Short versus long intramedullary nails for intertrochanteric hip fracture: Meta-analysis. / [Artículo traducido] Clavo corto versus clavo largo en la fractura intertrocantérica de cadera: metaanálisis.

OBJECTIVE: To compare short versus long intramedullary nails for intertrochanteric hip fractures in terms of efficacy and safety. METHODS: We included cohort studies and randomized clinical trials. The methodological quality of the studies was assessed by the Newcastle-Ottawa Scale. The meta-analysis was performed using the Review Manager 5.4. Heterogeneity was checked with the I2 test. A fixed effects model was adopted if there was no heterogeneity. RESULTS: Twelve studies were included. The reoperations rate was lower in the short nail group (OR: 0.58, 95%CI: 0.38-0.88) and there were no differences regarding the peri-implant fracture rate (OR: 1.77, 95%CI: 0.68-4.60). Surgery time and blood loss was significantly higher in the long nail group (MD: -12.44, 95%CI: -14.60 -10.28) (MD: -19.36, 95%CI: -27.24 -11.48). There were no differences in functional outcomes. CONCLUSIONS: The long nail showed a higher reoperation rate, blood loss and surgery time compared to the short nail. LEVEL OF EVIDENCE: III.

Short versus long intramedullary nails for intertrochanteric hip fracture: Meta-analysis.

OBJECTIVE: To compare short versus long intramedullary nails for intertrochanteric hip fractures in terms of efficacy and safety. METHODS: We included cohort studies and randomized clinical trials. The methodological quality of the studies was assessed by the Newcastle-Ottawa Scale. The meta-analysis was performed using the Review Manager 5.4. Heterogeneity was checked with the I2 test. A fixed effects model was adopted if there was no heterogeneity. RESULTS: Twelve studies were included. The reoperations rate was lower in the short nail group (OR 0.58, 95% CI 0.38-0.88) and there were no differences regarding the peri-implant fracture rate (OR 1.77, 95% CI 0.68-4.60). Surgery time and blood loss was significantly higher in the long nail group (MD -12.44, 95% CI -14.60 to (-10.28)) (MD -19.36, 95% CI -27.24 to (-11.48)). There were no differences in functional outcomes. CONCLUSIONS: The long nail showed a higher reoperation rate, blood loss and surgery time compared to the short nail.

Rara presentación de un linfoma espinal: informe de caso y diagnóstico mediante resonancia magnética / Rare presentation of a spinal lymphoma: case report and diagnosis by magnetic resonance imaging

El linfoma primario del sistema nervioso central es una forma de enfermedad extraganglionar originada en el cerebro, la leptomeninges, la médula espinal o los ojos. Los tumores espinales son neoplasias de baja prevalencia y pueden causar una morbimortalidad neurológica considerable. El linfoma aislado que surge dentro del conducto dural es la forma menos común de linfoma primario del sistema nervioso central: representa aproximadamente el 1% de los casos y se observa más a menudo en el contexto de diseminación secundaria que como el sitio primario de origen. Los síntomas son inespecíficos y dependen del nivel espinal involucrado. La presentación es insidiosa e incluye dorsalgia, debilidad y dificultad progresiva para la deambulación. La resonancia magnética es la modalidad de elección para búsqueda de lesiones dentro del conducto espinal/raquídeo, en pacientes que presentan síntomas neurológicos. El tratamiento quirúrgico no resulta útil, y el objetivo principal de la cirugía es conocer el diagnóstico histológico. (AU)

A primary central nervous system lymphoma is a form of extranodal disease originating in the brain, leptomeninges, spinal cord, or eyes. Spinal tumors are low-prevalence neoplasms and can cause considerable neurological morbidity and mortality. An isolated lymphoma emerging within the dural canal is the rarest form of primary central nervous system lymphoma: it accounts for approximately 1% of cases occurring more often in the context of secondary dissemination than as the primary site of origin. Symptoms are nonspecific and depend on the spinal level involved. The presentation is insidious and includes dorsalgia, weakness, and progressive difficulty in ambulatory function. MRI is the modality of choice to search for lesions within the spinal/rachial canal in patients presenting with neurological symptoms. Surgical treatment is not helpful, and the main objective of surgery is to know the histological diagnosis. (AU)

[Translated article] Comparative clinical and biomechanical study of different types of osteosynthesis in the treatment of distal femur fractures.

INTRODUCTION AND OBJECTIVES: Distal femoral fractures represent a problem due to their high number of complications. The aim was to compare the results, complications and stability achieved with retrograde intramedullary nailing and the angular stable plate in the treatment of distal femoral diaphyseal fractures. MATERIAL AND METHOD: A clinical and experimental biomechanical study was carried out using finite elements. The results of the simulations allowed us to obtain the main results related to the stability of osteosynthesis. For clinical follow-up data, frequencies were used for qualitative variables, and Fisher's exact test and χ2 test were used to evaluate the significance of the different factors, with the condition of P<.05. RESULTS: In the biomechanical study, the retrograde intramedullar nails demonstrated superiority, obtaining lower values in terms of global displacement, maximum tension, torsion resistance, and bending resistance. In the clinical study, the rate of consolidation of the plates was lower than nails (77% vs. 96%, P=.02). The factor that most influenced the healing of fractures treated with plate were the central cortical thickness (P=.019). The factor that most influenced the healing of nail-treated fractures was the difference between the diameter of the medullary canal and the nail. CONCLUSIONS: Our biomechanical study shows that both osteosynthesis provide sufficient stability, but biomechanically behaves differently. Nails provide greater overall stability being preferable the use of long nails adjusted to the diameter of the canal. Plates form less rigid osteosynthesis, with little resistance to bending.

