Análise econômica dos gastos diretos com internações hospitalares por vítimas de trauma do Sistema Único de Saúde em um município de Minas Gerais, 2011-2021 / Economic analysis of direct expenses with hospital admissions for victims of trauma in the United Health System in a municipality of Minas Gerais, 2011-2021

Objetivo: Determinar o perfil epidemiológico de pacientes atendidos pelo Sistema Único de Saúde (SUS), em determinado município do interior de Minas Gerais, bem como os gastos financeiros e o repasse financeiro para os centros de atendimento de traumas. Material e métodos: Trata-se de um estudo ecológico, descritivo, realizado a partir da coleta de dados pelo SIH-SUS, no período de janeiro de 2011 a dezembro de 2021, em um município do interior de Minas Gerais. Resultados: Foi identificado um total de 14.138 pacientes, com maior acometimento de pessoas do sexo masculino, com idade entre 15 e 44 anos. Como causas mais frequentes, destacaram-se os traumatismos de quadril e coxa, seguidos de traumatismos de membros superiores (ombro, antebraço, braço, punho e mão) e cabeça. Como tempo médio de permanência hospitalar, houve 4.693 diárias entre 2011 e 2021 secundárias a complicações em enfermarias e unidade de terapia intensiva, elevando cerca de 2,37% os valores repassados pelo SUS no período estudado. Em resumo, a análise da incidência de traumas nas emergências de um município do interior de Minas Gerais revela uma preocupante tendência em que homens na faixa etária de 15 a 44 anos emergem como as principais vítimas. Esse padrão pode ser influenciado por fatores como ocupação, comportamentos de risco e mobilidade. Conclusão: A compreensão dessa demografia específica é crucial para direcionar estratégias de prevenção e resposta adequadas. A implementação de medidas educativas, segurança no trânsito e promoção da saúde mental pode contribuir para mitigar os impactos dos traumas nesse grupo demográfico, melhorando sua qualidade de vida e a saúde geral da comunidade.

Objective: To determine the epidemiological profile of patients assisted by the unified health system, in a certain municipality in the interior of Minas Gerais, as well as the financial expenses and the financial transfer to trauma care centers. Material and methods: This is an ecological, descriptive study, carried out from data collection by SIH-SUS, from January 2011 to December 2021 in a municipality in the interior of Minas Gerais. Results: a total of 14,138 patients were identified, with greater involvement of male people aged between 15 and 44 years. As the most frequent causes, trauma to the hip and thigh stood out, followed by trauma to the upper limbs (shoulder, forearm, arm, wrist and hand) and head. As for the average length of hospital stay, there were 4,693 daily stays between 2011 and 2021 secondary to complications in wards and the intensive care unit. Increasing about 2.37% in the values transferred by the unified health system between the studied decade. In summary, the analysis of the incidence of trauma in emergencies in a municipality in the interior of Minas Gerais reveals a worrying trend in which men aged 15 to 44 years emerge as the main victims. This pattern can be influenced by factors such as occupation, risky behavior and mobility. Conclusion: Understanding this specific demographic is crucial to targeting appropriate prevention and response strategies. The implementation of educational measures, road safety and mental health promotion can help to mitigate the impacts of trauma in this demographic group, improving their quality of life and the general health of the community.

Validation of the Brazilian version of the Hip Sports Activity Scale (HSAS) for patients with femoroacetabular impingement: a cross-sectional study

ABSTRACT BACKGROUND: The Hip Sports Activity Scale (HSAS) is a hip-specific instrument for assessing the present levels of physical activity among patients with femoroacetabular impingement (FAI) syndrome. When evaluating treatment outcomes in patients with FAI syndrome, it is necessary to use joint-specific instruments and ones that can evaluate the levels of physical activity in these patients, such as the HSAS-Brazil. OBJECTIVE: To validate the HSAS-Brazil among a group of physically active patients after arthroscopic treatment of FAI syndrome. DESIGN AND SETTING: Cross-sectional research of quantitative and qualitative types using data obtained from July 2018 to October 2019. METHODS: A total of 58 patients of both genders diagnosed with FAI syndrome and who had undergone hip arthroscopy participated in this research. To establish reliability and validity, patients first answered the Brazilian versions of the 12-Item Short-Form Health Survey (SF-12), Nonarthritic Hip Score (NAHS), and HSAS; after a 48-hour interval, they answered the HSAS-Brazil again. RESULTS: For test-retest reliability, the interclass correlation was 0.908 (P < 0.001). The HSAS-Brazil correlated to the NAHS-Brazil (r = 0.63, P < 0.001), as well as the SF-12 (Physical Health) (r = 0.42, P = 0.001). CONCLUSION: The HSAS-Brazil was validated and proved to be a reliable and valid scale to assess sports activity levels in physically active patients with FAI syndrome after arthroscopic treatment.

