FRAGILITY FRACTURES IN BRAZIL: CROSS-SECTION STUDY.

Objective: To evaluate the involvement of orthopedists and orthopedic residents with fragility fractures, in its clinical, therapeutic, and social aspects. Methods: Cross-sectional observational and prospective study that took place in the period from June to August 2020. Results: 540 participants were analyzed. The population consisted of orthopedists (85.56%; N = 462) and residents (14.44%; N = 78), with a greater proportion of individuals from 41 to 50 years of age (36.67%; N = 198) and from the Southeast region (57.22%; N = 309). For 47.04% (N = 254) of the participants, the profile of the patient at risk for fragility fracture corresponds to: woman, sedentary, smoker and over 60 years of age. The consensus among the participants (97.96%; N = 529) is that fragility fractures occur in or near home environments. Moreover, 47.59% (N = 257) believe that the first fragility fracture is the most important predictive risk factor for subsequent occurrences and 63.89% (N = 345) of the participants claim to attend more than 15 cases per year. Regarding treatment, 74.44% (N = 402) are dedicated exclusively to orthopedic aspects (68.33%; N = 369). However, 62.41% (N = 337) of the participants believe that patients with fragility fractures should receive medication and supplements. Likewise, 70.74% (N = 382) of the participants consider that home security measures and training of family members are important, and they attribute the role to the multidisciplinary team. Conclusions: Fragility fractures are frequent in the routine of Brazilian orthopedists. However, they are not familiar with adjuvant treatments for fragility fractures, acting almost exclusively in the orthopedics aspects of these injuries. Level of Evidence II, Prospective Study.

Objetivo: Avaliar o entendimento entre ortopedistas e residentes em ortopedia sobre as fraturas por fragilidade, em seus aspectos clínicos, terapêuticos e sociais. Métodos: Estudo transversal, observacional e prospectivo que ocorreu no período de junho de agosto de 2020. Resultados: Foram analisados 540 participantes. A população foi composta por ortopedistas (85,56%; N = 462) e residentes (14,44%; N = 78), com prevalência de idade entre 41 e 50 anos (36,67%; N=198) e oriundos da região Sudeste (57,22%; N = 309). Para 47,04% (N = 254) dos participantes o perfil do paciente em risco para fratura por fragilidade corresponde a: mulher, sedentária, tabagista e acima dos 60 anos de idade. Sendo consenso entre os participantes (97,96%; N = 529) que as fraturas por fragilidade ocorrem em ambientes domiciliares ou próximo a eles. Além disso, 47,59% (N = 257) dos participantes acreditam que a primeira fratura por fragilidade seja o fator de risco preditivo mais importante para novo episódio de fratura e 63,89% (N = 345) dos avaliadores atendem mais de 15 casos por ano. Em relação ao tratamento, 74,44% (N = 402) dedicam-se exclusivamente aos aspectos ortopédicos (68,33%; N = 369). No entanto, 62,41% (N = 337) dos participantes acreditam que paciente devam receber medicamentos e suplementos. Da mesma forma, 70,74% (N = 382) dos avaliadores consideram que medidas de segurança domiciliar e treinamento de familiares sejam importantes e atribuídas a equipe multiprofissional. Conclusão: As fraturas por fragilidade são frequentes na rotina dos ortopedistas brasileiros. No entanto, estes não estão familiarizados com tratamentos adjuvantes nas fraturas consideradas por fragilidade, atuando quase que exclusivamente nos aspectos ortopédicos envolvidos nestas lesões. Nível de Evidência II, Estudo Prospectivo.

Fragility fractures in brazil: cross-section study / Fraturas por fragilidade no brasil: estudo transversal

ABSTRACT Objective: To evaluate the involvement of orthopedists and orthopedic residents with fragility fractures, in its clinical, therapeutic, and social aspects. Methods: Cross-sectional observational and prospective study that took place in the period from June to August 2020. Results: 540 participants were analyzed. The population consisted of orthopedists (85.56%; N = 462) and residents (14.44%; N = 78), with a greater proportion of individuals from 41 to 50 years of age (36.67%; N = 198) and from the Southeast region (57.22%; N = 309). For 47.04% (N = 254) of the participants, the profile of the patient at risk for fragility fracture corresponds to: woman, sedentary, smoker and over 60 years of age. The consensus among the participants (97.96%; N = 529) is that fragility fractures occur in or near home environments. Moreover, 47.59% (N = 257) believe that the first fragility fracture is the most important predictive risk factor for subsequent occurrences and 63.89% (N = 345) of the participants claim to attend more than 15 cases per year. Regarding treatment, 74.44% (N = 402) are dedicated exclusively to orthopedic aspects (68.33%; N = 369). However, 62.41% (N = 337) of the participants believe that patients with fragility fractures should receive medication and supplements. Likewise, 70.74% (N = 382) of the participants consider that home security measures and training of family members are important, and they attribute the role to the multidisciplinary team. Conclusions: Fragility fractures are frequent in the routine of Brazilian orthopedists. However, they are not familiar with adjuvant treatments for fragility fractures, acting almost exclusively in the orthopedics aspects of these injuries. Level of Evidence II, Prospective Study.

