Epidemiology and costs of surgical treatment of developmental dysplasia of hip in the Brazilian Public Health System in a decade.

OBJECTIVE: To describe and analyze the epidemiology and costs of surgical treatment of hip dysplasia in the Brazilian Public Health System. METHODS: An ecological analytical study that evaluated a time series and the geographic distribution of surgical treatment of hip dysplasia in Brazil. Frequencies of cases, number of cases and associated factors were analyzed. Correlations, frequency maps and flow maps are presented and discussed. RESULTS: During the study, 14,584 patients with dysplasia were admitted to hospitals according to Information Technology Department of the Public Health System. Patients underwent hospital treatment specific for dysplasia in 8,592 cases (at an average cost of R$ 2.225,50, total cost of R$ 19.124.086,25- updated values). In this group, mortality rate was 0.046% and mean hospitalization time was 4.41 days (standard deviation of 2,39 days). Age between 1 and 4 years (37.7%), female sex (64.5%) and white race (46%) were more frequent. Greater rates of specialists (R²=0.82; p<0.001), greater proportion of counties with high/very high human development index (R²=0.79; p<0.001), and higher per capita income (R²=0.68; p<0.001) correlated to greater rates of treatments undertaken per 1,000 live births (as per State of treatment). The factor most related to treatment rate per 1,000 live births (as per State of residence) was white race (R²=0.90; p<0.001). Southern states had higher treatment rates (as per State of residence, rate of 0.73/1,000), and Southeast states had greater absolute frequency of cases (46.7%) and greater flow of patients. CONCLUSION: The surgical treatment of hip dysplasia in Brazil occurs frequently, at relevant costs, and is distributed in a heterogenous and unequal fashion in the Public Health System. Southern states have a higher incidence of cases, and there is an association with racial and socioeconomic factors. There was no large variation in the incidence of cases over time.

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.

Epidemiology and costs of surgical treatment of developmental dysplasia of hip in the Brazilian Public Health System in a decade / Epidemiologia e custos do tratamento cirúrgico da displasia do desenvolvimento do quadril no Sistema Único de Saúde em uma década

ABSTRACT Objective: To describe and analyze the epidemiology and costs of surgical treatment of hip dysplasia in the Brazilian Public Health System. Methods: An ecological analytical study that evaluated a time series and the geographic distribution of surgical treatment of hip dysplasia in Brazil. Frequencies of cases, number of cases and associated factors were analyzed. Correlations, frequency maps and flow maps are presented and discussed. Results: During the study, 14,584 patients with dysplasia were admitted to hospitals according to Information Technology Department of the Public Health System. Patients underwent hospital treatment specific for dysplasia in 8,592 cases (at an average cost of R$ 2.225,50, total cost of R$ 19.124.086,25- updated values). In this group, mortality rate was 0.046% and mean hospitalization time was 4.41 days (standard deviation of 2,39 days). Age between 1 and 4 years (37.7%), female sex (64.5%) and white race (46%) were more frequent. Greater rates of specialists (R²=0.82; p<0.001), greater proportion of counties with high/very high human development index (R²=0.79; p<0.001), and higher per capita income (R²=0.68; p<0.001) correlated to greater rates of treatments undertaken per 1,000 live births (as per State of treatment). The factor most related to treatment rate per 1,000 live births (as per State of residence) was white race (R²=0.90; p<0.001). Southern states had higher treatment rates (as per State of residence, rate of 0.73/1,000), and Southeast states had greater absolute frequency of cases (46.7%) and greater flow of patients. Conclusion: The surgical treatment of hip dysplasia in Brazil occurs frequently, at relevant costs, and is distributed in a heterogenous and unequal fashion in the Public Health System. Southern states have a higher incidence of cases, and there is an association with racial and socioeconomic factors. There was no large variation in the incidence of cases over time.

RESUMO Objetivo: Descrever e analisar a epidemiologia e os custos do tratamento cirúrgico da displasia do quadril no Sistema Único de Saúde. Métodos: Estudo ecológico analítico da série temporal e distribuição geográfica dos casos de tratamento cirúrgico da displasia no Brasil. Foram avaliadas: frequências, taxas de casos e fatores de associação. Taxas de correlação, mapas de frequência e fluxos são apresentados e discutidos. Resultados: No período, foram internados 14.584 pacientes com displasia segundo o Departamento de Informática do Sistema Único de Saúde. Os pacientes receberam tratamento hospitalar específico para displasia em 8.592 casos (custo médio de R$ 2.225,50 por internação), com custo de R$ 19.124.086,25 (valores atualizados). Nesse grupo, o tempo médio de internação foi de 4,41 dias (desvio-padrão de 2,39 dias) e a mortalidade foi de 0,046%. Idade de 1 a 4 anos (37,7%), sexo feminino (64,5%) e raça branca (46%) foram as mais frequentes. Maiores taxas de especialistas (R²=0,82; p<0,001), maior proporção de municípios com desenvolvimento humano alto/muito alto (R²=0,79; p<0,001) e maior renda per capita (R²=0,68; p<0,001) foram relacionadas a maiores taxas de tratamentos realizados por mil nascidos vivos (por estado do tratamento). O fator mais relacionado à taxa de tratamentos realizados por mil nascidos vivos (conforme o estado de residência) foi a raça branca (R²=0,90; p<0,001). Estados do Sul tiveram as maiores taxas de tratamentos (por estado de residência, com taxa de 0,73/1.000), e os do Sudeste a maior frequência absoluta de casos (46,7%) e o maior influxo de pacientes. Conclusão: O tratamento cirúrgico para displasia do quadril no Brasil é frequente, gera custos relevantes e é distribuído de forma heterogênea e desigual no Sistema Único de Saúde. Estados do Sul tem a maior incidência de casos, e fatores raciais e socioeconômicos estão associados. Não houve grande variação na frequência de casos no período.

