TRANSOLECRANON FRACTURE-DISLOCATION: CONCEPTS AND FUNCTIONAL RESULTS OF SURGICAL TREATMENT.

Objectives: This study aimed to evaluate the functional results of the treatment protocol for the treatment of transolecranon fracture-dislocation, by surgical reduction and osteosynthesis with plate and screws, in patients attended at a referral hospital for orthopedic trauma, with a minimum follow-up period of six months. Methods: Twenty-five individuals treated surgically from January 2014 to November 2018 were selected for a primary observational longitudinal study using questionnaires to assess upper limb and elbow function (DASH and MEPS), quality of life (SF-12), pain (visual analog scale - VAS), and radiographic evaluation in anteroposterior and lateral views of the elbow. Results: Fifteen patients were male, and the mean age was 46.8 years. All participants had their fractures consolidated, with no radiolgraphic signs of implant failure, or degenerative arthritis. Mean range of motion was reduced relative to the contralateral limb: 102.6º for flexion-extension and 132.8º for pronation-supination. The mean MEPS and DASH scores were 89.6 and 16.5 respectively. There was no residual pain in 84% of the cases according to the VAS. Conclusion: The surgical treatment proposed for transolecranon fracture-dislocations showed satisfactory results according to MEPS, DASH scores and quality of life measures. Evidence Level IV; Retrospective observational study.

Objetivo: Avaliar os resultados funcionais do protocolo de tratamento da fratura-luxação transolecraniana, por redução cirúrgica e osteossíntese com placa e parafusos, nos pacientes atendidos em hospital de referência para trauma ortopédico, com seguimento mínimo de seis meses. Métodos: vinte e cinco indivíduos tratados cirurgicamente de janeiro de 2014 a novembro de 2018 foram selecionados para um estudo longitudinal observacional primário, utilizando questionários para avaliar a função do membro superior e cotovelo (DASH e MEPS), qualidade de vida (SF-12), dor (visual escala analógica - EVA), e avaliação radiográfica nas incidências anteroposterior e perfil do cotovelo. Resultados: Quinze pacientes eram do sexo masculino e a média de idade foi de 46,8 anos. Todos os participantes tiveram suas fraturas consolidadas, sem sinais radiográficos de falha do implante ou artrite degenerativa. A amplitude média do movimento foi reduzida em relação ao membro contralateral: 102,6º para flexo-extensão e 132,8º para pronossupinação. Os escores médios de MEPS e DASH foram 89,6 e 16,5, respectivamente. Não houve dor residual em 84% dos casos de acordo com a EAV. Conclusão: O tratamento cirúrgico proposto para a fratura-luxação transolecraniana apresentou resultados satisfatórios de acordo com MEPS, escores DASH e medidas de qualidade de vida. Nível de evidência IV; Estudo observacional retrospectivo.

Transolecranon fracture-dislocation: concepts and functional results of surgical treatment / Fratura luxação transolecraniana: conceitos e resultados funcionais do tratamento cirúrgico

ABSTRACT Objectives: This study aimed to evaluate the functional results of the treatment protocol for the treatment of transolecranon fracture-dislocation, by surgical reduction and osteosynthesis with plate and screws, in patients attended at a referral hospital for orthopedic trauma, with a minimum follow-up period of six months. Methods: Twenty-five individuals treated surgically from January 2014 to November 2018 were selected for a primary observational longitudinal study using questionnaires to assess upper limb and elbow function (DASH and MEPS), quality of life (SF-12), pain (visual analog scale - VAS), and radiographic evaluation in anteroposterior and lateral views of the elbow. Results: Fifteen patients were male, and the mean age was 46.8 years. All participants had their fractures consolidated, with no radiolgraphic signs of implant failure, or degenerative arthritis. Mean range of motion was reduced relative to the contralateral limb: 102.6º for flexion-extension and 132.8º for pronation-supination. The mean MEPS and DASH scores were 89.6 and 16.5 respectively. There was no residual pain in 84% of the cases according to the VAS. Conclusion: The surgical treatment proposed for transolecranon fracture-dislocations showed satisfactory results according to MEPS, DASH scores and quality of life measures. Evidence Level IV; Retrospective observational study.