Análise cienciométrica de pesquisas de enfermagem sobre fratura de quadril: tendências, tópicos e perfis / Análisis cienciométrico de estudios de enfermería sobre fractura de cadera: tendencias, temas y perfiles / Scientometric analysis of nursing research on hip fracture: trends, topics, and profiles

Resumo Objetivo Bibliometria, cienciometria e outras metodologias relacionadas podem ser usadas para revelar os padrões básicos, conexões com diferentes temas e áreas e elementos demográficos de um determinado tópico da literatura. O objetivo deste estudo é revelar os padrões e tendências na pesquisa de enfermagem sobre fratura de quadril. Métodos Estudo exploratório descritivo classificado em metodologias de bibliometria, cienciometria e inteligência de negócios. A Web of Science foi a principal fonte de dados. Foram considerados artigos relacionados publicados entre 1990 e 2020. Na análise de dados abstratos, além das tabelas, análise de texto e modelos de rede usados no mapeamento bibliométrico, também foi utilizada a Alocação Latente de Dirichilet ( Latent Dirichlet Allocation -LDA) enriquecida por inteligência de negócios. Resultados Foram identificados 380 estudos sobre fratura de quadril (artigo=351, revisão=29). O número de artigos levantados apresentou tendência de crescimento a cada ano, o maior número de artigos foi publicado em 2020. Em termos de distribuição dos 380 estudos por país, Estados Unidos (n=159), Suécia (n=52) e Austrália (n=32) foram os três primeiros países. Dentre os dez temas identificados pela LDA, destacam-se os cuidados de enfermagem, mortalidade e reabilitação. Enfermagem, delirium e idoso foram as palavras-chave mais utilizadas. Fragilidade e reabilitação foram as palavras-chave introduzidas mais recentemente. Conclusão Os temas cuidados de enfermagem, reabilitação e vivências de cuidado têm sido intensamente estudados. Estudos sobre questões que ocorrem com o aumento da idade e onde o cuidado de enfermagem é importante podem ser conduzidos futuramente com uso de inteligência de negócios e bibliometria.

Resumen Objetivo Bibliometría, cienciometría y otras metodologías relacionadas pueden ser utilizadas para descubrir las pautas básicas, conexiones con diferentes temas y áreas y elementos demográficos de un determinado asunto de la literatura. El objetivo de este estudio es descubrir las pautas y tendencias en la investigación de enfermería sobre fractura de cadera. Métodos Estudio exploratorio descriptivo clasificado en metodologías de bibliometría, cienciometría e inteligencia de negocios. La principal fuente de datos fue Web of Science. Se consideraron artículos relacionados publicados entre 1990 y 2020. En el análisis de datos abstractos, además de cuadros, análisis de texto y modelos de red utilizados en el mapeo bibliométrico, también se usó la Asignación Latente de Dirichlet ( Latent Dirichlet Allocation , LDA) enriquecida por inteligencia de negocios. Resultados Se identificaron 380 estudios sobre fractura de cadera (artículo=351, revisión=29). El número de artículos recopilados presentó una tendencia de crecimiento cada año, la mayor cantidad de artículos fue publicada en 2020. En términos de distribución por país de los 380 estudios, Estados Unidos (n=159), Suecia (n=52) y Australia (n=32) fueron los tres primeros países. Entre los diez temas identificados por la LDA, se destacaron cuidados de enfermería, mortalidad y rehabilitación. Enfermería, delirium y adulto mayor fueron las palabras clave más utilizadas. Fragilidad y rehabilitación fueron las palabras clave introducidas más recientemente. Conclusión Los temas cuidados de enfermería, rehabilitación y vivencias de cuidado fueron estudiados intensamente. Estudios sobre cuestiones que surgen con el aumento de la edad y donde los cuidados de enfermería son importantes pueden ser conducidos con el uso de inteligencia de negocios y bibliometría en un futuro.

Abstract Objective Bibliometrics, scientometrics and other related methodologies can be used to reveal the basic patterns, links to different subjects and areas, and demographic elements of a particular topic within the literature. The aim of this study is to reveal the patterns and trends in nursing research on hip fracture. Methods This descriptive exploratory study can be classified in methodologies of bibliometrics, scientometrics and business intelligence. The Web of Science was the main data source. Related articles published between 1990 and 2020 were considered. In addition to tables, text analytics, and network models used in bibliometric mapping, Latent Dirichlet Allocation (LDA) enriched by business intelligence was utilized in the analysis of abstract data. Results The total of 380 studies on hip fracture were identified (article=351, review=29). The number of retrieved articles exhibit an increasing trend by year, the highest number of articles was published in 2020. In terms of distribution of the 380 studies by country, the United States ( n =159), Sweden ( n =52) and Australia ( n =32) were the top three countries. Among the ten topics identified by LDA, nursing care, mortality, and rehabilitation were the prominent ones. Nursing, delirium, and elderly were the most frequently used keywords. Frailty and rehabilitation were the most recently introduced keywords. Conclusion The topics of nursing care, rehabilitation and care experiences have been studied intensively. Studies on issues that may occur with increasing age and where nursing care is important can be conducted in the future using business intelligence and bibliometric.

Hip Tendinopathies: An Update of Concepts and Approaches.

The present update was based on new scientific evidence of major hip-related tendinopathies. Themes were addressed that involve the principles of the onset of tendinopathies through, mainly, the principle of capacity versus demand and the biomechanical aspects involved in its onset, its main characteristics, and clinical presentations. Associated with this, treatment-related updates were presented, with exercise therapy being the focus of conservative treatment and surgical approaches necessary for the control or resolution of these cases.

School Nurses on the Front Lines of Healthcare: Emergencies Associated With Sport and Physical Activities (Part 4)-The Assessment of Pediatric Shoulder and Hip Injuries Utilizing the "SPASMS" Mnemonic.

Sport participation is an important part of the development, both physically and mentally, of children and adolescents in the United States. Illness and injury associated with sport and physical activities may occur in the school setting. Although most sport-related illness and injury in students are considered minor emergencies, life-threatening illnesses or injuries may occur. It is important for the school nurse to recognize potential life-threatening emergencies associated with sport and physical activity, to initiate stabilization of the student with life-threatening symptoms, and to triage these students to an appropriate level of care (back to the classroom, home with their guardian with follow up at their primary healthcare provider's office, or directly to the closest emergency department [ED] via Emergency Medical Services [EMS]). This article specifically describes the initial assessment and management of shoulder and hip injuries in pediatric athletes.

