Osteotomía selectiva como tratamiento de la inestabilidad medial de rodilla / Selective osteotomy as a treatment for medial knee instability

Las fracturas de platillos tibiales son lesiones frecuentes. Una de sus complicaciones postoperatorias es la pérdida de reducción con desviación de los ejes en los planos coronal, sagital y axial. La depresión ósea genera incongruencia articular con pérdida de tensión de estructuras ligamentarias indemnes, causando una pseudo-laxitud con inestabilidad. Esto requiere de una corrección ósea para aumentar la tensión de dichas estructuras ligamentarias y lograr así recuperar la congruencia y estabilidad articular en todo el rango de movilidad. El objetivo del presente trabajo es reportar un caso de inestabilidad medial en un paciente joven, quien, tras una fractura de platillo tibial medial mal consolidada, requirió una osteotomía selectiva biplanar e intraarticular para corregir dicha deformidad

Tibial plateau fractures are frequent. Loss of reduction with axis deviation in the coronal, sagittal and axial planes is one of the postoperative complications.Bone depression generates joint incongruity with loss of tension in undamaged ligament structures resulting in pseudo-laxity with instability. This requires a bone correction to increase the tension of ligament structures, hence achieving the recovery of joint congruence and stability throughout the range of mobility.The objective of the current paper is to report a case of medial instability in a young patient, who suffered a medial tibial plateau fracture with poor bone consolidation, with consequent laxity and pain in the medial compartment, which required a selective biplanar and intra-articular osteotomy to correct such deformity.

Corticoesteroide oral vs. intrarticular en el tratamiento de la capsulitis adhesiva / Oral versus intra-articular corticosteroid in the treatment of adhesive capsulitis

Introducción: La capsulitis adhesiva es una enfermedad que se caracteriza por el engrosamiento de la cápsula articular del hombro, lo que se traduce clínicamente en dolor y una pérdida progresiva de la movilidad. El tratamiento conservador es la primera opción. En este estudio, se evaluó el uso de corticoesteroides articulares para el manejo de este cuadro. Materiales y Métodos: Se llevó a cabo un estudio retrospectivo entre 2015 y 2020. Se evaluaron los registros de consulta externa de pacientes con diagnóstico de capsulitis adhesiva u hombro congelado, que recibieron tratamiento con corticoesteroides por vía oral o articular. Resultados: Se analizó a 19 pacientes, 8 recibieron tratamiento por vía oral y 11, por vía articular. Hubo una mejoría importante en ambos grupos, pero los pacientes que recibieron corticoesteroides articulares comunicaron una mejoría a largo plazo. Conclusiones: La administración de corticoesteroides tanto por vía oral como articular para tratar la capsulitis adhesiva fue eficaz; sin embargo, a largo plazo, los corticoesteroides articulares resultaron más eficaces. Nivel de Evidencia: III

Introduction: Adhesive capsulitis is a condition defined by thickening of the shoulder joint capsule, which clinically translates into discomfort and progressive loss of range of motion, with conservative therapy being the initial option. In this study, we evaluate the use of intra-articular corticosteroid injections for the treatment of this condition. Materials and Methods: A retrospective analysis was conducted between 2015 and 2020, assessing the outpatient records of patients diagnosed with adhesive capsulitis or frozen shoulder and treated with corticosteroids either orally or intra-articularly. Results: A total of 19 patients were analyzed, 8 received oral treatment and 11 received intra-articular injection, with both groups showing considerable improvement, with the difference that the patients in the articular corticosteroid group reported long-term improvement. Conclusion: Corticosteroids have been found to be effective in the treatment of adhesive capsulitis both orally and by intra-articular injection; however, intra-articular corticosteroids have proved to be more effective in the long term. Level of Evidence: III

Patients Who Present with Functional Limitations, Limited Range of Motion and Reduced Muscle Strength 6 Months after Total Hip Arthroplasty: A Cross-Sectional Study / Pacientes que apresentam limitações funcionais, amplitude de movimento limitada e força muscular reduzida, 6 meses após a artroplastia total do quadril: Um estudo de corte transversal

Abstract Objective To evaluate levels of pain, range of motion, hip isometric peak torque, and functional task performance in patients 6 months after total hip arthroplasty (THA) and to compare them to asymptomatic control participants (CG). Methods We recruited participants with unilateral THA due to hip osteoarthritis (OA) within a median of 6 months who had not developed postoperative complications. We assessed the pain levels, hip range of motion, peak isometric torque, self-reported assessment (Harris Hip Score) and objectively measured function (Timed Up & Go Test [TUG]) of the patients. The THA group was compared with a group of asymptomatic participants ≥50 years old recruited in the community. Comparisons are presented as mean differences (MDs) and 95% confidence intervals (CIs). Results A total of 23 participants were included in each group. Pain levels were low in the THA group (1.48 [1.60]), and 91.3% of the patients reported to be satisfied with the surgical procedure. Participants in the THA group reported significantly lower objectively measured (THA 12.2 [10.0-21.6]; CG 9.0 [6.7-12.2]) and self-reported function (THA 78.5 [43.8-93.9]; CG 100.0 [95.8-100.0]) compared with CG. The THA group also had significantly reduced range of motion for flexion (p< 0.001), internal (p< 0.001) and external rotation (p= 0.003) movements and reduced peak torque for flexion (p< 0.001), extension (p< 0.001), abduction (p< 0.001) and adduction (p= 0.024) movements compared with participants of the CG. Conclusions Despite reporting overall low pain scores and satisfaction with the surgery, the patients present with functional limitations, limited range of motion, and reduced muscle strength 6 months after THA. Evidence Level 3b

Resumo Objetivo Avaliar os níveis de intensidade da dor, amplitude de movimento, pico de torque isométrico do quadril e desempenho da tarefa funcional em pacientes 6 meses após a artroplastia total do quadril (ATQ), e comparar estes valores com os de participantes assintomáticos do grupo controle (GC). Métodos Recrutamos participantes com ATQ unilateral devida a osteoartrite (OA) do quadril, dentro de uma mediana de tempo de 6 meses, que não tinham desenvolvido complicações pós-operatórias. Os participantes foram avaliados quanto à intensidade da dor, à amplitude de movimento do quadril, ao pico de torque isométrico, à autoavaliação (questionário de avaliação do quadril Harris Hip Score [HHS, na sigla em inglês) e à função medida objetivamente por meio do teste Timed Up and Go (TUG, na sigla em inglês). O grupo ATQ foi comparado com um grupo de participantes assintomáticos com idade ≥ 50 anos recrutados na comunidade. As comparações são apresentadas como diferenças médias (DMs) e intervalos de confiança (ICs) de 95%. Resultados Cada grupo contou com 23 participantes. A intensidade da dor foi baixa no grupo ATQ (1,48 [1,60]), sendo que 91,3% dos pacientes relataram estar satisfeitos com o procedimento cirúrgico. Os participantes do grupo ATQ relataram uma função medida objetivamente significativamente menor (ATQ 12,2 [10,0-21,6]; GC 9,0 [6,7-12,2]) e a função autoavaliação (ATQ 78,5 [43,8-93,9]; GC 100,0 [95,8-100,0]), em comparação com o GC. O grupo ATQ também teve reduzida de forma significativa a amplitude de movimento para flexão (p< 0,001), os movimentos internos (p< 0,001) e de rotação externa (p= 0,003). O grupo ATQ também apresentou pico de torque reduzido para flexão (p< 0,001), extensão (p <0,001), movimentos de abdução (p< 0,001) e adução (p = 0,024) em comparação com os participantes do GC. Conclusões Apesar de informarem escores gerais de dor de baixa intensidade e satisfação com a cirurgia, os pacientes apresentaram limitações funcionais, amplitude de movimento limitada e redução da força muscular após 6 meses do procedimento cirúrgico de ATQ. Nível de Evidência3B.

