Efeito da fotobiomodulação na reabilitação de pacientes com patologias traumato-ortopédicas: revisão integrativa / Efectos de la fotobiomodulación en la rehabilitación de pacientes con patologías traumatoortopédicas: revisión integrativa / Effects of photobiomodulationin the rehabilitation of patients with traumato-orthopedic pathologies: integrative review

Introdução: Fotobiomodulação corresponde à exposição de tecidos biológicos a baixos níveis de luz vermelha e infravermelha, esta terapia favorece a reabilitação de diferentes tecidos e que pode ser utilizada para a melhora da prática clínica nas diferentes atuações da fisioterapia, como por exemplo, no tratamento dos acometimentos musculoesqueléticos e inflamatórios. Objetivo: Identificar os benefícios da fotobiomodulação empregados na reabilitação de pacientes nas diferentes patologias traumato-ortopédicas. Metodologia:Trata-se de uma revisão integrativa com busca online nas plataformas de dados: Medline e PubMed. Os descritores foram: fotobiomodulação, taumato-ortopedia e reabilitação. As línguas selecionadas foram: Português, Inglês e Espanhol, entre os anos de 2018 a 2022.Resultados:A descrição dos achados nos ensaios clínicos analisados mostra que a terapia de fotobiomodulação apresenta diferentes usos na prática clínica e que seu uso produz efeito analgésico, anti-inflamatório e regenerativo nos distúrbios musculoesqueléticos. Conclusões:De acordo com a revisão dos artigos, pôde-se perceber que a terapia por fotobiomodulação confirma seus benefícios e eficácia, portando, se fazendo positiva na atuação traumato-ortopédica, gerando resultados significativos quando comparada a outros recursos (AU).

Introduction: Photobiomodulationcorresponds to the exposure of biological tissues to low levels of red and infrared light, this therapy favors the rehabilitation of different tissues and can be used to improve clinical practice in different actions of physiotherapy, such as, for example, in the treatment of musculoskeletal and inflammatory disorders. Objective: To identify the benefits of photobiomodulation used in the rehabilitation of patients with different traumato-orthopedic pathologies. Methodology:This is an integrative review with online search on data platforms: Medline and PubMed. The descriptors were: photobiomodulation, thaumato-orthopedics and rehabilitation. The selected languages were: Portuguese, English and Spanish, from 2018 to 2022. Results: The description of the discovers in the analyzed clinical trials shows that photobiomodulation therapy has different uses in clinical practice and that its use produces analgesic, anti-inflammatory and regenerative effects in musculoskeletal disorders. Conclusions:According to the review of the articles, it could be seen that photobiomodulation therapy confirms its benefits and effectiveness, therefore, becoming positive in the trauma-orthopedic performance, generating significant results when compared to other resources (AU).

Introducción: La fotobiomodulacióncorresponde a la exposición de tejidos biológicos a bajos niveles de luz roja e infrarroja, esta terapia estimula la rehabilitación de diferentes tejidos y puede ser utilizada para mejorar la práctica clínica en diferentes áreas de fisioterapia, como por ejemplo, en tratamiento de Trastornos musculoesqueléticos e inflamatorios. Objetivo: Identificar los beneficios de la fotobiomodulación utilizada en la rehabilitación de pacientes con diferentes patologías traumato-ortopédicas. Metodología: Esta es una revisión integradora con búsqueda en línea en plataformas de datos: Medline y PubMed. Los descriptores fueron: fotobiomodulación, taumato-ortopedia y rehabilitación. Los idiomas seleccionados fueron: portugués, inglés y español, entre los años 2018 a 2022. Resultados: La descripción de los hallazgos en los ensayos clínicos analizados muestra que la terapia de fotobiomodulación tiene diferentes usos en la práctica clínica y que su uso produce efectos analgésicos, antiinflamatorios y regenerador en trastornos musculoesqueléticos. Conclusiones: De acuerdo con la revisión de los artículos, se pudo apreciar que la terapia de fotobiomodulación confirma sus beneficios y efectividad, por lo tanto, tornándose positiva en el desempeño trauma-ortopédico, generando resultados significativos cuando se compara con otros recursos (AU).

Spinal gunshot wounds: A retrospective, multicenter, cohort study. / [Artículo traducido] Lesiones vertebrales por proyectil de arma de fuego: estudio de cohorte retrospectivo, multicéntrico.

INTRODUCTION AND OBJECTIVE: To describe the demographic and clinical characteristics and treatment of patients with spinal gunshot wounds across Latin America. MATERIAL AND METHODS: Retrospective, multicenter cohort study of patients treated for gunshot wounds to the spine spanning 12 institutions across Latin America between January 2015 and January 2022. Demographic and clinical data were recorded, including the time of injury, initial assessment, characteristics of the vertebral gunshot injury, and treatment. RESULTS: Data on 423 patients with spinal gunshot injuries were extracted from institutions in Mexico (82%), Argentina, Brazil, Colombia, and Venezuela. Patients were predominantly male civilians in low-risk-of-violence professions, and of lower/middle social status, and a sizeable majority of gunshots were from low-energy firearms. Vertebral injuries mainly affected the thoracic and lumbar spine. Neurological injury was documented in 320 (76%) patients, with spinal cord injuries in 269 (63%). Treatment was largely conservative, with just 90 (21%) patients treated surgically, principally using posterior open midline approach to the spine (79; 87%). Injury features distinguishing surgical from non-surgical cases were neurological compromise (P = 0.004), canal compromise (P < 0.001), dirty wounds (P < 0.001), bullet or bone fragment remains in the spinal canal (P < 0.001) and injury pattern (P < 0.001). After a multivariate analysis through a binary logistic regression model, the aforementioned variables remained statistically significant except neurological compromise. CONCLUSIONS: In this multicenter study of spinal gunshot victims, most were treated non-surgically, despite neurological injury in 76% and spinal injury in 63% of patients.

[Clinical and radiographic factors associated with failure of the dynamic hip screw system]. / Factores clínicos y radiográficos asociados a la falla del sistema del tornillo dinámico de cadera.