INFLUENCE OF FEMORAL OFFSET ON FUNCTIONAL CAPACITY OF PATIENTS WITH TOTAL HIP ARTHROPLASTY.

Objective: To correlate vertical (VFO) and horizontal (HFO) femoral offset with hip range of motion (ROM), peak muscle torque (PT), functional, capacity, and lower limb length in patients with total hip arthroplasty (THA). Methods: A cross-sectional case control study, in which 22 individuals (10 men and 12 women) - aged 61 (41-72), and within 23 (10-40) postoperative days - were evaluated for active hip ROM (fleximetry); Isometric PT (portable dynamometer); functional capacity (Timed up and Go test (TUG) and Harris Hip Score questionnaire); lower limb length (measuring tape); and VFO and HFO (radiographs). Results: The operated limb showed a reduction in length (p = 0.006), ROM for abduction (p = 0.001), flexion (p = 0.003), and external rotation (p = 0.003), as well as in all PT (p < 0.05) when compared with the contralateral limb. Moderate correlations were observed between VFO and external rotators (r = 0.487; p = 0.021); HFO and external rotators PT (r = -0.508; p = 0.016); and the difference between the VFO (operated and non-operated limb) and the TUG (r = -0.570; p = 0.006). Conclusion: Changes to the femoral offset seem to influence functional capacity, as well as the movement and external rotators PT of the hips in patients with THA, considering the postoperative period evaluated. Level of Evidence III, Case Control Study.

Objetivo: Correlacionar achados do offset femoral vertical (OFV) e horizontal (OFH) aos da amplitude de movimento do quadril (ADM), pico de torque muscular (PT), capacidade funcional (CF) e comprimento dos membros inferiores (CM) em pacientes com artroplastia total de quadril (ATQ). Métodos: Estudo transversal, caso controle (nível de evidência III), foram avaliados 22 indivíduos (10 homens e 12 mulheres) com idade de 61 (41-72) anos e 23 (10-40) dias de pós-operatório, quanto à: ADM ativa do quadril (fleximetria); PT isométrico (dinamômetro portátil); CF - teste Timed up and Go (TUG) e questionário Harris Hip Score (HHS); CM (fita métrica); e OFV e OFH a partir de radiografias. Resultados: O membro operado apresentou redução no CM (p = 0,006), ADM de abdução (p = 0,001), flexão (p = 0,003) e RE (p = 0,003), e em todos os PT (p < 0,05) em comparação ao membro contralateral. Correlações moderadas encontradas entre: OFV e RE (r = 0,487; p = 0,021); OFH e PT dos RE (r = −0,508; p = 0,016);e a diferença do OFV (membro operado e não operado) e o TUG (r = −0,570; p = 0,006). Conclusão: Alterações no OF parecem influenciar a CF, bem como o movimento e o PT dos RE do quadril em pacientes com ATQ para o período pós-operatório avaliado. Nível de Evidência III, Estudo de Caso-Controle.

Hip Tendinopathies: An Update of Concepts and Approaches / Tendinopatias do quadril: Uma atualização de conceitos e abordagens

Abstract The present update was based on new scientific evidence of major hip-related tendinopathies. Themes were addressed that involve the principles of the onset of tendinopathies through, mainly, the principle of capacity versus demand and the biomechanical aspects involved in its onset, its main characteristics, and clinical presentations. Associated with this, treatment-related updates were presented, with exercise therapy being the focus of conservative treatment and surgical approaches necessary for the control or resolution of these cases.

Resumo A presente atualização foi embasada nas novas evidências científicas das principais tendinopatias relacionadas ao quadril. Foram abordadas temáticas que envolvem os princípios do aparecimento das tendinopatias através, principalmente, do princípio da capacidade versus demanda e os aspectos biomecânicos envolvidos no seu aparecimento, suas principais características e apresentações clínicas. Associadas a isso, foram expostas as atualizações voltadas ao tratamento, coma terapia por exercício sendo o foco do tratamento conservador e as abordagens cirúrgicas necessárias para o controle ou resolução desses casos.

The Brazilian version of the Hip Sports Activity Scale: translation and cross-cultural adaptation

Abstract BACKGROUND: The Hip Sports Activity Scale (HSAS) is a reliable and valid tool for determining the levels of sports activities among patients with femoroacetabular impingement (FAI). OBJECTIVE: To translate and cross-culturally adapt the HSAS to the Brazilian Portuguese language. DESIGN AND SETTING: This was a cross-sectional study conducted at the State University of Rio de Janeiro. METHODS: The Brazilian version of the HSAS was developed following a process that comprised six steps: translation, synthesis, back-translation, review by committee, pretesting and submission of documentation to the developers. The translation phase involved three independent bilingual translators whose mother language was Brazilian Portuguese. The back-translation phase involved three independent translators whose mother language was English. In order to verify comprehension of the questionnaire, 30 undergraduate students in physical education (65% men), with mean age 23.2 years (standard deviation = 6.8), participated in the pre-testing phase. RESULTS: During the translation step, some terms and expressions were changed to obtain cultural equivalence to the original HSAS. In the pre-testing phase, each item of the scale showed a comprehension level of 100%. CONCLUSION: The HSAS was translated from English to the Brazilian Portuguese language and adapted to Brazilian culture. The HSAS validation is ongoing.