RESUMO Objetivo: Avaliar o entendimento entre ortopedistas e residentes em ortopedia sobre as fraturas por fragilidade, em seus aspectos clínicos, terapêuticos e sociais. Métodos: Estudo transversal, observacional e prospectivo que ocorreu no período de junho de agosto de 2020. Resultados: Foram analisados 540 participantes. A população foi composta por ortopedistas (85,56%; N = 462) e residentes (14,44%; N = 78), com prevalência de idade entre 41 e 50 anos (36,67%; N=198) e oriundos da região Sudeste (57,22%; N = 309). Para 47,04% (N = 254) dos participantes o perfil do paciente em risco para fratura por fragilidade corresponde a: mulher, sedentária, tabagista e acima dos 60 anos de idade. Sendo consenso entre os participantes (97,96%; N = 529) que as fraturas por fragilidade ocorrem em ambientes domiciliares ou próximo a eles. Além disso, 47,59% (N = 257) dos participantes acreditam que a primeira fratura por fragilidade seja o fator de risco preditivo mais importante para novo episódio de fratura e 63,89% (N = 345) dos avaliadores atendem mais de 15 casos por ano. Em relação ao tratamento, 74,44% (N = 402) dedicam-se exclusivamente aos aspectos ortopédicos (68,33%; N = 369). No entanto, 62,41% (N = 337) dos participantes acreditam que paciente devam receber medicamentos e suplementos. Da mesma forma, 70,74% (N = 382) dos avaliadores consideram que medidas de segurança domiciliar e treinamento de familiares sejam importantes e atribuídas a equipe multiprofissional. Conclusão: As fraturas por fragilidade são frequentes na rotina dos ortopedistas brasileiros. No entanto, estes não estão familiarizados com tratamentos adjuvantes nas fraturas consideradas por fragilidade, atuando quase que exclusivamente nos aspectos ortopédicos envolvidos nestas lesões. Nível de Evidência II, Estudo Prospectivo.

Intramedullary nail versus bridge plate in open tibial fractures - randomized clinical trial.

INTRODUCTION: Open tibial shaft fractures present a challenge to the orthopedic surgeon, because they are common, have a high rate of complications and still have a controversial treatment. As a result of the high incidence of these fractures, the need of a definitive treatment and the unavailability of the intramedullary nail or a well-trained team, we developed this study to compare the effectiveness of the bridge-plating (BP) with the unreamed intramedullary nail (UIMN) in the treatment of open tibial shaft fractures. MATERIALS AND METHODS: Eighty patients were included in a prospective, consecutive and random way and then randomized in two groups of treatment: unreamed intramedullary nail and bridge-plating. The primary outcomes were the reoperation rate and the Johner-Wruhs functional criteria. Secondary outcomes were complication rates, partial and total weight bearing time and bone consolidation time. We verified the existence of normality in the quantitative variables for the outcomes using the Kolmogorov-Smirnov test. The Chi-Square test was utilized to compare the methods according to the relative frequencies and the comparison between the methods regarding the average of the quantitative variables was done through the T-Student test. RESULTS: Both the reoperation rates and the functional criteria of Johner-Wruhs showed no difference between the two groups. The exposure time and the total surgical time were longer in the UIMN group, however the consolidation time, partial weight bearing time and total weight bearing time did not show significant difference. A significant difference was found between the groups in the implant failure rate, in favor of UIMN, the angular malalignment was another secundary outcome that showed a non significant difference in favor of UIMN. CONCLUSIONS: We concluded that both methods were effective for the treatment of open tibia shaft fractures, however, the implant failure rate was higher in the bridge plate group.

Quick-DASH as a main early outcome of humeral shaft fractures: A Latin American multicenter prospective study.

