Antegrade posterior column screw fixation for acetabular fractures: It's time to standardize the surgical technique.

Antegrade fixation of posterior column fractures of the acetabulum is challenging due to the narrow corridor and risk of screw misplacement. Although both antegrade and retrograde lag screws have been previously described for posterior column fracture fixation, the literature lacks a standardized technique for correct and safe screw placement, especially in an antegrade fashion. This technical note aims to optimize intraoperative images during posterior screw insertion using the antegrade technique, according to predetermined landmarks to save surgical time, decrease radiation exposition, and prevent surgical complications.

Bone Marrow Aspirate Concentrate Improves Outcomes in Adults With Osteochondral Dissecans of the Talus and Achilles Rupture.

PURPOSE: The objective of this systematic literature review was to investigate the effects of the clinical application of bone marrow aspirate (BMA) and/or bone marrow aspirate concentrate (BMAC) in tendon and cartilage injuries in the foot and ankle. METHODS: A search of the Embase, MEDLINE/PubMed, CINAHL, and Cochrane databases was performed in January 2021. The risk of bias of the studies was assessed using the tool "A Cochrane Risk of Bias Assessment Tool for Non-Randomized Studies." The outcomes analyzed included pain reduction and functional improvement with the use of BMA/BMAC in patients with tendon and cartilage injuries in the foot and ankle. RESULTS: Eleven studies met the inclusion criteria for analysis, involving a total of 527 subjects with osteochondral lesions (OCLs) of the talus, cartilage lesions of the talus, and acute Achilles tendon rupture. BMAC was applied alone in 4 studies, and in 7 studies, it was compared with other techniques such as matrix-induced autologous chondrocyte implantation, particulate juvenile articular cartilage, or microfracture. Interventions demonstrated improved function and reduced foot and ankle pain and showed no serious adverse effects. CONCLUSIONS: Evidence indicates that BMAC provides good clinical results, with improved function and reduced pain in adults with OCL and cartilage lesions of the talus and acute Achilles tendon rupture. LEVEL OF EVIDENCE: Level IV, systematic review of level II to IV studies.

FRAGILITY FRACTURES IN BRAZIL: CROSS-SECTION STUDY.

Objective: To evaluate the involvement of orthopedists and orthopedic residents with fragility fractures, in its clinical, therapeutic, and social aspects. Methods: Cross-sectional observational and prospective study that took place in the period from June to August 2020. Results: 540 participants were analyzed. The population consisted of orthopedists (85.56%; N = 462) and residents (14.44%; N = 78), with a greater proportion of individuals from 41 to 50 years of age (36.67%; N = 198) and from the Southeast region (57.22%; N = 309). For 47.04% (N = 254) of the participants, the profile of the patient at risk for fragility fracture corresponds to: woman, sedentary, smoker and over 60 years of age. The consensus among the participants (97.96%; N = 529) is that fragility fractures occur in or near home environments. Moreover, 47.59% (N = 257) believe that the first fragility fracture is the most important predictive risk factor for subsequent occurrences and 63.89% (N = 345) of the participants claim to attend more than 15 cases per year. Regarding treatment, 74.44% (N = 402) are dedicated exclusively to orthopedic aspects (68.33%; N = 369). However, 62.41% (N = 337) of the participants believe that patients with fragility fractures should receive medication and supplements. Likewise, 70.74% (N = 382) of the participants consider that home security measures and training of family members are important, and they attribute the role to the multidisciplinary team. Conclusions: Fragility fractures are frequent in the routine of Brazilian orthopedists. However, they are not familiar with adjuvant treatments for fragility fractures, acting almost exclusively in the orthopedics aspects of these injuries. Level of Evidence II, Prospective Study.

Objetivo: Avaliar o entendimento entre ortopedistas e residentes em ortopedia sobre as fraturas por fragilidade, em seus aspectos clínicos, terapêuticos e sociais. Métodos: Estudo transversal, observacional e prospectivo que ocorreu no período de junho de agosto de 2020. Resultados: Foram analisados 540 participantes. A população foi composta por ortopedistas (85,56%; N = 462) e residentes (14,44%; N = 78), com prevalência de idade entre 41 e 50 anos (36,67%; N=198) e oriundos da região Sudeste (57,22%; N = 309). Para 47,04% (N = 254) dos participantes o perfil do paciente em risco para fratura por fragilidade corresponde a: mulher, sedentária, tabagista e acima dos 60 anos de idade. Sendo consenso entre os participantes (97,96%; N = 529) que as fraturas por fragilidade ocorrem em ambientes domiciliares ou próximo a eles. Além disso, 47,59% (N = 257) dos participantes acreditam que a primeira fratura por fragilidade seja o fator de risco preditivo mais importante para novo episódio de fratura e 63,89% (N = 345) dos avaliadores atendem mais de 15 casos por ano. Em relação ao tratamento, 74,44% (N = 402) dedicam-se exclusivamente aos aspectos ortopédicos (68,33%; N = 369). No entanto, 62,41% (N = 337) dos participantes acreditam que paciente devam receber medicamentos e suplementos. Da mesma forma, 70,74% (N = 382) dos avaliadores consideram que medidas de segurança domiciliar e treinamento de familiares sejam importantes e atribuídas a equipe multiprofissional. Conclusão: As fraturas por fragilidade são frequentes na rotina dos ortopedistas brasileiros. No entanto, estes não estão familiarizados com tratamentos adjuvantes nas fraturas consideradas por fragilidade, atuando quase que exclusivamente nos aspectos ortopédicos envolvidos nestas lesões. Nível de Evidência II, Estudo Prospectivo.