Comparative Study of Function and Quality of Life in Patients with Fracture of the Tibial Plateau Operated with Locked or Conventional Plates / Função e qualidade de vida de pacientes com fratura do planalto tibial operados com placa bloqueada ou convencional: estudo comparativo

Abstract Objective To compare clinical, functional, and quality of life outcomes between patients with tibial plateau fractures operated with locked or conventional plates, and to compare the costs of these implants. Methods This was a comparative cross-sectional study of a consecutive series of patients with tibial plateau fractures treated surgically from August 2015 to June 2016. Patients < 18 years old, those unable to answer the questionnaires or to attend the outpatient reassessment, polytrauma patients, those with associated injuries on the ipsilateral limb, and patients who had not undergone treatment with bone plates were excluded. The present study compared the costs of the implants for the hospital, quality of life (with the 12-Item Short Form Health Survey [SF-12]), Lysholm score, pain scale, and clinical and radiological parameters. Results A total of 45 patients with tibial plateau fractures were admitted, and 11 cases were excluded. Two cases were lost to follow-up; therefore, 32 remained for the analysis (94%). The mean follow-up time was of 15.1 months (standard deviation [SD] = 4.8 months). In group A (locked plates), there were 22 patients (69%), at an average hospital cost of BRL 4,125.39/patient (SD = 1,634.79/patient) for the implants. In group B (conventional plates) there were 10 patients (31%), at an average cost of BRL 438.53 (SD = 161.8/patient) (p < 0.00001). For the other parameters, no differences were observed, except for a greater articular depression in group A (2.7 mm ± 3.3 mm versus 0.5 mm ± 1.6 mm; p = 0.02; TE = 0.90). Conclusion The costs of locked implants for the treatment of tibial plateau fractures are significantly higher than those of conventional implants, without any clinical, quality of life, radiological, or functional advantages of the locked implants demonstrated in the present series.

Resumo Objetivos Comparar resultados clínicos, funcionais e de qualidade de vida de pacientes com fratura do planalto tibial operados com placa bloqueada ou convencional e comparar os custos hospitalares dos implantes. Métodos Estudo comparativo de coortes transversal, retrospectivo, em uma série consecutiva de pacientes com fratura do planalto tibial tratados cirurgicamente entre agosto de 2015 e junho de 2016. Foram excluídos: menores de 18 anos; indivíduos incapazes de responder os questionários ou de comparecer para reavaliação; politraumatizados ou comlesões associadas no mesmomembro; pacientes não tratados complaca ou conservadoramente. Os autores compararam os custos dos implantes, a qualidade de vida (SF-12), o escore de Lysholm, a escala visual de dor e os parâmetros clínicos e radiográficos. Resultados Foramobservadas 45 fraturas no período, das quais 11 foramexcluídas. Dos 34 pacientes, dois não compareceram à entrevista (seguimento de 94%). O tempo de seguimento foi 15,1 ± 4,8 meses.Ogrupo A (placa bloqueada) incluiu 22 pacientes (69%), comcusto hospitalarmédio dos implantes de R$ 4.125,39 (dp = R$1.634,79/paciente). O grupo B (placa convencional) incluiu dez pacientes (31%), a um custo médio de R$ 438,53 (dp = R$ 161,8/paciente; p < 0,00001). Para os demais parâmetros avaliados, não foram observadas diferenças significativas entre os grupos, exceto por ummaior degrau articular no grupo A (2,7 mm ± 3,3 mm vs. 0,5 mm ± 1,6 mm; p = 0,02; TE = 0,90). Conclusão O custo dos implantes bloqueados para o tratamento das fraturas do planalto tibial é significativamente superior aos implantes convencionais, embora não tenham apresentado vantagem clínica, radiográfica, funcional ou de qualidade de vida, nos pacientes dessa amostra.

