GIANT CELL TUMOR OF BONE: A MULTICENTER EPIDEMIOLOGICAL STUDY IN BRAZIL.

Introduction: Giant cell tumor of bone (GCTB) mainly affects young adults' long bone epiphyses, threatening bone strength and joint function. Surgery is the primary treatment, although post-surgery recurrence is significant. This study analyzes patient profiles, treatments, and outcomes for GCTB in Brazil. Methods: We retrospectively assessed local recurrence, metastasis, and treatment approaches in 643 GCTB patients across 16 Brazilian centers (1989-2021), considering regional differences. Results: 5.1% (n=33) developed pulmonary metastases, 14.3% (n=92) had pathological fractures, and the local recurrence rate was 18.2% (n=114). Higher rates of pulmonary metastases (12.1%) and advanced tumors (Campanacci III, 88.9%) were noted in lower-income North and Northeast regions. The North also had more pathological fractures (33.3%), extensive resections (61.1%), and amputations (27.8%). These regions faced longer surgical delays (36-39 days) than the South and Southeast (27-33 days). Conclusions: Our findings corroborate international data, underscoring regional disparities in Brazil that may lead to worse outcomes in disadvantaged areas. This highlights the need for improved orthopedic oncology care in Brazil's economically and structurally challenged regions. Level of Evidence III; Retrospective Cohort.

Introdução: O tumor de células gigantes do osso (TCG) atinge principalmente epífises de ossos longos em adultos jovens, impactando a resistência óssea e a funcionalidade articular. O tratamento principal é cirúrgico, mas há significativa recorrência pós-operatória. Este estudo analisa o perfil de pacientes e tumores de TCG no Brasil, abordagens de tratamento e resultados. Métodos: Avaliamos retrospectivamente taxas de recorrência, metástase e tratamentos em 643 pacientes tratados em 16 centros brasileiros de 1989 a 2021, considerando a distribuição geopolítica. Resultados: 5,1% desenvolveram metástases pulmonares e 14,3% tiveram fraturas patológicas. A recorrência local foi de 18,2%. Regiões economicamente menos favorecidas, como Norte e Nordeste, mostraram maiores incidências de metástases pulmonares (12,1%) e tumores avançados (Campanacci III, 88,9%). O Norte teve alta ocorrência de fraturas patológicas (33,3%), cirurgias extensas (61,1%) e amputações (27,8%). Nessas regiões, o tempo pré-cirúrgico foi mais longo (médias de 36 e 39 dias) comparado ao Sul e Sudeste (27 e 33 dias, respectivamente). Conclusões: Os resultados refletem disparidades regionais no Brasil, sugerindo que condições socioeconômicas influenciam os desfechos clínicos. Estes achados são importantes para melhorar o cuidado oncológico ortopédico em regiões desfavorecidas do país. Nível de Evidência III; Coorte Retrospectiva.

Minimally Invasive Tibiotalocalcaneal Arthrodesis with Blocked Retrograde Intramedullary Nail - Report of Three Cases.

Ankle osteoarthritis (AOA) is associated with pain and variable functional limitation, demanding clinical treatment and possible surgical indication when conservative measures are ineffective - arthrodesis has been the procedure of choice, because it reduces pain, restores joint alignment and makes the segment stable, preserving gait. The present study reports 3 cases (3 ankles) of male patients between 49 and 63 years old, with secondary AOA, preoperative American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS AHS) of 27 to 39 points, treated by minimally invasive tibiotalocalcaneal arthrodesis using blocked retrograde intramedullary nail. Hospital stay was of 1 day, and the patients were authorized for immediate loading with removable ambulation orthotics, as tolerated. The physical therapy treatment, introduced since hospitalization, was maintained, prioritizing gait training, strength gain, and proprioception. Clinical and radiographic follow-up was performed at weeks 1, 2, 6, 12 and 24. After evidence of consolidation (between the 6 th and 10 th weeks), the orthotics were removed. One patient complained of pain in the immediate postoperative period and, at the end of the 1 st year, only one patient presented pain during rehabilitation, which was completely resolved with analgesics. Currently, the patients do not present complaints, returning to activities without restrictions - one of them, to the practice of soccer and rappelling. The postoperative AOFAS AHS was from 68 to 86 points.