Background: The most widely used fixation system for transtrochanteric fractures is the dynamic hip screw system, which has a failure prevalence of 10 to 17% and it is associated with the presence of clinical and radiographic factors. Objective: To evaluate the association of clinical and radiographic factors with the failure of the screw system in post-operative patients for transtrochanteric hip fracture. Material y methods: A case-control study was carried out. The inclusion criteria were: patients > 18 years, who underwent surgery due to transtrochanteric fracture, were treated with the hip screw system, and who attended the Trauma Service. The patient with failure of the hip screw system was selected as the case and the patient without failure of the system as control. The variables analyzed in these groups were: age, gender, body mass index and radiographic variables. Statistical analysis was performed with chi-squared and Mann-Whitney U. Results: 163 patients (median 73 years), 20 cases and 143 controls, were included. The radiographic factors with a significant association with hip screw system failure were the AO classification of fractures (p < 0.001), the tip apex distance (p = 0.03), the calcar-referenced tip apex (p = 0.02), the position of the screw (p < 0.001), and quality of reduction (p < 0.003). Clinical factors did not show a significant association. Conclusions: Radiographic factors are associated with failure in the hip screw system in patients in post-operative care due to transtrochanteric fracture.

Introducción: el sistema de fijación más usado para fracturas transtrocantéricas es el sistema del tornillo dinámico de cadera, el cual tiene una prevalencia de falla del 10 al 17% y se asocia a la presencia de factores clínicos y radiográficos. Objetivo: evaluar la asociación de los factores clínicos y radiográficos con la falla del sistema del tornillo en pacientes postoperados de fractura transtrocantérica de cadera. Material y métodos: se hizo un estudio de casos y controles. Los criterios de inclusión fueron: pacientes > 18 años, postoperados de fractura transtrocantérica, tratados con el sistema del tornillo de cadera, que acudieron a la consulta de Traumatología. Se seleccionó como caso al paciente con falla del sistema del tornillo de cadera y como control al paciente sin falla de este. Las variables analizadas en los grupos fueron la edad, el género, el índice de masa corporal y las variables radiográficas. El análisis estadístico se hizo con chi cuadrada y U de Mann-Whitney. Resultados: se incluyeron 163 pacientes (mediana de 73 años), 20 casos y 143 controles. Los factores radiográficos con asociación significativa con la falla del sistema del tornillo de cadera fueron la clasificación AO de la fractura (p < 0.001), la distancia punta-ápex (p = 0.03), punta ápex calcar (p = 0.02), la posición del tornillo (p < 0.001) y la calidad de la reducción (p < 0.003). Los factores clínicos no mostraron asociación significativa. Conclusiones: los factores radiográficos se asocian con la falla en el sistema del tornillo de cadera en pacientes postoperados de fractura transtrocantérica.

Atuação do fisioterapeuta no serviço de emergência de um hospital de pronto socorro referência em trauma / The role of physical therapists in the emergency room of a trauma hospital

Emergências hospitalares são portas de entrada para pacientes graves com potencial risco de morte. Em um hospital referência em trauma, a função do fisioterapeuta dentro da equipe multiprofissional ainda tem necessidade de ser bem estabelecida. Objetivo: Discorrer sobre a atuação do fisioterapeuta no serviço de emergência de um hospital de pronto socorro referência em trauma e apresentar o perfil do paciente atendido. Método: Trata-se de uma pesquisa observacional descritiva, de caráter transversal retrospectiva a partir da análise dos atendimentos fisioterapêuticos registrados em prontuários de pacientes hospitalizados. Resultados: As causas mais frequentes de internação dos pacientes atendidos pela equipe de fisioterapia foram quedas (51,7%), acidentes de trânsito (14,9%), cardiovasculares (9,2%), agressões (9,1%), outros (8,3%) e respiratórias (6,8%). Quedas da própria altura com fratura de fêmur associadas representaram 26,4% da amostra. Nestes pacientes as condutas mais utilizadas pelos fisioterapeutas foram orientações, exercícios respiratórios, exercícios no leito e ajustes de posicionamento. O fisioterapeuta teve atuação com pacientes com pneumotórax, hemotórax ou hemopneumotórax submetidos à drenagem torácica, por meio de exercícios respiratórios expansivos, saída do leito e deambulação precoce. Observou-se também atuação com os pacientes em ventilação mecânica invasiva e não invasiva na sala vermelha. Conclusão: O fisioterapeuta, fazendo parte da equipe multiprofissional, apresenta importante atuação nas salas de emergência de um hospital de trauma, tal como o atendimento a pacientes submetidos a ventilação mecânica invasiva e não invasiva, uso de técnicas de fisioterapia respiratória para expansão pulmonar e remoção de secreções bem como a utilização de técnicas de cinesioterapia para manutenção e ganho de força muscular e funcionalidade.

Hospital emergencies are gateways to critically ill patients with potential risk of death. In a trauma referral hospital, the physical therapists role within the multiprofessional team must still be well established. Objective: To discuss the role of the physical therapist in the emergency department of a reference trauma hospital and to present the profile of the patients admitted to hospitalization. Method: This is a descriptive, observational, cross-sectional study that analyzes physiotherapy and records of hospitalized patients. Results: The most frequent causes of hospitalization of patients treated by the physiotherapy team were falls (51.7%), traffic accidents (14.9%), cardiovascular diseases (9.2%), assaults (9.1%), and respiratory (6.8%). Falls from standing height with associated femur fractures represented 26.4% of the records. With these patients, the procedures most used by physical therapists were orientations, breathing exercises, bedside exercises, and positioning adjustments. With lung-expanding breathing exercises, bedside exercises, and early walking, the physical therapist treated patients with pneumothorax, hemothorax, or hemopneumothorax who underwent thoracic drainage. Physical therapists also treated patients under invasive and non-invasive mechanical ventilation in the red ward. Conclusion: The physical therapist, as part of the multiprofessional team, has an essential role in the emergency rooms of a trauma hospital, such as care for patients undergoing invasive and non-invasive mechanical ventilation, use of respiratory physiotherapy techniques for lung expansion and removal of secretions, as well as the use of kinesiotherapy techniques to maintain and gain muscle strength and functionality.

Desarrollo e implementación de un programa de investigación durante la residencia de ortopedia y traumatología

Introducción: Dentro de las recomendaciones internacionales para la formación de médicos expertos, se encuentra el integrar la mejor evidencia disponible a la práctica clínica y contribuir a la creación del conocimiento científico. El objetivo de este trabajo es describir la implementación de un programa formal de investigación en residentes de ortopedia y traumatología. Metodología: Se desarrolló un programa de investigación para residentes de ortopedia y traumatología, coordinado por un equipo con formación en metodología y bioestadística. El objetivo principal fue que los residentes lograran adquirir herramientas en el desarrollo del método científico e integrar la medicina basada en la evidencia en la práctica profesional. Para ello, se enfocó en tres ejes: 1. formación general 2. análisis crítico de la literatura y 3. desarrollo de investigación científica. Resultados: El año 2015 se implementó el programa. Comenzó con el módulo de formación general a través de seminarios de investigación y una rotación mensual obligatoria. De forma semanal se implementaron reuniones de revisiones críticas de la literatura a partir de casos clínicos y cada dos o tres meses sesiones de journal club. Se han formulado 30 proyectos de investigación, 22 de ellos se han presentado en congresos y ha habido un total de 27 publicaciones con coautoría de residentes (6 de primer autor). Conclusión: A través del programa de investigación, los residentes han adquirido herramientas para poder integrar la medicina basada en la evidencia a su práctica profesional y desarrollar proyectos científicos.

