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Introduction: Radial head fractures are consistently part of a terrible triad of the elbow and can occur in association with Monteggia fracture-dislocations, transolecranon fractures, and their variations. Understanding the degree of comminution of the radial head fracture and the location of fragments determines the course of action to be taken. Objectives: To correlate fracture-dislocations with the pattern of radial head fracture (number of fragments) and involvement in the proximal radioulnar region. Materials and Methods: A retrospective study (level II) of patients undergoing surgery for radial head fractures associated with fracture-dislocations. Patients had radiographs in anteroposterior and lateral views, as well as tomography. The number of radial head fracture fragments and the presence of fractures in the proximal radioulnar region were correlated with the type of fracture-dislocation and demographic variables. Conclusion: Elbow fracture-dislocation types could not predict the number of fragments and the location of radial head fractures. However, most injuries presented three or more fragments in the radial head, and many had involvement of the proximal radioulnar region, suggesting high-energy trauma. Level of Evidence II; Retrospective Study.
Introdução: As fraturas da cabeça do rádio estão sempre presentes em uma tríade terrível do cotovelo e podem ocorrer associadas a uma fratura-luxação de Monteggia, fratura transolecraniana e suas variações. Conhecer o grau de cominuição da fratura da cabeça do rádio e a localização dos fragmentos determinam a conduta a ser tomada. Objetivos: Correlacionar as fraturas-luxações com o padrão da fratura da cabeça do rádio (número de fragmentos) e o acometimento na região radioulnar proximal. Material e Métodos: Estudo retrospectivo (nível II) de pacientes submetidos a cirurgia devido fraturas de cabeça de rádio associadas às fraturas-luxações. Os pacientes possuíam radiografia nas incidências anteroposterior e perfil e tomografia. O número de fragmentos da fratura da cabeça do rádio e a presença de fratura na região radioulnar proximal foram correlacionadas com o tipo de fratura-luxação e as varáveis demográficas. Conclusão: Os tipos de fratura-luxação do cotovelo não foram capazes de predizer o número de fragmentos e a localização da fratura da cabeça do rádio. Entretanto, a maioria das lesões apresentaram três ou mais fragmentos na cabeça do rádio e muitos apresentaram acometimento da região da radioulnar proximal sugerindo traumas de alta energia. Nível de Evidência II; Estudo Retrospectivo.
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ABSTRACT Introduction: Radial head fractures are consistently part of a terrible triad of the elbow and can occur in association with Monteggia fracture-dislocations, transolecranon fractures, and their variations. Understanding the degree of comminution of the radial head fracture and the location of fragments determines the course of action to be taken. Objectives: To correlate fracture-dislocations with the pattern of radial head fracture (number of fragments) and involvement in the proximal radioulnar region. Materials and Methods: A retrospective study (level II) of patients undergoing surgery for radial head fractures associated with fracture-dislocations. Patients had radiographs in anteroposterior and lateral views, as well as tomography. The number of radial head fracture fragments and the presence of fractures in the proximal radioulnar region were correlated with the type of fracture-dislocation and demographic variables. Conclusion: Elbow fracture-dislocation types could not predict the number of fragments and the location of radial head fractures. However, most injuries presented three or more fragments in the radial head, and many had involvement of the proximal radioulnar region, suggesting high-energy trauma. Level of Evidence II; Retrospective Study.
RESUMO Introdução: As fraturas da cabeça do rádio estão sempre presentes em uma tríade terrível do cotovelo e podem ocorrer associadas a uma fratura-luxação de Monteggia, fratura transolecraniana e suas variações. Conhecer o grau de cominuição da fratura da cabeça do rádio e a localização dos fragmentos determinam a conduta a ser tomada. Objetivos: Correlacionar as fraturas-luxações com o padrão da fratura da cabeça do rádio (número de fragmentos) e o acometimento na região radioulnar proximal. Material e Métodos: Estudo retrospectivo (nível II) de pacientes submetidos a cirurgia devido fraturas de cabeça de rádio associadas às fraturas-luxações. Os pacientes possuíam radiografia nas incidências anteroposterior e perfil e tomografia. O número de fragmentos da fratura da cabeça do rádio e a presença de fratura na região radioulnar proximal foram correlacionadas com o tipo de fratura-luxação e as varáveis demográficas. Conclusão: Os tipos de fratura-luxação do cotovelo não foram capazes de predizer o número de fragmentos e a localização da fratura da cabeça do rádio. Entretanto, a maioria das lesões apresentaram três ou mais fragmentos na cabeça do rádio e muitos apresentaram acometimento da região da radioulnar proximal sugerindo traumas de alta energia. Nível de Evidência II; Estudo Retrospectivo.
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Abstract Objectives: The aim of this study was to evaluate the effect of STS resection in the thigh on MS and the HRQoL. Methods: Fourteen adults patients with STS in the thigh who underwent wide resection and limb preservation were evaluated. The patients were submitted to the Mini-Mental State Examination (MMSE). A hand-held dynamometer was used to measure the MS the flexors, adductors, abductors, and extensors muscles of the operated and non-operated thighs and between the dominant and non-dominant operated sides. The Musculoskeletal Tumor Society (MSTS) and Short Form Health Survey-36 (SF-36) questionnaires were applied to quantify the psychometric properties of the HRQoL. The data were submitted to statistical analysis using the Wilcoxon test (MS), and Mann-Whitney and Spearman correlation (MSTS and SF-36) (α = 0.05). Results: There was no significant difference in MS between the operated side and the non-operated side, and between the dominant and non-dominant operated side (ρ > 0.05). The MSTS presented a significant difference in the emotional acceptance for patients submitted to radiotherapy (ρ = 0.029). The SF-36 showed significant differences in the emotional aspect for patients submitted to chemotherapy (ρ = 0.027) and in the social aspect between the dominant and non-dominant operated side (ρ = 0.024). Conclusions: The HRQoL of adult patients is hampered after the treatment of STS even when MS is maintained.
