[Classical and modern methods for the assessment of skeletal maturation and pubertal growth spurt]. / Klasszikus és modern vizsgálómódszerek a csontérettségi kor és a pubertáskori növekedési csúcs meghatározására.

The assessment of skeletal age is of utmost importance not only in the field of anthropology, forensic medicine, pediatrics, endocrinology but also in orthodontics and jaw orthopedics. Bone age refers to the individual's biological development which can differ within a relatively wide range for the same chronological age. Therefore, accurate assessment of skeletal maturity and pubertal growth plays an important role in establishing a diagnosis for certain diseases. In addition, it is essential for proper timing and success of treatments in many cases. Currently, there are many methods available to determine skeletal age and pubertal growth spurt. During growth, bones undergo significant changes, the sequence of which is strongly determined. These changes can be measured by various methods including radiological examinations. More specifically, these classical methods are often based on the radiological evaluation of morphological changes in the hand bones and cervical vertebrae. Methods based on dental development also exist to assess the biologic maturity of an individual. However, thanks to three-dimensional imaging techniques and molecular diagnostic methods, even more accurate tests can be performed to determine biological maturity. These modern methods rely on the information obtained from the cone-beam computer tomograph records and on the measurements of biomarkers present in different circulatory or other body fluids. The purpose of this summary is to provide an overview of the various classical and modern methods for the assessment of skeletal age that could aid us in many fields of science. Orv Hetil. 2018; 159(35): 1423-1432.

On the first occupational medicine initiatives in Mexico: The Real del Monte miners' hospital. / De las primeras iniciativas de medicina laboral en México: el hospital de mineros de Real del Monte.

Despite the legislation of Otto von Bismarck (1815-1898) on social security rights formulated in 1883 in Germany where it is stated that it is the duty of the State to promote the welfare of all members of society, particularly the weakest and most needy, using the means available to them, and the proposals of laws against accidents issued on April 30, 1904 in the State of Mexico in 1904, in the Mexico of the Porfirio Díaz era, providing workers with formal medical care was not contemplated, except in the case of some railway companies, hospitals for the care of patients with occupational diseases were not built. One of these exceptions was the Hospital del Mineral del Real del Monte de Pachuca, founded in the late nineteenth century and after the mining company passed to the Americans in 1906, it was agreed that the company acquired the hospital and equated it with the medical and surgical advances of the time for immediate care of injuries, especially of the orthopedic type, which enabled not only the healing of wounds, but also rehabilitation. This hospital is one of the oldest in Mexico with regard to three disciplines: orthopedics, occupational medicine and rehabilitation. It ceased to operate in 1982, and currently it is a museum with a rich collection of documents and instruments related to the aforementioned disciplines.

A pesar de la legislación de Otto von Bismarck (1815-1898) sobre derechos de seguridad social formulada en 1883 en Alemania donde se señala que es deber del Estado promover el bienestar de todos los miembros de la sociedad, particularmente de los más débiles y necesitados utilizando los medios con los que dispone, y las propuestas de leyes contra accidentes expedidas el 30 de abril de 1904 en el Estado de México, en el México del porfiriato no se consideró brindar atención médica formal a los trabajadores, salvo algunas empresas ferrocarrileras, no se construyeron hospitales para atender a pacientes con enfermedades laborales. Una de estas excepciones fue el Hospital del Mineral de Real del Monte de Pachuca, fundado a finales del siglo XIX y después de que la Compañía minera pasó a los norteamericanos en 1906, se acordó que la empresa adquiriera el hospital y lo equipara con los adelantos médicos y quirúrgicos de la época para la inmediata atención de lesiones, en especial de tipo ortopédico, lo que permitió curar heridas y la rehabilitación. Este nosocomio constituye uno de los antecedentes más antiguos en México en las tres disciplinas: ortopedia, medicina del trabajo y rehabilitación. Dejó de funcionar en 1982 y actualmente es un museo con un rico acervo documental y de instrumental de las disciplinas mencionadas.

What factors affect patient access and engagement with clubfoot treatment in low- and middle-income countries? Meta-synthesis of existing qualitative studies using a social ecological model.

OBJECTIVES: To conduct a systematic synthesis of previous research to identify factors that affect treatment-seeking for clubfoot and community-level interventions to improve engagement in low- and middle-income counties. METHODS: A search of five databases was conducted, and articles screened using six criteria. Quality was appraised using the Critical Appraisal Skills Programme checklist. Eleven studies were identified for inclusion. Analysis was informed by a social ecological model, which specifies five inter-related factors that may affect treatment-seeking: intrapersonal, interpersonal, institutional, community or socio-cultural factors and public policy. RESULTS: Intrapersonal barriers experienced were a lack of income and additional responsibilities. At the interpersonal level, support from fathers, the extended family and wider community affected on treatment-seeking. Institutional or organisational factors included long distances to treatment centres, insufficient information about treatments and challenges following treatment. Guardians' beliefs about the causes of clubfoot shaped behaviour. At the level of public policy, two-tiered healthcare systems made it difficult for some groups to access timely care. Interventions to address these challenges included counselling sessions, outreach clinics, brace recycling and a range of education programmes. CONCLUSIONS: This study identifies factors that affect access and engagement with clubfoot treatment across diverse settings and strategies to address them.

Exposición a radiación ionizante en médicos residentes de ortopedia en un hospital de referencia.

OBJECTIVE: To describe and analyze the exposure to ionizing radiation of orthopedic residents. METHOD: A prospective study was carried out to evaluate the degree of exposure to ionizing radiation with a bandage dosimeter placed under the lead apron for medical residents for 10 months. An online survey measured the degree of knowledge about radiation safety. RESULTS: 54 resident physicians participated. 55.6% report having knowledge of the existence of radiological protection equipment and 40.7% report that they had previous training in its use. 77.8% use the leaded apron and 31.5% use thyroid protection. 81.5% were positioned less than 1 meter from the source of the X-ray production of the arc in C. The total mean radiation exposure was 2.9 ± 2.17 mSv (95% confidence interval: 1.25-14.28; p = 0.424). CONCLUSIONS: Orthopedic residents present radiation doses below the International Commission on Radiological Protection recommended limit. However, there is a lack of knowledge of radiation protection and as well as a lack of interest and ignorance of the adverse effects of radiation.