Modificación de la actividad metabólica por medio de un dispositivo intraoral en pacientes con hiperplasia condilar confirmada por SPECT / Metabolic activity modification by means of an intraoral device in patients with condylar hyperplasia confirmed by SPECT

Objetivo: Evaluar los efectos de la aplicación de un dispositivo intraoral de uso permanente en el comportamien- to de los cóndilos con hiperplasia condilar (HC) confirmada por tomografía computarizada de emisión por fotón único (SPECT), estableciendo una comparación con un grupo de pacientes con HC que no utilizó el dispositivo. Materiales y métodos: 30 pacientes con una edad promedio de 21,7 años (+/-5,56) con HC confirmada con SPECT fueron asignados al azar a dos grupos: a los del grupo I (n=18) se les colocó un dispositivo intraoral de uso perma- nente para modificar la posición de la mandíbula, mientras que a los del grupo II (n=12) no se les colocó ningún dispo- sitivo. Se realizaron evaluaciones de dolor, del desvío de la línea media, de la apertura máxima y del disconfort al inicio del estudio y a los 2, 4, 6, 10, 12 y 14 meses. A los 19 meses promedio, la actividad osteoblástica (AO) fue reevaluada me- diante SPECT. Resultados: En el grupo I, la AO en los cortes coro- nales y transversales cesó o disminuyó (p<0,001) respecto a la condición inicial, mientras que en el grupo II la AO au- mentó (p<0,001). Los datos fueron analizados utilizando el test de Wilcoxon de rangos signados. Al ajustar un modelo de ANCOVA robusto utilizando el valor inicial como covariable también se observa que el efecto del grupo fue estadística- mente significativo en ambos cortes (p<0,001). Conclusiones: La aplicación de un dispositivo intrao- ral de uso permanente mejora la evolución de la hiperplasia condilar, lo que lo puede convertir en un tratamiento de uti- lidad para el tiempo que se aguarda para realizar una condi- lectomía alta de cuello de cóndilo, o incluso para evitar este procedimiento (AU)

Objective: To evaluate the effects of the application of an intraoral device for permanent use on the behavior of con- dyles with condylar hyperplasia (CH) confirmed by single photon emission computed tomography (SPECT), establish- ing a comparison with a group of patients with CH that did not use the device. Materials and methods: Thirty patients with an aver- age age of 21.7 years (+/-5.56) with CH confirmed by SPECT were randomly divided into two groups: the ones in group I (n=18) received an intraoral device for permanent use to align the mandible, while those in group II (n=12) did not get any device. Pain, midline shift, maximum opening, and discomfort were evaluated at the beginning of the study and at 2, 4, 6, 10, 12, and 14 months. At an average of 19 months, osteoblastic activity (AO) was reassessed by SPECT. Results: In group I, the AO in the coronal and trans- verse sections ceased or decreased (p<0.001) in comparison to the initial condition, while in group II the AO increased (p<0.001). The data was analyzed by the Wilcoxon signed rank test. Adjusting a robust ANCOVA model using the ini-tial value as a covariate made it possible to observe that the effect of the group was statistically significant in both cuts (p<0.001). Conclusions: The application of an intraoral device for permanent use improves the evolution of condylar hyperpla- sia, which can make it a useful treatment until a high condylectomy of the neck of the condyle is performed, or even to avoid this procedure (AU)

Gender-based Variations in Trunk Motion and Isometric Strength in Young Adults with Low Back Pain: A Prospective Case-control Study / Variações baseadas em gênero no movimento e na força isométrica do tronco em jovens adultos com dor lombar: Um estudo de caso-controle prospectivo

Abstract Objective To determine gender-based variations in trunk range of motion (RoM) and isometric strength (IS) in symptomatic and asymptomatic young adults. Methods In this prospective case-control study, 73 subjects with low back pain (LBP) and 80 asymptomatic subjects were analyzed. Dynamometer-based device trunk RoM and IS measurements in extension, flexion, and rotation were compared in both groups and gender-based subgroups. Multivariate analysis was used to determine factors influencing trunk RoM and IS. Results Symptomatic males had significantly less extension RoM and extension, flexion, and rotation isometric trunk strength (ITS) (p < 0.0001) compared with asymptomatic males, whereas no significant difference was found between asymptomatic and symptomatic females. However, the mean extension-flexion RoM and mean extension-flexion ITS ratios were significantly lower (p = 0.04) in asymptomatic females compared with symptomatic females. Female gender was significantly associated with less extension and flexion ITS in both asymptomatic and symptomatic subjects. Conclusion Males with LBP had significant global ITS weakness when compared with asymptomatic males. Despite no significant ITS difference in symptomatic versus asymptomatic females, LBP caused significant extension-flexion RoM and ITS imbalance in females. These gender-based variations in trunk RoM and IS, especially the extensor-flexor IS imbalance in females, must be considered while designing rehabilitation treatment protocols for LBP.

Resumo Objetivo Determinar as variações na amplitude de movimento (ADM) do tronco e na força isométrica do tronco (FIT) em jovens adultos sintomáticos e assintomáticos baseadas no gênero dos indivíduos. Métodos Neste estudo caso-controle prospectivo, 73 indivíduos com dor lombar (DL) e 80 indivíduos assintomáticos foram analisados. As medidas de ADM do tronco e FIT de extensão, flexão e rotação foram comparadas em ambos os grupos e em subgrupos organizados por gênero. A análise multivariada foi usada para determinar os fatores que influenciam a ADM do tronco e a FIT. Results Symptomatic males had significantly less extension RoM and extension, flexion, and rotation isometric trunk strength (ITS) (p < 0.0001) compared with asymptomatic males, whereas no significant difference was found between asymptomatic and symptomatic females. However, the mean extension-flexion RoM and mean extension-flexion ITS ratios were significantly lower (p = 0.04) in asymptomatic females compared with symptomatic females. Female gender was significantly associated with less extension and flexion ITS in both asymptomatic and symptomatic subjects. Conclusão Indivíduos do sexo masculino com DL apresentaram significativa fraqueza global relacionada à FIT quando comparados com indivíduos do sexo masculino assintomáticos. Apesar de não haver diferença significativa de FIT em indivíduos do sexo feminino sintomáticos versus assintomáticos, a DL impactou a ADM e a FIT de extensão-flexão em indivíduos do sexo feminino. Essas variações de ADM do tronco e FIT baseadas no sexo, especialmente o desequilíbrio extensor-flexor de força isométrica em indivíduos do sexo feminino, devem ser consideradas ao projetar-se protocolos de tratamento de reabilitação para lombalgia.

