Surgical treatment of ipsilateral bifocal tibial fractures: a challenge for the surgeon. / Tratamiento quirúrgico de las fracturas bifocales ipsilaterales de tibia: un reto para el cirujano.

INTRODUCTION: The association of ipsilateral tibia fractures has a low incidence, being up to 3.2% of total tibia fractures. Currently there is no gold standard regarding the ideal surgical treatment. The objective of this study is to analyze the surgical treatment and the radiographic and functional results, as well as the associated complication rate of ipsilateral bifocal tibia fractures. MATERIAL AND METHODS: Retrospective observational study in our hospital from 2010 to 2022 of 24 patients who underwent bifocal fracture of the ipsilateral tibia. Demographic and surgical data and complications during follow-up were included. RESULTS: The 24 patients were classified into group 1 when they presented a fracture of the plateau and distal tibia (25%), group 2 with a fracture of the plateau and diaphysis (33%) and group 3 with a fracture of the diaphysis and distal tibia (42%). 3 patients underwent surgery with 1 implant and 21 patients with 2 implants. The average follow-up time in outpatient clinics was 2 and a half years. At one year, 22 patients (92%) had full weight bearing and 2 patients had partial weight bearing (8%) due to the sequelae of the fractures. The average time for consolidation of the diaphysis was 7.75±2 months, with no significant differences observed between group 2 and group 3 (p=0.06). The average time for consolidation of the metaphysis was 3.50±1.5 months, with no significant differences observed between group 1 and group 2 (p=0.065). 7 patients (30%) had complications during follow-up. CONCLUSIONS: Bifocal tibia fractures can be treated using a combination of intramedullary nailing and plate osteosynthesis with good long-term results, obtaining an optimal union rate and low complications. In addition, it facilitates the reduction of the fracture, thus facilitating the patient's recovery and obtaining good long-term functional results.

Efeito da fotobiomodulação na reabilitação de pacientes com patologias traumato-ortopédicas: revisão integrativa / Efectos de la fotobiomodulación en la rehabilitación de pacientes con patologías traumatoortopédicas: revisión integrativa / Effects of photobiomodulationin the rehabilitation of patients with traumato-orthopedic pathologies: integrative review

Introdução: Fotobiomodulação corresponde à exposição de tecidos biológicos a baixos níveis de luz vermelha e infravermelha, esta terapia favorece a reabilitação de diferentes tecidos e que pode ser utilizada para a melhora da prática clínica nas diferentes atuações da fisioterapia, como por exemplo, no tratamento dos acometimentos musculoesqueléticos e inflamatórios. Objetivo: Identificar os benefícios da fotobiomodulação empregados na reabilitação de pacientes nas diferentes patologias traumato-ortopédicas. Metodologia:Trata-se de uma revisão integrativa com busca online nas plataformas de dados: Medline e PubMed. Os descritores foram: fotobiomodulação, taumato-ortopedia e reabilitação. As línguas selecionadas foram: Português, Inglês e Espanhol, entre os anos de 2018 a 2022.Resultados:A descrição dos achados nos ensaios clínicos analisados mostra que a terapia de fotobiomodulação apresenta diferentes usos na prática clínica e que seu uso produz efeito analgésico, anti-inflamatório e regenerativo nos distúrbios musculoesqueléticos. Conclusões:De acordo com a revisão dos artigos, pôde-se perceber que a terapia por fotobiomodulação confirma seus benefícios e eficácia, portando, se fazendo positiva na atuação traumato-ortopédica, gerando resultados significativos quando comparada a outros recursos (AU).

Introduction: Photobiomodulationcorresponds to the exposure of biological tissues to low levels of red and infrared light, this therapy favors the rehabilitation of different tissues and can be used to improve clinical practice in different actions of physiotherapy, such as, for example, in the treatment of musculoskeletal and inflammatory disorders. Objective: To identify the benefits of photobiomodulation used in the rehabilitation of patients with different traumato-orthopedic pathologies. Methodology:This is an integrative review with online search on data platforms: Medline and PubMed. The descriptors were: photobiomodulation, thaumato-orthopedics and rehabilitation. The selected languages were: Portuguese, English and Spanish, from 2018 to 2022. Results: The description of the discovers in the analyzed clinical trials shows that photobiomodulation therapy has different uses in clinical practice and that its use produces analgesic, anti-inflammatory and regenerative effects in musculoskeletal disorders. Conclusions:According to the review of the articles, it could be seen that photobiomodulation therapy confirms its benefits and effectiveness, therefore, becoming positive in the trauma-orthopedic performance, generating significant results when compared to other resources (AU).

Introducción: La fotobiomodulacióncorresponde a la exposición de tejidos biológicos a bajos niveles de luz roja e infrarroja, esta terapia estimula la rehabilitación de diferentes tejidos y puede ser utilizada para mejorar la práctica clínica en diferentes áreas de fisioterapia, como por ejemplo, en tratamiento de Trastornos musculoesqueléticos e inflamatorios. Objetivo: Identificar los beneficios de la fotobiomodulación utilizada en la rehabilitación de pacientes con diferentes patologías traumato-ortopédicas. Metodología: Esta es una revisión integradora con búsqueda en línea en plataformas de datos: Medline y PubMed. Los descriptores fueron: fotobiomodulación, taumato-ortopedia y rehabilitación. Los idiomas seleccionados fueron: portugués, inglés y español, entre los años 2018 a 2022. Resultados: La descripción de los hallazgos en los ensayos clínicos analizados muestra que la terapia de fotobiomodulación tiene diferentes usos en la práctica clínica y que su uso produce efectos analgésicos, antiinflamatorios y regenerador en trastornos musculoesqueléticos. Conclusiones: De acuerdo con la revisión de los artículos, se pudo apreciar que la terapia de fotobiomodulación confirma sus beneficios y efectividad, por lo tanto, tornándose positiva en el desempeño trauma-ortopédico, generando resultados significativos cuando se compara con otros recursos (AU).

Spinal gunshot wounds: A retrospective, multicenter, cohort study. / [Artículo traducido] Lesiones vertebrales por proyectil de arma de fuego: estudio de cohorte retrospectivo, multicéntrico.