OBJETIVO: Describir y analizar la exposición a radiación ionizante de los residentes de ortopedia. MÉTODO: Se realizó un estudio prospectivo para evaluar el grado de exposición a radiación ionizante con un dosímetro de placa colocado debajo del mandil plomado a médicos residentes, por 10 meses. Mediante una encuesta en línea se midió el grado de conocimientos sobre seguridad radiológica. RESULTADOS: Participaron 54 médicos residentes. El 55.6% refiere tener conocimiento de la existencia de equipo de protección radiológica y el 40.7% refiere que tuvo entrenamiento previo en su uso. El 77.8% utiliza el mandil plomado y el 31.5% la protección tiroidea. El 81.5% se posicionó a menos de 1 metro de la fuente de producción de rayos X del arco en C. La exposición a la radiación media total fue de 2.9 ± 2.17 mSv (intervalo de confianza del 95%: 1.25-14.28; p = 0.424). CONCLUSIONES: Los médicos residentes de ortopedia presentan dosis de radiación menores que el límite recomendado por la International Commission on Radiological Protection. Sin embargo, existe una falta de conocimientos sobre protección radiológica, así como falta de interés e ignorancia de los efectos adversos de la radiación.

[Translated article] Effect of the COVID pandemic on paediatric trauma emergencies in three areas of Spain with different incidence.

INTRODUCTION AND OBJECTIVES: Although much has been published on the effect of the pandemic on trauma emergencies, it has not been analysed whether the incidence of infection or different organisation of available resources according to the Spanish region were influential factors. We present a multicenter study of three tertiary hospitals in three Spanish cities with different characteristics to study how these factors influenced paediatric trauma emergencies during the first wave of the pandemic. MATERIAL AND METHODS: We present a retrospective cohort study that compares and analyzes paediatric trauma emergencies in three different hospitals during the period of the first wave of the COVID-19 pandemic and we compare them with the same period of the previous year, analyzing the number of emergencies, the severity of the pathology, the average age of the patients, the days of admission and the waiting time of the cases that required surgical treatment. RESULTS: A total of 6474 paediatric trauma emergency episodes have been analysed. There was a drastic reduction in activity in the three hospitals, but in different amounts: 83.5% in the hospital located in Madrid, 75% in the hospital located in Valencia and 65.9% in the one located in Palma, Majorca. The emergencies attended were more serious in 2020 compared to 2019. The average age of patients treated during the pandemic was lower compared to the previous year. There were no differences in the days of admission, but there were differences in the delay in surgery for surgical fractures. CONCLUSIONS: The impact of the first wave of the COVID-19 pandemic and the decreed confinement had a different impact on paediatric trauma emergencies in the different hospitals according to the incidence of infection and the measures adopted in the different regions. In all cases there was a significant reduction in activity, a greater proportion of medium and severe pathologies were attended to, the average age of the patients attended was lower and a delay was observed in surgeries performed in the emergency room, probably due to the need to request a PCR test to detect a COVID-19 infection.

Scientific Idea of Professor Marian Weiss.

This year marks the 100th birth anniversary of Professor Marian Alan Weiss. The following article serves as a reminder of this magnificent man, doctor and scientist and his indisputable multifaceted accomplishments. Prof. Weiss was a brilliant organizer. He proposed and then formed the largest medical rehabilitation centre in Poland, the STOCER Capital Rehabilitation Centre in Konstantin, and established one of the first university departments of rehabilitation in Europe. His medical achievements included Weiss' spring arthroplasty, a me-thod for stabilising the spine after an injury. He also promoted myoplastic amputation and early intraoperative prosthetic support (so-called rapid prosthesis) as well as early comprehensive rehabilitation, which is widely recognized today. Prof. Weiss was a first-rate scientist and lecturer. He published more than 200 articles in Polish and international journals, a few textbooks and monographs. He delivered many lectures and presentations at domestic and international congresses and symposia. As early as 1959, he lectured at international seminars on prosthetics and rehabilitation of amputees. As an expert of the WHO Regional Bureau, he organized international training workshops on rehabilitation, with English and French as languages of instruction. He was an honorary member of the New York Physical Medicine Society, held an honorary doctorate from Rennes University and an honorary membership of the Swedish Orthopaedic Society, and received the Honorary Medal of Vishnevsky Institute in Moscow. He also was Vice-president of the "Paraplegia" International Medical Society. His unexpected death in 1961 put an end to his further organizational, professional, scientific and educational plans.

Comparison of Locked Plates and Blade Plates for Varus Osteotomy of the Proximal Femur by the Finite Element Method / Avaliação entre placas bloqueadas e placas lâmina para osteotomia varizante do fêmur proximal pelo método dos elementos finitos

Abstract 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.

Resumo Objetivo: Testar a diferença do comportamento de distribuição de cargas e pressões da placa lâmina comparativamente com a placa bloqueada para osteotomia varizante do fêmur proximal através do método de elementos finitos. Métodos: A modelagem foi realizada através do escaneamento de um fêmur esquerdo com deformidade medial em valgo fabricado em poliuretano de tamanho médio. Resultados: Como resultados, pode-se inferir que a rigidez da placa bloqueada é maior do que a da placa lâmina. No entanto, essa diferença não foi significativa e, além disso, a placa bloqueada possui parafusos de travamento proximal para garantir que os momentos de flexão que agem nos parafusos sejam ainda menores durante o carregamento. Conclusão: Em síntese, ambos os materiais são consagrados e eficazes para serem utilizados, porém o estudo pelo método de elementos finitos apresenta papel importante para compreendermos a situação de distribuição de cargas e pressões do implante e abre novas possibilidades para novos estudos, como, por exemplo, o estudo da proposta cirúrgica e materiais a serem implantados de forma individual e personalizada.

What is the epidemiological profile of acute hand infections at a hospital in sao paulo? / Qual o perfil epidemiológico de infecções agudas na mão num hospital filantrópico de são paulo?

ABSTRACT Objective: To determine the epidemiological profile of patients treated at a philanthropic hospital specialized in Orthopedics and Traumatology, located in a significant urban center, and evaluate the efficacy of initial empirical antibiotic treatment. Methods: Patients diagnosed with hand infections from September 2020 to September 2022 were included, excluding cases related to open fractures or post-surgical infections and those with incomplete medical records. The chi-square test was performed using STATISTICA ® software to correlate various variables. Results: A total of 34 patients participated, including 24 men and 10 women, with an average age of 41.9 years. Most male patients had Diabetes Mellitus, HIV, and drug addiction, and they resided in urban areas. Half of the patients did not report any apparent trauma. The most common infectious agent was Staphylococcus aureus*. Nearly 62% of patients required a change in the initial antibiotic regimen, with Penicillin being the most frequently substituted medication. Beta-lactam antibiotics and Quinolones were the most effective. Conclusion: These results suggest the importance of carefully evaluating the epidemiological profile of patients with acute hand infections and improving initial empirical treatment to ensure appropriate and effective therapy. Level of Evidence IV, Cross-Sectional Observational Study.