Fragility fractures in brazil: cross-section study / Fraturas por fragilidade no brasil: estudo transversal

ABSTRACT Objective: To evaluate the involvement of orthopedists and orthopedic residents with fragility fractures, in its clinical, therapeutic, and social aspects. Methods: Cross-sectional observational and prospective study that took place in the period from June to August 2020. Results: 540 participants were analyzed. The population consisted of orthopedists (85.56%; N = 462) and residents (14.44%; N = 78), with a greater proportion of individuals from 41 to 50 years of age (36.67%; N = 198) and from the Southeast region (57.22%; N = 309). For 47.04% (N = 254) of the participants, the profile of the patient at risk for fragility fracture corresponds to: woman, sedentary, smoker and over 60 years of age. The consensus among the participants (97.96%; N = 529) is that fragility fractures occur in or near home environments. Moreover, 47.59% (N = 257) believe that the first fragility fracture is the most important predictive risk factor for subsequent occurrences and 63.89% (N = 345) of the participants claim to attend more than 15 cases per year. Regarding treatment, 74.44% (N = 402) are dedicated exclusively to orthopedic aspects (68.33%; N = 369). However, 62.41% (N = 337) of the participants believe that patients with fragility fractures should receive medication and supplements. Likewise, 70.74% (N = 382) of the participants consider that home security measures and training of family members are important, and they attribute the role to the multidisciplinary team. Conclusions: Fragility fractures are frequent in the routine of Brazilian orthopedists. However, they are not familiar with adjuvant treatments for fragility fractures, acting almost exclusively in the orthopedics aspects of these injuries. Level of Evidence II, Prospective Study.

RESUMO Objetivo: Avaliar o entendimento entre ortopedistas e residentes em ortopedia sobre as fraturas por fragilidade, em seus aspectos clínicos, terapêuticos e sociais. Métodos: Estudo transversal, observacional e prospectivo que ocorreu no período de junho de agosto de 2020. Resultados: Foram analisados 540 participantes. A população foi composta por ortopedistas (85,56%; N = 462) e residentes (14,44%; N = 78), com prevalência de idade entre 41 e 50 anos (36,67%; N=198) e oriundos da região Sudeste (57,22%; N = 309). Para 47,04% (N = 254) dos participantes o perfil do paciente em risco para fratura por fragilidade corresponde a: mulher, sedentária, tabagista e acima dos 60 anos de idade. Sendo consenso entre os participantes (97,96%; N = 529) que as fraturas por fragilidade ocorrem em ambientes domiciliares ou próximo a eles. Além disso, 47,59% (N = 257) dos participantes acreditam que a primeira fratura por fragilidade seja o fator de risco preditivo mais importante para novo episódio de fratura e 63,89% (N = 345) dos avaliadores atendem mais de 15 casos por ano. Em relação ao tratamento, 74,44% (N = 402) dedicam-se exclusivamente aos aspectos ortopédicos (68,33%; N = 369). No entanto, 62,41% (N = 337) dos participantes acreditam que paciente devam receber medicamentos e suplementos. Da mesma forma, 70,74% (N = 382) dos avaliadores consideram que medidas de segurança domiciliar e treinamento de familiares sejam importantes e atribuídas a equipe multiprofissional. Conclusão: As fraturas por fragilidade são frequentes na rotina dos ortopedistas brasileiros. No entanto, estes não estão familiarizados com tratamentos adjuvantes nas fraturas consideradas por fragilidade, atuando quase que exclusivamente nos aspectos ortopédicos envolvidos nestas lesões. Nível de Evidência II, Estudo Prospectivo.

Evoked potential as an adjuvant predictive tool for neurological deficit in acetabular and pelvic ring injuries: A meta-analysis.