INTRODUCTION AND OBJECTIVE: To describe the demographic and clinical characteristics and treatment of patients with spinal gunshot wounds across Latin America. MATERIAL AND METHODS: Retrospective, multicenter cohort study of patients treated for gunshot wounds to the spine spanning 12 institutions across Latin America between January 2015 and January 2022. Demographic and clinical data were recorded, including the time of injury, initial assessment, characteristics of the vertebral gunshot injury, and treatment. RESULTS: Data on 423 patients with spinal gunshot injuries were extracted from institutions in Mexico (82%), Argentina, Brazil, Colombia, and Venezuela. Patients were predominantly male civilians in low-risk-of-violence professions, and of lower/middle social status, and a sizeable majority of gunshots were from low-energy firearms. Vertebral injuries mainly affected the thoracic and lumbar spine. Neurological injury was documented in 320 (76%) patients, with spinal cord injuries in 269 (63%). Treatment was largely conservative, with just 90 (21%) patients treated surgically, principally using posterior open midline approach to the spine (79; 87%). Injury features distinguishing surgical from non-surgical cases were neurological compromise (P = 0.004), canal compromise (P < 0.001), dirty wounds (P < 0.001), bullet or bone fragment remains in the spinal canal (P < 0.001) and injury pattern (P < 0.001). After a multivariate analysis through a binary logistic regression model, the aforementioned variables remained statistically significant except neurological compromise. CONCLUSIONS: In this multicenter study of spinal gunshot victims, most were treated non-surgically, despite neurological injury in 76% and spinal injury in 63% of patients.

Trauma Registry: Trauma Quality indicators analysis in hospitalized patients / Registro de Trauma: análise dos Filtros de Qualidade nos pacientes internados

ABSTRACT Purpose: to consolidate a Trauma Register (TR) trough REDCap data acquisition platform and to validate, in this context, local Quality Indicators (QI) as improvement opportunities in trauma management. Methods: continuous data acquisition of all patients admitted in Irmandade da Santa Casa de Misericórdia de São Paulo adult Trauma bay and it's validation in REDCap platform; 6 months retrospective cohort of QI impact in length of hospitalar stay, complications and mortality. Fisher, Chi-squared, Wilcoxon and Kruskal-Wallis tests were used to correlate QIs fails with the endpoints, considering p<0.05 and CI <95% as statically significant. Results: 465 were admitted in Trauma bay, with 137 patients hospitalized (29.5%); the number of QIs compromised were related with more complications (p=0.075) and increased length of stay (p=0.028), especially the delay in open fracture's surgical management, which increased the severe complications' incidence (p=0.005). Conclusion: the REDCap data acquisition platform is useful as a tool for multi center TR implementation, from ethical and logistical point of view; nevertheless, the proposed QIs are validated as attention points in trauma management, allowing improvements in traumatized patients treatment.

RESUMO Objetivo: implementação de Registro de Trauma (RT) através da plataforma REDCap e validação dos Filtros de Qualidade (FQ) desenvolvidos como pontos de melhora no atendimento ao traumatizado. Métodos: implementação de coleta contínua dos dados de todos os pacientes adultos admitidos na sala de Trauma da Irmandade da Santa Casa de Misericórdia de São Paulo e validação destes na plataforma REDCap; realizada coorte retrospectiva dos dados validados em um período de 6 meses e o impacto dos FQ desenvolvidos no tempo de internação hospitalar, complicações e mortalidade dos pacientes. A correlação do comprometimento dos FQ com os desfechos foi obtida através dos testes de Fisher, Qui-Quadrado, Wilcoxon e Kruskal-Wallis, considerando p<0,05 e IC 95% como significativos. Resultados: incluídos no estudo 465 pacientes admitidos no período de estudo, com necessidade de internação em 137 casos (29,5%); o número de FQs comprometidos relacionou-se com maior número de complicações (p=0,075) e maior tempo de internação (p=0,028), sobretudo o atraso na ida ao Centro Cirúrgico de fraturas expostas, que aumentou a incidência de complicações graves (p=0,005). Conclusão: a plataforma REDCap é adequada e útil na implementação de RT, permitindo o uso ético e multicêntrico de dados; os FQs propostos determinam pontos de atenção a serem revistos no atendimento do trauma, permitindo melhorias na qualidade de atendimento ao paciente traumatizado.

Epidemiological profile of patients undergoing non-operative management of solid organ injury and associated factors with mortality / Perfil epidemiológico dos pacientes submetidos a tratamento não operatório de lesão de órgãos sólidos e os fatores associados a óbito

ABSTRACT Introduction: Trauma primarily affects the economically active population, causing social and economic impact. The non-operative management of solid organ injuries aims to preserve organ function, reducing the morbidity and mortality associated with surgical interventions. The aim of study was to demonstrate the epidemiological profile of patients undergoing non-operative management in a trauma hospital and to evaluate factors associated with mortality in these patients. Methods: This is a historical cohort of patients undergoing non-operative management for solid organ injuries at a Brazilian trauma reference hospital between 2018 and 2022. Included were patients with blunt and penetrating trauma, analyzing epidemiological characteristics, blood transfusion, and association with the need for surgical intervention. Results: A total of 365 patients were included in the study. Three hundred and forty-three patients were discharged (93.97%), and the success rate of non-operative treatment was 84.6%. There was an association between mortality and the following associated injuries: hemothorax, sternal fracture, aortic dissection, and traumatic brain injury. There was an association between the need for transfusion and surgical intervention. Thirty-eight patients required some form of surgical intervention. Conclusion: The profile of patients undergoing non-operative treatment consists of young men who are victims of blunt trauma. Non-operative treatment is safe and has a high success rate.

RESUMO Introdução: O trauma atinge principalmente a população economicamente ativa, causando impacto social e econômico. O tratamento não operatório das lesões de órgãos sólidos tem como objetivo preservar a função do órgão, diminuindo a morbimortalidade envolvida nos tratamentos cirúrgicos. O objetivo do estudo foi demonstrar o perfil epidemiológico dos pacientes submetidos ao tratamento não operatório em um hospital de trauma, bem como avaliar o fatores associados ao óbito nesses pacientes. Métodos: Trata-se de uma coorte histórica de pacientes submetidos à tratamento não operatório de lesão de órgãos sólidos, em um hospital referência de trauma brasileiro, entre 2018 e 2022. Foram incluídos pacientes vítimas de trauma contuso e penetrante, analisando as características epidemiológicas, hemotransfusão e associação ou não com necessidade de abordagem cirúrgica. Resultados: Foram incluídos 365 pacientes no estudo. Trezentos e quarenta e três pacientes receberam alta (93,97%) e a taxa de sucesso no tratamento não operatório foi de de 84,6%. Houve associação entre o desfecho óbito e as seguintes lesões associadas: hemopneumotorax, fratura de esterno, dissecção de aorta e traumatismo crânio encefálico. Houve associação entre necessidade de transfusão e abordagem cirúrgica. Trinta e oito pacientes necessitaram de alguma abordagem cirúrgica. Conclusão: O perfil dos pacientes submetidos a TNO são homens jovens, vítimas de trauma contuso. O tratamento não operatório é seguro e apresenta alta taxa de sucesso.