RESUMO Objetivo: Determinar o perfil epidemiológico de pacientes atendidos em um hospital filantrópico referência em Ortopedia e Traumatologia localizado em um centro urbano importante, e avaliar a eficácia do tratamento antibiótico empírico inicial. Métodos: Foram incluídos pacientes com diagnóstico de infecção na mão, atendidos no período de setembro de 2020 a setembro de 2022, excluindo-se casos relacionados a fraturas expostas ou pós-cirúrgicas e aqueles com prontuários incompletos. Realizou-se o teste do qui-quadrado, utilizando o software STATISTICA ® para correlacionar diversas variáveis. Resultados: Participaram do estudo 34 pacientes, sendo 24 homens e 10 mulheres, com média de idade de 41,9 anos. A maioria era de homens, com alta incidência de diabetes mellitus, HIV e drogadição, que residiam em áreas livres. Metade não relatou trauma evidente. O agente infeccioso mais comum foi o Staphylococcus aureus. Aproximadamente 62% dos pacientes precisaram de troca do esquema inicial de antibióticos, sendo a penicilina o medicamento mais frequentemente substituído. Os antibióticos beta-lactâmicos e quinolonas foram os mais eficientes. Conclusão: Esses resultados sugerem a importância de avaliar cuidadosamente o perfil epidemiológico dos pacientes com infecções agudas na mão e aprimorar o tratamento empírico inicial para garantir uma terapia adequada e eficaz. Nível de Evidência IV, Estudo Observacional Transversal.

Social Media Use among Orthopedic Trauma Fellowship-trained Surgeons / Uso de redes sociais por cirurgiões com treinamento especializado em trauma ortopédico

Abstract Objective: To quantify the use of social media platforms by orthopedic traumatologists with an emphasis on demographic, practice-based, and regional differences. Materials and Methods: Using the Orthopaedic Trauma Association (OTA) membership database, online searches were performed to identify professional profiles on numerous social media platforms. This presence was then quantified by a cumulative social media score which was correlated to the demographic information collected. Results: In total, 1,262 active fellowship-trained orthopedic traumatologists were identified. Surgeons practicing in an academic setting were found to be more likely to use numerous social media platforms and to present an overall greater social media score than those in private practices. No significant differences in use were found based on practice region. Conclusion: Social media platforms are currently underused by orthopedic traumatologists. Level of Evidence: IV.

Resumo Objetivo: Quantificar o uso de plataformas de rede social por traumato-ortopedistas, com ênfase nas diferenças demográficas, regionais e de tipo de prática clínica. Materiais e Métodos: Utilizando o banco de dados de membros da Orthopaedic Trauma Association (OTA), foram realizadas pesquisas on-line para identificar perfis de profissionais em diversas plataformas de rede social. Esta presença foi quantificada por uma pontuação cumulativa de redes sociais, que foi correlacionada com as informações demográficas coletadas. Resultados: Foram identificados 1.262 profissionais com treinamento especializado em trauma ortopédico. Observou-se que os cirurgiões que atuam em ambiente acadêmico têm maior probabilidade de usar diversas plataformas de rede social e apresentam pontuação geral maior em redes sociais do que aqueles que atuam em consultório particular. Não foram encontradas diferenças significativas quanto ao uso de redes sociais com base na região de atuação. Conclusão: Atualmente, as plataformas de rede social são subutilizadas pelos traumato-ortopedistas. Nível de Evidência: IV.

Methodology for Preoperative Planning of Bone Deformities Using Three-dimensional Modeling Software / Metodologia para planejamento pré-operatório de deformidades ósseas utilizando software de modelagem tridimensional

Abstract Rapid prototyping technology, known as three-dimensional (3D) printing, and its use in the medical field are advancing. Studies on severe bone deformity treatment with 3D printing showed benefits in postoperative outcomes thanks to this technology. Even so, preoperative planning guidance for surgeons is lacking. This technical note describes a practical step-by-step guide to help surgeons use this technology to optimize the therapeutic plan with free license software and an intuitive interface. This study aims to organize the 3D modeling process using a preoperative computed tomography (CT) scan. This technology allows a deeper understanding of the case and its particularities, such as the direction, planes, and dimensions of the deformity. Planning considering these topics may reduce the surgical time and result in better functional outcomes by understanding the deformity and how to correct it. Associating planning via software with 3D printing can further enhance this therapeutic method.

Resumo Observa-se o avanço da tecnologia de prototipagem rápida, conhecida como impressão tridimensional (3D) e seu uso na área médica. Existem estudos a respeito do tratamento de deformidades ósseas graves com impressão 3D, os quais mostram benefícios no resultado pós-operatório às custas do uso da tecnologia em questão. Ainda assim, nota-se a escassez quando o assunto é disponibilizar ao cirurgião orientações para planejamento pré-operatório. O objetivo desta nota técnica é descrever um passo-a-passo prático para auxiliar cirurgiões a utilizarem a tecnologia como ferramenta para otimizar o plano terapêutico, dispondo de um programa de licença gratuita e de interface intuitiva. Este é um estudo que visa a organização do processo de modelagem 3D, no qual foi utilizado um exame de tomografia computadorizada (TC) pré-operatória. Com esta tecnologia, é possível uma compreensão mais profunda do caso e suas particularidades como direção, planos e dimensões das deformidades. Acredita-se que um planejamento que leve em consideração tais tópicos gera redução do tempo cirúrgico e melhores resultados funcionais devido ao entendimento da deformidade e maneiras de correção. Associar o planejamento via software com a impressão 3D pode potencializar ainda mais na elaboração do método terapêutico.