OBJECTIVES: To identify the value of the evoked potential as an adjuvant predictive tool in pelvic ring and acetabulum fractures focusing on the neurological deficit. MATERIAL AND METHODS: Adhering to PRISMA guidelines, we performed a systematic review with a priori design to identify randomized controlled trials, retrospective and prospective cohort studies, and case-control studies of interventions in acetabular and pelvic ring injuries. The search strategy included the use of Title/Abstract related to: ("somatosensory" or "evoked potential" or "electrophysiology") and ("randomized controlled trials" or "clinical studies" or "controlled clinical trial" or "systematic literature review" or "meta-analysis" or "review" or "overview") and ("complications"). From 01/1985 to 12/2019, we searched MEDLINE, PubMed, EMBASE, and Cochrane, Centre for Reviews and Dissemination, reference lists and journals. The PRISMA checklist was adopted to evaluate reporting quality. Two reviewers independently selected studies and extracted data. Statistical analysis was conducted to assess the probability of evoked potential tests performed on random samples, with the assumption of normal distribution of the populations from which they were derived and knowledge of the parametric variance. RESULTS: Five articles fulfilled eligibility criteria. CONCLUSION: Evoked potential tests can quickly and accurately detect imminent neurological impairment during surgery of acetabular and pelvic ring injuries. This results in significantly better surgical outcomes, although in some cases the irreversible nature of the injury cannot be prevented.

Nailing the fibula: alternative or standard treatment for lateral malleolar fracture fixation? A broken paradigm.

PURPOSE: Despite the fact that open reduction and internal fixation with a plate, either non-locked or locked, is the standard of care for managing lateral malleolus fractures, intramedullary (IM) fixation of the fibula has been recently introduced as an alternative, mainly for some potential complicated situations. We hypothesized that almost all patterns of distal fibula fracture can be safely fixed with an IM device, with the potential benefit of providing biomechanical efficiency, but using a soft-tissue friendly implant. Here, we present a multicenter case series based on a proposed algorithm. PATIENTS AND METHODS: Sixty-nine consecutive patients were managed with fibular IM fixation for closed malleolar fractures. Twenty patients were managed by IM screw fixation and 49 by fibular nailing. Outcome was measured both according to the American Orthopaedic Foot and Ankle Society (AOFAS) score for ankle and hindfoot, and the time to bone union. RESULTS: The mean AOFAS for Group I was 99.35 ± 1.95 points and that for Group II was 89.30 ± 16.98 points. There were no significant differences between the fracture pattern, according to the Lauge-Hansen classification, and post-operative levels of pain and functional activity among patients in both groups (p > 0.05). All fractures healed uneventfully in both groups. The mean time to union for Group I was 8.15 weeks and for Group II was 8.25 weeks (p > 0.05). CONCLUSION: In this multicenter case series, intramedullary fixation for the lateral malleolus fracture presented itself as a viable and safe option for the treatment of almost all patterns of fibula fracture in adults. Overall, we were able to demonstrate the potential indications of the proposed algorithm for the choice of IM implant for the lateral malleolus fracture in terms of the Lauge-Hansen staged classification.

Expanding the indications for calcaneal plates beyond foot fractures: a technical trick and case series.

Although non-locking calcaneal plates are designed to treat calcaneal fractures, they present some interesting characteristics that justify using them beyond their current application in fractures of the foot. Calcaneal plates are malleable, have an increased footprint area for fracture containment or buttressing, and present several hole options for screw placement in different trajectories, thereby providing proper fixation even in comminuted fracture patterns. The aim of this study is to describe the unconventional use of calcaneal plates in the orthopaedic trauma scenario.

Intramedullary nailing of lateral malleolus in ankle fractures - surgical technique and literature review. / Haste intramedular de fíbula nas fraturas maleolares do tornozelo - técnica cirúrgica e revisão da literatura.

Our objective is to describe the technique of intramedullary (IM) nailing of lateral malleolus in the surgical management of ankle fractures. Fracture reduction is performed either percutaneously with a small pointed reduction clamp in simple oblique fractures or using longitudinal traction and rotation for comminuted fractures, thus reducing complications related to open reduction and internal fixation with a plate. The technique has been shown to be simple and reproducible. In addition, the technique allows early weight bearing, which accelerates rehabilitation and potentially fasten fracture healing. IM nailing is a viable option for the fixation of the of lateral malleolus in ankle fractures and should be considered in the surgeon's armamentarium.

Nosso objetivo é descrever a técnica de fixação intramedular (IM) da fíbula no tratamento cirúrgico das fraturas maleolares do tornozelo. A redução é realizada sempre de forma percutânea: quando o traço de fratura é oblíquo simples, utilizamos uma pinça de redução de pontas e quando a fratura apresenta padrão multifragmentar, usa-se tração longitudinal e rotação. Isso reduz as complicações relacionadas à redução aberta e fixação interna com placa. A técnica demonstrou ser simples e reprodutível. Além disso, essa forma de fixação permite apoio precoce do peso corporal, o que acelera o processo de reabilitação e potencialmente acelera a cicatrização da fratura. A fixação IM da fíbula mostrou-se uma opção viável para a fixação do maléolo lateral nas fraturas do tornozelo, devendo ser considerada no arsenal do cirurgião.