Introduction: In the international recommendations for resident education, there is integrating the best available evidence into clinical practice and contributing to the creation of scientific knowledge. This research aims to describe implementing a formal research program for orthopedic residents. Methodology: We developed a research program for orthopedic residents coordinated by a team trained in methodology and biostatistics. The main objective for residents was to acquire tools to develop the scientific method and to integrate evidence-based medicine into professional practice. To do this, it focused on: 1. theoretical courses, 2. critical analysis of literature, and 3. creation of scientific research. Results: 2015, the program started with a theoretical course through research seminars and a mandatory monthly rotation. Critical analysis of articles meetings were weekly, and journal club sessions every 2 or 3 months. Residents formulated 30 research projects and presented 22 at national and international congresses. There were 27 scientific publications with resident participation (6 were lead authors). Conclusion: Through the research program, residents have acquired tools to integrate evidence-based medicine into their professional practice and develop scientific projects.

Spinal gunshot wounds: A retrospective, multicenter, cohort study.

INTRODUCTION AND OBJECTIVE: To describe the demographic and clinical characteristics and treatment of patients with spinal gunshot wounds across Latin America. MATERIAL AND METHODS: Retrospective, multicenter cohort study of patients treated for gunshot wounds to the spine spanning 12 institutions across Latin America between January 2015 and January 2022. Demographic and clinical data were recorded, including the time of injury, initial assessment, characteristics of the vertebral gunshot injury, and treatment. RESULTS: Data on 423 patients with spinal gunshot injuries were extracted from institutions in Mexico (82%), Argentina, Brazil, Colombia, and Venezuela. Patients were predominantly male civilians in low-risk-of-violence professions, and of lower/middle social status, and a sizeable majority of gunshots were from low-energy firearms. Vertebral injuries mainly affected the thoracic and lumbar spine. Neurological injury was documented in n=320 (76%) patients, with spinal cord injuries in 269 (63%). Treatment was largely conservative, with just 90 (21%) patients treated surgically, principally using posterior open midline approach to the spine (n=79; 87%). Injury features distinguishing surgical from non-surgical cases were neurological compromise (p=0.004), canal compromise (p<0.001), dirty wounds (p<0.001), bullet or bone fragment remains in the spinal canal (p<0.001) and injury pattern (p<0.001). After a multivariate analysis through a binary logistic regression model, the aforementioned variables remained statistically significant except neurological compromise. CONCLUSIONS: In this multicenter study of spinal gunshot victims, most were treated non-surgically, despite neurological injury in 76% and spinal injury in 63% of patients.

Revisión bibliográfica sobre la Gestión Integral de la Farmacoterapia en pacientes hospitalizados en Cirugía Ortopédica y Traumatología / Literature review on Medication Therapy Management in patients admitted to Orthopedic Surgery and Trauma Departments

Objetivo: Explorar la literatura científica sobre las intervenciones farmacéuticas (IF) y la Gestión Integral de la Farmacoterapia (GIF) brindada por farmacéuticos en pacientes hospitalizados en Cirugía Ortopédica y Traumatología (COT). Métodos: Se realizó una búsqueda de artículos originales y revisiones, publicados en inglés o castellano, hasta el 17 de junio de 2021, cuyo tema principal fueran las IF en pacientes hospitalizados en COT. Bases de datos consultadas: Medline, Cochrane Library y Scielo. Términos empleados: “Orthopedics”, “Traumatology”, “orhopedic surgery”, “orhopedic trauma”, “Medication Therapy Management”, “Pharmacy Service, Hospital”, “Pharmacists”, “Medication Reconciliation”, “Pharmaceutical Care”, “Clinical Pharmacy”. La IF fue considerada GIF cuando implicaba una revisión profunda de la medicación del paciente (Valoración inicial/“Assessment”), evaluando indicación, efectividad, seguridad y cumplimiento/adherencia de cada uno de los medicamentos, y comprobando que todas sus necesidades farmacoterapéuticas estuvieran cubiertas. La implantación de la GIF fue considerada completa cuando además se realizaba un plan de cuidados farmacoterapéutico (“Care Plan”) y evaluación/seguimiento (“Follow up-evaluation”). Resultados: Se seleccionaron 29 artículos, principalmente estudios observacionales descriptivos (51,7%). La mayoría fueron publicados en Estados Unidos (27,6%) y España (20,7%). IF mayoritarias: conciliación de medicación (55,2%), revisión de medicación (44,8%), seguimiento farmacoterapéutico (SFT) (34,5%), manejo del dolor físico postquirúrgico (27,6%) y evaluación/reducción de riesgos (27,6%). La GIF fue analizada en cinco referencias bibliográficas (17,2%); siendo su implantación completa solamente en tres (10,3%). Conclusiones: La presente revisión bibliográfica sintetiza las principales IF en pacientes hospitalizados en COT, destacando: conciliación de medicación, revisión de medicación y SFT... (AU)

Objective: To review the scientific literature on Pharmaceutical Interventions (PIs) and Medication Therapy Management (MTM) by pharmacists in patients admitted to Orthopedic Surgery and Trauma (OST) Departments. Methods: A search was conducted of Medline, Cochrane Library, and Scielo databases for original articles and reviews on PIs in adults (≥18 yrs) hospitalized in OST published in English or Spanish up to June 17 2021. Search terms were: “orthopedics”, “traumatology”, “orthopedic surgery”, “orthopedic trauma”, “medication therapy management”, “pharmacy service, hospital”, “pharmacists”, “medication reconciliation”, “pharmaceutical care”, “clinical pharmacy”. Titles and abstracts of retrieved items were examined. A PI was considered MTM when part of a more in-depth review of the patient’s medication, evaluating the indication, effectiveness, safety, and treatment adherence for each medication and ensuring that all pharmacotherapeutic needs were covered (Assessment). MTM implementation was considered complete when plans for pharmacotherapy care (Care Plan) and follow-up (Follow-up evaluation) were developed. Results: The review included 29 articles, mainly descriptive observational studies (51.7%). The majority were published in the USA (27.6%) or Spain (20.7%). The most frequent PIs were: medication reconciliation (55.2%); medication review (44.8%); pharmacotherapeutic follow-up (34.5%); post-surgical physical pain management (27.6%); health education (27.6%); and risk assessment/reduction (27.6%). MTM was analyzed in five retrieved articles (17.2%) and its complete implementation in only three (10.3%). Conclusions: This literature review compiles the main PIs implemented in patients hospitalized in OST, highlighting medication conciliation, medication review, and pharmacotherapeutic follow-up. MTM implementation remains scarce in these patients. (AU)