RESUMO Objetivo: Avaliar os resultados funcionais do protocolo de tratamento da fratura-luxação transolecraniana, por redução cirúrgica e osteossíntese com placa e parafusos, nos pacientes atendidos em hospital de referência para trauma ortopédico, com seguimento mínimo de seis meses. Métodos: vinte e cinco indivíduos tratados cirurgicamente de janeiro de 2014 a novembro de 2018 foram selecionados para um estudo longitudinal observacional primário, utilizando questionários para avaliar a função do membro superior e cotovelo (DASH e MEPS), qualidade de vida (SF-12), dor (visual escala analógica - EVA), e avaliação radiográfica nas incidências anteroposterior e perfil do cotovelo. Resultados: Quinze pacientes eram do sexo masculino e a média de idade foi de 46,8 anos. Todos os participantes tiveram suas fraturas consolidadas, sem sinais radiográficos de falha do implante ou artrite degenerativa. A amplitude média do movimento foi reduzida em relação ao membro contralateral: 102,6º para flexo-extensão e 132,8º para pronossupinação. Os escores médios de MEPS e DASH foram 89,6 e 16,5, respectivamente. Não houve dor residual em 84% dos casos de acordo com a EAV. Conclusão: O tratamento cirúrgico proposto para a fratura-luxação transolecraniana apresentou resultados satisfatórios de acordo com MEPS, escores DASH e medidas de qualidade de vida. Nível de evidência IV; Estudo observacional retrospectivo.

Protocol of BRICS: Brazilian multicentric pragmatic randomised trial of surgical interventions for displaced diaphyseal clavicle fracture study: MIPO versus ORIF for the treatment of displaced midshaft clavicle fractures.

INTRODUCTION: Fractures of the diaphysis of the clavicle are common; however, treatment guidelines for this condition are lacking. Surgery is associated with a lower risk of non-union and better functional outcomes but a higher risk of complications. Open reduction and internal fixation with plates and screws are the most commonly performed techniques, but they are associated with paraesthesia in the areas of incisions, extensive surgical exposure and high rates of implant removal. Minimally invasive techniques for treating these fractures have a lower rate of complications. The aim of this study is to evaluate which surgical treatment option (minimally invasive osteosynthesis or open reduction and internal fixation) has better prognosis in terms of complications and reoperations. METHODS AND ANALYSIS: The study proposed is a multicentric, pragmatic, randomised, open-label, superiority clinical trial between minimally invasive osteosynthesis and open reduction and internal fixation for surgical treatment of patients with displaced fractures of the clavicle shaft. In the proposed study, 190 individuals with displaced midshaft clavicle fractures, who require surgery as treatment, will be randomised. The assessment will occur at 2, 6, 12, 24 and 48 weeks, respectively. The primary outcome of the study will be the number of complications and reoperations. For sample size calculation, a moderate effective size between the techniques was considered in a two-tailed test, with 95% confidence and 90% power. Complications include cases of infection, hypertrophic scarring, non-union, refracture, implant failure, hypoesthesia, skin irritation and shoulder pain. Reoperations are defined as the number of surgeries for pseudoarthrosis, implant failure, infection and elective removal of the implant. ETHICS AND DISSEMINATION: Study approved by the institutional ethics committee (number 34249120.9.0000.5505-V.3). The results will be disseminated by publications in peer-reviewed journals and presentations in medical meetings. TRIAL REGISTRATION NUMBER: RBR-3czz68)/UTN U1111-1257-8953.

Surgical Treatment of Comminuted Midshaft Clavicle Fracture by Minimally Invasive Technique: Description and Preliminary Results.

