SHORT-TERM EVALUATION BETWEEN POLYETHYLENE THICKNESS IN PRIMARY TOTAL KNEE ARTHROPLASTY.

Objective: The objective of the research was to carry out a comparative study between Smith & Nephew ® or Zimmer ® prostheses with thick versus thin polyethylene, in patients undergoing primary total knee arthroplasty, during a short-term follow-up. Thus, the objective was to analyze the survival of the implants in question under the clinical and radiographic aspect. Methods: The sample was divided into two groups: Group 1 with thick polyethylene and group 2 with thin polyethylene. A clinical analysis of the patients was carried out and the implants were checked for loosening. Results: The groups were similar when compared. According to the Ahlbäck classification, 83% of the patients were in groups IV and V. The median functional score in the postoperative period was similar between the two groups. Postoperatively, the tibiofemoral angle fluctuated between 5 and 6 0 valgus on average. Two complications were observed in each group. None of the evaluated patients presented implant loosening. Conclusion: Patients treated with thick polyethylene had the same functional score as the control group, as well as the absence of radiographic changes in this short-term follow-up, with implant survival and a similar rate of complications between both groups. Level of evidence III, Retrospective study.

Objetivo: O objetivo desta pesquisa foi realizar um estudo comparativo entre as próteses Smith & Nephew ® e Zimmer ®, com polietileno espesso versus o fino, em pacientes submetidos à artroplastia total primária do joelho, durante um seguimento de curto prazo. Dessa forma, foi analisada a sobrevida dos implantes em questão sob o aspecto clínico e radiográfico. Métodos: A amostra foi dividida em dois grupos: grupo 1 com polietileno espesso e grupo 2 com polietileno fino. Foi realizada análise clínica dos pacientes e verificado se ocorreu soltura dos implantes. Resultados: Os grupos tiveram resultados semelhantes quando comparados. Segundo a classificação de Ahlbäck, 83% dos pacientes eram dos grupos IV e V. A mediana do escore funcional no pós-operatório foi similar entre os grupos. No pós-operatório o ângulo tíbio-femoral oscilou na média entre 5 e 6 0 de valgo. Foram observadas duas complicações em cada grupo. Nenhum dos pacientes avaliados apresentou soltura do implante. Conclusão: Os pacientes tratados com o polietileno espesso apresentaram o mesmo escore funcional do grupo controle, assim como ausência de alterações radiográficas nesse seguimento de curto prazo, com sobrevida do implante e índice de complicações similar entre ambos os grupos. Nível de evidência III, Estudo retrospectivo.

Equal rates of bone healing and reduced surgical time with iliac crest allograft compared to autograft in medial opening wedge high tibial osteotomy: a randomized controlled clinical trial.

INTRODUCTION: Iliac crest autograft is frequently used to fill in bone defects after osteotomies. Nonetheless, surgery for bone autograft procurement is associated with morbidity and pain at the donor site. Alternatives to it have been explored, but there is no consensus to guide their application as a routine practice in several orthopedic procedures. Thus, this study was designed to compare the efficacy and safety between iliac crest autograft and allograft in medial opening wedge high tibial osteotomy. MATERIALS AND METHODS: Forty-seven patients with a symptomatic unilateral genu varum and an indication for high tibial osteotomy were randomly assigned to receive either autograft or allograft to fill the osteotomy site. Operative time, bone healing, and complication rates (delayed union, nonunion, superficial and deep infection, loss of correction, and hardware failure) were recorded after a one-year follow-up. Data were expressed as Mean ± Standard Deviation and considered statistically significant when p < 0.05. RESULTS: The time to radiologic union was similar between both groups (Allograft: 2.38 ± 0.97 months vs. Autograft: 2.45 ± 0.91 months; p = 0.79). Complication rates were also similar in both groups, with one infection in the allograft group and two in the autograft group, two delayed unions in the allograft group, and three in the autograft group. The operative time differed by 11 min between the groups, being lower in the allograft group (Allograft: 65.4 ± 15.1 min vs. Autograft: 76.3 ± 15.2 min; p = 0.02). CONCLUSION: Iliac crest allografts can be safely and effectively used in medial opening wedge high tibial osteotomy as it promotes the same rates of bone union as those achieved by autologous grafts, with the benefits of a shorter operative time. TRIAL REGISTRATION NUMBER: U1111-1280-0637 1 December 2022, retrospectively registered.