Artroplastia em Gap com Interposição de Fáscia de Temporal para o Tratamento de Anquilose de Articulação Temporomandibular: Relato de Caso / Gap Arthroplasty with Temporalis Fascia Interposition for the Treatment of Temporomandibular

A anquilose da articulação temporomandibular (ATM) é caracterizada pela união intracapsular do complexo disco-côndilo à superfície do osso temporal, podendo gerar restrição dos movimentos mandibulares e limitação de abertura bucal. São descritas ainda alterações como restrição da capacidade mastigatória, dificuldade de fonação e de uma adequada higiene bucal, além de dificuldade de interação social. O presente caso retrata um paciente feminino, 27 anos, com histórico de fratura de parassínfise e côndilo mandibular bilateral após trauma em 2014, evoluindo com anquilose da ATM direita, com abertura máxima de 13,27 mm. Para o tratamento do caso descrito, foi utilizado o acesso de Al-Kayat, coronoidectomia ipsilateral e ressecção de massa anquilótica em gap com interposição de retalho da fáscia do músculo temporal no lado direito. Após seis meses do procedimento cirúrgico, foi realizada uma nova tomografia da face na qual se observa ausência de lesões e de sinais de recidiva da anquilose e também foi observada a manutenção do espaço de lacuna feita pela ressecção óssea. O resultado satisfatório da técnica foi atribuído pela obtenção e estabilização de uma abertura bucal adequada, melhora da capacidade mastigatória e da fonação. Além do sucesso clínico, uma vantagem da técnica utilizada foi o baixo custo do procedimento por utilizar apenas interposição do músculo temporal sem uso de materiais aloplásticos. Além disso, a coronoidectomia ipsilateral associada foi suficiente para auxiliar na manutenção da abertura alcançada, não sendo necessária a coronoidectomia contralateral, o que minimizou o tempo operatório e a morbidade de mais um sítio cirúrgico acessado.

Ankylosis of the temporomandibular joint (TMJ) is characterized by the intracapsular union of the condyle- disc complex to the surface of the temporal bone, which can cause restriction of the mandibular movements and a limitation of a mouth opening. Alterations are also described as a restriction of masticatory capacity, difficulty in phonation and suitable oral hygiene, as well as difficulty in social interaction. A 27-year-old female patient with a bilateral history of parasymphysis and mandibular condyle fracture after a trauma in 2014, which evolved to an ankylosis of the right TMJ, with a maximum mouth opening of 13.27 mm. For the treatment of the described case, it was used the Al- Kayat approach, ipsilateral coronoidectomy and resection of the ankylotic mass in gap with interposition of temporalis muscle fascia flap on the right side. After six months of the surgical procedure, it was made a new computed tomography of the face in which it was possible to notice the absence of lesions and signs of recurrence of the ankylosis. It was also observed the maintenance of the gap space made by the bone resection. The satisfactory result of the technique was attributed to the achievement and stabilization of an adequate mouth opening, improved chewing ability and phonation. Besides the clinical success, an advantage of the technique used was the low cost of the procedure by using only temporal muscle interposition without the use of alloplastic materials. In addition, the associated ipsilateral coronoidectomy was sufficient to help maintaining the achieved mouth opening, and the contralateral coronoidectomy was not necessary, as a result it was minimized the surgical time and morbidity of one more accessed surgical site.

Caracterización clínica y epidemiológica de pacientes con fractura nasal atendidos en un hospital universitario cubano

Introducción: Las fracturas nasales son las más comunes de la región maxilofacial. Sin embargo, la literatura cubana sobre el tema es escasa y desactualizada, por lo que surgió la motivación para realizar esta investigación. Objetivo: Caracterizar clínica y epidemiológicamente los pacientes con fractura nasal atendidos en un hospital universitario cubano. Métodos: Se realizó un estudio observacional, descriptivo y transversal en pacientes atendidos en el Servicio de Cirugía Maxilofacial del Hospital General Universitario "Carlos Manuel de Céspedes" de Bayamo, provincia Granma, Cuba, en el período comprendido entre el 1 de enero y el 31 de diciembre del 2020. Se estudiaron variables clínicas, epidemiológicas y terapéuticas. Resultados: Se incluyeron 99 pacientes, de los cuales 74 (74,75 por ciento) fueron masculinos. En el 44,44 por ciento de los casos las edades estuvieron comprendidas entre los 21 y 40 años. Cincuenta pacientes (50,51 por ciento) tuvieron fracturas producto de la violencia interpersonal. Noventa y siete pacientes (97,98 por ciento) presentaron epistaxis. Cincuenta y nueve pacientes (59,60 por ciento) recibieron reducción cerrada asociada con taponamiento nasal y fijación externa con yeso. Conclusiones: Predominó el sexo masculino y el grupo de edades de 21 a 40 años. La principal etiología fue la violencia interpersonal. En la mayoría de los casos la epistaxis estuvo presente. Prevalecieron las fracturas cerradas, así como las que tuvieron el dorso desviado lateralmente(AU)

Introduction: Nasal fractures are the most common fractures of the maxillofacial region. However, Cuban literature on the subject is scarce and outdated, so the motivation for this research arose. Objective: To characterize patients with nasal fractures treated in a Cuban university hospital in a clinical and epidemiological manner. Methods: An observational, descriptive and cross-sectional study was carried out in patients treated at the Maxillofacial Surgery Service of the University General Hospital. "Carlos Manuel de Céspedes" of Bayamo, Granma province, Cuba, from January 1 to December 31, 2020. Clinical, epidemiological and therapeutic variables were studied. Results: 99 patients were included, of whom 74 (74.75 percent) were male. In 44.44 percent of the cases the ages were between 21 and 40 years. Fifty patients (50.51 percent) had fractures resulting from interpersonal violence. Ninety-seven patients (97.98 percent) presented epistaxis. Fifty-nine patients (59.60 percent) received closed reduction associated with nasal packing and external fixation with plaster cast. Conclusions: Male gender and age group 21 to 40 years predominated. The main etiology was interpersonal violence. Epistaxis was present in most cases. Closed fractures prevailed, as well as those with laterally deviated dorsum(AU)