¿Efectividad de la técnica de liberación miofacial en el aumento del rango articular en restricción glenohumeral? Una comparación con la kinesioterapia tradicional / Effectiveness of the myofascial release technique in increasing joint range in glenohumeral restriction? A comparison with traditional kinesiotherapy

OBJETIVO: comparar la kinesioterapia tradicional con la técnica miofacial en pacientes con restricción articular interna glenohumeral. MÉTODO: estudio comparativo de 8 pacientes en un grupo de intervención (GI) y kinésico (GC), durante 8 semanas. Se comparó el pre y post test del ROM interno glenohumeral en ambos grupos mediante t de student. RESULTADOS: el grupo de la técnica miofascial demostró una amento significativo de ROM interno glenohumeral de 15,2º (p < 0,001), mientras que el grupo control no fue significativo (p > 0,05) sólo de de 6,4º. CONCLUSIONES:Un tratamiento de terapia con la Técnicas Liberación Miofascial en pacientes con déficit rotacional interno de hombro es más eficaz para aumentar el rango de movimiento articular de rotación interna glenohumeral que una técnica tradicional y conservadora.

OBJETIVE: to compare traditional kinesiotherapy with myofacial technique in patients with glenohumeral internal joint restriction. METHODS: comparative study of 8 patients in an intervention (IG) and kinesiotherapy (CG) group for 8 weeks. The pre- and post-test of glenohumeral internal ROM in both groups was compared using Student's t-test. RESULTS: the myofascial technique group showed a significant increase in glenohumeral internal ROM of 15.2º (p < 0.001), while the control group was not significant (p > 0.05) only 6.4º. CONCLUSIONS: A therapy treatment with Myofascial Release Techniques in patients with shoulder internal rotational deficit is more effective in increasing glenohumeral internal rotational joint range of motion than a traditional, conservative technique.

Efeito do oncofitness na amplitude articular de pacientes com câncer de próstata / Efecto del oncofitnessen el rango de movimiento articular de pacientes con cáncer de próstata / Effect of oncofitness in joint amplitude of patients with prostate cancer

RESUMO O objetivo da pesquisa foi avaliar o efeito de um Programa de Exercício Físico Oncológico - ONCOFITNESS na amplitude articular em pacientes com câncer submetidos à radioterapia. O estudo é um tipo de ensaio clínico prospectivo randomizado controlado no qual se compara o efeito e o valor de uma intervenção, com características profiláticas ou terapêuticas, em seres humanos. Os procedimentos consideraram as normas para realização de pesquisas em seres humanos com a aprovação do projeto pelo CEP/Hospital Mário Kröeff. A avaliação da flexibilidade foi realizada seguindo o protocolo LABIFIE, com goniômetro de aço da marca Lafayette® (EUA). O grupo experimental realizou uma intervenção com Oncofitness. Após esse período, foi realizada outra avaliação, seguindo os mesmos procedimentos. A análise estatística foi realizada no programa SPSS (Statistical Package for the Social Sciences) versão 20.0. A amostra foi composta por 30 homens com idade GE (X ̅ = 59,0 ± 2,0 anos) e GC (X ̅ = 60,0 ± 1,0 anos). Os dados revelaram que os ganhos do GE foram observados em: flexão do joelho (∆%=5,0%, p=0,0011x); em abdução do quadril (∆%=15,8%, p=0,003x); em rotação interna (∆%=8,1%, p=0,0129x) e em flexão de ombro, (∆%=8,3%, p=0,0185x). Não foi observado ganho no GC, pode-se verificar que o Oncofitness proporcionou a redução de alguns dos sintomas relacionados aos tratamentos oncológicos devido à melhora da amplitude articular.

RESUMEN El objetivo de la investigación fue evaluar el efecto de un Programa de Ejercicios Físicos Oncológicos - ONCOFITNESS en la amplitud articular en pacientes oncológicos sometidos a radioterapia. El estudio es tipo ensayo clínico controlado randomizado, prospectivo en que compara el efecto y valor de una intervención, con características profilácticas o terapéuticas, en seres humanos. Los procedimientos consideraron las normas para la realización de investigación en seres humanos con la aprobación del proyecto por el CEP/Hospital Mário Kröeff. La evaluación de la flexibilidad fue realizada siguiendo el protocolo del LABIFIE, con un goniómetro de acero da marca Lafayette® (EUA). El grupo experimental realizó una intervención con el Oncofitness. Después de ese periodo, se realizó otra evaluación, siguiendo los mismos procedimientos. El análisis estadístico fue realizado mediante el SPSS (Statistical Package for the Social Sciences) versión 20.0. La muestra fue de 30 hombres con edades GE (X ̅ = 59,0 ± 2,0 años) y GC (X ̅ = 60,0 ± 1,0 años). Los datos revelaron que fueron observadas ganancias GE en: flexión de rodillas (∆%=5,0%, p=0,0011x); en la abducción de cadera (∆%=15,8%, p=0,003x); en la rotación interna (∆%=8,1%, p=0,0129x) y en flexión de hombro, (∆%=8,3%, p=0,0185x). No fue observada ganancia en el GC, se puede verificar que el Oncofitness proporcionó la reducción de algunos de los síntomas relacionados a los tratamientos oncológicos por la mejora de la amplitud articular.

ABSTRACT The research aimed to evaluate the effect of an Oncology Physical Exercises Program - ONCOFITNESS on the joint range of cancer patients undergoing radiotherapy. The study is considered a randomized controlled clinical trial, being prospective in that it compares the effect and value of an intervention, with prophylactic or therapeutic characteristics, in human beings. The procedures met the standards for researching human beings, and the project was approved. CEP/Hospital Mário Kröeff. Flexibility measurement performed following the LABIFIE protocol, with a Lafayette® brand steel goniometer (USA). The experimental group performed an intervention with Oncofitness. After this period, another evaluation was carried out, following the same procedures. Statistical analysis was performed using SPSS (Statistical Package for the Social Sciences) version 20.0. Sample of 30 men aged GE (X ̅ = 59.0 ± 2.0 years) and CG (X ̅ = 60.0 ± 1.0 years). The data revealed that gains were observed in the EG in knee flexion (∆%=5.0%, p=0.0011x); in hip abduction (∆%=15.8%, p=0.003x); in internal rotation (∆%=8.1%, p=0.0129x) and in shoulder flexion, (∆%=8.3%, p=0.0185x). As was not observed in the CG, Oncofitness provided a reduction in some of the symptoms related to oncological treatments by improving joint range of motion.