Avaliação do perfil do egresso e da residência médica em ortopedia e traumatologia do HCFMRP-USP / Evaluation of the graduate profile and of the medical residency in orthopedics and traumatology at HCFMRP-USP

Resumo Introdução: Bons programas de residência médica (PRM) devem investir na estruturação e no desenvolvimento contínuo dos serviços de assistência no contexto da rede de saúde, na organização da estrutura de apoio às atividades didáticas e assistenciais, e na remuneração e capacitação contínua de preceptores e coordenadores. Objetivo: Este estudo observacional, transversal e descritivo buscou caracterizar o perfil dos egressos do Programa de Residência Médica em Ortopedia e Traumatologia (PRMOT) do HCFMRP-USP e coletar dados sobre as características do programa que orientem ações de aperfeiçoamento na metodologia de ensino. Método: Participaram do estudo egressos do PRMOT ou que concluíram os programas de complementação especializada e residência médica em cirurgia da mão entre 1964 e 2020. Resultado: Foi encaminhado um questionário a 302 indivíduos (73,6% do total de egressos), obtendo 214 respostas (70,8% dos indivíduos contatados ou 52,2% do total de egressos). Indivíduos do sexo masculino correspondem a 92,5% dos egressos, e 71,9% residem no estado de São Paulo. As duas subespecialidades mais cursadas foram cirurgia do joelho e da mão. A pós-graduação stricto sensu fez parte da formação acadêmica de 40,6% dos egressos, dos quais 60,7% trabalharam com ensino médico. Dos egressos, 71% atuam na subespecialidade escolhida. Na avaliação do ensino do PRMOT e do grau de satisfação profissional, os aspectos que se destacaram positivamente foram: capacitação para atendimento em níveis terciário e secundário, número de atendimentos, variabilidade dos casos e preparo para o mercado de trabalho. Os aspectos que se destacaram negativamente foram: remuneração mensal, carga horária de aulas teóricas e realização de procedimentos cirúrgicos. Conclusão: O estudo conseguiu traçar o perfil do egresso e determinar os pontos fortes e as oportunidades de melhoria do PRMOT do HCFMRP-USP.

Abstract Introduction: Good Medical Residency Programs (PRM) must invest in the structuring and continuous development of care services in the health network setting; in the organization of the support structure for teaching and care activities and in the remuneration and continuous training of preceptors and coordinators. Objective: This study is an observational, cross-sectional, and descriptive investigation aimed at providing an in-depth understanding of the characteristics of individuals who have successfully completed the medical residency program in Orthopedics and Traumatology (MRPOT) at the Clinic Hospital of the Faculty of Medicine of Ribeirão Preto, University of São Paulo. Additionally, the study seeks to gather comprehensive data regarding the features of the educational program in order to offer insights for potential enhancements. The study encompassed a total of 418 participants who completed their training between 1964 and 2020. Methods: This group includes physicians who not only graduated from the MRPOT but also those who completed supplementary specialized programs and medical residencies in hand surgery, all within the same department. Data were systematically collected through an electronic questionnaire. Results: Among the participants, 302 graduates (73.6% of the total cohort) were identified, and responses were obtained from 214 individuals, which corresponds to 70.8% of the reached contacts or 52.2% of the entire graduate pool. The predominant demographic of the sample is male, with 198 respondents (92.5%), most of whom reside in the state of São Paulo (154 individuals, 71.9%). A significant portion of the participants, 184 (86%), pursued further specialized training or embarked on additional medical residencies within the field. The most prevalent subspecialties within this group are Knee Surgery, accounting for 63 individuals (34.2%), and Hand Surgery, comprising 49 individuals (26.6%). Postgraduate education played a role in the academic training of 87 respondents (40.6%). Research activities primarily took place within public universities (81%) and were carried out by 79 graduates (36.9%). A substantial proportion, 130 individuals (60.7%), had prior experience in medical education, either as preceptors or professors for both undergraduate and medical residency levels. The majority of participants, 152 individuals (71%), currently practice within their respective subspecialties. However, a considerable number of graduates also engage in traumatology (34.1%) and general orthopedics (31.8%). The evaluation of the educational framework of the program and the level of professional satisfaction revealed notable aspects that received positive assessments from the respondents. These included the diversity and volume of cases, training tailored for tertiary and secondary care, and preparation for the professional sphere. On the other hand, concerns were raised regarding the adequacy of monthly remuneration, the scarcity of theoretical instruction, and the limited exposure to surgical training. These specific areas garnered lower scores both in the objective metrics and subjective feedback. Conclusion: This study effectively delineated the characteristics of MRPOT graduates and identified the program's key strengths. Simultaneously, it highlights areas that have drawn criticism and warrant attention.

Surgical site infection in patients undergoing hip and knee arthroplastie / Infección del sitio quirúrgico en pacientes sometidos a artroplastias de cadera y rodilla / Infecção de sítio cirúrgico em pacientes submetidos a artroplastias de quadril e joelho

Objective: To characterize cases of Surgical Site Infections (SSI) in patients undergoing hip and knee arthroplasties. Method: A cross-sectional, retrospective, and quantitative study conducted in a public, teaching, and high-complexity hospital in the southern region of Brazil. Data collection took place between 2020 and 2022 from records contained in 91 medical records and post-discharge forms within 90 days after surgery for prosthesis implan-tation. Data were analyzed by descriptive statistics and SSI incidence rate. Results: 49 (53.8%) knee arthroplasty records and 42 (46.2%) hip arthroplasty records were analyzed. Five cases developed infection, all detected at the post-arthroplasty knee outpatient visit, resulting in an SSI incidence rate in arthroplasties of 5.5% (n=5). Infections were characterized as deep incisional (40%; n=2), organ or cavity (40%; n=2), and superficial (20%; n=1), resul-ting in readmission in 80% of cases and a corresponding average hospitalization time of 11 days (SD=4.2). Conclusion: The significant rate of SSI in clean surgeries points to the need to intensify good surgical practices. Outpatient surveillance is emphasized as a strategy for building realistic indicators and providing support for prevention efforts. (AU)

Objetivo: Caracterizar los casos de Infecciones del Sitio Quirúrgico (ISQ) en pacientes sometidos a artroplastia de cadera y rodilla. Método: Investigación transversal, retrospectiva y cuantitativa realizada en un hospital público, docente y de alta complejidad en la región sur de Brasil. La reco-lección de datos se realizó entre 2020 y 2022 en registros contenidos en 91 historias clínicas y formularios posteriores al alta hospitalaria en un período de hasta 90 días después de la cirugía destinada al implante de la prótesis. Los datos fueron analizaron mediante estadística descriptiva y tasa de incidencia de ISQ. Resultados: Se analizaron 49 (53,8%) registros de artroplastia de rodilla y 42 (46,2%) de cadera. Cinco casos evolucionaron con infección, todos detectados en el seguimiento ambulatorio después de la artroplastia de rodilla, lo que resultó en una tasa de incidencia de ISQ en artroplastias del 5,5% (n=5). Las infecciones se caracterizaron como incisionales profundas (40%; n=2), de órgano o cavidad (40%; n=2) y superficiales (20%; n=1); resultando en reingreso en el 80% de los casos y el correspondiente tiempo promedio de hospitalización de 11 días (SD=4,2). Conclusión: La tasa significativa de ISQ en cirugías limpias apunta a la necesidad de intensificar las buenas prácticas quirúrgicas. Se reitera la vigilancia ambulatoria como estrategia para la construcción realista de indicadores y apoyo a la prevención. (AU)

