Injury epidemiology in beach tennis: incidence and risk factors / Epidemiologia das lesões no beach tennis: incidência e fatores de risco

ABSTRACT Introduction: Due to the growing increase in beach tennis practice in Brazil and the lack of studies on the injuries that occur in this sport, it has become necessary to develop more research on the subject. Objective: to identify risk and protection factors for injuries in beach tennis, in order to generate prevention strategies for musculoskeletal injuries. Method: A cross-sectional epidemiological study, level 3 of evidence, was carried out through an electronic form with 698 Beach Tennis players, who answered questions about their relationship with the practice of the sport and occurrences of injuries. We researched the prevalence of injuries, their types, and their relation with personal physical characteristics and the practice of other sports. Results: We found a positive relationship between injuries when associated with longer exposure time and the presence of a previous injury. We did not find differences regarding BMI, gender, and stretching and muscle strengthening performance. Conclusion: the most frequent non-traumatic injuries were to the elbow and shoulder (tendonitis) and traumatic (sprain) injuries to the knee and ankle. Level of Evidence II; Cohort Study.

RESUMO Introdução: Devido ao crescente aumento da prática de Beach Tennis no Brasil e a carência de estudos sobre as lesões que ocorrem nesse esporte se faz necessário o desenvolvimento de mais pesquisas sobre o tema. Objetivo: identificar fatores de risco e de proteção para lesões no Beach Tennis, afim de gerar estratégias de prevenção às injurias musculoesqueléticas. Método: realizado estudo epidemiológico transversal nível 3 de evidência através de um formulário eletrônico com 698 praticantes de Beach Tennis, que responderam questionamentos sobre sua relação com a prática do esporte e ocorrências de lesões. Pesquisamos a prevalência das lesões e seus tipos, assim como sua relação com as características físicas pessoais e prática de outros esportes. Resultados: encontramos relação de positividade para lesões quando associadas a maior tempo de exposição e presença de lesão prévia. Não encontramos diferença quanto ao IMC, sexo e a realização de alongamento e fortalecimento muscular. Conclusão: as lesões mais frequentes não traumáticas foram no cotovelo e ombro (tendinite) e traumáticas (entorse) de joelho e tornozelo. Nível de Evidência II; Estudo de Coorte.

Bridging versus Nonbridging Dynamic External Fixation of Unstable Distal Radius Fractures in the Elderly with Polytrauma: A Randomized Study.

Background Despite the high prevalence of unstable distal radius fractures (DRFs), there is no consensus regarding the optimal method and treatment timing, especially for elderly patients with multiple associated injuries. Purpose This study aimed to compare the grip strength achieved with two different methods for definitive dynamic external fixation of DRFs in elderly patients with polytrauma operated on within the first 24 hours. Methods In this prospective randomized trial, 35 patients were assigned to undergo definitive external dynamic fixation of DRFs using the nonbridging (group A) or bridging (group B) method. The grip strength, range of motion (ROM), Disabilities of the Arm, Shoulder and Hand (QuickDASH) outcome measure, visual analog scale (VAS) score for pain, and radiographic characteristics were evaluated at 6 and 12 months. Results At 12 months, no significant between-group difference was observed with respect to grip strength. All patients showed results in the third or fourth quartiles. The mean ROMs were 96.94 and 96.38% and the mean QuickDASH scores were 3.53 and 3.85 in groups A and B, respectively. The VAS scores were 1.60 and 1.85 in groups A and B, respectively. The overall complication rates were 13.3 and 15% in groups A and B, respectively. Initial fracture reduction was maintained in 86.67 and 95% of the patients in groups A and B, respectively. Conclusions Both bridging and nonbridging external definitive dynamic fixation proved safe and reliable for the treatment of unstable DRFs in elderly patients with polytrauma. The grip strength results in both groups predicted the restoration of ability in elderly patients to perform activities of daily living independently.

Ulnar Lengthening/Reconstruction of Interosseous Membrane in Treatment of Osteochondroma.