High frequency transcutaneous electrical stimulation in the immediate postoperative period of anterior cruciate ligament reconstruction: a randomized clinical trial / Estimulação elétrica transcutânea de alta frequência no pós operatório imediato de reconstrução do ligamento cruzado anterior: um ensaio clínico randomizado

INTRODUCTION: The anterior cruciate ligament (ACL) is an important structure for knee stability. Transcutaneous electrical nerve stimulation (TENS) is an electrical current applied for significant pain relief. OBJECTIVE: To evaluate the effects of high-frequency TENS on the immediate postoperative period of ACL reconstruction. METHODS: 46 patients in the postoperative period of ACL reconstruction were randomly assigned to a control group (CG=23) and a TENS group (TG=23). Knee range of motion (ROM), pain, muscle strength, and drug intake were assessed before surgery and 24 and 48 hours after surgery. The TENS intervention protocol started in the recovery room, shortly after surgery, and was maintained continuously for the first 48 hours after surgery. RESULTS: The TENS group (TG) significantly controlled the increased level of postoperative pain (p<0.05) and significantly increased flexion ROM (p<0.05). When compared to the Control group (CG), the TENS group had a lower intake of ketoprofen (48.27%), diazepam (256.98%), and dipyrone (121.21%), morphine (320.77%), and tramadol (437.46%). CONCLUSION: Continuous high-frequency TENS significantly reduced pain intensity and significantly improved ROM, muscle strength, and drug intake in the postoperative period of ACL reconstruction.

Flexibility and achilles tendon: a brief review / Flexibilidade e tendão de aquiles: uma breve revisão

Performing flexibility training in an exercise program is important to improve range of motion (ROM). Tendons have a profound impact on the general function of the musculoskeletal system, influence the limitation of ROM, and its structure and mechanical properties can benefit from stretching protocols. The systematic use of lower limbs in locomotion caused the Achilles tendon to become the largest and strongest tendon in the human body. Therefore, understanding the best prescription and frequency of flexibility exercise leads to changes in tendon properties is essential for an appropriate and effective exercise routine. Thus, the aim of this review was to organize and discuss publications about the implications of triceps surae stretching in ROM, as well as its influence on tendon properties. Acute studies show that continuous stretching times between five and 10 minutes cause decreased tendon stiffness, which is not seen in fractionated stretching times less than five minutes. Chronic studies, in turn, also don't present significant results in stiffness with fractionated times and studies with continuous times were not found. Thus, it is not possible to know if a continuous stretching time (longer than one minute) or a total time longer than five minutes but fractionated, can influence the tendon stiffness. (AU)

A realização de treino de flexibilidade como rotina em um programa de exercícios é importante para melhorar amplitude de movimento (ADM). Os tendões têm um impacto profundo na função geral do sistema musculoesquelético, influenciam na limitação da ADM, e sua estrutura e propriedades mecânicas podem se beneficiar de protocolos de alongamento. O uso sistemático dos membros inferiores na locomoção fez com que o tendão de Aquiles se tornasse o maior e mais forte tendão do corpo humano. Portanto, entender qual a melhor prescrição e frequência de exercício de flexibilidade para que ocasione alterações nas propriedades tendíneas é essencial para uma rotina de exercícios adequada e eficaz. Sendo assim, o objetivo dessa revisão de literatura foi organizar e discutir publicações sobre as implicações do alongamento do tríceps sural na ADM, bem como sua influência nas propriedades tendíneas. Estudos agudos mostram que tempos contínuos entre cinco e 10 minutos de alongamento estático causam diminuição da rigidez tendínea, o que não é visto em tempos intervalados inferiores a cinco minutos. Os estudos crônicos, por sua vez, também não apresentam resultados significativos na rigidez com protocolos de alongamento intervalados e estudos com protocolos contínuos não foram encontrados. Dessa forma, não é possível saber se um tempo contínuo de alongamento (superior a um minuto) ou um tempo superior a cinco minutos, intervalado, podem influenciar na rigidez tendínea. (AU)

Relação entre o perfil de adesão e as barreiras para a permanência no programa de extensão "yoga: awaken one" / Relationship between the membership profile and the barriers to stay in the "yoga: awaken one" extension program

Objetivo: Investigar a relação entre o perfil de adesão e barreiras percebidas por estudantes universitários para permanência no Programa de Extensão "Yoga: Awaken ONE". Métodos: Foram realizados dois cortes transversais com universitários da Universidade Federal do Recôncavo da Bahia. O primeiro foi composto por 16 indivíduos e investigou o perfil demográfico, socioeconômico, antropométrico, da aptidão física e da qualidade de vida dos universitários que ingressaram no Programa de Extensão. O segundo visou identificar as barreiras para permanência de 13 estudantes (dentre os 16 iniciais) que haviam se afastado do Programa após quatro meses do início. Resultados: Houve predominância de indivíduos do sexo feminino, dos cursos de graduação em Educação Física e Pedagogia e da classe socioeconômica C. A maioria dos participantes estava com indicadores adequados de gordura corporal. Observou-se grande proporção de indivíduos com indicadores baixos de flexibilidade e força muscular. Para a qualidade de vida, a menor mediana foi observada para o domínio meio ambiente e a maior para o domínio relações sociais. As principais barreiras percebidas para a prática de yoga pelos universitários foram "jornada de estudos extensa" e "jornada de trabalho extensa". Observou-se correlação do perfil sociodemográfico, indicadores de obesidade, variáveis hemodinâmicas, flexibilidade, força muscular e qualidade de vida com barreiras percebidas para permanência no Programa de Extensão universitária "Yoga: Awaken ONE". Conclusões: Estes achados sugerem que o perfil do público universitário pode ser determinante para a permanência ou evasão de programas de promoção de exercícios físicos e precisa ser considerado em propostas de programas de extensão universitária.

Objective: Investigate the relationship between the member adherence profile and barriers perceived by university students to remain in the "Yoga: Awaken ONE" Extension Program. Methods: Two cross-sections were carried out with university students from the Federal University of Recôncavo da Bahia. The first was composed of 16 individuals and investigated the demographic, socioeconomic, anthropometric, physical fitness, and quality of life profile of university students joining the Extension Program. The second aimed at identifying the barriers to remain in the program faced by 13 students (out of the initial 16) who had withdrawn from the Program four months after the beginning. Results: There was a predominance of female individuals, from undergraduate courses in Physical Education and Pedagogy, and from the C socioeconomic class. Most participants had adequate body fat indexes. There was a large proportion of individuals with low flexibility and muscle strength. For quality of life, the lowest median was observed for the environment domain, while the highest could be noted for the social relationship domain. The main barriers perceived for the practice of yoga by university students were "long study hours" and "long work hours". There was a correlation between sociodemographic profile, obesity indicators, hemodynamic variables, flexibility, muscle strength, and QOL with the perceived barriers to stay in the "Yoga: Awaken ONE" university extension program. Conclusions: These findings suggest that the profile of the university audience can be a determinant for the permanence or dropout of programs that promote physical exercise and therefore, it should be taken into consideration in proposals for university extension programs.

