Telemedicine Effectiveness in the First Elective Orthopedic Care Compared to a Standard Face-to-face Visit / Efetividade da teleconsulta no primeiro atendimento ortopédico eletivo comparada ao padrão presencial

Abstract Objective The study aimed to compare whether the diagnoses of orthopedic diseases at telemedicine (TM) consultations are the same as those established at face-to-face visits. Method Primary, observational, prospective, analytical study, with subjects from the local municipal network who were referred to the orthopedics outpatient clinic from May to June 2021. Subjects underwent two assessments: a telemedicine (TM) consultation and a face-to-face (FF) visit. Two different physicians attended to the patients and established a diagnosis. The physician performing the FF visit was not aware of the previous diagnoses. We compared the diagnoses obtained at both modalities to assess the degree of similarity. In addition, we determined the time required for consultations and the degree of satisfaction of the physicians. Results We evaluated 43 patients and seven physicians, totaling 44 TM and 43 FF visits. The diagnostic similarity index was 81.4%. TM consultations were shorter (mean time, 4.8 minutes) than FF visits. Physicians were less satisfied with TM in the four criteria evaluated (respective scores of 79.1, 23.3, 46.6, and 37.2). Conclusion TM consultations have a diagnoses agreement higher than 80% compared with FF visits. On the other hand, TM consultations were faster, and physicians were less satisfied with them in comparison with FF visits.

Resumo Objetivo O objetivo do estudo foi comparar se os diagnósticos das doenças ortopédicas realizados por teleconsulta (TC) são os mesmos dos atendimentos presenciais. Método Estudo primário, observacional, prospectivo, analítico, com dados colhidos de maio a junho de 2021, com participantes provenientes da rede municipal local que foram encaminhados ao ambulatório de ortopedia de referência e oferecida participação no estudo com duas avaliações: a primeira por teleatendimento e a segunda de forma presencial. Cada participante foi atendido por dois diferentes profissionais, e cada um emitiu um diagnóstico. Os profissionais do atendimento presencial não conheciam os diagnósticos prévios. Os diagnósticos emitidos foram comparados para avaliar o grau de semelhança. Ainda, foi aferido o tempo para realização dos atendimentos e o grau de satisfação do profissional participante. Resultados Foram avaliados 43 pacientes e 07 profissionais participaram, totalizando 44 TC e 43 atendimentos presenciais. O índice de semelhança do diagnóstico foi de 81,4%. A TC teve um tempo menor para realização (média de 4,8 minutos), que o presencial. A satisfação dos profissionais foi menor na TC nos quatro critérios avaliados, sendo, respectivamente, 79,1, 23,3, 46,6 e 37,2. Conclusão A TC tem concordância no diagnóstico superior a 80% em comparação ao atendimento presencial. Já a realização do teleatendimento teve menor tempo de duração e os profissionais se consideraram menos satisfeitos em relação ao atendimento presencial.

Calculation of the Minimal Important Clinical Difference of the Lysholm and IKDC Scores After Anterior Cruciate Ligament Reconstruction.

Objective To calculate the minimal important clinical difference (MICD) value for the Lysholm and International Knee Documentation Committee (IKDC) scores in a sample of patients submitted to anterior cruciate ligament reconstruction. Methods Primary, observational, retrospective, analytical study of participants submitted to anterior cruciate ligament reconstruction from March 2019 to December 2020 by the same surgeon, with a minimum follow-up of 6 months, analysis of knee function in the pre- and postoperative period by the Lysholm and IKDC scores, and answer to an anchor question at 6 months postoperatively for the calculation of the MICD of each score. Results A total of 59 patients participated in the study, with a mean age of 27.1 ± 5.7 years old. In the comparison between pre- and postoperative scores of all groups, there was an increase in values with statistical significance after intervention. The MICD was 5.5 for the Lysholm score, and the MICD value for the IKDC score could not be determined. Conclusion For the Lysholm score, the calculation of the MICD value by the anchor question method in the sample evaluated was 5.5. It was not possible to determine the value of the MICD for the IKDC score.

Calculation of the Minimal Important Clinical Difference of the Lysholm and IKDC Scores After Anterior Cruciate Ligament Reconstruction / Cálculo da mínima diferença clínica importante dos escores Lysholm e IKDC após reconstrução do ligamento cruzado anterior

Abstract Objective To calculate the minimal important clinical difference (MICD) value for the Lysholm and International Knee Documentation Committee (IKDC) scores in a sample of patients submitted to anterior cruciate ligament reconstruction. Methods Primary, observational, retrospective, analytical study of participants submitted to anterior cruciate ligament reconstruction from March 2019 to December 2020 by the same surgeon, with a minimum follow-up of 6 months, analysis of knee function in the pre- and postoperative period by the Lysholm and IKDC scores, and answer to an anchor question at 6 months postoperatively for the calculation of the MICD of each score. Results A total of 59 patients participated in the study, with a mean age of 27.1 ± 5.7 years old. In the comparison between pre- and postoperative scores of all groups, there was an increase in values with statistical significance after intervention. The MICD was 5.5 for the Lysholm score, and the MICD value for the IKDC score could not be determined. Conclusion For the Lysholm score, the calculation of the MICD value by the anchor question method in the sample evaluated was 5.5. It was not possible to determine the value of the MICD for the IKDC score.

