Tratamiento funcional de las fracturas diafisarias de pierna en edad pediátrica: Cohorte única prospectiva y consecutiva de casos

Introducción: Las fracturas de tibia son lesiones frecuentes. En los niños existe una mayor capacidad de curación debido al mayor grosor y mejor vascularización que presenta su periostio. Como resultado, la mayoría pueden tratarse de manera exitosa de forma no quirúrgica. Está descrito el tratamiento funcional para estas fracturas, siguiendo los principios desarrollados por Sarmiento. Dada la falta de evidencia actual acerca del tratamiento funcional en este grupo etario, realizamos el análisis del mismo mediante una serie de casos tratados siguiendo este método. Materiales y métodos: Se incluyeron pacientes que cumplieron con los criterios de inclusión y exclusión, tratados mediante tratamiento funcional siguiendo los principios desarrollados por Sarmiento. Se evaluaron clínica y radiográficamente. Se evaluó la técnica registrando tiempos para cada período en este grupo etario, así como la satisfacción con el tratamiento de los pacientes y padres y/o tutores. Todas las complicaciones relacionadas fueron documentadas. Resultados: Evaluamos un total de 15 pacientes, con al menos 6 meses de seguimiento. La edad promedio fue de 11.7 años. Todas las fracturas consolidaron, el tiempo promedio hasta la consolidación fue de 7.6 semanas. El período agudo de 3.4 semanas y el período funcional de 4.2 semanas promedio respectivamente. Todas las fracturas consolidaron con una reducción aceptable. Existió un 100% de satisfacción tanto de los pacientes como de los padres ó tutores con el tratamiento implementado. Dos pacientes presentaron complicaciones menores. Conclusión: El tratamiento funcional para las fracturas de pierna en niños entre 10 y 15 años es una técnica segura, reproducible, con buenos resultados funcionales, que le permite tanto a los pacientes y a sus cuidadores gran independencia durante el período de curación.

Introduction: Tibial fractures are frequent injuries. In children there is a greater healing capacity due to the greater thickness and better vascularization of their periosteum. As a result, most of them can be successfully treated non-surgically. Functional treatment for these fractures is described, following the principles developed by Sarmiento. Given the lack of current evidence on functional treatment in this age group, we analyzed a series of cases treated following this method. Materials and methods: We included patients who met the inclusion and exclusion criteria, treated by functional treatment following the principles developed by Sarmiento. They were evaluated clinically and radiographically. The technique was evaluated by recording times for each period in this age group, as well as the satisfaction with the treatment of the patients and parents and/or guardians. All related complications were documented. Results: We evaluated a total of 15 patients, with at least 6 months of follow-up. The average age was 11.7 years. All fractures consolidated, the average time to consolidation was 7.6 weeks. The acute period of 3.4 weeks and the functional period of 4.2 weeks average respectively. All fractures healed with acceptable reduction. There was 100% satisfaction of both patients and parents or guardians with the treatment implemented. Two patients presented minor complications. Conclusion: Functional treatment for leg fractures in children between 10 and 15 years of age is a safe, reproducible technique, with good functional results, which allows both patients and their caregivers great independence during the healing period.

Introdução: As fracturas da tíbia são lesões comuns. Nas crianças existe uma maior capacidade de cicatrização devido à maior espessura e melhor vascularização do periósteo. Como resultado, a maioria pode ser tratada com sucesso de forma não cirúrgica. É descrito o tratamento funcional destas fracturas, seguindo os princípios desenvolvidos por Sarmiento. Dada a falta de evidência atual sobre o tratamento funcional neste grupo etário, procedeu-se à análise de uma série de casos tratados por este método. Material e métodos: Foram incluídos pacientes que preencheram os critérios de inclusão e exclusão, tratados por tratamento funcional seguindo os princípios desenvolvidos por Sarmiento. Foram avaliados clínica e radiograficamente. A técnica foi avaliada através do registro dos tempos para cada período nessa faixa etária, bem como a satisfação com o tratamento por parte dos pacientes e dos pais e/ou responsáveis. Todas as complicações relacionadas foram documentadas. Resultados: Avaliámos um total de 15 doentes, com pelo menos 6 meses de seguimento. A idade média foi de 11,7 anos. Todas as fracturas cicatrizaram, sendo o tempo médio de cicatrização de 7,6 semanas. O período agudo foi de 3,4 semanas e o período funcional de 4,2 semanas, em média, respetivamente. Todas as fracturas foram curadas com uma redução aceitável. Os doentes e os pais/encarregados de educação ficaram 100% satisfeitos com o tratamento efectuado. Dois doentes tiveram complicações ligeiras. Conclusão: O tratamento funcional das fracturas da perna em crianças com idades compreendidas entre os 10 e os 15 anos é uma técnica segura, reprodutível e com bons resultados funcionais, que permite aos doentes e aos seus cuidadores uma grande independência durante o período de cura.

An interesting case of a wristwatch associated open wrist fracture

Wrist fractures are commonly encountered injuries during bicycle accidents. Wrist fractures represent the most prevalent upper extremity fractures and account for over a sixth of all fractures seen in emergency department visits. Despite their common occurrence, many cyclists wear wristwatches without considering the potential consequences this may have during an accident when they sustain an upper limb injury. We present a unique case involving a 59-year-old woman with a wristwatch-associated open distal radio-ulnar fracture sustained from a cycling road traffic accident with the crown of the wristwatch being found embedded in the ulna shaft. Currently, there exists a limited knowledge in the literature addressing the safety implications of wearing wristwatches while cycling. This case serves to highlight the hazards associated with wristwatch use during cycling and underscores the hypothesis that wristwatches may act as stress risers, potentially exacerbating fracture severity and necessitating more intricate surgical interventions and subsequent follow-up care.