Does range of motion measurement and reference values differ?: a multi-centered study

This study is aimed to estimate and measure reference values in the normal range of motion of extremity joints in females and to provide a database for the assessment of impairments related to the mobility of the joints. This observational cross-sectional study was conducted at seven major educational institutes areas of Rawalpindi and Islamabad in Pakistan from January to June 2020 with a sample size of 600 healthy females aged 15 to 45 years and divided into three groups through non-probability sampling technique. In study Instruments, an electronic Goniometer was used for the measurement of the range of motions for different joints and then those ranges were recorded. The questionnaire had two sections demographic characteristics and ROM for both upper and lower limbs. Data was analyzed using SPSS V21. A p < 0.05 was considered statistically significant.In the result,Out of 600 participants,there was a statistically significant difference of (p < 0.001) in both upper and lower extremities motion between all the three groups for the measurements and noticeably no significant difference (p > 0.005) between group 1, 2 comparisons for the knee joint extension.To conclude, In most joints, the range of motion increases with age. The transition from group 1 to group 2 was aided by increased hormone participation in growth, an active lifestyle, and generally good health. Because of degenerative changes and joint stiffness, group 3's range of motion deteriorated, leading to a sedentary lifestyle and lack of physical activity. Standardized biomechanical measurements can help health practitioners, such as physiotherapists, choose appropriate therapy interventions to assess musculoskeletal disorders. To resolve the inconsistencies in the reliability and validity of goniometry values, more research is required.

The Use of Physical Screening Tools to Identify Injury Risk Within Pre-Professional Ballet Dancers: An Integrative Review / El uso de herramientas de cribado física para identificar el riesgo de lesiones en los bailarines de ballet preprofesionales: Una revisión integradora

Objective. To conduct an integrative review of all relevant research investigating the physical risk factors for injury within pre-professional ballet dancers, to provide insight that may benefit practitioners within these institutions and highlight areas for future research within this specialised population.Design. Studies were identified from the following electronic databases: MEDLINE via PubMed, SPORTDiscus via EBSCOhost, and Web of Science Core Collection via Web of Science. 8,415 titles were identified during the electronic search process. Five studies satisfied the inclusion criteria and were included in the review. The mod-ified Agency for Healthcare Research and Quality (AHRQ) scale for observational studies was used to assess study quality.Results. The review identified that the following physical characteristics may influ-ence prospective injury risk in pre-professional ballet dancers: age and maturation status, anthropometrics and body composition, strength and power, joint mobility and range of motion, specific dance function, and cardiorespiratory fitness.Limitations. The research identified lacked methodological quality. This, com-bined with the low number of studies identified, makes the design of screening pro-tocols challenging for practitioners.Originality. Despite the number of pre-professional balletic institutions worldwide, previous reviews have not used a systematic search strategy or investigated both sexes in this cohort. Due to the unique demands of ballet, an understanding of the inter-action between injury and physical characteristics is a critical step in order to reduce injury burden. Conclusions. This review succeeded in determining risk factors for injury within this population, but, due to insufficient evidence, could not provide robust screening recommendations

Objetivo. Llevar a cabo una revisión integradora de toda la investigación relevante sobre los factores de riesgo físico de las lesiones en los bailarines de ballet preprofesionales, para proporcionar una visión que pueda beneficiar a los profesionales de estas instituciones y resaltar las áreas para futuras investigaciones en esta población especializada. Diseño. Los estudios se identificaron en las siguientes bases de datos electrónicas: MEDLINE vía PubMed, SPORTDiscus vía EBSCOhost y Web of Science Core Collection vía Web of Science. Se identificaron 8.415 títulos durante el proceso de búsqueda electrónica. Cinco estudios cumplieron los criterios de inclusión y se incluyeron en la revisión. Para evaluar la calidad de los estudios, se utilizó la escala modificada de la Agency for Healthcare Research and Quality (AHRQ) para estudios observacionales. Resultados. La revisión identificó que las siguientes características físicas pueden influir en el riesgo prospectivo de lesiones en los bailarines de ballet preprofesionales: edad y estado de maduración, antropometría y composición corporal, fuerza y potencia, movilidad articular y amplitud de movimiento, función específica de la danza y aptitud cardiorrespiratoria. Limitaciones. La investigación identificada carecía de calidad metodológica. Esto, combinado con el bajo número de estudios identificados, hace que el diseño de protocolos de detección sea un reto para los profesionales. Originalidad. Las revisiones anteriores no han utilizado una estrategia de búsqueda sistemática ni han investigado ambos sexos en esta cohorte. Debido a las exigencias únicas del ballet, la comprensión de la interacción entre las lesiones y las características físicas es un paso fundamental para reducir la carga de lesiones. Conclusiones. Esta revisión logró determinar los factores de riesgo de lesiones dentro de esta población, pero, debido a la insuficiencia de evidencia, no pudo proporcionar recomendaciones sólidas de cribado.

La rotación axial de la clavícula que plantea la maniobra de Mulligan ¿produce una reducción de la presión en el espacio subacromial? Un estudio ex vivo exploratorio / Does the axial rotation of the clavicle posed by the Mulligan maneuver produce a pressure reduction in the subacromial space? An exploratory ex vivo study

RESUMEN: El pinzamiento de hombro es la principal causa del hombro doloroso. Dentro de las estrategias terapéuticas propuestas se encuentra la terapia manual. En este contexto, la maniobra de Mulligan, implica una rotación axial en sentido anterior de la clavícula, emulando la acción del músculo subclavio, lo cual hipotéticamente aumentaría el espacio subacromial. Sin embargo, no existen antecedentes que proporcionen sustento experimental a dicha hipótesis. El objetivo del presente estudio fue explorar si la rotación axial de la clavícula, producida por la maniobra de Mulligan, tiene efecto sobre la presión registrada en el espacio subacromial, con el propósito disponer de antecedentes metodológicos que puedan contribuir al diseño de futuros estudios que aborde la problemática expuesta y consideren un mayor tamaño de muestra. Mediante un estudio exploratorio ex-vivo, se evaluaron dos preparados anatómicos que comprendían la escapula, la clavícula y los dos tercios proximales del humero, ambos con indemnidad de la articulación glenohumeral y acromioclavicular. En estos se registraron la presión en el espacio subacromial y la rotación axial de la clavícula, todo durante la realización de una maniobra de rotación axial clavicular en sentido anterior. Se analizaron las diferencias de presión entre una condición basal y durante la maniobra, como también la máxima rotación axial de clavícula. Dichas variables fueron registradas mediante un sensor de presión y un sistema de análisis de movimiento. La presión en el espacio subacromial durante la maniobra, disminuyó en todas las repeticiones en un rango comprendido entre el 21-51 % de la presión basal. La máxima rotación axial registrada estuvo entre los 3.9-10°. Los resultados de este estudio exploratorio, dan pie para hipotetizar que la maniobra de rotación axial anterior de la clavícula produce una disminución de la presión subacromial, en el área comprendida inmediatamente bajo el acromion.

