Assessment of the Accuracy of the AO Spine-TL Classification for Thoracolumbar Spine Fractures Using the AO Surgery Reference Mobile App.

STUDY DESIGN: Cohort study. OBJECTIVES: This study aimed to evaluate the accuracy of the AO Surgery Reference mobile app in the diagnosis of thoracolumbar fractures of the spine according to the AO TL classification, and to discuss the usefulness of this app in the teaching and training of the resident physicians in orthopedics and traumatology area. METHODS: The 24 residents of Orthopedic and Traumatology program assessed 20 cases of thoracolumbar fractures selected from the hospital database on 2 different occasions, with a 30-day interval, and they classified these cases with and without using the AO Surgery Reference app. A group of spine experts previously established the gold standard and the answers were statistically compared, with the inter- and intraobserver reliability evaluated by the kappa index. RESULTS: The use of the AO Surgery Reference app increased the classification success rate of the fracture morphology (from 53.4% to 72.5%), of the comorbidity modifier (from 61.4% to 77.9%) and of the neurological status modifier (from 55.1% to 72.9%). In addition, the mobile app raised the classification agreement and accuracy. The kappa index increased from 0.30 to 0.53 regarding the morphological classification of fractures. CONCLUSIONS: The residents improved their ability to recognize and classify thoracolumbar spine fractures, which reinforces the importance of this tool in medical education and clinical practice.

EFFECT OF SUBSCAPULARIS TEARS ON FUNCTIONAL SCORES OF PATIENTS UNDERGOING ROTATOR CUFF REPAIR.

OBJECTIVE: To evaluate the influence of partial- and full-thickness upper third subscapularis tendon tears on the functional scores of patients undergoing arthroscopic rotator cuff repair. METHODS: Patients who underwent arthroscopic rotator cuff repair were divided into three groups according to the subscapularis tendon condition: intact, partial-thickness tear, or full-thickness upper third tear. Functional scores were compared among groups. Second, the influence of biceps and infraspinatus tears on the scores was tested using multivariate regression analysis. RESULTS: We evaluated 307 shoulders in 297 patients. Full-thickness upper third subscapularis tears presented significantly worse scores than intact tendons. Partial-thickness tears had scores that did not differ significantly from those of the other groups. Patients with full-thickness upper third tears presented a greater rate of injured and unstable biceps tendons. The multivariate analysis showed that biceps and infraspinatus tendon tears did not influence the scores or the intergroup comparison. CONCLUSION: Full-thickness upper third subscapularis tendon tears presented worse functional scores than intact subscapularis tendons among patients undergoing posterosuperior rotator cuff repair. Patients with full-thickness subscapularis tears were more likely to suffer biceps tears, but this fact did not influence functional scores. Level of Evidence I; Clinical randomized trial.

OBJETIVO: Avaliar a influência das lesões do terço superior do tendão subescapular nos escores funcionais de pacientes submetidos ao reparo artroscópico do manguito. MÉTODOS: Divisão em três grupos, conforme condição do tendão subescapular: intacto; ruptura de espessura parcial ou ruptura do terço superior de espessura total. Comparamos escores funcionais. Em seguida, a influência das lesões do bíceps e do infraespinhal nos escores foi testada através de análise de regressão multivariada. RESULTADOS: Avaliamos 307 ombros em 297 pacientes. Rupturas subescapulares no terço superior de espessura total apresentaram escores significativamente piores aos pacientes com tendão intacto. Rupturas de espessura parcial apresentaram escore sem diferença significativa em relação aos demais. Pacientes com rupturas do terço superior de espessura total apresentaram maior taxa de lesão e instabilidade tendínea do bíceps. Análise multivariada mostrou que as rupturas tendíneas do bíceps e infraespinal não influenciaram os escores. CONCLUSÃO: Pacientes com lesão do terço superior de espessura total do tendão do subescapular apresentaram escores funcionais piores do que pacientes com tendão intacto submetidos ao reparo artroscópico posterossuperior do manguito. Pacientes com rupturas do subescapular com espessura total foram mais propensos a apresentar rupturas do bíceps, sem influenciar escores funcionais. Nível de Evidência I, Estudo clínico randomizado.