Resumo Objetivo Calcular o valor da mínima diferença clinicamente importante (MDCI) para os escores de Lysholm e International Knee Documentation Commitee (IKDC) na amostra de pacientes submetidos a reconstrução de ligamento cruzado anterior. Métodos Estudo primário, observacional, retrospectivo, analítico, de participantes submetidos a reconstrução do ligamento cruzado anterior no período de março de 2019 a dezembro de 2020, pelo mesmo cirurgião, com seguimento mínimo de 6 meses, análise da função do joelho no período pré e pós-operatório pelos escores de Lysholm e IKDC, e resposta a uma pergunta âncora aos 6 meses de seguimento pós-operatório, para o MDCI de cada escore. Resultados Participaram do estudo 59 pacientes, com média de idade de 27,1 ± 5,7 anos. Na comparação dos escores pré- e pós-operatórios de todos os grupos, observa-se aumento dos valores com significância estatística após a intervenção. A MDCI foi de 5,5 para o escore de Lysholm, não tendo sido possível determinar o valor para o IKDC. Conclusão O cálculo do valor da MDCI pelo método da pergunta âncora, na amostra avaliada, foi de 5,5 para o escore de Lysholm. Não foi possível determinar o valor da MDCI para o IKDC.

Transolecranon fracture-dislocation: concepts and functional results of surgical treatment / Fratura luxação transolecraniana: conceitos e resultados funcionais do tratamento cirúrgico

ABSTRACT Objectives: This study aimed to evaluate the functional results of the treatment protocol for the treatment of transolecranon fracture-dislocation, by surgical reduction and osteosynthesis with plate and screws, in patients attended at a referral hospital for orthopedic trauma, with a minimum follow-up period of six months. Methods: Twenty-five individuals treated surgically from January 2014 to November 2018 were selected for a primary observational longitudinal study using questionnaires to assess upper limb and elbow function (DASH and MEPS), quality of life (SF-12), pain (visual analog scale - VAS), and radiographic evaluation in anteroposterior and lateral views of the elbow. Results: Fifteen patients were male, and the mean age was 46.8 years. All participants had their fractures consolidated, with no radiolgraphic signs of implant failure, or degenerative arthritis. Mean range of motion was reduced relative to the contralateral limb: 102.6º for flexion-extension and 132.8º for pronation-supination. The mean MEPS and DASH scores were 89.6 and 16.5 respectively. There was no residual pain in 84% of the cases according to the VAS. Conclusion: The surgical treatment proposed for transolecranon fracture-dislocations showed satisfactory results according to MEPS, DASH scores and quality of life measures. Evidence Level IV; Retrospective observational study.

RESUMO Objetivo: Avaliar os resultados funcionais do protocolo de tratamento da fratura-luxação transolecraniana, por redução cirúrgica e osteossíntese com placa e parafusos, nos pacientes atendidos em hospital de referência para trauma ortopédico, com seguimento mínimo de seis meses. Métodos: vinte e cinco indivíduos tratados cirurgicamente de janeiro de 2014 a novembro de 2018 foram selecionados para um estudo longitudinal observacional primário, utilizando questionários para avaliar a função do membro superior e cotovelo (DASH e MEPS), qualidade de vida (SF-12), dor (visual escala analógica - EVA), e avaliação radiográfica nas incidências anteroposterior e perfil do cotovelo. Resultados: Quinze pacientes eram do sexo masculino e a média de idade foi de 46,8 anos. Todos os participantes tiveram suas fraturas consolidadas, sem sinais radiográficos de falha do implante ou artrite degenerativa. A amplitude média do movimento foi reduzida em relação ao membro contralateral: 102,6º para flexo-extensão e 132,8º para pronossupinação. Os escores médios de MEPS e DASH foram 89,6 e 16,5, respectivamente. Não houve dor residual em 84% dos casos de acordo com a EAV. Conclusão: O tratamento cirúrgico proposto para a fratura-luxação transolecraniana apresentou resultados satisfatórios de acordo com MEPS, escores DASH e medidas de qualidade de vida. Nível de evidência IV; Estudo observacional retrospectivo.

Mentorship in Medical Residency in Orthopedics: Evaluation of a Program by Mentors and Mentees.