Minimally invasive retrieval of a bullet settling into the thoracic spinal canal in a pediatric patient: A case report / Recuperación mínimamente invasiva de una bala que se asienta en el canal espinal torácico en un paciente pediátrico: reporte de un caso

A 10-year-old boy presented to neurosurgery department after a gunshot wound to the upper thoracic spine. The bullet entered through the right deltoid muscle and lodged inside the spinal canal at T1 level. The patient arrived conscious and obeying commands; however, he experienced a loss of sensation below T3 level, loss of reflexes below the injured T1 level, loss of anal sphincter tone and paraplegia in the lower limbs (American Spinal Injury Association grade-A). Imaging studies revealed an intra-canalicular metallic bullet at the T1 level. The patient underwent urgent operation using a tubular retractor system and the microscope. Subsequently, the bullet was successfully retrieved. Postoperatively, the patient made a significant recovery and by the end of the 6th month, he was able to walk independently despite some gait instability. A minimally invasive approach for intra-canalicular bullet removal in the thoracic region is a safe and effective technique in pediatric patients. (AU)

Un niño de 10 años se presentó al departamento de neurocirugía después de una herida de bala en la columna torácica superior. La bala entró por el músculo deltoides derecho y se alojó dentro del canal espinal a nivel T1. El paciente llegó consciente y obedeciendo órdenes; sin embargo, experimentó una pérdida de sensibilidad por debajo del nivel T3, pérdida de reflejos por debajo del nivel T1 lesionado, pérdida del tono del esfínter anal y paraplejía en las extremidades inferiores (American Spinal Injury Association grado-A). Los estudios de imagen revelaron una bala metálica intracanalicular a nivel T1. El paciente fue intervenido de urgencia mediante un sistema retractor tubular y el microscopio. Posteriormente, la bala se recuperó con éxito. En el postoperatorio, el paciente se recuperó significativamente y, al final del sexto mes, podía caminar de forma independiente a pesar de cierta inestabilidad en la marcha. Un enfoque mínimamente invasivo para la extracción de balas intracanaliculares en la región torácica es una técnica segura y eficaz en pacientes pediátricos. (AU)

Minimally invasive retrieval of a bullet settling into the thoracic spinal canal in a pediatric patient: A case report.

A 10-year-old boy presented to neurosurgery department after a gunshot wound to the upper thoracic spine. The bullet entered through the right deltoid muscle and lodged inside the spinal canal at T1 level. The patient arrived conscious and obeying commands; however, he experienced a loss of sensation below T3 level, loss of reflexes below the injured T1 level, loss of anal sphincter tone and paraplegia in the lower limbs (American Spinal Injury Association grade-A). Imaging studies revealed an intra-canalicular metallic bullet at the T1 level. The patient underwent urgent operation using a tubular retractor system and the microscope. Subsequently, the bullet was successfully retrieved. Postoperatively, the patient made a significant recovery and by the end of the 6th month, he was able to walk independently despite some gait instability. A minimally invasive approach for intra-canalicular bullet removal in the thoracic region is a safe and effective technique in pediatric patients.

Comparative clinical and biomechanical study of different types of osteosynthesis in the treatment of distal femur fractures. / Estudio comparativo clínico y biomecánico de distintos tipos de osteosíntesis en el tratamiento de fracturas distales de fémur.

INTRODUCTION AND OBJECTIVES: Distal femoral fractures represent a problem due to their high number of complications. The aim was to compare the results, complications and stability achieved with retrograde intramedullary nailing and the angular stable plate in the treatment of distal femoral diaphyseal fractures. MATERIAL AND METHOD: A clinical and experimental biomechanical study was carried out using finite elements. The results of the simulations allowed us to obtain the main results related to the stability of osteosynthesis. For clinical follow-up data, frequencies were used for qualitative variables, and Fisher's exact test and χ2 test were used to evaluate the significance of the different factors, with the condition of P<.05. RESULTS: In the biomechanical study, the retrograde intramedullar nails demonstrated superiority, obtaining lower values in terms of global displacement, maximum tension, torsion resistance, and bending resistance. In the clinical study, the rate of consolidation of the plates was lower than nails (77% vs. 96%, P=.02). The factor that most influenced the healing of fractures treated with plate were the central cortical thickness (P=.019). The factor that most influenced the healing of nail-treated fractures was the difference between the diameter of the medullary canal and the nail. CONCLUSIONS: Our biomechanical study shows that both osteosynthesis provide sufficient stability, but biomechanically behaves differently. Nails provide greater overall stability being preferable the use of long nails adjusted to the diameter of the canal. Plates form less rigid osteosynthesis, with little resistance to bending.

Impacto clínico en el hombro del enclavijamiento endomedular anterógrado en el tratamiento de fracturas de la diáfisis humeral / Clinical impact on the shoulder after antegrade intramedullary nailing in humeral shaft fractures

Introducción: el enclavijamiento endomedular (EE) es una opción terapéutica para fracturas de la diáfisis humeral; sin embargo, algunos pacientes tratados con EE desarrollan signos de pinzamiento subacromial y disminución de la fuerza en movimientos de flexión y abducción.Objetivo: evaluar el impacto en el hombro del uso del EE anterógrado para el tratamiento de fracturas de la diáfisis humeral en términos de dolor, funcionalidad y signos de pinzamiento subacromial.Metodología: estudio observacional retrospectivo realizado en 25 pacientes adultos con fracturas de la diáfisis humeral tratadas con EE anterógrado. Se realizó seguimiento entre 6 y 12 meses después del procedimiento, valorando la funcionalidad (arcos de movimiento y escala QuickDASH) y la presencia de dolor (escala visual análoga [EVA]) y signos de pinzamiento subacromial (según Yocum, Neer y Hawkins-Kennedy). Los datos se describen utilizando frecuencias absolutas y relativas para las variables cualitativas, y medias y desviaciones estándar para las cuantitativas.Resultados: las medias de la flexión anterior, puntaje en la escala QuickDASH y escala EVA fueron 145° (±31,6), 6,1 (±8,5) y 2,32 (±2,06), respectivamente. El 32% de los pacientes presentó uno o más signos de pinzamiento subacromial. Además, la consolidación completa de la fractura ocurrió en todos los casos.Conclusiones: dado que no se evidenció un impacto significativo en el hombro en términos de movilidad, dolor o signos de pinzamiento subacromial y que la consolidación de la fractura ocurrió en todos los casos, el EE fue adecuado para el tratamiento de fracturas de la diáfisis humeral