Objective The present paper aimed to evaluate functional and radiographic outcomes from a group of patients with comminuted midshaft clavicle fracture who were surgically treated using a minimally invasive technique and followed-up for a minimum period of 12 months. Methods Longitudinal, observational study with 32 consecutive patients (31 males; mean age, 41 years old) with comminuted midshaft clavicle fracture who were surgically treated using the minimally invasive osteosynthesis technique with a 3.5-mm reconstruction plate in the upper position. Patients were clinically and radiologically evaluated for a minimum follow-up period of 12 months. Results In 30 patients (93.72%), fracture consolidation occurred in an average time of 17 weeks (range, 12 to 24 weeks). The mean follow-up time was 21 months (range, 12 to 45 months). No implant break or pseudoarthrosis were recorded. There was no complaint of paresthesia around the surgical incisions. The surgically-treated shoulder presented lower passive elevation and longer clavicle length ( p < 0.05) compared with the contralateral shoulder. Functional evaluation revealed an average Disability of Arm, Shoulder and Hand (DASH) score of 1.75, which is considered satisfactory. Age > 60 years old had a negative correlation with DASH score (p <0.05). Conclusion The minimally invasive osteosynthesis technique was satisfactory for the treatment of comminuted midshaft clavicle fracture, with a high consolidation rate and a low complication rate.

Surgical Treatment of Comminuted Midshaft Clavicle Fracture by Minimally Invasive Technique: Description and Preliminary Results / Tratamento cirúrgico da fratura multifragmentada da diáfise da clavícula pela técnica minimamente invasiva: Descrição e resultados preliminares

Abstract Objective Thepresentpaperaimedtoevaluatefunctionalandradiographicoutcomesfrom a group of patients with comminuted midshaft clavicle fracture who were surgically treated using a minimally invasive technique and followed-up for a minimum period of 12 months. Methods Longitudinal, observational study with 32 consecutive patients (31 males; mean age, 41 years old) with comminuted midshaft clavicle fracture who were surgically treated using the minimally invasive osteosynthesis technique with a 3.5mm reconstruction plate in the upper position. Patients were clinically and radiologically evaluated for a minimum follow-up period of 12 months. Results In 30 patients (93.72%), fracture consolidation occurred in an average time of 17 weeks (range, 12 to 24 weeks). The mean follow-up time was 21 months (range, 12 to 45 months). No implant break or pseudoarthrosis were recorded. There was no complaint of paresthesia around the surgical incisions. The surgically-treated shoulder presented lower passive elevation and longer clavicle length (p < 0.05) compared with the contralateral shoulder. Functional evaluation revealed an average Disability of Arm, Shoulder and Hand (DASH) score of 1.75, which is considered satisfactory. Age > 60 years old had a negative correlation with DASH score (p <0.05). Conclusion The minimally invasive osteosynthesis technique was satisfactory for the treatment of comminuted midshaft clavicle fracture, with a high consolidation rate and a low complication rate.

Resumo Objetivo Avaliar os resultados funcionais e radiográficos do tratamento cirúrgico realizado em um grupo de pacientes com fratura multifragmentada da diáfise de clavícula, pela técnica minimamente invasiva, em seguimento mínimo de 12 meses. Métodos Estudo observacional longitudinal de 32 pacientes consecutivos (31 do sexo masculino, idade média 41 anos) com fratura multifragmentada da diáfise da clavícula tratados cirurgicamente pela técnica minimamente invasiva de osteossíntese com placa de reconstrução de 3,5 mm na posição superior, avaliados clínica e radiologicamente, com seguimento mínimo de 1 ano Resultados Resultados Trinta pacientes (93,72%) evoluíram com consolidação da fratura em tempo médio de 17 semanas (entre 12 e 24 semanas). O tempo de seguimento médio foi de 21 meses (variando de 12 a 45 meses). Não houve quebra de implantes ou pseudoartroses. Não houve queixa de parestesia na região das incisões cirúrgicas. O ombro tratado cirurgicamente apresentou menor elevação passiva e maior comprimento da clavícula (p< 0,05) em relação ao contralateral. Na avaliação funcional, encontramos um valor médio de Disfunções do Braço, Ombro e Mão (DASH, na sigla em inglês) = 1,75, sendo o mesmo considerado satisfatório. Idade >60 anos apresentou correlação negativa com escore DASH (p< 0,05). Conclusão A técnica minimamente invasiva de osteossíntese mostrou-se satisfatória para o tratamento da fratura multifragmentada da diáfise da clavícula, com elevada taxa de consolidação e baixo índice de complicações.