Influence of femoral offset on functional capacity of patients with total hip arthroplasty / Influência do offset femoral na capacidade funcional de pacientes com artroplastia total de quadril

ABSTRACT Objective: To correlate vertical (VFO) and horizontal (HFO) femoral offset with hip range of motion (ROM), peak muscle torque (PT), functional, capacity, and lower limb length in patients with total hip arthroplasty (THA). Methods: A cross-sectional case control study, in which 22 individuals (10 men and 12 women) - aged 61 (41-72), and within 23 (10-40) postoperative days - were evaluated for active hip ROM (fleximetry); Isometric PT (portable dynamometer); functional capacity (Timed up and Go test (TUG) and Harris Hip Score questionnaire); lower limb length (measuring tape); and VFO and HFO (radiographs). Results: The operated limb showed a reduction in length (p = 0.006), ROM for abduction (p = 0.001), flexion (p = 0.003), and external rotation (p = 0.003), as well as in all PT (p < 0.05) when compared with the contralateral limb. Moderate correlations were observed between VFO and external rotators (r = 0.487; p = 0.021); HFO and external rotators PT (r = −0.508; p = 0.016); and the difference between the VFO (operated and non-operated limb) and the TUG (r = −0.570; p = 0.006). Conclusion: Changes to the femoral offset seem to influence functional capacity, as well as the movement and external rotators PT of the hips in patients with THA, considering the postoperative period evaluated. Level of Evidence III, Case Control Study.

RESUMO Objetivo: Correlacionar achados do offset femoral vertical (OFV) e horizontal (OFH) aos da amplitude de movimento do quadril (ADM), pico de torque muscular (PT), capacidade funcional (CF) e comprimento dos membros inferiores (CM) em pacientes com artroplastia total de quadril (ATQ). Métodos: Estudo transversal, caso controle (nível de evidência III), foram avaliados 22 indivíduos (10 homens e 12 mulheres) com idade de 61 (41-72) anos e 23 (10-40) dias de pós-operatório, quanto à: ADM ativa do quadril (fleximetria); PT isométrico (dinamômetro portátil); CF - teste Timed up and Go (TUG) e questionário Harris Hip Score (HHS); CM (fita métrica); e OFV e OFH a partir de radiografias. Resultados: O membro operado apresentou redução no CM (p = 0,006), ADM de abdução (p = 0,001), flexão (p = 0,003) e RE (p = 0,003), e em todos os PT (p < 0,05) em comparação ao membro contralateral. Correlações moderadas encontradas entre: OFV e RE (r = 0,487; p = 0,021); OFH e PT dos RE (r = −0,508; p = 0,016); e a diferença do OFV (membro operado e não operado) e o TUG (r = −0,570; p = 0,006). Conclusão: Alterações no OF parecem influenciar a CF, bem como o movimento e o PT dos RE do quadril em pacientes com ATQ para o período pós-operatório avaliado. Nível de Evidência III, Estudo de Caso-Controle.

Lesiones de cadera relacionadas con la actividad deportiva / Sports-Related Hip Injuries

Introducción: Las lesiones de la cadera relacionadas con las actividades deportivas han sido poco abordadas; sin embargo, han ido en aumento y su diagnóstico suele ser difícil o retardado. Incluyen múltiples afecciones y su recuperación suele ser larga. Objetivo: Actualizar conocimientos sobre algunas de las afecciones deportivas que afectan la cadera. Métodos: Se realiza una revisión bibliográfica sistemática y detallada sobre el tema, para lo cual se emplearon métodos teóricos, analítico-sintético, histórico-lógico e inductivo-deductivo y el análisis documental como método empírico. Se hizo una búsqueda sistemática sobre la temática en las bases de datos PubMed, Medscape y Google Academics desde junio de 2016 hasta la fecha. Se revisaron 500 artículos referentes al tema, de los cuales se seleccionaron 45 artículos para este trabajo. Análisis y síntesis de la información: Las lesiones de la cadera relacionadas con el deporte ocurren entre 5 y 9 por ciento de atletas adultos. Las actividades con movimientos rápidos, aceleraciones, desaceleraciones, y los cambios direccionales son la principal causa de tales lesiones. Provocan daños corporales provocados por una transferencia de energía, que excede la capacidad para mantener la estructura y/o la función íntegra, durante el entrenamiento o competición. Conclusiones: Las lesiones de la cadera relacionadas con el deporte pueden ser múltiples y son responsables de dolor en un gran número de atletas, fundamentalmente en el fútbol, la gimnasia y el beisbol. El diagnóstico precoz es fundamental para evitar la progresión de la lesión. Las mejoras en el diagnóstico radiológico y las posibilidades del uso de la artroscopia han mejorado la evolución y el pronóstico para los atletas(AU)

Introduction: Sports injuries of the hip have been little addressed; however, they have been increasing and their diagnosis is often difficult or delayed. They include multiple conditions and their recovery is usually long. Objective: To bring up to date knowledge on some of the sports conditions that affect the hip, which is particularly important to improve medical care. Methods: A systematic and detailed bibliographic review is carried out on the subject, for which theoretical, analytical-synthetic, historical-logical and inductive-deductive methods were used, as well as documentary analysis as an empirical method. A systematic search on the subject was carried out in PubMed, Medscape and Google Academics databases from June 2016 to date. Five hundred articles referring to the topic were reviewed. Forty-five articles the total were selected for this paper. Analysis and synthesis of the information: Sports-related hip injuries occur between 5 and 9 percent of adult athletes. Activities with rapid movements, accelerations, decelerations, and directional changes are the main cause of such injuries. They cause bodily harm produced by a transfer of energy, which exceeds the capacity to maintain the entire structure and, or function, during training or competition. Conclusions: Sports injuries of the hip can be multiple and are responsible for pain in a large number of athletes, mainly in soccer, gymnastics and baseball. Early diagnosis is essential to avoid progression of the lesion. Improvements in radiological diagnosis and the possibilities of the use of arthroscopy have improved the evolution and prognosis for athletes(AU)

Sequelae of late diagnosis and treatment of developmental dysplasia of the hip: case report and surgical technique description. / [Secuela de diagnóstico tardío y tratamiento en displasia del desarrollo de la cadera: reporte de caso y descripción de técnica quirúrgica.]