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ABSTRACT Background: Proximal humeral fractures can progress to osteonecrosis of the humeral head. Hertel developed a binary classification system (12 subtypes) and demonstrated that some patterns have more risk to develop osteonecrosis. Hertel described the prevalence and the risk factors for Humeral head osteonecrosis after osteosynthesis using a Deltopectoral approach. Few studies have evaluated the prevalence and the capacity of Hertel's classification to predict Humeral Head osteonecrosis following osteosynthesis of proximal Humeral fractures through the anterolateral approach. The objectives of this study were to correlate osteonecrosis predictors established by the Hertel classification with the risk of developing osteonecrosis and its prevalence after osteosynthesis using the anterolateral approach. Methods: This was a retrospective study of patients who underwent osteosynthesis of proximal humerus fractures using an anterolateral approach. Patients were divided into two groups: high risk for necrosis (group 1) and low risk for necrosis (group 2) according to Hertel's criteria. The overall prevalence of osteonecrosis and the prevalence in each group were calculated. A radiological examination was performed in the true anteroposterior (Grashey), scapular, and axillary views, before and after the operation (minimum 1 year after surgery). A KaplanMeier curve was used to assess the pattern of the temporal evolution of osteonecrosis. The groups were compared using the Chi-square test or Fisher's exact test. The unpaired t-test (parametric variables - age) and the MannWhitney test (non-parametric time between trauma and surgery) were used. Results: In total, 39 patients were evaluated. The postoperative follow-up time was 14.5 ± 3.3 months. The time to onset of necrosis was 14.1 ± 3.9 months. Sex, age, and time between trauma and surgery did not influence the risk of necrosis. Type 2, 9, 10, 11, and 12, or fractures with posteromedial head extension less than or equal to 8 mm, or diaphysis deviation greater than 2 mm, as well as grouping did not influence the risk for osteonecrosis. Conclusions: Hertel's criteria were not able to predict the development of osteonecrosis after osteosynthesis of proximal humerus fractures performed through the anterolateral approach. The total prevalence of osteonecrosis was 17.9% with a tendency toward an increased incidence after 1 year of surgical treatment.
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Abstract Background Systemic Sclerosis (SSc) patients may need hand surgery. Objective To develop a screening tool for rheumatologists to identify potential candidates with systemic sclerosis for hand surgery, optimizing referrals. Methods A pilot cross-sectional study from January 2015 to December 2016. Sample size: 51 participants. Inclusion criteria: ≥ 18 years old, meeting the 2013 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria for SSc and hand impairment. Data collected: age, sex, race, disease duration, SSc subtypes, vasodilator use, skin thickness, finger stiffness, presence of Digital Ulcers (DU) and/or calcinosis, presence of Raynaud's Phenomenon (RP) attacks, health status and disability, disease status, pain intensity and functional status of the hands. Data were analyzed by a multivariate logistic regression model. Results Fulfillment of surgical criteria: 68.8%. The surgical group had higher scores on the HAQ-DI (1.39 vs. 0.96, p =0.032) and CHFS (25.0 vs. 12.0, p =0.005) questionnaires, and a higher frequency of DU (91.43% vs. 18.75%, p <0.0010), calcinosis (60.0% vs. 0.0%, p <0.001), use of vasodilators (100.0% vs. 75.0%, p =0.007) and digital stiffness (28.57% vs. 0.0%, p =0.017). The presence of DU increased the chance of surgical indication by 46.2 times (ORIC 95% = 8.23 to 259.49). The statistical model showed good accuracy (86.3%, p <0.001), sensitivity (91.4%), and specificity (81.2%). Conclusion The presence of DU in SSc could be used as a screening feature for early identification and referral of potential candidates for hand surgery.
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ABSTRACT Monteggia fracture-dislocations are rare injuries, affecting about 2-5% of the population. Jesse Jupiter subdivided Bado's Type II fractures into four types, all of which presented an associated radial head fracture. Associated chondral and ligament injuries can evolve with postoperative complications. Objective: To evaluate the incidence of complications and risk factors that may influence the postoperative outcomes of Jupiter lesions. Methods: This retrospective study was conducted with surgically treated patients. The characteristics related to fractures and surgical approaches were evaluated and these variables were correlated with radiographic and functional postoperative complications. Results: A total of 15 patients were evaluated, mostly men and with a higher prevalence of Types IIA and IID. The most frequent complications were heterotopic ossification and osteolysis around the radial head prosthesis. Postoperative instability occurred only in the lateral collateral ligament. According to MEPS functional score, 53% of the patients evolved with unfavorable outcomes. Conclusion: The studied cases evolved with high rates of postoperative complications, mainly in Jupiter's Type IID fractures and associated coronoid fractures. Level of Evidence III, Therapeutic Study.