Pre-Operative Scapular Rehabilitation for Arthroscopic Repair of Traumatic Rotator Cuff Tear: Results of a Randomized Clinical Trial.

Background: Pre-operative rehabilitation aims to improve the functional capacity of the individual to enable him/her to prepare for the period of inactivity associated with the surgical procedure. Objective: To evaluate the impact of preoperative scapular rehabilitation before arthroscopic repair of traumatic rotator cuff injury, regarding pain, range of motion of the shoulder, and functional activity. Study Design: Randomized Clinical Trial (RCT) - pilot. Methods: Twenty adult individuals (age range: 47-69 years), with a diagnosis of traumatic rotator cuff tear and arthroscopic surgical repair, were randomized and allocated into two groups: experimental (EG) (n = 10) and control group (CG) (n = 10). All participants underwent preoperative rehabilitation for six weeks, consisting of mobility exercises of the cervical spine, elbow, wrist, and hand, and analgesics education. The EG also performed scapular and core stabilization exercises, which were not performed by the CG. Exercise instruction was performed by the same physiotherapist and the surgical team was blinded to group participation in the preoperative period. After arthroscopic repair, the patients followed the same protocol of postoperative rehabilitation for 16 weeks, and functional evaluation was conducted after three months and in a follow-up of at least one year. Results: Compared to the CG, the EG presented with a significant decrease in pain between the preoperative period and after one year (p < 0.05). In relation to the preoperative period, flexion and external rotation increased significantly in both groups after three months (p<0.05), and abduction was significantly higher in the EG (p < 0.05). Compared to CG, the EG presented a significantly higher SF-12 physical component after three months (48.47 vs. 40.33, p < 0.05), and a significantly lower Western Ontario Rotator Cuff Index (WORC) total after one year (85.00 vs. 1130.00, p < 0.05). Conclusion: Preoperative scapular rehabilitation had a positive impact on recovery after arthroscopic repair of traumatic rotator cuff injury, in the assessment of pain, range of motion of the shoulder, and quality of life. Levels of Evidence: Level 1.

Functional and Radiological Outcomes of the Surgical Treatment of Acute Acromioclavicular Dislocation with Anchors Associated with Clavicle and Scapula Fixation.

Objective To evaluate the clinical, radiological and functional results of the surgical treatment of acute acromioclavicular dislocation using a coracoclavicular fixation technique (syndesmopexy) with two metallic anchors, temporary clavicle and scapula fixation, and transfer of the coracoacromial ligament. Methods Longitudinal observational study of 30 patients with diagnoses of acute acromioclavicular dislocation, who were submitted to surgical treatment with a minimum follow-up of six months, and who were evaluated clinically, radiologically, and by the University of California at Los Angeles (UCLA), the Disabilities of the Arm, Shoulder and Hand (DASH) and the Constant-Murley functional scores. Results The mean values of the scores were: UCLA = 32; DASH = 11.21; and Constant-Murley = 86.93, with satisfactory results higher than 80%. The unsatisfactory results were associated with acromioclavicular pain on palpation, positive subacromial impingement tests, and older age group, presenting statistical significance ( p < 0.05). Radiologically, higher values on account of the coracoclavicular distance ratio from the operated shoulder compared to the normal shoulder were related to worse outcomes, but with no statistically significant difference. No associations were found between the results of the functional scores and the variables degree of the injury, coracoacromial ligament transfer, clinical impression of loss of reduction and scapulothoracic dyskinesis. Conclusion The technique used provides an efficient fixation, with a high level of satisfaction according to the UCLA, Constant-Murley and DASH scores; moreover, it has a low complication rate, despite the high rate of residual radiological acromioclavicular subluxation.