Análisis de la demanda asistencial desde atención primaria a traumatología: propuestas para la mejora del continuo asistencial / Analysis of the demand of care from Primary Care to Traumatology: Proposals for the improvement of the continuous care

Objetivo: Analizar las derivaciones dirigidas desde Atención Primaria a Cirugía Ortopédica y Traumatología. Como objetivo secundario, establecer 2escenarios de derivación, con el fin de conocer el impacto de la variabilidad en la derivación. Material y métodos: Estudio observacional de carácter transversal de análisis de las derivaciones de Atención Primaria a Cirugía Ortopédica y Traumatología durante el primer semestre de los años 2018, 2019 y 2021. Se ha examinado el número de derivaciones que emite cada facultativo y cada centro de salud de Atención Primaria, atendiendo a la clasificación de las distintas zonas básicas de salud. Resultados: Existe una gran variabilidad en el número de derivaciones, tanto según el tipo de zona básica de salud (p < 0,001) como por cada facultativo (p < 0,001). Las ratios de derivación se comportan de forma uniforme en el tiempo (p < 0,001). Debido al alto número de derivaciones, se han construido dosescenarios: en el primero de ellos la ratio de derivación se situaría en la zona media del espectro de la tasa de derivación. En el segundo escenario, se han tomado como referencia las menores ratios de derivación registradas. La reducción de la variabilidad en los 2escenarios supuestos proporciona una disminución importante de la demanda asistencial. Conclusiones: La reducción de la variabilidad tendría un efecto beneficioso sobre la capacidad asistencial del servicio de Cirugía Ortopédica y Traumatología.

Objective: To analyze referrals from Primary Care consultation to Orthopaedic Surgery reference department. As a secondary objective, to establish 2referral scenarios in order to determine the impact of variability on referral. Material and methods: Cross-sectional observational study, analyzing referrals from Primary Care to Orthopaedic Surgery during the first half of the years 2018, 2019, and 2021. The number of referrals issued by each doctor and each Primary Care Healthcare Center was examined, according to the classification of the different Basic Healthcare Zones. Results: There is great variability in the number of referrals, both according to the type of Basic Healthcare Zone and by each Primary Care facultative. The referral ratios behaved uniformly over time (P<0.001). Due to a large number of referrals, 2scenarios have been constructed: In the first scenario, the referral ratio would be in the middle of the referral rate spectrum. In the second scenario, the lowest referral ratios recorded have been taken as a reference. The reduction of variability in the 2scenarios assumed provides a significant reduction in the demand for care. Conclusion: Reducing variability would have a beneficial effect on the capacity of the Orthopaedic Surgery service to provide care.(AU)

[Translated article] Analysis of the demand of care from Primary Care to Traumatology: Proposals for the improvement of the continuous care / Análisis de la demanda asistencial desde atención primaria a traumatología: propuestas para la mejora del continuo asistencial

Objetivo: Analizar las derivaciones dirigidas desde Atención Primaria a Cirugía Ortopédica y Traumatología. Como objetivo secundario, establecer 2escenarios de derivación, con el fin de conocer el impacto de la variabilidad en la derivación. Material y métodos: Estudio observacional de carácter transversal de análisis de las derivaciones de Atención Primaria a Cirugía Ortopédica y Traumatología durante el primer semestre de los años 2018, 2019 y 2021. Se ha examinado el número de derivaciones que emite cada facultativo y cada centro de salud de Atención Primaria, atendiendo a la clasificación de las distintas zonas básicas de salud. Resultados: Existe una gran variabilidad en el número de derivaciones, tanto según el tipo de zona básica de salud (p < 0,001) como por cada facultativo (p < 0,001). Las ratios de derivación se comportan de forma uniforme en el tiempo (p < 0,001). Debido al alto número de derivaciones, se han construido dosescenarios: en el primero de ellos la ratio de derivación se situaría en la zona media del espectro de la tasa de derivación. En el segundo escenario, se han tomado como referencia las menores ratios de derivación registradas. La reducción de la variabilidad en los 2escenarios supuestos proporciona una disminución importante de la demanda asistencial. Conclusiones: La reducción de la variabilidad tendría un efecto beneficioso sobre la capacidad asistencial del servicio de Cirugía Ortopédica y Traumatología.

Objective: To analyze referrals from Primary Care consultation to Orthopaedic Surgery reference department. As a secondary objective, to establish 2referral scenarios in order to determine the impact of variability on referral. Material and methods: Cross-sectional observational study, analyzing referrals from Primary Care to Orthopaedic Surgery during the first half of the years 2018, 2019, and 2021. The number of referrals issued by each doctor and each Primary Care Healthcare Center was examined, according to the classification of the different Basic Healthcare Zones. Results: There is great variability in the number of referrals, both according to the type of Basic Healthcare Zone and by each Primary Care facultative. The referral ratios behaved uniformly over time (P<0.001). Due to a large number of referrals, 2scenarios have been constructed: In the first scenario, the referral ratio would be in the middle of the referral rate spectrum. In the second scenario, the lowest referral ratios recorded have been taken as a reference. The reduction of variability in the 2scenarios assumed provides a significant reduction in the demand for care. Conclusion: Reducing variability would have a beneficial effect on the capacity of the Orthopaedic Surgery service to provide care.(AU)

[Translated article] Analysis of the demand of care from Primary Care to Traumatology: Proposals for the improvement of the continuous care.

OBJECTIVE: To analyse referrals from Primary Care consultation to Orthopaedic Surgery reference department. As a secondary objective, to establish 2 referral scenarios in order to determine the impact of variability on referral. MATERIAL AND METHODS: Cross-sectional observational study, analyzing referrals from Primary Care to Orthopaedic Surgery during the first half of the years 2018, 2019, and 2021. The number of referrals issued by each doctor and each Primary Care Healthcare Center was examined, according to the classification of the different Basic Healthcare Zones. RESULTS: There is great variability in the number of referrals, both according to the type of Basic Healthcare Zone and by each Primary Care facultative. The referral ratios behaved uniformly over time (p<0.001). Due to a large number of referrals, 2 scenarios have been constructed: In the first scenario, the referral ratio would be in the middle of the referral rate spectrum. In the second scenario, the lowest referral ratios recorded have been taken as a reference. The reduction of variability in the 2 scenarios assumed provides a significant reduction in the demand for care. CONCLUSION: Reducing variability would have a beneficial effect on the capacity of the Orthopaedic Surgery service to provide care.