PURPOSE: The main objective of this study was to evaluate the Quick-Disabilities of the Arm, Shoulder and Hand Score (DASH) score as the main early (90 days) outcome in a prospective multicenter observational Latin American study on isolated humeral shaft fractures. METHODS: From December 2015 to April 2017, in six Latin American countries, patients 18 years or older with a closed, isolated nonpathological 12A, 12B, or 12C AO/OTA (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association) fractures were included. The 90 (±10)-day Quick-DASH score was used to compare the results of the different treatments. The secondary outcomes were patient treatment satisfaction, shoulder and elbow range of motion, and radiographic evaluation. RESULTS: A total of 92 patients successfully completed the Quick-DASH questionnaire. Surgical treatments resulted in better outcomes than nonsurgical treatment, but only minimally invasive plate osteosynthesis produced significantly lower Quick-DASH scores than nonsurgical treatment (p < 0.05). There were strong correlations between patient self-evaluation and the Quick-DASH score (p < 0.0005) but not between the Quick-DASH score and radiographic fracture healing. No significant difference was found between the treatments regarding the rate of return to work, but the medical center had a significant influence on treatment choice (p < 0.0005). CONCLUSION: The high correlation between Quick-DASH score and patient satisfaction and functional outcome indicates that the Quick-DASH questionnaire is a suitable tool for evaluating adult humeral shaft fracture outcomes. Patients with a Quick-DASH score below 15 could be considered recovered, and patients with a Quick-DASH score above 40 could be considered not yet recovered. Quick-DASH scores were not significantly associated with radiographic fracture healing.

Minimally invasive posteromedial percutaneous plate osteosynthesis for diaphyseal tibial fractures: technique description.

PURPOSE: The aim of this study was to evaluate the feasibility of performing minimally-invasive plate osteosynthesis (MIPO) in tibial fractures using two posteromedial incisions, and to measure the distance between the plate and neurovascular structures. MATERIALS AND METHODS: We performed nine dissections of specimens that were submitted to tibial MIPO with two posteromedial incisions. One locking compression plate (LCP) of 14 to 16 holes was inserted into the submuscular tunnel in a retrograde manner. Incisions were linked to evaluate the distance between neurovascular structures and the plate. RESULTS: During the proximal incision, a blunt dissection between semitendinosus and medial gastrocnemius tendons, as well as their lateral shift, helped to protect the main local neurovascular structures. In its distal portion, the submuscular plate tunnel insertion and its direction to the proximal incision prevented direct contact and possible damage to neurovascular structures. Moreover, we obtained successful results from a patient submitted to this procedure. CONCLUSION: Posteromedial MIPO represents a safe and attractive alternative for tibial fractures, particularly if there are damaged soft tissues in the anterior and medial side, or when access to intramedullary osteosynthesis is blocked.

Risk of injury to vascular-nerve bundle after calcaneal fracture: comparison among three techniques.

OBJECTIVE: To ascertain whether the number of screws or pins placed in the calcaneus might increase the risk of injury when three different techniques for treating calcaneal fractures. METHOD: 126 radiographs of patients who suffered displaced calcaneal fractures were retrospectively analyzed. Three surgical techniques were analyzed on an interobserver basis: 31 radiographs of patients treated using plates that were not specific for the calcaneus, 48 using specific plates and 47 using an external fixator. The risk of injury to the anatomical structures in relation to each Kirschner wire or screw was determined using a graded system in accordance with the Licht classification. The total risk of injury to the anatomical structures through placement of more than one wire/screw was quantified using the additive law of probabilities for the product, for independent events. RESULTS: All of the models presented high explanatory power for the risk evaluated, since the coefficient of determination values (R (2)) were greater than 98.6 for all the models. Therefore, the set of variables studied explained more than 98.6% of the variations in the risks of injury to arteries, veins or nerves and can be classified as excellent models for prevention of injuries. CONCLUSION: The risk of injury to arteries, veins or nerves is not defined by the total number of pins/screws. The region and the number of pins/screws in each region define and determine the best distribution of the risk.

OBJETIVO: Verificar se o número de parafusos ou pinos colocados no calcanhar aumentaria o risco de lesão quando usamos três técnicas diferentes para o tratamento das fraturas. MÉTODO: Foram analisadas retrospectivamente 126 radiografias de pacientes que sofreram fratura desviada do calcanhar. Foram analisadas três técnicas cirúrgicas sob a forma interobservador: 31 radiografias de pacientes tratados com placa não específica para o calcanhar, 48 com placa específica e 47 com fixador externo. O risco de lesão das estruturas anatômicas em relação a cada fio de Kirschner ou parafuso foi determinado pelo sistema de graduação segundo a classificação de Licht. A quantificação do risco total de lesão das estruturas anatômicas na colocação de mais de um fio/parafuso foi calculada pela lei aditiva das probabilidades do produto para eventos independentes. RESULTADOS: Todos os modelos apresentaram um alto poder de explicação do risco avaliado, uma vez que os valores do coeficiente de determinação R2 são maiores do que 98,6 para todos os modelos. Portanto, o conjunto de variáveis estudado explica mais de 98,6% das variações dos riscos de lesão das artérias, veias ou dos nervos e podem ser classificados como excelentes modelos para prevenção de lesões. CONCLUSÃO: O risco de lesão das artérias, veias ou dos nervos não é definido pelo total de pinos/parafusos. A região e a quantidade de pinos/parafusos em cada região definem e determinam melhor a distribuição do risco.