Violencia y maltrato infantil. El aporte del médico radiólogo al abordaje integral multidisciplinario / Child maltreatment and violence. Contributions from radiologists to a comprehensive multidisciplinary approach

El maltrato infantil es definido por la Organización Mundial de la Salud (OMS) como "el abuso y la desatención que sufren los niños menores de 18 años. Incluye todo tipo de maltrato físico y/o emocional […] que resulte en un daño real o potencial para la salud, la supervivencia, el desarrollo o la dignidad del niño". Al examinar los rastros corporales del maltrato físico, siguiendo los mecanismos de lesión más frecuentemente implicados, es posible detectar patrones radiológicos típicos. La evaluación imagenológica del hueso en reparación permite inferir cronologías para correlacionar con los datos obtenidos en la anamnesis. Los profesionales de la salud deben detectar oportunamente lesiones radiológicas sospechosas y activar de forma temprana el resguardo del menor. Nuestro propósito es realizar una revisión sobre las publicaciones recientes referidas al estudio imagenológico en niños de quienes se sospeche que puedan ser víctimas de violencia física.

The World Health Organization (WHO) defines child maltreatment as "the abuse and neglect that occurs to children under 18 years of age. It includes all types of physical and/or emotional ill-treatment [...], which results in actual or potential harm to the child's health, survival, development or dignity." By examining the bodily traces of physical abuse, following the most frequently involved mechanisms of injury, it is possible to identify typical radiological patterns. The imaging studies of the bone under repair allows inferring a timeline that may be correlated to the data obtained during history taking. Health care providers should detect suspicious radiological lesions in a timely manner and promptly activate the safeguarding of the child. Our objective was to review recent publications on the imaging studies of children suspected of being victims of physical violence.

A Novel Method of Treatment of Small Osteolabral Avulsions Associated with Posterior Fracture dislocation of the Hip / Um novo método de tratamento de pequenas avulsões osteolabrais associadas a fratura-luxação posterior do quadril

Abstract Small osteolabral avulsions of the hip can be easily missed, and postreduction stress testing and computed tomography (CT) scans of the hip should be performed to look for these injuries. The usual modality of treatment of these unstable osteolabral avulsions is suture anchors, Herbert screws or spring plates. But when the bony avulsion is small, the use of these implants becomes a tedious job. We present a novel technique to fix small osteochondral avulsion fractures not amenable to fixation using screws or spring plates. We performed a retrospective analysis of 57 cases of patients who underwent open reduction and internal fixation for posterior fracture dislocation of the acetabulum, and we identified 6 cases of small posterior labral osteochondral fragments leading to instability. These injuries were fixed using a novel method. The mean Harris Hip Score at the final follow-up was of 92.5. Fixation of osteochondral avulsions associated with posterior hip fracture dislocation can be a difficult task if the bony fragment is small. Our technique is a simple, cost-effective and reliable way of fixing such avulsions with satisfactory outcomes.

Resumo Pequenas avulsões osteolabrais do quadril podem passar despercebidas, e testes de estresse pós-redução e tomografia computadorizada do quadril devem ser realizados para sua detecção. O tratamento dessas avulsões osteolabrais instáveis geralmente é feito com âncoras de sutura, parafusos de Herbert ou placas-molas. Em avulsões ósseas pequenas, porém, o uso desses implantes é um trabalho tedioso. Apresentamos uma nova técnica de fixação de pequenas fraturas com avulsões osteocondrais não passíveis de fixação com parafusos ou placas-molas. Realizamos uma análise retrospectiva de 57 casos de pacientes submetidos à redução aberta e fixação interna de fratura-luxação posterior do acetábulo, e identificamos 6 casos em que um pequeno fragmento osteocondral labral posterior causava instabilidade. Essas lesões foram corrigidas com um novo método. A pontuação média no Harris Hip Score no último acompanhamento foi de 92,5. A fixação de avulsões osteocondrais associadas a fratura-luxação posterior do quadril pode ser difícil se o fragmento ósseo for pequeno. Nossa técnica é uma maneira simples, econômica e confiável de corrigir tais avulsões com resultados satisfatórios.

Treatment of Two-column Acetabular Fractures by Double Extrapelvic Approach: Three Clinical Cases / Tratamento de fraturas acetabulares de duas colunas por dupla via extrapélvica: Três casos clínicos

Abstract Fractures of two columns of the acetabulum according to the Letournel classification are among the most common in frequency, indication and surgical complexity. These are mainly the result of lateral compression mechanisms and are characterized by originating a disconnected acetabulum from the axial skeleton. Its surgical treatment may include: isolated anterior or posterior approach; combined, at the same surgical time or not; or broad approaches. The authors present another surgical option with association of the Kocher-Langenbeck pathway with the iliac crest approach simultaneously and in the same positioning (lateral decubitus) based on the first three clinical cases performed and their clinical and imaging results. In addition to the presentation of the cases, a description of the three characteristic fragments of this type of acetabular fractures, the approach pathway, and the reduction sequence performed are made. From the results obtained and the associated advantages, the authors believe that the addition of the iliac crest approach to the Kocher-Langenbeck pathway may be a very attractive option to consider in the surgical treatment of properly selected fractures of two columns of the acetabula.

Resumo As fraturas de duas colunas do acetábulo segundo a classificação de Letournel são das mais comuns em frequência, indicação e complexidade cirúrgica. Estas resultam essencialmente de mecanismos de compressão lateral e caracterizam-se por originarem um acetábulo desconectado do esqueleto axial. O seu tratamento cirúrgico pode incluir: abordagem anterior ou posterior isolada; combinadas, no mesmo tempo cirúrgico ou não; ou abordagens alargadas. Os autores apresentam outra opção cirúrgica com associação de via de Kocher-Langenbeck e abordagem da crista ilíaca simultânea e no mesmo posicionamento (decúbito lateral) com base nos três primeiros casos clínicos realizados e seus resultados clínicos e imagiológicos. Para além da apresentação dos casos, é feita uma descrição dos três fragmentos característicos deste tipo de fraturas acetabulares, da via de abordagem e da sequência de redução realizada. Pelos resultados obtidos e vantagens associadas, os autores acreditam que a adição da abordagem da crista ilíaca à via de Kocher-Langenbeck pode ser uma opção muito atrativa a ter em conta no tratamento cirúrgico de fraturas de duas colunas do acetábulo devidamente selecionadas.

