Eficácia do aprendizado da videoartroscopia em modelos sintéticos / Effectiveness of the videoarthroscopy learning process in synthetic shoulder modelss

OBJETIVOS: Os autores avaliaram o aprendizado da técnica de triangulação videoartroscópica, utilizando o simulador sintético SAM® (Shoulder Arthroscopy Model). Método: Vinte residentes de Ortopedia, sem conhecimento prévio da técnica artroscópica, foram avaliados antes e depois do treinamento. As tarefas consistiam em posicionar, em portais preestabelecidos, quatro fios presos a uma âncora colocada no colo anatômico do úmero. Foram observados o tempo, o número de movimentos, a quantidade de tentativas, a quantidade de erros e a comparação das etapas das tarefas antes e depois do treinamento no modelo. RESULTADOS: Os dados foram submetidos à avaliação estatística, havendo diferença significativa na comparação das variáveis avaliadas antes e depois do treinamento. CONCLUSÃO: O resultado deste estudo nos permite concluir que o treinamento da videoartroscopia no modelo SAM possibilita que o cirurgião consiga realizar tarefas necessárias para a cirurgia videoartroscópica em menor tempo, cometendo menos erros, desenvolvendo também a habilidade de lidar com a imagem videoartroscópica.

OBJECTIVES: The authors evaluate the learning of the videoarthroscopic technique, using the video surgery simulator SAM® (Shoulder Arthroscopy Model). Method: Twenty medical residents in Orthepaedics, without prior knowledge of the arthroscopic technique, were evaluated before and after training. The tasks consisted of positioning, in holes that simulated portals, four surgical threads attached to an anchor placed in the anatomical neck of the humerus in the synthetic model. Time, number of movements, number of attempts, amount of errors and comparison between the two phases of training before and after - were observed and noted. RESULTS: The data was submitted to statistical analysis, and a significant difference was found in the comparison of the variables before and after the training. CONCLUSION: The result of this study enables us to conclude that training in the videoarthroscopic technique using the video surgery simulator SAM enables the surgeon to execute essential tasks involved in these techniques, in less time, making less mistakes, and developing the ability to deal better with the videoarthrocopic image.

EFFECTIVENESS OF THE VIDEOARTHROSCOPY LEARNING PROCESS IN SYNTHETIC SHOULDER MODELS.

OBJECTIVES: The authors evaluate the learning of the videoarthroscopic technique, using the video surgery simulator SAM® (Shoulder Arthroscopy Model). METHODS: Twenty medical residents in Orthepaedics, without prior knowledge of the arthroscopic technique, were evaluated before and after training. The tasks consisted of positioning, in holes that simulated portals, four surgical threads attached to an anchor placed in the anatomical neck of the humerus in the synthetic model. Time, number of movements, number of attempts, amount of errors and comparison between the two phases of training before and after - were observed and noted. RESULTS: The data was submitted to statistical analysis, and a significant difference was found in the comparison of the variables before and after the training. CONCLUSION: The result of this study enables us to conclude that training in the videoarthroscopic technique using the video surgery simulator SAM enables the surgeon to execute essential tasks involved in these techniques, in less time, making less mistakes, and developing the ability to deal better with the videoarthrocopic image.

ARTHROSCOPIC TREATMENT OF ELBOW STIFFNESS.

UNLABELLED: To present the arthroscopic surgical technique and the evaluation of the results from this technique for treating elbow stiffness. METHODS: Between April 2007 and January 2010, ten elbows of ten patients with elbow stiffness underwent arthroscopic treatment to release the range of motion. The minimum follow-up was 11 months, with an average of 27 months. All the patients were male and their average age was 32.8 years (ranging from 22 to 48 years). After the arthroscopic treatment, they were followed up weekly in the first month and every three months thereafter. The clinical evaluation was made using the criteria of the University of California at Los Angeles (UCLA). RESULTS: All the patients were satisfied with the results from the arthroscopic treatment. The average UCLA score was 33.8 points. CONCLUSION: Arthroscopic treatment for elbow stiffness is a minimally invasive surgical technique that was shown to be efficient for treating this complication.

Tromboembolia pulmonar após videoartroscopia de ombro / Thromboembolic complication after arthroscopic shoulder surgery

Embora fenômenos tromboembólicos sejam complicações frequentes em cirurgias dos membros inferiores, apenas dois relatos de casos de tromboembolia pulmonar após artroscopia de ombro são encontrados na literatura. É descrito o caso de uma paciente com 76 anos com embolia pulmonar bilateral após artroscopia cirúrgica do ombro. Não foram encontradas anormalidades vasculares e nenhuma origem do trombo foi detectada, ficando desconhecida a causa exata responsável pela tromboembolia.

Though thromboembolisms are frequent complications of surgery of the lower extremities, only two cases of pulmonary thromboembolism after shoulder arthroscopy are found in the literature. We describe the case of a 76-year-old patient with pulmonary embolism in both lungs after shoulder arthroscopy. No vascular abnormalities nor the origin of the thrombus was detected. The etiology of the thromboembolism remains unknown.