Giant cell tumor of bone: a multicenter epidemiological study in brazil / Tumor de células gigantes ósseas: estudo epidemiológico multicêntrico no brasil

ABSTRACT Introduction: Giant cell tumor of bone (GCTB) mainly affects young adults' long bone epiphyses, threatening bone strength and joint function. Surgery is the primary treatment, although post-surgery recurrence is significant. This study analyzes patient profiles, treatments, and outcomes for GCTB in Brazil. Methods: We retrospectively assessed local recurrence, metastasis, and treatment approaches in 643 GCTB patients across 16 Brazilian centers (1989-2021), considering regional differences. Results: 5.1% (n=33) developed pulmonary metastases, 14.3% (n=92) had pathological fractures, and the local recurrence rate was 18.2% (n=114). Higher rates of pulmonary metastases (12.1%) and advanced tumors (Campanacci III, 88.9%) were noted in lower-income North and Northeast regions. The North also had more pathological fractures (33.3%), extensive resections (61.1%), and amputations (27.8%). These regions faced longer surgical delays (36-39 days) than the South and Southeast (27-33 days). Conclusions: Our findings corroborate international data, underscoring regional disparities in Brazil that may lead to worse outcomes in disadvantaged areas. This highlights the need for improved orthopedic oncology care in Brazil's economically and structurally challenged regions. Level of Evidence III; Retrospective Cohort.

RESUMO Introdução: O tumor de células gigantes do osso (TCG) atinge principalmente epífises de ossos longos em adultos jovens, impactando a resistência óssea e a funcionalidade articular. O tratamento principal é cirúrgico, mas há significativa recorrência pós-operatória. Este estudo analisa o perfil de pacientes e tumores de TCG no Brasil, abordagens de tratamento e resultados. Métodos: Avaliamos retrospectivamente taxas de recorrência, metástase e tratamentos em 643 pacientes tratados em 16 centros brasileiros de 1989 a 2021, considerando a distribuição geopolítica. Resultados: 5,1% desenvolveram metástases pulmonares e 14,3% tiveram fraturas patológicas. A recorrência local foi de 18,2%. Regiões economicamente menos favorecidas, como Norte e Nordeste, mostraram maiores incidências de metástases pulmonares (12,1%) e tumores avançados (Campanacci III, 88,9%). O Norte teve alta ocorrência de fraturas patológicas (33,3%), cirurgias extensas (61,1%) e amputações (27,8%). Nessas regiões, o tempo pré-cirúrgico foi mais longo (médias de 36 e 39 dias) comparado ao Sul e Sudeste (27 e 33 dias, respectivamente). Conclusões: Os resultados refletem disparidades regionais no Brasil, sugerindo que condições socioeconômicas influenciam os desfechos clínicos. Estes achados são importantes para melhorar o cuidado oncológico ortopédico em regiões desfavorecidas do país. Nível de Evidência III; Coorte Retrospectiva.

PRIMARY TOTAL HIP ARTHROPLASTIES UNDER BRAZILIAN PUBLIC HEALTH SYSTEM (2012-2021).

Objectives: To describe the regional distribution of hospital admission authorizations (HAA), hospitalization costs (HC), the average length of stay (LOS), and mortality rates (MR) related to primary total hip arthroplasties (THA) funded by the Brazilian Health Unic System (SUS) from 2012 to 2021. Methods: Descriptive cross-sectional study using secondary data of public domain obtained from the Department of Informatics of SUS (DATASUS) database website. Results: A total of 125,463 HAA were released with HC of 552,218,181.04 BRL in the evaluated period. The average LOS was of 6.8 days. MR was 1.62%. Conclusion: The regional distribution of HAA was 65,756 (52%) in the Southeast; 33,837 (27%) in the South; 14,882 (12%) in the Northeast; 9,364 (8%) in Midwest; and 1,624 (1%) in North - in 2020 there was a sharp decrease of the released HAA, probably due to the COVID-19 pandemic. HC was 293,474,673.20 BRL in the Southeast; 144,794,843.11 BRL in the South; 61,751,644.36 BRL in the Northeast; 45,724,353.80 BRL in the Midwest; and 6,472,666.57 BRL in the North. The average LOS was 6.7 in the Southeast; 5.3 in the South; 9.2 in the Northeast; 7.6 in the Midwest; and, 13.6 in the North. MR was as follows: Southeast=1.88%; South=1.07%; Northeast=1.83%; Midwest=1.44%; and North=1.47%. Evidence Level III; Retrospective Comparative Study .