BACKGROUND: We aim to measure the quality of life and clinical and functional outcomes of a patient who had undergone ligament reconstruction of the forearm interosseous membrane, using brachioradialis tendon more ulna distraction osteogenesis in treatment with multiple cartilaginous exostosis. CASE DESCRIPTION: We present a 11-year-old boy with congenital deformity in his right, dominant forearm,Type IIb by Masada classification. Distraction of the ulna, resection of exostosis, and reconstruction of the distal part of the interosseous membrane was performed. One year later, the patient experienced good evaluation. Wrist flexion was 70 degrees, extension was 60 degrees, radial deviation was 20 degrees, and ulnar deviation was 30 degrees. Forearm pronation was 60 degrees and supination was 90 degrees. Elbow flexion was 120 degrees, extension was -5 degrees, and digit motion was full. DASH score of 5, VAS of 0, and grip strength of 92% compared to the unaffected side were obtained. Forearm radiographic aspects showed healing of the distraction, articular congruency, the distal radioulnar joint (DRUJ), and radiocapitellum joint. The distraction distance was 28 mm, the distraction period was 67 days, the consolidation period was 96 days, and the period of fixator treatment was 92 days. The distraction speed was 0.5 mm/day. Good stability and joint congruency of the DRUJ and elbow were obtained. Good radiographic, clinical, and functional results were obtained improving the life quality of that patient. LITERATURE REVIEW: The treatment of forearm deformities is difficult and complicated. There is no consensus to the overall management. As there is still a lack of long-term results, the indications for surgery, various surgical options, and the timing of the intervention have been a matter of controversy in the literature. Would DRUJ be stable when ulnar lengthening is combined with excision of exostosis? Is it possible to reduce the radial head with this technique? CLINICAL RELEVANCE: We would like to suggest an interosseous membrane (distal oblique band) reconstruction to improve this treatment. We believe this suggestion could maintain DRUJ and elbow more stable and functional. We agree that the best time to perform the corrections is early and gradually. We prefer to correct the ulna, radius, DRUJ and elbow in many steps than in only one procedure.

Femur lengthening with monoplanar external fixator associated with locked intramedullary nail.

OBJECTIVE: This study aimed to demonstrate that the lengthening technique of an external fixator associated with locked intramedullary nail is an efficient method that decreases the duration of the external fixation and improves the rehabilitation period. METHODS: From January of 2005 to May of 2014, 31 patients with mean lower limb discrepancy of 5.31 cm were treated. The etiologies of the deformity were femur fracture sequelae, infection, hip development dysplasia, polio, and congenital short femur. RESULTS: The mean duration of external fixation was 2.47 months (external fixation index of 16.15 days per cm). The mean time for bone healing was 6.66 months (consolidation index 43 days per cm). Initial mean knee range of motion was -1° to 100°, progressing to 0°-115° at the end of treatment. The complications observed were incomplete osteotomies, hip subluxation, broken fixator, decreased knee range of motion, and need for locking screw removal. CONCLUSION: Femur lengthening with a monoplanar external fixator associated with locked intramedullary nail allowed for a shorter period of external fixation use, better protection for the regenerated bone tissue, and early rehabilitation with possible complications.

OBJETIVO: Demonstrar que a técnica de alongamento do fixador externo associado a haste intramedular bloqueada é eficaz e traz benefícios quanto ao tempo de uso do fixador e a melhoria na reabilitação. MÉTODO: Entre janeiro de 2005 e maio de 2014 foram tratados 31 pacientes com discrepância de membros inferiores com média de encurtamento de 5,31 cm. As etiologias da deformidade foram sequelas de fratura de fêmur, infecção, displasia de desenvolvimento do quadril, paralisia infantil e fêmur curto congênito. RESULTADOS: O tempo médio de fixação externa foi de 2,47 meses (índice de fixação externa de 16,15 dias por centímetro). O tempo médio necessário para consolidação óssea foi 6,66 meses (índice de consolidação 43 dias por centímetro). A amplitude de movimento do joelho média inicial era de -1 a 100 graus e no término do tratamento de 0 a 115 graus. As complicações observadas foram osteotomias incompletas, subluxação de quadril, quebra do fixador, limitação da amplitude do joelho e necessidade de retirada de material. CONCLUSÃO: A técnica de alongamento femoral com fixador externo monolateral sobre haste intramedular propicia um tempo menor de uso do fixador externo, melhor proteção do regenerado ósseo e reabilitação precoce, não isenta de complicações.

Femur lengthening with monoplanar external fixator associated with locked intramedullary nail / Alongamento ósseo femoral com fixador externo monoplanar associado a haste intramedular bloqueada

ABSTRACT OBJECTIVE: This study aimed to demonstrate that the lengthening technique of an external fixator associated with locked intramedullary nail is an efficient method that decreases the duration of the external fixation and improves the rehabilitation period. METHODS: From January of 2005 to May of 2014, 31 patients with mean lower limb discrepancy of 5.31 cm were treated. The etiologies of the deformity were femur fracture sequelae, infection, hip development dysplasia, polio, and congenital short femur. RESULTS: The mean duration of external fixation was 2.47 months (external fixation index of 16.15 days per cm). The mean time for bone healing was 6.66 months (consolidation index 43 days per cm). Initial mean knee range of motion was -1° to 100°, progressing to 0°-115° at the end of treatment. The complications observed were incomplete osteotomies, hip subluxation, broken fixator, decreased knee range of motion, and need for locking screw removal. CONCLUSION: Femur lengthening with a monoplanar external fixator associated with locked intramedullary nail allowed for a shorter period of external fixation use, better protection for the regenerated bone tissue, and early rehabilitation with possible complications.