Avaliação do perfil do egresso e da residência médica em ortopedia e traumatologia do HCFMRP-USP / Evaluation of the graduate profile and of the medical residency in orthopedics and traumatology at HCFMRP-USP

Resumo Introdução: Bons programas de residência médica (PRM) devem investir na estruturação e no desenvolvimento contínuo dos serviços de assistência no contexto da rede de saúde, na organização da estrutura de apoio às atividades didáticas e assistenciais, e na remuneração e capacitação contínua de preceptores e coordenadores. Objetivo: Este estudo observacional, transversal e descritivo buscou caracterizar o perfil dos egressos do Programa de Residência Médica em Ortopedia e Traumatologia (PRMOT) do HCFMRP-USP e coletar dados sobre as características do programa que orientem ações de aperfeiçoamento na metodologia de ensino. Método: Participaram do estudo egressos do PRMOT ou que concluíram os programas de complementação especializada e residência médica em cirurgia da mão entre 1964 e 2020. Resultado: Foi encaminhado um questionário a 302 indivíduos (73,6% do total de egressos), obtendo 214 respostas (70,8% dos indivíduos contatados ou 52,2% do total de egressos). Indivíduos do sexo masculino correspondem a 92,5% dos egressos, e 71,9% residem no estado de São Paulo. As duas subespecialidades mais cursadas foram cirurgia do joelho e da mão. A pós-graduação stricto sensu fez parte da formação acadêmica de 40,6% dos egressos, dos quais 60,7% trabalharam com ensino médico. Dos egressos, 71% atuam na subespecialidade escolhida. Na avaliação do ensino do PRMOT e do grau de satisfação profissional, os aspectos que se destacaram positivamente foram: capacitação para atendimento em níveis terciário e secundário, número de atendimentos, variabilidade dos casos e preparo para o mercado de trabalho. Os aspectos que se destacaram negativamente foram: remuneração mensal, carga horária de aulas teóricas e realização de procedimentos cirúrgicos. Conclusão: O estudo conseguiu traçar o perfil do egresso e determinar os pontos fortes e as oportunidades de melhoria do PRMOT do HCFMRP-USP.

Abstract Introduction: Good Medical Residency Programs (PRM) must invest in the structuring and continuous development of care services in the health network setting; in the organization of the support structure for teaching and care activities and in the remuneration and continuous training of preceptors and coordinators. Objective: This study is an observational, cross-sectional, and descriptive investigation aimed at providing an in-depth understanding of the characteristics of individuals who have successfully completed the medical residency program in Orthopedics and Traumatology (MRPOT) at the Clinic Hospital of the Faculty of Medicine of Ribeirão Preto, University of São Paulo. Additionally, the study seeks to gather comprehensive data regarding the features of the educational program in order to offer insights for potential enhancements. The study encompassed a total of 418 participants who completed their training between 1964 and 2020. Methods: This group includes physicians who not only graduated from the MRPOT but also those who completed supplementary specialized programs and medical residencies in hand surgery, all within the same department. Data were systematically collected through an electronic questionnaire. Results: Among the participants, 302 graduates (73.6% of the total cohort) were identified, and responses were obtained from 214 individuals, which corresponds to 70.8% of the reached contacts or 52.2% of the entire graduate pool. The predominant demographic of the sample is male, with 198 respondents (92.5%), most of whom reside in the state of São Paulo (154 individuals, 71.9%). A significant portion of the participants, 184 (86%), pursued further specialized training or embarked on additional medical residencies within the field. The most prevalent subspecialties within this group are Knee Surgery, accounting for 63 individuals (34.2%), and Hand Surgery, comprising 49 individuals (26.6%). Postgraduate education played a role in the academic training of 87 respondents (40.6%). Research activities primarily took place within public universities (81%) and were carried out by 79 graduates (36.9%). A substantial proportion, 130 individuals (60.7%), had prior experience in medical education, either as preceptors or professors for both undergraduate and medical residency levels. The majority of participants, 152 individuals (71%), currently practice within their respective subspecialties. However, a considerable number of graduates also engage in traumatology (34.1%) and general orthopedics (31.8%). The evaluation of the educational framework of the program and the level of professional satisfaction revealed notable aspects that received positive assessments from the respondents. These included the diversity and volume of cases, training tailored for tertiary and secondary care, and preparation for the professional sphere. On the other hand, concerns were raised regarding the adequacy of monthly remuneration, the scarcity of theoretical instruction, and the limited exposure to surgical training. These specific areas garnered lower scores both in the objective metrics and subjective feedback. Conclusion: This study effectively delineated the characteristics of MRPOT graduates and identified the program's key strengths. Simultaneously, it highlights areas that have drawn criticism and warrant attention.

Comparison of Locked Plates and Blade Plates for Varus Osteotomy of the Proximal Femur by the Finite Element Method / Avaliação entre placas bloqueadas e placas lâmina para osteotomia varizante do fêmur proximal pelo método dos elementos finitos

Abstract Objective: The present study compared the difference in load and pressure distribution behavior of the blade plate and locked plate for varus osteotomy of the proximal femur per the finite element method. Methods: Modeling was performed by scanning a medium-sized left femur with medial valgus deformity made of polyurethane. Results: The stiffness of the locked plate is higher compared with that of the blade plate. However, this difference was not significant. In addition, the locked plate has proximal locking screws to ensure that the bending moments on the screws are smaller during loading. Conclusion: In summary, both plates are well-established and effective. However, the study using the finite element method plays a fundamental role in understanding the load and pressure distribution of the implant. Moreover, it opens up new possibilities for further studies, including surgical proposals and customized implant materials.

Resumo Objetivo: Testar a diferença do comportamento de distribuição de cargas e pressões da placa lâmina comparativamente com a placa bloqueada para osteotomia varizante do fêmur proximal através do método de elementos finitos. Métodos: A modelagem foi realizada através do escaneamento de um fêmur esquerdo com deformidade medial em valgo fabricado em poliuretano de tamanho médio. Resultados: Como resultados, pode-se inferir que a rigidez da placa bloqueada é maior do que a da placa lâmina. No entanto, essa diferença não foi significativa e, além disso, a placa bloqueada possui parafusos de travamento proximal para garantir que os momentos de flexão que agem nos parafusos sejam ainda menores durante o carregamento. Conclusão: Em síntese, ambos os materiais são consagrados e eficazes para serem utilizados, porém o estudo pelo método de elementos finitos apresenta papel importante para compreendermos a situação de distribuição de cargas e pressões do implante e abre novas possibilidades para novos estudos, como, por exemplo, o estudo da proposta cirúrgica e materiais a serem implantados de forma individual e personalizada.