Objetivos: Descrever a distribuição regional das autorizações de internação hospitalar (AIH), custos de internação (CI), tempo médio de permanência (TMP) e taxa de mortalidade (TM) relacionados às artroplastias totais de quadril (ATQ) primárias financiadas pelo Sistema Único de Saúde (SUS) de 2012 a 2021. Métodos: Estudo transversal descritivo utilizando dados secundários de domínio público obtidos no site do banco de dados do Departamento de Informática do SUS (DATASUS). Resultados: Foram liberadas 125.463 AIH com CI de R$ 552.218.181,04 no período avaliado. O TMP foi de 6,8 dias. A TM foi de 1,62%. Conclusões: A distribuição regional de AIH foi de 65.756 (52%) no Sudeste; 33.837 (27%) no Sul; 14.882 (12%) no Nordeste; 9.364 (8%) no Centro-Oeste; e, 1.624 (1%) no Norte - em 2020 houve queda acentuada das AIH liberadas, provavelmente devido à pandemia COVID-19. Os CI foram de R$ 293.474.673,20 no Sudeste; R$ 144.794.843,11 no Sul; R$ 61.751.644,36 no Nordeste; R$ 45.724.353,80 no Centro-Oeste; e R$ 6.472.666,57 no Norte. O TMP foi de 6,7 no Sudeste; 5,3 no Sul; 9,2 no Nordeste; 7,6 no Centro-Oeste; e 13,6 no Norte. A TM foi como se segue: Sudeste=1,88%; Sul=1,07%; Nordeste=1,83%; Centro-Oeste=1,44%; e, Norte=1,47%. Nível de Evidência III; Estudo Retrospectivo Comparativo .

EVALUATION OF OUTCOMES IN INTERVENTION RANDOMIZED CLINICAL TRIALS - DISTAL RADIUS FRACTURES.

Objectives: Describe the frequency and types of outcomes in randomized clinical trials (RCT) of intervention for distal radius fractures, analyze how confusing outcome presentations can lead to misinterpretations, and suggest strategies to improve the reader's understanding of the decision-making process. Methods: A retrospective study was conducted through a systematized search on the PubMed® database in the last 10 years, in which only intervention RCT was included for distal radius fractures, and outcomes were analyzed. Results: Of the primary outcomes analyzed in the 75 selected articles, 46.6% were classified as clinical outcomes, 20% as surrogate, 30.6% as composite, 1.3% as complex scales, and 1.3% as safety outcomes. 34.7% of the articles did not report adverse events. Conclusion: The presentation of outcomes with little clinical relevance represented more than half of the sample (53.4%) - such studies can harm the reader since they confuse the interpretation of scientific evidence; the Core Outcome Measures in Effectiveness Trials (COMET) initiative could help health professionals in understanding and selecting the most appropriate therapeutic interventions for patients. Level of Evidence III; Retrospective comparative study .

Objetivos: Descrever a frequência e os tipos de desfechos em ensaios clínicos randomizados (RCT) de intervenção para fraturas distais do rádio, analisar como apresentações confusas de desfechos podem levar a interpretações equivocadas e sugerir estratégias para melhorar a compreensão do leitor sobre o processo de tomada de decisão. Métodos: Foi realizado estudo retrospectivo mediante busca sistematizada na base de dados PubMed® nos últimos 10 anos, na qual foram incluídos apenas RCT de intervenção para fraturas do segmento distal do rádio, cujos desfechos foram analisados. Resultados: Dos desfechos primários analisados nos 75 artigos selecionados, 46,6% foram classificados como desfechos clínicos, 20% como substitutos, 30,6% como compostos, 1,3% como escalas complexas e em 1,3% como desfechos de segurança. 34,7% dos artigos não reportaram eventos adversos. Conclusão: A apresentação de desfechos com pouca relevância clínica representou mais da metade da amostra (53,4%) - tais estudos podem prejudicar o leitor, uma vez que confundem a interpretação das evidências científicas; a iniciativa Core Outcome Measures in Effectiveness Trials (COMET) auxilia os profissionais de saúde na compreensão e seleção das intervenções terapêuticas mais adequadas para os pacientes. Nível de Evidência III; Estudo retrospectivo comparativo .

Multiple Myeloma (Part 2) - Update on The Approach to Bone Disease.

The increase in life expectancy of the world population has led to a concomitant increase in the prevalence of multiple myeloma (MM), a disease that usually affects the elderly population. Bone lesions are frequent in patients with this condition, demanding an early approach, from drug treatment, through radiotherapy to orthopedic surgery (prophylactic or therapeutic) with the objective of preventing or delaying the occurrence of fracture, or, when this event has already occurred, treat it through stabilization or replacement (lesions located in the appendicular skeleton) and/or promote stabilization and spinal cord decompression (lesions located in the axial skeleton), providing rapid pain relief, return to ambulation and resocialization, returning quality of life to patients. The aim of this review is to update the reader on the findings of pathophysiology, clinical, laboratory and imaging, differential diagnosis and therapeutic approach of multiple myeloma bone disease (MMBD).