Short-term evaluation between polyethylene thickness in primary total knee arthroplasty / Avaliação a curto prazo entre a espessura do polietileno na artroplastia total primária do joelho

ABSTRACT Objective: The objective of the research was to carry out a comparative study between Smith & Nephew ® or Zimmer ® prostheses with thick versus thin polyethylene, in patients undergoing primary total knee arthroplasty, during a short-term follow-up. Thus, the objective was to analyze the survival of the implants in question under the clinical and radiographic aspect. Methods: The sample was divided into two groups: Group 1 with thick polyethylene and group 2 with thin polyethylene. A clinical analysis of the patients was carried out and the implants were checked for loosening. Results: The groups were similar when compared. According to the Ahlbäck classification, 83% of the patients were in groups IV and V. The median functional score in the postoperative period was similar between the two groups. Postoperatively, the tibiofemoral angle fluctuated between 5 and 6 0 valgus on average. Two complications were observed in each group. None of the evaluated patients presented implant loosening Conclusion: Patients treated with thick polyethylene had the same functional score as the control group, as well as the absence of radiographic changes in this short-term follow-up, with implant survival and a similar rate of complications between both groups. Level of evidence III, Retrospective study.

RESUMO Objetivo: O objetivo desta pesquisa foi realizar um estudo comparativo entre as próteses Smith & Nephew ® e Zimmer ®, com polietileno espesso versus o fino, em pacientes submetidos à artroplastia total primária do joelho, durante um seguimento de curto prazo. Dessa forma, foi analisada a sobrevida dos implantes em questão sob o aspecto clínico e radiográfico. Métodos: A amostra foi dividida em dois grupos: grupo 1 com polietileno espesso e grupo 2 com polietileno fino. Foi realizada análise clínica dos pacientes e verificado se ocorreu soltura dos implantes. Resultados: Os grupos tiveram resultados semelhantes quando comparados. Segundo a classificação de Ahlbäck, 83% dos pacientes eram dos grupos IV e V. A mediana do escore funcional no pós-operatório foi similar entre os grupos. No pós-operatório o ângulo tíbio-femoral oscilou na média entre 5 e 6 0 de valgo. Foram observadas duas complicações em cada grupo. Nenhum dos pacientes avaliados apresentou soltura do implante. Conclusão: Os pacientes tratados com o polietileno espesso apresentaram o mesmo escore funcional do grupo controle, assim como ausência de alterações radiográficas nesse seguimento de curto prazo, com sobrevida do implante e índice de complicações similar entre ambos os grupos. Nível de evidência III, Estudo retrospectivo.

Predictive and protective factors for allogenic blood transfusion in total knee arthroplasty. A retrospective cohort study.

Background: This study aimed to identify the predictive and protective factors of blood transfusion in patients undergoing total knee arthroplasty (TKA) and therefore determine the profile of patients with low and high risk of blood transfusion after arthroplasty. Methods: We conducted a retrospective study with all patients who underwent primary TKA between January 2017 and December 2019 (n = 1.028 patients) in our institution. Information about allogenic transfusion was collected from medical records to determine the incidence, the predictive and protective factors of blood transfusion. All cases of blood transfusions were documented as well the number of units and the moment of each transfusion. We performed univariate and multivariate logistic regression analyses to identify the independent risk and protective factors. Results: The total transfusion rate was 11%, 1.1% at intraoperative and 9,9% at postoperative period. The independent risk factors for transfusion were female gender (OR 1.64), older age (>55yo, OR > 2) higher surgical risk (ASA III, OR 3.07), lower preoperative hemoglobin levels (p = 0.024), post-traumatic arthritis (OR 4.11) and use of postoperative drains (OR 1.81) The protective factors for transfusion were male gender (OR 0.60), obesity (IMC >30, OR 0.60) and use of intravenous tranexamic acid intraoperatively (OR 0.40). Conclusions: We conclude that in addition to the well-established risk factors for blood transfusion such as advanced age, low hemoglobin levels and high surgical risk, we can add post-fracture arthroplasty, non-use of tranexamic acid and the use of postoperative joint drain.

