Clinical and functional outcomes of surgical treatment of grade III ulnar collateral ligament injuries of thumb metacarpophalangeal joint.

OBJECTIVES: The aim of this study was to compare the clinical and functional outcomes of three surgical techniques (subperiosteal suture, bone anchor and direct repair) for the management of severe acute ulnar collateral ligament injuries of the thumb metacarpophalangeal joint with a minimum of 1 year follow-up. MATERIAL AND METHODS: Between 2015 and 2020, 230 collateral ligament injuries required surgical treatment in our department. After the inclusion and exclusion criteria were applied, 100 were included in the study. The Glickel score and functional scores such as QuickDASH and PRWE were assessed. Time to return to work and to sport was quantified. RESULTS: Ulnar collateral ligament injuries affected men who were statistically younger than women (41.8 years old vs 48.3). Subperiosteal suture was the preferred technique (81%), then bone anchor reattachment (12%) and direct repair (7%). All three techniques produced excellent stability (91-100%). Better range of motion was reported in the subperiosteal group, but better strength was found in the bone anchor group. Subperiosteal suture had 89% excellent and good results, while there was 83% in the bone anchor group and 71% in the direct repair group. Mean time to return to work was 2 months in the bone anchor group versus 3 months in the subperiosteal group. Mean QuickDASH was 8.7/100 and mean PRWE was 7.1/100. CONCLUSION: This is the biggest case series to date on surgical treatment of severe ulnar collateral ligament injuries of the thumb metacarpophalangeal joint. The subperiosteal technique is simpler and less expensive. While the results are not often described in the literature, it produces comparable clinical and functional outcomes to bone anchor reattachment with a minimum follow-up of 1 year.

Validation of the spontaneous lateral laxity sign for radial collateral ligament sprain of the metacarpophalangeal joint of the fingers: Anatomical study.

Severe collateral ligament sprain of the metacarpophalangeal joint (MCP) of the fingers is rare. Clinical examination is mandatory to diagnose severity. The purpose of our study was to validate a clinical sign for MCP joint laxity: the spontaneous lateral laxity sign (SLLS), recently described by Meyer et al. to diagnose severe MCP radial collateral ligament (RCL) sprain, with a comparison with the already validated rotational laxity test (RLT). SLLS and RLT were assessed before RCL transection, after RCL transection and after RCL repair on 40 long fingers in 10 fresh thawed cadavers. SLLS was performed with the elbow on the table, wrist in 70° flexion, in neutral pronation-supination, hands drooping passively with the dorsal side toward the examiner and the ulnar side toward the table. The MCP joints were at rest, in passive slight extension. Positive results were defined as an overlap of the damaged finger on the next, or as an increased abduction of the little finger. Correlation between the two tests was calculated. SLLS was positive in 0% of cases before RCL transection, 100% after transection and 0% after repair. Mean arcs of pronation and supination on RLT were 16 and 19.5 mm before section, 24 and 33 mm after section (52% and 69% increase compared to preoperative data), and 17 and 21 mm after repair (7% and 8% increase). Correlation between the two tests was 100%. The spontaneous lateral laxity sign is a simple and reliable clinical sign for diagnosing complete long-finger MCP RCL tears requiring surgery. LEVEL OF EVIDENCE: : III, case-control study.

Long-term outcomes following surgical repair of acute injuries of the thumb metacarpophalangeal joint ulnar collateral ligament.

The primary aim of this study was to describe the long-term patient reported outcomes following surgical repair of acute injuries to the thumb metacarpophalangeal (MCP) joint ulnar collateral ligament (UCL). The secondary aims were to describe the long-term health related quality of life, patient satisfaction and complication rate. From a single surgeon series, 30 patients were identified over an 11 year period (February 2000-February 2011). QuickDASH, EQ-5D-5L, and satisfaction scores were collected from 22 patients (73%) at mean 183 month follow up. The median QuickDASH score was 2.27. Median EQ-5D-5L was 0.88. Satisfaction rate was 82%, Net Promotor Score was 90. Significantly worse QuickDASH scores were seen in patients that developed MCP joint arthrosis or had had subsequent ipsilateral hand injuries (median 39.7 vs 2.27; p = 0.002). All the patients employed at the time of surgery returned to work without long-term adaptations. Surgical repair of acute UCL injury generally provides an excellent long-term functional outcome and satisfaction rate. Complications are rare but where MCP joint arthrosis develops functional outcomes can be significantly worse.