Multiple Myeloma (Part 1) - Update on Epidemiology, Diagnostic Criteria, Systemic Treatment and Prognosis.

Multiple myeloma (MM) is a hematological malignancy characterized by unregulated and clonal proliferation of plasma cells in the bone marrow; these cells produce and secrete an anomalous monoclonal immunoglobulin, or a fragment of this, called M protein. The clinical manifestations of MM result from the proliferation of these plasmocytes, the excessive production of monoclonal immunoglobulin and the suppression of normal humoral immunity, leading to hypercalcemia, bone destruction, renal failure, suppression of hematopoiesis and humoral immunity, increasing the risk for the development of infections. The increase in life expectancy of the world population led to a concomitant increase in the prevalence of MM, a pathology that usually affects the elderly population. The aim of this review is to update the reader on epidemiology, diagnostic criteria, differential diagnosis with other monoclonal gammopathies, systemic treatment and prognosis of MM.

Update in Imaging Evaluation of Bone and Soft Tissue Sarcomas.

The evolution in imaging evaluation of musculoskeletal sarcomas contributed to a significant improvement in the prognosis and survival of patients with these neoplasms. The precise characterization of these lesions, using the most appropriate imaging modalities to each clinical condition presented, is of paramount importance in the design of the therapeutic approach to be instituted, with a direct impact on clinical outcomes. The present article seeks to update the reader regarding imaging methodologies in the context of local and systemic evaluation of bone sarcomas and soft tissues.

Multiple Myeloma (Part 2) - Update on The Approach to Bone Disease / Mieloma múltiplo (Parte 2) - Atualização sobre a abordagem da doença óssea

Abstract The increase in life expectancy of the world population has led to a concomitant increase in the prevalence of multiple myeloma (MM), a disease that usually affects the elderly population. Bone lesions are frequent in patients with this condition, demanding an early approach, from drug treatment, through radiotherapy to orthopedic surgery (prophylactic or therapeutic) with the objective of preventing or delaying the occurrence of fracture, or, when this event has already occurred, treat it through stabilization or replacement (lesions located in the appendicular skeleton) and/or promote stabilization and spinal cord decompression (lesions located in the axial skeleton), providing rapid pain relief, return to ambulation and resocialization, returning quality of life to patients. The aim of this review isto update the reader on the findings of pathophysiology, clinical, laboratory and imaging, differential diagnosis and therapeutic approach of multiple myeloma multiple myeloma bone disease (MMBD).

Resumo O aumento da expectativa devida da população mundial levou a incremento concomitante na prevalência de mieloma múltiplo (MM), patologia que geralmente afeta a população idosa. Lesões ósseas são frequentes nos portadores desta condição, demandando abordagem precoce, desde o tratamento medicamentoso, passando pela radioterapia até a cirurgia ortopédica (profilática ou terapêutica) com os objetivos de prevenir ou retardar a ocorrência de fratura, ou, quando este evento já ocorreu, tratá-la mediante estabilização ou substituição (lesões situadas no esqueleto apendicular) e/ou promover estabilização e descompressão medular (lesões situadas no esqueleto axial), proporcionando rápido alívio da dor, retorno à deambulação e ressocialização, devolvendo a qualidade de vida aos pacientes. O objetivo desta revisão é atualizar o leitor sobre a fisiopatologia, a clínica, exames laboratoriais e de imagem, diagnóstico diferencial e abordagem terapêutica da doença óssea no mieloma múltiplo (DOMM).

Multiple Myeloma (Part 1) - Update on Epidemiology, Diagnostic Criteria, Systemic Treatment and Prognosis / Mieloma múltiplo (Parte 1) - Atualização sobre epidemiología, critérios diagnósticos, tratamento sistêmico e prognóstico

Abstract Multiple myeloma (MM) is a hematological malignancy characterized by unregulated and clonal proliferation of plasma cells in the bone marrow; these cells produce and secrete an anomalous monoclonal immunoglobulin, or a fragment of this, called M protein. The clinical manifestations of MM result from the proliferation of these plasmocytes, the excessive production of monoclonal immunoglobulin and the suppression of normal humoral immunity, leading to hypercalcemia, bone destruction, renal failure, suppression of hematopoiesis and humoral immunity, increasing the risk for the development of infections. The increase in life expectancy of the world population led to a concomitant increase in the prevalence of MM, a pathology that usually affects the elderly population. The aim of this review is to update the reader on epidemiology, diagnostic criteria, differential diagnosis with other monoclonal gam-mopathies, systemic treatment and prognosis of MM.