Analysis of the demand of care from Primary Care to Traumatology: Proposals for the improvement of the continuous care. / Análisis de la demanda asistencial desde atención primaria a traumatología: propuestas para la mejora del continuo asistencial.

OBJECTIVE: To analyze referrals from Primary Care consultation to Orthopaedic Surgery reference department. As a secondary objective, to establish 2referral scenarios in order to determine the impact of variability on referral. MATERIAL AND METHODS: Cross-sectional observational study, analyzing referrals from Primary Care to Orthopaedic Surgery during the first half of the years 2018, 2019, and 2021. The number of referrals issued by each doctor and each Primary Care Healthcare Center was examined, according to the classification of the different Basic Healthcare Zones. RESULTS: There is great variability in the number of referrals, both according to the type of Basic Healthcare Zone and by each Primary Care facultative. The referral ratios behaved uniformly over time (P<0.001). Due to a large number of referrals, 2scenarios have been constructed: In the first scenario, the referral ratio would be in the middle of the referral rate spectrum. In the second scenario, the lowest referral ratios recorded have been taken as a reference. The reduction of variability in the 2scenarios assumed provides a significant reduction in the demand for care. CONCLUSION: Reducing variability would have a beneficial effect on the capacity of the Orthopaedic Surgery service to provide care.

Evaluation of the epidemiology of exposed fractures before and during the covid-19 pandemic / Avaliação da epidemiologia das fraturas expostas antes e durante a pandemia de covid-19

ABSTRACT Objective: To assess the impact of the COVID-19 pandemic on the epidemiology and clinical outcomes of open fractures considering the periods before and during the pandemic. Methods: An observational and retrospective study, which included patients aged over 18 years, admitted to the Orthopedics and Traumatology Ward of Hospital São Paulo, of the Federal University of São Paulo (UNIFESP). Data was collected in two moments: pre-pandemic (March 1, 2019, to February 29, 2020) and during the pandemic (March 1, 2020, to February 28, 2021). Results: In total, 183 patients were evaluated with a mean age of 36 years ± 14 years. In the pre-pandemic period, 94 patients underwent surgery, 81 men (85.37%) and 13 women (14.2%), with a mean age of 36 ± 3 years. During the pandemic period, 89 patients were subjected to surgery, 77 men (86.6%) and 12 women (13.4%), with a mean age of 38 ± 3 years. Conclusion: During the pandemic, open fractures were still more common in men. Regarding hospital indicators, the prevalence of infections in the surgical wound and the length of stay of patients with open fractures increased, however, with little significance. Fractures classified as Gustilo IIIA were the most common, while the most common according to the AO classification were 33, 34, 42, 43, 2R3, and 2R3 + 2U2. The frequency of run overs during the pandemic decreased. However, firearm projectile injuries and falls and occupational injuries increased. Level of Evidence III, Retrospective Comparative Study.

RESUMO Objetivo: Avaliar o impacto da COVID-19 na epidemiologia e nos desfechos clínicos das fraturas expostas considerando os períodos antes e durante a pandemia. Métodos: Estudo observacional e retrospectivo que incluiu pacientes maiores de 18 anos, internados na Enfermaria de Ortopedia e Traumatologia do Hospital São Paulo, da Universidade Federal de São Paulo. Os dados foram coletados em dois momentos - antes (março de 2019 a fevereiro de 2020) e durante a pandemia (março de 2020 a fevereiro de 2021) -, por meio da análise de prontuários eletrônicos de todos os registros hospitalares dessa instituição. Resultados: No total, foram avaliados 183 pacientes com média de idade de 36 ± 14 anos. No período pré-pandêmico, foram operados 94 pacientes, sendo 81 homens (85,37%) e 13 mulheres (14,2%), com média de idade de 36 ± 3 anos. Já ao longo do período pandêmico, foram operados 89 pacientes, sendo 77 homens (86,6%) e 12 mulheres (13,4%), com média de idade de 38 ± 3 anos. Conclusão: Durante a pandemia, a ocorrência de fraturas expostas se manteve com maior frequência em indivíduos do sexo masculino. Quanto aos indicadores hospitalares, houve aumento da prevalência de infecções na ferida operatória, assim como do tempo de internação dos pacientes, todavia, com pouca significância. Foram mais frequentes as fraturas classificadas como Gustilo IIIA e, pela classificação AO, as fraturas 33, 34, 42, 43, 2R3 e 2R3 + 2U2. Notamos redução da frequência de atropelamentos durante a pandemia e aumento dos casos de ferimentos por projétil de arma de fogo, quedas e acidentes ocupacionais. Nível de Evidência III, Estudo Retrospectivo Comparativo.

Epidemiological study of pediatric trauma in a reference hospital in Curitiba / Estudo epidemiológico do trauma pediátrico em um hospital de referência em Curitiba

ABSTRACT Objective: to analyze the prevalence of types of trauma, resulting injuries and managements in children and adolescents between 0 and 17 years old, treated in an Emergency Room in 2019. Methods: a retrospective cross-sectional descriptive study carried out by collecting data from medical records from January to December of 2019, encompassing pediatric trauma victims, divided according to age groups: infants (0-1 year), preschool children (2-4 years), school children (5-10 years) and adolescents (11-17 years). Results: 3,741 patients records were included in the study. The search for assistance occurred spontaneously in about 70% of the cases and males were the most affected at all ages. In infants and preschoolers, the main mechanism of trauma was fall from heights, corresponding to 57.2% and 34.1%, respectively, whereas in school children and adolescents, the main mechanism was ground-level falls (38%) and sports trauma (22,3%), in this order. The main injuries presented, in general, were traumatic brain injury (28,2%), upper limb contusion (23,2%) and upper limb fractures (16,3%). Conclusions: the profile of the victims analyzed indicates the male sex as the most affected, with the trauma mechanism being the differential according to age. The most frequent mechanism is falls, more prevalent in infants and preschoolers, and the most common injury is extremity contusion, with the upper limbs being the most affected. In general, the cases were considered of low complexity, with a hospitalization rate of 6%.