Application of the Ottawa Protocol by Medical Students and Orthopedic Residents on Ankle Sprains at a Trauma Hospital / Aplicação do protocolo Ottawa por estudantes de medicina e residentes de ortopedia em entorses de tornozelo em um hospital de trauma

Abstract Objective To verify the applicability and agreement of the Ottawa ankle rules applied by medical students and orthopedic residents in a tertiary trauma service thus validating the Ottawa protocol for use on Brazilian soil. Prospective This was a prospective study, conducted in a tertiary hospital, including all patients with acute torsial trauma of the tibiotarsal joint. The patients underwent ankle and/or foot radiographs, and the questionnaire with the Ottawa ankle rules was applied by academics and, subsequently, by residents. The radiographs were evaluated by on-call orthopedists and specialist in foot and ankle, and the expert opinion was considered the gold standard for analysis. Results Two hundred and sixty-three patients were evaluated, and, after application of the established inclusion criteria, 226 cases remained for evaluation. The sensitivity to detect lesions and negative predictive value (NPV) was 100%. The most sensitive test with higher NPV for both academics and residents was palpation of the lateral malleolus. The study presented potential for a reduction of 30% in the total number of tests requested. Conclusion The data showed applicability and agreement between academics and residents, which allows for the validation of the Ottawa protocol in emergency care in Brazil.

Resumo Objetivo Verificar a aplicabilidade e a concordância das regras do tornozelo de Ottawa aplicadas por estudantes de medicina e residentes de ortopedia em um serviço de trauma terciário, validando assim as regras de Ottawa para utilização em solo brasileiro. Método Estudo prospectivo, realizado em um hospital terciário, incluindo todos os pacientes com trauma torcional agudo da articulação tibiotársica. Os pacientes realizaram radiografias de tornozelo e/ou pé, tendo sido aplicado o questionário com as regras do tornozelo de Ottawa por acadêmicos e, na sequência, por residentes. As radiografias foram avaliadas por ortopedistas plantonistas e especialista em pé e tornozelo, sendo a opinião do especialista considerada padrão-ouro da análise. Resultados Foram avaliados 263 pacientes e, após aplicados os critérios de inclusão estabelecidos, restaram para a avaliação 226 casos. A sensibilidade para detectar lesões e o valor preditivo negativo (VPN) foi de 100%. O teste mais sensível e com maior VPN para ambos, acadêmicos e residentes, foi a palpação do maléolo lateral. O estudo apresentou potencial de redução de 30% no total de exames solicitados. Conclusão Os dados demostraram aplicabilidade e concordância entre acadêmicos e residentes, o que permite a validação do protocolo de Ottawa nos atendimentos de urgência e emergência no Brasil.

Terapia manual na recuperação funcional pós-entorse lateral de tornozelo: revisão sistemática / Manual therapy in the functional recovery after the ankle side entry: systematic review

INTRODUÇÃO: O tornozelo é considerado uma das regiões do corpo mais propensa às lesões esportivas, sendo 70% dessas lesões entorses de tornozelo. A recidiva de entorses pode provocar um prejuízo crônico na função proprioceptiva e sensório-motora. Não existe um tratamento específico para as entorses, sendo utilizados protocolos como o PRICE, abordagem passiva, imobilização da articulação e terapia manual. OBJETIVO: Trazer informações mais consistentes que elucidem os efeitos da terapia manual na recuperação da funcionalidade do paciente. MATERIAIS E MÉTODOS: Tratase de uma revisão sistemática baseada no PRISMA, com buscas realizadas nas bases de dados: PubMed, SciELO, LILACS e PEDro. Foram pesquisados apenas ensaios clínicos randomizados, com avaliação maior ou igual a 5/10 na escala PEDro, nos idioma português e inglês. Os estudos deveriam incluir população com idade entre 18 e 60 anos utilizando técnicas de terapia manual como: Mulligan, Maitland, mobilização neural, massoterapia, liberação miofascial, pompage e alongamento passivo. RESULTADOS: Foram incluídos 7 artigos com um total de 300 indivíduos. Os estudos incluídos investigaram a recuperação da funcionalidade de pacientes submetidos à terapia manual. Limitações: heterogeneidade no tempo de lesão. CONCLUSÃO: Os resultados evidenciaram melhora na capacidade física para correr, saltar, pousar e realizar movimentos de corte e laterais, melhora da cinemática, marcha, distribuição de descarga de peso e função global.