Introduction: Intramedullary nailing (IN) is a common therapeutic option for humeral shaft fractures. However, some patients treated with IN develop signs of subacromial impingement and decreased strength in flexion and abduction movements. Objective: To evaluate the clinical impact of the use of antegrade IN on the shoulder for the treatment of humeral shaft fractures in terms of pain, functionality, and subacromial impingement symptoms.Methodology: Retrospective observational study carried out in 25 adult patients with humeral shaft fractures treated with antegrade IN. Follow-up was performed 6 to 12 months after the procedure, assessing functionality (arcs of motion and QuickDASH scale), as well as the presence of pain (visual analog scale [VAS]) and signs of subacromial impingement (according to Yocum, Neer and Hawkins-Kennedy). Data are described using absolute and relative frequencies for qualitative variables and means and standard deviations for quantitative variables.Results: The mean anterior flexion, QuickDASH score, and VAS score were 145° (±31.6), 6.1 (±8.5), and 2.32 (±2.06), respectively. One or more signs of subacromial impingement were observed in 32% of the patients. In addition, complete fracture healing occurred in all cases.Conclusion: Given that no significant impact on the shoulder was evidenced in terms of mobility, pain or signs of subacromial impingement and that fracture healing occurred in all cases, IN was adequate for the treatment of humeral shaft fractures.

Metacarpal fractures treatment: comparasion between kirschner wire and intramedullary screw / Tratamento de fraturas metacarpais: comparação entre fios de kirschner e fixação intramedular

ABSTRACT Introduction: Metacarpal fractures are common and can be treated surgically using Kirschner wires (K-wires) or intramedullary fixation with compression screws (IMCS). Objectives: Analyze the postsurgical results from treating the metacarpal extra-articular fractures through the retrograde Kirschner wire technique, and compare it with the intramedullary compression screw fixation. Methods: Retrospective and quantitative studies were to analyze patients' medical records, and a postsurgical evaluation questionnaire was given to the patients, who were divided into K-wire and IMCS. Results: The period of immobilization with a splint took six weeks for the K-wire group and four weeks for the IMCS group. The average time for consolidation took, respectively, fifty-seven days and forty-seven days. The first group could restart their activities twenty-two days after the other, and the average force value of the treated hand, when compared with its contralateral, was 93.9% and 95.4%, respectively. Between the operated hand and its contralateral, there was a difference of 16° in the total measures of the metacarpophalangeal and interphalangeal joint's range of movement among the K-wire group and 5° among the IMCS group. Conclusion: The patients who participated in this study showed excellent results after surgery, and both treatments were proven to be safe and reliable. Evidence level III; Retrospective comparative study .

RESUMO Introdução: Fraturas dos metacarpos são frequentes e podem ser tratadas de forma cirúrgica com os fios de Kirschner (FK) e Fixação Intramedular com Parafuso de Compressão (FIPC). Objetivo: Analisar os resultados pós-operatórios do tratamento das fraturas extra-articulares dos metacarpos pela técnica retrógrada com fios de Kirschner e comparar com a fixação intramedular utilizando parafuso de compressão. Métodos: Estudo retrospectivo, quantitativo, com análise de prontuários, utilizando questionários de avaliação pós-operatória em dez pacientes divididos em dois grupos: FIPC e FK. Resultados: O período de imobilização com tala nos grupos FK e FIPC foram de seis e quatro semanas respectivamente, já o tempo médio para consolidação foi de 57 e 47 dias respectivamente. O grupo FK retornou as atividades laborais após os FIPC. O valor médio de força na mão acometida comparada a contralateral foi de 93,9% no grupo FK, e no FIPC de 95,4%. Medidas da soma de amplitude de movimento das articulações metacarpofalangeanas e interfalangeanas no grupo FK obtiveram diferença média entre as mãos operada e a contralateral de 16°, já na FIPC observou-se 5°. Conclusão: Os pacientes estudados apresentaram excelentes resultados pós-operatórios e ambos os tratamentos provam ser seguros e confiáveis. Nível de evidência III; Estudo retrospectivo comparativo .

Wedge fragment variations of tibial shaft fractures with intramedullary nailing / Fragmento em cunha das fraturas da diáfise da tíbia com haste intramedular

ABSTRACT Introduction: Tibial shaft fracture is the most common long-bone fracture, and the standard treatment is intramedullary (IM) nail fixation. Regardless of the development of this technique pseudoarthrosis remains prevalent. Objectives: Evaluate the correlation between wedge fragment size and displacement, displacement of the main fragments of the 42B2 type, and pseudoarthrosis incidence. Methods: We retrospectively assessed all patients with 42B2 type fracture treated with IM nailing between January, 2015 and December, 2019. Six radiographic parameters were defined for preoperative radiographs in the anteroposterior (AP) and lateral views. Another six parameters were defined for postoperative radiographs at three, six, and 12 months. The Radiographic Union Score for Tibial Fractures score was used to assess bone healing. Results: Of 355 patients with tibial shaft fractures, 51 were included in the study. There were 41 (82.0%) male patients, with a mean age of 36.7 years, 37 (72.5%) had open fractures, and 28 (54.9%) had associated injuries. After statistical analysis, the factors that correlated significantly with nonunion were wedge height > 18 mm, preoperative translational displacement of the fracture in the AP view > 18 mm, and final distance of the wedge in relation to its original anatomical position after IM nailing > 5 mm. Conclusion: Risk factors for nonunion related to the wedge and42B2 fracture are wedge height > 18 mm, initial translation in the AP view of the fracture > 18 mm, and distance > 5 mm of the wedge from its anatomical position after IM nailing. Evidence level III; Retrospective comparative study .