SUMMARY: Shoulder impingement is the main cause of shoulder pain. Manual therapy is one of the proposed therapeutic strategies. In this context, the Mulligan maneuver implies anterior axial rotation of the clavicle, emulating the action of the subclavius muscle, which hypothetically would increase the subacromial space. However, there are no antecedents that provide experimental support for this hypothesis. The objective of the present study was to explore whether the axial rotation of the clavicle, produced by the Mulligan maneuver, has an effect on the pressure registered in the subacromial space, with the purpose of having methodological antecedents that can contribute to the design of future studies that address the problem exposed and consider a larger sample size. Through an ex-vivo exploratory study, two anatomical preparations comprising the scapula, clavicle, and proximal two-thirds of the humerus, both with glenohumeral and acromioclavicular joint sparing, were evaluated. In these, the pressure in the subacromial space and the axial rotation of the clavicle were recorded, all during the performance of an anterior clavicular axial rotation maneuver. Pressure differences between a basal condition and during the maneuver were analyzed, as well as the maximum axial rotation of the clavicle. These variables were recorded using a pressure sensor and a movement analysis system. The pressure in the subacromial space during the maneuver decreased in all repetitions in a range between 21-51% of the basal pressure. The maximum axial rotation recorded was between 3.9-10°. The results of this exploratory study give rise to the hypothesis that the anterior axial rotation maneuver of the clavicle produces a decrease in subacromial pressure, in the area immediately below the acromion.

Efectos del autoinjerto hueso-tendón patelar-hueso sobre la posición articular y la fuerza en pacientes con reconstrucción del ligamento cruzado anterior / Effects of bone-patellar tendon-bone autograft on joint position and strength in patients with anterior cruciate ligament reconstruction

RESUMEN: El objetivo del estudio fue comparar el déficit propioceptivo a través del Joint position sense (JPS) y Force steadiness en pacientes con reconstrucción del ligamento cruzado anterior (LCA) injerto hueso-tendón patelar-hueso (HTH) 6 a 12 meses postcirugía. Participaron 15 pacientes (13 hombres y 2 mujeres, 25,5 ± 1,3 años) con reconstrucción de LCA con autoinjerto HTH y 20 personas sin lesión del LCA (19 hombres y 1 mujer, 24,1 ± 0,8 años). Para evaluar la sensación de posición de la articulación de la rodilla se midió la Joint position sense (JPS) en tres rangos: 0°-30°, 31°-60° y 61°-90° y la sensación de fuerza del cuádriceps fue evaluada con la prueba Force steadiness (FS) al 15 % de la contracción voluntaria máxima (CVM), ambas pruebas realizadas 6 a 12 meses post cirugía. Los resultados mostraron que no hubo diferencias estadísticamente significativas en la sensación de la posición articular (JPS 0°-30°) (p=0.564) y 31°-60° (p=0.681), mientras que en el rango 61°-90° (p=0.003) existieron diferencias estadísticamente significativas. En las mediciones de sensación de fuerza del cuádriceps (FS al 15 % CVM) entre los pacientes operados de LCA técnica HTH y el grupo control no hubo diferencias estadísticas (p= 0.987) La sensación de la fuerza del cuádriceps medida con la prueba FS al 15 % CVM no presentaría déficit entre los 6 a 12 meses en pacientes post operados de LCA al ser comparados con sujetos sin lesión ni cirugía de este ligamento. Se concluye que la sensación de la posición articular medida con la prueba JPS en en tres rangos articulares de pacientes con reconstrucción de LCA injerto HTH 6 a 12 meses post cirugía sólo mostró alteraciones en el rango de 61°- 90° al ser comparado con el grupo control, lo cual indica que la sensación de la posición articular presenta un déficit en este rango específico.

SUMMARY: The aim of the study was to compare the proprioceptive deficit through the Joint position sense (JPS) and Force steadiness in patients with anterior cruciate ligament (ACL) bone-patellar tendon-bone graft (PTH) reconstruction 6 to 12 months post-surgery. Fifteen patients (13 men and 2 women, 25.5 ± 1.3 years) with ACL reconstruction with HTH autograft and 20 persons without ACL injury (19 men and 1 woman, 24.1 ± 0.8 years) participated. To assess knee joint position sensation, Joint position sense (JPS) was measured in three ranges: 0°-30°, 31°- 60° and 61°-90° and quadriceps strength sensation was assessed with the Force steadiness (FS) test at 15 % of maximal voluntary contraction (MVC), both tests performed 6 to 12 months post surgery. The results showed that there were no statistically significant differences in joint position sensation (JPS 0°-30°) (p=0.564) and 31°-60° (p=0.681), while in the range 61°-90° (p=0.003) there were statistically significant differences. In the quadriceps strength sensation measurements (FS at 15 % CVM) between the patients operated on ACL HTH technique and the control group there were no statistical differences (p= 0.987). The quadriceps strength sensation measured with the FS test at 15 % CVM would not present a deficit between 6 to 12 months in post- operated ACL patients when compared to subjects without injury or surgery of this ligament. It is concluded that the joint position sensation measured with the JPS test in three joint ranges of patients with ACL reconstruction HTH graft 6 to 12 months post surgery only showed alterations in the range of 61°- 90° when compared to the control group, indicating that the joint position sensation presents a deficit in this specific range.

Lateralización y distalización objetiva en prótesis reversa de lateralización glenoidea / Lateralization and distalization in reverse shoulder arthroplasty

Introducción: la artroplastia reversa de hombro (RSA, por su nombre en inglés) con un centro de rotación lateralizado ha demostrado reducir las tasas de notching, restaurar el contorno del hombro y mejorar la rotación externa. La lateralización puede lograrse desde el componente glenoideo o desde el vástago humeral. Boutsadis et al. describieron dos mediciones angulares en radiografías postoperatorias para determinar objetivamente la lateralización y la distalización en la RSA: el ángulo de lateralización del hombro (LSA, por su nombre en inglés) y el ángulo de distalización del hombro (DSA, por su nombre en inglés). Estas mediciones son reproducibles y se correlacionan con los resultados funcionales y la amplitud de movimiento. La prótesis DJO (DJO Surgical, Austin, TX, EE. UU.) presenta una glenosfera con centro de rotación lateralizado, con un ángulo cuello-eje de 135°. Este implante ha dado resultados clínicos satisfactorios en los estudios de seguimiento a medio y largo plazo. Hasta la fecha, no se ha descripto la medición objetiva de los índices de lateralización y su asociación con la amplitud de movimiento postoperatorio mediante LSA y DSA en este tipo de implante. Materiales y métodos: se realizó una revisión retrospectiva de las artroplastias inversas de hombro efectuadas en una única institución por un único cirujano de hombro formado en la especialidad (autor principal) entre enero de 2014 y abril de 2021. Se incluyeron los pacientes que se sometieron a una RSA por artropatía del manguito rotador o por osteoartritis glenohumeral primaria con un implante lateralizado en el lado de la glenoides y un ángulo cuello-eje de 135°. En todos los pacientes se obtuvo una radiografía postoperatoria para evaluar las medidas radiográficas de la LSA y la DSA. Las radiografías fueron revisadas de manera independiente por tres autores y se evaluó la concordancia entre los examinadores. Resultados: un total de treinta y nueve pacientes cumplieron los criterios de inclusión. Su edad media fue de 77.5 años, y la distribución por sexos fue de un 74.3% de mujeres. La mediana final de rotación externa activa fue de 26° y la mediana final de flexión activa hacia adelante fue de 125°. El análisis radiográfico realizado por los tres revisores dio como resultado un ángulo de lateralización con un punto de corte de 93° (73° ­ 118°) y un ángulo de distalización con un punto de corte de 40° (15° ­ 65°). El coeficiente de correlación entre los tres evaluadores para el ángulo de lateralización fue de 0.59 y para el ángulo de distalización fue de 0.79.Discusión: el principal hallazgo de esta investigación es que un implante RSA con lateralización glenoidea proporciona una lateralización objetiva con LSA de 93° y una distalización con DSA de 40°. Estos resultados cumplen el rango ideal para la restauración óptima del movimiento. Las mediciones radiográficas postoperatorias de la lateralización y la distalización para este tipo de implante son reproducibles entre diferentes observadores. Nivel de Evidencia: IV