Use of Three-dimensional Printing for Tibial Pilon Fracture Diagnosis and Treatment / Uso da impressão tridimensional para auxílio diagnóstico e terapêutico das fraturas de pilão tibial

Abstract Objective To evaluate whether three-dimensional (3D) printing increases agreement in the classification of tibial pilon fractures. Methods Orthopedists and traumatologists reviewed radiographs, computed tomography scans with 3D reconstruction, and prototyping 3D printing, and classified the fractures based on the Rüedi-Allgöwer and Arbeitsgemeinschaft für Osteosynthesefragen (AO, Association for the Study of Internal Fixation) Foundation/Orthopedic Trauma Association (AO/OTA) classification systems. Next, data evaluation used Kappa agreement coefficients. Results The use of the 3D model did not improve agreement for tibial pilon fractures regarding the treatment proposed by the groups. Regarding the classification systems, the agreement only improved concerning the AO/OTA classification when the 3D model was used in the assessment by the foot and ankle specialists. Conclusion Although 3D printing is statistically relevant for surgeons specializing in foot and ankle, its values remain lower than optimal.

Resumo Objetivo Avaliar se a impressão tridimensional (3D) aumenta a concordância na classificação de fraturas do pilão tibial. Métodos Foram selecionadas radiografias, tomografias com reconstrução 3D e impressão de prototipagem em impressora 3D. Os exames foram apresentados a profissionais da área de Ortopedia e Traumatologia que classificaram as fraturas com base nas classificações da Arbeitsgemeinschaft für Osteosynthesefragen (AO, Associação para o Estudo da Fixação Interna) Foundation/Orthopedic Trauma Association (AO/OTA) e de Rüedi-Allgöwer. Posteriormente, os dados foram avaliados pelos coeficientes de concordância de Kappa. Resultados O uso do modelo 3D não melhorou a concordância na fratura do pilão tibial quanto ao tratamento proposto pelos grupos. Em relação aos sistemas de classificação, somente a concordância na classificação AO/OTA melhorou quando foi utilizado o modelo 3D na avaliação pelos especialistas em pé e tornozelo. Conclusão Apesar de o uso da impressão 3D ter relevância estatística para os cirurgiões especialistas em pé e tornozelo, ainda apresenta valores menores do que os ideais.

Early Intraprosthetic Dislocation of Total Hip Arthroplasty with Double Mobility Implant: Case Report / Luxação intraprotética precoce de artroplastia total do quadril com implante de dupla mobilidade: Relato de caso

Abstract Total hip arthroplasty (THA) is a successful surgery in the treatment of hip pain, but there are potential complications, of which dislocation is one of the most common. Dislocation management is a challenging problem that requires a multimodal approach, and the use of dual mobility implants is an option. We present a patient with a history of femoral neck fracture who underwent THA with a double mobility implant. On the 18th postoperative day, after a fall to the ground, she developed prosthesis dislocation and had a complication after closed reduction, a subsequent intraprosthetic dislocation. After a radiographic diagnosis, the patient presented mechanical signs of hip flexion caused by a disassociated double mobility implant. The revision surgery was indicated, but the patient chose not to perform the necessary surgical procedure. A careful postoperative study of the radiographs revealed an eccentric femoral head and evidence of disassociated implantation in the surrounding soft tissues. Radiographs after closed reduction of intraprosthetic dislocations should be examined thoroughly.

Resumo A artroplastia total do quadril (ATQ) é uma cirurgia bem-sucedida no tratamento da dor no quadril, mas existem complicações potenciais, das quais a luxação é uma das mais comuns. O gerenciamento das luxações é um problema desafiador que requer uma abordagem multimodal, e o uso de implantes de mobilidade dupla é uma opção. Apresentamos uma paciente com história de fratura do colo do fêmur que foi submetida a ATQ com um implante de dupla mobilidade. No 18° dia pós-operatório, após queda ao solo, a paciente evoluiu com luxação da prótese e teve uma complicação após redução fechada, uma luxação intraprotética subsequente. Após um diagnóstico radiográfico, a paciente apresentou sinais mecânicos na flexão do quadril causados por um implante de mobilidade dupla desassociado. A cirurgia de revisão foi indicada, mas a paciente optou por não realizar o procedimento cirúrgico necessário. O estudo pós-operatório cuidadoso das radiografias revelou uma cabeça femoral excêntrica e evidências do implante desassociado nos tecidos moles circundantes. As radiografias após a redução fechada das luxações intraprotéticas devem ser examinadas minunciosamente.

Fracturas de fémur distal en población geriátrica: Evaluación de estadía hospitalaria y morbimortalidad / Distal femoral fractures in the elderly: assessment of length of stay and morbimortality

