Classificação e tratamento da mão em fenda: revisão da literatura / Cleft hand classification and treatment: literature review

A mão em fenda é uma deformidade congênita rara caracterizada por uma deficiência longitudinal dos raios centrais da mão, podendo estar associada a outras malformações. Devido ao amplo espectro de manifestações, o tratamento de mãos em fenda é desafiador. Este estudo objetiva apresentar as classificações, técnicas cirúrgicas mais indicadas e seguimentos adotados conforme a manifestação clínica. Foi realizada uma pesquisa nos bancos de dados Web of Science, PubMed, Scopus, Cochrane e Embase, descritores e termos relacionados à anomalia mão em fenda típica. Trinta e dois artigos foram incluídos, sendo analisados quanto a classificação da anomalia, classificação da gravidade de expressão, técnicas cirúrgicas e estudos com informações da intervenção cirúrgica adotada para uma coorte de pacientes. Considerando que estudos sobre mão em fenda são diretamente afetados pelas descobertas embriológicas, genéticas e de biologia molecular, diferentes classificações foram descritas e diversos estudos de complementação de técnicas cirúrgicas já existentes foram encontrados. Estudos inovadores são escassos. A padronização na descrição das técnicas e resultados, além de pesquisas de melhor qualidade, poderiam elucidar lacunas ainda existentes em torno das opções de tratamento.

Cleft hand is a rare congenital deformity characterized by a longitudinal deficiency of the central rays of the hand, which may be associated with other malformations. Due to the wide spectrum of manifestations, the treatment is challenging. This study aims to present the most suitable classifications, surgical techniques and follow-up adopted according to the clinical manifestation. A search was performed in the databases Web of Science, PubMed, Scopus, Cochrane and Embase, descriptors and terms related to the hand anomaly in a typical cleft. Thirty-two articles were included and analyzed regarding the classification of the anomaly, classification of the severity of expression, surgical techniques and studies with information on the surgical intervention adopted for a cohort of patients. Considering that studies about cleft hand could be directly affected by embryological, genetic and molecular biology discoveries, different classifications have been described and several studies to complement existing surgical techniques have been found. Innovative studies are scarce. Standardization in the description of techniques and results, in addition to better quality research, could elucidate gaps that still exist around treatment options.

Arthroscopic Treatment of Bucket-Handle Triangular Fibrocartilage Complex Injury.

Bucket-handle injury to the triangular fibrocartilage complex is a rare and poorly described condition in the literature that is not included in the Palmer classification. A young man presented with right wrist torsional trauma while playing sports. He progressed with local pain and limited range of motion with a supination block. Magnetic resonance imaging revealed a bucket-handle injury to the central portion of the triangular fibrocartilage complex with a volar flap, measuring 0.6 cm × 0.6 cm. The patient underwent wrist arthroscopy with debridement, removal of a loose body, and resection of the bucket-handle lesion. In the postoperative period, pain alleviation and a considerable gain in range of motion occurred. The patient was able to resume his participation in sporting activities 3 months after surgery. There is no consensus about the treatment of bucket-handle injuries to the triangular fibrocartilage complex because of the small number of cases described in the literature.

Evaluation of distal forearm fractures using the ao 2018 classification / Avaliação das fraturas da extremidade distal do antebraço pela classificação ao 2018

ABSTRACT Objective: Distal forearm fractures are among the most common upper limb fractures in all ages, and many classifications have been proposed to describe them. Recently, a new version of AO/OTA classification was proposed. The aim of this study is to use the AO/OTA 2018 classification to report the epidemiology of distal forearm fractures in adults treated at a single center. Methods: A retrospective analysis of the initial radiographs obtained from cases of distal forearm fractures in an orthopedic emergency room at a single tertiary hospital. Results: Three hundred twenty-two cases were studied, aged 50.35 ± 18.98 years, 55.3% were female and 44.7% were right-sided. Type 2R3A, 2R3B and 2R3C fractures corresponded to 32.3%, 18.0% and 48.4% of the cases, respectively. Distal ulnar fracture was present in 41.9%. There was a correlation between age and sex: 78.3% of the subjects aged under 30 years were male, and 80.6% of those aged over 60 years were female (p<0.001). Conclusion: The most common type of radial fractures was 2R3C, and the most common type of ulna fracture was 2U3A1.1. There was a correlation between age and sex. Level of evidence IV, Case-series.

RESUMO Objetivo: As fraturas distais do antebraço são uma das mais comuns do membro superior em todas as idades, e muitas classificações foram propostas para descrevê-las. Atualmente, uma nova versão da classificação AO/OTA foi proposta. O objetivo deste estudo foi utilizar a classificação AO/OTA 2018 para descrever a epidemiologia das fraturas distais do antebraço no adulto tratadas em um único centro. Métodos: Estudo retrospectivo, em que se avaliaram as radiografias obtidas no primeiro atendimento dos casos de fraturas da extremidade distal do antebraço de esqueletos maduros, atendidas no pronto-socorro ortopédico de um único hospital terciário. Resultados: Foram estudados 322 casos, com média da idade de 50,35 ± 18,98 anos, 55,3% do sexo feminino e 44,7% do lado direito. As fraturas do tipo 2R3A, 2R3B e 2R3C corresponderam a 32,3%, 18,0% e 48,4%, respectivamente. A ulna distal foi envolvida em 41,9%. Houve correlação entre a idade e o sexo, de modo que, no grupo etário com idade até 30 anos, 78,3% eram do sexo masculino e, acima dos 60, 80,6% do sexo feminino (p<0,001). Conclusão: As fraturas do tipo 2R3C foram as mais comuns do rádio, e as 2U3A1.1 foram as mais comuns da ulna. Houve correlação entre idade e sexo. Nível de evidência IV, Série de casos.

Tension pneumopericardium in blunt thoracic trauma.

INTRODUCTION: Pneumopericardium, defined as the presence of gas in the pericardial sac, is a rare condition caused mostly by trauma. Tension pneumopericardium is a cause of hemodynamic instability; hence, it consists in a life-threatening situation and should be regarded in blunt chest trauma. CASE REPORT: A 51-year-old male was victim of a 4m fall and burial. He was stable upon admission and presented a simple pneumopericardium and pneumomediastinum on CT. While being submitted to an upper digestive endoscopy he presented respiratory failure and had to be intubated, suddenly evolving to shock. He was promptly referred to the operating room; a pericardial window confirmed tension pneumopericardium and immediately hemodynamic stability was restored. A pericardial drain was placed and kept for 15days. He was discharged at the 18th day post-trauma after a satisfactory recovery at the trauma ICU. DISCUSSION: Blunt thoracic trauma causes pneumopericardium by various mechanisms. Tension pneumopericardium is a possible outcome, probably related to positive-pressure ventilation. It leads to hemodynamic instability and requires immediate decompression and placement of a pericardial drain.