Tratamiento de las fracturas maxilofaciales en un hospital cubano durante la pandemia de COVID-19

Introducción: La epidemiología de las fracturas maxilofaciales varía en dependencia de los estilos de vida, el nivel cultural y el estatus socioeconómico en diferentes zonas geográficas. Objetivo: Caracterizar epidemiológica y terapéuticamente a los pacientes con fracturas maxilofaciales, atendidos en un hospital universitario cubano durante la pandemia de COVID-19. Métodos: Se realizó un estudio observacional, descriptivo y transversal a los pacientes atendidos en el Servicio de Cirugía Maxilofacial del Hospital General Universitario "Carlos Manuel de Céspedes" de Bayamo, provincia Granma, durante el 1 de enero y el 31 de diciembre de 2020. Se estudiaron variables epidemiológicas y terapéuticas. Resultados: Se incluyeron 85 pacientes con 220 fracturas. Los hombres fueron los más afectados (n = 74; 87,06 %) y la proporción hombre/mujer resultó de 6,73:1. El grupo etario de 41-60 años (n = 40; 47,06 %) sobresalió. En el 38,89 % de los casos el trauma se relacionó con violencia interpersonal. Cincuenta y cuatro pacientes (63,52 %) tuvieron fracturas del complejo cigomático. El ángulo mandibular constituyó la localización anatómica más afectada. Las fracturas mandibulares se trataron fundamentalmente mediante reducción cerrada. Conclusiones: El perfil epidemiológico de las fracturas maxilofaciales se destacó en los pacientes adultos masculinos debido, principalmente, a la violencia interpersonal. Las fracturas complejas del tercio medio facial se trataron por método abierto. La distribución temporal de los casos mostró el impacto de la COVID-19 en la epidemiología de estos traumas.

Introduction: The epidemiology of maxillofacial fractures varies according to lifestyles, cultural level and socioeconomic status in different geographical areas. Objective: To characterize epidemiologically and therapeutically the patients with maxillofacial fractures treated in a Cuban university hospital during the COVID-19 pandemic. Methods: An observational, descriptive and cross-sectional study was carried out on patients attended at the Maxillofacial Surgery Service of the General University Hospital "Carlos Manuel de Céspedes" of Bayamo, Granma province, between January 1 and December 31, 2020. Epidemiological and therapeutic variables were studied. Results: 85 patients with 220 fractures were included. Men were the most affected (n = 74; 87.06 %) and the male/female ratio was 6.73:1. The age group 41-60 years (n = 40; 47.06 %) stood out. In 38.89 % of the cases the trauma was related to interpersonal violence. Fifty-four patients (63.52 %) had fractures of the zygomatic complex. The mandibular angle was the most damaged anatomical location. Fractures were treated primarily by closed reduction. Conclusions: The epidemiological profile of maxillofacial fractures was prominent in adult male patients mainly due to interpersonal violence. Complex fractures of the midfacial third were treated by open method. The temporal distribution of the cases showed the impact of COVID-19 on the epidemiology of these traumas.

[Clinical and radiographic factors associated with failure of the dynamic hip screw system]. / Factores clínicos y radiográficos asociados a la falla del sistema del tornillo dinámico de cadera.

Background: The most widely used fixation system for transtrochanteric fractures is the dynamic hip screw system, which has a failure prevalence of 10 to 17% and it is associated with the presence of clinical and radiographic factors. Objective: To evaluate the association of clinical and radiographic factors with the failure of the screw system in post-operative patients for transtrochanteric hip fracture. Material y methods: A case-control study was carried out. The inclusion criteria were: patients > 18 years, who underwent surgery due to transtrochanteric fracture, were treated with the hip screw system, and who attended the Trauma Service. The patient with failure of the hip screw system was selected as the case and the patient without failure of the system as control. The variables analyzed in these groups were: age, gender, body mass index and radiographic variables. Statistical analysis was performed with chi-squared and Mann-Whitney U. Results: 163 patients (median 73 years), 20 cases and 143 controls, were included. The radiographic factors with a significant association with hip screw system failure were the AO classification of fractures (p < 0.001), the tip apex distance (p = 0.03), the calcar-referenced tip apex (p = 0.02), the position of the screw (p < 0.001), and quality of reduction (p < 0.003). Clinical factors did not show a significant association. Conclusions: Radiographic factors are associated with failure in the hip screw system in patients in post-operative care due to transtrochanteric fracture.

Introducción: el sistema de fijación más usado para fracturas transtrocantéricas es el sistema del tornillo dinámico de cadera, el cual tiene una prevalencia de falla del 10 al 17% y se asocia a la presencia de factores clínicos y radiográficos. Objetivo: evaluar la asociación de los factores clínicos y radiográficos con la falla del sistema del tornillo en pacientes postoperados de fractura transtrocantérica de cadera. Material y métodos: se hizo un estudio de casos y controles. Los criterios de inclusión fueron: pacientes > 18 años, postoperados de fractura transtrocantérica, tratados con el sistema del tornillo de cadera, que acudieron a la consulta de Traumatología. Se seleccionó como caso al paciente con falla del sistema del tornillo de cadera y como control al paciente sin falla de este. Las variables analizadas en los grupos fueron la edad, el género, el índice de masa corporal y las variables radiográficas. El análisis estadístico se hizo con chi cuadrada y U de Mann-Whitney. Resultados: se incluyeron 163 pacientes (mediana de 73 años), 20 casos y 143 controles. Los factores radiográficos con asociación significativa con la falla del sistema del tornillo de cadera fueron la clasificación AO de la fractura (p < 0.001), la distancia punta-ápex (p = 0.03), punta ápex calcar (p = 0.02), la posición del tornillo (p < 0.001) y la calidad de la reducción (p < 0.003). Los factores clínicos no mostraron asociación significativa. Conclusiones: los factores radiográficos se asocian con la falla en el sistema del tornillo de cadera en pacientes postoperados de fractura transtrocantérica.

Desarrollo e implementación de un programa de investigación durante la residencia de ortopedia y traumatología / Development and implementation of a research program during the orthopedics residency

Introducción: Dentro de las recomendaciones internacionales para la formación de médicos expertos, se encuentra el integrar la mejor evidencia disponible a la práctica clínica y contribuir a la creación del conocimiento científico. El objetivo de este trabajo es describir la implementación de un programa formal de investigación en residentes de ortopedia y traumatología. Metodología: Se desarrolló un programa de investigación para residentes de ortopedia y traumatología, coordinado por un equipo con formación en metodología y bioestadística. El objetivo principal fue que los residentes lograran adquirir herramientas en el desarrollo del método científico e integrar la medicina basada en la evidencia en la práctica profesional. Para ello, se enfocó en tres ejes: 1. formación general 2. análisis crítico de la literatura y 3. desarrollo de investigación científica. Resultados: El año 2015 se implementó el programa. Comenzó con el módulo de formación general a través de seminarios de investigación y una rotación mensual obligatoria. De forma semanal se implementaron reuniones de revisiones críticas de la literatura a partir de casos clínicos y cada dos o tres meses sesiones de journal club. Se han formulado 30 proyectos de investigación, 22 de ellos se han presentado en congresos y ha habido un total de 27 publicaciones con coautoría de residentes (6 de primer autor). Conclusión: A través del programa de investigación, los residentes han adquirido herramientas para poder integrar la medicina basada en la evidencia a su práctica profesional y desarrollar proyectos científicos.