Objetivo: Caracterizar os casos de Infecções de Sítio Cirúrgico (ISC) em pacientes submetidos a artroplastias de quadril e joelho. Método:Pesquisa transversal, retrospectiva e quantitativa realizada em um hospital público, de ensino e de alta complexidade da região sul do Brasil. A coleta de dados ocorreu entre 2020 e 2022 em registros contidos em 91 prontuários e fichas pós alta hospitalar no período de até 90 dias após a cirurgia destinada ao implante da prótese. Os dados foram analisados por estatística descritiva e taxa de incidência de ISC. Resultados: Foram analisados 49 (53,8%) regis-tros de artroplastia de joelho e 42 (46,2%) de quadril. Cinco casos evoluíram com infecção, todos detectados no retorno ambulatorial pós artroplastia de joelho, resultando em taxa de incidência de ISC em artroplastias de 5,5% (n=5). As infecções foram caracterizadas como incisional profunda (40%; n=2), de órgão ou cavidade (40%; n=2) e superficial (20%; n=1); decorrendo em reinternação em 80% dos casos e correspondente tempo médio de hospitaliza-ção de 11 dias (DP=4,2). Conclusão: O expressivo índice de ISC em cirurgias limpas direciona para a necessidade de intensificar boas práticas cirúrgicas. Reitera-se a vigilância ambulatorial como estratégia para a construção realística de indicadores e subsídio para a prevenção. (AU)

Osteochondritis dissecans of the hip in legg-calvé-perthes disease: case report and review / Osteocondrite dissecante do quadril na doença de legg-calvé-perthes: relato de caso e revisão

ABSTRACT Introduction: Legg-Calvé-Perthes disease (LCPD) is the idiopathic osteonecrosis of the capital femoral epiphysis in children. It is a self-healing condition, and the morphology of the hip may vary according to the severity of the disease, among several other factors. The treatment focuses on attempts to prevent femoral head collapse, obtain functional hip motion recovery, and reduce pain. Osteochondritis Dissecans (OCD) of the femoral head has been reported in 2% to 7% of patients diagnosed with healed LCPD. Although OCD may remain asymptomatic, the osteochondral fragment has the potential to become unstable, evolving into symptoms of pain, locking, catching, and snapping. Case report: We present a case report of a ten-year-old boy with an OCD lesion following LCPD who underwent effective osteochondral fixation through the surgical hip dislocation approach. The patient evolved to excellent functional recovery at 1 year post-operatively. Discussion: The surgical hip dislocation approach allows anatomical fixation of the OCD fragment, as well as improvement of hip biomechanics, decreasing pain, improving range of motion and joint congruency, and preserving the native articular cartilage. It also gives the surgeon the opportunity to assess hip stability, femoroacetabular impingement and labral tears, allowing a wide variety of options for the treatment of the healed LCPD. Level of Evidence IV; Type of study Case Report.

RESUMO Introdução: A Doença de Legg-Calvé-Perthes (DLCP) é a osteonecrose idiopática da epífise femoral proximal em crianças. É uma condição auto resolutiva, porém a morfologia final do quadril pode variar de acordo com a gravidade da doença. O tratamento concentra-se na tentativa de prevenir o colapso da cabeça femoral, obtendo recuperação funcional do movimento do quadril e redução da dor. A osteocondrite dissecante (OCD) da cabeça femoral foi relatada em 2% a 7% dos pacientes diagnosticados com DLCP já curada. Embora a OCD possa permanecer assintomática, o fragmento osteocondral tem potencial para se tornar instável, evoluindo para sintomas de dor, bloqueio, impacto e estalido. Relato de caso: Apresentamos o relato de caso de um menino de 10 anos com OCD da cabeça femoral após DLCP, submetido à fixação osteocondral do fragmento por meio da abordagem cirúrgica de luxação do quadril. O paciente evoluiu com excelente recuperação funcional 1 ano após a cirurgia. Discussão: A abordagem cirúrgica da luxação do quadril permite a fixação anatômica do fragmento da OCD, bem como a melhora da biomecânica do quadril, diminuindo a dor, melhorando a amplitude de movimento e a congruência articular e preservando a cartilagem articular nativa. Também dá ao cirurgião a oportunidade de avaliar a estabilidade do quadril, impacto femoroacetabular e lesões labrais, permitindo uma ampla variedade de opções para o tratamento das sequelas da DLCP. Nível de evidência IV; tipo de estudo Relato de Casos.

Effects of Adipose-derived Stem Cells in the Treatment of Knee Osteoarthritis: A Case Report in Brazil's Unified Health System / Efeitos das células-tronco mesenquimais no tratamento da osteoartrite de joelho: Um relato de caso no Sistema Único de Saúde do Brasil

Abstract Osteoarthritis (OA) can incapacitate the individual to perform their activities of daily living due to pain. This is an important public health issue that worsens worldwide and in Brazil, since the population goes through an aging process, and has caused increased public spending on the monitoring and maintenance of treatments that can last for years and still not be resolutive. Thus, the search for innovative and effective therapies that can reduce costs becomes necessary. In this context, the present study reports the first application of cell therapy with adipose-derived stem cells in the treatment of cases of OA that are refractory to the conservative treatment, performed in the Brazilian Unified Health System (Sistema Único de Saúde, SUS). The evaluation was performed with the application of the Visual Analog Scale (VAS), the Short Form Health Survey (SF-36) and the Western Ontario and McMaster Universities (WOMAC), specifics for OA evaluation, and also an analysis of the synovial fluid (inflammatory cytokines). The cell therapy improved the scores on the WOMAC, SF-36 and EVA, and reduced the inflammatory process. We observed a decrease of 0.73x in the TNF, of 0,71x in IL-1b, of 0,68x in IL-8, and of 0,70x in IL-10. For IL-6, an increase of 1,48x was observed. Therefore, this cell therapy can be considered promising in aiding the management of this disease, since it improved the patient's pain, decrease inflammatory markers, and enabled the return to activities of daily living, which resulted in an improvement in their quality of life.