Risk of injury to vascular-nerve bundle after calcaneal fracture: comparison among three techniques / Risco de lesão do feixe vasculonervoso após fratura do calcâneo: comparação entre três técnicas

OBJECTIVE: To ascertain whether the number of screws or pins placed in the calcaneus might increase the risk of injury when three different techniques for treating calcaneal fractures. METHOD: 126 radiographs of patients who suffered displaced calcaneal fractures were retrospectively analyzed. Three surgical techniques were analyzed on an interobserver basis: 31 radiographs of patients treated using plates that were not specific for the calcaneus, 48 using specific plates and 47 using an external fixator. The risk of injury to the anatomical structures in relation to each Kirschner wire or screw was determined using a graded system in accordance with the Licht classification. The total risk of injury to the anatomical structures through placement of more than one wire/screw was quantified using the additive law of probabilities for the product, for independent events. RESULTS: All of the models presented high explanatory power for the risk evaluated, since the coefficient of determination values (R2) were greater than 98.6 for all the models. Therefore, the set of variables studied explained more than 98.6% of the variations in the risks of injury to arteries, veins or nerves and can be classified as excellent models for prevention of injuries. CONCLUSION: The risk of injury to arteries, veins or nerves is not defined by the total number of pins/screws. The region and the number of pins/screws in each region define and determine the best distribution of the risk.

OBJETIVO: Verificar se o número de parafusos ou pinos colocados no calcanhar aumentaria o risco de lesão quando usamos três técnicas diferentes para o tratamento das fraturas. MÉTODO: Foram analisadas retrospectivamente 126 radiografias de pacientes que sofreram fratura desviada do calcanhar. Foram analisadas três técnicas cirúrgicas sob a forma interobservador: 31 radiografias de pacientes tratados com placa não específica para o calcanhar, 48 com placa específica e 47 com fixador externo. O risco de lesão das estruturas anatômicas em relação a cada fio de Kirschner ou parafuso foi determinado pelo sistema de graduação segundo a classificação de Licht. A quantificação do risco total de lesão das estruturas anatômicas na colocação de mais de um fio/parafuso foi calculada pela lei aditiva das probabilidades do produto para eventos independentes. RESULTADOS: Todos os modelos apresentaram um alto poder de explicação do risco avaliado, uma vez que os valores do coeficiente de determinação R2 são maiores do que 98,6 para todos os modelos. Portanto, o conjunto de variáveis estudado explica mais de 98,6% das variações dos riscos de lesão das artérias, veias ou dos nervos e podem ser classificados como excelentes modelos para prevenção de lesões. CONCLUSÃO: O risco de lesão das artérias, veias ou dos nervos não é definido pelo total de pinos/parafusos. A região e a quantidade de pinos/parafusos em cada região definem e determinam melhor a distribuição do risco.

Treatment of pelvic fractures - a national survey.

INTRODUCTION: This survey was conducted during the 38(th) Brazilian Congress of Orthopaedics and Traumatology to identify the opinion of Brazilian orthopaedic surgeons on the standard treatment of pelvic fractures. MATERIALS AND METHODS: Participants were randomly selected and invited to voluntarily answer a questionnaire of 10 multiple choice questions addressing the main aspects of the treatment of pelvic fractures: classification, fixation methods in unstable patients, optimal surgical timing in stable patients, and fixation methods in different types of anterior and posterior pelvic injuries. RESULTS/CONCLUSION: Three hundred and fifty-two questionnaires were completed, and the following main observations were made: most orthopaedists prefer to use an external fixator in the iliac crest for the emergency stabilisation of pelvic injuries in haemodynamically unstable patients (79.5%); they consider a period of up to one week as optimal for fixation in stable patients (55.1%); they use a plate for the fixation of fractures of the iliopubic rami through a Pfannenstiel or ilio-inguinal approach (53.9%); and they use reconstruction plates for the fixation of fractures of the iliac wing (63.1%). Regarding other studied aspects, there was no predominance of more than 50% of the choices among respondents.

Profile of trauma victims of motorcycle accidents treated at hospital São Paulo.