RESUMO A fratura-luxação de Monteggia é uma lesão rara que acomete cerca de 2-5% da população. Jesse Jupiter subdividiu as fraturas tipo II de Bado em quatro tipos, todos eles associados à fratura da cabeça do rádio. As lesões condral e ligamentares associadas podem evoluir com complicações pós-operatórias. Objetivo: Avaliar a incidência das complicações e os fatores de risco que podem influenciar os resultados pós-operatórios nas fraturas de Monteggia tipo II de Jupiter. Métodos: Estudo retrospectivo com pacientes tratados cirurgicamente. Avaliaram-se as características relacionadas às fraturas e as técnicas cirúrgicas utilizadas e, em seguida, tais variáveis foram correlacionadas com complicações pós-operatórias radiográficas e funcionais. Resultados: Foram avaliados 15 pacientes, havendo predomínio do sexo masculino e maior prevalência das fraturas tipo IIA e IID. As complicações mais frequentes foram a ossificação heterotópica e a osteólise ao redor da prótese da cabeça do rádio. A instabilidade pós-operatória ocorreu somente no complexo ligamentar lateral. Funcionalmente, segundo o Mayo Elbow Performance Score, 53% dos pacientes evoluíram com resultados desfavoráveis. Conclusão: Observou-se alta taxa de complicação pós-operatória, principalmente nas fraturas tipo II-D de Jupiter e naquelas com fratura do coronoide associada. Nível de Evidência III, Estudo Terapêutico.
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Abstract Objective To evaluate the postoperative functional and radiographic outcomes of the shoulder of patients submitted to transosseous suturing of a greater tuberosity fracture (GTF) through an anterolateral route and the influence of the glenohumeral dislocation on these outcomes. Methods We conducted a retrospective study and functional assessment using the Constant-Murley score. The distance between the greater tuberosity and the joint surface of the proximal humerus (in true anteroposterior radiographs) after the union was calculated. We used the Fisher exact test for the categorical independent variables, and the Student t or Mann-Whitney test for the non-categorical variables. Results In total, 26 patients met the inclusion criteria, and 38% of the sample presented an association between glenohumeral dislocation and GTF. The mean Constant-Murley score was of 82.5 + 8.02 points. The presence of an associated dislocation did not alter the functional outcome. The mean distance between the greater tuberosity of the humerus and the joint surface of the humeral head after the union was of 9 + 4.3 mm below the articular line of the humeral head. The dislocation led to a lower level of reduction, but this did not influence the Constant-Murley score. Conclusion The cases of GTF submitted to surgical treatment with transosseous sutures had good functional outcomes. The presence of dislocation made the anatomical reduction of the greater tuberosity difficult. However, it did not influence the Constant-Murley score.
Resumo Objetivo Avaliar os resultados funcional e radiográfico pós-operatórios do ombro, em pacientes submetidos a sutura transóssea de fratura da tuberosidade maior (FTM) por acesso anterolateral, e a influência da luxação glenoumeral nesses resultados. Métodos Realizou-se estudo retrospectivo e avaliação funcional (pela escala de Constant-Murley). Calculou-se a distância entre a tuberosidade maior e a superfície articular do úmero proximal (por meio de radiografia em incidência anteroposterior verdadeira) após a consolidação. Usou-se o teste Exato de Fisher para as variáveis independentes categóricas, e os testes tde Student ou de Mann-Whitney para as não categóricas. Resultados Ao todo, 26 pacientes preencheram os critérios de inclusão. A associação de luxação glenoumeral com FTM foi observada em 38% da amostra. A média da pontuação na escala de Constant-Murley foi de 82,5 + 8,02. A presença de luxação associada não alterou o resultado funcional. A distância média da consolidação da tuberosidade maior do úmero em relação à superfície articular da cabeça umeral foi de 9 + 4,3 mm abaixo da linha articular da cabeça umeral. Pacientes com luxação associada evoluíram com redução menor, mas isso não influenciou na pontuação na escala de Constant-Murley. Conclusão As FTMs submetidas ao tratamento cirúrgico com sutura transóssea evoluíram com bom resultado funcional. A presença de luxação dificultou a redução anatômica da tuberosidade maior. Entretanto, isso não influenciou na pontuação na escala de Constant-Murley.
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Humanos , Luxación del Hombro/cirugía , Técnicas de Sutura , Anclas para Sutura , Fracturas del Húmero/cirugíaRESUMEN
ABSTRACT Most epidemiological studies do not exclusively address fractures treated surgically but include those with conservative treatment. In Brazil, few epidemiological studies address fractures prevalence undergoing surgical treatment. Objective: To assess the prevalence, demographics, and associated injuries of surgically treated humeral shaft fractures. Methods: A retrospective study between 2009 and 2019 with patients undergoing osteosynthesis of humeral shaft fracture. Categorical variables were assessed using Fisher's chi-square or exact test, and non-categorical variables were assessed using the unpaired t-test. A significance level of 5% was adopted. Results: A total of 115 patients were evaluated. Mean age was 37.9 ± 15.6 years, with a male predominance (66.9%) due to car accidents. The most prevalent fracture type was 12 A3. Open fracture prevalence was 11.3%. Radial nerve damage prevalence was 33% and low-energy trauma was twice as likely. Conclusion: Surgically treated humeral shaft fractures were more prevalent in men, young, and related to high-energy trauma, with a transverse line pattern. Fractures secondary to low-energy trauma had a greater association with radial nerve injury. Level of Evidence III, Epidemiological, Retrospective Study.