Introduction: In the international recommendations for resident education, there is integrating the best available evidence into clinical practice and contributing to the creation of scientific knowledge. This research aims to describe implementing a formal research program for orthopedic residents. Methodology: We developed a research program for orthopedic residents coordinated by a team trained in methodology and biostatistics. The main objective for residents was to acquire tools to develop the scientific method and to integrate evidence-based medicine into professional practice. To do this, it focused on: 1. theoretical courses, 2. critical analysis of literature, and 3. creation of scientific research. Results: 2015, the program started with a theoretical course through research seminars and a mandatory monthly rotation. Critical analysis of articles meetings were weekly, and journal club sessions every 2 or 3 months. Residents formulated 30 research projects and presented 22 at national and international congresses. There were 27 scientific publications with resident participation (6 were lead authors). Conclusion: Through the research program, residents have acquired tools to integrate evidence-based medicine into their professional practice and develop scientific projects.

Atuação do fisioterapeuta no serviço de emergência de um hospital de pronto socorro referência em trauma / The role of physical therapists in the emergency room of a trauma hospital

Emergências hospitalares são portas de entrada para pacientes graves com potencial risco de morte. Em um hospital referência em trauma, a função do fisioterapeuta dentro da equipe multiprofissional ainda tem necessidade de ser bem estabelecida. Objetivo: Discorrer sobre a atuação do fisioterapeuta no serviço de emergência de um hospital de pronto socorro referência em trauma e apresentar o perfil do paciente atendido. Método: Trata-se de uma pesquisa observacional descritiva, de caráter transversal retrospectiva a partir da análise dos atendimentos fisioterapêuticos registrados em prontuários de pacientes hospitalizados. Resultados: As causas mais frequentes de internação dos pacientes atendidos pela equipe de fisioterapia foram quedas (51,7%), acidentes de trânsito (14,9%), cardiovasculares (9,2%), agressões (9,1%), outros (8,3%) e respiratórias (6,8%). Quedas da própria altura com fratura de fêmur associadas representaram 26,4% da amostra. Nestes pacientes as condutas mais utilizadas pelos fisioterapeutas foram orientações, exercícios respiratórios, exercícios no leito e ajustes de posicionamento. O fisioterapeuta teve atuação com pacientes com pneumotórax, hemotórax ou hemopneumotórax submetidos à drenagem torácica, por meio de exercícios respiratórios expansivos, saída do leito e deambulação precoce. Observou-se também atuação com os pacientes em ventilação mecânica invasiva e não invasiva na sala vermelha. Conclusão: O fisioterapeuta, fazendo parte da equipe multiprofissional, apresenta importante atuação nas salas de emergência de um hospital de trauma, tal como o atendimento a pacientes submetidos a ventilação mecânica invasiva e não invasiva, uso de técnicas de fisioterapia respiratória para expansão pulmonar e remoção de secreções bem como a utilização de técnicas de cinesioterapia para manutenção e ganho de força muscular e funcionalidade.

Hospital emergencies are gateways to critically ill patients with potential risk of death. In a trauma referral hospital, the physical therapists role within the multiprofessional team must still be well established. Objective: To discuss the role of the physical therapist in the emergency department of a reference trauma hospital and to present the profile of the patients admitted to hospitalization. Method: This is a descriptive, observational, cross-sectional study that analyzes physiotherapy and records of hospitalized patients. Results: The most frequent causes of hospitalization of patients treated by the physiotherapy team were falls (51.7%), traffic accidents (14.9%), cardiovascular diseases (9.2%), assaults (9.1%), and respiratory (6.8%). Falls from standing height with associated femur fractures represented 26.4% of the records. With these patients, the procedures most used by physical therapists were orientations, breathing exercises, bedside exercises, and positioning adjustments. With lung-expanding breathing exercises, bedside exercises, and early walking, the physical therapist treated patients with pneumothorax, hemothorax, or hemopneumothorax who underwent thoracic drainage. Physical therapists also treated patients under invasive and non-invasive mechanical ventilation in the red ward. Conclusion: The physical therapist, as part of the multiprofessional team, has an essential role in the emergency rooms of a trauma hospital, such as care for patients undergoing invasive and non-invasive mechanical ventilation, use of respiratory physiotherapy techniques for lung expansion and removal of secretions, as well as the use of kinesiotherapy techniques to maintain and gain muscle strength and functionality.

Spinal gunshot wounds: A retrospective, multicenter, cohort study.

INTRODUCTION AND OBJECTIVE: To describe the demographic and clinical characteristics and treatment of patients with spinal gunshot wounds across Latin America. MATERIAL AND METHODS: Retrospective, multicenter cohort study of patients treated for gunshot wounds to the spine spanning 12 institutions across Latin America between January 2015 and January 2022. Demographic and clinical data were recorded, including the time of injury, initial assessment, characteristics of the vertebral gunshot injury, and treatment. RESULTS: Data on 423 patients with spinal gunshot injuries were extracted from institutions in Mexico (82%), Argentina, Brazil, Colombia, and Venezuela. Patients were predominantly male civilians in low-risk-of-violence professions, and of lower/middle social status, and a sizeable majority of gunshots were from low-energy firearms. Vertebral injuries mainly affected the thoracic and lumbar spine. Neurological injury was documented in n=320 (76%) patients, with spinal cord injuries in 269 (63%). Treatment was largely conservative, with just 90 (21%) patients treated surgically, principally using posterior open midline approach to the spine (n=79; 87%). Injury features distinguishing surgical from non-surgical cases were neurological compromise (p=0.004), canal compromise (p<0.001), dirty wounds (p<0.001), bullet or bone fragment remains in the spinal canal (p<0.001) and injury pattern (p<0.001). After a multivariate analysis through a binary logistic regression model, the aforementioned variables remained statistically significant except neurological compromise. CONCLUSIONS: In this multicenter study of spinal gunshot victims, most were treated non-surgically, despite neurological injury in 76% and spinal injury in 63% of patients.