RESUMO OBJETIVO: Demonstrar que a técnica de alongamento do fixador externo associado a haste intramedular bloqueada é eficaz e traz benefícios quanto ao tempo de uso do fixador e a melhoria na reabilitação. MÉTODO: Entre janeiro de 2005 e maio de 2014 foram tratados 31 pacientes com discrepância de membros inferiores com média de encurtamento de 5,31 cm. As etiologias da deformidade foram sequelas de fratura de fêmur, infecção, displasia de desenvolvimento do quadril, paralisia infantil e fêmur curto congênito. RESULTADOS: O tempo médio de fixação externa foi de 2,47 meses (índice de fixação externa de 16,15 dias por centímetro). O tempo médio necessário para consolidação óssea foi 6,66 meses (índice de consolidação 43 dias por centímetro). A amplitude de movimento do joelho média inicial era de -1 a 100 graus e no término do tratamento de 0 a 115 graus. As complicações observadas foram osteotomias incompletas, subluxação de quadril, quebra do fixador, limitação da amplitude do joelho e necessidade de retirada de material. CONCLUSÃO: A técnica de alongamento femoral com fixador externo monolateral sobre haste intramedular propicia um tempo menor de uso do fixador externo, melhor proteção do regenerado ósseo e reabilitação precoce, não isenta de complicações.

Ensaio experimental para tratamento cirúrgico das fraturas transversas da falange proximal - Técnica com parafuso intramedular cônico de compressão versus placa de compressão lateral / Experimental trial on surgical treatment for transverse fractures of the proximal phalanx: technique using intramedullary conical compression screw versus lateral compression plate

Comparar os parâmetros mecânicos entre dois métodos de estabilização por com pressão: placa de compressão axial de 1,5 mm com o parafuso cônico de compressão usado como tutor intramedular. Métodos: Foram usados modelos de poliuretano (Sawbone(r)) que simulam a fratura da falange proximal transversa, divididos em três grupos (placa lateral, parafuso cônico, sem implante). Resultados: Há necessidade de uma maior força para resultar na fadiga da síntese com para fuso intramedular. Comprova-se, assim, a supremacia mecânica desse sobre o modelo com a placa lateral. Conclusão: A estabilização com o parafuso Acutrak(r), no tratamento das fraturas no modelo adotado neste ensaio, apresenta resultados mecânicos superiores e estatisticamente sig nificativos em comparacão com a técnica de compressão axial com o uso da placa lateral (Aptus Hand (r)).

To compare the mechanical parameters between two methods for stabilization through compression: 1.5 mm axial compression plate versus conical compression screw used as an intramedullary tutor. METHODS: Polyurethane models (Sawbone(r)) that simulated transverse fractures of the proximal phalanx were used. The models were divided into three groups: lateral plate, conical screw and no implant. RESULTS: Greater force was needed to result in fatigue in the synthesis using an intramedullary plate. Thus, this model was proven to be mechanically superior to the model with the lateral plate. CONCLUSION: Stabilization using the Acutrak(r) screw for treating fractures in the model used in this trial presents mechanical results that are statistically significantly superior to those from the axial compression technique using the lateral plate (Aptus Hand(r)).

Estudo biomecânico da fixação da fratura sacroilíaca com barras de titânio e parafusos pediculares / Biomechanical study of the sacroiliac fracturefixation with titanium rods and pedicle screws

Objetivos: Avaliar biomecanicamente diferentes tipos de fixação da articulação sacroilíaca com parafusos pediculares e comparar parafusos de perfil baixo e tradicional. Métodos: Foi utilizado um corpo de prova de polietileno representando o anel pélvico e simulou-se uma luxação sacroilíaca unilateral. Foram montadas três fixações diferentes:1) dois parafusos ligados a uma haste; 2) duas hastes conectadas adois parafusos de baixo perfil cada; e 3) a mesma montagem com parafusos de perfil tradicional. Foram realizados testes em um laboratório de ensaios biomecânicos e mecanográficos. Resultados: No grupo 1 houve suporte de carga máxima média de 99,70 N. O grupo 2suportou carga máxima média de 362,46 N. O grupo 3 suportou carga máxima média de 404,15 N. Na montagem com uma haste houve diminuição de resistência, quando comparado com as montagens com duas barras: 72,5% comparando com parafusos de baixo perfile 75,3% com parafuso tradicional. Conclusão: A montagem com barra única apresentou resultados muito inferiores comparada com a barra dupla. Não houve diferença estatística na comparação dos resultados entre os parafusos utilizados. Estudo Experimental.