INTRODUCTION: The ankle is considered one of the regions of the body most prone to sports injuries, with 70% of these injuries ankle sprains. The recurrence of sprains can cause chronic impairment in proprioceptive and sensorymotor function. There is no specific treatment for sprains, using protocols such as PRICE, passive approach, immobilization of the joint and manual therapy. Manual therapy in patients who have undergone lateral ankle sprains can provide beneficial results by improving range of motion, subtalar joint slippage, speed and length of steps, distribution of gait forces, pain relief, and activities of daily living. OBJECTIVE: The objective of this study is to provide more consistent information that elucidates the effects of manual therapy on the recovery of the patient's functionality. MATERIALS AND METHODS: This is a systematic review that followed some PRISMA rules in the databases: PubMed, SciELO, LILACS and PEDro. The articles were searched in Portuguese and English. RESULTS: Seven articles with a total of 300 individuals were included. The included studies investigated the retrieval of the functionality of patients undergoing manual therapy. CONCLUSION: The results showed an improvement in physical ability to run, jump, land and perform lateral and lateral movements, improvement of kinematics, improvement of gait, better distribution of weight discharge and improvement of overall function.

Caracterização clínico epidemiológica das entorses de tornozelo atendidas no pronto socorro do Hospital Universitário Evangélico de Curitiba / Clinic and epedemiological characterization of ankle sprain attended in Hospital Evangelico of Curitiba emergency room

As entorses de tornozelo estão relacionadas com diversas atividades diárias, aumentando a incidência deste tipo de lesão em pronto atendimento hospitalar. Trabalho quantitativo e prospectivo, realizado no serviço de Ortopedia do pronto socorro do Hospital Universitário Evangélico de Curitiba, avaliou e caracterizou a clínica e a epidemiologia das entorses de tornozelo de 100 pacientes. Apurou-se que 88% dos atendimentos foram de indivíduos economicamente ativos. A prática esportiva gerou 25 entorses na população estudada. Das entorses em inversão 12,65% apresentaram complicações agudas, enquanto que as entorses por eversão apresentaram 35% complicações agudas graves. Em 73% dos casos os tratamentos foram conservadores. Foram emitidos 93 pedidos de radiografia, com 90 pacientes encaixados nos critérios de Ottawa. A terapêutica farmacológica sugerida para 87% dos pacientes foi anti-inflamatório não esteroidal. Somente 6 pacientes necessitaram de reparo cirúrgico. Conclusão: pacientes mais jovens apresentaram maior recidiva. Apesar do menor índice as eversões apresentaram uma maior taxa de complicações agudas

Ankle sprains are related intto several daily activities, increasing the incidence of this type of injury in the emergency rooms. This is a quantitative and prospective study, performed at the Orthopedics department of the emergency room of the Hospital Universitário Evangélico de Curitiba, evaluated and characterized the clinical and epidemiology of ankle sprains in 100 patients. It was found that 88% of the cases was of economically active individuals. The sporting practice generated 25 sprains in the studied population. In all inversion sprains, only 12.65% presented acute complications, whereas the sprains by eversion presented 35% serious acute complications. In 73% of the cases the treatments were conservative. A total of 93 radiographic applications were dispensed, with 90 match of patients with the Ottawa criteria. The suggested pharmacological therapy for 87% of the patients was non-steroidal anti-inflammatory. Only 6 patients required surgical repair. Conclusion: younger patients presented greater relapse. Despite the lower rate, eversions presented a higher rate of acute complications

Grade V acromioclavicular joint separation in a 57-year-old mountain biker.

Patients rarely present to a chiropractic office setting during the acute stage of a high-grade (i.e. Rockwood types IV-VI) separation of the acromioclavicular (AC) joint. Moreover, such cases are non-existent in the peer-reviewed chiropractic literature. Some controversy exists over the optimal (surgical vs. non-surgical) treatment of severe AC joint injuries. Published reports of nonoperative management for grade V injuries of the AC joint are also scarce. This case review highlights the plain film imaging and conservative management of a 57-year-old patient diagnosed with an acute Rockwood type V AC joint separation. Radiographs with nine years of follow-up are presented.

Les patients se présentent rarement à une clinique de chiropratique pendant la phase aiguë d'une séparation de haut grade (c.-à-d., types IV à VI de Rockwood) de l'articulation acromio-claviculaire(AC). En outre, ces cas n'existent pas dans la littérature sur la chiropratique examinée par les pairs. Le traitement optimal (chirurgical vs non chirurgical) des lésions graves de l'articulation AC ne fait pas l'unanimité. Les rapports publiés sur la prise en charge non chirurgicale des lésions de grade V de l'articulation AC sont également peu abondants. Cet examen de cas met en lumière l'imagerie par radiographie et la prise en charge conservatrice d'un patient de 57 ans souffrant de séparation aiguë de l'articulation AC de type V de Rockwood. Les radiographies avec neuf ans de suivi sont présentées.

Rotational stability test for the diagnosis of radial collateral ligament rupture in the fingers: Anatomical study.