INTRODUCCION Las fracturas de fémur distal (FFD) son un problema importante de salud pública. Con el envejecimiento de la población, se espera un incremento de esta lesión en los próximos años. Objetivo Describir las complicaciones y la mortalidad de las FFD en un grupo de pacientes geriátricos. MATERIALES Y METODOS Estudio descriptivo y retrospectivo de pacientes mayores de 60 años operados por FFD, todos tratados en un mismo centro, entre 2011 y 2015, con al menos 1 año de seguimiento. Se excluyeron pacientes con ficha incompleta. Se analizaron los datos demográficos y radiológicos, las complicaciones locales y sistémicas, la estadía hospitalaria y la mortalidad. RESULTADOS En total, 16 pacientes cumplieron con los criterios de selección; tenían una mediana de edad de 73 (rango: 61 a 93) años, y 14 (87,5%) eran mujeres. La clasificación de la Asociación para el Estudio de la Fijación Interna (Arbeitsgemeinschaft für Osteosynthesefragen, AO, en alemán) de las fracturas fue: A ­12 (75%); B ­ 2 (12,5%); y C ­ 2 (12,5%). No hubo casos de fractura expuesta. Un total de 9 (56,3%) pacientes fueron operados con placa condilar dinámica, 4 (25%), con placa bloqueada, y 3 (19%), con clavo retrógrado. La mediana de latencia quirúrgica fue de 10 (rango: 3 a 27) días, con una mediana de hospitalización de 14 (rango: 5 a 47) días. Complicaciones fueran presentadas por 6 (37,5%) pacientes: 2 (12,5%) casos de tromboembolismo pulmonar y 4 (25%) casos que requirieron reintervención (2 fallos de osteosíntesis, 1 artrofibrosis y 1 no unión aséptica). No hubo complicaciones infecciosas. La mortalidad a 12 meses fue de 0%. CONCLUSIONES Los pacientes con FFD en esta cohorte geriátrica presentaron una larga estadía hospitalaria, con una alta tasa de complicaciones, que incluye un 25% de reintervenciones. Pese a esto, la mortalidad a 12 meses fue de 0%

INTRODUCTION Distal femoral fractures (DFF) are a relevant problem for public health worldwide. As the population ages, an increase in the rate of these lesions is expected in the next few years. Objective To describe the complications and mortality from DFF in geriatric patients. MATERIALS AND METHODS A descriptive and retrospective study with patients aged 60 years or older who underwent surgery due to DFF. All subjects received treatment in the same trauma center from 2011 to 2015 and underwent a minimum follow-up of 1 year. Patients with incomplete medical records were excluded. We analyzed demographics, radiological findings, local and systemic complications, length of stay, and mortality rates. RESULTS In total, 16 patients met the inclusion criteria; their median age was of 72 (range: 61 to 93) years, and 14 subjects (87,5%) were female. The classification of the Association for the Study of Internal Fixation (Arbeitsgemeinschaft für Osteosynthesefragen, AO, in German) was as follows: A ­ 12 patients (75%); B ­ 2 patients (12.5%); and C ­ 2 patients (12.5%). There were no open fractures. The devices used in the operations included dynamic condylar screw (DCS) plates (9 subjects; 56%), distal femur locking compression plates (LCPs) (4 subjects; 25%), and retrograde distal femoral nails (DFNs) (3 subjects; 19%). The median time until surgery was of 10 (range: 3 to 27) days, with a median length of stay of 14 (range: 5 to 47) days. Complications were presented by 6 (37.5%) patients: 2 (12.5%) cases of pulmonary thromboembolism and 4 (25%) cases which required reintervention (2 due to hardware failure, 1 because of arthrofibrosis, and 1 due to aseptic nonunion); there were no cases of infection. The mortality rate at 12 months was of 0%. CONCLUSION The patients with DFF in this geriatric cohort presented a long length of stay, with a high rate of complications, including a rate of 25% of reintervention. Nevertheless, the 1-year mortality rate was of 0%

An evaluation of effectiveness of Ilizarov external fixation in treating infected non-union tibial fractures: a prospective observational study

Background: Infected non-union tibial fractures pose significant challenges in orthopedic care. Ilizarov external fixation has emerged as a promising treatment option for such complex fractures. The purpose of this research is to evaluate the efficacy and safety of Ilizarov fixation in non-union, infected tibial fractures. Methods: A prospective observational study was conducted on 30 patients at Indira Gandhi Institute of Medical Sciences. Inclusion criteria involved patients aged 20-65 with clinical and radiological signs of infection and non-union of the tibia. Data on patient demographics, injury details, treatment history, and outcomes were collected. Ilizarov fixation was performed, and patients were followed up. Results: The study cohort, primarily males (80%), with mean age of 35.75 years, displayed a high incidence of type III compound injuries (63.33%). Monofocal and bifocal osteosynthesis effectively reduced limb shortening, with an overall average residual shortening of 1.8 cm. Bony outcomes were favorable, with 16 cases achieving excellence. Functional outcomes were also promising. Complications included stiffness, infections, and deformities. Conclusions: Ilizarov external fixation demonstrates potential in managing infected non-union tibial fractures, offering favorable bony and functional outcomes. However, post-operative complications require vigilant management. Further research is needed to validate and optimize this approach.

An epidemiological trend in surgical management of pelvis and acetabulum fractures at Indira Gandhi Institute of Medical Sciences level-1 trauma centre in Patna: a retrospective study

Background: Pelvic and acetabular fractures, principally resulting from high-energy trauma like motor vehicle accidents, are challenging orthopedic injuries that can lead to significant morbidity and functional impairment. Understanding their epidemiology, treatment, and outcomes is crucial for improving patient care. Methods: This retrospective cohort study involving 34 patients who underwent surgery for pelvic and acetabular fractures from April 2021 to September 2023. Data on patient demographics, injury mechanisms, fracture types, surgical approaches, and post-operative outcomes were collected and analyzed. Results: The study group comprised predominantly males (67%) with mean age of 35 years. Road traffic accidents were the leading cause of injuries (95%). The most common fracture types were the posterior wall of the acetabulum (10%) and type II anteroposterior compression fractures (10%). Related injuries included long bone fractures (62.5%) and posterior hip dislocation (33.33%). Surgical treatment primarily involved open reduction and internal fixation with various approaches. Postoperative complications included sciatic nerve palsy (4.17%), venous thromboembolism (20.83%), and wound infections (12.5%), but both post-operative mortality and heterotopic ossification were absent. Conclusions: The study highlights the prevalence of pelvic and acetabular fractures due to road traffic accidents and the complexity of their surgical management. The associated injuries and postoperative complications underscore the need for specialized orthopedic care.