Artroplastia em Gap com Interposição de Fáscia de Temporal para o Tratamento de Anquilose de Articulação Temporomandibular: Relato de Caso / Gap Arthroplasty with Temporalis Fascia Interposition for the Treatment of Temporomandibular

A anquilose da articulação temporomandibular (ATM) é caracterizada pela união intracapsular do complexo disco-côndilo à superfície do osso temporal, podendo gerar restrição dos movimentos mandibulares e limitação de abertura bucal. São descritas ainda alterações como restrição da capacidade mastigatória, dificuldade de fonação e de uma adequada higiene bucal, além de dificuldade de interação social. O presente caso retrata um paciente feminino, 27 anos, com histórico de fratura de parassínfise e côndilo mandibular bilateral após trauma em 2014, evoluindo com anquilose da ATM direita, com abertura máxima de 13,27 mm. Para o tratamento do caso descrito, foi utilizado o acesso de Al-Kayat, coronoidectomia ipsilateral e ressecção de massa anquilótica em gap com interposição de retalho da fáscia do músculo temporal no lado direito. Após seis meses do procedimento cirúrgico, foi realizada uma nova tomografia da face na qual se observa ausência de lesões e de sinais de recidiva da anquilose e também foi observada a manutenção do espaço de lacuna feita pela ressecção óssea. O resultado satisfatório da técnica foi atribuído pela obtenção e estabilização de uma abertura bucal adequada, melhora da capacidade mastigatória e da fonação. Além do sucesso clínico, uma vantagem da técnica utilizada foi o baixo custo do procedimento por utilizar apenas interposição do músculo temporal sem uso de materiais aloplásticos. Além disso, a coronoidectomia ipsilateral associada foi suficiente para auxiliar na manutenção da abertura alcançada, não sendo necessária a coronoidectomia contralateral, o que minimizou o tempo operatório e a morbidade de mais um sítio cirúrgico acessado.

Ankylosis of the temporomandibular joint (TMJ) is characterized by the intracapsular union of the condyle- disc complex to the surface of the temporal bone, which can cause restriction of the mandibular movements and a limitation of a mouth opening. Alterations are also described as a restriction of masticatory capacity, difficulty in phonation and suitable oral hygiene, as well as difficulty in social interaction. A 27-year-old female patient with a bilateral history of parasymphysis and mandibular condyle fracture after a trauma in 2014, which evolved to an ankylosis of the right TMJ, with a maximum mouth opening of 13.27 mm. For the treatment of the described case, it was used the Al- Kayat approach, ipsilateral coronoidectomy and resection of the ankylotic mass in gap with interposition of temporalis muscle fascia flap on the right side. After six months of the surgical procedure, it was made a new computed tomography of the face in which it was possible to notice the absence of lesions and signs of recurrence of the ankylosis. It was also observed the maintenance of the gap space made by the bone resection. The satisfactory result of the technique was attributed to the achievement and stabilization of an adequate mouth opening, improved chewing ability and phonation. Besides the clinical success, an advantage of the technique used was the low cost of the procedure by using only temporal muscle interposition without the use of alloplastic materials. In addition, the associated ipsilateral coronoidectomy was sufficient to help maintaining the achieved mouth opening, and the contralateral coronoidectomy was not necessary, as a result it was minimized the surgical time and morbidity of one more accessed surgical site.

Caracterización clínica y epidemiológica de pacientes con fractura nasal atendidos en un hospital universitario cubano / Clinical and epidemiological characterization of patients with nasal fracture treated in a Cuban university hospital

Introducción: Las fracturas nasales son las más comunes de la región maxilofacial. Sin embargo, la literatura cubana sobre el tema es escasa y desactualizada, por lo que surgió la motivación para realizar esta investigación. Objetivo: Caracterizar clínica y epidemiológicamente los pacientes con fractura nasal atendidos en un hospital universitario cubano. Métodos: Se realizó un estudio observacional, descriptivo y transversal en pacientes atendidos en el Servicio de Cirugía Maxilofacial del Hospital General Universitario "Carlos Manuel de Céspedes" de Bayamo, provincia Granma, Cuba, en el período comprendido entre el 1 de enero y el 31 de diciembre del 2020. Se estudiaron variables clínicas, epidemiológicas y terapéuticas. Resultados: Se incluyeron 99 pacientes, de los cuales 74 (74,75 por ciento) fueron masculinos. En el 44,44 por ciento de los casos las edades estuvieron comprendidas entre los 21 y 40 años. Cincuenta pacientes (50,51 por ciento) tuvieron fracturas producto de la violencia interpersonal. Noventa y siete pacientes (97,98 por ciento) presentaron epistaxis. Cincuenta y nueve pacientes (59,60 por ciento) recibieron reducción cerrada asociada con taponamiento nasal y fijación externa con yeso. Conclusiones: Predominó el sexo masculino y el grupo de edades de 21 a 40 años. La principal etiología fue la violencia interpersonal. En la mayoría de los casos la epistaxis estuvo presente. Prevalecieron las fracturas cerradas, así como las que tuvieron el dorso desviado lateralmente(AU)

Introduction: Nasal fractures are the most common fractures of the maxillofacial region. However, Cuban literature on the subject is scarce and outdated, so the motivation for this research arose. Objective: To characterize patients with nasal fractures treated in a Cuban university hospital in a clinical and epidemiological manner. Methods: An observational, descriptive and cross-sectional study was carried out in patients treated at the Maxillofacial Surgery Service of the University General Hospital. "Carlos Manuel de Céspedes" of Bayamo, Granma province, Cuba, from January 1 to December 31, 2020. Clinical, epidemiological and therapeutic variables were studied. Results: 99 patients were included, of whom 74 (74.75 percent) were male. In 44.44 percent of the cases the ages were between 21 and 40 years. Fifty patients (50.51 percent) had fractures resulting from interpersonal violence. Ninety-seven patients (97.98 percent) presented epistaxis. Fifty-nine patients (59.60 percent) received closed reduction associated with nasal packing and external fixation with plaster cast. Conclusions: Male gender and age group 21 to 40 years predominated. The main etiology was interpersonal violence. Epistaxis was present in most cases. Closed fractures prevailed, as well as those with laterally deviated dorsum(AU)

Revisión bibliográfica sobre la Gestión Integral de la Farmacoterapia en pacientes hospitalizados en Cirugía Ortopédica y Traumatología / Literature review on Medication Therapy Management in patients admitted to Orthopedic Surgery and Trauma Departments