RESUMO Introdução: A fratura da diáfise da tíbia é a fratura mais comum dentre os ossos longos, sendo o tratamento padrão a fixação com haste intramedular (HIM). Independentemente do desenvolvimento da técnica cirúrgica, a pseudoartrose continua prevalente. Objetivo: Avaliar a associação entre o tamanho e o desvio da cunha, os desvios dos fragmentos principais do tipo 42B2 e a incidência de pseudoartrose. Métodos: Avaliamos, retrospectivamente, todos os pacientes com fraturas tipo 42B2 tratados com hastes intramedulares entre janeiro de 2015 e dezembro de 2019. Seis parâmetros radiográficos foram definidos para as radiografias pré-operatórias nas incidências anteroposterior (AP) e perfil. Outros seis parâmetros foram definidos para as radiografias pós-operatórias em 3, 6 e 12 meses de acompanhamento pós-operatório. O Escore Radiográfico de União para as Fraturas da Tíbia (RUST) foi o instrumento usado para avaliar a consolidação óssea. Resultados: Dos 355 pacientes com fraturas da diáfise da tíbia, 51 foram incluídos no estudo. Os pacientes incluídos foram 41 (82,0%) do sexo masculino, com idade média de 36,7 anos, 37 (72,5%) com fraturas expostas e 28 (54,9%) com lesões associadas. Após análise estatística, os fatores que se correlacionaram significativamente com a não consolidação foram a altura da cunha > 18 mm, o deslocamento translacional pré-operatório da fratura na incidência AP > 18 mm e a distância final da cunha em relação à sua posição anatômica original após a cravação do MI > 5 mm. Conclusão: Os fatores de risco para a pseudartrose relacionada com a fratura em cunha e42B2 são a altura da cunha > 18 mm, a translação inicial na vista AP da fratura > 18 mm e a distância > 5 mm da cunha em relação à sua posição anatómica após a fixação IM. Nível de evidência III; estudo comparativo retrospectivo. Nível de evidência III; Estudo retrospectivo comparativo .

Flexible intramedullary nails in pediatric subtrochanteric femur fracture: biomechanical study / Hastes flexíveis na fixação de fratura subtrocantérica de fêmur pediátrico: análise biomecânica

ABSTRACT Objective Evaluate the stability provided by two flexible intramedullary nails (FINs) in a simulation of fractures at the proximal levels in pediatric femur models. Methods Two FINs were inserted in 18 synthetic models of pediatric femurs. Fractures were simulated at one of three levels, and the models were divided into the following groups (n=6): diaphysis (control), subtrochanteric and trochanteric. Flex-compression tests were performed with force up to 85 N. Relative stiffness and the average deformation was obtained. Torsion tests were performed by rotating the proximal fragment until 20°, to obtain the average torque. Results At flex-compression, the set's average relative stiffness and average deformations were: 54.360x103 N/m and 1.645 mm in the control group, respectively. In the subtrochanteric group, the relative stiffness was 31.415x103 N/m (-42.2%) and the deformation was 2.424 mm (+47.3%) (p<0.05). For the trochanteric group, the relative stiffness was 30.912x103 N/m (+43.1%) and the deformation was 2.508 mm (+52.4%) (p<0.05). In torsion, the average torque was 1.410 Nm in the control group; 1.116 Nm in the subtrochanteric group (-20.8%), and 2.194 Nm in the trochanteric group (+55.6%) (p<0.05). Conclusion FINs do not seem to be biomechanically competent for the treatment of proximal femoral fractures. Level of Evidence I; Therapeutic Studies - Investigating the results of treatment.

RESUMO Objetivo avaliar a estabilidade proporcionada por duas hastes intramedulares flexíveis na simulação de fraturas nos níveis proximais em modelos pediátricos de fêmur. Métodos Duas hastes foram inseridas em 18 modelos sintéticos de fêmures pediátricos. As fraturas foram simuladas em um dos três níveis, e os modelos foram divididos nos seguintes grupos (n=6): diáfise(controle), subtrocantérico e trocantérico. Testes de flexão-compressão foram realizados com força de até 85N. A rigidez relativa e a deformação média foram obtidas. Os testes de torção foram realizados girando o fragmento proximal até 20°, para obter o torque médio. Resultados Na flexo-compressão, a rigidez relativa média e as deformações médias do conjunto foram: 54,360x103 N/m e 1,645 mm no grupo controle, respectivamente. No grupo subtrocantérico a rigidez relativa foi de 31,415x103 N/m (-42,2%) e a deformação foi de 2,424 mm (+47,3%) (p<0,05). Para o grupo trocantérico a rigidez relativa foi de 30,912x103 N/m (+43,1%) e a deformação foi de 2,508 mm (+52,4%) (p<0,05). Na torção, o torque médio foi de 1.410 Nm no grupo controle; 1,116 Nm no grupo subtrocantérico (-20,8%) e 2,194 Nm no grupo trocantérico (+55,6%) (p<0,05). Conclusão As hastes intramedulares flexíveis não parecem ser biomecanicamente competentes para o tratamento das fraturas proximais do fêmur. Nível de Evidência I; Estudos terapêuticos - Investigação dos resultados do tratamento.