Developmental hip dysplasia (DHD) is a common entity that affects 4 out of every 1000 live births and is a recognized cause of secondary hip osteoarthritis despite routine perinatal controls. In most patients, the early diagnosis of the pathology allows an evolution without sequelae. However, in the basis that patients diagnosed late and with multiple surgeries are patients with open physis, ossification nuclei present and previous surgeries in the approach area, the late diagnosis represents a real challenge for the orthopedist. We report below the case of a patient treated in our center since birth, who evolved with complications associated with late diagnosis and surgical interventions, describing rescue surgery performed at 12 years of age and finally highlighting the importance of routine perinatals and early diagnosis of DHD.

La displasia del desarrollo de la cadera (DDC) es una entidad frecuente que afecta a 4 de cada 1000 nacidos vivos y es una causa reconocida de artrosis de cadera secundaria a pesar de los controles perinatales de rutina. En la mayoría de los pacientes, el diagnóstico precoz de la patología permite una evolución sin secuelas. Sin embargo, el diagnóstico tardío con múltiples intervenciones representa un verdadero reto para el ortopedista, ya que se trata de pacientes con fisis abierta, nucleos de osificación presentes y cirugías previas en la zona de abordaje. Se reporta a continuación el caso de una paciente tratada en nuestro centro desde su nacimiento, que evolucionó con complicaciones asociadas al diagnóstico tardío y a las intervenciones quirúrgicas, describiendo la cirugía de salvataje realizada a los 12 años de edad y destacando finalmente la importancia de los controles perinatales de rutina y el diagnóstico precoz de la DDC.

Análisis de la mortalidad tras una fractura de cadera en un período de 15 años: la mortalidad al año se correlaciona directamente con la mortalidad a los 2 años / Mortality trend over 15 years in hip fracture: mortality at 1 year directly correlates with mortality at 2 years

OBJETIVO: Evaluar la tendencia de la letalidad al año y a 2 años, tiempo de espera de cirugía y estadía hospitalaria en fractura de cadera entre 2002 y 2016. Además, evaluar la correlación entre letalidad a uno y dos años. MÉTODO: Diseño transversal. Fueron incluidos pacientes mayores de 60 años que ingresaron por fractura de cadera entre 2002 y 2016. Se solicitó al Registro Civil reportar si los pacientes estaban con vida al 30 de junio de 2019. La correlación de Spearman fue estimada para determinar la tendencia de la letalidad a uno y dos años, la edad, el tiempo de espera de cirugía, y la estadía hospitalaria durante el periodo estudiado. Además, una regresión linear fue estimada entre letalidad a un año y dos años. RESULTADOS: Fueron incluidos 961 fracturas de cadera. Se observó una tendencia a la disminución en la letalidad a 1 (rho » -0.23) y 2 años (rho » -0.29), en la proporción de hombres (rho » -0.25), en la estadía hospitalaria (rho » -0.06), y en el tiempo de espera de cirugía (rho » -0.11), sin alcanzar significancia estadística. La letalidad a 1 año fue de 0,17 (intervalo de confianza de 95% [IC95%]: 0,14 a 0,19), y a 2 años, de 0,26 (IC 95%: 0,23 a 0,29). Se estimó un R2 de 0,60 entre la letalidad a 1 y 2 años. CONCLUSIONES: La letalidad a uno y dos años, el tiempo de espera de cirugía, la edad de presentación, y la estadía hospitalaria no han variado significativamente en el periodo estudiado. Se observa una fuerte correlación entre la letalidad a uno y dos años, lo que sugiere un riesgo constante de mortalidad después de una fractura de cadera.

PURPOSE: To evaluate the trend in 1 and 2 years, the fatality rate, the waiting time for surgery, and the length of hospital stay in a single center between 2002 and 2016. Also, to evaluate the relationship between the one-year and two-year fatality rates. METHODS: A cross-sectional study. Patients older than 60 years of age who were admited due to hip fracture between 2002 and 2016 were included. A request was made to the Chilean National Civil Registry to determine if the patients were alive on June 30, 2019. The Spearman correlation was estimated to determine the trend of the one-year and two-year fatality rates, the age, the type of fracture, and the waiting time for surgery. Also, a linear regression analysis was estimated between the one-year and two-year fatality rates. RESULTS: A total of 961 hip fractures were included. From 2002 to 2016, a downward trend was found in the 1-year (rho » -0.23) and 2-year fatality rates (rho » -0.29), in the proportion of male patients (rho » -0.25), in the length of hospital stay (rho » -0.06), and in the waiting time for surgery (rho » -0.11), not reaching statistical difference. The 1-year fatality rate was of 0,17 (95% confidence interval [95%CI]: 0.14 to 0.19) and the 2-year fatality rate was of 0,26 (95%CI: 0.23 to 0.29). An R2 of 0.60 was estimated between the 1-year and 2-year fatality rates. CONCLUSIONS: The one-year and two-year fatality rates, the waiting time for surgery, and the length of hospital stay remained constant during the period analyzed. A strong correlation between the one-year and two-year fatality rates was found, which suggests a constant risk of death after hip fracture.