Introduction: reverse shoulder arthroplasty (RSA) with a lateralized center of rotation has proven to reduce notching rates, restore shoulder contour and improve external rotation. Lateralization can be achieved from the glenoid component or from the humeral stem. Boutsadis et al. described two angular measurements on postoperative radiographs to objectively determine lateralization and distalization in RSA: the lateralization shoulder angle (LSA) and the distalization shoulder angle (DSA). These measurements are reproducible, and they correlate with functional outcomes and range of motion. The DJO prosthesis (DJO Surgical, Austin, TX, USA) features a lateralized center of rotation glenosphere, with a neck-shaft angle of 135°. This implant has yielded satisfactory clinical outcomes in the medium, and long term follow-up studies. To date, objective measurement of lateralization rates and their association postoperative range of motion using LSA and DSA has not been described in this type of implant.Materials and methods: a retrospective review was performed of reverse shoulder arthroplasties performed in a single institution by a single fellowship trained shoulder surgeon (senior author) between January 2014 and April 2021. Patients were included if they underwent a RSA for rotator cuff arthropathy or primary glenohumeral osteoarthritis with a glenoid-side lateralized implant and a 135° neck-shaft angle. In all patients, a postoperative X-ray was obtained in order to evaluate the radiographic measurements of LSA and DSA. Radiographs were independently reviewed by three authors and the agreement between the examiners was assessed.Results: a total of thirty-nine patients met the inclusion criteria. Their average age was 77.5 years, the sex distribution was 74.3% female patients. Final median active external rotation was 26° and final median active forward flexion was 125°. The radiographic analysis performed by the three reviewers resulted in a lateralization angle with a cut-off point of 93° (73° ­ 118°) and a distalization angle with a cut-off point of 40° (15° ­ 65°). The correlation coefficient between the three evaluators for the lateralization angle was 0.59and for the distalization angle was 0.79.Discussion: the main finding of this research is that an RSA implant with glenoid-side lateralization provides an objective lateralization with LSA of 93° and a distalization with DSA of 40°. These results met the ideal range for optimal restoration of motion. Postoperative radiographic lateralization and distalization measurements for this type of implant are reproducible between different observers. Level of Evidence: IV

Validación al español del instrumento Self-Administered Patient Satisfaction Scale (SAPS) para reemplazo total de cadera o de rodilla / Validation of the spanish version of the self-administered patient satisfaction scale (sAPs) for total hip and knee arthroplasty

Introducción: La satisfacción del paciente es un indicador importante al evaluar los resultados clínicos de un reemplazo total de cadera o rodilla. El objetivo de este estudio fue validar al idioma español el instrumento Self-Administered Patient Satisfaction Scale (SAPS) para reemplazo total de cadera o rodilla, y estudiar sus propiedades psicométricas. materiales y métodos: Se realizó un estudio de validación de corte transversal para evaluar el contenido, la consistencia interna y la validez de criterio de la SAPS. Se incluyó a 105 pacientes con reemplazo total de cadera o rodilla. La validez de criterio fue valorada con las escalas WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) y SF-36 (36-Item Short Form Survey). Resultados: Se analizó a 50 pacientes con reemplazo total de cadera y 55 con reemplazo total de rodilla y una mediana de seguimiento de 14 meses (rango intercuartílico, 11-19), con una edad de 71.3 ± 11.6 años; 73,3% (77) eran mujeres. El coeficiente alfa de Cronbach fue de 0,797 indicando una consistencia interna aceptable. La correlación entre las escalas SAPS y WOMAC fue moderada (coeficiente de Spearman 0,488; p <0,05), al igual que con el componente físico de la SF-36 (coeficiente de Spearman 0,525; p <0,05). Conclusión: La versión en español de la SAPS es una herramienta válida y confiable para medir el grado de satisfacción de los pacientes sometidos a reemplazo total de cadera o rodilla, tiene propiedades psicométricas similares a las de la escala original. Nivel de Evidencia: II

Introduction: Patient satisfaction is an important parameter when evaluating clinical outcomes after total hip (THA) or knee (TKA) arthroplasty. The objective of this work was to validate the Spanish version of the Self-Administered Patient Satisfaction scale (SAPS) for THA or TKA, as well as to study its psychometric properties. materials and methods: A cross-sectional validation study was carried out to evaluate the content, internal consistency, and criterion validity of the SAPS scale. A total of 105 subjects who were treated with THA or TKA were included. Criterion validity was assessed with the WOMAC scale (Western Ontario and McMaster Universities Osteoarthritis Index) and SF-36 (Short Form 36 Health Survey). Results: Fifty patients undergoing THA and 55 undergoing TKA were analyzed at a median follow-up of 14 months (Interquartile range, 11-19) after surgery, with a mean age of 71.3 ± 11.6 years; 73.3% (77) were women. Cronbach's alpha was 0.797, indicating an acceptable internal consistency. A moderate correlation was found between the SAPS scale and the WOMAC scale (Spearman's coefficient: 0.488, p <0.05), as well as with the physical component of the SF-36 (Spearman's coefficient: 0.525, p <0.05). Conclusion: The Spanish version of the SAPS scale is a valid and reliable tool to measure patient satisfaction after THA or TKA, with psychometric properties similar to those of the original scale. Level of Evidence: II

Aumento con injerto estructural endomedular en la osteosíntesis de fracturas de húmero proximal / Endosteal strut allograft augmentation in the osteosynthesis of proximal humerus fractures