Effect of subscapularis tears on functional scores of patients undergoing rotator cuff repair / Influência da lesão do subescapular nos escores funcionais de pacientes submetidos a reparo do manguito rotador

ABSTRACT Objective: To evaluate the influence of partial- and full-thickness upper third subscapularis tendon tears on the functional scores of patients undergoing arthroscopic rotator cuff repair. Methods: Patients who underwent arthroscopic rotator cuff repair were divided into three groups according to the subscapularis tendon condition: intact, partial-thickness tear, or full-thickness upper third tear. Functional scores were compared among groups. Second, the influence of biceps and infraspinatus tears on the scores was tested using multivariate regression analysis. Results: We evaluated 307 shoulders in 297 patients. Full-thickness upper third subscapularis tears presented significantly worse scores than intact tendons. Partial-thickness tears had scores that did not differ significantly from those of the other groups. Patients with full-thickness upper third tears presented a greater rate of injured and unstable biceps tendons. The multivariate analysis showed that biceps and infraspinatus tendon tears did not influence the scores or the intergroup comparison. Conclusion: Full-thickness upper third subscapularis tendon tears presented worse functional scores than intact subscapularis tendons among patients undergoing posterosuperior rotator cuff repair. Patients with full-thickness subscapularis tears were more likely to suffer biceps tears, but this fact did not influence functional scores. Level of Evidence I; Clinical randomized trial

RESUMO Objetivo: Avaliar a influência das lesões do terço superior do tendão subescapular nos escores funcionais de pacientes submetidos ao reparo artroscópico do manguito. Métodos: Divisão em três grupos, conforme condição do tendão subescapular: intacto; ruptura de espessura parcial ou ruptura do terço superior de espessura total. Comparamos escores funcionais. Em seguida, a influência das lesões do bíceps e do infraespinhal nos escores foi testada através de análise de regressão multivariada. Resultados: Avaliamos 307 ombros em 297 pacientes. Rupturas subescapulares no terço superior de espessura total apresentaram escores significativamente piores aos pacientes com tendão intacto. Rupturas de espessura parcial apresentaram escore sem diferença significativa em relação aos demais. Pacientes com rupturas do terço superior de espessura total apresentaram maior taxa de lesão e instabilidade tendínea do bíceps. Análise multivariada mostrou que as rupturas tendíneas do bíceps e infraespinal não influenciaram os escores. Conclusão: Pacientes com lesão do terço superior de espessura total do tendão do subescapular apresentaram escores funcionais piores do que pacientes com tendão intacto submetidos ao reparo artroscópico posterossuperior do manguito. Pacientes com rupturas do subescapular com espessura total foram mais propensos a apresentar rupturas do bíceps, sem influenciar escores funcionais. Nível de Evidência I, Estudo clínico randomizado.

Improving cardiovascular prevention through patient awareness.

OBJECTIVE: Patients with peripheral artery disease (PAD) or coronary artery disease (CAD) must have their risk factors rigorously controlled, but there is a gap between practice and ideal. This study aimed to demonstrate how cardiovascular prevention is performed for these patients in a Brazilian university hospital, and to identify predictors of good practice. METHODS: 192 patients with CAD or PAD were included in this transversal study. Six prevention goals were analyzed: 1) systolic blood pressure < 140 mmHg; 2) diastolic blood pressure < 90 mmHg; 3) LDL < 100 mg/dL; 4) HDL > 40 mg/dL for men/ > 50 mg/dL for women; 5) not smoking; 6) regular practice of aerobic exercise. RESULTS: The mean age of the patients was 65.7 years, and 60% were men. The percentage of patients that achieved goals 1 to 6 was 57.3%, 67.2%, 40.1%, 27.6%, 88.5%, and 25%, respectively. The average number of goals achieved by patients was 3.06 ± 1.31. When asked about the reason for being treated, 182(94.8%) patients claimed to know about their disease, but when the diagnosis reported by the patients with the physician's diagnosis were compared, it was discordant in 12% of cases. The average number of goals achieved by patients was 2.67 and 3.46 for the PAD and the CAD group, respectively. The independent predictors of a higher number of goals/patient were: male gender (p = 0.011), hospitalization (p < 0.0001), CAD diagnosis (p = 0.011), knowing the reason for treatment (p = 0.028), and receiving prescription of ß -blocker (p = 0.011). CONCLUSION: Even in an university hospital, prevention is far from ideal. Efforts to increase patients' awareness should be stimulated, and can possibly improve the effectiveness of preventive measures.