Hip apophyseal injuries in soccer players: can MRI findings be useful to define when to return to play?

OBJECTIVE: To describe magnetic resonance imaging (MRI) findings in professional soccer players with acute apophyseal injury of the hip and to assess their relationship with return to sports. MATERIAL AND METHODS: Adolescent soccer players with diagnosis of apophyseal injury in the anterosuperior and anteroinferior iliac spine were retrospectively evaluated between 2008 and 2016. All athletes underwent hip MRI examination within 4 days after onset of clinical complaint. Images were independently analyzed by two radiologists. Medical records were reviewed to obtain clinical data. RESULTS: Mean displacement of the apophysis was 4.8 ± 4.6 mm. Bone edema was present in 82% of athletes and muscular edema in 41%. The mean time to return to sports was 37.3 ± 14.7 days. The difference between the measurements of the two radiologists was close to zero with agreement limits below 1.0 mm (p < 0.001). There was a significant correlation between displacement of the apophysis and return to sports, as well as between both and the presence of muscular edema. A displacement of the apophysis of 3.0 mm might serve as a parameter to predict return to sports/activity before 40 days, with a sensitivity of 92% and specificity of 96%, considering conservative physiotherapy treatment. CONCLUSION: Displacement of the apophysis and presence of muscular edema evaluated by MRI showed a significant correlation with return to sports in athletes with acute apophyseal injuries of the anterosuperior and anteroinferior iliac spines.

Are lateral view radiographs necessary to properly classify femoral neck fractures? Intra and interobserver analysis using Garden's classification system / [¿Es necesaria la incidencia radiográfica de perfil para clasificar las fracturas mediales de cadera? Análisis intra e inter observador utilizando la clasificación de Garden]

INTRODUCTION: Femoral neck fractures have been historically diagnosed by anteroposterior (AP) and lateral (L) radiographic views. We analyzed the importance of the L view for management of femoral neck fractures, using the Garden's classification system. MATERIALS AND METHODS: Slides were elaborated with AP and L radiographic views of 100 patients with femoral neck fractures admitted to our emergency department. Three hip surgeons assessed independently AP views only and then AP and L views together using Garden's classification system. RESULTS: No statistically significant differences (Kruskal Wallis 0, p=1) were found while comparing categories among Garden's classification system, after assessing L views. There was an 81 % (p < 0.001) agreement of Garden category between AP and AP combined with L views. When analyzing patients with changing categories between displaced and non displaced after assessing L view images, we found a 5% (n=5, CI 95% 1-11%) of change. For comparing AP Garden with L view Garden, we used a quadratic weighted kappa method. CONCLUSIONS: There is a high agreement in the Garden category when comparing AP with combined AP and L observations. Five patients would have received a different surgical treatment dependent on the hip surgeon who assessed the radiographs. This highlights the relevance of routinely L radiographs whenever a femoral neck fracture is suspected.

INTRODUCCIÓN: Históricamente, el diagnóstico de una fractura medial de cadera requiere de una radiografía anteroposterior (AP) y de perfil (P). Nos propusimos analizar la importancia de la radiografía de perfil en la evaluación y planificación del tratamiento de las fracturas mediales de cadera, utilizando la clasificación de Garden. RESULTADOS: Se utilizó el método de Kruskal Wallis para comparar los rangos en la clasificación de Garden después de ver la proyección de P y no se encontraron diferencias estadísticamente significativas (Kruskal Wallis 0, p=1). El acuerdo ponderado entre AP y el AP combinado con el P del Garden promedio fue de 81 % (p < 0.001). Se analizó el porcentaje de pacientes recategorizados entre fracturas no desplazadas y desplazadas, tras observar el perfil: 5% (n=5, IC 95% 1-11%) . Para comparar el Garden AP con el Garden P, se utilizó el método kappa ponderado cuadrático. MATERIALES Y MÉTODOS: Se prepararon diapositivas con radiografías AP y de P de 100 pacientes con fracturas mediales de cadera admitidos en nuestra central de emergencias.  Tres cirujanos de cadera evaluaron de forma independiente las incidencias AP únicamente y luego las vistas AP y P, utilizando la clasificación de Garden. RESULTADOS: Se utilizó el método de Kruskal Wallis para comparar los rangos en la clasificación de Garden después de ver la proyección de P y no se encontraron diferencias estadísticamente significativas (Kruskal Wallis 0, p=1). El acuerdo ponderado entre AP y el AP combinado con el P del Garden promedio fue de 81 % (p < 0.001). Se analizó el porcentaje de pacientes recategorizados entre fracturas no desplazadas y desplazadas, tras observar el perfil: 5% (n=5, IC 95% 1-11%) . Para comparar el Garden AP con el Garden P, se utilizó el método kappa ponderado cuadrático. CONCLUSIONES: Existe una alta concordancia en la clasificación de Garden al comparar las observaciones de las radiografías AP, con las observaciones AP y P juntas. Cinco pacientes hubiesen recibido un tratamiento quirúrgico diferente dependiendo del especialista que interpretaba las radiografías. Esto permite destacar la importancia de solicitar la incidencia de perfil de rutina en pacientes con sospecha de fractura medial de cadera. palabras clave: cadera; fracturas de cadera; prótesis de cadera; lesiones de la cadera; radiografía.

