Cross-sectional study of Gartland II and III humerus supracondylar fracture treatment in childhood: Brazilian orthopedists' opinion / Estudo transversal sobre o tratamento das fraturas supracondilianas do úmero na infância dos tipos Gartland II e III: opinião do ortopedista brasileiro

ABSTRACT Objective: This study is aimed at determining, through a cross-sectional study, the preferred therapeutic method in Brazil considering the approach to Gartland type II and III supracondylar humerus fractures during childhood. Methods: The research project was approved by the Research Ethics Committee of Plataforma Brasil and the material was collected during the 46th Brazilian Orthopedics and Traumatology Congress. A questionnaire was developed to analyze two clinical scenarios about Gartland type II and III fractures. Results: The sample consisted of 301 questionnaires obtained from 5500 participants of the Congress who met the inclusion and non-inclusion criteria. In case 1, the following was observed: 140 (46.5%) of physicians opted for closed reduction with immobilization and 116 (38.5%) selected closed reduction and osteosynthesis, of whom 82 (70.7%) preferred two crossed Kirschner wires. In case 2, 294 (97.7%) considered that the treatment is urgent, and 225 (74.8%) of the interviewed orthopedists answered that they perform osteosynthesis with two crossed Kirschner wires. Conclusions: The opinion of orthopedic surgeons in Brazil varies for Gartland type II fractures. Type III fractures have a uniform conduct and they are treated urgently (97.7%). When osteosynthesis is necessary, it was observed that 82 (70.7%) and 225 (74.8%) of the interviewed surgeons opted for fixation with two crossed Kirschner wires.

RESUMO Objetivo: Este trabalho teve como objetivo determinar, num estudo transversal, qual é o método terapêutico preferencial usado no Brasil quando são abordadas as fraturas supracondilianas do úmero na infância dos tipos II e III da classificação de Gartland. Métodos: O projeto de pesquisa foi aprovado pelo Comitê de Ética em Pesquisa da Plataforma Brasil e o material foi coletado durante o 46° Congresso Brasileiro de Ortopedia e Traumatologia. Elaboramos um questionário para averiguar a conduta nas duas situações clínicas de fraturas do tipo Gartland II e III. Resultados: A amostra constou de 301 questionários obtidos de 5.500 participantes do Congresso que contemplaram os critérios de inclusão e não inclusão. Para o caso 1 observamos que 140 (46,5%) médicos optam pela redução incruenta e imobilização e 116 (38,5%), pela redução incruenta e osteossíntese, dos quais 82 (70,7%) preferem a osteossíntese com dois fios de Kirschner cruzados. Para o caso 2, 294 (97,7%) entrevistados consideram que essas lesões devam ser abordadas na urgência, na qual 225 (74,8%) fazem a osteossíntese com dois fios de Kirschner cruzados. Conclusões: A opinião do ortopedista no Brasil varia para as fraturas do tipo II. Para as do tipo III, observamos que existe uma conduta uniforme, pois essas são tratadas na urgência (97,7%). Quando é necessária a osteossíntese, observamos que 82 (70,7%) e 225 (74,8%) dos entrevistados optam pela fixação com dois fios de Kirschner cruzados.

Orthopedic injuries in soccer - an analysis of a professional championship tournament in brazil / Lesões ortopédicas no futebol - análise do campeonato paulista da série a2

ABSTRACT Objective: To analyze the incidence of orthopedic injuries which occurred during a professional soccer championship in São Paulo, Brazil in 2010. Methods: This assessment collected data from the pre-season until the final stage of the championship. Results: We analyzed 227 professional players from eight of the top teams in this championship. Data were obtained for 71.02% of all games. The athletes were all male with a mean age of 23.1 years; the average number of injuries was 1.6 per athlete, with muscle injuries and sprains resulting from indirect origin predominating in the legs. Conclusion: Injuries were more frequent in forwards and outside backs, and players generally returned to play within one week of treatment. Level of Evidence III, Study of Non Consecutive Patients; Without Consistently Applied Reference "Gold" Standard.