RESUMO A maior parcela dos estudos epidemiológicos não aborda exclusivamente as fraturas tratadas cirurgicamente, mas engloba as de tratamento conservador. No Brasil existem poucos estudos epidemiológicos que versam sobre a prevalência das fraturas submetidas ao tratamento cirúrgico. Objetivo: Avaliar a prevalência, os dados demográficos e as lesões associadas das fraturas da diáfise do úmero tratadas cirurgicamente. Métodos: Estudo retrospectivo conduzido entre 2009 e 2019, com pacientes submetidos a osteossíntese de fratura diafisária do úmero. As variáveis categóricas foram testadas pelo teste qui-quadrado ou teste exato de Fisher, enquanto as não categóricas foram medidas pelo teste t não pareado. Adotou-se nível de significância de 5%. Resultados: Foram avaliados 115 pacientes. A média de idade foi de 37,9 ± 15,6 anos, com uma predominância de pacientes do sexo masculino (66,9%) devido a acidentes automobilísticos. A fratura tipo 12 A3 foi a mais prevalente. A prevalência de fratura exposta foi de 11,3%. A lesão nervo radial ocorreu em 33%, principalmente em traumas de baixa energia. Conclusão: As fraturas diafisárias do úmero tratadas cirurgicamente foram mais prevalentes em homens jovens e relacionadas a traumas de alta energia, com padrão de traço transverso. Fraturas secundárias e traumas de baixa energia tiveram maior associação com lesão do nervo radial. Nível de Evidência III, Estudo Epidemiológico, Retrospectivo.
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ABSTRACT Mortality of patients after osteosynthesis of proximal humeral fractures (PHF) has been poorly studied in contrast to fractures of the proximal femur. Objective: To evaluate the mortality of older patients with PHF undergoing surgical treatment. Methods: Retrospective study of patients undergoing surgical treatment PHF between 2009-2019. Demographic data, Neer classification, and mortality of this cohort of patients were evaluated. Non-categorical variables were tested using the Kolmogorov-Smirnov test. The unpaired t-test (parametric variables) was used. Categorical variables were tested by Fisher's exact test. A Kaplan-Meier mortality curve was constructed. Results: 59 patients were evaluated. There was a predominance of females in the sixth decade of life. The most prevalent fractures were Neer's type III. The highest mortality occurred in the first 4 years after surgery (4.1 + 3.2 years). The only comorbidity capable of changing the survival curve was DM (p = 0.03) Conclusion: Overall mortality was 11.3%. The highest mortality occurred in the first 4 years of follow-up. Diabetic patients evolve with earlier mortality and have 7 times more chance of death. Level of Evidence III, Retrospective Study.
RESUMO A mortalidade de pacientes após osteossíntese de fratura de úmero proximal (FUP) é pouco estudada em comparação com as fraturas do fêmur proximal. Objetivo: Avaliar a mortalidade de pacientes idosos com FUP submetidos a tratamento cirúrgico. Métodos: Estudo retrospectivo de pacientes submetidos ao tratamento cirúrgico FUP entre 2009 e 2019. Foram avaliados dados demográficos, classificação de Neer e a mortalidade dessa coorte de pacientes. As variáveis não categóricas foram testadas pelo teste de Kolmogorov-Smirnov. Utilizou-se o teste t não pareado para variáveis paramétricas. As variáveis categóricas foram testadas pelo teste exato de Fisher. Construiu-se a curva de mortalidade pelo método de Kaplan-Meier. Resultados: Foram avaliados 59 pacientes, havendo predomínio do sexo feminino na faixa dos 60 anos. As fraturas mais prevalentes foram as do tipo III de Neer. A maior mortalidade ocorreu nos quatro primeiros anos pós-operatórios (4,1 + 3,2 anos). A única comorbidade capaz de mudar a curva de sobrevida foi o diabetes mellitus (p = 0,03). Conclusão: A mortalidade geral foi de 11,3%. A maior mortalidade ocorreu nos primeiros quatro anos de seguimento. Pacientes diabéticos evoluem com mortalidade mais precoce e possuem sete vezes mais chance de óbito. Nível de Evidência III, Estudo Retrospectivo.
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Abstract Musculoskeletal sarcomas are rare diseases that require attention. They often present high degree of malignancy at diagnosis and, if underestimated, they can evolve aggressively locally and systemically. They present as soft tissues arcoma and bone sarcomas, with soft tissue being four to five times more common. Most soft tissue sarcomas occur in the extremities. The most common subtypes in children and adolescents are rhabdomyosarcoma and synovial sarcoma; in adults, undifferentiated pleomorphic sarcoma, liposarcoma, leiomyosarcoma, myxofibrosarcoma and synovial sarcoma; all with a high degree of histological malignancy. Many soft tissue sarcomas are confused with benign soft tissue tumors, 100 times more common, so they are resected without the necessary planning, resulting in amputation of a limb that could have been preserved. As in all cancers, the most important prognostic factor is metastatic disease. When it is present, the overall survival rate falls around 20 to 30%. Survival rates are generally similar between bone and soft tissue sarcomas. So soft tissue sarcomas, in addition to being more prevalent, are as aggressive as bones arcomas, deserving a lot of attention from orthopedic surgeons, who are often the first line of care of carriers of these tumors.