Análise epidemiológica das fraturas de mão em um hospital terciário / Epidemiological analysis of hand fractures in a tertiary hospital

Introdução: O trauma de mão constitui uma epidemia, ocorrendo por diversos fatores, como acidentes de trabalho e violência urbana. Isso gera um impacto significativo por ser uma unidade anatômica vulnerável e importante na realização de atividades cotidianas e para o trabalho. Desse modo, faz-se necessária uma avaliação epidemiológica mais aprofundada no que tange, sobretudo, às fraturas de mãos, entendendo sua elevada morbidade. Método: Estudo descritivo e retrospectivo, feito por análise de prontuários de pacientes conduzidos em um hospital terciário no período de janeiro de 2018 a dezembro de 2020. Resultados: Participaram do estudo 290 pacientes, sendo 85,7% do sexo masculino e 14,3% do sexo feminino. 138 indivíduos tinham entre 20 e 39 anos, representando um total de 47,6%. 51,6% eram do interior do estado do Ceará e 48,4% eram da capital. O principal mecanismo de trauma associado às fraturas foram os acidentes de trânsito (36,4%), seguidos por acidentes de trabalho (26,9%) e ferimentos por arma de fogo (14%). Em relação aos ossos fraturados, houve uma acentuada prevalência do acometimento das falangeanas, em todas as faixas etárias, representando 210 pacientes (72,4%). Conclusão: O presente estudo corrobora com os dados presentes na literatura. Desse modo, é evidenciada a repetição de prevalência de faixa etária, principais mecanismos de trauma envolvidos, bem como ossos acometidos nas fraturas de mão.

Introduction: Hand trauma is an epidemic occurring due to several factors, such as work accidents and urban violence. This significantly impacts it as it is a vulnerable and important anatomical unit for daily activities and work. Therefore, a more in-depth epidemiological assessment is necessary regarding hand fractures and understanding their high morbidity. Method: A descriptive and retrospective study was conducted by analyzing the medical records of patients treated in a tertiary hospital from January 2018 to December 2020. Results: 290 patients participated in the study, 85.7% male and 14.3 % female. One hundred thirty-eight individuals were between 20 and 39 years old, representing 47.6%. 51.6% were from the interior of the state of Ceará, and 48.4% were from the capital. The main trauma mechanism associated with fractures was traffic accidents (36.4%), followed by work accidents (26.9%) and firearm injuries (14%). Concerning fractured bones, there was a marked prevalence of phalangeal involvement in all age groups, representing 210 patients (72.4%). Conclusion: The present study corroborates the data present in the literature. In this way, the repetition of the prevalence of age group, main trauma mechanisms involved, as well as bones affected by hand fractures is evidenced.

O trauma de face submetido a cirurgia: Uma análise epidemiológica de 10 anos no interior do Brasil / Facial trauma undergoing surgery: A 10-year epidemiological analysis in the interior of Brazil

Introdução: O trauma de face representa significativa incapacitação para a vítima, além de um desafio para as equipes de saúde devido a sua complexidade e envolvimento de estruturas nobres. Analisar a sua epidemiologia permite coordenar medidas em saúde pública para melhorar o atendimento e a prevenção. Método: Estudo observacional, descritivo, longitudinal, com abordagem retrospectiva a partir dos prontuários dos pacientes vítimas de trauma de face atendidos pela clínica cirúrgica no período entre 2010 e 2019. Resultados: Dentre os 529 prontuários incluídos no estudo e analisados, 71,08% tratava-se de cirurgias eletivas e o restante, 28,92%, de cirurgias de urgência. O trauma foi mais frequente em indivíduos de 20 a 29 anos, o que corresponde a 31,76% do total de casos. Também foi mais frequente em indivíduos do sexo masculino, correspondendo a 78,45% do total de casos. Acidentes automobilísticos foram a causa mais comum, descrita em 22,31% dos prontuários, e a principal fratura, presente em 85,83% dos casos, foi dos ossos próprios do nariz. Conclusão: As vítimas de traumatismo bucomaxilofacial atendidas no Hospital de Clínicas da Universidade Federal do Triângulo Mineiro são predominantemente homens na terceira década de vida, envolvidos em acidentes automobilísticos, com lesões em ossos do nariz que foram abordadas de forma eletiva.

Introduction: Facial trauma represents significant incapacitation for the victim, as well as a challenge for healthcare teams due to its complexity and involvement of important structures. Analyzing its epidemiology allows us to coordinate public health measures to improve care and prevention. Method: Observational, descriptive, longitudinal study with a retrospective approach based on the medical records of patients who suffered facial trauma treated by the surgical clinic between 2010 and 2019. Results: Among in individuals aged 20 to 29 years, which corresponds to 31.76% of total cases. It was also more common in males, corresponding to 78.45% of total cases. Car accidents were the most common cause, described in 22.31% of medical records, and the main fracture, present in 85.83% of cases, was of the bones of the nose. Conclusion: Victims of oral and maxillofacial trauma treated at the Hospital de Clínicas da Universidade Federal do Triângulo Mineiro are predominantly men in their third decade of life, involved in automobile accidents, with injuries to the bones of the nose that were treated electively.