Introducción: Las fracturas de húmero proximal son frecuentes, particularmente en la población mayor. Los resultados de la fijación con placa bloqueada siguen siendo impredecibles. El soporte de la columna medial jugaría un rol significativo. Nuestro pro-pósito fue evaluar los resultados de la osteosíntesis de húmero proximal con aloinjerto óseo estructural. Materiales y métodos: Se evaluaron los resultados clínico-radiológicos en 12 pacientes con fractura de húmero proximal tratados con placa bloqueada e injerto estructural endostal. Se definió como pérdida de reducción a un cambio del ángulo cervicodiafisario >5° o en la altura de la cabeza humeral >3 mm. La evaluación clínica incluyó rango de movilidad, puntaje de Constant-Murley, valor subjetivo del hombro, escala analógica visual para dolor y retorno a la actividad habitual. Resultados: Doce pacientes completaron el seguimiento (edad promedio 62.8 años). Diez mantuvieron la reducción. El puntaje promedio de Constant-Murley fue de 82,1; el del valor subjetivo del hombro, del 80%, y el de la escala analógica visual, de 1,9. La elevación anterior fue de 138,3°; la rotación externa, de 49,5°, y la rotación interna a nivel de la vértebra de L3. La diferencia de la altura de la cabeza humeral y el ángulo cervicodiafisario fue de 2,3 mm y 4,92°. No hubo complicaciones. Conclusiones: La osteosíntesis con placa bloqueada y aumento con injerto estructural endomedular es una técnica fiable para tratar fracturas de cuello quirúrgico del húmero. Proporciona soporte al cuello humeral y mantiene la reducción en la fractura de húmero proximal con rotura de la bisagra medial. Nivel de Evidencia: IV

Introduction: Proximal humeral fractures (PHF) are common, particularly in the elderly. To date, locking plate fixation continues to provide unpredictable outcomes. Medial hinge support plays a significant role in stability until the bone heals. We aim to evaluate the outcomes of plate fixation with endosteal strut allograft augmentation in the treatment of PHF. Materials and methods: We evaluated clinical and radiological outcomes in the medium-term follow-up of 12 patients with PHF who were treated with plate fixation and strut allograft augmentation. The strut allograft was introduced into the humeral shaft to add support to the medial hinge. We compared the final follow-up radiographs to those taken immediately after surgery. We defined a loss of reduction if the change in Humeral Head Height or the Neck-Shaft Angle measured over 3 mm or 5°, respectively. The clinical evaluation included range of motion, Constant-Murley (CM) score, Subjective Shoulder Value (SSV), Visual Analog Scale (VAS), and return to daily activities. Results: Twelve patients completed follow-up. The patients' average age was 62.8. Ten patients healed without loss of reduction. Average CM and SSV scores were 82.1 and 80%, respectively, and average VAS was 1.9. Anterior elevation averaged 138.3°, external rotation 49.5°, and internal rotation at L3 level. The mean differences in HHH and NSA were 2.3 mm and 4.92°, respectively. We recorded no complications associated to the procedure. Conclusion: Locking plate fixation with endosteal strut allograft augmentation is a reliable technique for the treatment of PHF. It provides support to the humeral neck and maintains reduction in fractures with disruption of the medial hinge. Level of Evidence: IV

Fracturas articulares complejas del húmero distal. Recomendaciones para optimizar los resultados y disminuir las complicaciones / Complex articular fractures of the distal humerus. Recommendations to optimize outcomes and reduce complications

Las fracturas articulares complejas del húmero distal suponen un gran desafío para el cirujano ortopédico. La complejidad de la anatomía, la presencia de múltiples fragmentos y la mala calidad ósea representan algunas de las principales dificultades para resolver. La relativa infrecuencia de estas fracturas atenta directamente contra el entrenamiento y la sistematización del procedimiento quirúrgico y, por consiguiente, tiene impacto sobre el resultado final y la tasa de complicaciones. El objetivo de esta comunicación es proporcionar herramientas al cirujano a través de la revisión de la bibliografía y la experiencia de los autores para disminuir las complicaciones y optimizar los resultados en el tratamiento de estas fracturas..Nivel de Evidencia: V

Complex articular fractures of the distal humerus represent a real challenge for orthopedic surgeons. The complexity of the anatomy, fracture patterns, the presence of multiple fragments, and low bone density in the elderly represent some difficulties to address. The relatively low frequency of these fractures directly undermines training and systematization of the surgical procedure and therefore has an impact on the final functional outcome and complication rate. The aim of this article is to provide practical tools to the novel surgeon, through the review of the literature and the author ́s experience, to reduce complications and optimize the treatment of these fractures. Level of Evidence: V

Influencia de la consolidación de las tuberosidades en los resultados clínicos de la prótesis invertida para fracturas de húmero proximal / Influence of the consolidation of the tuberosities on the clinical outcomes of the reverse arthroplasty in proximal humerus fractures

Objetivo: Comparar los resultados clínicos y las complicaciones de una serie consecutiva de pacientes con fracturas de húmero proximal tratados con prótesis invertida de hombro y con consolidación anatómica de las tuberosidades o sin ella. Materiales y Métodos: Se evaluó a 113 pacientes >65 años con fractura de húmero proximal tratados con prótesis invertida de hombro. Setenta presentaron consolidación anatómica de las tuberosidades y 43, ausencia de consolidación. Se evaluó el rango de movilidad, y se utilizaron los puntajes de Constant-Murley, ASES, SANE y la escala analógica visual. Se documentaron todas las complicaciones y las reoperaciones. Resultados: El seguimiento promedio fue de 56 meses (rango 24-96) y la edad media era de 73 años (rango 65-83). La elevación activa y la rotación interna medias posoperatorias fueron de 131° (± 14) y 27° (± 5), respectivamente. La rotación externa posoperatoria media en abducción y aducción fue de 27° (± 1) y 15° (± 6), respectivamente. La escala analógica visual promedio posoperatoria fue de 1,7 (± 0,8). Los puntajes ASES, de Constant-Murley y SANE promedio fueron de 76 (± 6), 62 (± 11) y 74% (± 7), respectivamente. La elevación anterior, la rotación externa y los puntajes funcionales promedio finales ASES y de Constant-Murley fueron significativamente mejores en el grupo con consolidación de las tuberosidades. Conclusiones: En pacientes >65 años con fractura de húmero proximal tratados con prótesis invertida de hombro tanto la movilidad posoperatoria, como los puntajes funcionales fueron significativamente mejores en los pacientes con consolidación anatómica de las tuberosidades. Nivel de Evidencia: III

Objective: The objective of this study was to compare the clinical outcomes and complications of a consecutive series of patients with proximal humerus fractures (PHF) treated with reverse shoulder arthroplasty (RSA), with and without anatomical healing of the tuberosities. Materials and Methods: We evaluated 113 patients >65 years old with PHF treated with RSA. Seventy patients presented anatomical healing of the tuberosities and 43 presented absence of healing. Range of motion (ROM), Constant score, ASES score, visual analog scale (VAS) and the score of the numerical evaluation of single evaluation (SANE) were evaluated. Results: The mean follow-up was 56 months (range, 24-96 months) and the mean age was 73 years (range, 65-83 years). Mean postoperative active elevation and internal rotation were 131° (±14) and 27° (±5), respectively. The mean postoperative external rotation in abduction and adduction was 27° (±1) and 15° (±6) respectively. The mean postoperative VAS was 1.7 (±0.8). The mean ASES, Constant and SANE scores were 76 (±6), 62 (±11) and 74% (±7), respectively. Anterior elevation, external rotation, and final mean ASES and Constant functional scores were significantly better in the group with tuberosity healing than in the group without healing. Conclusions: In patients >65 years old with PHF treated with RSA, both postoperative ranges of motion and functional scores were significantly better in patients where anatomic tuberosity healing was achieved than in those where it was not achieved. Level of Evidence: III