Ankle arthrodesis with intramedullary retrograde nail for bone tumors. preliminary results and surgical technique / Artrodese do tornozelo com cavilha intramedular retrógrada para tumores ósseos. resultados preliminares e técnica cirúrgica

ABSTRACT Objective Present the preliminary results of a case series using the surgical ankle arthrodesis technique with an intramedullary retrograde nail for bone tumors. Methods We present the preliminary data of 4 patients, 3 males and 1 female, with a mean age of 46,2 (range 32 to 58) years, with histology proven Giant Cell Tumour of bone in 3 and osteosarcoma in 1. The mean resection length of distal tibia was 11,75 (range 9 to 16) cm, and all the patients underwent reconstruction with a tibiotalocalcaneal arthrodesis with an intercalary allograft fixed by a retrograde intramedullary nail. Results Oncological follow-up evolved without evidence of local recurrence or disease progression in all patients. After a mean time of 69.5 (range 32 to 98 months), patients had a mean MSTS12 functional score of 82.5% (range 75 to 90). All tibial arthrodesis and diaphyseal osteotomy sites were fused within 6 months with a return to activities without complications related to coverage skin or infection. Conclusion No complications were recorded; all arthrodesis and diaphysial tibial osteotomy sites fused by 6 months, and the mean follow-up of those patients was 69,5 (range 32 to 988) months, with a mean functional MSTS score of 82,5% (range 75-90). Level of Evidence: IV; Retrospective Case Series.

RESUMO Objetivo Apresentar os resultados preliminares de uma série de casos utilizando a técnica cirúrgica de artrodese do tornozelo com haste intramedular retrógada para tumores ósseos. Métodos Apresentamos os dados preliminares de quatro pacientes, três homens e uma mulher, com idade média de 46,2 (variação de 32 a 58) anos, com histologia comprovada de tumor de células gigantes em três e osteossarcoma em um. O comprimento médio de ressecção da tíbia distal foi de 11,75 (variação de 9 a 16) cm, e todos os pacientes foram submetidos à reconstrução com uma artrodese tibiotalocalcaneana com um aloenxerto intercalar fixado por uma haste intramedular retrógrada. Resultados O acompanhamento oncológico evoluiu sem evidências de recidiva local ou progressão da doença, em todos os pacientes. Após um tempo médio de 69,5 (variação de 32 a 98 meses), os pacientes tiveram uma pontuação média funcional MSTS12 de 82,5% (variação de 75 a 90). Todos os locais de artrodese e osteotomia diafisária tibiais foram fundidos em 6 meses com retorno às atividades de vida diária sem complicações relacionadas à cobertura ou infecção. Conclusão Não foram registradas complicações; todos os locais de artrodese e osteotomia diafisária da tíbia fundiram-se em 6 meses, e o acompanhamento médio desses pacientes foi de 69,5 (variação de 32 a 988) meses, com uma pontuação média funcional MSTS de 82,5% (variação de 75-90). Nível de Evidência IV; Série de Casos Retrospectivos.

Intramedullary pancreatic adenocarcinoma metastasis: The first case in literature / Metástasis de adenocarcinoma de páncreas intramedular: primer caso en la literatura

Background Pancreatic cancer is a common gastrointestinal malignancy, and is often associated with a poor prognosis. Although liver is generally seen as a distant metastasis point, it has been shown that it can metastasize to any organ, especially the gastrointestinal tract, and approximately 0.3% of metastases are observed in spinal cord. Case description We report a 36-year-old woman with a prior history of pancreatic adenocarcinoma who presented to us with a thoracic intramedullary lesion and recent onset of neurological deficits. She underwent surgery with histological confirmation of a diagnosis of metastatic adenocarcinoma. Conclusion To our knowledge there is no prior report of pure intramedullary spinal cord metastasis from a pancreatic adenocarcinoma in the literature. We report the present patient in view of the rarity of intramedullary spinal cord metastasis and its clinical significance. Although intramedullary metastases are rare, they should be investigated in every patient with malignancy and progressive neurological deficit. While its general prognosis is poor regardless of the type of treatment, early diagnosis and treatment is important in terms of quality of life and survival (AU)

Antecedentes El cáncer de páncreas es una neoplasia maligna gastrointestinal común y, a menudo, se asocia con un mal pronóstico. Aunque el hígado generalmente se ve como un punto de metástasis distante, se ha demostrado que puede hacer metástasis a cualquier órgano, especialmente al tracto gastrointestinal, y aproximadamente el 0,3% de las metástasis se observan en la médula espinal. Descripción del caso Presentamos una mujer de 36 años con antecedentes de adenocarcinoma de páncreas que se presentó con una lesión intramedular torácica y de reciente aparición de déficits neurológicos. Fue intervenida quirúrgicamente con confirmación histológica de diagnóstico de adenocarcinoma metastásico. Conclusión Hasta donde sabemos, no existe en la literatura ningún informe previo de metástasis intramedular pura de la médula espinal de un adenocarcinoma pancreático. Presentamos el presente paciente en vista de la rareza de la metástasis intramedular de la médula espinal y su importancia clínica. Aunque las metástasis intramedulares son raras, deben investigarse en todo paciente con neoplasia maligna y déficit neurológico progresivo. Si bien su pronóstico general es malo independientemente del tipo de tratamiento, el diagnóstico y el tratamiento precoces son importantes en términos de calidad de vida y supervivencia (AU)

Intramedullary pancreatic adenocarcinoma metastasis: The first case in literature.