RESUMO Objetivo: analisar a prevalência dos tipos de trauma, lesões decorrentes e condutas tomadas em crianças e adolescentes entre 0 e 17 anos, atendidos em um Pronto-Socorro no ano de 2019. Métodos: estudo transversal retrospectivo descritivo realizado através do levantamento de dados dos prontuários médicos no período de janeiro a dezembro de 2019, englobando pacientes pediátricos vítimas de trauma, divididos conforme a faixa etária: lactentes (0-1 ano), pré-escolares (2-4 anos), escolares (5-10 anos) e adolescentes (11-17 anos). Resultados: foram incluídos no estudo 3741 prontuários de pacientes. A procura de assistência médica ocorreu de maneira espontânea em cerca de 70% dos casos, sendo o sexo masculino o mais acometido significativamente em todas as idades. Em lactentes e pré-escolares, o principal mecanismo de trauma foi a queda de outro nível, correspondendo a 57,2% e a 34,1% das ocorrências, respectivamente; já nos escolares e adolescentes o principal mecanismo foi a queda de mesmo nível (38%) e o trauma esportivo (22,3%), nessa ordem. As principais lesões apresentadas, de maneira geral, foram o traumatismo cranioencefálico (28,2%), contusão de membros superiores (23,2%) e fratura de membros superiores (16,3%). Conclusões: o perfil das vítimas analisadas aponta o sexo masculino como o mais acometido, sendo o mecanismo de trauma o diferencial conforme a idade. Os mecanismos mais frequentes são as quedas, mais prevalentes em lactentes e pré-escolares, e a lesão mais comum é a contusão de extremidades, sendo os membros superiores os mais acometidos. Em geral, os casos foram considerados de baixa complexidade, com uma taxa de internação de 6%.

Anatomía humana. Inicios y actualidad / Human anatomy. Beginnings and current state

Siempre se ha enfatizado la importancia de la anatomía humana como base de la formación de los cirujanos ortopédicos, por lo que esta materia siempre hará parte del plan de estudios de la especialización en ortopedia y traumatología. En este sentido, si bien para muchos médicos los cursos de anatomía no traen muy buenos recuerdos, para otros la anatomía se vuelve una pasión, especialmente aquellos que optan por estudiar especialidades quirúrgicas.

The importance of human anatomy has always been emphasized as the basis for the training of orthopedic surgeons, so this subject will always be part of the curriculum of the specialization in orthopedics and traumatology. In this sense, although for many doctors anatomy courses do not bring back very good memories, for others anatomy becomes a passion, especially those who choose to study surgical specialties.

Orthopedics and Traumatology Skill Matrix for Musculoskeletal System Approach by Medical Graduates / Matriz de competências em ortopedia e traumatologia para abordagem do sistema musculoesquelético para graduação médica

Abstract Objective This study aimed to build a matrix of orthopedics and traumatology skills focusing on the musculoskeletal system for graduates of a medical course in Brazil. Methods The study used the e-Delphi methodology to retrieve opinions anonymously. The first proposal included 42 items determined at a bibliographical review and their epidemiological relevance. This proposal was available via Google Forms, and we sent it using the instant messaging application WhatsApp. We grouped the panel of 26 specialists into three categories: Orthopedics and Traumatology professors, Primary Care doctors, and Emergency Physicians. We reached a consensus after three rounds, with at least 75% agreement between the items initially presented. We also considered the following four indicators: prerequisite, essential, desirable, and advanced skills. Results We created a matrix with 34 musculoskeletal system-related skills, including diagnostic and management actions for all age groups. Conclusion We devised a skill matrix in Orthopedics and Traumatology for medical graduation for complete or partial use according to the institutional curriculum.

Resumo Objetivo Construir uma matriz de competências em ortopedia e traumatologia, com enfoque no sistema musculoesquelético, necessárias ao egresso do curso de medicina no Brasil. Método Utilizou-se a metodologia e-Delphi, visando captar a opinião de participantes de forma anônima. A primeira proposta contou com 42 itens, frutos de revisão bibliográfica e relevância epidemiológica, disponibilizados para os painelistas pelo Google Forms e enviados através do aplicativo de mensagens instantâneas Whatsapp. Constituiu-se um painel de 26 especialistas agrupados em três categorias: docentes de Ortopedia e Traumatologia, médicos da Atenção Primária e Emergencistas. O consenso foi obtido após a realização de 3 rodadas, com pelo menos 75% de concordância entre os itens inicialmente apresentados. Foram também considerados quatro indicadores: competências pré-requisito, essenciais, desejáveis e avançadas. Resultados obteve-se uma matriz com 34 competências relativas à abordagem do sistema musculoesquelético, que contempla ações de diagnóstico e conduta de todas as faixas etárias. Conclusão Foi construída uma matriz de competências em Ortopedia e Traumatologia para graduação médica com possibilidades de ser utilizada na sua íntegra ou de forma parcial, de acordo com o perfil do currículo institucional.

Fatores associados à maior permanência hospitalar na fratura do planalto (platô) tibial / To evaluate associated factors and epidemiology related to increased length of stay and costs in patients with tibial plateau fractures

Introdução: As fraturas de platô tibial são consideradas lesões intraarticulares comuns do joelho. Objetivo: Avaliar os fatores associados e a relação ao aumento do tempo de internação e custos nesses pacientes. Métodos: Estudo qualitativo descritivo de tabelas de frequência e cruzadas de 108 pacientes vítimas de trauma ortopédico. Foram avaliadas as médias de idade; gênero; trauma de alta energia; tempo de internação; e tempo médio da interferência. Resultados: O perfil epidemiológico foi idade média de 41,2 anos; homens (70,4%); vítimas de trauma de alta energia (53,70%); tempo de internação; e tempo mediano. Os fatores que interferiram para aumento dessas 2 últimas variáveis foram: mecanismos de lesão de alta energia (8 dias); tratamento provisório (10 dias); tratamento cirúrgico definitivo (8 dias); prolongamento justificado dos dias (8 dias), complicações na internação (11 dias); lesão de partes moles (10 dias); infecção da ferida (12 dias) e internamento na UTI (26 dias). Conclusão: Os fatores que apresentaram diferença significativa em relação ao aumento de dias de internamento hospitalar foram: mecanismo de lesão de alta energia, realização de tratamento provisório, fraturas complexas (tipo IV, V, VI), tipo de tratamento cirúrgico definitivo, complicações na internação - principalmente lesão de partes moles, infecção e internamento em UTI.

Introduction: Tibial plateau fractures are considered common intraarticular knee injuries. Objective: To evaluate the associated factors and their relationship to increased length of stay and costs in these patients. Methods: Descriptive qualitative study of frequency and cross tables of 108 patients who were victims of orthopedic trauma. Were evaluated mean age; gender; high-energy trauma; hospitalization time; and median time of the interference. Results: The epidemiological profile was a mean age of 41.2 years; men (70.4%); high-energy trauma victims (53.70%); hospitalization time; and median time. The factors that interfered with the increase in these last 2 variables were: high-energy injury mechanisms (8 days); interim treatment (10 days); definitive surgical treatment (8 days); justified extension of days (8 days), hospitalization complications (11 days); soft tissue injury (10 days); wound infection (12 days) and ICU stay (26 day\s). Conclusion: The factors that showed a significant difference in relation to the increase in hospitalization days were: mechanism of high-energy injury, provisional treatment, complex fractures (type IV, V, VI), type of definitive surgical treatment, complications in hospitalization - mainly soft tissue injury, infection and ICU admission.