Treatment of Distal Patellar Tendon Chronic Rupture: The X-Wave Technique.

Injuries to the patellar tendon (PT) are associated with knee function deterioration and loss of the capacity to perform daily and sports activities. Patellar tendon injury is often misdiagnosed at emergency rooms, leading to chronic proximal retraction and a challenging clinical scenario. Proximal PT injuries are more common, while distal ones, which can involve tibial bone avulsion fractures or direct tendon avulsion, are rarer. The low incidence of distal PT rupture and the variety of injury patterns make a personal approach reasonable when based on the intraoperative findings and the surgeon's experience. Our purpose is to describe a surgical technique to restore the knee extensor mechanism after chronic distal PT rupture using two kinds of graft, one as a waveform augmentation of the native tendon and the other as reinforcement in a letter X aspect.

STUDY BETWEEN SEMI-CONSTRAINED TOTAL KNEE ARTHROPLASTY WITH OR WITHOUT INTRAMEDULLARY STEM.

Objective: This research sought to carry out a comparative study observing the clinical and radiographic analysis of primary prostheses of the type TC3 Depuy Johnson® with or without a stem during a short-term follow-up. Methods: The sample was divided into three groups: Group 1 (with stem), Group 2 (without stem) and Group 3 (mixed). Patients were evaluated to assess whether the implants were loosening and a clinical analysis was performed. Results: Preoperative deformities were predominantly considered severe. The total range of motion in the postoperative period was above 96.7° in the three groups. In the postoperative period, the femoral-tibial angle oscillated on average between 5 to 6° valgus. There was no record of implant loosening for cases treated with stem, and the incidence of loosening was 14.3% for the group without stem and 16.7% among cases in the mixed group. Conclusion: In general, preoperative deformities were considered severe. In the postoperative period, the total range of motion was above 96.7°. The postoperative femoral-tibial angle obtained an average of 5 to 6° valgus. There is no significant difference in implants loosening in the three groups. Level of Evidence III, Retrospective Comparative Study.

Objetivo: Realizar um estudo comparativo observando a análise clínica e radiográfica das próteses primárias do tipo TC3 Johnson ® com ou sem haste durante um seguimento de curto prazo. Métodos: A amostra foi dividida em três grupos: Grupo 1 com haste, Grupo 2 sem haste e Grupo 3 misto. Foi realizada a análise clínica dos pacientes e verificado se ocorreu soltura dos implantes. Resultados: As deformidades pré-operatórias foram predominantemente graves. O arco de movimento total no pós-operatório foi acima de 96,7° nos três grupos. No pós-operatório o ângulo tíbio-femoral oscilou na média entre 5 e 6° de valgo. Não houve registro de soltura do implante para os casos tratados com haste; a incidência de soltura foi de 14,3% entre os casos do grupo sem haste e de 16,7% entre os casos do grupo misto. Conclusão: Em geral, as deformidades pré-operatórias foram consideradas graves. No pós-operatório a amplitude total do arco de movimento foi acima de 96,7°. O ângulo tíbio-femoral pós-operatório obteve uma média entre 5 e 6° de valgo. Não há diferença significativa na soltura dos implantes nos três grupos. Nível de Evidência III, Estudo Retrospectivo Comparativo.