Unstable intertrochanteric femoral fracture care in older population

Background: The present study aimed to compare outcomes between geriatric patients treated with cementless bipolar hip arthroplasty (BHA) and proximal femoral nail (PFN) for intertrochanteric femur fractures, focusing on postoperative complications, reoperation rates, implant-related issues, and functional outcomes. Methods: The present study took place at PRM medical college, Baripada for a period of 4 years and employed a prospective design with 76 individuals with femoral shaft fractures who underwent surgical treatment, wherein 40 were treated using cementless BHA and 36 with PFN. Evaluation included the HHS at the last follow-up, alongside recorded blood transfusion rates and surgery duration, statistically compared between the two groups. Results: The study involved elderly patients with intertrochanteric femur fractures (average age: 82.9 years). BHA and PFN groups had differing average ages (81.4 and 83.9 years, respectively). Follow-up durations were 18.6 months overall, 23.8 months for BHA, and 13.1 months for PFN. PFN showed advantages in surgery duration and blood transfusion rates. Adverse effects in BHA included 4 epidermal infections, while PFN had 2 epidermal infections and 2 instances of implant malfunction, resulting in extraction. PFN demonstrated a 5.5% cut-out rate. Conclusions: The study compares the outcomes of elderly patients with femoral shaft fractures treated with cementless BHA and PFN. The results indicate that PFN presents advantages over BHA in terms of shorter surgery duration and reduced blood transfusion rates. However, further research and extended review are warranted to draw definitive results about the superiority of either approach.

Abordagem cirúrgica de fratura blow-out através de acesso transconjuntival: relato de caso / Surgical approach to blow-out fracture through transconjunctival access: case report

Introdução: a região orbitária é bastante suscetível a fraturas, devido a sua posição exposta e a ossos frágeis. As fraturas do tipo blow-out caracterizam-se pela fratura do assoalho orbitário com ou sem herniação de conteúdo para o seio maxilar, gerando consequências funcionais e estéticas. Relato do caso: paciente do sexo feminino, 48 anos de idade, vítima de queda da própria altura, compareceu ao Hospital Geral do Estado da Bahia com queixa de diplopia, apresentando fratura de assoalho de órbita direita. Foi programada uma abordagem transconjuntival e instalação de tela de titânio para reconstrução. Na alta hospitalar, a paciente negou diplopia, não apresentando prejuízos funcionais ou estéticos. Conclusão: o acesso transconjuntival possibilita uma adequada exposição do assoalho de órbita, para colocação de telas, deixando uma cicatriz imperceptível na conjuntiva. Apesar das vantagens, este acesso cirúrgico apresenta maior complexidade técnica, sendo pouco realizado pelos cirurgiões

Introduction: the orbital region is very susceptible to fractures due to its exposed position and fragile bones. Blow-out fractures are characterized by fractures of the orbital floor with or without herniation of contents to the maxillary sinus, generating functional and aesthetic consequences. Case report: a 48-year-old female patient, victim of a fall from her height, presented to the General Hospital of the State of Bahia complaining of diplopia, presenting with a fracture of the floor of the right orbit. A transconjunctival approach and installation of titanium mesh for reconstruction were scheduled. At hospital discharge, the patient denied diplopia, with no functional or aesthetic impairments. Conclusion: the transconjunctival approach allows adequate exposure of the orbital floor for mesh placement, leaving an imperceptible scar on the conjunctiva. Despite the advantages, this surgical approach presents greater technical complexity and is rarely performed by surgeons.

Efecto del shiatsu sobre el dolor en personas con fracturas de extremidades: ensayo clínico / Efeito do shiatsu sobre a dor de pessoas com fraturas nos membros: ensaio clínico / Effects of shiatsu on pain in people with limb fractures: clinical trial

The postoperative period for limbs fractures is characterized by different levels of pain intensity. Shiatsu is a therapy applied with the hands on meridians and tsubos (points similar to acupuncture) related to pain. Objective: To evaluate the effect of shiatsu on postoperative pain in men with arm and leg fractures. Method: Non-randomized and uncontrolled clinical trial, with assessment of pain levels using the Visual Numerical Scale (VNS) (0­10) and measurement of salivary cortisol. The R software and the Wilcoxon test and Fisher's exact test were used. Results: 41 people participated in the research; the initial mean value of salivary cortisol concentration was 0.39 µg/dl and, after shiatsu intervention, it decreased to 0.32 µg/dl (p<0.0001). The Mean pain value was 4.93 (VNS) before the intervention and 3.90 (p<0.0001) after. Conclusion: The application of shiatsu contributed to reducing pain and cortisol levels in people undergoing orthopedic surgery. (AU)

O pós-operatório de fraturas dos membros superiores e inferiores é caracterizado por diversos níveis de intensidade dolorosa. O shiatsu é uma terapia aplicada com as mãos nos meridianos e tsubos (pontos similares aos da acupuntura) relacionados à dor. Objetivo: Avaliar o efeito do shiatsu sobre a dor no pós-operatório de homens com fraturas dos braços e pernas. Método: Ensaio clínico não randomizado e não controlado, com avaliação dos níveis de dor por meio da Escala Numérica Visual (ENV) (0­10) e de mensuração do cortisol salivar. Foi utilizado o software R e o teste de Wilcoxon e o teste exato de Fisher. Resultados: 41 pessoas participaram da pesquisa; o valor médio inicial da concentração salivar de cortisol foi de 0,39 µg/dl e, depois da intervenção com shiatsu, diminuiu para 0,32 µg/dl (p<0,0001). O valor médio da dor foi 4,93 (ENV) antes da intervenção e 3,90 (p<0,0001) depois. Conclusão: A aplicação do shiatsu contribuiu para reduzir os níveis de dor e cortisol em pessoas submetidas a cirurgias ortopédicas. (AU)

El postoperatorio de fracturas de miembros superiores e inferiores se caracteriza por diferentes niveles de intensidad del dolor. El Shiatsu es una terapia que se aplica con las manos sobre meridianos y tsubos (puntos similares a la acupuntura) relacionados con el dolor. Objetivo: Evaluar el efecto del Shiatsu sobre el dolor postoperatorio en hombres con fracturas de brazo y pierna. Método: ensayo clínico no aleatorizado y no controlado, con evaluación de los niveles de dolor mediante la Escala Numérica Visual (ENV) (0­10) y medición de cortisol salival. Se utilizó el software R, la prueba de Wilcoxon y la prueba exacta de Fisher. Resultados: Participaron de la investigación 41 personas y el valor medio inicial de la concentración de corti-sol salival fue de 0,39 µg/dl y después de la intervención de Shiatsu disminuyó a 0,32 µg/dl (p<0,0001). El valor promedio del dolor fue de 4,93 (ENV) antes de la intervención y de 3,90 (p<0,0001) después de la intervención. Conclusión: La aplicación de Shiatsu contribuyó a reducir el dolor y los niveles de cortisol en personas sometidas a cirugía ortopédica. (AU)