Resumo Os sarcomas musculoesqueléticos são doenças raras que exigem atenção. Frequentemente, apresentam alto grau de malignidade ao diagnóstico e se subestimados podem evoluir de forma agressiva local e sistemicamente. Apresentam-se como sarcoma de partes moles e sarcomas ósseos, sendo os de partes moles quatro a cinco vezes mais comuns. A maioria dos sarcomas de partes moles ocorre nos membros. Os subtipos mais comuns nas crianças e adolescentes são o rabdomiossarcoma e o sarcoma sinovial, nos adultos o sarcoma pleomórfico indiferenciado, lipossarcoma, leiomiossarcoma, mixofibrossarcoma e sarcoma sinovial; todos de alto grau de malignidade histológica. Muitos sarcomas de partes moles são confundidos com tumores benignos de partes moles, 100 vezes mais comuns, por isso são ressecados sem o planejamento necessário, acarretando em amputação de um membro que poderia ter sido preservado. Como em todos os cânceres, o fator prognóstico mais importante é a doença metastática. Na sua vigência, a taxa de sobrevida global cai em torno de 20 a 30%. As taxas de sobrevida no geral são parecidas entre os sarcomas ósseos e de partes moles, portanto o sarcoma de partes moles, além de mais prevalente, mostra-se tão agressivo quanto os sarcomas ósseos, por isso merece muita atenção dos ortopedistas que frequentemente são a primeira linha de atendimento dos portadores destes tumores.
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Humanos , Sarcoma/diagnóstico , Sarcoma/terapia , Sarcoma/epidemiología , Neoplasias de Tejido Óseo , Detección Precoz del Cáncer , Metástasis de la NeoplasiaRESUMEN
OBJECTIVES: The aim of this study was to evaluate the role of amphiregulin protein, an epidermal growth factor receptor ligand, in cartilaginous tumors. METHODS: Amphiregulin expression was examined in 31 enchondromas and 67 chondrosarcomas using immunohistochemistry analysis. RESULTS: Overall, 15 enchondromas (48.40%) and 24 chondrosarcomas (35.82%) were positive for amphiregulin. According to the receiver operating characteristic curve test, no difference in amphiregulin expression was observed between enchondromas and low-grade chondrosarcomas (p=0.0880). Additionally, 39 lesions (16 in short bones, 13 in long bones, and 10 in flat bones) were positive for amphiregulin, exhibiting a higher percentage of positive cells (p=0.0030) and intensity of immunohistochemical expression (p=0.0055) in short bone lesions than in others. Among 25 enchondromas localized in short bones, 15 expressed amphiregulin; however, all 6 cases localized in long bones were negative for this marker (p=0.0177). CONCLUSIONS: Amphiregulin did not help in distinguishing enchondromas from low-grade chondrosarcomas. The present study is the first to document the expression of this immunohistochemical marker in enchondromas. Furthermore, amphiregulin expression in enchondromas was localized in short bones, indicating a phenotypic distinction from that in long bones. This distinction may contribute to an improved understanding of the pathogenesis of these lesions.
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Humanos , Neoplasias Óseas , Condroma , Condrosarcoma , Anfirregulina/genética , InmunohistoquímicaRESUMEN
Abstract Objective To evaluate 15 patients with ruptured distal biceps tendon submitted to reinsertion via a single, anterior and transverse approach using two anchors. They were submitted to a rehabilitation protocol and, within six months, to an evaluation of the range of motion and strength intensity during flexion and supination of the operated elbow. Methods The data were collected prospectively, and were analyzed through the Mann-Whitney test and the mixed-model test to evaluate the force between the operated and non-operated elbows. Results A total of 80% of the patients were men, 60% were injured on the dominant side, 46% were manual workers, and 73% led sedentary lifestyles. The use of anabolic steroids was reported by two patients. After the treatment, the patients recovered supination strength by 98% and flexion by 94%. According to the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, 73% of the patients presented the score expected of a normal population. Conclusion The single, anterior and transverse approach associated with tendon repair using anchors was esthetically satisfactory, with good strength recovery during flexion and supination, and no occurrence of heterotopic ossification.
Resumo Objetivo Avaliar 15 pacientes com ruptura do tendão distal do bíceps submetidos a reinserção por meio de via única, anterior e transversa no antebraço com o uso de duas âncoras. Os pacientes foram submetidos a um protocolo de reabilitação e, ao término de seis meses, efetuou-se avaliação do arco de movimento do cotovelo operado e da intensidade de força durante a flexão e a supinação. Métodos Os dados foram coletados de maneira prospectiva, e foram analisados pelo teste de Mann-Whitney e pelo teste de modelos mistos para avaliar a força entre os cotovelos operado e não operado. Resultados Um total de 80% dos pacientes eram homens, 60% sofreram lesão do lado dominante, 46% eram trabalhadores braçais, e 73% não praticavam atividades físicas regularmente. O uso de anabolizante foi relatado por dois pacientes. Após o tratamento, os pacientes recuperaram 98% da força de supinação, e 94% da de flexão. De acordo com questionário de Disfunções do Braço, Ombro e Mão (Disabilities of the Arm, Shoulder and Hand, DASH), 73% dos pacientes encontram-se dentro do esperado para uma população normal. Conclusão A via única, anterior e transversa associada ao reparo do tendão com o uso de âncoras apresentou-se esteticamente satisfatória, com boa recuperação da força durante a flexão e a supinação, não ocorrendo casos de ossificação heterotópica ou complicações graves.