Objetivo: Explorar la literatura científica sobre las intervenciones farmacéuticas (IF) y la Gestión Integral de la Farmacoterapia (GIF) brindada por farmacéuticos en pacientes hospitalizados en Cirugía Ortopédica y Traumatología (COT). Métodos: Se realizó una búsqueda de artículos originales y revisiones, publicados en inglés o castellano, hasta el 17 de junio de 2021, cuyo tema principal fueran las IF en pacientes hospitalizados en COT. Bases de datos consultadas: Medline, Cochrane Library y Scielo. Términos empleados: “Orthopedics”, “Traumatology”, “orhopedic surgery”, “orhopedic trauma”, “Medication Therapy Management”, “Pharmacy Service, Hospital”, “Pharmacists”, “Medication Reconciliation”, “Pharmaceutical Care”, “Clinical Pharmacy”. La IF fue considerada GIF cuando implicaba una revisión profunda de la medicación del paciente (Valoración inicial/“Assessment”), evaluando indicación, efectividad, seguridad y cumplimiento/adherencia de cada uno de los medicamentos, y comprobando que todas sus necesidades farmacoterapéuticas estuvieran cubiertas. La implantación de la GIF fue considerada completa cuando además se realizaba un plan de cuidados farmacoterapéutico (“Care Plan”) y evaluación/seguimiento (“Follow up-evaluation”). Resultados: Se seleccionaron 29 artículos, principalmente estudios observacionales descriptivos (51,7%). La mayoría fueron publicados en Estados Unidos (27,6%) y España (20,7%). IF mayoritarias: conciliación de medicación (55,2%), revisión de medicación (44,8%), seguimiento farmacoterapéutico (SFT) (34,5%), manejo del dolor físico postquirúrgico (27,6%) y evaluación/reducción de riesgos (27,6%). La GIF fue analizada en cinco referencias bibliográficas (17,2%); siendo su implantación completa solamente en tres (10,3%). Conclusiones: La presente revisión bibliográfica sintetiza las principales IF en pacientes hospitalizados en COT, destacando: conciliación de medicación, revisión de medicación y SFT... (AU)

Objective: To review the scientific literature on Pharmaceutical Interventions (PIs) and Medication Therapy Management (MTM) by pharmacists in patients admitted to Orthopedic Surgery and Trauma (OST) Departments. Methods: A search was conducted of Medline, Cochrane Library, and Scielo databases for original articles and reviews on PIs in adults (≥18 yrs) hospitalized in OST published in English or Spanish up to June 17 2021. Search terms were: “orthopedics”, “traumatology”, “orthopedic surgery”, “orthopedic trauma”, “medication therapy management”, “pharmacy service, hospital”, “pharmacists”, “medication reconciliation”, “pharmaceutical care”, “clinical pharmacy”. Titles and abstracts of retrieved items were examined. A PI was considered MTM when part of a more in-depth review of the patient’s medication, evaluating the indication, effectiveness, safety, and treatment adherence for each medication and ensuring that all pharmacotherapeutic needs were covered (Assessment). MTM implementation was considered complete when plans for pharmacotherapy care (Care Plan) and follow-up (Follow-up evaluation) were developed. Results: The review included 29 articles, mainly descriptive observational studies (51.7%). The majority were published in the USA (27.6%) or Spain (20.7%). The most frequent PIs were: medication reconciliation (55.2%); medication review (44.8%); pharmacotherapeutic follow-up (34.5%); post-surgical physical pain management (27.6%); health education (27.6%); and risk assessment/reduction (27.6%). MTM was analyzed in five retrieved articles (17.2%) and its complete implementation in only three (10.3%). Conclusions: This literature review compiles the main PIs implemented in patients hospitalized in OST, highlighting medication conciliation, medication review, and pharmacotherapeutic follow-up. MTM implementation remains scarce in these patients. (AU)

Análisis de la demanda asistencial desde atención primaria a traumatología: propuestas para la mejora del continuo asistencial / Analysis of the demand of care from Primary Care to Traumatology: Proposals for the improvement of the continuous care

Objetivo: Analizar las derivaciones dirigidas desde Atención Primaria a Cirugía Ortopédica y Traumatología. Como objetivo secundario, establecer 2escenarios de derivación, con el fin de conocer el impacto de la variabilidad en la derivación. Material y métodos: Estudio observacional de carácter transversal de análisis de las derivaciones de Atención Primaria a Cirugía Ortopédica y Traumatología durante el primer semestre de los años 2018, 2019 y 2021. Se ha examinado el número de derivaciones que emite cada facultativo y cada centro de salud de Atención Primaria, atendiendo a la clasificación de las distintas zonas básicas de salud. Resultados: Existe una gran variabilidad en el número de derivaciones, tanto según el tipo de zona básica de salud (p < 0,001) como por cada facultativo (p < 0,001). Las ratios de derivación se comportan de forma uniforme en el tiempo (p < 0,001). Debido al alto número de derivaciones, se han construido dosescenarios: en el primero de ellos la ratio de derivación se situaría en la zona media del espectro de la tasa de derivación. En el segundo escenario, se han tomado como referencia las menores ratios de derivación registradas. La reducción de la variabilidad en los 2escenarios supuestos proporciona una disminución importante de la demanda asistencial. Conclusiones: La reducción de la variabilidad tendría un efecto beneficioso sobre la capacidad asistencial del servicio de Cirugía Ortopédica y Traumatología.

Objective: To analyze referrals from Primary Care consultation to Orthopaedic Surgery reference department. As a secondary objective, to establish 2referral scenarios in order to determine the impact of variability on referral. Material and methods: Cross-sectional observational study, analyzing referrals from Primary Care to Orthopaedic Surgery during the first half of the years 2018, 2019, and 2021. The number of referrals issued by each doctor and each Primary Care Healthcare Center was examined, according to the classification of the different Basic Healthcare Zones. Results: There is great variability in the number of referrals, both according to the type of Basic Healthcare Zone and by each Primary Care facultative. The referral ratios behaved uniformly over time (P<0.001). Due to a large number of referrals, 2scenarios have been constructed: In the first scenario, the referral ratio would be in the middle of the referral rate spectrum. In the second scenario, the lowest referral ratios recorded have been taken as a reference. The reduction of variability in the 2scenarios assumed provides a significant reduction in the demand for care. Conclusion: Reducing variability would have a beneficial effect on the capacity of the Orthopaedic Surgery service to provide care.(AU)

[Translated article] Analysis of the demand of care from Primary Care to Traumatology: Proposals for the improvement of the continuous care / Análisis de la demanda asistencial desde atención primaria a traumatología: propuestas para la mejora del continuo asistencial

Objetivo: Analizar las derivaciones dirigidas desde Atención Primaria a Cirugía Ortopédica y Traumatología. Como objetivo secundario, establecer 2escenarios de derivación, con el fin de conocer el impacto de la variabilidad en la derivación. Material y métodos: Estudio observacional de carácter transversal de análisis de las derivaciones de Atención Primaria a Cirugía Ortopédica y Traumatología durante el primer semestre de los años 2018, 2019 y 2021. Se ha examinado el número de derivaciones que emite cada facultativo y cada centro de salud de Atención Primaria, atendiendo a la clasificación de las distintas zonas básicas de salud. Resultados: Existe una gran variabilidad en el número de derivaciones, tanto según el tipo de zona básica de salud (p < 0,001) como por cada facultativo (p < 0,001). Las ratios de derivación se comportan de forma uniforme en el tiempo (p < 0,001). Debido al alto número de derivaciones, se han construido dosescenarios: en el primero de ellos la ratio de derivación se situaría en la zona media del espectro de la tasa de derivación. En el segundo escenario, se han tomado como referencia las menores ratios de derivación registradas. La reducción de la variabilidad en los 2escenarios supuestos proporciona una disminución importante de la demanda asistencial. Conclusiones: La reducción de la variabilidad tendría un efecto beneficioso sobre la capacidad asistencial del servicio de Cirugía Ortopédica y Traumatología.