Resumo O mieloma múltiplo (MM) constitui neoplasia maligna de origem hematológica caracterizada pela proliferação desregulada e clonal de plasmócitos na medula óssea; estas células produzem e secretam imunoglobulina monoclonal anômala, ou um fragmento desta, denominado proteína M. As manifestações clínicas do MM decorrem da proliferação destes plasmócitos, da produção excessiva de imunoglobulina monoclonal e da supressão da imunidade humoral normal, levando à hipercalcemia, destruição óssea, insuficiência renal, supressão da hematopoiese e da imunidade humoral,aumentandooriscoparaodesenvolvimento de infecções. O aumento na expectativa de vida da população mundial levou a concomitante incremento na prevalência do MM, patologia que habitualmente acomete a população idosa. O objetivo desta revisão é atualizar o leitor sobre a epidemiologia, critérios diagnósticos, diagnóstico diferencial com outras gamopatias monoclonais, tratamento sistêmico e prognóstico do MM.

Update in Imaging Evaluation of Bone and Soft Tissue Sarcomas / Atualização na avaliação por imagens dos sarcomas ósseos e das partes moles

Abstract The evolution in imaging evaluation of musculoskeletal sarcomas contributed to a significant improvement in the prognosis and survival of patients with these neoplasms. The precise characterization of these lesions, using the most appropriate imaging modalities to each clinical condition presented, is of paramount importance in the design of the therapeutic approach to be instituted, with a direct impact on clinical outcomes. The present article seeks to update the reader regarding imaging methodologies in the context of local and systemic evaluation of bone sarcomas and soft tissues.

Resumo A evolução na avaliação por imagens dos sarcomas musculoesqueléticos contribuiu para melhora significativa no prognóstico e na sobrevida dos portadores destas neoplasias. A caracterização precisa destas lesões, mediante utilização das modalidades de imagem mais adequadas a cada condição clínica apresentada, é de suma importância no delineamento da abordagem terapêutica a ser instituída, com impacto direto sobre os desfechos clínicos. O presente artigo busca atualizar o leitor a propósito das metodologias de imagem no contexto da avaliação local e sistêmica dos sarcomas ósseos e das partes moles.

Bovine Grafting: An Effective Alternative after Curettage of Benign Bone Tumors.

We retrospectively reviewed 28 patients (15 women and 13 men) with benign bone tumors or pseudotumors treated with curettage and filling with freeze-dried bovine bone graft Orthogen (Baumer S/A, São Paulo, Brazil). The aim of the study was to evaluate the rate of incorporation of Orthogen into the host bone, as well as to describe the outcomes of bone healing (quality, time, and complications). General characteristics, tumor volume, size, site, complications, percent filled, and healing quality at 6 and 12 months were assessed through radiographs. Mean patient age was 20.5 (range 4.7-75.1) years. The most common lesion type was simple bone cyst (12/28), and the most common sites were the tibia (7/28) and humerus (7/28). There were no postoperative pathologic fractures. Two cases (7.1%) of serous fluid leakage through the wound occurred. Mean cavity volume was 20.1 (range 2.7-101.4) cm3. At 6 and 12 months, 75% and 77.8% of cavities, respectively, showed complete bone healing. At 12 months, 81% of cavities filled >90% with graft showed complete bone healing vs. only 19% of those filled <90%. Filling with bovine bone graft resulted in few complications and excellent healing after curettage of benign bone tumors or pseudotumors. Complete healing occurred in most cases by 12 months. Cavities with a higher percentage of filling had a higher rate of complete radiographic incorporation.