Resumo A osteoartrite (OA) pode deixar o indivíduo incapacitado para realizar suas atividades da vida diária devido ao quadro álgico. Essa é uma importante questão de saúde pública que se agrava no mundo inteiro e no Brasil, uma vez que a população passa pelo processo de envelhecimento, e isso causa um aumento nos gastos públicos com o acompanhamento e manutenção dos tratamentos que podem perdurar por anos e mesmo assim não serem resolutivos. Assim, torna-se necessária a busca por terapias inovadoras e eficazes que possam reduzir esses custos. Nesse contexto, o presente estudo relata a primeira aplicação de terapia celular com células-tronco mesenquimais do tecido adiposo no tratamento de OA refratária ao tratamento conservador realizada no Sistema Único de Saúde (SUS). Na avaliação, foram usados os instrumentos Escala Visual Analógica (EVA), os questionários de qualidade de vida Short Form Health Survey (SF-36) e Western Ontario and McMaster Universities (WOMAC), específicos para avaliação da OA, e fez-se uma análise do líquido sinovial (citocinas inflamatórias). A terapia celular melhorou as pontuações no WOMAC, SF-36, e EVA, e reduziu o processo inflamatório. Observou-se redução de 0,73 × do TNF, de 0,71 × da IL-1b, de 0,68 × da IL-8, e de 0,70 × da IL-10. Já para a IL-6, observou-se aumento de 1,48 ×. Portanto, considera-se este tipo de terapia celular promissora no auxílio do manejo desta doença, pois melhorou o quadro álgico do paciente, reduziu os marcadores inflamatórios, e possibilitou o retorno às atividades da vida diária, o que resultou em uma melhora de sua qualidade de vida.

Insuficiente aplicación de Medicina Natural y Tradicional en afecciones relacionadas con la ortopedia y la traumatología / Unsatisfactory Application of Natural and Traditional Medicine in Conditions Related with Orthopedics and Traumatology

La Medicina Natural y Tradicional aplica sus diferentes modalidades en la práctica médica moderna, segura, económica, inocua y simple; y con pocos efectos colaterales resuelve grandes problemas de salud en situaciones especiales o de desastres con recursos limitados. De ahí que el egresado de programas de especialización de las ciencias médicas cuenta con sólidos conocimientos para su aplicación, especialmente en las afecciones osteomioarticulares, donde la especialidad de ortopedia y traumatología tiene un papel primordial para identificar las causas y consecuencias de la insuficiencia de su aplicación en pacientes portadores de afecciones relacionadas con esta especialidad. A través de un estudio crítico reflexivo basado en el análisis y la síntesis, así como de la constatación de la validez de los puntos de vista asumidos como referentes en el proceso de superación del especialista de ortopedia y traumatología, se pudo mostrar cómo se ha concebido la superación profesional en el Hospital General Dr. Juan Bruno Zayas Alfonso, al integrar adecuadamente los conocimientos y las competencias. Esto se expresó en la elaboración e implementación de una estrategia de superación profesional, que permitió la actualización de relevantes conocimientos necesarios en el campo de la MNT para el desempeño de este profesional. Se concluyó que era insuficiente el nivel de conocimiento de los contenidos, como también los cursos ofertados para su desarrollo, lo que trajo como consecuencia una atención médica sin calidad(AU)

Natural and traditional medicine applies its different modalities in modern, safe, economical, innocuous and simple medical practice; with few collateral effects, it solves major health problems in special or disaster situations with limited resources. Hence, the graduate of specialization programs in medical sciences possesses solid knowledge for its application, especially in osteomyoarticular conditions, in which the specialty of orthopedics and traumatology has a key role in identifying the causes and consequences of its unsatisfactory application in patients with conditions related to this specialty. Through a reflexive and critical study based on analysis and synthesis, as well as the verification of the validity of the viewpoints assumed as referents in the process of improvement of the orthopedics and traumatology specialist, it was possible to show how professional improvement has been conceived at Hospital General Dr. Juan Bruno Zayas Alfonso, by adequately integrating knowledge and competences. This was expressed through the elaboration and implementation of a professional improvement strategy, which allowed updating relevant knowledge necessary in the field of natural and traditional medicine for the performance of this professional. The level of knowledge about the contents was concluded to be insufficient, while the courses offered for its development were so, which resulted in a medical care without quality(AU)

Uso de técnicas no farmacológicas para favorecer el estado emocional durante la aplicación del método Ponseti en pacientes pediátricos con pie equino varo congénito en Bogotá, Colombia / Non-pharmacological techniques to improve emotional state while using the Ponseti method in pediatric patients with congenital talipes equinovarus in Bogotá, Colombia

Introducción. Durante la aplicación del método Ponseti (MP), el niño puede mostrar incomodidad, tensión muscular o movimientos corporales que hacen del procedimiento una experiencia desagradable y estresante para pacientes, familiares y personal de salud.Objetivos. Describir los desenlaces de la aplicación de técnicas no farmacológicas (TNF) para el favorecer el estado emocional durante la atención estándar de pacientes con pie equino varo congénito (PEVC) tratados con el MP, el nivel de satisfacción del paciente y su familia con la atención recibida y la calidad de la atención en salud, y evaluar los posibles factores asociados al éxito de la aplicación de las TNF. Metodología. Estudio observacional descriptivo realizado en una cohorte de 21 niños atendidos en una clínica Ponseti de Bogotá (Colombia) entre febrero y noviembre de 2021. Las TNF se aplicaron en dos esquemas diferenciados por los sentidos estimulados. Los datos se describen usando medidas de tendencia central y de dispersión (prueba de Shapiro-Wilk), y la asociación exploratoria entre tener éxito en los esquemas de TNF y las variables se determinó con la prueba de chi-cuadrado (p≥0,05).Resultados. La mediana de edad fue 4,5 meses y el primer esquema de TNF fue exitoso en el 66,67% de los pacientes (97 consultas). El nivel de satisfacción de los cuidadores fue alto (86,07%). El equipo sanitario reportó que el procedimiento fue "extremadamente fácil" o "muy fácil" (86,07%-88,52%). Se identificaron como posibles factores asociados explor-atoriamente al éxito del primer esquema de TNF el sexo, antecedente de tratamiento con MP, y nivel de satisfacción del cuidador con la atención recibida.Conclusión. Las TNF mejoran el estado psicoemocional del niño, facilitando la aplicación del MP y aumentando la satisfacción del cuidador y del equipo sanitario con las sesiones de tratamiento