Relationship of the Pelvic-Trochanteric Index with greater trochanteric pain syndrome

OBJECTIVES: This study aimed to correlate a higher Pelvic-Trochanteric Index (PTI) with an increased varus of the femoral neck with greater trochanteric pain syndrome (GTPS). The secondary objective was to check whether the pelvic width changes with age. METHODS: A prospective study was conducted to compare female patients diagnosed with GTPS (case group) with asymptomatic female participants (control group) from March 2011 to June 2017. On an anteroposterior pelvic radiograph, lines were drawn by two radiologists, and the PTI (ratio of the distance between the greater trochanters and distance between the iliac crests) was defined and the femoral neck-shaft angle was measured. RESULTS: Data collected based on radiographs of 182 female patients (cases) and 150 female participants (controls) showed that the mean PTI was 1.09 (SD=0.01) in the case group and 1.07 (SD=0.01) in the control group (p<0.05), regardless of age. The distance between iliac crests increased with age (p<0.05) in symptomatic and asymptomatic individuals. It was also found that the mean femoral neck-shaft angle was 130.6° (SD=0.59) and progression of the varus angulation occurred with age in both groups, with a significance level of 5%. CONCLUSIONS: The PTI was higher in patients with GTPS. The femoral neck-shaft angle does not differ between individuals with and without GTPS; however, it does decrease with age. The pelvic width tends to increase with aging in symptomatic or asymptomatic individuals; therefore, the increase in the pelvic width and decrease in the femoral neck-shaft angle can be interpreted as normal in aging women, which could alter the biomechanics of the hips and pelvis.

Comparison between the Dominant and Non-dominant Sides of Athletes with Groin Pain.

Objective To compare the difference in range of motion (ROM) between the dominant and nondominant hips of the athletes and to correlate the results with groin pain, as well as to compare the differences in ROM among the main hip injuries. Methods The participants included 75 athletes, 56 males and 19 females, aged between 20 and 46 years old, who were diagnosed with hip injury. These individuals were subdivided according to the pathologies (femoroacetabular impact or labral lesion, adductor and pubic lesions and trochanteric syndrome) and characteristics of each hip were analyzed. Results A total of 150 hips (right and left) were measured for the present analysis. When comparing the ROM of the injured hip with the healthy hip, no statistically significant differences were found. There were also no significant differences between the amplitudes of hip movement when the main pathologies were compared. Conclusion The present study did not find differences in ROM rotation between the various pathologies of the hip.

Comparison between the Dominant and Non-dominant Sides of Athletes with Groin Pain / Comparação funcional entre membro dominante e não dominante em atletas com dor inguinal

Abstract Objective To compare the difference in range of motion (ROM) between the dominant and nondominant hips of the athletes and to correlate the results with groin pain, as well as to compare the differences in ROM among the main hip injuries. Methods The participants included 75 athletes, 56 males and 19 females, aged between 20 and 46 years old, who were diagnosed with hip injury. These individuals were subdivided according to the pathologies (femoroacetabular impact or labral lesion, adductor and pubic lesions and trochanteric syndrome) and characteristics of each hip were analyzed. Results A total of 150 hips (right and left) were measured for the present analysis. When comparing the ROM of the injured hip with the healthy hip, no statistically significant differences were found. There were also no significant differences between the amplitudes of hip movement when the main pathologies were compared. Conclusion The present study did not find differences in ROM rotation between the various pathologies of the hip.

Resumo Objetivo Comparar a diferença do arco de movimento (ADM) entre o quadril com lesão e o não lesionado de atletas com as principais patologias femoroacetabulares. Além disso, analisar a diferença da ADM do quadril em cada patologia considerada. Métodos Os participantes do presente estudo foram 75 atletas de diversas modalidades esportivas, sendo 56 mulheres e 19 homens, com idades entre 20 e 46 anos, os quais tinham diagnóstico de lesão do quadril. Esses indivíduos foram subdivididos em três grupos de acordo com as patologias (impacto femoroacetabular ou lesão labral, pubalgia ou lesão dos adutores e síndrome trocantérica) e as características de cada quadril foram analisadas. Resultados Um total de 150 quadris (direito e esquerdo) foram mensurados para a presente análise. Comparou-se o ADM do quadril lesado e do quadril saudável de cada atleta e não foram encontradas diferenças estatísticas. Da mesma forma, não houve diferença significativa entre a ADM do quadril entre as principais injúrias. Conclusão O presente estudo não encontrou diferenças no arco de movimento entre o quadril lesionado e o contralateral, bem como não houve diferença na amplitude dos movimentos entre as patologias femoroacetabulares analisadas.

Imagenological findings of external snapping hip syndrome. case report

ABSTRACT Introduction: External snapping hip syndrome is characterized by a painful sensation accompanied by an audible snapping noise in the hip when moving. Even though orthopedists are widely aware of this condition, imaging findings still need to be recognized by all radiologists in order to provide more information that allows for the best multidisciplinary treatment. Z-plasty of the iliotibial band is the most used treatment with the best results. Case presentation: Female patient with bilateral external hip snapping syndrome on the right side, who was treated initially in a conservative manner without adequate response; hence, she required surgical management with arthroscopy. All treatment options used for this patient were not successful, and symptoms recurred. Discussion: The diagnosis of snapping hip syndrome is mainly clinical. However, the contribution of diagnostic imaging is important to characterize the structures involved in this nosological process, in order to develop the therapeutic planning and do the follow-up. Conclusion: Knowledge on ultrasound and magnetic resonance findings related to this pathology allows radiologists to identify this syndrome and contribute to a timely treatment.

