Clinical and Image Outcomes of the Hill-Sachs Injury Approach by the Remplissage Technique on the Anterior Shoulder Instability.

OBJECTIVE: To evaluate the functional outcome of the remplissage technique, the healing of the capsulotenodesis of the infraspinatus tendon in Hill-Sachs lesion, and the degree of fatty infiltration of the infraspinatus muscle and its postoperative strength. METHODS: Twenty-five patients with recurrent anterior dislocation of the shoulder and Hill-Sachs lesion with a Hardy index > 20% who underwent the remplissage arthroscopic technique were evaluated with a minimum follow-up of 1 year. Patients underwent a clinical evaluation (Carter-Rowe and Walch-Duplay functional scores, measurement of range of motion and strength) and a magnetic resonance imaging (MRI) exam on the operated shoulder. RESULTS: Eighty-eight percent and 92% of the patients had good or excellent scores in the functional assessments of the Carter-Rowe and Walch-Duplay scores, respectively. A mean difference of - 1 kg in the strength of the operated limb was observed when compared with the contralateral limb ( p < 0.001), as well as a mean difference of 10° in external rotation 1 and 2 ( p < 0.001), also compared with the contralateral side. All of the patients who underwent an MRI exam presented high-grade filling of the Hill-Sachs lesion by capsulotenodesis, as well as absence of or minimal fatty infiltration in the infraspinatus muscle. CONCLUSION: The remplissage technique had good/excellent functional score results, despite the discrete, albeit statistically significant, loss of strength and of external rotation amplitude. Successful capsulotenodesis healing and filling of the Hill-Sachs defect were demonstrated.

Clinical and Image Outcomes of the Hill-Sachs Injury Approach by the Remplissage Technique on the Anterior Shoulder Instability / Resultados clínicos e de imagem da abordagem da lesão de Hill-Sachs pela técnica de remplissage na instabilidade anterior do ombro

Abstract Objective To evaluate the functional outcome of the remplissage technique, the healing of the capsulotenodesis of the infraspinatus tendon in Hill-Sachs lesion, and the degree of fatty infiltration of the infraspinatus muscle and its postoperative strength. Methods Twenty-five patients with recurrent anterior dislocation of the shoulder and Hill-Sachs lesion with a Hardy index > 20% who underwent the remplissage arthroscopic technique were evaluated with a minimum follow-up of 1 year. Patients underwent a clinical evaluation (Carter-Rowe and Walch-Duplay functional scores, measurement of range of motion and strength) and a magnetic resonance imaging (MRI) exam on the operated shoulder. Results Eighty-eight percent and 92% of the patients had good or excellent scores in the functional assessments of the Carter-Rowe andWalch-Duplay scores, respectively. Amean difference of - 1 kg in the strength of the operated limbwas observedwhen compared with the contralateral limb (p < 0.001), as well as amean difference of 10° in external rotation 1 and 2 (p < 0.001), also compared with the contralateral side. All of the patients who underwent an MRI exam presented high-grade filling of the Hill-Sachs lesion by capsulotenodesis, as well as absence of or minimal fatty infiltration in the infraspinatus muscle. Conclusion The remplissage technique had good/excellent functional score results, despite the discrete, albeit statistically significant, loss of strength and of external rotation amplitude. Successful capsulotenodesis healing and filling of the Hill-Sachs defect were demonstrated.

Resumo Objetivos Avaliar o resultado funcional da técnica de remplissage, a cicatrização da capsulotenodese do tendão infraespinal no defeito de Hill-Sachs, o grau de infiltração gordurosa do músculo infraespinal e sua força de rotação lateral no pós-operatório. Método Foram avaliados 25 pacientes comluxação anterior recidivante do ombro e lesão de Hill-Sachs comíndice de Hardy maior do que 20%, submetidos à técnica artroscópica de remplissage com seguimento mínimo de um ano. Os pacientes foram submetidos a avaliação clínica (escores funcionais deCarter-RoweeWalch-Duplay,medição de amplitude de movimento e força) e exame de ressonância magnética no ombro operado. Resultados Dos pacientes, 88% e 92% apresentaram resultados bons ou excelentes nas avaliações funcionais pelos escores de Carter-Rowe e Walch-Duplay, respectivamente. Identificou-se diferença média de 1 kg a menos de força do membro operado em relação ao contralateral (p < 0,001) e diferença média de 10° em rotação lateral 1 e 2 (p < 0,001), novamente com o uso como referência do lado contralateral. Todos os pacientes submetidos a ressonância magnética apresentaram preenchimento de alto grau da lesão de Hill-Sachs pela capsulotenodese, assim como ausência ou mínima infiltração gordurosa no músculo infraespinal. Conclusão A técnica de remplissage apresentou resultados bons/excelentes nos escores funcionais, apesar da perda discreta de força e amplitude de rotação lateral com significância estatística. Foram observados resultados excelentes quanto à cicatrização da capsulotenodese e ao preenchimento do defeito de Hill-Sachs.

Erro médico: análise das denúncias contra médicos apresentadas ao Conselho Regional de Medicina do Estado do Pará no período de 2008 a 2010

O erro médico é um problema grave, que causa enorme preocupação na classe médica e em toda a sociedade. Nos últimos anos, observa-se um aumento de casos de denúncias contra médicos em todo país, muitas delas com grande repercussão na mídia. Nesse contexto, este trabalho tem como objetivo qualificar e quantificar denúncias contra médicos identificando motivo, local, distribuição mensal e anual, especialidade envolvida, evolução processual e penalidades adotadas no julgamento destas...The malpractice is a serious problem that causes great concern in the medical profession and throughout society. In recent years, there has been an increase in cases of complaints against doctors across the country, many with media coverage. In this context, this paper aims to qualify and quantify complaints against physicians identifying reason, local, monthly and annual distribution, specialty involved, penalties and procedural changes adopted in the trial of these ...