Haste intramedular de fíbula nas fraturas maleolares do tornozelo - técnica cirúrgica e revisão da literatura / Intramedullary nailing of lateral malleolus in ankle fractures - surgical technique and literature review

RESUMO Nosso objetivo é descrever a técnica de fixação intramedular (IM) da fíbula no tratamento cirúrgico das fraturas maleolares do tornozelo. A redução é realizada sempre de forma percutânea: quando o traço de fratura é oblíquo simples, utilizamos uma pinça de redução de pontas e quando a fratura apresenta padrão multifragmentar, usa-se tração longitudinal e rotação. Isso reduz as complicações relacionadas à redução aberta e fixação interna com placa. A técnica demonstrou ser simples e reprodutível. Além disso, essa forma de fixação permite apoio precoce do peso corporal, o que acelera o processo de reabilitação e potencialmente acelera a cicatrização da fratura. A fixação IM da fíbula mostrou-se uma opção viável para a fixação do maléolo lateral nas fraturas do tornozelo, devendo ser considerada no arsenal do cirurgião.

ABSTRACT Our objective is to describe the technique of intramedullary (IM) nailing of lateral malleolus in the surgical management of ankle fractures. Fracture reduction is performed either percutaneously with a small pointed reduction clamp in simple oblique fractures or using longitudinal traction and rotation for comminuted fractures, thus reducing complications related to open reduction and internal fixation with a plate. The technique has been shown to be simple and reproducible. In addition, the technique allows early weight bearing, which accelerates rehabilitation and potentially fasten fracture healing. IM nailing is a viable option for the fixation of the of lateral malleolus in ankle fractures and should be considered in the surgeon's armamentarium.

DEMOGRAPHIC ANALYSIS OF ACETABULAR FRACTURES TREATED IN A QUATERNARY CARE HOSPITAL FROM 2005 TO 2016.

OBJECTIVE: Analyze the clinical and sociodemographic data on acetabular fractures in a Brazilian quaternary care hospital and compare with data reported in the literature. METHODS: A descriptive, analytical cross-sectional epidemiological study analyzing 87 patients with acetabular fractures at Hospital São Paulo (UNIFESP/EPM) between 2005 and 2016. Demographic variables such as age, sex, occupation, educational level and color were investigated. Acetabular fractures were classified according to the AO/OTA group and Judet and Letournel classification. Therapeutic approach, hospital length of stay and waiting time for surgery as well as complications were analyzed. Associations were established among the various variables obtained. RESULTS: The mean age of patients with acetabulum fractures was 39.8 years (SD 13.1 years). There was a predominance of posterior wall (34.5%) and dual-column (14.9%) fractures. The average hospital length of stay was 14.4 days. More than 90% of patients underwent a surgical procedure. One-fourth of patients had complications, the main one being infection (12.6%). CONCLUSIONS: Unimodal age distribution was obtained with a predominance of white male economically active patients. There was a predominance of posterior wall fractures. More than 90% of patients underwent surgery before they had been in hospital for 14 days. A statistically significant association was found between complications and exceeded length of hospital stay. Level of evidence II, Retrospective study.

OBJETIVO: Analisar os dados clínicos e sociodemográficos das fraturas acetabulares em um hospital quaternário brasileiro e comparar com dados relatados na literatura. MÉTODOS: Estudo epidemiológico, descritivo, analítico transversal, em que foram analisados 87 pacientes com fraturas acetabulares no Hospital São Paulo (UNIFESP/EPM) entre 2005 e 2016. Variáveis demográficas como idade, sexo, profissão, escolaridade e cor foram pesquisadas. As fraturas acetabulares foram classificadas conforme o grupo AO/OTA e conforme Judet e Letournel. A terapêutica, o tempo de internação e de espera para cirurgia bem como as complicações foram analisadas. Foram feitas associações entre as diversas variáveis obtidas. RESULTADOS: A média de idade dos pacientes vítimas de fraturas do acetábulo foi de 39,8 anos (DP 13,1 anos). Houve predomínio das fraturas da parede posterior (34,5%) e dupla coluna (14,9%). Os pacientes ficaram, em média, 14,4 dias internados. Mais de 90% dos pacientes foram submetidos à abordagem cirúrgica. Um quarto dos pacientes tiveram complicações, sendo a principal, infecção (12,6%). CONCLUSÕES: Foi obtida uma amostra etária unimodal com predomínio de pacientes do sexo masculino, brancos e economicamente ativos. Houve um predomínio das fraturas da parede posterior. Mais de 90% dos pacientes foram operados antes dos 14 dias de internação. Constatou-se uma associação estatisticamente significante entre complicações e tempo excedido de permanência hospitalar. Nível de evidência II, Estudo retrospectivo.