Objectives: To assess biomechanically different fixations means of the sacroiliac joint with pedicle screws and to compare the traditional head height with reduced ones. Methods: We used a polyethylene model representing the pelvic ring and simulated a unilateral sacroiliac dislocation. We set up three different constructions: 1) two screws attached to a rod; 2) two rods connected to two small head screws each; and 3) two rods connected to two average headed screws each. We conducted tests in a biomechanical testing and a mechanized processing laboratory. Results: Group 1 supported an average maximum load of 99.70 N.Group 2 supported an average maximum load of 362.46 N. Group3 endured an average maximum load of 404.15 N. In the assembly with one rod, the resistance decreased as compared with the one with two bars: 72.5 % compared to small-headed screws and75.3 % to the traditional screw. Conclusion: The assembly with a single bar presented inferior results when compared to the double bar assembly. There was no statistical difference in the results between the screws used. Experimental Study.

Bone tissue repair in patients with open diaphyseal tibial fracture treated with biplanar external fixation or reamed locked intramedullary nailing.

INTRODUCTION: Open tibial fractures are usually caused by high-energy trauma. There is no consensus about the best treatment for these fractures. Biomechanical studies show that fixing on two planes approaches the rigidity of the bone, whereas the use of interlocking intramedullary nailing is widely used and reported to produce better therapeutic results in fracture healing. OBJECTIVE: To compare bone tissue repair in patients with open diaphyseal tibial fracture treated with biplanar external fixation or reamed locked intramedullary nailing. METHOD: Prospective randomised study with 68 patients undergoing two types of surgical treatment: biplanar external fixation or reamed locked intramedullary nailing. Consolidation, complications (infection, malunion and non-union) and quality of life using the SF-36 Health Survey were assessed 12 months after surgery. RESULTS: Consolidation occurred in 84.6% of patients who underwent reamed intramedullary nailing, and in 90.3% of patients who were treated with biplanar external fixation. In the intramedullary nailing group, there were two cases of non-union, three cases of malunion and two cases of infection. In the patients treated with biplanar fixation, there were three cases of non-union, five cases of malunion and no cases of infection. There were no statistically significant differences between the treatment groups for these results. Patient quality of life was statistically equal for both methods. CONCLUSION: Treatment with biplanar external fixation was associated with statistically similar results compared with intramedullary locking.

Efeito do Symphytum officinale na consolidação de fraturas de rádio e ulna de ratos / Symphytum officinale effect on the consolidation of radio and ulna fractures in rats

Introdução: o estudo da consolidação óssea e dos diversos fatores capazes de estimular o processo de reparo ósseo envolve muitas pesquisas na literatura. Objetivo: testar o efeito do Symphytum officinale na consolidação de fraturas de rádio e ulna em ratos. Método: os autores avaliaram 34 ratos da linhagem Wistar, nos quais foi realizada fratura manual dos ossos do antebraço direito sob anestesia. Os ratos foram divididos aleatoriamente em dois grupos. O grupo experimento recebeu duas gotas da substância Symphytum officinale e o grupo controle recebeu duas gotas de soro fisiológico 0,9%, administradas em ambos na frequência de três vezes ao dia pelo método da gavagem. Após o sacrifício, aos 14 e 28 dias de tratamento, foi realizada dissecção dos rádios e das ulnas. Os ossos foram radiografados e submetidos à leitura da densitometria óptica radiográfica. Resultados: foram observadas diferenças na formação do calo ósseo ulnar em relação ao radial, independentemente do grupo estudado na comparação entre o grupo controle e experimento. Conclusões: a formação do calo ósseo ulnar apresentou maior densidade óssea em relação ao calo radial, independentemente do grupo estudado, e a substância Symphytum officinale, em doses homeopáticas, não se mostrou estimulante da consolidação de fraturas em antebraços de ratos da raça Wistar.