Objective To demonstrate the degree of recommendation of mentors and mentees regarding a mentorship program, to assess the degree of satisfaction of the participants, and to describes the main characteristics of the meetings in pairs. Materials and Methods A primary, retrospective, analytical study based on answers to the annual evaluation questionnaires of the institutional mentorship program in pairs of the Orthopedics and Traumatology residency from December 2017 to February 2021. Results We compiled 52 responses from 26 mentorship preceptors and 26 mentored residents. The mentees and mentors had average ages of 27 (±1.5) years and 45 (±8.2) years respectively. A total of 96% of the participants recommend the program, and 89% of the mentees reported that the mentors contributed to their personal and professional decision-making process. Conclusion The mentorship program proved to be a highly recommended strategy in medical residency in Orthopedics. Data show that mentors contributed to the mentees' personal and professional decision-making process.

Mentorship in Medical Residency in Orthopedics: Evaluation of a Program by Mentors and Mentees / Mentoria na residência médica em Ortopedia: Avaliação de um programa por mentores e mentorados

Abstract Objective To demonstrate the degree of recommendation of mentors and mentees regarding a mentorship program, to assess the degree of satisfaction of the participants, and to describes the main characteristics of the meetings in pairs. Materials and Methods A primary, retrospective, analytical study based on answers to the annual evaluation questionnaires of the institutional mentorship program in pairs of the Orthopedics and Traumatology residency from December 2017 to February 2021. Results We compiled 52 responses from 26 mentorship preceptors and 26 mentored residents. The mentees and mentors had average ages of 27 (±1.5) years and 45 (±8.2) years respectively. A total of 96% of the participants recommend the program, and 89% of the mentees reported that the mentors contributed to their personal and professional decision-making process. Conclusion The mentorship program proved to be a highly recommended strategy in medical residency in Orthopedics. Data show that mentors contributed to the mentees' personal and professional decision-making process.

Resumo Objetivo Demonstrar o grau de recomendação de mentores e mentorados quanto à participação em um programa de mentoria, avaliar o grau de satisfação dos participantes, e descrever as principais características das reuniões em dupla. Materiais e Métodos Estudo primário, retrospectivo, analítico, com análise das respostas dos questionários de avaliação anual do programa de mentoria em dupla da residência de Ortopedia e Traumatologia da instituição de dezembro de 2017 a fevereiro de 2021. Resultados Foram obtidas 52 respostas de 26 preceptores mentores e 26 residentes mentorados. A média de idade dos mentorados foi de 27 anos (±1,5 ano), ao passo que a média de idade dos mentores foi de 45 anos (±8,2 anos). O grau de recomendação do programa pelos participantes foi de 96%, e 89% dos mentorados consideraram que os mentores contribuíram para a tomada de decisões pessoais e profissionais. Conclusão O programa de mentoria se mostrou uma estratégia com alto grau de recomendação na residência médica em Ortopedia. Os dados mostram que os mentores contribuíram para a tomada de decisões pessoais e profissionais dos mentorados.

Pre-contoured superior locking plates offer poor bone fit for midshaft clavicle fracture fixation: cadaveric analysis of 4 commercially available systems.

OBJECTIVE: The goal of this study is to verify how commercially available pre-contoured superior plates fit on clavicle midshaft fractures. METHODS: 100 cadaveric clavicles were evaluated by three distinct observers applying the clavicle congruence score and comparing four different 6 to 8-hole pre-contoured anatomic locking-plate systems. RESULTS: the inter-observer agreement was considered moderate by the percentage agreement and fair by the Fleiss' Kappa, with no significant differences between evaluations. Only 1 of the 8 plates presented an anatomic fit greater than 70%. Long plates (8 holes) presented a poor fit compared to short plates (6 or 7 holes). CONCLUSIONS: the overall evaluation showed that currently-available pre-contoured superior plate systems provide a poor fit on clavicles for midshaft fracture fixations. Long plates present a worse fit compared to short ones.

Pre-contoured superior locking plates offer poor bone fit for midshaft clavicle fracture fixation: cadaveric analysis of 4 commercially available systems / Placas pré-moldadas superiores possuem adaptação ruim para fixação de fraturas do terço médio da clavícula: análise cadavérica de quatro sistemas disponíveis comercialmente

ABSTRACT Objective: The goal of this study is to verify how commercially available pre-contoured superior plates fit on clavicle midshaft fractures. Methods: 100 cadaveric clavicles were evaluated by three distinct observers applying the clavicle congruence score and comparing four different 6 to 8-hole pre-contoured anatomic locking-plate systems. Results: the inter-observer agreement was considered moderate by the percentage agreement and fair by the Fleiss' Kappa, with no significant differences between evaluations. Only 1 of the 8 plates presented an anatomic fit greater than 70%. Long plates (8 holes) presented a poor fit compared to short plates (6 or 7 holes). Conclusions: the overall evaluation showed that currently-available pre-contoured superior plate systems provide a poor fit on clavicles for midshaft fracture fixations. Long plates present a worse fit compared to short ones.