Demographic analysis of acetabular fractures treated in a quaternary care hospital from 2005 to 2016 / Análise demográfica das fraturas do acetábulo tratadas em um hospital quaternário de 2005 a 2016

ABSTRACT Objective: Analyze the clinical and sociodemographic data on acetabular fractures in a Brazilian quaternary care hospital and compare with data reported in the literature. Methods: A descriptive, analytical cross-sectional epidemiological study analyzing 87 patients with acetabular fractures at Hospital São Paulo (UNIFESP/EPM) between 2005 and 2016. Demographic variables such as age, sex, occupation, educational level and color were investigated. Acetabular fractures were classified according to the AO/OTA group and Judet and Letournel classification. Therapeutic approach, hospital length of stay and waiting time for surgery as well as complications were analyzed. Associations were established among the various variables obtained. Results: The mean age of patients with acetabulum fractures was 39.8 years (SD 13.1 years). There was a predominance of posterior wall (34.5%) and dual-column (14.9%) fractures. The average hospital length of stay was 14.4 days. More than 90% of patients underwent a surgical procedure. One-fourth of patients had complications, the main one being infection (12.6%). Conclusions: Unimodal age distribution was obtained with a predominance of white male economically active patients. There was a predominance of posterior wall fractures. More than 90% of patients underwent surgery before they had been in hospital for 14 days. A statistically significant association was found between complications and exceeded length of hospital stay. Level of evidence II, Retrospective study.

RESUMO Objetivo Analisar os dados clínicos e sociodemográficos das fraturas acetabulares em um hospital quaternário brasileiro e comparar com dados relatados na literatura. Métodos: Estudo epidemiológico, descritivo, analítico transversal, em que foram analisados 87 pacientes com fraturas acetabulares no Hospital São Paulo (UNIFESP/EPM) entre 2005 e 2016. Variáveis demográficas como idade, sexo, profissão, escolaridade e cor foram pesquisadas. As fraturas acetabulares foram classificadas conforme o grupo AO/OTA e conforme Judet e Letournel. A terapêutica, o tempo de internação e de espera para cirurgia bem como as complicações foram analisadas. Foram feitas associações entre as diversas variáveis obtidas. Resultados: A média de idade dos pacientes vítimas de fraturas do acetábulo foi de 39,8 anos (DP 13,1 anos). Houve predomínio das fraturas da parede posterior (34,5%) e dupla coluna (14,9%). Os pacientes ficaram, em média, 14,4 dias internados. Mais de 90% dos pacientes foram submetidos à abordagem cirúrgica. Um quarto dos pacientes tiveram complicações, sendo a principal, infecção (12,6%). Conclusões: Foi obtida uma amostra etária unimodal com predomínio de pacientes do sexo masculino, brancos e economicamente ativos. Houve um predomínio das fraturas da parede posterior. Mais de 90% dos pacientes foram operados antes dos 14 dias de internação. Constatou-se uma associação estatisticamente significante entre complicações e tempo excedido de permanência hospitalar. Nível de evidência II, Estudo retrospectivo.

Safety and efficacy of surgical fixation of fibula fractures using an intramedullary nail: a retrospective observational cohort study in 30 patients.

BACKGROUND: Open reduction and internal fixation remains the standard treatment for displaced unstable ankle fractures. Plate fixation represents the most frequently used instrumentation option in fibula fractures and favourable outcomes have been reported. Recently, intramedullary nailing techniques have been suggested as a viable alternative resulting in less soft tissue disruption. The objectives of this study are to describe the surgical technique and to evaluate the safety and efficacy of using an intramedullary nail in patients undergoing surgical fixation of their fibula fracture. METHODS: A total of 30 skeletally mature patients with unstable ankle fracture who underwent intramedullary fixation of their fibula fractures from February 2016 to July 2017 were included in this retrospective study. Patients were evaluated using the Short Form-36 (SF-36) and the American Orthopaedic Foot and Ankle Society (AOFAS) at 18 months after surgery. RESULTS: All patients went on to fracture union. Two patients required a secondary surgical procedure. No patient included in this series developed any wound complications. The mean Physical Component Summary (PCS) of the SF-36 was 53.90 ± 13.3 and the mean Mental Component Summary Score (MCS) was 52.63 ± 11.12. The AOFAS subscale scores were 34.67 ± 1.03 for pain, 42.40 ± 0.2997 for function and 9.50 ± 0.2785 for alignment. CONCLUSIONS: Our study demonstrates promising outcomes associated with intramedullary nail fixation of unstable fibula fractures. We recommend intramedullary nail fixation of fibula fractures to be a safe procedure with a low complication rate. LEVEL OF EVIDENCE: Level 4 retrospective case series.

Does Early Surgical Fixation of Proximal Femoral Fractures in Elderly Patients Affect Mortality Rates?