Artroplastias de quadril no Sistema Único de Saúde: análise dos dados brasileiros de 2008 a 2015 / Hip replacements in the Brazilian Unified Health System: review of national data from 2008 to 2015

Objetivo: Analisar a incidência, distribuição espacial e os fatores que influenciam a realização de artroplastias de quadril no SUS, especialmente artroplastias totais (ATQs). Material e Método: Estudo ecológico analítico nível III, analisou uma série temporal e a distribuição espacial dos casos de artroplastias de quadril realizadas no SUS entre 2008 e 2015, através de dados obtidos da plataforma DATASUS. Resultados: Foram realizadas 166.365 artroplastias de quadril, sendo 94.737 (56,9%) ATQs primárias. O custo total foi R$636.332.731,90. Houve aumento no número de cirurgias realizadas, em especial após 2012. A média anual de ATQ primárias foi 11.842,1 cirurgias/ano (dp=868,3 cirurgias/ano), a um custo médio de R$45.473.445,65/ano (dp=R$8.269.970,1/ano). Em 2012 as não-cimentadas e híbridas se tornaram as mais comuns. A distribuição das frequencias nos estados brasileiros é heterogênea e os fatores associados foram proporção de indivíduos com mais de 50 anos de idade (p=0,000175) e proporção de municípios com IDH alto ou muito alto (p=0,037). Conclusão: A incidência de ATQs no SUS aumentou no período de 2008 a 2015. Sua distribuição foi maior nos Estados com maior proporção de indivíduos >50 anos e com maior proporção de municípios com IDH alto ou muito alto. A incidência de ATQs primárias cimentadas foi superada pelas não cimentadas e híbridas em 2012.

Objective: To evaluate the incidence, spatial distribution and the factors that influence the numbers of hip arthroplasties in the Unified Health System in Brazil(SUS), especially total hip arthroplasties (THA). Methods: An level III analytical ecological study of the time series and the spatial distribution of the cases of hip arthroplasties performed in SUS between 2008 and 2015, using of data obtained from the DATASUS platform. Results: 166,365 hip arthroplasties were performed, of which 94,737 (56,9%) were primary THA. The total cost of the former was of BRL636,332,731.90 for SUS and there was an increase in the number of surgeries performed, especially from 2012. The annual average of primary THA was 11,842.1 surgeries/year (sd= 868.3 surgeries/year), at an average cost of BRL45,473,445.65/year (sd= BRL8,269,970.10/year).In 2012 the uncemented and hybrid arthroplasties became the most common. The distribution in the Brazilian states is heterogeneous and the factors positively associated were the % of citizens aging above 50 (p=0,000175) and the % of cities with high or very high HDI in each State (p=0,037). Conclusion: The incidence of primary THA in the SUS increased between 2008 and 2015. Its spatial distribution was greater on States with bigger proportions of people aging above 50 years and more cities with HDI rated as high or very high. The incidence of cemented primary THA was overcome by the uncemented and hybrid in 2012.

Mixed-type femoroacetabular impingement associated with subspine impingement: recognizing the trifocal femoropelvic impingement.

To describe the arthroscopic surgical technique for subspine impingement (SSI) of the anterior inferior iliac spine (AIIS) associated with mixed type femoroacetabular impingement (FAI), through two standard arthroscopic portals (anterolateral and distal mid-anterior) in two patients with trifocal impingement. The authors report the cases of two young male patients, aged 32 and 36 years old, with trifocal femoropelvic impingement (TFPI). The technique consists of segmental capsulectomy, arthroscopic dissection of the AIIS, partial release of the direct head of the rectus femoris, resection of the AIIS projection with a burr and with fluoroscopic aid, correction of the pincer deformity, repair of the labrum with bioabsorbable anchors, and femoral osteoplasty. Details of the diagnostic workup and of the surgical technique are provided and discussed. In these cases, full range of motion was regained after surgery, as well as complete relief of pain, which was sustained in the last follow-up, one year post-operatively. Radiographs show adequate correction of the deformities in all three impingement sites. Simultaneous correction of the three sites (cam, pincer, and subspinal) provided full relief of symptoms and allowed return to work and sports. The authors propose that when approaching the symptomatic SSI, the possibility of concomitant FAI should always be considered and, in those cases, the approach must be comprehensive.

O objetivo deste trabalho foi descrever a abordagem cirúrgica artroscópica do impacto subespinhal (ISE) da espinha ilíaca anteroinferior (EIAI) associado ao impacto femoroacetabular (IFA) misto, por meio de dois portais artroscópicos padrão (anterolateral e medioanterior distal) em pacientes com impacto trifocal. Os autores relatam os casos de dois pacientes do sexo masculino, de 32 e 36 anos, com impacto femoropelvico trifocal (IFPT). A técnica consiste na ressecção segmentar da cápsula, dissecção artroscópica da EIAI com liberação parcial do reto femoral, osteoplastia com ressecção da proeminência com lâmina óssea e auxílio radioscópico, correção do pincer, reparo da lesão condrolabial com âncoras e osteoplastia femoral. Detalhes sobre o diagnóstico e a técnica são apresentados e discutidos. Nos casos operados, foi observada recuperação do arco de movimento normal do quadril e ausência de dor, que se mantiveram por um ano pós-operatório. Radiografias demonstram boa correção dos três focos de impacto em ambos os pacientes. A simultânea correção do IFPT nos seus três componentes (came, pincer e subespinhal) promoveu alívio completo dos sintomas e o retorno ao trabalho e aos esportes. Propõe-se que, na abordagem do ISE sintomático, sempre seja considerada a possibilidade da presença de IFA associado; nesses casos, a abordagem deve ser completa.