Diagnosing rupture of the radial collateral ligament (RCL) of the finger metacarpophalangeal (MCP) joints is difficult. The aim of this cadaver study was to validate a rotational test for the MCP after RCL transection. With the MCP and proximal interphalangeal joints in flexion, rotation along the axis of the proximal phalanx was applied through an extended distal interphalangeal joint to 36 cadaver fingers. Each finger's pulp described an arc of pronation and supination that was noted on the palm. The test was repeated three times: before transection, after transection of the proper collateral ligament (CL) and after transection of both the proper and accessory CLs. Rotational arcs were measured in pronation and supination. Mean length of the pronation arc after transection of the main RCL was 17.53mm, while it was only 12.41mm before transection for the supination arc. Mean length of the pronation arc after transection of both CLs was 22.83mm compared to only 11.93mm before transection. Our results show a significant difference in pronation stability of the MCP joint after transection of the RCL proper. We can conclude that this rotational stability test is a valid test for diagnosing RCL rupture in MCP joints.

Results of conservative treatment of volar plate sprains of the proximal interphalangeal joint with and without avulsion fracture.

The prognosis of isolated volar plate sprains of the proximal interphalangeal (PIP) joint is related to the extension deficit. Some consider an associated avulsion fracture as a sign of severity. The goal of this study was to find out whether the outcomes of conservative treatment in PIP volar plate injury was impacted by the presence of an avulsion fracture. Our series included 75 patients, 27 years old on average, of which 58 were men. All sprains were stable. The X-rays were normal in 52 cases (group 1); an avulsion fracture was found in 23 cases (group 2). The patients were treated by buddy taping during the day and a straight finger splint at night for 3 weeks. At the last follow-up, no significant difference was found between the two groups regarding pain, extension/flexion range of motion or edema. The results of this study show that the prognosis of conservative treatment of PIP volar plate injuries does not depend on the presence of an avulsion fracture.

Análise do COP e sentido de posição em jogadores universitários de futebol com e sem instabilidade de tornozelo / The analysis of COP and joint position sense in university soccer players with and without ankle instability

Resumo O objetivo do estudo foi comparar o comportamento do COP e do sentido de posição articular passivo em indivíduos com e sem instabilidade de tornozelo, e correlacionar as variáveis de COP e sentido de posição articular passivo. Participaram 20 indivíduos, divididos em dois grupos: grupo estável (GE) e grupo instável (GI). A avaliação do COP foi feita com o teste de apoio unipodal, com olhos abertos e fechados sobre uma plataforma de força. O teste de reposicionamento articular passivo foi realizado com os olhos vendados. O tornozelo foi posicionado em um ângulo alvo (10° e 20°) e o dinamômetro movia passivamente o tornozelo, então os participantes eram instruídos a apertar o botão para parar o movimento quando sentissem que o tornozelo estava no ângulo alvo, obtendo assim o erro angular absoluto (EAA). Foram obtidas as variáveis: deslocamento total (DT); desvio padrão ântero-posterior (DPap) e médio-lateral (DPml); velocidade média total (VMT); velocidade média ântero-posterior (VMap) e médio-lateral (VMml). A comparação entre dados que apresentaram distribuição normal foi feita com o teste t de Student, enquanto que para DT e DPml foi utilizado o teste de Mann-Whitney. Da mesma forma, foram usados os testes de Pearson e Spearman para correlacionar as variáveis. Foi adotado α < 0,05. Houve diferença entre EAA-10° (p < 0,05). Foram encontradas fortes correlações entre: EAA-10° e VMT (p < 0,01 r = −0,867); EAA-10° e VMap (p < 0,01 r = −0,854); EAA-10° e VMml (p < 0,01 r = −0,771), na condição olhos abertos, e EAA-10° e DT (p < 0,05 r = −0,666); EAA-10° e DPap (p < 0,05 r = −0,685) e EAA-10° e VMml (p < 0,05 r = −0,766) na condição olhos fechados. Entorses de tornozelo prejudicam o sentido de posição, sem afetar o equilíbrio.(AU)

Abstract The aim of the study was to compare the behavior of COP and passive ankle position sense in subjects with and without functional ankle instability. Took part in this study 20 subjects, divided into two groups: stable group (SG) and unstable group (UG). The COP evaluation was made with the single-leg balance test, with eyes opened and closed, on a force plate. The passive ankle position sense test was performed with subjects blindfolded. The ankle was positioned in a target angle (10° and 20°) and the dynamometer moved passively the ankle, then the subjects were instructed to push the stop button when they feel that the ankle was on the target angle, obtaining the absolute angular error (AAE). The following variables were obtained: total displacement (TD); antero-posterior (SDap) and medio-lateral standard deviation (SDml); total mean velocity (TMV); antero-posterior (MVap) and medio-lateral mean velocity (MVml). The comparison between the data with normal distribution was made with the Student's t test, while to the TD and SDml was used the Mann-Whitney test. The correlations were performed with the Pearson and Spearman tests. We adopted α < 0.05. We observed difference between AAE-10° (p < 0.05). Strong correlations were found between: AAE-10° and TMV (p < 0.01 r = −0.867); AAE-10° and MVap (p < 0.01 r = −0.854); AAE-10° and MVml (p < 0.01 r = −0.771), with eyes opened, and AAE-10° and TD (p < 0.05 r = −0.666); AAE-10° and SDap (p < 0.05 r = −0,685) and AAE-10° and MVml (p < 0.05 r= −0.766) with eyes closed. Ankle sprains harm the joint position sense without affecting the balance.(AU)