Analysis of primary care of victims of interpersonal and self inflicted violence during the COVID-19 pandemic / Análise do atendimento primário de pacientes vítimas de violência interpessoal e autodirigida durante a pandemia da COVID-19

ABSTRACT Objectives: to analyze the epidemiological profile of aggression victims admitted at the emergency room on a trauma hospital during the COVID-19 pandemic, to compare these data in different restriction periods and with prepandemic data from the same service. Methods: cross-sectional study with probabilistic sampling using medical records of patients who were victims of aggression admitted at the hospital between June 2020 and May 2021. In addition to the epidemiological variables, other variables collected were the current restriction level, mechanism of aggression, resulting injuries and the Revised Trauma Score (RTS). The data was compared between the three restriction levels and the proportion of attendances during the study period was compared with the pre-pandemic study (December 2016 to February 2018). Results: the average age was 35.5 years, 86.1% of the patients were male and 61.6% of the attendances were due to blunt injury. The highest average of attendances per day occurred during the "yellow" restriction level (2.9), however there was no significant difference when comparing the restriction periods two by two. There was also no significant difference either in the analysis of the standardized residuals of the proportions of aggressions or the mechanism of aggression in the pre-pandemic and pandemic periods. Conclusions: there was a predominance of attendances due to blunt trauma and in young male patients. There was no significant difference between the average daily attendance for aggression during the three restriction levels and between the proportion of attendances in the pre-pandemic and pandemic period.

RESUMO Objetivo: analisar o perfil epidemiológico dos pacientes vítimas de agressão admitidos na sala de emergência de um hospital de trauma durante a pandemia da COVID-19, comparar tais dados entre os diferentes períodos de restrição e com os dados de um estudo pré-pandêmico do mesmo hospital. Métodos: estudo transversal com amostragem probabilística utilizando prontuários de pacientes vítimas de agressão admitidos no referido hospital entre junho de 2020 e maio de 2021. Além das variáveis epidemiológicas, coletou-se o nível de restrição vigente, o mecanismo de agressão, as lesões resultantes e o Revised Trauma Score (RTS). Os dados foram comparados entre os três níveis e a proporção de atendimentos no período do estudo foi comparada com a do estudo pré-pandêmico (dezembro de 2016 a fevereiro de 2018). Resultados: a média etária foi de 35,5 anos, 86,1% dos pacientes eram do sexo masculino. e 61,6% dos atendimentos corresponderam a agressão física por ferimento contuso. A maior média de atendimentos por dia ocorreu durante o nível amarelo (2,9), contudo não houve diferença significativa nos atendimentos quando comparados os períodos de restrição dois a dois. Também não houve diferença significativa tanto na análise dos resíduos padronizados das proporções de agressões quanto em cada mecanismo de agressão nos períodos pré-pandêmico e pandêmico. Conclusões: houve predominância de atendimentos por agressão por trauma contuso e em pacientes jovens do sexo masculino. Não houve diferença significativa entre a média diária de atendimentos por agressão durante os três níveis de restrição implementados e entre a proporção de atendimentos do período pré-pandemico e pandêmico.

Influence of the COVID-19 pandemic on the epidemiological profile of the initial care of victims of falls / Influência da pandemia da COVID-19 no perfil epidemiológico do atendimento inicial de pacientes vítimas de quedas

ABSTRACT Objective: to assess the epidemiological profile of trauma patients from fall from the same level (FSL) and fall from an elevated level (FEL) during the COVID-19 pandemic, and to compare it with data from different levels of restriction (flags) and data prior to the pandemic. Method: a cross-sectional study with a probability sample of the medical records of patients aged 18 years or older admitted to the emergency room due to falls, from June 2020 to May 2021. Epidemiological data, such as sex, age and injuries were analyzed, as well the current level of restriction. The three restriction periods were compared between then and the proportion of admissions due to falls was compared with the period from December 2016 to February 2018. Results: a total of 296 admissions were evaluated, 69.9% were victims of FSL and 30.1% of FEL. The mean age was 57.6 years, and 45.6% were over 60 years old. Admissions among men predominated, and 40.2% of patients required hospitalization. During the red flag period, there were proportionally more injuries to the head and neck (p=0.016), injuries to extremities (p=0.015) and neurological trauma (p<0.001). An average of 6.1, 6.3 and 5.2 admissions per day was obtained during the yellow, orange and red flag, respectively. There was a relative increase in falls when compared to the pre-pandemic period. Conclusions: there was an absolute reduction in admissions of victims of falls in midst of the most restrictive period during the pandemic. However, when compared to pre-pandemic data, there was a relative increase in falls.

RESUMO Objetivo: avaliar o perfil epidemiológico do trauma por quedas de mesmo nível (QMN) e quedas de nível elevado (QNE) durante a pandemia da COVID-19, realizar a comparação dos dados entre os níveis de restrição (bandeiras) e comparar com dados prévios à pandemia. Método: estudo transversal com amostragem probabilística de prontuários de pacientes com 18 anos ou mais admitidos na sala de emergência devido a quedas de junho de 2020 a maio de 2021. Foram avaliados dados epidemiológicos, como sexo, idade e lesões resultantes, além da bandeira vigente. Os três períodos de restrição foram comparados entre si e a proporção de atendimentos por quedas foi comparada com o período de dezembro de 2016 a fevereiro de 2018. Resultados: avaliou-se 296 atendimentos, sendo 69,9% vítimas de QMN e 30,1% de QNE. A média de idade foi 57,6 anos, sendo que 45,6% apresentavam idade superior a 60 anos. Sexo masculino predominou e 40,2% dos pacientes necessitaram internamento hospitalar. Durante a bandeira vermelha proporcionalmente ocorreram mais lesões em cabeça e pescoço (p=0,016), trauma em extremidades (p=0,015) e neurológico (p<0,001). Obteve-se uma média de 6,1, 6,3 e 5,2 atendimentos/dia durante a bandeira amarela, laranja e vermelha respectivamente. Ocorreu um aumento significativo da ocorrência de quedas quando comparado ao período prévio à pandemia. Conclusões: durante o período pandêmico, verificou-se uma redução absoluta de atendimentos de vítimas de quedas na bandeira mais restritiva. Porém, quando comparado ao período pré-pandêmico, verifica-se um aumento significativo das quedas.