Mixed-type femoroacetabular impingement associated with subspine impingement: recognizing the trifocal femoropelvic impingement / Impacto femoroacetabular misto associado a impacto subespinhal: reconhecimento do impacto femoropelvico trifocal

ABSTRACT To describe the arthroscopic surgical technique for subspine impingement (SSI) of the anterior inferior iliac spine (AIIS) associated with mixed type femoroacetabular impingement (FAI), through two standard arthroscopic portals (anterolateral and distal mid-anterior) in two patients with trifocal impingement. The authors report the cases of two young male patients, aged 32 and 36 years old, with trifocal femoropelvic impingement (TFPI). The technique consists of segmental capsulectomy, arthroscopic dissection of the AIIS, partial release of the direct head of the rectus femoris, resection of the AIIS projection with a burr and with fluoroscopic aid, correction of the pincer deformity, repair of the labrum with bioabsorbable anchors, and femoral osteoplasty. Details of the diagnostic workup and of the surgical technique are provided and discussed. In these cases, full range of motion was regained after surgery, as well as complete relief of pain, which was sustained in the last follow-up, one year post-operatively. Radiographs show adequate correction of the deformities in all three impingement sites. Simultaneous correction of the three sites (cam, pincer, and subspinal) provided full relief of symptoms and allowed return to work and sports. The authors propose that when approaching the symptomatic SSI, the possibility of concomitant FAI should always be considered and, in those cases, the approach must be comprehensive.

RESUMO O objetivo deste trabalho foi descrever a abordagem cirúrgica artroscópica do impacto subespinhal (ISE) da espinha ilíaca anteroinferior (EIAI) associado ao impacto femoroacetabular (IFA) misto, por meio de dois portais artroscópicos padrão (anterolateral e medioanterior distal) em pacientes com impacto trifocal. Os autores relatam os casos de dois pacientes do sexo masculino, de 32 e 36 anos, com impacto femoropelvico trifocal (IFPT). A técnica consiste na ressecção segmentar da cápsula, dissecção artroscópica da EIAI com liberação parcial do reto femoral, osteoplastia com ressecção da proeminência com lâmina óssea e auxílio radioscópico, correção do pincer, reparo da lesão condrolabial com âncoras e osteoplastia femoral. Detalhes sobre o diagnóstico e a técnica são apresentados e discutidos. Nos casos operados, foi observada recuperação do arco de movimento normal do quadril e ausência de dor, que se mantiveram por um ano pós-operatório. Radiografias demonstram boa correção dos três focos de impacto em ambos os pacientes. A simultânea correção do IFPT nos seus três componentes (came, pincer e subespinhal) promoveu alívio completo dos sintomas e o retorno ao trabalho e aos esportes. Propõe-se que, na abordagem do ISE sintomático, sempre seja considerada a possibilidade da presença de IFA associado; nesses casos, a abordagem deve ser completa.

Primary and secondary osteoporotic fractures prophylaxis: evaluation of a prospective cohort.

OBJECTIVE: To measure the prevalence of primary drug prevention of fractures due to osteoporosis in patients admitted to a tertiary teaching hospital, in a medium-sized city, admitted with osteoporotic fractures. Moreover, to identify the incidence of prescribing secondary prophylaxis after the first fracture event. At the same time, the prevalence of risk factors for such fractures as described in the literature was measured. METHODS: This longitudinal prospective study was based on a cohort of patients admitted in a tertiary teaching hospital from October 2015 to January 2016. Patients with low energy or fragility fractures were included in the study regardless of gender or race, over the age of 50 years. All patients who did not have these characteristics were excluded. The follow-up lasted four months. Serial questionnaires were applied at admission and in the follow-up consultations at four to eight weeks and at 16 weeks. RESULTS: Only one patient reported receiving treatment with specific drugs for the disease before hospital admission, resulting in a prevalence of primary chemoprophylaxis of only 2.27%. No patient was prescribed medication for the treatment of osteoporosis after the fracture. The prevalence of risk factors was similar to those found in the literature review. CONCLUSION: In the present study, the frequency of primary and secondary osteoporosis chemoprophylaxis in patients who were admitted with fragility fractures was low, as well as the early indication of drug treatment after the first fracture. The prevalence of fragility fracture risk factors is similar to those reported in the literature.