BACKGROUND: Pancreatic cancer is a common gastrointestinal malignancy, and is often associated with a poor prognosis. Although liver is generally seen as a distant metastasis point, it has been shown that it can metastasize to any organ, especially the gastrointestinal tract, and approximately 0.3% of metastases are observed in spinal cord. CASE DESCRIPTION: We report a 36-year-old woman with a prior history of pancreatic adenocarcinoma who presented to us with a thoracic intramedullary lesion and recent onset of neurological deficits. She underwent surgery with histological confirmation of a diagnosis of metastatic adenocarcinoma. CONCLUSION: To our knowledge there is no prior report of pure intramedullary spinal cord metastasis from a pancreatic adenocarcinoma in the literature. We report the present patient in view of the rarity of intramedullary spinal cord metastasis and its clinical significance. Although intramedullary metastases are rare, they should be investigated in every patient with malignancy and progressive neurological deficit. While its general prognosis is poor regardless of the type of treatment, early diagnosis and treatment is important in terms of quality of life and survival.

Revascularización ósea: aloinjerto estructural intramedular versus extramedular. Trabajo experimental / Bone revascularization: structural allograft intramedullary vs extramedullary. Experimental work

Resumen: Introducción: el tratamiento exitoso en pacientes con importantes defectos óseos secundarios a infección, no consolidación y fracturas osteoporóticas consecuentes a traumatismos previos representa un desafío. En la literatura actual no encontramos ningún reporte que compare el uso de Tablas de aloinjerto intramedular versus las mismas colocadas lateral a la lesión. Material y métodos: se trabajó sobre una muestra de 20 conejos (dos grupos de 10 conejos cada uno). El grupo 1 fue operado mediante la técnica de colocación extramedular del aloinjerto, mientras que el grupo 2 con técnica intramedular. A los cuatro meses postquirúrgico se realizaron estudios por imágenes e histología para comparar un grupo con el otro. Resultados: el análisis de los estudios por imágenes evidenció una diferencia estadísticamente significativa entre ambos grupos con mayor reabsorción e integración ósea del aloinjerto colocado intramedular. Respecto a la histología, no hubo diferencias estadísticamente significativas, pero sí una predicción significativa con p valor < 0.10 a favor del aloinjerto intramedular. Conclusión: mediante nuestro trabajo pudimos mostrar la gran diferencia que hay entre la técnica de colocación del aloinjerto respecto al análisis imagenológico e histológico utilizando marcadores de revascularización. Si bien el aloinjerto colocado de manera intramedular nos muestra mayor integración ósea, el injerto extramedular brindará más soporte y estructura en pacientes que así lo requieran.

Abstract: Introduction: successful treatment in patients with significant bone defects secondary to infection, non-union and osteoporotic fractures resulting from previous trauma is challenging. In the current literature we did not find any reports that compare the use of intramedullary allograft boards versus the same ones placed lateral to the lesion. Material and methods: we worked on a sample of 20 rabbits (2 groups of 10 rabbits each). Group 1 underwent surgery using the extramedullary allograft placement technique, while group 2 with the intramedullary technique. Four months after surgery, imaging and histology studies were performed to compare between groups. Results: the analysis of the imaging studies showed a statistically significant difference between both groups with greater resorption and bone integration of the intramedullary placed allograft. Regarding histology, there were no statistically significant differences, but there was a significant prediction with a p value < 0.10 in favor of the intramedullary allograft. Conclusion: through our work we were able to show the great difference between the allograft placement technique with respect to imaging and histological analysis using revascularization markers. Although the intramedullary placed allograft shows us greater bone integration, the extramedullary graft will provide more support and structure in patients who require it.

Intramedullary nail versus locked plate in the treatment of two- and three-part proximal humerus fractures: a retrospective comparative study of 46 cases / Haste intramedular versus placa bloqueada no tratamento da fratura do úmero proximal em duas e três partes: um estudo comparativo retrospectivo de 46 casos

Objective: to retrospectively evaluate and compare the proportions of complications and radiographic findings of two- and three-part proximal humerus fracture osteosynthesis with two treatment methods: third-generation locked intramedullary nail and locked plate. Methods: 46 patients with a mean age of 58.9±16.6 years were evaluated between January 2020 and January 2021. In sixteen cases (34.8%), an intramedullary nail was used, and in thirty cases (65 .2%), the proximal humerus locked plate. The evaluation used included the rate of complications with a minimum follow-up of 6 months postoperatively and radiographic evaluation. Results: there was no significant difference between the groups regarding the proportion of complications (nail group 18.8%, plate group 13.3%; p=0.681). The nail group showed less residual loss in varus (cervicodiaphyseal angle, nail group 132.1º±2.3º, plate group 123.8º±10.1º; p<0.001). In the plaque group, women had a lower value (1.43±0.22) of the tuberosity-deltoid index (DTI) compared to men (1.58±0.11) (p=0.022). Conclusions: in the short-term follow-up, osteosynthesis, with locked plate and intramedullary nail, did not show differences in the proportions of complications. The nail group showed less change in the post-operative cervicodiaphyseal angle, however, there were two serious complications with cut out and varus deviation requiring a new surgical approach in the nail group.