The role of extrinsic ligaments in maintaining carpal stability - A prospective statistical analysis of 85 arthroscopic cases.

Several biomechanical studies have shown that the scapholunate (SL) and lunotriquetral (LT) ligaments are not the only stabilizers of the proximal carpal row. However, no study has yet analyzed the range of ligament lesions leading to instability in vivo. Arthroscopy has been used to assess the condition of the wrist's extrinsic ligaments by palpating and tensioning the various ligament and capsule structures. In this prospective study, this arthroscopic method was used in 85 cases of wrist sprain without static instability to evaluate the correlation between lesions of the intrinsic and extrinsic carpal ligaments and carpal instability. In SL instability, a scapholunate interosseous ligament (SLIL) lesion was statistically correlated with lesions of the long radiolunate ligament (P<0.05). There also was a statistically significant correlation between lesions of the SLIL and the radioscaphocapitate, scaphotrapezial and dorsal intercarpal ligaments. There was a correlation between the stage of SL instability and the number of lax extrinsic ligaments (P<0.05) but not with the severity of the extrinsic ligament lesions. In LT instability, a LT interosseous ligament lesion was statistically correlated with lesions of the dorsal intercarpal ligament (P<0.05). There also was a correlation between the stage of LT instability and the number (P<0.005) and severity (P<0.001) of the extrinsic ligament lesions. Arthroscopy can reveal hidden radiographic instability and can also be used to define the number and severity of injured ligaments. In carpal instability, a lesion of one intrinsic carpal ligament was associated with a lesion of one or more extrinsic ligaments.

Duration of sick leave after surgical repair of the ulnar collateral ligament of the thumb metacarpophalangeal joint with K-wire immobilization: Prospective case series of 21 patients.

Surgical repair of the ulnar collateral ligament (UCL) of the thumb metacarpophalangeal (MCP) joint after complete rupture is usually protected by cast immobilization, which hinders return to work. The goal of this study was to determine the duration of sick leave for patients who had 6 weeks of K-wire immobilization instead of cast immobilization after surgical repair of the UCL. This prospective, observational, non-comparative study included patients who had surgical repair of the UCL of the thumb MCP joint followed by K-wire immobilization. Manual laborers were excluded. The main outcome measure was the duration of sick leave. The other outcomes were the need to adapt to the work duties and the patient's subjective assessment of the result. The data were collected by telephone interview. Twenty-one patients were included, 13 (62%) of whom returned to work within 7 days. The average sick leave duration was 3 weeks and 2 days; 10% of patients required adaptation of the work duties. The average satisfaction score was 4.4 out of 5. The average follow-up was 3 years and 5 months. There were no complications. In conclusion, K-wire immobilization after surgical repair of the UCL of the thumb MCP joint, along with precautionary measures is an option that allows early return to work, except for manual labourers.

Entorse de tornozelo / Ankle sprain

Uma breve revisão atualizada sobre entorses de tornozelo com foco nas lesões ligamentares do tornozelo. Este é um assunto de grande importância no cotidiano médico devido aos seus altíssimos níveis de incidência. Essa revisão, de uma maneira sucinta, tem como objetivo elucidar a epidemiologia, o diagnóstico e o manejo dessa patologia.

A brief updated revision about ankle sprain focused on ligament injuries of the ankle. This is a major issue in medical practice due to its extremely high level of incidence. This review, briefly, aims to elucidate the epidemiology, diagnosis and treatment of this pathology.

The effect of 8-weeks proprioceptive exercise program in postural sway and isokinetic strength of ankle sprains of Tunisian athletes.