RESUMO Objetivo: Analisar a incidência de lesões ortopédicas ocorridas durante o Campeonato Paulista Profissional da Série A2 de 2010. Métodos: Esta avaliação restringiu-se à coleta de dados desde a pré-temporada até a fase final do campeonato. Resultados: Foram analisados 227 jogadores profissionais de oito das principais equipes deste campeonato. Foram obtidos dados de 71,02% do total de jogos. Os atletas eram todos do sexo masculino, com média de idade de 23,1 anos; o número médio de lesões foi de 1,6 por atleta com predomínio de lesões musculares e entorses indiretos nos membros inferiores. Conclusão: Houve uma frequência maior de lesão em atacantes e laterais, com retorno predominante ao esporte em até uma semana de tratamento. Nível de Evidência III, Estudo de Pacientes Não Consecutivos; Sem Padrão de Referência "Ouro" Aplicado Uniformemente.

Analysis of the pattern and mechanism of elbow injuries related to armbar-type armlocks in jiu-jitsu fighters / Análise do padrão e mecanismo das lesões do cotovelo submetido à chave do tipo armlock em lutadores de jiu-jítsu

ABSTRACT Objective: The objective of this study was to analyze elbow injuries and their probable mechanism in Jiu-Jitsu fighters resulting from the armbar-type armlock. Methods: We evaluated 5 high-performance Jiu-Jitsu fighters from the Gracie Elite gym who were injured during a tournament. All were healthy males with a mean age of 28.8 years. The right arm was involved in three patients (60%). The athletes were followed for approximately 4.6 months, and pain was present in all cases. Clinical examination of the elbow was performed immediately after the injury and when magnetic resonance imaging (MRI) was performed. The radiography showed no changes. Clinical examination detected specific tender points on the medial and anterior topography of the elbows, but no ligamentous instability of the elbow was seen during dynamic testing. Results: The main MRI findings were injury to the common flexor tendon and the ulnar collateral ligament, bone contusion of the distal humerus and olecranon, and joint effusion. Conclusion: The main pattern of injury indicated by the MRI in the athletes was injury to the medial elbow complex. The primary mechanism that determined the injury was most likely elbow hyperextension applied with the forearm in neutral position of forearm. Level of Evidence IV, Case Series.

RESUMO Objetivo: Demonstrar os resultados da análise das lesões do cotovelo e seu provável mecanismo em cinco atletas lutadores de jiu-jítsu decorrentes da chave de braço do tipo armlock. Métodos: Foram avaliados cinco lutadores de jiu-jítsu da academia Gracie Elite, de alto rendimento esportivo, que sofreram lesão durante a realização de um campeonato dessa modalidade. Todos eram do sexo masculino, com média de idade 28,8 anos, hígidos que sofreram lesão durante a participação nesse torneio. O braço direito foi acometido em três pacientes (60%). O seguimento dos atletas foi, em média, de 4,6 meses, sendo que a queixa de dor estava presente em todos os casos. O exame clínico da região do cotovelo foi realizado imediatamente após a ocorrência da lesão e no momento da realização do exame de ressonância magnética (RM). O exame radiográfico não demonstrou alterações. Durante o exame clínico, foram detectados pontos dolorosos específicos na topografia medial e anterior dos cotovelos examinados, na qual não se observaram instabilidades ligamentares do cotovelo durante os testes dinâmicos. Resultados: Os principais achados da RM foram: lesão do tendão comum dos músculos flexores e do ligamento colateral ulnar, contusão óssea na porção distal do úmero e do olécrano e derrame articular. Conclusão: O principal padrão de lesão reconhecido pela RM nos atletas estudados foi a lesão do complexo medial do cotovelo. Sugerimos que o mecanismo primário que determinou as lesões foi a hiperextensão do cotovelo aplicada com a posição neutra do antebraço. Nível de Evidência IV, Série de Casos.

Surgical treatment of acromioclavicular dislocation using the endobutton / Tratamento cirúrgico da luxação acromioclavicular com o uso de endobutton

ABSTRACT OBJECTIVE: To evaluate the clinical and radiographic results of 23 patients diagnosed with acute type III acromioclavicular dislocation treated with the Endobutton. METHODS: Twenty-three patients with a diagnosis of type III acromioclavicular dislocation were treated surgically. RESULTS: Twenty-one patients were male (91.3%) and 2 (8.7%) were female. The dominant side was affected in 15 patients (65.21%) and the non-dominant side in 8 patients (34.79%). All patients were operated on by the same surgical team within 4 weeks of the trauma. According to the UCLA score, 14 patients (60.86%) presented excellent results, 7 patients (30.43%) had good results and 2 patients (8.69%) had regular results. CONCLUSION: The technique was effective in treating acute type III dislocations with a high degree of patient satisfaction. Level of Evidence IV, Case Series.