Objective To analyze whether a reduction in the waiting time for orthopedic surgery in elderly patients with fracture of the proximal end of the femur leads to a reduction in in-hospital mortality, 6-month mortality, and duration of hospitalization. Methods This was a retrospective cohort study including 81 patients with intertrochanteric and subtrochanteric fractures who underwent surgical repair between 2015 and 2016 in a referral hospital, before and after a protocol for early surgical fixation (< 48 hours) was implemented. Results The mean length of hospital stay decreased from 17 to 11 days. Regarding the in-hospital mortality rate, five patients died before, and another five died after the protocol was implemented. The 6-month postoperative mortality decreased from 26.7% to 19.4%. The results showed no statistical significance. Conclusion The present study demonstrated that there is a tendency to reduce the length of hospital stay and 6-month mortality when the surgery for the treatment of proximal femoral fractures in the elderly is performed within 48 hours of hospitalization.

Does Early Surgical Fixation of Proximal Femoral Fractures in Elderly Patients Affect Mortality Rates? / A cirurgia precoce nas fraturas do fêmur proximal em idosos reduz a taxa de mortalidade?

Abstract Objective To analyze whether a reduction in the waiting time for orthopedic surgery in elderly patients with fracture of the proximal end of the femur leads to a reduction in in-hospital mortality, 6-month mortality, and duration of hospitalization. Methods This was a retrospective cohort study including 81 patients with intertrochanteric and subtrochanteric fractures who underwent surgical repair between 2015 and 2016 in a referral hospital, before and after a protocol for early surgical fixation (< 48 hours) was implemented. Results Themean length of hospital stay decreased from17 to 11 days. Regarding the in-hospital mortality rate, five patients died before, and another five died after the protocol was implemented. The 6-month postoperative mortality decreased from 26.7% to 19.4%. The results showed no statistical significance. Conclusion The present study demonstrated that there is a tendency to reduce the length of hospital stay and 6-month mortality when the surgery for the treatment of proximal femoral fractures in the elderly is performed within 48 hours of hospitalization.

Resumo Objetivo Analisar se a redução no tempo de espera para cirurgia ortopédica nos pacientes idosos com fratura da extremidade proximal do fêmur impacta na redução da mortalidade intra-hospitalar, da mortalidade em 6 meses de seguimento, e na redução do tempo de internação hospitalar. Métodos Trabalho de coorte retrospectiva fundamentado na análise de prontuários de 81 pacientes internados com diagnóstico de fratura transtrocanteriana ou subtrocanteriana do fêmur, e submetidos a tratamento cirúrgico em 2015 e 2016 em um hospital de referência no atendimento ao trauma, antes e após a implantação de protocolo para cirurgia em até 48 horas. Resultados Observou-se redução do tempo médio de internação de 17 para 11 dias após a implantação do protocolo. Com relação à mortalidade intra-hospitalar, cinco pacientes faleceram antes da implantação do protocolo, e cinco, após a implantação do protocolo. Referente à mortalidade extra-hospitalar, avaliada em 6 meses de pósoperatório, observou-se uma redução de 26,7% para 19,4%. Os resultados não apresentaram significância estatística. Conclusão Opresente estudodemonstrouque existe uma tendência à redução dotempo de internação hospitalar e damortalidadeem6meses quando a cirurgia para tratamento de fraturas do fêmur proximal no idoso é feita em até 48 horas de internação hospitalar.

Use of a stainless steel locking calcaneal plate for quadrilateral plate buttress in the treatment of acetabular fractures.

Operative fixation of acetabular fractures involving the quadrilateral surface presents a challenging clinical scenario. Classically, quadrilateral plate buttress was achieved via the use of a "seven" plate. More recently, the use of an anatomic, pre-contoured design has been gaining popularity due to its pre-contoured shape and larger footprint, allowing for a wider quadrilateral plate buttress. The current study presents using a stainless steel locking calcaneal plate to obtain similar surface area coverage as the modern pre-contoured quadrilateral plate, but at a lower cost.Level of evidence IV.

EVALUATION AND COMPARISON OF OPEN AND CLOSED TIBIA SHAFT FRACTURES IN A QUATERNARY REFERENCE CENTER.

INTRODUCTION: Tibia shaft fractures are among the most common in orthopedic practice, but Brazilian literature remains limited on the subject. OBJECTIVE: To evaluate the characteristics of tibia shaft fractures and conduct a comparison between exposed and closed fractures of the tibia. METHODS: This comparative prospective study examined all tibia shaft fractures admitted to our services over a twelve-month period. The cases were evaluated according to age, trauma mechanism, sex, associated fractures, treatment, hospital stay, and readmission rate during the six months after discharge. RESULTS: Fifty-three cases met the inclusion criteria. The average age was 36 years (SD 14.3) and 83% were males (p<0.001). Traffic accidents were responsible for 73.6% of fractures (p<0.001). Exposed fractures were found in 52.8% of the cases (p=0.56). When initial treatment consisted of stabilization with external fixation, these cases were more likely to be rehospitalized (p=0.009). Cases of open fracture also had longer hospital stays (p<0.001) and a higher readmission rate (p=0.028). CONCLUSION: Open fractures are associated with more severe trauma, expressed in longer hospital stays and high rates of readmission. Cases of fracture which were initially treated with external fixation had a higher readmission rate. Level of Evidence II; Prospective comparative study.