OBJETIVO: Medir a prevalência da profilaxia medicamentosa primária de fraturas por osteoporose em pacientes internados em um hospital terciário de ensino, em uma cidade de médio porte, admitidos com fraturas osteoporóticas. Além disso, identificar a incidência de prescrição de profilaxia medicamentosa secundária após o evento da primeira fratura. Paralelamente, medimos a prevalência de fatores de risco para fratura por osteoporose descritos na literatura. MÉTODO: Estudo longitudinal de uma coorte prospectiva de pacientes admitidos em hospital terciário de ensino de outubro de 2015 a janeiro 2016. Foram incluídos pacientes com fraturas de baixa energia ou por fragilidade, independentemente do gênero ou etnia, acima de 50 anos. Todos os pacientes que não apresentavam essas características foram excluídos. O seguimento foi de quatro meses. Foram aplicados questionários seriados na admissão, no retorno com quatro a oito semanas e com 16 semanas. RESULTADO: Somente um paciente referiu ter recebido tratamento com drogas específicas para a doença antes da internação hospitalar, o que revela uma prevalência de quimioprofilaxia primária de apenas 2,27%. Nenhum paciente recebeu prescrição para tratamento da osteoporose após a fratura. A prevalência dos fatores de risco de fratura se assemelha àquela encontrada na literatura. CONCLUSÃO: A frequência de quimioprofilaxia primária e secundária da osteoporose em pacientes admitidos com fraturas por fragilidade é baixa em nosso meio, assim como a indicação precoce de tratamento medicamentoso após a primeira fratura. A prevalência dos fatores de risco de fratura por fragilidade é semelhante àquela citada na literatura.

Parental awareness and perception for correct use of child restraint systems and airbags in Brazil.

OBJECTIVE: The objective of this study was to obtain information about the current knowledge and habits of parents who transport children in cars in Brazil. METHODS: A cross-sectional survey was conducted using specifically designed self-report questionnaires to parents of children attending a private pediatric office in a town in southwest Brazil. Data were collected regarding children's age, gender, height, and weight and possession of an automobile child restraint system (CRS), its type, frequency and adequacy of use, and reasons for not possessing or not using the devices. Parents were asked whether their cars were equipped with airbags and about the use of the restraints in seats with airbags. RESULTS: We interviewed parents of 293 children transported in cars who met the criteria for use of a CRS. Children were younger than 1 year in 15.3% of the cases, between 1 and 4 years in 38.6%, and older than 4 in 46.1%. Cars were equipped with CRS in 78.5% of the cases, but in only 58% of the cases was the device proper for child's age and adequately installed in the seat. Among owners of the devices, 84.3% reported that they always used it. Reasons for infrequency were forgetting the device at home or in another car (6.4%), the child disliking the device (3.2%), or the false impression that the child was grown enough not to use it (3.2%)l 87.1% did not justify why they did not always use the CRS. Considering type of CRS, correct installation of the seat, and frequency of use, only 44.4% of children under 1 year, 69.9% of those 1 to 4 years, and 52.6% over age 4 were protected. Only 28.6% of the parents knew that children should never be positioned in a seat with active airbags. CONCLUSION: Considering appropriateness for age, correctness of installation (in the back seat in the correct orientation), and frequency of use, only 50.85% (149/293) of the children were reported as always protected with a CRS. Children between 1 and 4 years were more likely to always use a CRS in this Brazilian survey. We were also able to identify an important gap in the knowledge about airbags among parents. Further efforts are needed to correct those distortions.

Primary and secondary osteoporotic fractures prophylaxis: evaluation of a prospective cohort / Profilaxia primária e secundária de fraturas osteoporóticas: avaliação de uma coorte prospectiva

ABSTRACT Objective: To measure the prevalence of primary drug prevention of fractures due to osteoporosis in patients admitted to a tertiary teaching hospital, in a medium-sized city, admitted with osteoporotic fractures. Moreover, to identify the incidence of prescribing secondary prophylaxis after the first fracture event. At the same time, the prevalence of risk factors for such fractures as described in the literature was measured. Methods: This longitudinal prospective study was based on a cohort of patients admitted in a tertiary teaching hospital from October 2015 to January 2016. Patients with low energy or fragility fractures were included in the study regardless of gender or race, over the age of 50 years. All patients who did not have these characteristics were excluded. The follow-up lasted four months. Serial questionnaires were applied at admission and in the follow-up , consultations at four to eight weeks and at 16 weeks. Results: Only one patient reported receiving treatment with specific drugs for the disease before hospital admission, resulting in a prevalence of primary chemoprophylaxis of only 2.27%. No patient was prescribed medication for the treatment of osteoporosis after the fracture. The prevalence of risk factors was similar to those found in the literature review. Conclusion: In the present study, the frequency of primary and secondary osteoporosis chemoprophylaxis in patients who were admitted with fragility fractures was low, as well as the early indication of drug treatment after the first fracture. The prevalence of fragility fracture risk factors is similar to those reported in the literature.