Study between semi-constrained total knee arthroplasty with or without intramedullary stem / Estudo entre artroplastia total do joelho semi-constrita com ou sem haste intramedular

ABSTRACT Objective: This research sought to carry out a comparative study observing the clinical and radiographic analysis of primary prostheses of the type TC3 Depuy Johnson® with or without a stem during a short-term follow-up. Methods: The sample was divided into three groups: Group 1 (with stem), Group 2 (without stem) and Group 3 (mixed). Patients were evaluated to assess whether the implants were loosening and a clinical analysis was performed. Results: Preoperative deformities were predominantly considered severe. The total range of motion in the postoperative period was above 96.7° in the three groups. In the postoperative period, the femoral-tibial angle oscillated on average between 5 to 6° valgus. There was no record of implant loosening for cases treated with stem, and the incidence of loosening was 14.3% for the group without stem and 16.7% among cases in the mixed group. Conclusion: In general, preoperative deformities were considered severe. In the postoperative period, the total range of motion was above 96.7°. The postoperative femoral-tibial angle obtained an average of 5 to 6° valgus. There is no significant difference in implants loosening in the three groups. Level of Evidence III, Retrospective Comparative Study.

RESUMO Objetivo: Realizar um estudo comparativo observando a análise clínica e radiográfica das próteses primárias do tipo TC3 Johnson ® com ou sem haste durante um seguimento de curto prazo. Métodos: A amostra foi dividida em três grupos: Grupo 1 com haste, Grupo 2 sem haste e Grupo 3 misto. Foi realizada a análise clínica dos pacientes e verificado se ocorreu soltura dos implantes. Resultados: As deformidades pré-operatórias foram predominantemente graves. O arco de movimento total no pós-operatório foi acima de 96,7° nos três grupos. No pós-operatório o ângulo tíbio-femoral oscilou na média entre 5 e 6° de valgo. Não houve registro de soltura do implante para os casos tratados com haste; a incidência de soltura foi de 14,3% entre os casos do grupo sem haste e de 16,7% entre os casos do grupo misto. Conclusão: Em geral, as deformidades pré-operatórias foram consideradas graves. No pós-operatório a amplitude total do arco de movimento foi acima de 96,7°. O ângulo tíbio-femoral pós-operatório obteve uma média entre 5 e 6° de valgo. Não há diferença significativa na soltura dos implantes nos três grupos. Nível de Evidência III, Estudo Retrospectivo Comparativo.

Continuous Meniscal Suture in Radial Meniscal Tear: The Hourglass Technique.

The key to preventing early knee osteoarthritis is meniscal preservation. The main functions of the meniscus are impact absorption, mechanical load transmission, lubrication, joint stability, and proprioception. Radial lesions that extend to the joint capsule are called complete radial tears. This type of injury compromises 2 of the main meniscal functions, which are impact absorption and load distribution, which is equivalent, from a biomechanical perspective, to a total meniscectomy. In the recent past, the treatment of choice for this type of injury was partial meniscectomy. However, several studies have observed progressive joint degeneration after this type of treatment. Recently, different types of meniscal sutures involving radial lesions of the meniscus have been developed. It is believed that such repairs may bring a decrease in future osteoarthritis in this patient profile. The purpose of this article is to describe the steps of continuous meniscal suture for the treatment of radial tears of the medial and lateral menisci.

Intraoperative morphometric study of distal femur in Brazilian patients undergoing total knee arthroplasty.