INTRODUÇÃO: Fratura diafisária de tíbia é uma das fraturas mais comuns na prática ortopédica, porém a literatura brasileira ainda é limitada na sua avaliação. OBJETIVO: Avaliar as características das fraturas diafisárias de tíbia e realizar uma comparação entre as expostas e fechadas. MATERIAL E MÉTODOS: Foi realizado um estudo, prospectivo comparativo por 12 meses, com todas as fraturas diafisárias de tíbia admitidas. Os pacientes foram avaliados nos seguintes critérios: idade, mecanismo de trauma, sexo, fraturas associadas, tratamento, tempo de internação e índice de reinternação nos seis meses subsequentes à alta. RESULTADOS: Foram avaliados 53 casos que se encaixavam nos critérios de inclusão. A idade média dos pacientes avaliados no nosso estudo era de 36 anos (DP14,3), 83% eram homens (p<0,001). Acidente de tráfego foi responsável por 73,6% (p<0,001). Lesões expostas foram encontradas em 52,8% (p=0,56). O fixador externo, quando utilizado como método de estabilização inicial, apresentou maior índice de reinternação (p=0,009). As lesões expostas apresentaram tempo de internação (p<0,001) e índice de reinternação superior as fechadas (p=0,028). CONCLUSÕES: As fraturas expostas estão envolvidas com traumas de maior gravidade, tanto pelo tempo aumentado de internação hospitalar quanto pelo alto índice de reinternação. Fraturas tratadas inicialmente com fixador externo apresentam maior taxa de reinternação. Nível de Evidência II; Estudo prospectivo comparativo.

Evaluation and comparison of open and closed tibia shaft fractures in a quaternary reference center / Comparação das fraturas diafisárias de tibia expostas e fechadas em um serviço quaternário

ABSTRACT Introduction Tibia shaft fractures are among the most common in orthopedic practice, but Brazilian literature remains limited on the subject. Objective To evaluate the characteristics of tibia shaft fractures and conduct a comparison between exposed and closed fractures of the tibia. Methods This comparative prospective study examined all tibia shaft fractures admitted to our services over a twelve-month period. The cases were evaluated according to age, trauma mechanism, sex, associated fractures, treatment, hospital stay, and readmission rate during the six months after discharge. Results Fifty-three cases met the inclusion criteria. The average age was 36 years (SD 14.3) and 83% were males (p<0.001). Traffic accidents were responsible for 73.6% of fractures (p<0.001). Exposed fractures were found in 52.8% of the cases (p=0.56). When initial treatment consisted of stabilization with external fixation, these cases were more likely to be rehospitalized (p=0.009). Cases of open fracture also had longer hospital stays (p<0.001) and a higher readmission rate (p=0.028). Conclusion Open fractures are associated with more severe trauma, expressed in longer hospital stays and high rates of readmission. Cases of fracture which were initially treated with external fixation had a higher readmission rate. Level of Evidence II; Prospective comparative study.

RESUMO Introdução Fratura diafisária de tíbia é uma das fraturas mais comuns na prática ortopédica, porém a literatura brasileira ainda é limitada na sua avaliação. Objetivo Avaliar as características das fraturas diafisárias de tíbia e realizar uma comparação entre as expostas e fechadas. Material e Métodos Foi realizado um estudo, prospectivo comparativo por 12 meses, com todas as fraturas diafisárias de tíbia admitidas. Os pacientes foram avaliados nos seguintes critérios: idade, mecanismo de trauma, sexo, fraturas associadas, tratamento, tempo de internação e índice de reinternação nos seis meses subsequentes à alta. Resultados Foram avaliados 53 casos que se encaixavam nos critérios de inclusão. A idade média dos pacientes avaliados no nosso estudo era de 36 anos (DP14,3), 83% eram homens (p<0,001). Acidente de tráfego foi responsável por 73,6% (p<0,001). Lesões expostas foram encontradas em 52,8% (p=0,56). O fixador externo, quando utilizado como método de estabilização inicial, apresentou maior índice de reinternação (p=0,009). As lesões expostas apresentaram tempo de internação (p<0,001) e índice de reinternação superior as fechadas (p=0,028). Conclusões As fraturas expostas estão envolvidas com traumas de maior gravidade, tanto pelo tempo aumentado de internação hospitalar quanto pelo alto índice de reinternação. Fraturas tratadas inicialmente com fixador externo apresentam maior taxa de reinternação. Nível de Evidência II; Estudo prospectivo comparativo.