RESUMO Objetivo: verificar como as placas superiores pré-moldadas disponíveis no mercado se adaptam às fraturas do terço médio da clavícula. Método: 100 clavículas de cadáveres foram avaliadas por três observadores distintos, aplicando-se o escore de congruência da clavícula e comparando quatro sistemas diferentes de placas bloqueadas anatômicas pré-moldadas de seis a oito furos. Resultados: a concordância interobservador foi considerada moderada pelo percentual de concordância e regular pelo índice Kappa de Fleiss, sem diferenças significativas entre as avaliações. Apenas uma das oito placas apresentou encaixe anatômico maior que 70%. As placas longas (oito furos) apresentaram um encaixe ruim em comparação com as placas curtas (seis ou sete furos). Conclusões: os sistemas de placa superior pré-moldadas disponíveis atualmente fornecem um encaixe inadequado às clavículas para fixações de fraturas do terço médio. Placas longas apresentam um encaixe pior que as curtas.

Síndrome do piriforme: diagnóstico e tratamento: um estudo retrospectivo / Piriformis syndrome: diagnosis and treatment: a retrospective study

Introdução: A síndrome do piriforme (SP) é uma causa de dor ciática pouco entendida e conhecida, por isso, subdiagnosticada. Possui múltiplas possibilidades etiológicas e a abordagem terapêutica corrente privilegia o tratamento conservador. Objetivo: Neste estudo retrospectivo são destacados o diagnóstico, a etiologia, o diagnóstico diferencial e analisados os resultados do tratamento instituído. Métodos: 34 casos com seguimento mínimo de seis meses e máximo de 12 meses avaliados por uma escala simplificada de graduação de sintomas. Resultados: O tratamento clínico-conservador obteve excelentes resultados em 23 pacientes (67,6%), bom em nove pacientes (26,4%) e razoáveis (insatisfatórios) em dois pacientes (5,8%). Conclusões: Na dor com característica ciática, contínua ou intermitente e sem evidências de compressão radicular ou herniação discal lombar, deve-se pesquisar a possibilidade de síndrome do piriforme como um diagnóstico eminentemente clínico e de exclusão. O tratamento conservador apresenta resultados satisfatórios na maioria dos casos e a indicação cirúrgica está reservada como último recurso às falhas da terapia conservadora.

Introduction: Piriformis syndrome is a cause of sciatalgy barely understood and frequently unrecognized. It has multiple possible etiologic factors and the treatment of option is largely conservative. Objective: In this retrospective study, the diagnostic signs, the ethiology, the diferential diagnosis and the treatment results are discussed. Methods: 34 patients were followed-up for 6-12 months and evaluated by a simplified symptom rating scale. Results: Excellent results in 23 patients (67,6%), good in 9 patients (26,4%) and fair (unsatisfactory) in 2 patients (5,8%). Conclusions: In patients with sciatic pain without proved rachidian or discal lumbar disease, the possibility of Piriformis Syndrome must be investigated mainly by proper clinical examination and seen as a diagnosis of exclusion. The conservative treatment has satisfactory outcomes in most of cases and surgical procedure is reserved as a last resort in case of failure of the conservative management.

Triathlete with Multiple Stress Fractures in the Lower Limbs: Case Report and Literature Review.

Recurrent stress fractures rarely affect the same athlete. We present the case of a female triathlete who suffered multiple stress fractures in both tibias, the right fibula, and the left femoral neck. Conservative treatment was instituted in all episodes, with rest, reduced training load, and physical therapy rehabilitation. The relative energy deficiency in sport syndrome, along with an eating disorder, training overload, and osteopenia, was identified as a risk factor. Although rare, multiple stress fractures can occur in female triathletes. These patients must be screened for risk factors associated with biomechanics, nutrition, and training to develop an effective prevention and treatment program.

Triathlete with Multiple Stress Fractures in the Lower Limbs: Case Report and Literature Review / Triatleta com múltiplas fraturas por estresse nos membros inferiores: Relato de um caso e revisão da literatura

Abstract Recurrent stress fractures rarely affect the same athlete. We present the case of a female triathlete who suffered multiple stress fractures in both tibias, the right fibula, and the left femoral neck. Conservative treatment was instituted in all episodes, with rest, reduced training load, and physical therapy rehabilitation. The relative energy deficiency in sport syndrome, along with an eating disorder, training overload, and osteopenia, was identified as a risk factor. Although rare, multiple stress fractures can occur in female triathletes. These patients must be screened for risk factors associated with biomechanics, nutrition, and training to develop an effective prevention and treatment program.

Resumo Fraturas por estresse recorrentes num mesmo atleta são raras. Apresentamos o caso de uma triatleta que sofreu múltiplas fraturas por estresse na tíbia bilateral, na fíbula direita e no colo femoral esquerdo. O tratamento conservador foi instituído em todos os episódios, com repouso, redução da carga de treino e reabilitação fisioterápica. Foi identificada como fator de risco a síndrome da deficiência energética relativa no esporte, com distúrbio alimentar, sobrecarga de treino e osteopenia. Mesmo que seja raro, múltiplas fraturas por estresse podem ocorrer em mulheres triatletas, nas quais é importante avaliar os fatores de risco associados à biomecânica, nutrição e ao treinamento para arquitetar um programa de prevenção e tratamento efetivos.