Functional and Radiological Outcomes of the Surgical Treatment of Acute Acromioclavicular Dislocation with Anchors Associated with Clavicle and Scapula Fixation / Resultados funcionais e radiológicos do tratamento cirúrgico da luxação acromioclavicular aguda com âncoras e fixação clavículo-escapular

Abstract Objective To evaluate the clinical, radiological and functional results of the surgical treatment of acute acromioclavicular dislocation using a coracoclavicular fixation technique (syndesmopexy) with two metallic anchors, temporary clavicle and scapula fixation, and transfer of the coracoacromial ligament. Methods Longitudinal observational study of 30 patients with diagnoses of acute acromioclavicular dislocation, who were submitted to surgical treatment with a minimum follow-up of six months, and who were evaluated clinically, radiologically, and by the University of California at Los Angeles (UCLA), the Disabilities of the Arm, Shoulder and Hand (DASH) and the Constant-Murley functional scores. Results The mean values of the scores were: UCLA = 32; DASH = 11.21; and Constant-Murley = 86.93, with satisfactory results higher than 80%. The unsatisfactory results were associated with acromioclavicular pain on palpation, positive subacromial impingement tests, and older age group, presenting statistical significance (p < 0.05). Radiologically, higher values on account of the coracoclavicular distance ratio from the operated shoulder compared to the normal shoulder were related to worse outcomes, but with no statistically significant difference. No associations were found between the results of the functional scores and the variables degree of the injury, coracoacromial ligament transfer, clinical impression of loss of reduction and scapulothoracic dyskinesis. Conclusion The technique used provides an efficient fixation, with a high level of satisfaction according to the UCLA, Constant-Murley and DASH scores; moreover, it has a low complication rate, despite the high rate of residual radiological acromioclavicular subluxation.

Resumo Objetivo Avaliar os resultados clínicos, radiológicos, e funcionais do tratamento cirúrgico da luxação acromioclavicular aguda, utilizando a técnica de sindesmopexia coracoclavicular com duas âncoras metálicas, fixação temporária clavículo-escapular, e transferência do ligamento coracoacromial. Métodos Estudo observacional longitudinal com trinta pacientes com diagnóstico de luxação acromioclavicular aguda submetidos à cirurgia, com seguimento mínimo de seis meses, avaliados clínica, radiograficamente, e pelos escores de University of California at Los Angeles (UCLA), Disabilities of the Arm, Shoulder and Hand (DASH) e Constant-Murley. Resultados Os valores médios dos escores foram: UCLA = 32; DASH = 11,21; e Constant-Murley = 86,93, com resultados satisfatórios acima de 80%. Os resultados insatisfatórios foram relacionados à dor acromioclavicular, a testes de impacto subacromial positivos, e aos pacientes de faixa etária mais elevada (p < 0,05). Radiologicamente, valores maiores em razão da distância coracoclavicular do ombro operado, comparado com o ombro normal, foram relacionados a piores resultados, embora sem significância estatística. Não foi observada associação entre os resultados dos escores funcionais e as variáveis grau da lesão, transferência do ligamento coracoacromial, impressão clínica de perda de redução, e discinesia escapulo-torácica. Conclusão A técnica utilizada propicia uma fixação eficiente, com alto índice de satisfação segundo os escores de UCLA, Constant-Murley e DASH. Observou-se baixo índice de complicações apesar da frequência elevada de subluxação acromioclavicular radiológica residual.

Hyperbaric oxygen therapy as treatment for bilateral arm compartment syndrome after CrossFit: case report and literature review.

INTRODUCTION: CrossFit is a physical fitness program characterized by high-intensity workouts that can be associated with serious injury. Acute compartment syndrome in the upper limbs is a rare occurrence. It may occur after intense physical exercise, and its usual treatment is surgical. Hyperbaric oxygen therapy is a treatment described as adjunctive in cases of compartmental syndrome. PRESENTATION: We describe the case of a CrossFit practitioner who, after intense training, developed progressive symptoms of rhabdomyolysis and acute bilateral arm compartment syndrome, who was successfully treated with hyperbaric oxygen therapy and required no fasciotomy as surgical treatment. CONCLUSIONS: Acute compartment syndrome in the arms after intense physical exercise is a rare occurrence that should be suspected by practitioners of physical activity experiencing intense, disproportionate and progressive pain. In the case presented, hyperbaric oxygen therapy was successfully used in the treatment of the disorder, with satisfactory progress, and without the need for a surgical fasciotomy as therapy.