Objective: To analyze referrals from Primary Care consultation to Orthopaedic Surgery reference department. As a secondary objective, to establish 2referral scenarios in order to determine the impact of variability on referral. Material and methods: Cross-sectional observational study, analyzing referrals from Primary Care to Orthopaedic Surgery during the first half of the years 2018, 2019, and 2021. The number of referrals issued by each doctor and each Primary Care Healthcare Center was examined, according to the classification of the different Basic Healthcare Zones. Results: There is great variability in the number of referrals, both according to the type of Basic Healthcare Zone and by each Primary Care facultative. The referral ratios behaved uniformly over time (P<0.001). Due to a large number of referrals, 2scenarios have been constructed: In the first scenario, the referral ratio would be in the middle of the referral rate spectrum. In the second scenario, the lowest referral ratios recorded have been taken as a reference. The reduction of variability in the 2scenarios assumed provides a significant reduction in the demand for care. Conclusion: Reducing variability would have a beneficial effect on the capacity of the Orthopaedic Surgery service to provide care.(AU)

Analysis of the demand of care from Primary Care to Traumatology: Proposals for the improvement of the continuous care. / Análisis de la demanda asistencial desde atención primaria a traumatología: propuestas para la mejora del continuo asistencial.

OBJECTIVE: To analyze referrals from Primary Care consultation to Orthopaedic Surgery reference department. As a secondary objective, to establish 2referral scenarios in order to determine the impact of variability on referral. MATERIAL AND METHODS: Cross-sectional observational study, analyzing referrals from Primary Care to Orthopaedic Surgery during the first half of the years 2018, 2019, and 2021. The number of referrals issued by each doctor and each Primary Care Healthcare Center was examined, according to the classification of the different Basic Healthcare Zones. RESULTS: There is great variability in the number of referrals, both according to the type of Basic Healthcare Zone and by each Primary Care facultative. The referral ratios behaved uniformly over time (P<0.001). Due to a large number of referrals, 2scenarios have been constructed: In the first scenario, the referral ratio would be in the middle of the referral rate spectrum. In the second scenario, the lowest referral ratios recorded have been taken as a reference. The reduction of variability in the 2scenarios assumed provides a significant reduction in the demand for care. CONCLUSION: Reducing variability would have a beneficial effect on the capacity of the Orthopaedic Surgery service to provide care.

[Translated article] Analysis of the demand of care from Primary Care to Traumatology: Proposals for the improvement of the continuous care.

OBJECTIVE: To analyse referrals from Primary Care consultation to Orthopaedic Surgery reference department. As a secondary objective, to establish 2 referral scenarios in order to determine the impact of variability on referral. MATERIAL AND METHODS: Cross-sectional observational study, analyzing referrals from Primary Care to Orthopaedic Surgery during the first half of the years 2018, 2019, and 2021. The number of referrals issued by each doctor and each Primary Care Healthcare Center was examined, according to the classification of the different Basic Healthcare Zones. RESULTS: There is great variability in the number of referrals, both according to the type of Basic Healthcare Zone and by each Primary Care facultative. The referral ratios behaved uniformly over time (p<0.001). Due to a large number of referrals, 2 scenarios have been constructed: In the first scenario, the referral ratio would be in the middle of the referral rate spectrum. In the second scenario, the lowest referral ratios recorded have been taken as a reference. The reduction of variability in the 2 scenarios assumed provides a significant reduction in the demand for care. CONCLUSION: Reducing variability would have a beneficial effect on the capacity of the Orthopaedic Surgery service to provide care.

Orthopedics and Traumatology Skill Matrix for Musculoskeletal System Approach by Medical Graduates / Matriz de competências em ortopedia e traumatologia para abordagem do sistema musculoesquelético para graduação médica

Abstract Objective This study aimed to build a matrix of orthopedics and traumatology skills focusing on the musculoskeletal system for graduates of a medical course in Brazil. Methods The study used the e-Delphi methodology to retrieve opinions anonymously. The first proposal included 42 items determined at a bibliographical review and their epidemiological relevance. This proposal was available via Google Forms, and we sent it using the instant messaging application WhatsApp. We grouped the panel of 26 specialists into three categories: Orthopedics and Traumatology professors, Primary Care doctors, and Emergency Physicians. We reached a consensus after three rounds, with at least 75% agreement between the items initially presented. We also considered the following four indicators: prerequisite, essential, desirable, and advanced skills. Results We created a matrix with 34 musculoskeletal system-related skills, including diagnostic and management actions for all age groups. Conclusion We devised a skill matrix in Orthopedics and Traumatology for medical graduation for complete or partial use according to the institutional curriculum.

Resumo Objetivo Construir uma matriz de competências em ortopedia e traumatologia, com enfoque no sistema musculoesquelético, necessárias ao egresso do curso de medicina no Brasil. Método Utilizou-se a metodologia e-Delphi, visando captar a opinião de participantes de forma anônima. A primeira proposta contou com 42 itens, frutos de revisão bibliográfica e relevância epidemiológica, disponibilizados para os painelistas pelo Google Forms e enviados através do aplicativo de mensagens instantâneas Whatsapp. Constituiu-se um painel de 26 especialistas agrupados em três categorias: docentes de Ortopedia e Traumatologia, médicos da Atenção Primária e Emergencistas. O consenso foi obtido após a realização de 3 rodadas, com pelo menos 75% de concordância entre os itens inicialmente apresentados. Foram também considerados quatro indicadores: competências pré-requisito, essenciais, desejáveis e avançadas. Resultados obteve-se uma matriz com 34 competências relativas à abordagem do sistema musculoesquelético, que contempla ações de diagnóstico e conduta de todas as faixas etárias. Conclusão Foi construída uma matriz de competências em Ortopedia e Traumatologia para graduação médica com possibilidades de ser utilizada na sua íntegra ou de forma parcial, de acordo com o perfil do currículo institucional.