Introduction: there are several studies in medical literature covering the subject of bones consolidation, as well as the several stimulating factors related to it. Objective: to test the effect of Symphytum officinale in bone consolidation of radio and ulna fractures in rats. Method: the authors describe a survey conducted over a sample of 34 rats of Wistar lineage, randomly divided in two different groups, on which a manual procedure to cause the fractures in the bones of the right forearm was conducted with anesthesia. The rats of the experimental group were given two drops of a substance known as Symphytum officinale and the rats of the control group were given two drops of physiologic saline, 0.9%. For those two groups, the drugs were given three times per day by gavage. After the sacrifice of the rats, a series of dissections of the radio and the ulna bones was conducted. All bones were submitted to X-rays and to optical densitometry radiographic devices. Results: a difference in the bone callus formation of ulna was observed when compared to the bone callus formation of radio, regardless of the groups. Conclusions: the bone callus formation of the ulna presented more bone density in relation to radio callus, independently to the studied group and Symphytum officinale, in homeopathic doses, did not stimulate the bone fractures consolidation in forearms of Wistar rats lineage.

Análise experimental da resistência dos nós na osteossíntese tipo banda de tensão / Experimental analysis of knot resistance in tension band osteosynthesis

Introdução: Realizou-se estudo experimental com objetivo de avaliar a resistência de nós de fios metálicos confeccionados com tensionador de fios AO-ASIF (Grupo 1) comparados àqueles realizados com torção manual (Grupo 2), na síntese do tipo tirante de tensão. Método: Foram utilizados 28 corpos-de-prova de nylon 6,6 com 32 mm de diâmetro e 50 cm de comprimento com uma secção transversal incompleta de 27 mm no centro, formando uma zona de tensão na face íntegra do tarugo. Os fios foram aplicados aos tarugos e dois tipos de nós foram utilizados (Grupos 1 e 2). O conjunto foi montado em máquina de ensaios mecânicos de tração/compressão até fadiga da síntese, com mensuração da tensão. Resultados: O resultado estatístico da tensão no momento de fadiga, segundo média, desvio padrão, mediana, tensão mínima e máxima, demonstrou que o grupo 1 possui um nó 50% menos resistente à distração que o grupo 2. Conclusão: Os resultados mostraram que o tensionador de fios AO-ASIF produz um nó cerca de 50% menos resistente à distração quando comparado ao nó de torção manual.

Introduction: An experimental study aiming at evaluating the resistance of metallic threads knots made using a thread tensionator AO-ASIF (Group 1) was accomplished in order to compare them to those made with manual torsion (Group 2) in the tension strut type synthesis. Method: Twenty-eight proof bodies were used. They consisted of nylon 6.6 with 32 mm of diameter and 50 cm of length with an incomplete transversal section of 27 mm in the center, forming a tension zone in the pin?s complete face. The threads were applied to the pins and two-knot types were used (Groups 1 and 2). The proof body and cerclage were set up in a traction/compression mechanical assays machine till synthesis fatigue, measuring the tension. Results: Tension statistical results obtained in the fatigue moment, using the average, deviation standard, medium, minimum and maximum tension, demonstrated that Group 1 has a knot 50% less resistant to the distraction than Group 2. Conclusion: The results showed that the thread tensionator AO-ASIF produces a knot almost 50% less resistant to the distraction when compared to the manual torsion knot.

Tratamento da falha óssea parcial pelo transporte ósseo parietal / Partial bone defect treatment using parietal bone transportation

OBJETIVO: Descrever a técnica de transporte ósseo parietal para tratamento de falha óssea parcial, e descrever o resultado clínico e radiográfico de uma série de pacientes tratados por esta técnica. CASUíSTICA E MÉTODO: tratamos nove pacientes portadores de lesão óssea parcial, sendo seis localizada na tíbia e três no fêmur. Todos apresentavam lesão infectada, acompanhada de pseudo-artrose. O procedimento iniciou-se com estabilização do segmento ósseo com fixador externo, seguido de corticotomia parietal, em osso sadio adjacente à falha, para criar o fragmento que foi transportado. Este fragmento foi transfixado por fios olivados, que conectados às hastes sulcadas permitiam o transporte ósseo. Em dois pacientes os fragmentos utilizados eram de osso adjacente (fíbula), transportados para a tíbia em direção da tíbia. A latência, velocidade e ritmo de distração foram os preconizados por Ilizarov. RESULTADOS: a infecção e a pseudo-artrose foram curadas em todos os casos, com preenchimento da falha óssea. As complicações encontradas foram infecção nos orifícios dos fios na pele e regenerado hipotrófico. CONCLUSAO: o tratamento da falha óssea parcial pelo transporte ósseo parietal determinou solução do processo infeccioso, com consolidação da pseudo-artrose e preenchimento da falha óssea.