RESUMEN Introducción. El síndrome de cadera en resorte externa es una entidad en la cual hay una sensación de dolor acompañada de un sonido palpable durante el movimiento de la cadera. Esta es una condición ampliamente conocida por los ortopedistas, pero aún es necesario que los hallazgos imagenológicos sean reconocidos por todos los radiólogos con el fin de brindar mayor información que permita un adecuado manejo multidisciplinario. La Z-plastia de la banda iliotibial es la técnica de tratamiento más reconocida y con mejores resultados. Presentación del caso. Paciente femenino con síndrome de cadera en resorte externo bilateral sintomático en el lado derecho, quien fue manejada de forma conservadora sin adecuada respuesta y requirió manejo quirúrgico por vía artroscópica. Las técnicas utilizadas en la paciente no fueron exitosas y se presentó recurrencia de los síntomas. Discusión. El diagnóstico del síndrome de cadera en resorte es principalmente clínico. Sin embargo, el aporte de las imágenes diagnósticas es importante para caracterizar las estructuras involucradas en este proceso nosológico, para realizar el planeamiento terapéutico y para hacer el seguimiento. Conclusión. Conocer los hallazgos imagenológicos en ultrasonido y resonancia magnética del síndrome en cadera en resorte externa permite a los radiólogos identificarlo y hacer aportes al manejo de esta patología en forma oportuna.

Post-Treatment Classification for Acetabular Chondral Lesions in Hip Arthroscopy / Classificação pós-tratamento para lesões condrais acetabulares na artroscopia de quadril

Abstract Objective To describe a postarthroscopic treatment classification system for acetabular chondral damage in the hip and to report the intraobserver and interobserver reliability of such classification. Methods This is a retrospective review of ninety-nine digital video recordings made during arthroscopic surgery. Patients who underwent arthroscopic treatment for femoroacetabular impingement and evaluated at the hip arthroscopy outpatient clinic between March 2015 and March 2016 were included in the study. Patients with a history of previous hip surgery, radiologic evidence of advanced osteoarthritis (Tönnis grade > 2), who underwent labral resection, or whose digital recordings were incomplete or of insufficient quality for adequate review were excluded. Two orthopedic surgeons, who did not participate in the surgery, independently reviewed the video recordings and classified the remaining acetabular cartilage using the post-treatment classification system. Intraobserver and interobserver analysis was then conducted using intraclass correlation coefficient (ICC). Results Excellent intraobserver reliability (ICC = 0.790; p < 0.001) and interobserver reliability (ICC = 0.882; p < 0.001) were observed. Both ICC values were statistically significant. Conclusion The posttreatment classification of the remaining acetabular cartilage has excellent intra and interobserver reliability.

Resumo Objetivo Descrever um sistema de classificação de tratamento pós-artroscópico para as lesões condrais acetabulares no quadril e relatar as confiabilidades intra e interobservador deste sistema. Métodos Esta é uma revisão retrospectiva de 99 gravações de vídeo digital realizadas durante artroscopia. Os pacientes submetidos a tratamento artroscópico para impacto femoroacetabular e avaliados no ambulatório de quadril entre março de 2015 e março de 2016 foram incluídos no estudo. Os pacientes com histórico de cirurgia anterior do quadril, evidência radiológica de osteoartrose avançada (Tönnis > 2), pacientes submetidos à ressecção labral ou cujas gravações digitais estavam incompletas ou de qualidade insuficiente para avaliação adequada foram excluídos. Dois ortopedistas, que não participaram da cirurgia, revisaram de forma independente as gravações de vídeo e classificaram a cartilagem acetabular remanescente usando o sistema de classificação pós-tratamento. A análise intra e interobservador foi então realizada utilizando o coeficiente de correlação intraclasse (CCI). Resultados Excelente confiabilidade intraobservador (CCI = 0,790; p < 0,001) e confiabilidade interobservador (CCI = 0,882; p < 0,001). Ambos os valores de CCI foram estatisticamente significativos. Conclusão a classificação pós-tratamento da cartilagem acetabular remanescente possui excelente confiabilidade intra e interobservador.

Prevalence of Radiographic Signs of Femoroacetabular Impingement in Asymptomatic Patients and Non-Athletes.

OBJECTIVE: Femoroacetabular impingement has been described as an anatomical variation of the proximal femur and/or acetabular rim, impinging the hip joint. A portion of the population asymptomatic in the hip may present radiographic changes from femoroacetabular impingement. The aim of the present study was to evaluate the prevalence of these signs in asymptomatic and sedentary males. METHODS: This was a clinical, observational, primary, cross-sectional, controlled study. A total of 32 male volunteers aged between 18 and 40 years, asymptomatic in the hip and sedentary, were selected from a university hospital orthopedic emergency room. All patients underwent standard anteroposterior pelvic radiographs. The measurements of the alpha angle, the retroversion index, the ischial spine signal, and the posterior wall sign were analyzed. RESULTS: The mean age was 29 years (18-40 years old). The prevalence of radiographic signs of femoroacetabular impingement using an alpha angle of 67 o was of 53.1%; with an alpha angle of 82 o , it was of 31.2%. The mean alpha angle was 67 o (52.4-88.2 o ), with 35.9% of the hips classified as borderline and 6.3% as pathological. The mean alpha angle for the right side was 67.5 o (52.5-88.2 o ), and, for the left, it was 66.6 o (53.1-86.9 o ). The mean retroversion index was 0.048 (right side: 0.044; left side: 0.052). The spine signal was positive in 15.6%, and the posterior wall sign, in 20.3% of the cases. CONCLUSION: This study showed that the prevalence of radiographic signs in a population of asymptomatic and sedentary adult men was high (31.2%). New studies are required to explian the actual clinical significance of this finding.