Primary total hip arthroplasties under brazilian public health system (2012-2021) / Artroplastias primárias totais do quadril no sistema público de saúde (2012-2021)

ABSTRACT Objectives: To describe the regional distribution of hospital admission authorizations (HAA), hospitalization costs (HC), the average length of stay (LOS), and mortality rates (MR) related to primary total hip arthroplasties (THA) funded by the Brazilian Health Unic System (SUS) from 2012 to 2021. Methods: Descriptive cross-sectional study using secondary data of public domain obtained from the Department of Informatics of SUS (DATASUS) database website. Results: A total of 125,463 HAA were released with HC of 552,218,181.04 BRL in the evaluated period. The average LOS was of 6.8 days. MR was 1.62%. Conclusion: The regional distribution of HAA was 65,756 (52%) in the Southeast; 33,837 (27%) in the South; 14,882 (12%) in the Northeast; 9,364 (8%) in Midwest; and 1,624 (1%) in North - in 2020 there was a sharp decrease of the released HAA, probably due to the COVID-19 pandemic. HC was 293,474,673.20 BRL in the Southeast; 144,794,843.11 BRL in the South; 61,751,644.36 BRL in the Northeast; 45,724,353.80 BRL in the Midwest; and 6,472,666.57 BRL in the North. The average LOS was 6.7 in the Southeast; 5.3 in the South; 9.2 in the Northeast; 7.6 in the Midwest; and, 13.6 in the North. MR was as follows: Southeast=1.88%; South=1.07%; Northeast=1.83%; Midwest=1.44%; and North=1.47%. Evidence Level III; Retrospective Comparative Study .

RESUMO Objetivos: Descrever a distribuição regional das autorizações de internação hospitalar (AIH), custos de internação (CI), tempo médio de permanência (TMP) e taxa de mortalidade (TM) relacionados às artroplastias totais de quadril (ATQ) primárias financiadas pelo Sistema Único de Saúde (SUS) de 2012 a 2021. Métodos: Estudo transversal descritivo utilizando dados secundários de domínio público obtidos no site do banco de dados do Departamento de Informática do SUS (DATASUS). Resultados: Foram liberadas 125.463 AIH com CI de R$ 552.218.181,04 no período avaliado. O TMP foi de 6,8 dias. A TM foi de 1,62%. Conclusões: A distribuição regional de AIH foi de 65.756 (52%) no Sudeste; 33.837 (27%) no Sul; 14.882 (12%) no Nordeste; 9.364 (8%) no Centro-Oeste; e, 1.624 (1%) no Norte - em 2020 houve queda acentuada das AIH liberadas, provavelmente devido à pandemia COVID-19. Os CI foram de R$ 293.474.673,20 no Sudeste; R$ 144.794.843,11 no Sul; R$ 61.751.644,36 no Nordeste; R$ 45.724.353,80 no Centro-Oeste; e R$ 6.472.666,57 no Norte. O TMP foi de 6,7 no Sudeste; 5,3 no Sul; 9,2 no Nordeste; 7,6 no Centro-Oeste; e 13,6 no Norte. A TM foi como se segue: Sudeste=1,88%; Sul=1,07%; Nordeste=1,83%; Centro-Oeste=1,44%; e, Norte=1,47%. Nível de Evidência III; Estudo Retrospectivo Comparativo .

Evaluation of outcomes in intervention randomized clinical trials - distal radius fractures / Avaliação dos desfechos em ensaios clínicos randomizados de intervenção - fraturas distais do rádio

ABSTRACT Objectives: Describe the frequency and types of outcomes in randomized clinical trials (RCT) of intervention for distal radius fractures, analyze how confusing outcome presentations can lead to misinterpretations, and suggest strategies to improve the reader's understanding of the decision-making process. Methods: A retrospective study was conducted through a systematized search on the PubMed® database in the last 10 years, in which only intervention RCT was included for distal radius fractures, and outcomes were analyzed. Results: Of the primary outcomes analyzed in the 75 selected articles, 46.6% were classified as clinical outcomes, 20% as surrogate, 30.6% as composite, 1.3% as complex scales, and 1.3% as safety outcomes. 34.7% of the articles did not report adverse events. Conclusion: The presentation of outcomes with little clinical relevance represented more than half of the sample (53.4%) - such studies can harm the reader since they confuse the interpretation of scientific evidence; the Core Outcome Measures in Effectiveness Trials (COMET) initiative could help health professionals in understanding and selecting the most appropriate therapeutic interventions for patients. Level of Evidence III; Retrospective comparative study .