BACKGROUND: Total knee arthroplasty (TKA) is the treatment option for patients with severe osteoarthritis (OA) of the knee whose symptoms are refractory to conservative management. Unfortunately, the level of patient dissatisfaction is high, reaching up to 25%. The reasons for this dissatisfaction are multifactorial, but bone-implant mismatch significantly increases the chance of pain and functional limitation. Sex-specific prosthesis designs have been developed to overcome this issue, but their use is still controversial. The primary objective of this study was to evaluate possible sex differences in the shape of the distal femur in patients with osteoarthritis. Secondary objectives were to investigate interpersonal variability of the distal femur and to determine the number of femoral implant sizes required to meet shape variations. METHODS AND FINDINGS: A cross-sectional observational study prospectively compared 294 knees of 293 patients with osteoarthritis according to sex (201 female/93 male). Six intraoperative measurements were performed on the distal femur (height and width of both lateral and medial condyles, total medial-lateral width of the femur, and intercondylar distance). Sex differences and interpersonal variability were analyzed by multiple linear regressions. Measurements were also correlated with patient height. An optimization analysis was used to estimate the number of femoral implant sizes required. There were significant sex differences in the distal femur, where men had higher values than women in all measurements. Great interpersonal variability was found. The height of the lateral condyle was correlated with patient height, but the correlation was not strong. Twenty-five femoral implant sizes were required to meet the shape variations in our sample. CONCLUSIONS: The shape of the distal femur in patients with osteoarthritis shows great interpersonal variability, with men showing significantly higher values than women. A total of 25 different implant sizes would be necessary to adequately meet the variations observed in our study population.

Outcomes after knee arthroplasty in extra-articular deformity.

PURPOSE: To assess functional outcomes in patients undergoing total knee arthroplasty (TKA) without previous corrective osteotomy for treatment of knee osteoarthritis associated with extra-articular deformity. METHODS: From January to December 2016, patients with knee osteoarthritis with extra-articular deformities who presented for preoperative assessment before TKA were evaluated prospectively. Physical and radiological characteristics were documented pre- and postoperatively. RESULTS: TKA was performed in 33 knees; 25 were considered for analysis. The mean age was 65.2 years (range, 48-79 years). Sixteen deformities were secondary to fractures and nine to failed osteotomies. The mean Knee Society Score (KSS) improved from 27.1 pre-operatively to 68.7 post-operatively (p = 0.000). Pre-operative mechanical axis ranged from 32° varus (negative) to 26° valgus. After correction, 20 knees were within 3° (varus or valgus) of mechanical alignment. CONCLUSION: In patients with extra-articular deformities, TKA with asymmetric intra-articular resection and ligament balancing can relieve pain and realign the mechanical axis of the lower limb.

The use of tourniquet during total knee replacement in patients with and without popliteal artery calcification.

OBJECTIVE: Identify the clinical and surgical complications associated with the use of a tourniquet in total knee arthroplasty in patients with or without calcification of the popliteal artery. METHODS: The study was performed retrospectively, analyzing 58 patients with calcification of the popliteal artery and 57 patients as a control group. RESULTS: The case group patients were significantly older than patients in the control group; however, this had no impact on the clinical outcome in the analyzed period.There were no complications during surgery in the groups studied, as there were no statistically significant differences between the incidence of local or systemic intercurrences in the analyzed period. CONCLUSION: This study found low rates of complications in patients undergoing total knee arthroplasties with use of a tourniquet, with or without calcification of the popliteal artery.

OBJETIVO: Identificar as complicações clínicas e cirúrgicas associadas ao uso de torniquete na artroplastia total de joelho em pacientes com ou sem calcificação da artéria poplítea. MÉTODOS: O estudo foi feito de modo retrospectivo, analisou 64 pacientes com calcificação da artéria poplítea e 57 pacientes como grupo controle. RESULTADOS: Os pacientes do grupo de casos eram significativamente mais velhos do que os pacientes do grupo controle. Entretanto, tal fato não teve repercussão quanto ao desfecho clínico no período analisado. Não houve complicações durante o ato cirúrgico nos grupos estudados, bem como não houve diferenças estatisticamente significantes entre a incidência de intercorrências locais ou sistêmicas no período analisado. CONCLUSÃO: O presente estudo observou baixos índices de complicações em pacientes submetidos a artroplastia total do joelho com uso de torniquete com ou sem calcificação da artéria poplítea.

Modified axillary radiograph of the shoulder: a new position.