Evaluation of functional results from shoulders after arthroscopic repair of complete rotator cuff tears associated with traumatic anterior dislocation.

OBJECTIVE: To evaluate the clinical outcome of arthroscopic rotator cuff fixation and, when present, simultaneous repair of the Bankart lesion caused by traumatic dislocation; and to assess whether the size of the rotator cuff injury caused by traumatic dislocation has any influence on the postoperative clinical outcomes. METHODS: Thirty-three patients with traumatic shoulder dislocation and complete rotator cuff injury, with at least two years of follow up, were retrospectively evaluated. For analysis purposes, the patients were divided into groups: presence of fixed Bankart lesion or absence of this lesion, and rotator cuff lesions smaller than 3.0 cm (group A) or greater than or equal to 3.0 cm (group B). All the patients underwent arthroscopic repair of the lesions and were evaluated postoperatively by means of the UCLA (University of California at Los Angeles) score and strength measurements. RESULTS: The group with Bankart lesion repair had a postoperative UCLA score of 33.96, while the score of the group without Bankart lesion was 33.7, without statistical significance (p = 0.743). Group A had a postoperative UCLA score of 34.35 and group B, 33.15, without statistical significance (p = 0.416). CONCLUSION: The functional outcomes of the patients who only presented complete rotator cuff tearing after traumatic shoulder dislocation, which underwent arthroscopic repair, were similar to the outcomes of those who presented an associated with a Bankart lesion that was corrected simultaneously with the rotator cuff injury. The extent of the original rotator cuff injury did not alter the functional results in the postoperative evaluation.

OBJETIVO: Avaliar o desfecho clínico da fixação artroscópica do manguito rotador (MR) e, quando presente, a correção simultânea da lesão de Bankart, causadas por luxação traumática. Avaliar se a dimensão da lesão do MR causada por luxação traumática influenciou nos resultados clínicos pós-operatórios. MÉTODOS: Foram avaliados retrospectivamente 33 pacientes com luxação traumática do ombro e lesão completa do manguito rotador e seguimento mínimo de dois anos. Para fins de análise, os pacientes foram divididos em grupos: presença de lesão de Bankart fixada ou ausência da lesão e lesões do MR menores do que 3 cm (grupo A) ou iguais a ou maiores do que 3 cm (grupo B). Todos foram submetidos a reparo artroscópico das lesões e avaliados, pós-operatoriamente, pelo escore da UCLA (University of California at Los Angeles) e medida da força. RESULTADOS: O grupo em que houve o reparo da lesão de Bankart apresentou UCLA pós-operatório de 33,96, em relação ao grupo em que essa lesão não estava presente 33,7, sem significância estatística (p = 0,743). O grupo A apresentou resultado de UCLA pós-operatório de 34,35 e grupo B 33,15, sem significância estatística (p = 0,416). CONCLUSÃO: Os resultados funcionais dos pacientes que apresentaram apenas rotura completa do manguito rotador após luxação traumática do ombro, submetidos ao reparo artroscópico, mostrou-se semelhante àqueles que apresentaram associação da lesão de Bankart, corrigida simultaneamente com a lesão do manguito rotador. A extensão da lesão inicial do manguito rotador não alterou os resultados funcionais na avaliação pós-operatória.