Surgical Treatment of Comminuted Midshaft Clavicle Fracture by Minimally Invasive Technique: Description and Preliminary Results.

Objective The present paper aimed to evaluate functional and radiographic outcomes from a group of patients with comminuted midshaft clavicle fracture who were surgically treated using a minimally invasive technique and followed-up for a minimum period of 12 months. Methods Longitudinal, observational study with 32 consecutive patients (31 males; mean age, 41 years old) with comminuted midshaft clavicle fracture who were surgically treated using the minimally invasive osteosynthesis technique with a 3.5-mm reconstruction plate in the upper position. Patients were clinically and radiologically evaluated for a minimum follow-up period of 12 months. Results In 30 patients (93.72%), fracture consolidation occurred in an average time of 17 weeks (range, 12 to 24 weeks). The mean follow-up time was 21 months (range, 12 to 45 months). No implant break or pseudoarthrosis were recorded. There was no complaint of paresthesia around the surgical incisions. The surgically-treated shoulder presented lower passive elevation and longer clavicle length ( p < 0.05) compared with the contralateral shoulder. Functional evaluation revealed an average Disability of Arm, Shoulder and Hand (DASH) score of 1.75, which is considered satisfactory. Age > 60 years old had a negative correlation with DASH score (p <0.05). Conclusion The minimally invasive osteosynthesis technique was satisfactory for the treatment of comminuted midshaft clavicle fracture, with a high consolidation rate and a low complication rate.

Surgical Treatment of Comminuted Midshaft Clavicle Fracture by Minimally Invasive Technique: Description and Preliminary Results / Tratamento cirúrgico da fratura multifragmentada da diáfise da clavícula pela técnica minimamente invasiva: Descrição e resultados preliminares

Abstract Objective Thepresentpaperaimedtoevaluatefunctionalandradiographicoutcomesfrom a group of patients with comminuted midshaft clavicle fracture who were surgically treated using a minimally invasive technique and followed-up for a minimum period of 12 months. Methods Longitudinal, observational study with 32 consecutive patients (31 males; mean age, 41 years old) with comminuted midshaft clavicle fracture who were surgically treated using the minimally invasive osteosynthesis technique with a 3.5mm reconstruction plate in the upper position. Patients were clinically and radiologically evaluated for a minimum follow-up period of 12 months. Results In 30 patients (93.72%), fracture consolidation occurred in an average time of 17 weeks (range, 12 to 24 weeks). The mean follow-up time was 21 months (range, 12 to 45 months). No implant break or pseudoarthrosis were recorded. There was no complaint of paresthesia around the surgical incisions. The surgically-treated shoulder presented lower passive elevation and longer clavicle length (p < 0.05) compared with the contralateral shoulder. Functional evaluation revealed an average Disability of Arm, Shoulder and Hand (DASH) score of 1.75, which is considered satisfactory. Age > 60 years old had a negative correlation with DASH score (p <0.05). Conclusion The minimally invasive osteosynthesis technique was satisfactory for the treatment of comminuted midshaft clavicle fracture, with a high consolidation rate and a low complication rate.

Resumo Objetivo Avaliar os resultados funcionais e radiográficos do tratamento cirúrgico realizado em um grupo de pacientes com fratura multifragmentada da diáfise de clavícula, pela técnica minimamente invasiva, em seguimento mínimo de 12 meses. Métodos Estudo observacional longitudinal de 32 pacientes consecutivos (31 do sexo masculino, idade média 41 anos) com fratura multifragmentada da diáfise da clavícula tratados cirurgicamente pela técnica minimamente invasiva de osteossíntese com placa de reconstrução de 3,5 mm na posição superior, avaliados clínica e radiologicamente, com seguimento mínimo de 1 ano Resultados Resultados Trinta pacientes (93,72%) evoluíram com consolidação da fratura em tempo médio de 17 semanas (entre 12 e 24 semanas). O tempo de seguimento médio foi de 21 meses (variando de 12 a 45 meses). Não houve quebra de implantes ou pseudoartroses. Não houve queixa de parestesia na região das incisões cirúrgicas. O ombro tratado cirurgicamente apresentou menor elevação passiva e maior comprimento da clavícula (p< 0,05) em relação ao contralateral. Na avaliação funcional, encontramos um valor médio de Disfunções do Braço, Ombro e Mão (DASH, na sigla em inglês) = 1,75, sendo o mesmo considerado satisfatório. Idade >60 anos apresentou correlação negativa com escore DASH (p< 0,05). Conclusão A técnica minimamente invasiva de osteossíntese mostrou-se satisfatória para o tratamento da fratura multifragmentada da diáfise da clavícula, com elevada taxa de consolidação e baixo índice de complicações.

Pre-Operative Scapular Rehabilitation for Arthroscopic Repair of Traumatic Rotator Cuff Tear: Results of a Randomized Clinical Trial.