RESUMO Objetivos: Descrever a frequência e os tipos de desfechos em ensaios clínicos randomizados (RCT) de intervenção para fraturas distais do rádio, analisar como apresentações confusas de desfechos podem levar a interpretações equivocadas e sugerir estratégias para melhorar a compreensão do leitor sobre o processo de tomada de decisão. Métodos: Foi realizado estudo retrospectivo mediante busca sistematizada na base de dados PubMed® nos últimos 10 anos, na qual foram incluídos apenas RCT de intervenção para fraturas do segmento distal do rádio, cujos desfechos foram analisados. Resultados: Dos desfechos primários analisados nos 75 artigos selecionados, 46,6% foram classificados como desfechos clínicos, 20% como substitutos, 30,6% como compostos, 1,3% como escalas complexas e em 1,3% como desfechos de segurança. 34,7% dos artigos não reportaram eventos adversos. Conclusão: A apresentação de desfechos com pouca relevância clínica representou mais da metade da amostra (53,4%) - tais estudos podem prejudicar o leitor, uma vez que confundem a interpretação das evidências científicas; a iniciativa Core Outcome Measures in Effectiveness Trials (COMET) auxilia os profissionais de saúde na compreensão e seleção das intervenções terapêuticas mais adequadas para os pacientes. Nível de Evidência III; Estudo retrospectivo comparativo .

Influence of surface peripheral electrical stimulation on nerve regeneration after digital nerve neurorrhaphy: study protocol for a randomized clinical trial.

We will study the influence of low intensity and frequency surface peripheral electrical stimulation (PES) on nerve regeneration of digital nerve injuries of the hand after its surgical repair in humans. Participants will be patients with acute traumatic peripheral nerve injury referred to the Hand Surgery Service of the General Hospital of the State of Bahia, a reference service in the state. These patients will undergo surgery followed by PES in the immediate postoperative period. After hospital discharge, they will be followed up on an outpatient basis by researchers, who will remotely supervise a physiotherapy program. Our hypothesis is that PES will positively influence the recovery of sensory function in patients undergoing neurorrhaphy of digital nerves of the hand. ReBEC registration:  U1111-1259-1998 (12/18/2020).

Updating on Bone and Soft Tissue Sarcomas Staging.

Bone and soft tissue sarcomas consist of a heterogeneous group of malignant tumors of mesenchymal origin that can affect patients from any age. The precise staging of these lesions determines the best therapeutic strategies and prognosis estimates. Two staging systems are the most frequently used: the system proposed by the University of Florida group, led by Dr. William F. Enneking (1980) and adopted by the Musculoskeletal Tumor Society (MSTS), and the system developed by the American Joint Committee on Cancer (AJCC) (1977), currently in its 8 th edition (2017). This paper updates the reader on the staging of bone and soft tissue sarcomas affecting the musculoskeletal system.

Updating on Bone and Soft Tissue Sarcomas Staging / Atualização no estadiamento dos sarcomas ósseos e das partes moles

Abstract Bone and soft tissue sarcomas consist of a heterogeneous group of malignant tumors of mesenchymal origin that can affect patients from any age. The precise staging of these lesions determines the best therapeutic strategies and prognosis estimates. Two staging systems are the most frequently used: the system proposed by the University of Florida group, led by Dr. William F. Enneking (1980) and adopted by the Musculoskeletal Tumor Society (MSTS), and the system developed by the American Joint Committee on Cancer (AJCC) (1977), currently in its 8th edition (2017). This paper updates the reader on the staging of bone and soft tissue sarcomas affecting the musculoskeletal system.

Resumo Os sarcomas ósseos e das partes moles consistem em grupo heterogêneo de neoplasias malignas de origem mesenquimal que podem ocorrer em qualquer faixa etária. O estadiamento preciso destas lesões determina as melhores estratégias terapêuticas e estimativas de prognóstico. Dois sistemas de estadiamento são os mais frequentemente empregados no manejo destas neoplasias: o sistema proposto pelo grupo da Universidade da Flórida, liderado pelo Dr. William F. Enneking (1980), adotado pela Musculoskeletal Tumor Society (MSTS) e o sistema desenvolvido pela American Joint Committee on Cancer (AJCC) (1977) que se encontra em sua 8a edição (2017). O presente artigo busca atualizar o leitor a respeito do estadiamento dos sarcomas ósseos e das partes moles que acometem o sistema musculoesquelético.

Femoral fractures in the elderly in Brasil - incidence, lethality, and costs (2008-2018).