Evaluation of functional results from shoulders after arthroscopic repair of complete rotator cuff tears associated with traumatic anterior dislocation / Avaliação dos resultados funcionais dos ombros submetidos ao reparo artroscópico de roturas completas do manguito rotador associadas a luxações traumáticas anteriores

OBJECTIVE: To evaluate the clinical outcome of arthroscopic rotator cuff fixation and, when present, simultaneous repair of the Bankart lesion caused by traumatic dislocation; and to assess whether the size of the rotator cuff injury caused by traumatic dislocation has any influence on the postoperative clinical outcomes. METHODS: Thirty-three patients with traumatic shoulder dislocation and complete rotator cuff injury, with at least two years of follow up, were retrospectively evaluated. For analysis purposes, the patients were divided into groups: presence of fixed Bankart lesion or absence of this lesion, and rotator cuff lesions smaller than 3.0 cm (group A) or greater than or equal to 3.0 cm (group B). All the patients underwent arthroscopic repair of the lesions and were evaluated postoperatively by means of the UCLA (University of California at Los Angeles) score and strength measurements. RESULTS: The group with Bankart lesion repair had a postoperative UCLA score of 33.96, while the score of the group without Bankart lesion was 33.7, without statistical significance (p = 0.743). Group A had a postoperative UCLA score of 34.35 and group B, 33.15, without statistical significance (p = 0.416). CONCLUSION: The functional outcomes of the patients who only presented complete rotator cuff tearing after traumatic shoulder dislocation, which underwent arthroscopic repair, were similar to the outcomes of those who presented an associated with a Bankart lesion that was corrected simultaneously with the rotator cuff injury. The extent of the original rotator cuff injury did not alter the functional results in the postoperative evaluation.

OBJETIVO: Avaliar o desfecho clínico da fixação artroscópica do manguito rotador (MR) e, quando presente, a correção simultânea da lesão de Bankart, causadas por luxação traumática. Avaliar se a dimensão da lesão do MR causada por luxação traumática influenciou nos resultados clínicos pós-operatórios. MÉTODOS: Foram avaliados retrospectivamente 33 pacientes com luxação traumática do ombro e lesão completa do manguito rotador e seguimento mínimo de dois anos. Para fins de análise, os pacientes foram divididos em grupos: presença de lesão de Bankart fixada ou ausência da lesão e lesões do MR menores do que 3 cm (grupo A) ou iguais a ou maiores do que 3 cm (grupo B). Todos foram submetidos a reparo artroscópico das lesões e avaliados, pós-operatoriamente, pelo escore da UCLA (University of California at Los Angeles) e medida da força. RESULTADOS: O grupo em que houve o reparo da lesão de Bankart apresentou UCLA pós-operatório de 33,96, em relação ao grupo em que essa lesão não estava presente 33,7, sem significância estatística (p = 0,743). O grupo A apresentou resultado de UCLA pós-operatório de 34,35 e grupo B 33,15, sem significância estatística (p = 0,416). CONCLUSÃO: Os resultados funcionais dos pacientes que apresentaram apenas rotura completa do manguito rotador após luxação traumática do ombro, submetidos ao reparo artroscópico, mostrou-se semelhante àqueles que apresentaram associação da lesão de Bankart, corrigida simultaneamente com a lesão do manguito rotador. A extensão da lesão inicial do manguito rotador não alterou os resultados funcionais na avaliação pós-operatória.

Preliminary analysis on the MD-4(®) plasma-sprayed titanium acetabular component.

OBJECTIVES: To evaluate the short-term performance of a type of implant manufactured in Brazil. METHODS: This study analyzed a cohort of 60 patients who underwent implantation of MD-4(®) acetabular components during primary hip arthroplasty procedures performed between January 1, 2010, and August 1, 2012. The patients were studied retrospectively with regard to clinical behavior, stability and radiological osseointegration. The patients were followed up for a minimum of 12 months and a maximum of 42 months (mean: 27) and were evaluated by means of the Harris Hip Score, SF-36 questionnaire and serial conventional radiographs. RESULTS: All the components were radiologically stable, without evidence of migration or progressive radiolucency lines. On average, the Harris Hip Score evolved from 36.1 to 92.1 (p < 0.001) and the SF-36 showed significant increases in all its domains (p < 0.001). No differences were observed among patients with osteoarthrosis, osteonecrosis, hip dysplasia or other conditions. CONCLUSIONS: The short-term results showed clinical and radiological signs of stability and osseointegration of the implants, which may represent a predictive factor regarding medium-term survival of this acetabular component.