OBJECTIVE: To evaluate retrospectively, through analysis of medical records, the epidemiological aspects of patients traumatized by motorcycle accidents treated at the orthopedics ward, Hospital São Paulo, Brazil. METHODS: It is a retrospective observational study. The analysis of patients' medical records comprised the period from January 2008 to December 2009. The data checked were: age, gender, type of collision, type and location of fracture, treatment performed (conservative or surgical), type of surgery, cost of synthesis material and hospitalization, period of hospitalization and postoperative complications. After data collection, statistical analysis was performed. RESULTS: We analyzed 381 victims involved in motorcycle accidents. Patients were predominantly male (85%), with a mean age of 30.7 years old. Referring to distribution and site of lesions, 75.5% of individuals had lower limb fractures and in 95.4% of the cases, the treatment of choice was surgery. Twenty-nine patients were rehospitalized due to postoperative complications, such as exposure and failure of synthesis material, wound infection, necrosis, osteomyelitis, and pseudoarthrosis. CONCLUSION: It was possible to identify useful characteristics for planning preventative strategies to reduce the rate of motorcycle accidents and redirect public investment in health. Level of Evidence III, Retrospective Study.

Perfil das vítimas de trauma por acidente motociclístico tratados no Hospital São Paulo / Profile of trauma victims of motorcycle accidents treated at Hospital São Paulo

Verificar, retrospectivamente por meio da análise de prontuários,os aspectos epidemiológicos dos indivíduos traumatizadospor acidente motociclístico tratados na enfermaria de Ortopedia eTraumatologia do Hospital São Paulo, SP, Brasil. Métodos: Trata-sede estudo observacional retrospectivo. A análise dos prontuários dospacientes compreendeu o período de janeiro de 2008 a dezembro de2009. Os dados verificados foram: idade, sexo, tipo de colisão, tipo elocal da fratura, tratamento realizado (conservador ou cirúrgico), tipode cirurgia, custo do material de síntese e da internação, tempo deinternação e complicações pós-operatória. Após o levantamento, osdados foram tabulados e analisados estatisticamente. Resultados:Foram analisados 381 vítimas de acidentes envolvendo motocicletas.Houve predomínio do gênero masculino entre as vítimas (85%), commédia de idade de 30,7 anos. Quanto à distribuição e local das lesões,75,5% dos indivíduos sofreram fraturas dos membros inferiorese em 95,4% dos casos, o tratamento de escolha foi o cirúrgico. Foramreinternados 29 pacientes por complicações pós-operatórias, taiscomo exposição do material de síntese, falha do material de síntese,infecção da ferida operatória, necrose, osteomielite e pseudoartrose.Conclusão: Foi possível identificar características úteis para o planejamentode estratégias preventivas com o objetivo de reduzir os índicesde acidentes motociclísticos e redirecionar os investimentos públicosna área da saúde. Nível de Evidência III, Estudo Retrospectivo...

To evaluate retrospectively, through analysis of medicalrecords, the epidemiological aspects of patients traumatizedby motorcycle accidents treated at the orthopedics ward,Hospital São Paulo, SP, Brazil. Methods: It is a retrospectiveobservational study. The analysis of patients’ medical recordscomprised the period from January 2008 to December 2009.The data checked were: age, gender, type of collision, type andlocation of fracture, treatment performed (conservative or surgical),type of surgery, cost of synthesis material and hospitalization,period of hospitalization and postoperative complications.After data collection, statistical analysis was performed. Results:We analyzed 381 victims involved in motorcycle accidents. Patientswere predominantly male (85%), with a mean age of 30.7years old. Referring to distribution and site of lesions, 75.5%of individuals had lower limb fractures and in 95.4% of the cases,the treatment of choice was surgery. Twenty-nine patientswere rehospitalized due to postoperative complications, suchas exposure and failure of synthesis material, wound infection,necrosis, osteomyelitis, and pseudoarthrosis. Conclusion: Itwas possible to identify useful characteristics for planning preventativestrategies to reduce the rate of motorcycle accidentsand redirect public investment in health. Level of Evidence III,Retrospective Study...

Minimal invasive ostheosintesis for treatment of diaphiseal transverse humeral shaft fractures.

OBJECTIVE: To evaluate patients with transverse fractures of the shaft of the humerus treated with indirect reduction and internal fixation with plate and screws through minimally invasive technique. METHODS: Inclusion criteria were adult patients with transverse diaphyseal fractures of the humerus closed, isolated or not occurring within 15 days of the initial trauma. Exclusion criteria were patients with compound fractures. RESULTS: In two patients, proximal screw loosening occurred, however, the fractures consolidated in the same mean time as the rest of the series. Consolidation with up to 5 degrees of varus occurred in five cases and extension deficit was observed in the patient with olecranon fracture treated with tension band, which was not considered as a complication. There was no recurrence of infection or iatrogenic radial nerve injury. CONCLUSION: It can be concluded that minimally invasive osteosynthesis with bridge plate can be considered a safe and effective option for the treatment of transverse fractures of the humeral shaft. Level of Evidence III, Therapeutic Study.