OBJECTIVES: To describe the incidence by gender and region, lethality, and costs associated with the treatment of femoral fractures in the elderly (≥ 60 years) hospitalized in the Unified Health System (SUS) of Brasil between 2008 and 2018. METHODS: This is a cross-sectional, descriptive, retrospective study of hospitalizations of elderly people due to femoral fractures by analyzing secondary data obtained from the SUS Hospital Information System (SIH/SUS) between 2008 and 2018; for calculation of epidemiological coefficients, we used information from demographic censuses (2000 and 2010) of the Brazilian Geography and Statistics Institute (IBGE). RESULTS: A total of 478,274 hospitalizations were recorded in the period; the incidence was 1.7 times higher in females (overall average of 274.91/100,000 for women and 161/100,000 for men). The Southeast region had the highest absolute number of hospitalizations and the South region presented the highest annual overall average incidence (224.02/100,000). The average annual cost for SUS for the treatment of femoral fractures in the elderly was R$ 99,718,574.30. CONCLUSIONS: In the evaluated period (2008-2018), femoral fractures in the elderly had a high incidence (478,274 hospitalizations; 224.02 cases/100,000 elderly), a predominance of females (1.7F/1.0M), a higher absolute number of hospitalizations in the Southeast region and a higher incidence in the South region; the lethality was high (an increase of 17.46%; overall mean coefficient of 4.99%/year); and the costs for the SUS were huge (an increase of 126.24%; average annual expenditure of R$ 99,718,574.30).

Femoral fractures in the elderly in Brasil - incidence, lethality, and costs (2008-2018)

SUMMARY OBJECTIVES: To describe the incidence by gender and region, lethality, and costs associated with the treatment of femoral fractures in the elderly (≥ 60 years) hospitalized in the Unified Health System (SUS) of Brasil between 2008 and 2018. METHODS: This is a cross-sectional, descriptive, retrospective study of hospitalizations of elderly people due to femoral fractures by analyzing secondary data obtained from the SUS Hospital Information System (SIH/SUS) between 2008 and 2018; for calculation of epidemiological coefficients, we used information from demographic censuses (2000 and 2010) of the Brazilian Geography and Statistics Institute (IBGE). RESULTS: A total of 478,274 hospitalizations were recorded in the period; the incidence was 1.7 times higher in females (overall average of 274.91/100,000 for women and 161/100,000 for men). The Southeast region had the highest absolute number of hospitalizations and the South region presented the highest annual overall average incidence (224.02/100,000). The average annual cost for SUS for the treatment of femoral fractures in the elderly was R$ 99,718,574.30. CONCLUSIONS: In the evaluated period (2008-2018), femoral fractures in the elderly had a high incidence (478,274 hospitalizations; 224.02 cases/100,000 elderly), a predominance of females (1.7F/1.0M), a higher absolute number of hospitalizations in the Southeast region and a higher incidence in the South region; the lethality was high (an increase of 17.46%; overall mean coefficient of 4.99%/year); and the costs for the SUS were huge (an increase of 126.24%; average annual expenditure of R$ 99,718,574.30).

RESUMO OBJETIVOS: Descrever a incidência por gênero e região, a letalidade e os custos associados ao tratamento de fraturas do fêmur em idosos (≥ 60 anos) internados no Sistema Único de Saúde (SUS) do Brasil entre 2008 e 2018. MÉTODOS: Estudo transversal, descritivo e retrospectivo das internações de idosos por fraturas do fêmur mediante análise dos dados secundários obtidos do Sistema de Informações Hospitalares do SUS (SIH/SUS) entre 2008 e 2018; para cálculo dos coeficientes epidemiológicos, utilizamos informações dos censos demográficos (2000 e 2010) do Instituto Brasileiro de Geografia e Estatística (IBGE). RESULTADOS: Foram registradas 478.274 mil internações no período. A incidência foi 1,7 vezes maior no gênero feminino (média geral de 274,91/100.000 para mulheres e 161/100.000 para homens). A região sudeste obteve maior número absoluto de internações e na região sul apresentou a maior incidência média geral anual (224,02/100.000). O custo médio anual do SUS para o tratamento das fraturas de fêmur em idosos foi de R$ 99.718.574,30. CONCLUSÕES: No período avaliado (2008-2018), as fraturas do fêmur em idosos apresentaram alta incidência (478.274 mil internações; 224,02 casos/100.000 idosos), predomínio do gênero feminino (1,7F/1,0M), maior número absoluto de internações na região sudeste e maior incidência na região sul; a letalidade foi elevada (aumento de 17,46%; média geral do coeficiente de 4,99%/ano); e, os custos para o SUS foram vultuosos (aumento de 126,24%, média anual de gastos de R$ 99.718.574,30).

Calcaneal chondroblastoma with secondary aneurysmal bone cyst: a case report.

We present a case of destructive chondroblastoma associated with secondary aneurysmal bone cyst involving the left calcaneus. Because of the extensive destruction of the calcaneus, total calcanectomy was the treatment of choice.