Introduction: Children may show discomfort, muscle tension or body movements while using the Ponseti method (PM), making the procedure an unpleasant and stressful experience for patients, family members, and health care personnel. Objectives: To describe the outcomes achieved following the use of non-pharmacological techniques (NPT) for emotional support when providing standard care to patients with congenital talipes equinovarus (CTEV) treated with the PM, as well as the level of patient and family satisfaction with the care received and the quality of health care, and to evaluate the possible factors associated with the success of the use of NPT.Methodology: Descriptive observational study conducted in a cohort of 21 children treated in a Ponseti clinic in Bogotá (Colombia) between February and November 2021. NPT were implemented in two schemes differentiated by the senses stimulated. Data are described using measures of central tendency and dispersion (Shapiro-Wilk test), and the exploratory association between having success with the NPT schemes and the variables was determined using the chi-square test (p≥0.05). Results: The median age was 4.5 months, and the first NPT scheme was successful in 66.67% of patients (97 consultations). The level of caregiver satisfaction was high (86.07%). The healthcare team reported that the procedure was "extremely easy" or "very easy" (86.07%-88.52%). Possible factors exploratorily associated with the success of the first NPT scheme were identified as gender, history of treatment with the PM, and level of caregiver satisfaction with the care received.Conclusion: NPT improve the psychoemotional state of the child, facilitating PM implementation, and increasing caregiver and healthcare team satisfaction with the treatment sessions

Ortopedia prequirúrgica en paciente de un año de vida con labio y paladar hendido no sindrómico sin queiloplastia previa: reporte de caso / Ortopedia pré-cirúrgica em paciente de um ano de idade com fissura labiopalatina não sindrômica sem queiloplastia prévia: relato de caso / Pre-surgical orthopedics in a one-year-old patient with non-syndromic cleft lip and palate without prior cheiloplasty: case report

El labio/paladar hendido (LPH), se produce debido a la falta de la fusión de numerosos procesos faciales durante las primeras semanas del desarrollo embrionario. El uso de ortopedia prequirúrgica nos ayuda a corregir el colapso óseo que los pacientes con LPH pueden presentar, así como estimular el crecimiento de los segmentos palatinos iniciando su uso en las primeras horas de vida. Debido a la pandemia ocasionada por COVID, muchos pacientes no recibieron atención, generando una necesidad de tratamiento enfocado en sus características. Objetivo. Generar desarrollo transversal en un paciente masculino de 1 año de vida y rotar el segmento maxilar izquierdo para conformar el arco, y así, favorecer el pronóstico de la cirugía del paciente con labio y paladar hendido sin queiloplastia al año de vida. Presentación del caso. Paciente masculino con labio y paladar hendido sin queiloplastia al año de vida se presenta a clínica de labio paladar hendido TiENES que sonreír, UNAMos esfuerzos. Refiere haber sido tratado con ortopedia prequirúrgica. Clínicamente se observa labio paladar hendido, además del segmento maxilar izquierdo colapsado, generando una falta de continuidad y perímetro de arco. La fase de tratamiento consistió en una placa removible unida en su parte central por tres helix, para rotar el segmento maxilar izquierdo. Resultados. Se generó un desarrollo maxilar adecuado y se conformó el arco. Conclusiones. Es importante resaltar las características de cada caso para así poder generar un plan de tratamiento apto a las necesidades del paciente, ya que esto mejora el pronóstico postquirúrgico.

A fissura labiopalatina (FLP) ocorre devido à falta de fusão de numerosos processos faciais durante as primeiras semanas de desenvolvimento embrionário. O uso da ortopedia pré-cirúrgica nos ajuda a corrigir o colapso ósseo que os pacientes com FLP podem apresentar, bem como estimular o crescimento dos segmentos palatinos iniciando seu uso nas primeiras horas de vida. Devido à pandemia causada pela COVID, muitos pacientes não receberam atendimento, gerando necessidade de tratamento focado em suas características. Mirar. Gerar desenvolvimento transversal em paciente do sexo masculino com 1 ano de idade e girar o segmento maxilar esquerdo para formar o arco, e assim, favorecer o prognóstico da cirurgia para o paciente com fissura labiopalatina sem queiloplastia com um ano de idade. Apresentação do caso. Paciente do sexo masculino com fissura labiopalatina sem queiloplastia com um ano de idade se apresenta na clínica de fissura labiopalatina VOCÊ TEM QUE SORRIR, JUNTE-SE A NÓS Esforços. Relata ter sido tratado com ortopedia pré-cirúrgica. Clinicamente observa-se fissura labiopalatina, além do segmento maxilar esquerdo colapsado, gerando falta de continuidade e perímetro do arco. A fase de tratamento consistiu em uma placa removível unida em sua parte central por três hélices, para rotação do segmento maxilar esquerdo. Resultados. O desenvolvimento maxilar adequado foi gerado e o arco foi formado. Conclusões. É importante destacar as características de cada caso para gerar um plano de tratamento adequado às necessidades do paciente, pois isso melhora o prognóstico pós-cirúrgico

Cleft lip/palate (CLP) occurs due to the lack of fusion of numerous facial processes during the first weeks of embryonic development. The use of presurgical orthopedics helps us correct the bone collapse that patients with CLP may present, as well as stimulate the growth of the palatal segments by starting its use in the first hours of life. Due to the pandemic caused by COVID, many patients did not receive care, generating a need for treatment focused on their characteristics. Aim. Generate transverse development in a 1-year-old male patient and rotate the left maxillary segment to form the arch, and thus, favor the prognosis of surgery for the patient with cleft lip and palate without cheiloplasty at one year of age. Presentation of the case. Male patient with cleft lip and palate without cheiloplasty at one year of age presents to cleft lip and palate clinic. YOU HAVE TO SMILE, JOIN US Efforts. He reports having been treated with pre-surgical orthopedics. Clinically, a cleft lip and palate is observed, in addition to the collapsed left maxillary segment, generating a lack of continuity and arch perimeter. The treatment phase consisted of a removable plate joined in its central part by three helixes, to rotate the left maxillary segment. Results. Adequate maxillary development was generated and the arch was formed. Conclusions. It is important to highlight the characteristics of each case in order to generate a treatment plan suitable for the patient's needs, since this improves the postsurgical prognosis.

Anatomía humana. Inicios y actualidad / Human anatomy. Beginnings and current state

Siempre se ha enfatizado la importancia de la anatomía humana como base de la formación de los cirujanos ortopédicos, por lo que esta materia siempre hará parte del plan de estudios de la especialización en ortopedia y traumatología. En este sentido, si bien para muchos médicos los cursos de anatomía no traen muy buenos recuerdos, para otros la anatomía se vuelve una pasión, especialmente aquellos que optan por estudiar especialidades quirúrgicas.

The importance of human anatomy has always been emphasized as the basis for the training of orthopedic surgeons, so this subject will always be part of the curriculum of the specialization in orthopedics and traumatology. In this sense, although for many doctors anatomy courses do not bring back very good memories, for others anatomy becomes a passion, especially those who choose to study surgical specialties.