Obtaining axillary radiographs of the shoulder in acute trauma is not always feasible. The authors present a new modification of this radiographic view, in order to assess the anatomic relationship between the humeral head and the glenoid cavity. The incidence is performed with the patient sitting on X-ray table, with the affected limb supported thereon. The authors describe the case of a 28-year-old male who suffered an anterior glenohumeral dislocation that was clearly evidenced by this modified radiograph. The concentric relationship between the humeral head and the glenoid cavity was also easily confirmed by obtaining such radiograph after the reduction maneuver.

A obtenção de radiografias em perfil axilar do ombro em situação de trauma agudo nem sempre é tarefa fácil. Os autores apresentam uma modificação inédita dessa incidência radiográfica, com o objetivo de avaliar a relação anatômica da cabeça umeral com a cavidade glenoide. A incidência é medida com o paciente sentado sobre a mesa de exames de raios X, com o membro acometido apoiado sobre ela. Os autores descrevem o caso de um paciente de 28 anos que sofreu um episódio de luxação glenoumeral anterior que foi claramente evidenciada pela radiografia modificada. A relação de concentricidade entre a cabeça umeral e a cavidade glenoide foi facilmente confirmada pela obtenção da referida incidência radiográfica obtida após a manobra de redução.

A survey to assess the educational-level interference on self-evaluation of acute pain.

OBJECTIVE: The present study aimed to evaluate whether patient education level interferes in the percentage of pain relief or increase using visual analogue scale (VAS) and subjective pain perception. PATIENTS AND METHODS: Ninety-five patients presenting acute shoulder pain due to enthesitis were evaluated. They were asked to quantify the pain using VAS before steroid articular infiltration. One week later, patients reevaluated the pain using VAS and orally stated the percentage of perceived pain increase or relief. The information gathered was then compared among three patient educational levels (elementary, high school, and university). RESULTS: Percentages of improvement stated orally and utilizing VAS presented no statistically significant differences among the three educational status levels (p = 0.804). CONCLUSION: Patient educational status caused no impact in the results of acute pain self-assessment with VAS and oral evaluation.

Patellar ligament rupture in an adolescent.

Rupture of the patellar tendon is a well-known injury in the orthopaedic literature. However, it is unusual and rarely reported in adolescent children. On the one hand, in the immature skeleton, the most frequent lesion above the kneecap is the sleeve fracture. On the other hand, in the distal region, avulsion of the tibial tuberosity is more common. Patellar tendon rupture in an adolescent is a rare lesion. We report a case in which an adolescent sustained a fall when jumping. No predisposing factors have been found. The injury was treated with surgical repair with transosseous suturing and reinforcement with semitendinosus tendon. The aim of this study is to present a case of traumatic rupture of the extensor mechanism of the knee in an adolescent and the therapy used.

Radiographic analysis of factors predisposing toward tendon tears in the knee extensor mechanism.

OBJECTIVES: to review radiographs of patients who suffered tendon tears of the knee extensor apparatus and observe alterations that might be factors predisposing toward this type of injury. METHODS: we retrospectively analyzed 60 cases of injury to the knee extensor mechanism that were treated surgically at the Miguel Couto Municipal Hospital between March 2004 and March 2011. Four patients were excluded due to poor quality of the examination. RESULTS: of the 56 patients evaluated, 23 were considered to be normal and 33 presented radiographic alterations. Among these, eight (24.3%) presented suprapatellar osteophytes alone; seven (21.2%), infrapatellar calcification; seven (21.2%), suprapatellar calcification; six (18.2%), supra- and infrapatellar osteophytes; and five (15.1%), infrapatellar osteophytes alone. CONCLUSION: radiographic alterations were frequently observed in patients with extensor mechanism tears.