OBJETIVOS: avaliar o desempenho em curto prazo de um tipo de implante fabricado no Brasil. MÉTODOS: estudo de uma coorte de 60 pacientes que tiveram componentes acetabulares MD-4® implantados durante artroplastias primárias do quadril, entre 1 de janeiro de 2010 e 1 de agosto de 2012, e foram estudados retrospectivamente com relação ao comportamento clínico, à estabilidade e à osteointegração radiológica. Os indivíduos foram acompanhados por 12 meses no mínimo e no máximo 42 (média: 27) e avaliados por meio do Harris Hip Score, do questionário SF-36 e de radiografias convencionais seriadas. RESULTADOS: todos os componentes estavam radiologicamente estáveis, sem evidência de migração ou de linhas de radioluzência progressivas. Em média, o Harris Hip Score evoluiu de 36,1 para 92.1 (p < 0,001) e o SF-36 mostrou incremento significativo em todos os domínios (p < 0,001). Nenhuma diferença foi observada entre pacientes com osteoartrose, osteonecrose, displasia do quadril ou outras condições. CONCLUSÕES: os resultados de curto prazo mostraram sinais clínicos e radiológicos de estabilidade e de osteointegração dos implantes, o que pode representar um fator preditivo quanto à sobrevivência em médio prazo do componente acetabular considerado.

Preliminary analysis on the MD-4(r) plasma-sprayed titanium acetabular component / Análise preliminar do componente acetabular de titânio plasma-spray MD-4(r)

OBJECTIVES: To evaluate the short-term performance of a type of implant manufactured in Brazil. METHODS: This study analyzed a cohort of 60 patients who underwent implantation of MD-4(r) acetabular components during primary hip arthroplasty procedures performed between January 1, 2010, and August 1, 2012. The patients were studied retrospectively with regard to clinical behavior, stability and radiological osseointegration. The patients were followed up for a minimum of 12 months and a maximum of 42 months (mean: 27) and were evaluated by means of the Harris Hip Score, SF-36 questionnaire and serial conventional radiographs. RESULTS: All the components were radiologically stable, without evidence of migration or progressive radiolucency lines. On average, the Harris Hip Score evolved from 36.1 to 92.1 (p < 0.001) and the SF-36 showed significant increases in all its domains (p < 0.001). No differences were observed among patients with osteoarthrosis, osteonecrosis, hip dysplasia or other conditions. CONCLUSIONS: The short-term results showed clinical and radiological signs of stability and osseointegration of the implants, which may represent a predictive factor regarding medium-term survival of this acetabular component. .

OBJETIVOS: avaliar o desempenho em curto prazo de um tipo de implante fabricado no Brasil. MÉTODOS: estudo de uma coorte de 60 pacientes que tiveram componentes acetabulares MD-4(r) implantados durante artroplastias primárias do quadril, entre 1 de janeiro de 2010 e 1 de agosto de 2012, e foram estudados retrospectivamente com relação ao comportamento clínico, à estabilidade e à osteointegração radiológica. Os indivíduos foram acompanhados por 12 meses no mínimo e no máximo 42 (média: 27) e avaliados por meio do Harris Hip Score, do questionário SF-36 e de radiografias convencionais seriadas. RESULTADOS: todos os componentes estavam radiologicamente estáveis, sem evidência de migração ou de linhas de radioluzência progressivas. Em média, o Harris Hip Score evoluiu de 36,1 para 92,1 (p < 0,001) e o SF-36 mostrou incremento significativo em todos os domínios (p < 0,001). Nenhuma diferença foi observada entre pacientes com osteoartrose, osteonecrose, displasia do quadril ou outras condições. CONCLUSÕES: os resultados de curto prazo mostraram sinais clínicos e radiológicos de estabilidade e de osteointegração dos implantes, o que pode representar um fator preditivo quanto à sobrevivência em médio prazo do componente acetabular considerado. .