Nursing Delirium Screening Scale: Avaliação das propriedades psicométricas num serviço de ortopedia em Portugal / Nursing Delirium Screening Scale: Evaluation of psychometric properties in an orthopedic service in Portugal / Nursing Delirium Screening Scale: Evaluación de las propiedades psicométricas en un servicio de ortopedia de Portugal

Resumo Enquadramento: A identificação do delirium pelos enfermeiros é de extrema relevância. Assim, parece relevante a possibilidade de recurso à versão portuguesa da Nursing Delirium Screening Scale (Nu-DESC). Objetivo: Avaliar as propriedades psicométricas da versão portuguesa da Nu-DESC em contexto cirúrgico. Metodologia: Estudo metodológico, incluindo utentes com 65 ou mais anos de idade, com o diagnóstico de fratura proximal do fémur. Recorreu-se a três medidas de avaliação para analisar a concordância entre os resultados obtidos através das mesmas. Resultados: Numa amostra de 81 utentes, a sensibilidade da Nu-DESC foi de 92% relativamente ao Confusion Assessment Method (CAM) e de 91% face à aplicação dos critérios do DSM-5. Já a especificidade do instrumento foi de 98% relativamente ao CAM e de 94% face à aplicação dos critérios do DSM-5. O alfa de Cronbach da Nu-DESC variou entre 0,86 e 0,89. Conclusão: A avaliação das propriedades psicométricas da Nu-DESC num contexto cirúrgico confirmou que a escala apresenta uma elevada sensibilidade e especificidade para a avaliação de delirium nesse mesmo contexto.

Abstract Background: The identification of delirium by nurses extremely relevant. The Portuguese version of the Nursing Delirium Screening Scale (Nu-DESC) is a tool that can be used in this setting. Objective: To evaluate the psychometric properties of the Portuguese version of the Nu-DESC in a surgical context. Methodology: Methodological study with patients aged 65 years or older with a diagnosis of proximal femur fracture. Three assessment tools were used to analyze the agreement between the results. Results: In a sample of 81 patients, the sensitivity of the Nu-DESC was 92% compared to the Confusion Assessment Method (CAM) and 91% compared to the application of the DSM-5 criteria. The specificity of the instrument was 98% compared to CAM and 94% compared to the DSM-5. Cronbach's alpha ranged between 0.86 and 0.89 Conclusion: The evaluation of the psychometric properties of the Nu-DESC in a surgical context confirmed the validity and reliability of the instrument. The results show that the scale has a high sensitivity and specificity for assessing delirium.

Resumen Marco contextual: La identificación del delirio por parte del personal de enfermería es extremadamente importante. De ahí la posibilidad de utilizar la versión portuguesa del Nursing Delirium Screening Scale (Nu-DESC). Objetivo: Evaluar las propiedades psicométricas de la versión portuguesa del Nu-DESC en entornos quirúrgicos. Metodología: Estudio metodológico que incluyó a usuarios de 65 años o más, con diagnóstico de fractura proximal de fémur. Se utilizaron tres medidas de evaluación para analizar la concordancia entre los resultados obtenidos a través de ellas. Resultados: En una muestra de 81 usuarios, la sensibilidad del Nu-DESC fue del 92% en relación con el Confusion Assessment Method (CAM) y del 91% cuando se aplican los criterios del DSM-5. La especificidad del instrumento fue del 98% en relación con el CAM y del 94% frente a la aplicación del DSM-5. El alfa de Cronbach de la Nu-DESC varió entre 0,86 y 0,89. Conclusión: La evaluación de las propiedades psicométricas de la Nu-DESC en un contexto quirúrgico confirmó que la escala presenta una alta sensibilidad y especificidad para la evaluación del delirio en este mismo contexto.

Uso del modelador nasolabial (NAM) como tratamiento ortopédico prequirúrgico de paciente con labio y paladar hendido / Use of nasoalveolar molding (NAM) as a pre-surgical orthopedic treatment for patients with cleft lip and palate

Introducción: el labio y paladar hendido es la malformación craneofacial congénita más frecuente y es producida por una falla en la fusión de procesos faciales durante periodos iniciales en el desarrollo embrionario. Objetivo: el objetivo de la ortopedia prequirúrgica es facilitar la primera intervención para la corrección de esta condición de manera que disminuya el trauma quirúrgico, al obtener una menor formación de cicatrices y menor riesgo de complicaciones postquirúrgicas, además de ayudar a obtener una óptima deglución en el paciente para mejorar el aspecto nutricional en el bebé. Material y métodos: el paciente fue llevado a la clínica a las dos semanas de nacido para la toma de impresión y colocación de un aparato ortopédico; se le colocó el NAM (nasoalveolar molding), la cinta transport, además se realizaban citas una vez al mes para evaluar el stent nasal, activarlo y revisar que la colocación de la cinta estuviese correcta, así como para comprobar que la alimentación del bebé estuviera mejorando. Resultados: se observa una mejoría anatómica y fisiológica, también una disminución de la fisura labial de 6 mm y una remodelación nasal. Se notó una mejora en deglución y alimentación con ganancia de peso. Conclusiones: la ortopedia prequirúrgica con el NAM es una terapia aceptable y recomendable para los pacientes con labio y paladar hendido, ya que nos ayudan a generar mejores resultados quirúrgicos, además de colaborar con el aspecto nutricional del bebe (AU)

Introduction: cleft lip and palate is a craniofacial malformation most frequent congenital and is produced by a failure to fuse facial processes during early periods in embryonic development. Objective: the objective of pre-surgical orthopedics is to facilitate the first intervention for the correction of this condition, reducing surgical trauma, obtaining less scar formation and less risk of post-surgical complications, in addition to helping the patient obtain better swallowing to improve the nutritional aspect in the baby. Material and methods: the patient came to the clinic at two weeks of age for impression taking and placement of the orthopedic device. The NAM (nasoalveolar molding) and the transport tape were placed and appointments were made once a month to evaluate the nasal stent, activate it and check that the placement of the tape was correct, as well as to check that the baby's feeding was improving. Results: an anatomical and physiological improvement is observed, as well as a 6mm decrease in the cleft lip and nasal remodeling. An improvement in swallowing and feeding with weight gain was observed. Conclusions: pre-surgical orthopedics with NAM is an acceptable and recommended therapy for patients with cleft lip and palate since it helps us to generate better surgical results in addition to collaborating with the nutritional aspect of the baby (AU)