OBJETIVOS: revisar radiografias de pacientes vítimas de rupturas tendinosas do aparelho extensor do joelho e observar alterações que possam ser um fator predisponente a esse tipo de lesão. MÉTODOS: analisamos, retrospectivamente, 60 lesões do mecanismo extensor do joelho, tratadas cirurgicamente no Hospital Municipal Miguel Couto, de março de 2004 a março de 2011, e quatro pacientes foram excluídos por má qualidade do exame. RESULTADOS: dos 56 pacientes avaliados, 23 foram considerados normais e 33 apresentaram alterações radiográficas, oito (24,3%) com presença de osteófito suprapatelar isolado, sete (21,2%) com calcificação infrapatelar, sete (21,2%) com calcificação suprapatelar, seis (18,2%) com osteófitos supra e infrapatelares e cinco (15,1%) com osteófito infrapatelar isolado. CONCLUSÃO: as alterações radiográficas foram frequentes em pacientes com ruptura do mecanismo extensor.

Fracture of tibial tuberosity in an adult.

The fracture of tibial tuberosity is a rare lesion and still more unusual in adults. We describe a case in an adult who suffered a left knee injury due to a fall from height. No risk factors were identified. The lesion was treated with surgical reduction and internal fixation. The rehabilitation method was successful, resulting in excellent function and rage of motion of the knee. The aim of this study was to present an unusual case of direct trauma of the tibial tuberosity in an adult and the therapy performed.

Total rupture of the quadriceps muscle in an adolescent.

The total rupture of the quadriceps muscle in an adolescent is a rare lesion. We report a case of a 13 year old boy who suffered a direct trauma to the left knee. No predisposing factors have been diagnosed. The lesion was treated with surgical repair and transosseus sutures. The aim of this study was to present a rare case of rupture of the quadriceps muscle in an adolescent and the therapy used.

EPIDEMIOLOGICAL STUDY ON TENDON RUPTURES OF THE KNEE EXTENSOR MECHANISM AT A LEVEL 1 HOSPITAL.

OBJECTIVES: The purpose of the present study was to review the epidemiological aspects of tendon ruptures of the knee extensor apparatus at a level 1 hospital. METHODS: We retrospectively analyzed 76 lesions of the knee extensor apparatus that were treated surgically at the Miguel Couto Municipal Hospital between March 2004 and March 2011. We took into consideration age, sex, trauma mechanism, anatomical classification of the lesion, affected side, comorbidities and associated lesions. RESULTS: Among the patients studied, 68 were male and the mean age was 36 years. Regarding the trauma mechanism, 62 lesions occurred due to direct trauma; the right side was affected in 21 cases; eight presented comorbidities and four presented associated lesions. CONCLUSION: The majority of the patients were male, at an economically active age (young people), and were victims of direct trauma. Ruptures of the patellar ligament were the most frequent lesions. Associated lesions were rare and comorbidities were infrequent in our sample.

[Comparative study between different radiographic plans in knee osteoarthritis]. / Estudo comparativo entre incidências radiográficas para a osteoartrose do joelho.

UNLABELLED: Perform a comparative analysis (with the criteria of Ahlbäck original classification) of the anteroposterior (AP) weight-bearing radiograph of knee in extension and of Rosenberg(2) view, in symptomatic arthritic knees. The analysis aims at revealing agreement or disagreement between (AP) view and Rosenberg view and the degree of articular degeneration and the advantages of these views. PATIENTS AND METHODS: From January 2005 to March 2007, a prospective study was conducted with 76 selected patients (111 arthritic knees) attending the outpatient clinic, at the knee unit, and subjected to the radiographs proposed in the present study. Of the total number of patients (76), 52 were females and 24 males, having an average age of 62 (range, 50- 82 years). 41 patients had unilateral degeneration and 35 patients had bilateral degeneration. Of the total number of assessed knees (111), 66 were right knees and 45 were left knees. The study used the Kappa statistical analysis, which assesses interobserver agreement of qualitative data. RESULTS: According to the Ahlbäck score, there was agreement between the orthopedist and the radiologist in 98.2% of cases in the AP weight-bearing view, and in 88.3% in the Rosenberg view. A highly significant agreement on both views between the orthopedist and the radiologist was noticed. However, the degree of agreement was higher for the AP weigh-bearing view than for the Rosenberg view. According to the Ahlbäck score, the AP weight-bearing view agreed with the Rosenberg view in only 27% of the cases for the orthopaedist, and in 31.5% for the radiologist. No significant agreement was found between the AP weight-bearing view and the Rosenberg view for the orthopedist and the radiologist. CONCLUSIONS: There is no significant disagreement between experts concerning the classification of knee osteoarthritis, according to the Ahlbäck score, both for the AP weight-bearing view and the Rosenberg view. There is no agreement between the views, concerning the classification of knee osteoarthritis, both for the orthopedist and the radiologist, the Rosenberg view having shown more clearly the degree of articular degeneration. The posteroanterior view of Rosenberg provided a better assessment of degeneration of the articular surface, which in some cases led to a change in the classification of knee osteoarthritis and was routinely used.