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Humanos , Masculino , Femenino , Rehabilitación , Rotura , Encuestas y Cuestionarios , Rango del Movimiento Articular , Codo , Antebrazo , Estilo de Vida , Grupos Profesionales , Músculos IsquiosuralesRESUMEN
ABSTRACT Objective: To evaluate normative data of shoulder isokinetic strength in healthy professional judo athletes. Methods: Cross-sectional study with 20 professional male and female athletes (10 female), evaluated with an isokinetic dynamometer. The strength assessment was carried out in external and internal rotation, flexion, extension, adduction and abduction. All data collected on muscle torque were normalized with body mass index. Results: Athletes demonstrated higher peak torque and joint work in shoulder adduction, abduction, flexion, and extension for the dominant limb compared to the non-dominant limb (p <0.05), with most of these deficits below 10%. Shoulder internal/external rotation ratios for male and female athletes had no significant differences between dominant and non-dominant sides, demonstrating values at 60°/s of 49.4 ± 7.2 on the dominant side of males and 49.1 ± 4.9 for females. Conclusion: The normative data are described to assist during treatment, return to sport and injury prevention. Level of evidence IV, cross-sectional study.
RESUMO Objetivo: Avaliar dados normativos da força isocinética do ombro de judocas profissionais, saudáveis. Métodos: Estudo transversal com 20 atletas profissionais de ambos os sexos (dez mulheres) avaliados com dinamômetro isocinético. A avaliação da força foi realizada em rotação externa e interna, flexão, extensão, adução e abdução. Todos os dados coletados do torque muscular foram normalizados com o índice de massa corporal. Resultados: Os atletas demonstraram maior pico de torque e trabalho articular em adução, abdução, flexão e extensão do ombro para o membro dominante, comparado ao contralateral (p < 0,05), com a maioria desses défices abaixo de 10%. As razões de rotação interna/externa do ombro para atletas de ambos os sexos não apresentaram diferenças significativas entre o lados dominante e não dominante, demonstrando valores a 60°/s de 49,4 ± 7,2 no lado dominante dos homens e 49,1 ± 4,9 no das mulheres. Conclusão: Os dados normativos são descritos para auxiliar durante o tratamento, o retorno ao esporte e a prevenção de lesões. Nível de evidência IV, estudo transversal.
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ABSTRACT Objective: To evaluate the choice of surgical approach among Brazilian orthopedists and whether shoulder surgery specialty training or duration of experience influences the decision-making. Methods: A questionnaire on the preferred approach and complications was administered to orthopedic surgeons with and without shoulder specialization training. The chi-square test or Fisher's exact test was applied. Results: We interviewed 114 orthopedists, 49 (43.0%) traumatologists, 36 (31.5%) specialist surgeons, and 29 (25%) shoulder surgery specialist residents. In cases of fracture without dislocation, specialized training and duration of experience did not influence the approach used (primarily deltopectoral). In cases of fracture/dislocation, 97.2% of the specialists versus 82.1% of the traumatologists opted for the deltopectoral approach (p = 0.034). In cases of fractures/dislocation, 92.5% of surgeons with more than 5 years of experience and 78.7% with less than 5 years of experience opted for the deltopectoral approach (p = 0.032). Conclusion: Specialization in shoulder surgery did not influence surgeons' approaches to manage fractures without dislocation. In cases of fracture/dislocation, shoulder surgery specialization training and duration of experience were associated with selection of the deltopectoral approach. Level of Evidence V, Expert opinion.
RESUMO Objetivo: Avaliar a via de acesso de escolha entre os ortopedistas brasileiros e se a formação de especialista em cirurgia do ombro e/ou tempo de experiência influenciam nessa decisão. Métodos: Realizou-se questionário entre ortopedistas, com e sem especialização em ombro, sobre qual a via de acesso preferida e as complicações observadas. Aplicou-se o teste do qui-quadrado ou o teste exato de Fisher. Resultados: Foram entrevistados 114 ortopedistas, 49 (43,0 %) traumatologistas, 36 (31,5 %) cirurgiões especialistas e 29 (25 %) residentes de especialização em cirurgia do ombro. Nas fraturas sem luxação a formação especializada e o tempo de experiência não influenciaram na escolha (maioria deltopeitoral). Na fratura/luxação, 97,2% dos especialistas optaram pela deltopeitoral, comparado com 82,1% dos traumatologistas (p=0,034). Nas fraturas/luxação, cirurgiões com experiência superior a 5 anos optaram pela deltopeitoral (92,5%) e aqueles com menos de 5 anos optaram pela via deltopeitoral (78,7%) (p=0,032). A diminuição do arco de movimento (ADM) foi a complicação mais relatada. Conclusão: A especialização em cirurgia do ombro não influenciou na escolha nas fraturas sem luxação. Na fratura/luxação, a especialização e o tempo de experiência associaram-se à escolha da via deltopeitoral. A complicação mais frequente foi a diminuição do ADM, principalmente entre os cirurgiões do Ombro. Nível de Evidência V, Opinião de especialistas.