RESUMO Objetivo: Medir a prevalência da profilaxia medicamentosa primária de fraturas por osteoporose em pacientes internados em um hospital terciário de ensino, em uma cidade de médio porte, admitidos com fraturas osteoporóticas. Além disso, identificar a incidência de prescrição de profilaxia medicamentosa secundária após o evento da primeira fratura. Paralelamente, medimos a prevalência de fatores de risco para fratura por osteoporose descritos na literatura. Método: Estudo longitudinal de uma coorte prospectiva de pacientes admitidos em hospital terciário de ensino de outubro de 2015 a janeiro 2016. Foram incluídos pacientes com fraturas de baixa energia ou por fragilidade, independentemente do gênero ou etnia, acima de 50 anos. Todos os pacientes que não apresentavam essas características foram excluídos. O seguimento foi de quatro meses. Foram aplicados questionários seriados na admissão, no retorno com quatro a oito semanas e com 16 semanas. Resultado: Somente um paciente referiu ter recebido tratamento com drogas específicas para a doença antes da internação hospitalar, o que revela uma prevalência de quimioprofilaxia primária de apenas 2,27%. Nenhum paciente recebeu prescrição para tratamento da osteoporose após a fratura. A prevalência dos fatores de risco de fratura se assemelha àquela encontrada na literatura. Conclusão: A frequência de quimioprofilaxia primária e secundária da osteoporose em pacientes admitidos com fraturas por fragilidade é baixa em nosso meio, assim como a indicação precoce de tratamento medicamentoso após a primeira fratura. A prevalência dos fatores de risco de fratura por fragilidade é semelhante àquela citada na literatura.

Developmental dysplasia of the hip: do the responsible for screening know what to do?

ABSTRACT Objective: To evaluate the knowledge on developmental dysplasia of the hip (DDH) by professionals involved in its diagnosis. Methods: This is a cross-sectional study using questionnaires to assess the knowledge about DDH. Orthopedic surgeons and pediatricians, residents and medical students from a tertiary teaching hospital were included in the study. Results: We evaluated 142 medical students, eight orthopedic residents, ten pediatric residents, seven pediatricians, and nine orthopedic surgeons; 50% declared not having examined any DDH case in the last year and only three had diagnosed more than 10 cases during their career. Regarding self-assessed knowledge (0-10), the average score was 4.25 [n=186; SD=2.43]. Nineteen percent of the participants ignored semiological tests and 26.1% of pediatricians (specialists and residents), were unaware of how to perform them. The most acknowledged and neglected risk factor was pelvic presentation (68%) and CMT (9.3%), respectively. None of the participants were able to identify all the risk factors. The average number of risk factors identified was two (n=186; SD=1.58). Forty seven point three percent of the participants failed to recognize the time of birth as the ideal moment for diagnosis; 17% reported it was after the first month. Regarding neglected severe DDH, 45.3% failed to recognize its natural history. Conclusion: Knowledge on DDH among health professionals who are involved in screening is flawed. Level of Evidence IV, Developing a Decision Model.

DEVELOPMENTAL DYSPLASIA OF THE HIP: DO THE RESPONSIBLE FOR SCREENING KNOW WHAT TO DO?

OBJECTIVE: To evaluate the knowledge on developmental dysplasia of the hip (DDH) by professionals involved in its diagnosis. METHODS: This is a cross-sectional study using questionnaires to assess the knowledge about DDH. Orthopedic surgeons and pediatricians, residents and medical students from a tertiary teaching hospital were included in the study. RESULTS: We evaluated 142 medical students, eight orthopedic residents, ten pediatric residents, seven pediatricians, and nine orthopedic surgeons; 50% declared not having examined any DDH case in the last year and only three had diagnosed more than 10 cases during their career. Regarding self-assessed knowledge (0-10), the average score was 4.25 [n=186; SD=2.43]. Nineteen percent of the participants ignored semiological tests and 26.1% of pediatricians (specialists and residents), were unaware of how to perform them. The most acknowledged and neglected risk factor was pelvic presentation (68%) and CMT (9.3%), respectively. None of the participants were able to identify all the risk factors. The average number of risk factors identified was two (n=186; SD=1.58). Forty seven point three percent of the participants failed to recognize the time of birth as the ideal moment for diagnosis; 17% reported it was after the first month. Regarding neglected severe DDH, 45.3% failed to recognize its natural history. CONCLUSION: Knowledge on DDH among health professionals who are involved in screening is flawed. Level of Evidence IV, Developing a Decision Model.

Surgical Treatment of a Case of Ledderhose's Disease: A Safe Plantar Approach to Subtotal Fasciectomy.

Plantar fibromatosis, Ledderhose's disease, or Morbus Ledderhose is an uncommon benign nodular hyperplasia of the plantar aponeurosis. The aim of this paper was to report the case of a 47-year-old male patient who had concomitant Dupuytren's disease and failed all conservative measures. He was treated surgically with prompt and complete relief of symptoms postoperatively, and he has had no recurrence at the 2-year follow-up. In this richly documented case, we discuss details of the surgical technique and anatomy, which was important for a successful outcome and preventing complications. The technique for subtotal fasciectomy is reviewed and the relevance of the adequate choice of skin incision to prevent painful scarring, skin necrosis, and difficulties with shoe wearing is highlighted.