Background: Pre-operative rehabilitation aims to improve the functional capacity of the individual to enable him/her to prepare for the period of inactivity associated with the surgical procedure. Objective: To evaluate the impact of preoperative scapular rehabilitation before arthroscopic repair of traumatic rotator cuff injury, regarding pain, range of motion of the shoulder, and functional activity. Study Design: Randomized Clinical Trial (RCT) - pilot. Methods: Twenty adult individuals (age range: 47-69 years), with a diagnosis of traumatic rotator cuff tear and arthroscopic surgical repair, were randomized and allocated into two groups: experimental (EG) (n = 10) and control group (CG) (n = 10). All participants underwent preoperative rehabilitation for six weeks, consisting of mobility exercises of the cervical spine, elbow, wrist, and hand, and analgesics education. The EG also performed scapular and core stabilization exercises, which were not performed by the CG. Exercise instruction was performed by the same physiotherapist and the surgical team was blinded to group participation in the preoperative period. After arthroscopic repair, the patients followed the same protocol of postoperative rehabilitation for 16 weeks, and functional evaluation was conducted after three months and in a follow-up of at least one year. Results: Compared to the CG, the EG presented with a significant decrease in pain between the preoperative period and after one year (p < 0.05). In relation to the preoperative period, flexion and external rotation increased significantly in both groups after three months (p<0.05), and abduction was significantly higher in the EG (p < 0.05). Compared to CG, the EG presented a significantly higher SF-12 physical component after three months (48.47 vs. 40.33, p < 0.05), and a significantly lower Western Ontario Rotator Cuff Index (WORC) total after one year (85.00 vs. 1130.00, p < 0.05). Conclusion: Preoperative scapular rehabilitation had a positive impact on recovery after arthroscopic repair of traumatic rotator cuff injury, in the assessment of pain, range of motion of the shoulder, and quality of life. Levels of Evidence: Level 1.

Functional and Radiological Outcomes of the Surgical Treatment of Acute Acromioclavicular Dislocation with Anchors Associated with Clavicle and Scapula Fixation.

Objective To evaluate the clinical, radiological and functional results of the surgical treatment of acute acromioclavicular dislocation using a coracoclavicular fixation technique (syndesmopexy) with two metallic anchors, temporary clavicle and scapula fixation, and transfer of the coracoacromial ligament. Methods Longitudinal observational study of 30 patients with diagnoses of acute acromioclavicular dislocation, who were submitted to surgical treatment with a minimum follow-up of six months, and who were evaluated clinically, radiologically, and by the University of California at Los Angeles (UCLA), the Disabilities of the Arm, Shoulder and Hand (DASH) and the Constant-Murley functional scores. Results The mean values of the scores were: UCLA = 32; DASH = 11.21; and Constant-Murley = 86.93, with satisfactory results higher than 80%. The unsatisfactory results were associated with acromioclavicular pain on palpation, positive subacromial impingement tests, and older age group, presenting statistical significance ( p < 0.05). Radiologically, higher values on account of the coracoclavicular distance ratio from the operated shoulder compared to the normal shoulder were related to worse outcomes, but with no statistically significant difference. No associations were found between the results of the functional scores and the variables degree of the injury, coracoacromial ligament transfer, clinical impression of loss of reduction and scapulothoracic dyskinesis. Conclusion The technique used provides an efficient fixation, with a high level of satisfaction according to the UCLA, Constant-Murley and DASH scores; moreover, it has a low complication rate, despite the high rate of residual radiological acromioclavicular subluxation.

Functional and Radiological Outcomes of the Surgical Treatment of Acute Acromioclavicular Dislocation with Anchors Associated with Clavicle and Scapula Fixation / Resultados funcionais e radiológicos do tratamento cirúrgico da luxação acromioclavicular aguda com âncoras e fixação clavículo-escapular

Abstract Objective To evaluate the clinical, radiological and functional results of the surgical treatment of acute acromioclavicular dislocation using a coracoclavicular fixation technique (syndesmopexy) with two metallic anchors, temporary clavicle and scapula fixation, and transfer of the coracoacromial ligament. Methods Longitudinal observational study of 30 patients with diagnoses of acute acromioclavicular dislocation, who were submitted to surgical treatment with a minimum follow-up of six months, and who were evaluated clinically, radiologically, and by the University of California at Los Angeles (UCLA), the Disabilities of the Arm, Shoulder and Hand (DASH) and the Constant-Murley functional scores. Results The mean values of the scores were: UCLA = 32; DASH = 11.21; and Constant-Murley = 86.93, with satisfactory results higher than 80%. The unsatisfactory results were associated with acromioclavicular pain on palpation, positive subacromial impingement tests, and older age group, presenting statistical significance (p < 0.05). Radiologically, higher values on account of the coracoclavicular distance ratio from the operated shoulder compared to the normal shoulder were related to worse outcomes, but with no statistically significant difference. No associations were found between the results of the functional scores and the variables degree of the injury, coracoacromial ligament transfer, clinical impression of loss of reduction and scapulothoracic dyskinesis. Conclusion The technique used provides an efficient fixation, with a high level of satisfaction according to the UCLA, Constant-Murley and DASH scores; moreover, it has a low complication rate, despite the high rate of residual radiological acromioclavicular subluxation.