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OBJECTIVE: Unplanned excision of soft tissue sarcomas is common because benign soft tissue lesions are very frequent. This study evaluated the impact of unplanned resections on overall survival, local recurrence and distant metastasis in patients with soft tissue sarcomas of the extremities. METHODS: In total, 52 patients who were diagnosed with soft tissue sarcomas between May 2001 and March 2011 were analyzed in a retrospective study. Of these patients, 29 (55.8%) had not undergone previous treatment and the remaining 23 (44.2%) patients had undergone prior resection of the tumor without oncological planning. All subsequent surgical procedures were performed at the same cancer referral center. The follow-up ranged from 6 to 122 months, with a mean of 39.89 months. Age, lesion size and depth, histological grade, surgical margins, overall survival, local and distant recurrence and adjuvant therapies were compared. RESULTS: Residual disease was observed in 91.3% of the re-resected specimens in the unplanned excision group, which exhibited greater numbers of superficial lesions, low histological grades and contaminated surgical margins compared with the re-resected specimens in the planned excision group. No differences were observed in local recurrence and 5-year overall survival between the groups, but distant metastases were significantly associated with planned excision after adjustment for the variables. CONCLUSIONS: There was no difference between patients undergoing unplanned excision and planned excision regarding local recurrence and overall survival. The planned excision group had a higher risk of distant metastasis, whereas there was a high rate of residual cancer in the unplanned excision group. .
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Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Humanos , Persona de Mediana Edad , Adulto Joven , Extremidades/cirugía , Sarcoma/cirugía , Neoplasias de los Tejidos Blandos/cirugía , Estimación de Kaplan-Meier , Análisis Multivariante , Clasificación del Tumor , Factores de Riesgo , Sarcoma/mortalidad , Sarcoma/patología , Neoplasias de los Tejidos Blandos/mortalidad , Neoplasias de los Tejidos Blandos/patología , Resultado del Tratamiento , Carga TumoralRESUMEN
OBJETIVO: Realizar a tradução e adaptação cultural do questionário Rowe modificado para atletas arremessadores. MÉTODOS: O processo de tradução e adaptação cultural envolveu as etapas de tradução, síntese, retrotradução e revisão pelo grupo de tradução. Foi então criada uma versão pré-final do questionário, sendo os domínios "função" e "dor" aplicados a 20 atletas que realizam movimentos de arremesso e que sofreram lesões do tipo SLAP no ombro dominante, e os domínios "teste de compressão ativa e teste de apreensão anterior" e "mobilidade" foram aplicados a 15 profissionais da saúde. RESULTADOS: Durante o processo de tradução foram realizadas pequenas alterações no questionário com o objetivo de adaptá-lo à cultura brasileira, sem alterar a semântica e o conceito idiomático originalmente descritos. CONCLUSÕES: O questionário foi facilmente compreendido pelos sujeitos do estudo, sendo possível obter a versão brasileira do questionário Rowe modificado para avaliar a capacidade funcional de atletas arremessadores que passaram por tratamento cirúrgico da lesão do tipo SLAP.
OBJECTIVE: Study was to translate and culturally adapt the modified Rowe score for overhead athletes. METHODS: The translation and cultural adaptation process initially involved the stages of transla tion, synthesis, back-translation, and revision by the Translation Group. It was than created the pre-final version of the question naire, being the areas "function" and "pain" applied to 20 athletes that perform overhead movements and that suffered SLAP lesions in the dominant shoulder and the areas "active compression test and anterior apprehension test" and "motion" were applied to 15 health professionals. RESULTS: During the translation process there were made little modifications in the questionnaire in order to adapt it to Brazilian culture, without changing the semantics and the idiomatic concept originally described. CONCLUSIONS: The questionnaire was easily understood by the subjects of the study, being possible to obtain the Brazilian version of the modified Rowe score for over head athletes that underwent surgical treatment of the SLAP lesion.
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Traumatismos en Atletas , Hombro/lesiones , Encuestas y Cuestionarios , Estudios de Validación como AsuntoRESUMEN
OBJETIVO: Traduzir e adaptar culturalmente o questionário Rowe para ser utilizado no Brasil. MÉTODOS: O processo de tradução e adaptação cultural envolveu inicialmente as etapas de tradução, síntese, retro-tradução e revisão pelo Grupo de Tradução. Foi então criada uma versão pré-final do questionário, sendo os domínios Estabilidade e Função aplicados a 20 pacientes que sofreram luxação anterior do ombro e o domínio Mobilidade aplicado a 20 profissionais da saúde. RESULTADOS: Foi observada dificuldade de entendimento de algumas expressões do questionário por parte dos pacientes, as quais foram substituídas por termos mais fáceis de serem compreendidos. Todos os profissionais da saúde compreenderam a tradução do domínio Mobilidade. Dessa forma, o questionário foi reaplicado a outros 20 pacientes, sendo compreendido por todos os sujeitos avaliados. CONCLUSÃO: Após um processo criterioso de tradução e adaptação cultural, foi possível obter a versão brasileira do questionário Rowe. Nível de Evidência II, Estudos diagnósticos; investigação de um exame para diagnóstico.
OBJECTIVE: To translate and culturally adapt the Rowe score for use in Brazil.METHODS: The translation and cross-cultural adaptation process initially involved the steps of translation, synthesis, back-translation and revision by the Translation Group. The pre-final version of the questionnaire was then created. The Stability and Function fields were applied to 20 patients with anterior shoulder luxation, and the Mobility field was applied to 20 health professionals.RESULTS: It was found that some of the patients had difficulty understanding some of the expressions of the questionnaire, so these were replaced with terms that were easier to understand. All health professionals understood the translation of the Mobility field. The altered questionnaire was then reapplied to another 20 patients, and this time it was understood by all the assessed subjects. CONCLUSION: After a careful process of translation and cultural adaptation, a definitive version of the Rowe questionnaire was obtained in Brazilian Portuguese. Level of Evidence II, Development of diagnostic criteria on consecutive patients.