Superficial acral fibromyxoma of the thumb: a case report

The authors report a case of superficial acral fibromyxioma (SAF) in a 74-year-old male who presented with a painless mass in a periungual dorsoradial region of the right thumb. It is a rare benign neoplasm, which was recently described, that arouse on the skin and subcutaneous tissue of the hands and feet, especially in the proximity to the ungual region of male adults. Surgical treatment was performed with the excision in blocks of the margins of the lesion and fragmentation of the nail and nail matrix, according to the literature recommendation. Although there may be local recurrence in 22% of the cases, the patient presents no symptoms, deformities or functional limitations. In addition, there was no sign of tumor recurrence 18 months after the surgery. We are not aware of a similar case report in the Brazilian literature.

Superficial Acral Fibromyxoma of the Thumb: A Case Report.

The authors report a case of superficial acral fibromyxioma (SAF) in a 74-year-old male who presented with a painless mass in a periungual dorsoradial region of the right thumb. It is a rare benign neoplasm, which was recently described, that arouse on the skin and subcutaneous tissue of the hands and feet, especially in the proximity to the ungual region of male adults. Surgical treatment was performed with the excision in blocks of the margins of the lesion and fragmentation of the nail and nail matrix, according to the literature recommendation. Although there may be local recurrence in 22% of the cases, the patient presents no symptoms, deformities or functional limitations. In addition, there was no sign of tumor recurrence 18 months after the surgery. We are not aware of a similar case report in the Brazilian literature.

Do complications in hip arthroscopy change with experience?

PURPOSE: The aim of this study was to evaluate the type and incidence of complications during the development of hip arthroscopic techniques. METHODS: A retrospective series of 194 files of patients treated with hip arthroscopy in a tertiary hospital from December 1999 to March 2008 was reviewed for complications. The incidence of complications was recorded consecutively for each group of 30 patients and in intervals of 2 years. A comparison between the complication rates was performed within the time frames and the set of cases. The type and severity of complications were also recorded. RESULTS: There were 12 complications (6.1%) in this series. Of these, 5 were neurologic (2.6%), 4 were musculoskeletal (2%), and 3 were vascular/ischemic (1.5%). According to severity, 2 were considered major complications (1%), 8 were intermediate (4.1%), and 2 were minor (1%). The incidence of complications did not change with time (P = .959) or with the number of cases performed (P = .771), but different types of complications occurred along the learning curve. CONCLUSIONS: The nature of complications changed with experience, but no significant variation in the incidence was observed over the 9-year period of experience with hip arthroscopy. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Aspectos da distribuição de tecidos músculo-esqueléticos de um banco de tecidos / Aspects of the distribution of musculoskeletal tissues by a tissue bank

OBJETIVO: Avaliar as características da distribuição desses por um Banco de Tecidos no Brasil. MÉTODOS: Base de dados do Banco de Tecidos entre setembro de 2006 e junho de 2008. Características dos receptores foram tabuladas. Os tipos de tecidos processados foram: cabeças femorais, osso metafisio-epifisário, osso cortical, ossos curtos ou chatos e tendões. O destino dos enxertos foi analisado. Frequências das distribuições foram obtidas e analisadas. RESULTADOS: Foram distribuídas 734 unidades tecidos fresco-congelados, transplantadas em 683 receptores. Doadores de múltiplos órgãos originaram 97,9 por cento dos tecidos e doadores vivos os demais. Foram transplantados 489 unidades de osso córtico-esponjoso, 137 de osso metafisio-epifisário, 44 de osso chato ou curto, 3 de tendão, 29 de osso particulado e 32 de cabeças femorais. A média de idade dos receptores foi 50,3 anos, sendo 59,5 por cento do sexo feminino e 40,5 por cento do masculino. Os tecidos foram destinados para uso ortopédico em 21,1 por cento dos casos e buco-maxilo-facial, em 78,9 por cento. CONCLUSÃO: O Banco de Tecidos aumentou o número de distribuições em resposta à demanda crescente de tecidos, principalmente para uso em cirurgia buco-maxilo-facial.

OBJECTIVE: Is to evaluate the characteristics of the distribution of these grafts by a Tissue Bank in Brazil. METHODS: Tissue Bank database from September 2006 to June 2008. The characteristics of the recipients were drawn up in the table form. The types of tissue processed were: femoral heads, metaphyseal-epiphyseal bone, cortical bone, flat or short bones and tendons. The intended purpose of the grafts was analyzed, and distribution frequencies were also obtained and analyzed. RESULTS: Altogether, 734 units of fresh-frozen tissue were distributed and transplanted into 683 recipients. In terms of origin of the tissues, 97.9 percent came from multiple organ donors, and the remainder from living donors. A total of 489 units of cortical bone were transplanted, 137 of metaphyseal-epiphyseal bone, 44 of short or flat bones, 3 of tendon, 29 of particulate bone and 32 femoral heads. The mean age of the recipients was 50.3 years; 59.5 percent were women and 40.5 percent men. The tissues were used in orthopedic surgeries in 21.1 percent of the cases, and in oral and maxillofacial procedures in 78.9 percent. CONCLUSION: The Tissue Bank has increased the number of distributions in response to the growing demand for tissues, particularly for use in oral and maxillofacial procedures.