Strategies for X-ray utilization in the evaluation of knee injuries

Knee injuries are prevalent among young athletes, and an accurate diagnosis is essential for effective treatment. Knee pain is a widespread issue among adolescent athletes. About 50% of athletes experience knee pain every year, and an estimated 2.5 million sports-related knee injuries occur annually in young athletes. The study discusses common knee injuries, including fractures, cartilage damage, patellar injuries, and meniscus tears. It highlights the Ottawa knee rules (OKRs) as a valuable clinical decision tool for guiding the necessity of knee X-rays, emphasizing their high sensitivity and potential cost savings. Prevention strategies for youth athletes, such as injury prevention programs and neuromuscular training, are also discussed. Additionally, the review underscores the importance of radiation exposure and patient safety when utilizing diagnostic imaging, emphasizing adherence to radiation safety principles and the ALARA principle. In conclusion, this review emphasizes multifaceted role of X-rays in diagnosing knee injuries and importance of evidence-based decision rules, prevention strategies, and radiation safety in adolescent knee healthcare.

Osteomielitis, perimplantitis y fractura vertical radicular mandibular en un paciente con fibromialgia: presentación de caso / Osteomyelitis, Peri-implantitis and Mandibular Root Vertical Fracture in a Patient with Fibromyalgia: Case Report / Osteomielite, peri-implantite e fratura vertical da raiz mandibular em um paciente com fibromialgia: relato de caso

Introducción: se considera la osteomielitis mandibular un proceso patológico poco frecuente. La mayor parte de los casos presentados involucran pacientes con osteorradionecrosis y aquellos pacientes con ingesta de algunos medicamentos antirresortivos. El objetivo es informar un caso inusual de una paciente con osteomielitis, perimplantitis y fractura vertical radicular con antecedentes de fibromialgia. Presentación del caso: mujer de 70 años de edad, no fumadora ni consumidora de alcohol, que acudió con un dolor posteroinferior izquierdo de un año de evolución. Presentaba una profundidad de son-deo mayor de 12 mm en el órgano dental (od) 37, sangrado a la palpación, dolor y movilidad grado ii. En el od 36 fue notoria la exposición clínica del tercio superior del implante dental, sin movilidad, con una profundidad de 4 mm. El tratamiento consistió en una exodoncia atraumática del od 37, donde se identificó una fractura radicular vertical. Discusión: actualmente, los implantes dentales permiten restablecer la salud bucodental. Sin embargo, ellos también pueden inducir una osteomielitis en los maxilares. La terapia instaurada redujo ostensiblemente la morbilidad del implante dental implicado y regeneró la zona intervenida.

Introduction: Mandibular osteomyelitis is considered a rare pathological process. Most of the cases pre-sented involve patients with osteoradionecrosis and those patients with intake of some antiresorptive drugs. The objective of this report is to report an unusual case of a patient with osteomyelitis, peri-im-plantitis and vertical root fracture with a history of fibromyalgia. Case presentation: A 70-year-old female patient, non-smoker or alcohol consumer, who presented with lower left postero-pain of one year's evolution. She presented a probing depth greater than 12 mm in dental organ (od) 37, bleeding on palpation, pain and grade II mobility. At the level of do 36, the clinical exposure of the upper third of the dental implant was notorious, without mobility, with a depth of 4 mm. The treatment consisted of an atraumatic extraction of do 37, where a vertical root fracture was identified. Discussion: Currently, dental implants make it possible to restore oral health. However, they can also induce osteomyelitis in the jaws. The established therapy ostensibly reduced the morbidity of the involved dental implant and regeneration of the intervened area

Introdução: a osteomielite mandibular é considerada um processo patológico raro. A maioria dos casos apresentados envolve pacientes com osteorradionecrose e aqueles pacientes com uso de alguns medi-camentos antirreabsortivos. O objetivo deste relato é relatar um caso incomum de um paciente com osteomielite, periimplantite e fratura radicular vertical com histórico de fibromialgia. Apresentação do caso: paciente do sexo feminino, 70 anos, não fumante ou etilista, que apresentou dor póstero-infe-rior esquerda com um ano de evolução. Apresentava profundidade de sondagem maior que 12 mm no órgão dentário (od) 37, sangramento à palpação, dor e mobilidade grau ii. Ao nível de do 36, foi notória a exposição clínica do terço superior do implante dentário, sem mobilidade, com profundidade de 4 mm. O tratamento consistiu em uma extração atraumática de do 37, onde foi identificada uma fratura vertical da raiz. Discussão: atualmente, os implantes dentários possibilitam o restabelecimento da saúde bucal. No entanto, eles também podem induzir osteomielite nos maxilares. A terapia instituída reduziu ostensivamente a morbidade do implante dentário envolvido e a regeneração da área intervencionada

A comparative study on the functional outcomes of patients who underwent internal versus external fixation for Tibial Plateau fractures two years post-surgery