Resumo Objetivo Avaliar os resultados clínicos, radiológicos, e funcionais do tratamento cirúrgico da luxação acromioclavicular aguda, utilizando a técnica de sindesmopexia coracoclavicular com duas âncoras metálicas, fixação temporária clavículo-escapular, e transferência do ligamento coracoacromial. Métodos Estudo observacional longitudinal com trinta pacientes com diagnóstico de luxação acromioclavicular aguda submetidos à cirurgia, com seguimento mínimo de seis meses, avaliados clínica, radiograficamente, e pelos escores de University of California at Los Angeles (UCLA), Disabilities of the Arm, Shoulder and Hand (DASH) e Constant-Murley. Resultados Os valores médios dos escores foram: UCLA = 32; DASH = 11,21; e Constant-Murley = 86,93, com resultados satisfatórios acima de 80%. Os resultados insatisfatórios foram relacionados à dor acromioclavicular, a testes de impacto subacromial positivos, e aos pacientes de faixa etária mais elevada (p < 0,05). Radiologicamente, valores maiores em razão da distância coracoclavicular do ombro operado, comparado com o ombro normal, foram relacionados a piores resultados, embora sem significância estatística. Não foi observada associação entre os resultados dos escores funcionais e as variáveis grau da lesão, transferência do ligamento coracoacromial, impressão clínica de perda de redução, e discinesia escapulo-torácica. Conclusão A técnica utilizada propicia uma fixação eficiente, com alto índice de satisfação segundo os escores de UCLA, Constant-Murley e DASH. Observou-se baixo índice de complicações apesar da frequência elevada de subluxação acromioclavicular radiológica residual.

Predictive Factors of Death after Surgery for Treatment of Proximal Femoral Fracture.

Objective To evaluate predictive factors of death in patients aged ≥ 70 years old with proximal femoral fracture (PFF) submitted to surgical treatment. Methods An analysis of medical records by creating a retrospective cohort with a 6-month follow-up. A total of 124 charts were analyzed after applying the inclusion and exclusion criteria. All of the patients were treated by a single orthopedic surgeon under uniform conditions. Results The mortality rate was of 34.7%, and the most common profile was female, 85 years old, and with at least 1 comorbidity. Patients > 85 years old, hospitalized for > 7 days, with at least 1 comorbidity, and staying at the intensive care unit (ICU) had a higher risk of death (2, 2.5, 4, and 4 times higher, respectively). Conclusion Regarding the death outcome, although we did not find a statistically significant difference in the topography of the lesion and in its behavior in its coexistence with ICU hospitalization, we believe that further investigations under this perspective are required in a population with the studied profile.

Predictive Factors of Death after Surgery for Treatment of Proximal Femoral Fracture / Fatores preditivos de morte após cirurgia para tratamento de fratura proximal do fêmur

Abstract Objective To evaluate predictive factors of death in patients aged ≥ 70 years old with proximal femoral fracture (PFF) submitted to surgical treatment. Methods An analysis of medical records by creating a retrospective cohort with a 6- month follow-up. A total of 124 charts were analyzed after applying the inclusion and exclusion criteria. All of the patients were treated by a single orthopedic surgeon under uniform conditions. Results The mortality rate was of 34.7%, and the most common profile was female, 85 years old, and with at least 1 comorbidity. Patients > 85 years old, hospitalized for > 7 days, with at least 1 comorbidity, and staying at the intensive care unit (ICU) had a higher risk of death (2, 2.5, 4, and 4 times higher, respectively). Conclusion Regarding the death outcome, although we did not find a statistically significant difference in the topography of the lesion and in its behavior in its coexistence with ICU hospitalization, we believe that further investigations under this perspective are required in a population with the studied profile.

Resumo Objetivo Avaliar fatores preditivos de morte em pacientes de idade igual ou superior a 70 anos com fratura proximal do fêmur submetidos a tratamento cirúrgico. Métodos Análise de prontuários médicos criando-se uma coorte retrospectiva com seguimento de 6meses. Foramanalisados 124 prontuários após aplicação dos critérios de inclusão e exclusão. Todos os pacientes foram tratados por um único cirurgião ortopédico em condições de uniformidade. Resultados Taxa de mortalidade de 34.7%, sendo o perfil mais comum de paciente o indivíduo do gênero feminino, com 85 anos e ao menos 1 comorbidade. Os pacientes com idade superior a 85 anos, internação hospitalar por mais de 7 dias, ao menos 1 comorbidade presente e internação em centro de terapia intensiva (CTI) apresentaram maior risco de óbito (respectivamente 2; 2,5; 4 e 4 vezes maior). Conclusão Em relação ao desfecho óbito, apesar de não encontramos diferença estatisticamente significativa no que se refere à topografia da lesão e como essas se comportamnomomento em que coexistemjunto a internação em CTI, acreditamos na necessidade de maiores investigações sob essa ótica na população com o perfil estudado.