RESUMO OBJETIVO: Avaliar os resultados clínicos e radiográficos de 23 pacientes com diagnóstico de luxação acromioclavicular aguda tipo III tratados com uso de placa Endobutton. MÉTODOS: Foram submetidos a tratamento cirúrgico 23 pacientes com diagnóstico LAC III. RESULTADOS: O sexo masculino foi prevalente, sendo 21 (91,3%) homens e duas (8,7%) mulheres. O lado dominante foi acometido em 15 pacientes (65,21%) e o não dominante, em oito pacientes (34,79%). Todos os pacientes foram operados pela mesma equipe cirúrgica em até quatro semanas da data do trauma. Pelo escore da UCLA: 14 pacientes (60,86%) apresentaram excelentes resultados, sete pacientes (30,43%), bons resultados e em dois pacientes (8,69%) os resultados foram regulares. CONCLUSÃO: A técnica mostrou-se efetiva no tratamento das luxações agudas de grau III, com elevado grau de satisfação dos pacientes. Nível de Evidência IV, Série de Casos.

Bilateral stress fracture of femoral neck in non-athlete - case report / Fratura de estresse bilateral do colo do fêmur em não atleta - relato de caso

ABSTRACT Bilateral stress fracture of femoral neck in healthy young patients is an extremely rare entity, whose diagnostic and treatment represent a major challenge. Patients with history of hip pain, even non-athletes or military recruits, should be analyzed to achieve an early diagnosis and prevent possible complications from the surgical treatment. This report describes a 43-year-old male patient, non-athlete, without previous diseases, who developed bilateral stress fracture of femoral neck without displacement. He had a late diagnosis; bilateral osteosynthesis was made using cannulated screws. Although the diagnosis was delayed in this case, the study highlights the importance of the diagnosis of stress fracture, regardless of the activity level of the patients, for the success of the treatment.

RESUMO A fratura de estresse bilateral do colo do fêmur em pacientes adultos sadios é uma entidade extremamente rara, cujo diagnóstico e tratamento representam um grande desafio. Pacientes com história de dor no quadril, mesmo se não forem atletas ou militares, devem ser analisados para se obter um diagnóstico precoce e prevenir possíveis complicações provenientes do tratamento cirúrgico. Este relato descreve um paciente de 43 anos, não atleta, do gênero masculino, sem doenças prévias, que desenvolveu fratura de estresse do colo do fêmur bilateral sem desvio, diagnosticado e tratado tardiamente com osteossíntese bilateral com parafusos canulados. Apesar de o diagnóstico ter sido tardio nesse caso, enfatiza-se a importância de se obter diagnóstico de fratura de estresse, independentemente do nível de atividade dos pacientes, para o sucesso do tratamento.

PREFERED SURGICAL TECHNIQUE USED BY ORTHOPEDISTS IN ACUTE ACROMIOCLAVICULAR DISLOCATION

ABSTRACT Objective: To determine whether training on shoulder and elbow surgery influences the orthopedist surgeons' preferred technique to address acute acromioclavicular joint dislocation (ACD). Methods: A survey was conducted with shoulder and elbow specialists and general orthopedists on their preferred technique to address acute ACD. Results: Thirty specialists and forty-five general orthopedists joined the study. Most specialists preferred the endobutton technique, while most general orthopedists preferred the modified Phemister procedure for coracoclavicular ligament repair using anchors. We found no difference between specialists and general orthopedists in the number of tunnels used to repair the coracoclavicular ligament; preferred method for wire insertion through the clavicular tunnels; buried versus unburied Kirschner wire insertion for acromioclavicular temporary fixation; and time for its removal; and regarding the suture thread used for deltotrapezoidal fascia closure. Conclusion: Training on shoulder and elbow surgery influences the surgeons' preferred technique to address acute ACD. Level of Evidence V, Expert Opinion.

FREQUENCY AND RISK FACTORS OF CLAVICLE FRACTURES IN PROFESSIONAL CYCLISTS

ABSTRACT Objective: To evaluate the prevalence of clavicle fractures in professional and amateur cyclists and evaluate the factors associated with its occurrence. Method: One hundred and forty professional and amateur athletes were interviewed through a questionnaire regarding age and time practicing bicycling, among others. Results: Among the 140 evaluated cyclists, there were 19 (13.5%) clavicle fractures associated with this sports modality. Conclusion: There was a positive association between time practicing bicycling and frequency of clavicle fractures, as well as between hours of weekly training and clavicle fractures. Level of Evidence IV, Case-Series.