Improving cardiovascular prevention through patient awareness / Melhora da prevenção cardiovascular pelo conhecimento do paciente

OBJECTIVE: Patients with peripheral artery disease (PAD) or coronary artery disease (CAD) must have their risk factors rigorously controlled, but there is a gap between practice and ideal. This study aimed to demonstrate how cardiovascular prevention is performed for these patients in a Brazilian university hospital, and to identify predictors of good practice. METHODS: 192 patients with CAD or PAD were included in this transversal study. Six prevention goals were analyzed: 1) systolic blood pressure < 140 mmHg; 2) diastolic blood pressure < 90 mmHg; 3) LDL < 100 mg/dL; 4) HDL > 40 mg/dL for men/ > 50 mg/dL for women; 5) not smoking; 6) regular practice of aerobic exercise. RESULTS: The mean age of the patients was 65.7 years, and 60% were men. The percentage of patients that achieved goals 1 to 6 was 57.3%, 67.2%, 40.1%, 27.6%, 88.5%, and 25%, respectively. The average number of goals achieved by patients was 3.06 ± 1.31. When asked about the reason for being treated, 182(94.8%) patients claimed to know about their disease, but when the diagnosis reported by the patients with the physician's diagnosis were compared, it was discordant in 12% of cases. The average number of goals achieved by patients was 2.67 and 3.46 for the PAD and the CAD group, respectively. The independent predictors of a higher number of goals/patient were: male gender (p = 0.011), hospitalization (p < 0.0001), CAD diagnosis (p = 0.011), knowing the reason for treatment (p = 0.028), and receiving prescription of β -blocker (p = 0.011). CONCLUSION: Even in an university hospital, prevention is far from ideal. Efforts to increase patients' awareness should be stimulated, and can possibly improve the effectiveness of preventive measures.

OBJETIVO: Pacientes com doença arterial periférica (DAP) ou doença arterial coronariana (DAC) necessitam de um controle rigoroso dos seus fatores de risco, mas essa prática ainda está muito aquém da ideal. O objetivo deste estudo foi verificar como é feita a prevenção cardiovascular nesses pacientes em um hospital universitário no Brasil e identificar os preditores de melhor prevenção secundária. MÉTODOS: Trata-se de estudo transversal, com 192 pacientes portadores de DAC ou DAP. Foram analisadas seis metas a serem atingidas: 1) pressão arterial sistólica < 140 mmHg; 2) pressão arterial diastólica < 90 mmHg; 3) LDL < 100 mg/dL; 4) HDL > 40 mg/dL para homens/> 50 mg/dL para mulheres; 5) não fumar; 6) prática de exercício físico aeróbico regular. RESULTADOS: A idade média dos pacientes é 65,7 anos e 60% são do sexo masculino. A porcentagem dos pacientes que atingiram de 1 a 6 metas foi 57,3%; 67,2%; 40,1%; 27,6%; 88,5% e 25%, respectivamente. O número médio de metas atingidas por paciente foi 2,67 e 3,46 para os pacientes com DAP e DAC, respectivamente. Os preditores independentes de maior número de metas/paciente foram: sexo masculino (p = 0,011), estar internado (p < 0,001), diagnóstico de DAC (p = 0,011), saber o motivo do tratamento (p = 0,028) e receber prescrição de β-bloqueador (p = 0,011). CONCLUSÃO: Mesmo em um hospital universitário, a prevenção encontra-se longe da ideal. Esforços para aumentar a conscientização do paciente devem ser estimulados e podem possivelmente melhorar a efetividade das medidas preventivas.