Minimal invasive ostheosintesis for treatment of diaphiseal transverse humeral shaft fractures

OBJECTIVE: To evaluate patients with transverse fractures of the shaft of the humerus treated with indirect reduction and internal fixation with plate and screws through minimally invasive technique. METHODS: Inclusion criteria were adult patients with transverse diaphyseal fractures of the humerus closed, isolated or not occurring within 15 days of the initial trauma. Exclusion criteria were patients with compound fractures. RESULTS: In two patients, proximal screw loosening occurred, however, the fractures consolidated in the same mean time as the rest of the series. Consolidation with up to 5 degrees of varus occurred in five cases and extension deficit was observed in the patient with olecranon fracture treated with tension band, which was not considered as a complication. There was no recurrence of infection or iatrogenic radial nerve injury. CONCLUSION: It can be concluded that minimally invasive osteosynthesis with bridge plate can be considered a safe and effective option for the treatment of transverse fractures of the humeral shaft. Level of Evidence III, Therapeutic Study. .

Estudo transversal sobre os diferentes pontos de entrada na osteossíntese intramedular femoral anterógrada / Cross-sectional study on different entry points for anterograde femoral intramedullary osteosynthesis

OBJETIVO: Analisar o grau de conhecimento dos profissionais que tratam essas fraturas com a técnica preconizada relacionando a haste ao ponto de entrada considerado apropriado. MÉTODOS: Foi desenvolvido um questionário no qual constavam cinco tipos de hastes e simulada uma fratura diafisária do fêmur transversa. RESULTADOS: Os pontos de entrada correspondentes à escolha do tipo de haste foram respondidos por 370 médicos ortopedistas que participaram do 41º Congresso Brasileiro de Ortopedia e Traumatologia. Constatou-se que somente 20 por cento acertaram o ponto de entrada e que não houve diferença entre os profissionais que faziam a especialidade Traumatologia e os demais. CONCLUSÃO: Concluiu-se que a maioria dos médicos que frequentaram o congresso desconhece tal fato.

OBJECTIVE: To analyze the degree of knowledge among professionals who treat fractures using the recommended technique, with regard to correlating the nail with the entry point that is considered appropriate. METHODS: A questionnaire that presented five types of nail and simulated a transverse diaphyseal fracture of the femur was developed. RESULTS: Responses regarding the entry points corresponding to choosing the type of nail were obtained from 370 orthopedists who were participating in the 41st Brazilian Congress of Orthopedics and Traumatology. It was observed that only 20 percent correctly identified the entry point and that there was no difference between the professionals within the specialty of Traumatology and the others. CONCLUSION: It was concluded that the majority of the physicians attending the congress were unaware of the entry points.

Correlação entre tempo para o tratamento cirúrgico e mortalidade em pacientes idosos com fratura da extremidade proximal do fêmur / Correlation between time until surgical treatment and mortality among elderly patients with fractures at the proximal end of the femur

OBJETIVO: O objetivo primário do estudo é analisar a possível associação entre o atraso para a realização do tratamento cirúrgico e mortalidade em pacientes idosos com fratura da extremidade proximal do fêmur. MÉTODOS: Foram estudados 269 pacientes com fraturas da extremidade proximal do fêmur (fraturas do colo do fêmur e fraturas intertrocanterianas), tratadas cirurgicamente no Hospital São Paulo - Unifesp-SP, no período de janeiro de 2003 a dezembro de 2007. Foram analisados e comparados com a literatura referente ao assunto os seguintes atributos: sexo, idade, tipo de fratura, classificação da mesma, lado acometido, síntese utilizada, mecanismo de trauma, tempo de internação, tempo para cirurgia, comorbidades associadas, hemograma de entrada, tipo de anestesia, necessidade de transfusão sanguínea, dia da semana e estação do ano da fratura. RESULTADOS: O estudo apresentou correlação entre maior número de comorbidades clínicas, maior tempo de internação e utilização de anestesia geral na cirurgia com maior mortalidade dos pacientes. CONCLUSÃO: Não houve associação entre tempo para realização da cirurgia e mortalidade.