OBJECTIVE: Our objective is to investigate the effects of proprioceptive exercises rehabilitation on isokinetic strength and postural balance in athletes with sprain ankle. MATERIALS AND METHODS: The ankles of 16 subjects were tested: eight in the functional instability (FI) group and eight non-injured (NI) subjects in the control group. Subjects were asked to take part in a testing session. The test order for the postural stability and isokinetic strength tests was randomized to avoid learning or fatigue effects. The testing session started with a 5-minute warm-up. Subjects were then instructed to perform several lower body flexibility exercises. The test procedure consisted in static assessments, where single-limb (right and left) stance postural stability was assessed. Three practice trials were allowed for each subject. The assessment quantifies postural sway velocity while the athlete stands calmly on one foot on the force plate, for each leg. They were asked to stand as still as possible for 30s, upper limbs along the body. The subjects were requested to maintain balance with eyes open and then with the eyes closed on the firm surface. The sway velocity (in degrees per second) is given for all trials. Subjects were allowed a 1-minute rest between tests. The regime of isokinetic evaluation of dorsi-plantar flexions is concentric, with three successive speeds: slow (30°/s, reps 5), average (60°/s, reps 10), and fast (120°/s, reps 15), according to the protocol established by European Group for the development and the isokinetic research and the procedural guidelines. Relative moment of strength and times of acceleration and deceleration were calculated for each set of isokinetic testing repetitions per body side, muscle group and testing speed. RESULTS: The results of tests-retest and between both groups (injured vs. healthy) show that after eight weeks of proprioceptive work, significant increase of maximal strength, decrease in times of acceleration and deceleration at the level of plantar flexors and better stability of the injured limb at slow and average (P<0.05). For the healthy limb, improvements varying from 1 to 39% were obtained between test and retest on all the variables. However, these variations were not statistically significant. CONCLUSION: Proprioceptive training exercises can effectively stabilize an unstable ankle above for muscular and postural control. However, 8 weeks does not assess whether we have achieved maximum effect. In addition, we do not know to what extent these effects will continue over time. It would be interesting to later re-evaluate the athletes for the effect of this treatment, which is based on a proprioceptive training program on a year or more.

Interest of rehabilitation in healing and preventing recurrence of ankle sprains.

UNLABELLED: To assess the impact of rehabilitation on healing and recurrence rate of ankle sprain, 1year apart, 111 patients, who suffered an ankle sprain (67 men and 44 women; 17 mild sprains, 67 medium and 27 severe), were included by emergency physicians of four emergency rooms (ER) of Finistère. The physician was free to prescribe, or not, further investigations. He prescribed systematically to patients RICE (rest, ice, compression, elevation) protocol, put an ankle brace, and gave a prescription of standardized rehabilitation. The prescription was the same for the four ER. All patients were recalled to 1year. Of the 111 patients initially included, 21 patients were excluded for lack of response after three phone calls. In the end, 90 patients were assessable (56 men and 34 women), mean age 31.4±12.6years (range 15-55) at the time of initial trauma. Emergency physicians had diagnosed, initially, 16 mild sprains (17.8%), 56 medium sprains (62.2%) and 18 severe sprains (20%). Of the 90 patients, 73 patients have been rehabilitated (81.1%). Of the 44 accidents of everyday life, 31 were rehabilitated (70.5%). Of the 27 sports accidents, 25 were rehabilitated (92.6%). Of the 19 work-related injuries, 17 were rehabilitated (89.5%). There is no significant relationship between rehabilitation and no recurrence (P=0.45) nor between rehabilitation and full recovery of the ankle (P=0.59). CONCLUSION: We find no association between rehabilitation and prevention of recurrence, nor between rehabilitation and healing of patients. However, our study is limited by the small size of the non-rehabilitated group.

[Finger bone and joint trauma of the hand in children]. / Les fractures, luxations et entorses digitales chez l'enfant.

The hand is the most commonly injured location of a child. Fractures of the digits are the most frequent lesions with two specific locations: 1) in the young child, the fracture is usually a crush injury, such as occurs when a hand gets caught in a door, with lesion of the distal phalanx; soft tissue associated injuries are the main problem in this location; 2) in the older child, the fracture is usually secondary to recreational sports, with lesion on the proximal phalanx of the second and fifth digits. Dislocations or sprains are less common. Most interphalangeal joint injuries occur at the proximal interphalangeal joint and are secondary to hyperextension with as results a volar plate injury. Most fingers injuries in children are treated non operatively with a favorable outcome. The treating physician should however identify those clinical situations that require surgery, as complications are most commonly due to a failure to identify and treat an injury requiring an operation acutely. These injuries include intra-articular fractures, displaced phalangeal neck fractures, and malrotated fractures. Malrotation or intra-articular malunion have no remodeling capacity. Non-union and stiff digits are uncommon but a significant trauma or a high-energy mechanism with severe soft tissues injuries appears to be a factor of risk.