Tratamento artroscópico da osteocondromatose sinovial no quadril / Arthroscopic treatment of synovial osteochondromatosis in the hip

OBJETIVO: O objetivo deste trabalho é mostrar os resultados obtidos no tratamento da osteocondromatose no quadril pela via artroscópica. MÉTODOS: Foram avaliados seis pacientes submetidos à artroscopia do quadril por osteocondromatose sinovial, quanto à função e dor nos períodos pré e pós-operatórios. O tempo de queixa pré-operatória variou de nove a 48 meses, média de 28,2 meses e o seguimento variou de oito a 25 meses, média de 17,1 meses. A idade média foi de 45,1 anos, quatro pacientes (66,6 por cento) eram do sexo feminino e o lado direito foi acometido em cinco casos (83,3 por cento). RESULTADOS: Quanto aos resultados pelos critérios de Harris modificados por Byrd, a pontuação evoluiu de média de 54,1 para 90,4 pontos e a escala de expressões faciais para quantificação da dor variou de média de 1,7 ponto para 5,1 pontos. CONCLUSÃO: A artroscopia é boa alternativa para o tratamento da osteocondromatose no quadril, apesar de ser necessário maior tempo de seguimento para afirmar isso categoricamente. Os resultados observados até então são animadores. Trata-se de procedimento pouco invasivo e que permite boa recuperação.

OBJECTIVE: The objective of this study is to show the results achieved in the treatment of hip osteochondromatosis by arthroscopy. METHODS: Six patients submitted to hip arthroscopy for synovial osteochondromatosis have been assessed for pre- and postoperative function and pain. The time of preoperative complaint ranged from nine to 48 months, in an average of 28.2 months and the follow-up ranged from eight to 25 months (mean: 17.1 months). Mean age was 45.1 years, with four female patients (66.6 percent) and the right side affected in five cases (83.3 percent). RESULTS: Concerning the results according to Byrd-modified Harris' criteria, the mean score evolved from 54.1 to 90.4, and the mean score on the face expressions scale for pain assessment ranged from 1.7 to 5.1. CONCLUSION: arthroscopy is a good alternative for hip osteochondromatosis treatment, although longer follow-up times are required to strictly stating this. The results found so far are encouraging, constituting a little-invasive procedure allowing good recovery.

Perfil da utilização de dispositivos de segurança em automóveis por pacientes de uma clínica pediátrica / Use profile of protective devices for children in vehicles among patients from a private pediatrics' clinic

Acidentes de trânsito são grave problema de saúde pública. A elevada mortalidade entre crianças no trânsito e a proteção oferecida por equipamentos de segurança, justificam a necessidade de conhecer melhor seu uso para elaborar estratégias que objetivem diminuir a morbimortalidade. O presente trabalho avaliou a utilização de equipamentos de segurança para crianças nos automóveis e o conhecimento dos pais sobre o seu uso correto. Foram aplicados questionários aos responsáveis pelos clientes da clínica CORPEL, em Santos Dumont-MG, de maio a setembro de 2004, num estudo de corte seccional. Foram entrevistados 390 responsáveis, sendo 101 excluídos. Das crianças incluídas no estudo, 17,3% tinham menos de 1 ano; 24,2% 1 ano ou mais e menos de 4 anos; e 58,5%, 4 anos ou mais. Dos responsáveis entrevistados que não possuíam equipamento de segurança (74,1%), 57,4% declararam achar que a criança já podia usar cinto; 5,5% não achavam importante; 5,5% achavam caro; e 2% não conheciam. Entre os que utilizavam, 56% o faziam sempre, sendo a adequação do uso de 33,3%. Portanto, apenas 8,7% das crianças estavam sendo transportadas corretamente. Somente 20,7% dos pais conheciam o correto uso das bolsas de ar. Os resultados deste trabalho demonstram uma falha na informação dos pais, permitindo inferir que campanhas educativas e regulamentação específica poderiam ter impacto positivo na utilização dos dispositivos de segurança.

Traffic accidents are a serious public health problem. High mortality rates among children and the protection provided by child restraints, justify the need to study the use of preventive equipment, in order to develop strategies to reduce injuries and deaths. This study evaluated the use of children`s restraints and parental knowledge about their correct use. Questionnaires were administered to parents in CORPEL clinic, in Santos Dumont - MG, from May to September, 2004, in a cross-sectional study. 390 parents were interviewed and 101 were excluded. Among the included, 17.3% were less then one year of age; 24.2% were 1 year or over of age but less then four years; and 58.5% were four years old or over. Among those who did not have protective devices (74.1%), 57.4% had the impression the child was old enough to wear a seat belt; 5.5% regarded it as not important; 5.5% believed it was too expensive; and 2% did not know it existed. Among those who had such devices, 56% always used them, but just 33.3% knew the proper use. Therefore, only 8.7% of the children were safely transported. Just 20.7% of the parents knew the correct use of air-bags. The results of this study showed a great flaw in parental knowledge. Educational programs and stricter regulations might have a positive impact on the use of children`s restraints.