Introduction@#Tibial plateau fractures are due to high energy trauma brought about by axial compression forces and associated varus or valgus component. @*Objective@#Patients diagnosed with tibial plateau fractures from January to December 2018 treated with internal vs. external fixation will be described according to their Schatzker classification. The study further aims to compare the functional outcomes between the two groups in terms of surgery done. @*Methods@#A chart review determined the distribution of demographics. The Modified Rasmussen Score (MRS) was used to determine the clinical and radiographic parameters after taking a new knee radiograph and assessment from the rehabilitation department. The MRS determined the functional outcomes of the said patients. Ethical considerations and proper informed consent were upheld after being reviewed by the hospital’s research committee. @*Results@#Out of 48 patients, 35 underwent internal fixation via open reduction using plates and/or screws, while 13 underwent external fixation using hybrid external fixator. The demographic profile showed mostly males between ages 20 to 49 years old. Most cases were due to vehicular accidents affecting the left lower extremity. In terms of Schatzker classification, the most common was type VI. The computed mean MRS of the internal fixation group was 30.43 while the external fixation group was 30.00, generally showing no significant difference. @*Conclusion@#Surgical intervention of tibial plateau fractures aims for anatomic reduction using internal or external fixation. There was no significant difference on the functional outcome of the two groups despite classifying the respondents according to Schatzker type, hence we can conclude that external fixation be chosen as the treatment of choice for tibial plateau fractures when properly indicated.

Vertebral fractures combined with prolonged activated partial prothrombin time:A case report / 北京大学学报(医学版)

With the development of modern medical standards,autoimmune diseases and their associ-ated successive osteoporosis have received increasing attention in recent years.Patients with autoimmune diseases,due to the characteristics of the disease and the prolonged use of glucocorticoid hormone thera-py,may affect the bone formation and bone absorption of the patient,followed by severe successive osteo-porosis,thereby increasing the risk of osteoporotic vertebral fractures.Vertebral compression fractures of the spine are common fracture types in patients with osteoporotic fractures.Osteoporosis is a common complication after glucocorticoid therapy in patients with autoimmune diseases.Percutaneous vertebro-plasty(PVP)and percutaneous kyphoplasty(PKP)are minimally invasive operation and are commonly used surgical methods for the treatment of osteoporotic vertebral compression fractures.However,due to the operation of spinal puncture during the operation,there are serious surgical risks such as bone cement leakage,spinal epidural hemorrhage,subdural hemorrhage,and subarachnoid hemorrhage in both PVP and PKP.As a result,it is necessary to evaluate the patient's body before surgery carefully,especially in the case of blood coagulation.This article reports a case of autoimmune disease patient admitted to Peking University People's Hospital due to lumbar 4 vertebral compression fracture combined with Sj?gren's syn-drome.The patient's preoperative examination showed that the activated partial thromboplastin time(APTT)was significantly prolonged.After completing the APTT extended screening experiment and lu-pus anticoagulant factor testing,the multi-disciplinary team(MDT)of Peking University People's Hospi-tal jointly discussed the conclusion that the patient's test results were caused by an abnormal self-immuni-ty anti-copulant lupus(LAC).Based on the results of the laboratory examination,the patient was con-sidered to be diagnosed with combined antiphospholipid syndrome(APS).For such patients,compared with the patient's tendency to bleed,we should pay more attention to the risk of high blood clotting in the lower limbs of the patient,pulmonary clots and so on.With timely anti-coagulation treatment,the patient safely passed the peripheral period and was successfully discharged from the hospital.Therefore,for pa-tients with autoimmune diseases with prolonged APTT in the perioperative period,doctors need to careful-ly identify the actual cause and carry out targeted treatment in order to minimize the risk of surgical and perioperative complications and bring satisfactory treatment results to the patients.

Application of artificial bone material in percutaneous vertebroplasty treatment for osteoporotic vertebral compression fractures / 国际外科学杂志

Objective:To explore the clinical efficacy of combined use of artificial bone materials in percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCF).Methods:One hundred and eighty-four consecutive patients with OVCF admitted to Beijing Friendship Hospital, Capital Medical University from June 2020 to June 2021 were retrospectively analyzed. All patients had single-level fracture and treated with PVP. According to whether artificial bone materials were used, the patients were divided into experimental group ( n=95) and control group ( n=89). The experimental group was treated with bone cement mixed with artificial bone materials, and the control group was treated with bone cement. The following indices were observed in the two groups before surgery and at 3 days, 3 months, 12 months (final follow-up) after surgery: visual analogue scale (VAS) score, Oswestry disability index (ODI), Cobb angle of kyphosis, and the percentage of anterior vertebral height, the amount of bone cement injected, postoperative complications and adjacent vertebral fractures were recorded. Measurement data were expressed as mean±standard deviation ( ± s), and t-test was used for comparison between groups; Chi- test was used for comparison between groups for count data. Results:All patients successfully completed the operation and were followed up for 12-20 months, with a mean follow-up of (14.24±2.51) months. The VAS score at 3 days, 3 months after operation and final follow-up (experimental group: 2.00±0.71, 1.89±0.71, 1.41±0.49; control group: 2.13±0.73, 1.81±0.60, 1.44±0.50) and ODI index at 3 months after operation and the final follow-up [experimental group: (21.56±4.68)%, (23.22±4.11)%; control group: (22.46±3.74)%, (22.39±4.05)%] were significantly improved compared with those before operation [VAS, experimental group: 7.66±0.86, control group: 7.81±0.89; ODI, experimental group: (70.11±8.24)%, control group: (68.97±8.59)%], and the differences were statistically significant ( P<0.05). There were no significant differences in the amount of bone cement injected between the two groups ( P>0.05). There was no significant difference in the Cobb angle of kyphosis and the percentage of anterior vertebral height at each time point ( P>0.05). The incidence of bone cement leakage in the experimental group was 15.8% (15/95), slightly lower than that in the control group [22.5% (20/89)], but the difference was not statistically significant ( P>0.05). As of the final follow-up, the incidence of adjacent vertebral fracture in the experimental group was 8.4% (8/95), which was lower than that in the control group (19.1%, 17/89), and the difference was statistically significant ( P< 0.05). Conclusion:The application of bone cement mixed with artificial bone materials in PVP for OVCF, can achieve good clinical efficacy, and reduce the incidence of adjacent vertebral fractures.