Alterações neuromusculares no quadril associadas a entorses do tornozelo: revisão de literatura / Neuromuscular alterations on the hip associated to ankle sprains: literature review

INTRODUÇÃO: O tornozelo é a articulação mais frequentemente lesada na vida diária e nas atividades esportivas, sendo a entorse em inversão a lesão mais comum, com importantes repercussões funcionais e alto índice de recorrência após um evento de entorse primário. Os efeitos da lesão no tornozelo não se restringem a essa articulação, de modo que alterações na ativação e força da musculatura do quadril têm sido observadas após entorses em inversão do tornozelo. Essas alterações podem modificar o posicionamento do pé no instante do toque do calcanhar no solo, tornando o tornozelo mais suscetível à lesão por inversão. OBJETIVOS: O propósito deste estudo foi realizar uma revisão dos estudos da literatura que analisaram alterações neuromusculares presentes na articulação do quadril associadas a entorses em inversão do tornozelo. MATERIAIS E MÉTODOS: Foi realizada uma busca em bases eletrônicas (PubMed, MEDLINE, Cochrane, Web of Science, PEDro, SciELO, LILACS e Embase), do ano de 1966 até 2009, tendo sido encontrados 13 trabalhos considerados pertinentes ao tema. RESULTADOS: Desses estudos, nove observaram alterações de força e/ou recrutamento dos músculos do quadril após entorses do tornozelo, sugerindo-se que as consequências da lesão local manifestam-se também em estruturas proximais no membro inferior, com possível influência na ocorrência de recidivas. Apenas dois trabalhos foram análises prospectivas e não evidenciaram alterações neuromusculares no quadril antes da lesão do tornozelo, sugerindo-se que as alterações de força e/ou recrutamento dos músculos do quadril são provavelmente secundárias à lesão articular distal. CONCLUSÃO: Mais estudos, com maior uniformidade metodológica, são necessários para maior elucidação sobre a questão.

INTRODUCTION: The ankle is the most frequently injured joint both in athletics and daily life, and the inversion sprain is the most common injury with significant functional repercussion, given the high recurrence rate after a primary sprain. The effects of ankle injury are not restricted to that joint and changes in the recruitment and strength of the hip muscles have been found after ankle inversion sprains. These changes may implicate in modified positions of the foot in gait during heel strike, making the ankle more susceptible to inversion injury. OBJECTIVES: The purpose of this article was to perform a review of the literature studies that have analyzed the neuromuscular alterations of the hip joint associated with ankle inversion sprains. MATERIALS AND METHODS: A search in electronic databases (PubMed, MEDLINE, Cochrane, Web of Science, PEDro, SciELO, LILACS and Embase) was performed from 1966 to 2009, with 13 studies found to be pertinent to this matter. RESULTS: Among these, nine have found alterations in strength and/or recruitment of the hip muscles after an ankle sprain, suggesting that the implications of the local injury also manifest in proximal structures of the lower limb, with possible influence in recurrence of the injury. Only two articles were prospective analysis, and in those no evidence of neuromuscular alterations on the hip was found prior to the ankle injury, suggesting that the changes in strength and firing of the hip muscles are probably secondary to the distal lesion. CONCLUSION: More studies, with more methodological uniformity, are necessary for further elucidation on this matter.

Effect of high-voltage pulsed current plus conventional treatment on acute ankle sprain / Efeito da adição da estimulação de alta voltagem ao tratamento convencional do entorse de tornozelo numa etapa aguda

BACKGROUND: The effectiveness of high-voltage pulsed current (HVPC) treatments in humans as a means of controlling edema and post-traumatic pain has not yet been established. Objective: To analyze the effects of HVPC plus conventional treatment on lateral ankle sprains. METHODS: This was a randomized, controlled, double-blind clinical trial with three intervention groups: CG (control group with conventional treatment); HVPC(-) group (conventional treatment plus negative polarity HVPC); HVPC(+) group (conventional treatment plus positive polarity HVPC). Twenty-eight participants with lateral ankle sprain (2 to 96h post-trauma) were evaluated. Conventional treatment consisted of cryotherapy (20min) plus therapeutic exercises. Additionally, the HVPC(-) and HVPC(+) groups received 30min of electrical stimulation (submotor level; 120 pps). Pain, edema, range of motion (ROM) and gait were assessed before the first treatment session and after the last treatment session. RESULTS: At the final evaluation, there were no significant differences between groups. Nevertheless, the HVPC(-) group had greater values in all assessed parameters. The data analysis showed that the HVPC(-) group had greater reductions in volume and girth, and greater recovery of ROM and gait velocity. This group also reached the end of the treatment (1.7 weeks; range 1.2-2.2) faster than the HVPC(+) group and the CG (2.2 weeks; range 1.8-2.6). CONCLUSIONS: There were no differences between the study groups, but the results suggest that HVPC(-) can accelerate the initial phase of recovery from ankle sprain.