Objetivo: avaliar intra, de modo retrospectivo, e comparando as complicações e os achados radiográficos da osteossíntese da úmero proximal em duas e três partes com dois métodos de tratamento: a terceira geração e placa bloqueada do tratamento. Métodos: foram obtidos 46 pacientes com média de idade de 58,9±16,6 anos entre janeiro de 2020 a janeiro de 2021. ,2%), uma placa bloqueada de úmero proximal. A utilização de uma taxa de acompanhamento com acompanhamento de acompanhamento pós-operatório e avaliação radiográfica. Resultados: não houve diferença significativa entre os grupos quanto à proporção de complicações (grupo pressa, 8%, grupo placa 13,61; p=0,61). O grupo pressa apresentou menor perda residual em varo (ângulo cervicodiafisário grupo pressa 132,1º±2,3º, grupo placa 123,8º±10,1º; p<0,001). No grupo placa, as mulheres apresentaram menor valor (1,43±0,22) do índice tuberosidade-deltoide (DTI) em relação aos homens (1,58±0,11) (p=0,022). Conclusões: sem seguimento de curto prazo, a osteoconformidade com placas fixadas e pressa intramedular, não apresentou diferenças nas proporções de complicações. O grupo apresentou menor alteração do projeto cervicodiafisário pós-operatório, entretanto, duas complicações graves com cut out e desvio em varo com necessidade de reabordagem integrada no grupo pressa. 22) do índice tuberosidade-deltoide (DTI) em relação aos homens (1,58±0,11) (p=0,022). Conclusões: sem seguimento de curto prazo, a osteoconformidade com placas fixadas e pressa intramedular, não apresentou diferenças nas proporções de complicações. O grupo apresentou menor alteração do projeto cervicodiafisário pós-operatório, entretanto, duas complicações graves com cut out e desvio em varo com necessidade de reabordagem integrada no grupo pressa. 22) do índice tuberosidade-deltoide (DTI) em relação aos homens (1,58±0,11) (p=0,022). Conclusões: sem seguimento de curto prazo, a osteoconformidade com placas fixadas e pressa intramedular, não apresentou diferenças nas proporções de complicações. O grupo apresentou menor alteração do projeto cervicodiafisário pós-operatório, entretanto, duas complicações graves com cut out e desvio em varo com necessidade de reabordagem integrada no grupo pressa. 

Primera serie de casos de alargamiento femoral mediante clavo intramedular Precice® en nuestro centro / First case series of femoral lengthening using a Precice® intramedullary nail in our center

Resumen: Introducción: el alargamiento femoral mediante clavo intramedular es una de las opciones quirúrgicas en el tratamiento de las dismetrías severas de miembros inferiores en la práctica clínica habitual. Material y métodos: se realizó un estudio descriptivo retrospectivo de una serie de cinco pacientes con una media de edad de 15.4 años, intervenidos de alargamiento femoral mediante clavo intramedular Precice®. La etiología en todos los casos fue idiopática. Se midió la dismetría o alargamiento teórico prequirúrgico y el definitivo postquirúrgico, así como la precisión del alargamiento, la tasa y el índice de distracción (mm/día y días/cm respectivamente) y el índice de consolidación (días/cm). Se identificaron las complicaciones intra y postoperatorias en todos los casos. Resultados: la media de seguimiento fue de 21 meses (12-42), sin pérdidas en el seguimiento. La duración media del procedimiento quirúrgico fue de 126 minutos (105-160). La dismetría teórica prequirúrgica fue de 38 ± 2.7 mm. El alargamiento medio final fue de 41 ± 7.5 mm. La precisión media fue de 108% (91-125) y la tasa de distracción de 0.9 ± 0.4 mm/día. El índice de distracción fue de 13.9 ± 5.1 días/cm y el índice de consolidación, de 26.6 ± 9.1 días/cm. La consolidación ósea se observó en la totalidad de los pacientes con una media de 113 ± 58 días. Con respecto a las complicaciones, se encontraron un total de cuatro complicaciones menores de índole muscular. Conclusión: el clavo intramedular Precice® es una buena opción de tratamiento para casos de acortamiento femoral severo aportando buenos resultados clínicos y radiológicos con una baja tasa de complicaciones y fallo del implante.

Abstract: Introduction: femoral lengthening using an intramedullary nail is one of the surgical options in the treatment of severe lower limb dysmetria in routine clinical practice. Material and methods: a retrospective descriptive study was carried out on a series of five patients with a mean age of 15.4 years, who underwent femoral lengthening surgery using a Precice® intramedullary nail. The etiology in all cases was idiopathic. Preoperative and definitive postoperative theoretical lengthening or dysmetry was measured, as well as lengthening accuracy, distraction rate and index (mm/day and days/cm, respectively) and consolidation index (days/cm). Intraoperative and postoperative complications were identified in all cases. Results: mean follow-up was 21 months (12-42), with no loss to follow-up. The mean duration of the surgical procedure was 126 minutes (105-160). The preoperative theoretical dysmetry was 38 ± 2.7 mm. The final mean lengthening was 41 ± 7.5 mm. The mean accuracy was 108% (91-125) and the distraction rate was 0.9 ± 0.4 mm/day. The distraction rate was 13.9 ± 5.1 days/cm and the consolidation rate was 26.6 ± 9.1 days/cm. Bone consolidation was observed in all patients with a mean of 113 ± 58 days. Regarding complications, a total of four minor muscular complications were found. Conclusion: the Precice® intramedullary nail is a good treatment option for cases of severe femoral shortening, providing good clinical and radiological results with a low rate of complications and implant failure.