OBJECTIVE: The primary aim of this study was to analyze the possible association between delay in receiving surgical treatment and mortality among elderly patients with fractures at the proximal end of the femur. METHODS: 269 patients with fractures at the proximal end of the femur (femur neck and intertrochanteric fractures) who were treated surgically at Hospital São Paulo, UNIFESP, São Paulo, between January 2003 and December 2007, were studied. Sex, age, type of fracture, classification of the fracture, affected side, synthesis used, trauma mechanism, length of hospitalization, length of surgery, associated comorbidities, hemogram at admission, type of anesthesia, need for blood transfusion, day of the week and season of the year of the fracture were analyzed and compared with the literature relating to this subject. RESULTS: The study showed that higher mortality correlated with higher numbers of clinical comorbidities, longer hospitalization and use of general anesthesia during the surgery. CONCLUSION: There was no association between the time spent waiting for surgery and mortality.

Trombose venosa da veia subclávia após fratura de clavícula: relato de caso / Subclavian vein thrombosis following fracture of the clavicle: case report

A trombose venosa profunda no membro superior não é frequente na literatura ortopédica. Relatamos um caso de trombose da veia subclávia durante o tratamento conservador de fratura do terço médio da clavícula. O diagnóstico é difícil e requer um alto grau de suspeição e o tratamento pode prevenir um tromboembolismo fatal. Há raros casos descritos associados à fratura de clavícula.

Deep vein thrombosis in the upper limbs is uncommon in the orthopedic literature. We report on a case of subclavian vein thrombosis that occurred during conservative treatment of a fracture in the middle third of the clavicle. This is difficult to diagnose and requires a high degree of suspicion. Treating it may prevent fatal thromboembolism. In some rare cases, it has been described in association with fractures of the clavicle.

Fraturas da extremidade proximal do fêmur tratadas no Hospital São Paulo/Unifesp: estudo epidemiológico / Proximal femur fractures treated at Hospital São Paulo/Unifesp: epidemiological study

Foram estudados, retrospectivamente, 314 prontuários de pacientes com fraturas da extremidade proximal do fêmur (fraturas do colo do fêmur e fraturas intertrocanterianas), tratadas cirurgicamente no Hospital São Paulo ? UNIFESP-SP, no período de janeiro de 2003 a dezembro de 2007. Foram analisados e comparados com a literatura referente ao assunto os seguintes atributos: sexo, idade, tipo de fratura, classificação da mesma, lado acometido, síntese utilizada, mecanismo de trauma, tempo de internação, tempo para cirurgia, comorbidades associadas, hemograma de entrada, tipo de anestesia, grau de deambulação prévia, necessidade de transfusão sanguínea, dia da semana e estação do ano da fratura.Observou-se que pacientes com diagnóstico de fratura do colo são predominantemente da sétima e oitava décadas de vida e aqueles com diagnóstico de fratura transtrocanteriana da oitava década de vida em diante. A causa da fratura mais comum foi queda (91,4%). O tempo de internação hospitalar foi em média de 10,65 dias. Já o tempo para cirurgia foi em média de 6,89 dias. Não houve predomínio de fraturas em determinada estação do ano. A taxa de mortalidade em um ano de acompanhamento foi de 32%. Da totalidade dos óbitos em cinco anos de acompanhamento, dois terços aconteceram nos primeiros seis meses.

SUBCLAVIAN VEIN THROMBOSIS FOLLOWING FRACTURE OF THE CLAVICLE: CASE REPORT.

Deep vein thrombosis in the upper limbs is uncommon in the orthopedic literature. We report on a case of subclavian vein thrombosis that occurred during conservative treatment of a fracture in the middle third of the clavicle. This is difficult to diagnose and requires a high degree of suspicion. Treating it may prevent fatal thromboembolism. In some rare cases, it has been described in association with fractures of the clavicle.

CORRELATION BETWEEN TIME UNTIL SURGICAL TREATMENT AND MORTALITY AMONG ELDERLY PATIENTS WITH FRACTURES AT THE PROXIMAL END OF THE FEMUR.

OBJECTIVE: The primary aim of this study was to analyze the possible association between delay in receiving surgical treatment and mortality among elderly patients with fractures at the proximal end of the femur. METHODS: 269 patients with fractures at the proximal end of the femur (femur neck and intertrochanteric fractures) who were treated surgically at Hospital São Paulo, UNIFESP, São Paulo, between January 2003 and December 2007, were studied. The following attributes were analyzed and compared with the literature relating to this subject: sex, age, type of fracture, classification of the fracture, affected side, synthesis used, trauma mechanism, length of hospitalization, waiting time for surgery, associated comorbidities, hemogram on admission, type of anesthesia, need for blood transfusion, day of the week and season of the year of the fracture. RESULTS: The study showed that higher mortality correlated with higher numbers of clinical comorbidities, longer hospitalization and use of general anesthesia during the surgery. CONCLUSION: There was no association between the time spent waiting for surgery and mortality.

