Medial Opening Wedge High Tibial Osteotomy Decreases Medial Meniscal Extrusion and Improves Clinical Outcomes and Return to Activity.

BACKGROUND: Medial meniscal extrusion (MME) is defined as displacement of the meniscus that extends beyond the tibial margin. Knee varus malalignment increases MME. PURPOSE/HYPOTHESIS: The purpose of this study was to quantify MME before and after medial opening wedge high tibial osteotomy (HTO) and to correlate the reduction of MME with clinical outcomes and return to activity. It was hypothesized that MME would decrease after HTO and that patients with lower MME after surgery would have improved clinical outcomes and return to activity at short-term follow-up. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: This study included 66 patients who underwent HTO to correct the anatomic axis with a minimum follow-up of 2 years. MME was measured using magnetic resonance imaging preoperatively and 6 weeks after surgery (study protocol). Patients were assessed preoperatively and postoperatively with the Knee injury and Osteoarthritis Outcome Score (KOOS), visual analog scale (VAS) score for pain, and Tegner score. RESULTS: The mean ± SD preoperative and postoperative MME values were 3.9 ± 0.6 mm and 0.9 ± 0.5 mm, respectively. At 2 years after surgery, KOOS, pain VAS, and Tegner scores were higher than those found preoperatively (P < .001). Patients with less than 1.5 mm of MME after surgery had better clinical outcomes and return to activity compared with patients who had MME of 1.5 mm or more (P < .05). CONCLUSION: Medial opening wedge HTO decreased MME after 6 weeks and improved clinical outcomes and return to activity at a minimum 2-year follow-up. Additionally, patients with postoperative MME of less than 1.5 mm had better clinical outcomes and return to activity compared with patients who had postoperative MME of 1.5 mm or more.

Intrapelvic Migration of the Cephalic Screw of a Proximal Femoral Long Intramedullary Nail: Case Report.

The use of cephalomedullary devices has gained popularity in the treatment of proximal femoral fractures. Despite their biomechanical advantages, several complications are well described in the literature. One of these complications, which is rarely reported, is the medial migration of the cephalic screw. The authors present this unusual complication in a case of a long-nail implant, which was treated with removal of the implants as a first step, and posterior osteosynthesis with a locked proximal femur plate as a second step, as well the outcome until fracture consolidation and resolution of the case.

Intrapelvic Migration of the Cephalic Screw of a Proximal Femoral Long Intramedullary Nail: Case Report* / Migração intrapélvica do parafuso cefálico da haste intramedular longa para fêmur proximal: Relato de caso

Abstract The use of cephalomedullary devices has gained popularity in the treatment of proximal femoral fractures. Despite their biomechanical advantages, several complications are well described in the literature. One of these complications, which is rarely reported, is the medial migration of the cephalic screw. The authors present this unusual complication in a case of a long-nail implant, which was treated with removal of the implants as a first step, and posterior osteosynthesis with a locked proximal femur plate as a second step, as well the outcome until fracture consolidation and resolution of the case.

Resumo O uso dos dispositivos cefalomedulares tem ganhado popularidade no tratamento das fraturas do fêmur proximal. Apesar das vantagens biomecânicas, várias complicações são descritas, entre as quais a migração medial do parafuso cefálico é pouco conhecida. Os autores apresentam um caso dessa complicação incomum em um implante de haste longa tratada em dois tempos cirúrgicos para a retirada dos implantes e posterior osteossíntese com placa bloqueada para fêmur proximal, assim como o desfecho até a consolidação da fratura e resolução do caso.

Higher Axial Tibiofemoral Rotation and Functional Outcomes with Mobile-Bearing Compared with Fixed-Bearing Total Knee Arthroplasty at 1- but Not at 2-Year Follow-Up-A Randomized Clinical Trial.

The objective of this study was to determine in vivo knee kinematics and clinical outcomes of patients who underwent fixed- and mobile-bearing total knee arthroplasty (TKA) at 1- and 2-year follow-up. This prospective double-blinded randomized controlled trial was performed from November 2011 to December 2012. A total of 64 patients were randomized to fixed- and mobile-bearing TKA groups (32 patients in each group). All patients were evaluated with the following: three-dimensional in vivo knee kinematics analysis during gait, stepping up and stepping down stair steps, and getting up from and sitting on a chair; and knee range of motion and patient-reported outcome measures (Knee Outcome Survey Activities of Daily Living Scale [KOS-ADLS] and pain visual analog scale [VAS]) at 1- and 2-year follow-up. Descriptive statistics (means, standard deviations, and percentages) were calculated for all variables. The Kolmogorov-Smirnov test was used to test if variables were normally distributed. A Student's t-test was used to compare continuous variables between patients in the two groups. The chi-square test was used to compare the groups with respect to categorical variables. The α level for statistical significance was set at p < 0.05. The mean axial tibiofemoral rotation in patients who underwent mobile-bearing TKA was significantly higher during gait (13.3 vs. 10.7), stepping up (12.8 vs. 10) stair steps, and getting up (16.1 vs. 12.1) from a chair compared with fixed-bearing TKA patients at 1-year follow-up (p < 0.05). KOS-ADLS function score was significantly higher in the mobile-bearing compared with the fixed-bearing TKA group (32 vs. 27.7) at 1-year follow-up (p < 0.05). No significant difference in kinematics and clinical outcomes between fixed- and mobile-bearing TKA groups was observed at 2-year follow-up (p > 0.05). Based on the results of this study, mobile-bearing TKA allowed a higher degree of rotation when walking, stepping up stair steps, and standing up from a chair, and had higher functional outcomes compared with fixed-bearing TKA at 1-year follow-up. However, no difference in in vivo kinematics or in clinical outcomes was observed between fixed- and mobile-bearing prostheses at 2-year follow-up.