Obesidade, Diabetes Mellitus tipo 2 e fragilidade óssea: uma revisão narrativa / Obesity, type 2 Diabetes Mellitus and bone fragility: a narrative review

Durante anos a obesidade foi vista como um fator protetor para fraturas e osteoporose. Diversos estudos, no entanto, contestam esta tese, descrevendo que a obesidade na verdade afeta negativamente o sistema esquelético, em especial a homeostase óssea, diminuindo a rigidez do tecido ósseo e aumentando o risco de fraturas. A obesidade e o diabetes estão frequentemente associados no mesmo paciente, e a compreensão da alteração do tecido ósseo nestas duas condições clínicas é fundamental para o melhor cuidado destes pacientes, principalmente devido ao risco aumentado de fraturas, que estão associadas a maior número de complicações no seu tratamento. O presente estudo, em revisão narrativa, descreve a relação entre obesidade e homeostase óssea, a fragilidade óssea nos pacientes obesos, diabéticos ou não, e a relação entre obesidade e fraturas.

Obesity has seen as a protective factor for fractures and osteoporosis for ages. However, several studies challenged this thesis and reported obesity really affects skeletal system negatively, especially bone homeostasis, decreasing bone tissue stiffness and rising the risk of fractures. Data demonstrate that obesity and diabetes are frequently associated in the same patient, and that understanding the alteration of bone tissue in these two clinical conditions is fundamental for the better care of these patients, mainly due to the increased risk of fractures, which are associated with greater number of complications in their treatment. This narrative review aims to describe the relationship between obesity and bone homeostasis, bone fragility in obese patients with or without diabetes, and the relationship between obesity and fractures.

Are diaphyseal clavicular fractures still treated traditionally in a non-surgical way? / Fraturas da diáfise da clavícula ainda são tratadas tradicionalmente, de forma não cirúrgica?

ABSTRACT OBJECTIVE: To evaluate the decision of orthopedics surgeons regarding which cases they would indicate surgery or non-surgical treatment. METHODS: 20 images of radiographs with fracture in the middle third of the collar bone (AO/OTA 15-B) in anteroposterior view were analyzed, and divided into four groups: group 1 - fracture type AO/OTA 15-B1 without displacement; group 2 - fracture type AO/OTA 15-B1 with displacement; group 3 - fracture type AO/OTA 15-B2; group 4 - fracture type AO/OTA 15-B3. The evaluator was requested to indicate the choice of treatment, surgical or non-surgical. RESULTS: There was no strong correlation between the amount of surgical indications and the working experience or age of the medical evaluator. It was observed that the average of surgical indications in the total sample was 52%. When indications were studied in different areas of Brazil, there was no significant difference among them. No pattern for the Brazilian regions studied was observed in the case analysis. Even within a group (cases of the same complexity), no specific pattern of surgical indication was observed. CONCLUSION: No association between surgical indication and the length of professional experience was found. The Southern and Southeastern regions were those that most recommended surgeries in groups 2, 3, and 4. In no region the same level of surgical indication for cases of the same complexity rate was kept.

RESUMO OBJETIVO: Avaliar a decisão de cirurgiões ortopédicos sobre em que casos indicariam a cirurgia ou tratariam não cirurgicamente. MÉTODOS: Foram analisadas 20 imagens de radiografias com fratura do terço médio da clavícula (AO/OTA 15-B) em incidência anteroposterior, que foram divididas em quatro grupos: 1 - fratura do tipo AO/OTA 15-B1 sem desvio; 2 - fratura do tipo AO/OTA 15-B1 com desvio; 3 - fratura do tipo AO/OTA 15-B2; 4 - fratura do tipo AO/OTA 15-B3. Ao avaliador, foi solicitado que indicasse o tipo de tratamento: cirúrgico ou não cirúrgico. RESULTADOS: Não houve correlação forte entre a quantidade de indicações cirúrgicas e o tempo de atuação do médico avaliador ou sua idade. Verificou-se que a média de indicação de cirurgias no total da amostra foi de 52%. Quando estudadas as indicações por diferentes regiões do Brasil, não houve diferença significativa. Não foi verificado qualquer padrão para as regiões brasileiras na análise por caso. Mesmo dentro de um grupo (casos de mesma complexidade), não foi verificado um padrão específico de indicação cirúrgica. CONCLUSÃO: Não foi verificada associação entre a indicação cirúrgica e o tempo de atuação do profissional. As regiões Sul e Sudeste são as que mais recomendam a cirurgia dos grupos 2, 3 e 4. Verificou-se que em nenhuma região foi mantido o mesmo nível de indicação de cirurgias para casos do mesmo grau de complexidade.