Safe surgical technique: intramedullary nail fixation of tibial shaft fractures.

Statically locked, reamed intramedullary nailing remains the standard treatment for displaced tibial shaft fractures. Establishing an appropriate starting point is a crucial part of the surgical procedure. Recently, suprapatellar nailing in the semi-extended position has been suggested as a safe and effective surgical technique. Numerous reduction techiques are available to achieve an anatomic fracture alignment and the treating surgeon should be familiar with these maneuvers. Open reduction techniques should be considered if anatomic fracture alignment cannot be achieved by closed means. Favorable union rates above 90 % can be achieved by both reamed and unreamed intramedullary nailing. Despite favorable union rates, patients continue to have functional long-term impairments. In particular, anterior knee pain remains a common complaint following intramedullary tibial nailing. Malrotation remains a commonly reported complication after tibial nailing. The effect of postoperative tibial malalignment on the clinical and radiographic outcome requires further investigation.

Advances in Intramedullary Nailing: Suprapatellar Nailing of Tibial Shaft Fractures in the Semiextended Position.

Reamed locked intramedullary nailing remains the standard treatment for displaced tibial shaft fractures. Supra-patellar tibial nailing in the semiextended position has been suggested as a safe and effective surgical technique that allows mitigating certain challenges of the standard subpatellar approach. Suprapatellar nailing seems to facilitate achieving and maintaining fracture reduction, particularly in proximal third tibia fractures. Preliminary investigations have suggested that this technique is associated with a low rate of complications, including a reduced incidence of postoperative anterior knee pain. Further clinical investigations are necessary to establish overall complication rates and long-term subjective outcomes.

Treatment of chronic plantar fasciitis with extra corporeal shock wave therapy: ultrasonographic morphological aspect and functional evaluation / Tratamento da fasciíte plantar crônica pela terapia de ondas de choque: avaliação morfológica ultrassonográfica e funcional

Objective: This paper has the purpose to analyze prospectively the treatment results in patients with chronic plantar fasciitis resistant to conservative treatment who underwent extracorporeal shock wave therapy (ESWT). Methods: We evaluated 30 patients (36 feet); 16 (53.3%) patients were male and 14 (47.7%) female with mean age of 48.7 y.o., varying from 33 to 78 y.o.; 16 (53.3%) present the problem on the left side, 14 (46.7%) on the right ones and 6 (20%) bilateral; the symptomatology varied from 6 to 60 months, with the average of 13.58 months. These patients were submitted to a weekly ESWT session for 4 consecutive weeks. We measured the plantar fascia thickness millimeters with ultrasound and we applied American Orthopaedic Foot and Ankle Society (AOFAS) scale for ankle and hindfoot, and Roles & Maudsley scales in pre ESWT, after one, three and six months after and decrease in the plantar fascia thickness by the ultrasound (p = 0.011) along the different moments studied. Results: We observed improvement of the evaluated criteria (p < 0.001) and plantar fascia thickness by ultrasound (p = 0.011) at different time points studied. Conclusion: The ESWT can be considered an important tool in the primary or adjuvant treatment of the chronic plantar fasciitis when associated with conventional therapies. This methodology is safe, non-invasive and provides precocious rehabilitation and return to regular activities considering the results of the statistical analysis. This resource provides decrease in the thickness of the plantar fascia. .

Objetivo: Este trabalho teve como objetivo analisar prospectivamente os resultados do tratamento com terapia de ondas de choque (TOC) em pacientes portadores de fasciíte plantar crônica resistente ao tratamento conservador. Métodos: Obtivemos 30 pacientes (36 pés), 16 (53,3%) do sexo masculino e 14 (47,7%) do feminino, cuja idade, em média, foi de 48,37 anos, com variação de 33 a 78 anos; 16 (53,3%) apresentavam a afecção no pé esquerdo, 14 (46,7%) no direito e seis (20%) bilateralmente; a sintomatologia variou de seis a 60 meses, com média de 13,58 meses. Os pacientes foram submetidos a uma sessão semanal de TOC por quatro semanas consecutivas. Mensuramos a espessura da fáscia plantar em milímetros pelo ultrassom e usamos a escala da American Orthopaedic Foot and Ankle Society (AOFAS) para tornozelo e retropé e a escala de Roles & Maudsley nos momentos pré-TOC, após o primeiro, o terceiroeosexto meses após a aplicação. Resultados: Observamos melhoria dos critérios avaliados (p < 0,001) e da espessura da fáscia plantar pelo ultrassom (p = 0,011) nos diferentes momentos estudados. Conclusão: A TOC pode ser considerada importante instrumento no tratamento primário ou adjuvante da fasciíte plantar crônica, quando aliada às terapias convencionais. Essa metodologia é segura, não invasiva e promove reabilitação e retorno precoces às atividades habituais pelos resultados das análises estatísticas. Proporciona também redução da espessura da fáscia plantar. .