Análise do equilíbrio espinopélvico em pacientes com espondilolistesedegenerativa L4-L5 / Analysis of spinopelvic balance in patients with L4-L5 degenerative spondylolisthesis

Objetivos: Avaliar o equilíbrio espinopélvico em pacientes portadores de espondilolistese degenerativa L4-L5. Métodos: Analisamos as radiografias pré-operatórias lombopélvicas, em perfil, de 33 pacientes portadores de espondilolistese degenerativa L4-L5 para a mensuração dos parâmetros envolvidos no equilíbrio espinopélvico. Resultados: Dos 33 pacientes, 22 pertencem ao sexo feminino, com média de idade de 59 anos. A média da incidência pélvica (IP), inclinação pélvica (TILT) e inclinação sacral (SLOP) foi 61,4°; 22,1º e 38,3º, respectivamente, havendo correlação positiva entre IP e TILT e correlação negativa entre SLOP e TILT, ambas com significância estatística. Conclusão: Na espondilolistese degenerativa L4-L5, a IP, TILT e SLOP tiveram suas médias iguais a 61,4°, 38,3° e 22,1°, respectivamente, revelando alteração na conformação pélvica que culminou em um desequilíbrio espinopélvico nesses pacientes.

Objectives: To evaluate and analyze the spinopelvic balance in patients with L4-L5 degenerative spondylolisthesis. Methods: We analyzed the lumbopelvic preoperative radiographs in profile, 33 patients with L4-L5 degenerative spondylolisthesis to measure the parameters involved in spinopelvic balance as pelvic incidence (PI), pelvic tilt (TILT pelvic) and sacral slope (SLOP sacral). Results: Of the 33 patients with degenerative spondylolisthesis, 22 were female and the mean age was 59 years. The average IP, TILT and SLOP was 61.4°, 22.1° and 38.3°, respectively, with a positive correlation between IP and TILT and a negative correlation between SLOP and TILT, both with statistical significance. Conclusion: Patients with L4-L5 DS, IP, TILT and SLOP had their means equal to 61.4°, 38.3° and 22.1°, respectively, demonstrated that possibility the pelvic imbalance in these patients.

Internações por condições sensíveis à atenção primária no Espírito Santo: estudo ecológico descritivo no período 2005-2009 / Hospitalization for primary care sensitive conditions in Espirito Santo: an ecological decriptive study, 2005–2009

Objetivo: descrever as internações por condições sensíveis à atenção primária (CSAP) no estado do Espírito Santo, Brasil, no período 2005-2009. Métodos: estudo ecológico descritivo das internações do Sistema Único de Saúde, classificadas conforme a lista brasileira de internações por CSAP, estudadas por municípios de residência, distribuídas por microrregião, sexo, faixa etária e grupo de causas. Resultados: registro de 823.343 internações por CSAP no período, representando 28,9 por cento do total de internações por CSAP em 2005 e 23,2 por cento em 2009; coeficiente de internações por CSAP reduzido de 14,1 para 11,4/1000 habitantes, diferentemente segundo microrregiões; internações por CSAP mais frequentes em menores de cinco anos e idosos, 29,3 e 39,1/1000 habitantes respectivamente; gastroenterites, pneumonias, insuficiência cardíaca e infecção no rim e trato urinário somaram 50,3 por cento das causas. Conclusões: há indícios de melhoria no quadro das internações por CSAP apesar dos ganhos irregulares.

Objective: to describe hospitalization for ambulatory care sensitive conditions (ACSC) in the state of Espírito Santo, Brazil, in the period 2005-2009. Methods: an ecological descriptive study of hospitalizations in the National Health System, based on the Brazilian list of ACSC, by Municipalities of residence, distributed by Micro-region, gender, age group and causes. Results: were recorded 823,343 hospitalizations for ACSC in the period, representing 28,9 percent of these admissions in 2005 and 23,2 percent in 2009; ACSC rates per 1000 population decreased from 14,1 to 11,4 per 1000 inhabitants, differently among micro-regions; children underfive years and elderly were more likely to hospitalization, 29,3 and 39,1/1000 inhabitants respectively; gastroenteritis, bacterial pneumonia, heart failure and infection in urinary tract account for 50,3 percent of cases. Conclusion: there are indications of improvement on hospitalizations for ACSC in the State despite irregular gains.