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Humanos , Masculino , Femenino , Características Culturales , Encuestas y Cuestionarios , Traducciones , Estudios de Validación como Asunto , Luxación del HombroRESUMEN
OBJECTIVE: The aim of this study was to investigate bone repair after the implantation of vancomycin-loaded poly-L-lactic acid/poly-ethylene oxide microspheres compared with vancomycin-unloaded poly-L-lactic acid/poly-ethylene oxide microspheres. METHODS: Poly-L-lactic acid/poly-ethylene oxide microspheres were implanted in rat tibiae and evaluated for periods of 2, 4, 8, and 12 days and 4, 8, 16, and 32 weeks. The groups implanted with vancomycin-loaded and vancomycin-unloaded microspheres were compared. Histopathologic (semi-quantitative) and histomorphometric analyses were performed to evaluate the bone formation process. RESULTS: During the first period (second day), fibrin and hemorrhaging areas were observed to be replaced by granulation tissue around the microspheres. Woven bone formation with progressive maturation was observed. All of the histopathological findings, evaluated by a semi-quantitative assay and a quantitative analysis (percentage of bone formation), were similar between the two groups. CONCLUSION: Vancomycin-loaded poly-L-lactic acid/poly-ethylene oxide microspheres are a good bone substitute candidate for bone repair. Local antibiotic therapy using vancomycin-loaded poly-L-lactic acid/poly-ethylene oxide microspheres should be considered after the microbiological evaluation of its efficacy.
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Animales , Masculino , Ratas , Sustitutos de Huesos/uso terapéutico , Ácido Láctico/uso terapéutico , Osteogénesis/fisiología , Polietilenglicoles/uso terapéutico , Polímeros/uso terapéutico , Fracturas de la Tibia/cirugía , Vancomicina/uso terapéutico , Materiales Biocompatibles , Microesferas , Ratas Wistar , Factores de Tiempo , Fracturas de la Tibia/patologíaRESUMEN
OBJECTIVES: To study the role of angiogenesis and cyclooxygenase-2 expression in cartilaginous tumors and correlate these factors with prognosis. INTRODUCTION: For chondrosarcoma, the histological grade is the current standard for predicting tumor outcome. However, a low-grade chondrosarcoma can follow an aggressive course-as monitored by sequential imaging techniques-even when it is histologically indistinguishable from an enchondroma. Therefore, additional tools are needed to help identify the biological potential of these tumors. The degree of angiogenesis that is induced by the tumor could assist in this task. Angiogenesis can be quantified by measuring the expression of vascular endothelial growth factor and CD34, and cyclooxygenase-2 can induce angiogenesis by stimulating the production of proangiogenic factors. METHODS: In total, 21 enchondromas and 58 conventional chondrosarcomas were studied by examining the clinical and histopathological findings in conjunction with the immunostaining markers of angiogenesis and cyclooxygenase- 2 expression. RESULTS: The significant variables that were associated with poor outcome were 1) higher-grade chondrosarcomas, 2) tumors that developed in flat bones, and 3) over-expression of CD34 (with a median count that was higher than 5.9 vessels in 5 high power fields). Moreover, CD34 expression (measured using the Chalkley method) revealed significantly higher microvessel density in flat bone chondrosarcomas. DISCUSSION: Previous studies have shown a positive correlation between Chalkley microvessel density and histological grade; however, in our sample, we found that the former is predictive of the outcome. Chondrosarcomas in flat bones have been shown to correlate with a poor prognosis. We also found that CD34 microvessel density values were significantly higher in flat-bone chondrosarcomas. This could explain-at least in part-the more aggressive biological course that is taken by these tumors. CONCLUSIONS: These results provide evidence that CD34 microvessel density in chondrosarcomas can be helpful in predicting patient outcome and may add to our understanding of chondrosarcoma pathogenesis.
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Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , /análisis , Neoplasias Óseas/patología , Condroma/patología , Condrosarcoma/patología , /análisis , Neovascularización Patológica/patología , Neoplasias Óseas/irrigación sanguínea , Neoplasias Óseas/química , Condroma/irrigación sanguínea , Condroma/química , Condrosarcoma/irrigación sanguínea , Condrosarcoma/química , Métodos Epidemiológicos , Microcirculación , Neovascularización Patológica/metabolismo , PronósticoRESUMEN
OBJETIVO: Avaliar a evolução oncológica de portadores de condrossarcomas grau I de acordo com o tipo de tratamento cirúrgico efetuado. Existe controvérsia em relação à necessidade de ressecções agressivas para obtenção de uma evolução clínica favorável. MATERIAIS E MÉTODOS: Os prontuários de 23 portadores de condrossarcoma grau I foram analisados. A idade dos pacientes variou de 11 a 70 anos com média de 38,4 anos, 52% eram homens e 48% mulheres. O local mais acometido foi o fêmur com 13 pacientes. Dezessete lesões (74%) foram classificadas como IA e seis (26%) como IB. Setenta e quatro por cento dos tumores eram medulares, 22% eram periféricas e uma lesão indeterminada. O tamanho dos tumores variou de 2 a 25 cm, média de 7,9 cm. Onze pacientes foram submetidos a ressecção intralesional, nove a ressecção ampla e três a ressecção radical. O seguimento variou de 24 a 192 meses. RESULTADOS: Complicações não oncológicas ocorreram em sete pacientes. Nenhum dos pacientes apresentou recidiva local ou metástase. Estes dados sugerem que os procedimentos cirúrgicos menos agressivos são seguros para o tratamento dos pacientes com condrossarcoma grau I.