CONTEXTUALIZAÇÃO: A eficácia da estimulação elétrica de alta voltagem (EEAV) em humanos, como uma forma de tratamento para controlar o edema e a dor pós-traumáticos, ainda não foi estabelecida. OBJETIVO: Analisar o efeito da adição da EEAV ao tratamento convencional do pós-entorse de tornozelo em humanos. MÉTODOS: Ensaio clínico controlado e aleatorizado, duplo cego com três grupos de intervenção: grupo controle (GC) com tratamento convencional; tratamento convencional EEAV(-) e polaridade negativa EEAV (-); tratamento convencional e EEAV polaridade positiva EEAV(+). Vinte e oito portadores de entorse lateral do tornozelo (2 a 96 horas pós-trauma) foram avaliados. O tratamento convencional consistiu em crioterapia (20 minutos) e exercício terapêutico. Adicionalmente, os grupos EEAV(-) e EEAV(+) receberam 30 minutos de estimulação elétrica (nível submotor, 120pps). As variáveis de dor, edema, amplitude de movimento (ADM) e marcha foram avaliadas antes da primeira sessão de tratamento e após a última sessão de tratamento. RESULTADOS: Na avaliação final, não houve diferenças significativas entre os três grupos. Porém, os indivíduos do grupo EEAV(-) demonstraram valores superiores em todos os parâmetros de avaliação. A análise dos dados mostrou que o EEAV(-) apresentou maior redução do volume e do perímetro, maior recuperação da ADM e da cadência da marcha. Esse grupo também alcançou o término de tratamento mais rápido (1,7 semanas [1,2-2,2]), comparado com o EEAV(+) e o GC (2,2 semanas [1,8-2,6]). CONCLUSÕES: Não houve diferença entre os grupos estudados, mas os resultados sugerem que a EEAV(-) pode contribuir para acelerar a recuperação do entorse de tornozelo em sua fase inicial.

Avaliação funcional dos pacientes operados pelatécnica cirúrgica de brostrõm devido à instabilidadelateral crônica do tornozelo / The outcome of patients who underwent the brostrõm's technique with chronic lateral ankle instability

Objetivo. As entorses do complexo lateral do tornozelo são lesões freqüentementeencontradas na prática de atividades físicas, sendo o ligamento fibulotalar anterior o mais comumente lesado; a maioria delas responde satisfatoriamente ao tratamento conservador. Parte dos pacientes desenvolve dor e instabilidade crônica, necessitando tratamento cirúrgico. A proposta deste estudo foi avaliar os pacientes operados pela técnica de Brostrõm devido à instabilidade lateral crônica do tornozelo.MétodosForam analisados no Hospital e Maternidade Celso Pierro 20 pacientes cominstabilidade lateral crônica do tornozelo submetidos à técnica cirúrgica deBrostrõm, sendo onze mulheres e nove homens, com média de idade de 32,7 anos. Os pacientes foram submetidos à avaliação clínica funcional por meio dos protocolos da American Orthopaedics Foot and Ankle Society e Maryland Foot Score no momento da indicação cirúrgica e um ano após a cirurgia. Resultados As avaliações pós-operatórias mostraram acréscimo de zero a 64, com média de 25,1 pontos, pelo protocolo da American Orthopaedics Foot and Ankle Society, e de zero a 45 com média de 14,6 pontos pelo protocolo da Maryland Foot Score, que classificou 14 resultados como excelentes (70%), cinco como bons (25%), e um como regular (5%). ConclusãoA técnica de Brostrõm mostrou-se eficaz no tratamento das instabilidades laterais crônicas do tornozelo.

Objective Spraining of the ankle's lateral complex are lesions that occur frequently during the practice of sports activities. The anterior fibulotalar ligament is most commonly affected and usually responds well to non-surgical treatment. The patients that present pain and chronic instability usually require surgery. The purpose of this study was to evaluate the patients who underwent the Brostrõm?s technique with chronic lateral ankle instability.MethodsTwenty patients were analyzed at the Maternity Hospital Celso Piero. Eleven women and nine men, with an average age of 32.7 years, presenting chronic lateral instability were submitted to surgery using the Brostrõm?s technique. A clinical analysis of the patients was done at the moment of the surgical indication and one year after the procedure. The parameters analyzed were based on the protocols established by the American Orthopaedics Foot and Ankle Society (AOFAS) and Maryland Foot Score.ResultsThe post-operative scores showed an increase of zero to 64 points, with an average of 25.1 points according to the American Orthopaedics Foot and Ankle Society protocol. An increase of zero to 45 points, with the average of 14.6 points was observed using the Maryland Foot Scores, being 14 results classified as excellent (70%), five as effective (25%) and one as regular (5%).ConclusionThe Brostrõm?s technique therefore presents good results for the surgicaltreatment of chronic lateral instabilities of the ankle.