Operative treatment of transverse acetabular fractures: is it really necessary to fix both columns?

OBJECTIVE: we prospectively evaluated clinical and radiographic outcomes in patients with displaced combined transverse-posterior wall acetabular fractures managed at our Institution over a period of seven years by posterolateral single approach, direct posterior wall and posterior column reduction and plating, and indirect reduction of anterior column controlled by fluoroscopic images with or without lag-screw fixation. The aim was to identify if the obtained immediate postoperative Matta radiographic roof-arc angles after fracture reduction and fixation alters in the postoperative period when comparing posterior plating alone versus posterior plate and anterior column lag-screw fixation. PATIENTS AND METHODS: 35 skeletally mature patients (31 male and four female, with mean age of 39.9 years old [range, 23.3 to 66.7 y/o]) with combined transverse-posterior wall acetabular fractures surgically treated by a posterolateral single approach were enrolled in this prospective investigation. Nineteen patients had associated orthopaedic injuries. The first part of the acetabular fracture management was similar to all patients and consisted in anatomical reduction and fixation of the transverse posterior component followed by anatomical reduction and fixation of the posterior wall component. The transverse anterior component reduction was controlled by fluoroscopic images (anteroposterior (AP), iliac oblique, and obturator oblique views) and digital palpation through the greater sciatic notch. Fifteen of the 35 patients had an additional lag-screw fixation from the posterior to the anterior columns with an extra-long small-fragment cortical screw. AP and Judet oblique radiographic views were taken at the end of the procedure and roof-arc angles were measured. Clinical results were assigned according to the grading system of Merle D'Aubigne and Postel as modified by Matta et al. Radiographic roof-arc angles were checked and compared between the two groups of patients to the same data collected both at the time of the surgical procedure and at three months postoperatively. Statistical analysis was done by either using chi-square (clinical outcome) and Mann-Whitney (roentgenographic outcome) tests, with a level of significance of alpha = 5%. RESULTS: at final follow-up examination 18 to 84 months postoperatively (mean, 46.8 months), the clinical results were considered satisfactory in 31 (88.6%) patients (excellent in nine (25.7%) and good in 22 (62.9%) patients). There was no difference between patients with (n = 15) and without (n = 20) fixation of the transverse anterior component of the acetabular fracture (p = 0.67). Radiographic roof-arc angles measured at discharge, at three months postoperatively and at the last follow-up consultation didn't changed significantly (p > 0.05). There was no statistically significant difference between patients treated with (n = 15) and without (n = 20) fixation of the anterior component of the transverse acetabular fracture in terms of medial displacement of the femoral head. CONCLUSION: the authors suggest that associated transverse-posterior wall acetabular fractures can be managed by a single posterior approach. Direct reduction and fixation of the posterior wall and column components is an adequate option for these injuries. If there is adequate indirect reduction of the anterior column, as checked by digital palpation and fluoroscopy, we feel that it is not necessary to fix the anterior column component of the transverse acetabular fracture.