CROSS-SECTIONAL STUDY ON DIFFERENT ENTRY POINTS FOR ANTEROGRADE FEMORAL INTRAMEDULLARY OSTEOSYNTHESIS.

OBJECTIVE: To analyze the degree of knowledge among professionals who treat fractures using the recommended technique, with regard to correlating the nail with the entry point that is considered appropriate. METHODS: A questionnaire that presented five types of nail and simulated a transverse diaphyseal fracture of the femur was developed. RESULTS: Responses regarding the entry points corresponding to choosing the type of nail were obtained from 370 orthopedists who were participating in the 41(st) Brazilian Congress of Orthopedics and Traumatology. It was observed that only 20% correctly identified the entry point and that there was no difference between the professionals within the specialty of Traumatology and the others. CONCLUSION: It was concluded that the majority of the physicians attending the congress were unaware of the entry points.

Fixação das fraturas do platô tibial com placas pela via de acesso posterior - relato preliminar de 12 casos / Tibial plateau fractures fixation using posterior approaches - preliminary results of 12 cases

OBJETIVO: Apresentar os resultados preliminares com técnicas de abordagem posterior para fraturas do platô tibial, com traço de cisalhamento no plano sagital. MÉTODOS: Doze pacientes com fraturas do platô tibial tratados cirurgicamente através de um acesso posterior direto foram incluídos no estudo. Foram revisados os prontuários, as radiografias e tomografias dos pacientes bem como as avaliações clínicas. Todos os casos foram acompanhados até o momento da consolidação óssea, definido como aquele em que o paciente apresentava sinais radiográficos compatíveis sendo capaz de apoiar carga total sobre o membro sem referir dor. RESULTADOS: Entre julho de 2009 e abril de 2010, foram atendidos em nosso serviço 89 pacientes com fraturas da extremidade proximal da tíbia. Desses, 80 (89,9 por cento) foram tratados cirurgicamente. Doze pacientes (13,6 por cento) apresentavam uma fratura com um componente de cisalhamento posterior e, portanto, foram submetidos a abordagens posteriores para redução e fixação da fratura. Em três destes casos associou-se uma abordagem antero-lateral. A média de idades dos pacientes foi de 35 anos. O acompanhamento médio foi de 12 meses (entre 8 e 23 meses). As fraturas foram classificadas de acordo com o sistema AO/OTA: cinco como 41 B1, quatro como 41 B3, duas como 41 C1 e uma como 41 C3. Dentre as complicações, tivemos uma deiscência de sutura, tratada com curativos, e uma perda de redução que necessitou de uma reoperação. Em nenhum caso ocorreu lesão neurovascular, retarde de consolidação, pseudartrose ou instabilidade articular residual. Em 4 casos a redução foi considerada ruim (> 2mm de degrau articular), em 5 casos foi considerada imperfeita (< 2 mm de degrau articular) e em 3 casos obtivemos uma redução anatômica. CONCLUSÃO: Os autores concluem que o uso da abordagem posterior deve ser considerada em casos de fraturas com onde haja componente de cisalhamento posterior do planalto da tíbia. Uma casuística ampliada é necessária para avaliar o real benefício desta abordagem.

OBJECTIVE: To describe our preliminary results of posterior shearing tibia plateau fractures treated by a direct dorsal approach and plate fixation. METHODS: A consecutive series of twelve patients with tibia plateau fractures treated by direct posterior approach was selected from our database. Conventional radiographies, computed tomography scans and medical records were reviewed. All cases were followed to union, as defined by painless weight bearing and radiographic healing. RESULTS: Between July 2009 and April 2010, our trauma service received 89 tibia plateau fractures and treated 80 (89,9 percent) operatively. Twelve patients (13,5 percent) sustained posterior shearing tibia plateau fractures. All fractures were treated through the posterior approach, although 3 required association with an anterolateral approach as well. The mean age of patients was 35 years and mean follow-up was 12 (range 8-23) months. The fractures were classified according to AO/OTA: five 41 B1, four 41 B3, two 41 C1 and one 41 C3. There was one wound dehiscence, managed with local wound care, and one loss of reduction treated by reoperation. No patient sustained neurovascular injury, nonunion, malunions or knee instability. In four cases the reduction was rated as poor (> 2 mm step off), in five cases reduction was rated as imperfect (<2 mm step off) and in three cases the reduction was rated as anatomic (absolutely no step-off). CONCLUSION: Authors conclude that posterior approaches should be considered when tibial plateau fractures result in posterior displaced fragments. A larger sample is needed to get definitive conclusions.