyles were included in the control group. 3-mL blood samples were collected from each participant, and they were analyzed using an enzyme-linked immunosorbent assay (ELISA). Results A comparison of the CTX-II concentrations of the players of different sports with those of the control group resulted in the following p-values: volleyball (p = 0.21); soccer (p = 0.91); handball (p = 0.13); futsal (p = 0.02); and swimming (p = 0.0015). Therefore, in the investigated population, futsal represented the highest risk for type-II collagen degradation and, consequently, for articular cartilage degradation, whereas swimming was a protective factor for the articular cartilage. No statistically significant difference was found in the body mass index among the groups. Conclusion Futsal players are exposed to greater articular degradation, while swimmers exhibited less cartilage degradation compared with the control group in the study population, suggesting that strengthening the periarticular muscles and aerobic exercise in low-load environments has a positive effect on the articular cartilage.

Resumo Objetivo Determinar se a degradação de colágeno tipo II é determinada pelo tipo de esporte. O telopeptídeo carboxiterminal do colágeno tipo II (CTX-II), biomarcador de soro de degradação de colágeno, foi medido em atletas de esportes diferentes e comparado aos controles correspondentes. Métodos A amostra consistiu em 70 participantes do sexo feminino com idade entre 18 a 25 anos, das quais 15 eram membros de uma equipe de futebol, 10 de uma equipe de futebol de salão, 10 de uma equipe de handebol, 18 de uma equipe de voleibol, e 7 de uma equipe de natação. Foram incluídos no grupo de controle 9 indivíduos sedentários, pareados por idade e sexo. Uma amostra de sangue de 3 ml foi coletada de cada participante e analisada usando um ensaio imunossorvente ligado a enzima (ELISA, do inglês enzyme-linked immunosorbent assay). Resultados Uma comparação das concentrações de CTX-II das praticantes de diferentes esportes em comparação com o grupo de controle apresentou os seguintes valores de p: voleibol (p = 0,21); futebol (p = 0,91); handebol (p = 0,13); futebol de salão (p = 0,02) e natação (p = 0,0015). Portanto, na população investigada, o futebol de salão apresentou o maior risco de degradação do colágeno tipo II, e, consequentemente, de degradação da cartilagem articular, enquanto a prática de natação foi um fator protetor para a cartilagem articular. Não foi observada diferença estatisticamente significativa no índice de massa corporal entre os grupos. Conclusão As jogadoras de futebol de salão estão expostas a uma maior degradação articular, enquanto as nadadoras apresentam menor degradação da cartilagem em comparação com o grupo de controle na população estudada, o que sugere que o fortalecimento dos músculos periarticulares e o exercício aeróbico em ambientes de baixa carga têm um efeito positivo na cartilagem articular.

Epidemiological and Clinical Aspects of Cleft Hand: Case Series From a Tertiary Public Hospital in São Paulo, Brazil.

Background: Cleft hand is a rare and congenital deformity that affects hands and feet and can be associated with other malformations. The objective was to evaluate the epidemiological and clinical aspects of cleft hand patient in a case series. Methods: Baseline characteristics associated with this deformity, such as sociodemographic characteristics, affected upper limb side, family history, clinical manifestations, and the degree of deficiency according to Barsky, Manske and Halikis, and Valenti classifications, were analyzed in 38 patients treated in the Department of Orthopedic Surgery of the Irmandade da Santa Casa de Misericórdia de São Paulo, Brazil. Results: A predominance of typical hands as classified by Barsky, types II and IV by Manske and Halikis, and type IV by Valenti was found. A high frequency of typical cases (55.3%), as defined by Barsky, had a positive family history (P = .031) and were associated with other clinical manifestations (44.7%), when compared with atypical cleft hand patients (P < .001). Conclusion: In our study, there were more typical cleft hands than atypical, and they were more commonly associated with family history and other clinical manifestations.