THROMBOEMBOLIC COMPLICATION AFTER ARTHROSCOPIC SHOULDER SURGERY.

Although thromboembolic phenomena are frequent complications in lower-limb surgery, there are only two cases of pulmonary thromboembolism following shoulder arthroscopy in the literature. We describe the case of a 76-year-old patient with pulmonary embolism in both lungs after shoulder arthroscopy. No vascular abnormalities were found and no origin for the thrombus was detected. The exact cause of the thromboembolism remains unknown.

EXTENSIVE OSTEOLYSIS AFTER THE USE OF A BIOABSORBABLE SUTURE ANCHOR: CASE REPORT AND LITERATURE REVIEW.

Bioabsorbable implants are very frequently used to treat rotator cuff and shoulder labrum injuries. Many researchers have observed small areas of osteolysis after treating pathological conditions of the shoulder using bioabsorbable anchors. Biological and mechanical theories have been put forward to account for the osteolysis caused by these materials. The case of a patient who was simultaneously treated for a rotator cuff lesion using the double-row technique and a Bankart lesion using bioabsorbable PLLA anchors and Fiber Wire®, and developed extensive osteolysis of the anatomical neck of the humerus, is described. Given that an anchor was used in the glenoid, and this did not present osteolysis, the hypothesis that mechanical factors are important in the etiology of this complication is raised.

Osteólise extensa após uso de âncora bioabsorvível: relato de caso e revisão da literatura / Extensive osteolysis after the use of a bioabsorbable suture anchor: case report and literature review

Os implantes bioabsorvíveis são usados com muita frequência no tratamento das lesões do manguito rotador e lesões labiais do ombro. Vários pesquisadores observaram áreas pequenas de osteólise depois da utilização destas âncoras bioabsorvíveis no tratamento das patologias do ombro. Teorias biológicas e mecânicas são levantadas para justificar a osteólise causada por estes materiais. É descrito o caso de um paciente que realizou, simultaneamente, sutura do manguito rotador com a técnica de dupla fileira e sutura da lesão de Bankart com âncoras bioabsorvíveis de PLDLA e fios Fiber Wire®; evoluindo com extensa osteólise do colo anatômico do úmero. Tendo em vista que foi utilizada uma âncora na glenoide e esta não apresentou osteólise, levanta-se a hipótese de que os fatores mecânicos sejam importantes na etiologia desta complicação.

Bioabsorbable implants are frequently used in the treatment of rotator cuff and shoulder labrum injuries. Many authors have observed small areas of osteolysis after repair of shoulder abnormalities with absorbable anchors. Biological and mechanic theories are put forward to account for the osteolysis caused by these materials. We present a case of a patient who was simultaneously treated for a rotator cuff lesion with the double-row technique and a Bankart lesion with bioabsorbable PLLA anchors, and developed extensive osteolysis of the anatomic neck of the humerus. Because no lysis appeared in the glenoid around the other PLLA implant, we hypothesized that mechanical factors are important in the etiology of this complication.

Avaliação do tratamento cirúgico da fratura em duas partes do colo cirúrgico do úmero com placa PFS 80® / Assessment of surgical treatment of two-part humerus surgical neck fracture with PFS 80® plate

As fraturas em duas partes do colo cirúrgico do úmero são relativamente freqüentes e, quando desviadas, são preferencialmente tratadas por redução e osteossíntese. Entre janeiro de 1996 e maio de 2002, 74 pacientes com essa lesão foram operados: 60 pelo Grupo de Ombro e Cotovelo do Departamento de Ortopedia e Traumatologia da Faculdade de Ciências Médicas da Santa Casa de São Paulo e 14 pelo Grupo de Ombro e Cotovelo do Hospital Moinhos de Vento de Porto Alegre. Desses, 46 foram reavaliados com seguimento médio de 29 meses. A média de idade dos pacientes foi de 59 anos e meio, sendo 69,6por cento do sexo feminino e 30,4 por cento do masculino. O ombro dominante foi acometido em metade dos casos. Pelo método de avaliação da UCLA, encontraram-se 91,3por cento de resultados excelentes (65,2 por cento) e bons (26,2 por cento) e 8,7 por cento insatisfatórios (4,3 por cento regulares e 4,3 por cento ruins). A consolidação ocorreu em 97,8 por cento dos pacientes. Nove pacientes (19,6 por cento) apresentaram complicações: três casos de capsulite adesiva, dois pacientes com soltura do material de síntese, uma necrose avascular, uma pseudartrose, uma lâmina intra-articular e um hematoma. O objetivo deste estudo é estimar os resultados do tratamento cirúrgico dessas fraturas quando fixadas por um novo material de osteossíntese, a placa PFS 80®, avaliando o seu desempenho, que variou de excelente a bom em 91,3 por cento dos casos. Os autores concluem que o tratamento cirúrgico da fratura em duas partes do colo cirúrgico do úmero com placa PFS 80®, é um método eficaz e com alto índice de excelentes e bons resultados