Antegrade nailing versus locking plate of 2-and 3-part proximal humerus fractures / Haste intramedular versus placa bloqueada no tratamento da fratura do úmero proximal em duas e três partes

ABSTRACT Objective: To evaluate and compare the proportions of complications and radiographic findings of osteosynthesis of 2- and 3-part proximal humerus fractures with two methods of treatment: third-generation antegrade nailing and locking plate. Methods: 46 patients with a mean age of 58.9 ± 16.6 years between January 2020 and January 2021 were evaluated. In sixteen cases (34.8%), antegrade nailing was used, and in thirty cases (65, 2%), a locking proximal humerus plate. The method used included the rate of complications with a minimum follow-up of 6 months after surgery and radiographic evaluation. Results: There was no difference between the groups regarding the proportion of complications (nail group 18.8%, plate group 13.3%; p = 0.681). The nail group had less residual varus loss (cervicodiaphyseal angle nail group with 132.1º ± 2.3º, plate group 123.8º ± 10.1º; p < 0.001). In the plate group, women had the lowest value (1.43 ± 0.22) of the deltoid tuberosity index (DTI) compared to men (1.58 ± 0.11) (p = 0.022). Conclusion: Osteosynthesis, with a locking plate and antegrade nailing, did not show differences in the proportion of complications. The nail group had less change in the postoperative cervicodiaphyseal angle, however, there were two serious complications with screw cut-out and varus deviation, requiring surgical reapproach. Level of Evidence II, Retrospective Observational Study.

RESUMO Objetivo: Avaliar retrospectivamente e comparar proporções de complicações e achados radiográficos da osteossíntese da fratura do úmero proximal em duas e três partes com dois métodos de tratamento: haste intramedular bloqueada de terceira geração e placa bloqueada. Métodos: Foram avaliados 46 pacientes com idade média de 58,9 ± 16,6 entre janeiro de 2020 a janeiro de 2021. Em 16 casos (34,8%), utilizou-se a haste intramedular e, em 30 casos (65,2%), a placa bloqueada de úmero proximal. A avaliação incluiu a taxa de complicações com seguimento mínimo de seis meses de pós-operatório e avaliação radiográfica. Resultados: Não houve diferença significativa entre os grupos quanto à proporção de complicações (grupo haste: 18,8%; grupo placa: 13,3%; p = 0,681). O grupo haste apresentou menor perda residual em varo (ângulo cervicodiafisário: grupo haste com 132,1º ± 2,3º; grupo placa com 123,8º ± 10,1º; p < 0,001). No grupo placa, as mulheres apresentaram menor índice de tuberosidade-deltoide (DTI) (1,43 ± 0,22) em relação aos homens (1,58 ± 0,11) (p = 0,022). Conclusão: No seguimento de curto prazo, a osteossíntese, com placa bloqueada ou haste intramedular, não apresentou diferenças nas proporções de complicações. O grupo haste apresentou menor alteração do ângulo cervicodiafisário no pós-operatório; entretanto, ocorreram duas complicações graves com cut out e desvio em varo com necessidade de reabordagem cirúrgica no grupo haste. Nível de Evidência II, Estudo Retrospectivo Observacional.

Intramedullary Fixation with Headless Screws versus Bouquet in Unstable Metacarpal Neck Fractures in Active Patients: A Randomized Study / Fixação intramedular com parafusos de compressão versus técnica do buquê em fraturas instáveis do colo do metacarpo em pacientes ativos: Ensaio clínico randomizado

Abstract Objeticve To compare the range of motion (ROM), return-to-work time, visual analogue score (VAS), disability of the arm, shoulder, and hand (QuickDASH), and radiographic outcomes of two methods of definitive internal fixation in active patients with boxer's fractures, operated in the first week. Methods This was a prospective, randomized trial, in which 50 patients, with a mean age range of 18 to 40 years old, were randomized and treated to definitive intramedullary fixation using 2 headless screws (n = 20) or bouquet (2 or 3 Kirschner wires) (n = 20). The patients were assessed on return-to-work time, ROM, patient reported QuickDASH outcome, VAS, and radiographic evaluation at 6 months. Results At 6 months, there were no differences between the two groups in terms of ROM, postoperative pain (VAS), or QuickDASH score. The overall complication rate was 4.76% in the screw group, compared with 5% in the bouquet-fixation group. Conclusions In the treatment of the active patients with unstable boxer's fractures, headless screws and bouquet fixation proved to be a safe and reliable treatment. The outcomes were similar in both groups.

Resumo Objetivo Comparar a amplitude de movimento (ADM), o tempo de retorno de trabalho, a pontuação na escala visual analógica (EVA), o escore no questionário abreviado incapacidade do braço, ombro e mão (QuickDASH, na sigla em inglês) e os resultados radiográficos de dois métodos de fixação interna definitiva em pacientes ativos com fraturas do boxer; operados na primeira semana. Métodos Este foi um ensaio prospectivo randomizado, no qual 50 pacientes, com idade mediana na faixa de 18 a 40 anos, foram randomizados e tratados com fixação intramedular definitiva utilizando 2 parafusos de compressão (n = 20) ou buquê (2 ou 3 fios de Kirschner) (n = 20). Os pacientes foram avaliados em relação ao tempo de retorno ao trabalho, à ADM, ao desfecho relatado pelo paciente no questionário QuickDASH, à EVA e à avaliação radiográfica aos 6 meses. Resultados Aos 6 meses, não houve diferenças entre os 2 grupos em termos de ADM, dor pós-operatória (EVA) ou escore no QuickDASH. A taxa global de complicações foi de 4,76% no grupo de fixação com parafusos, em comparação com 5% no grupo de fixação com a técnica do buquê. Conclusões Parafusos de compressão e fixação com buquês provaram ser tratamentos seguros e confiáveis para pacientes ativos com fraturas instáveis. Os resultados foram semelhantes nos dois grupos.

The missing link in the history of the locked intramedullary nail / O elo perdido na história da haste intramedular bloqueada

ABSTRACT Femoral Shaft intramedullary nails were first described by the Aztecs in 16th century, but the modern use of intramedullary nails as the gold standard treatment for femoral shaft fractures began with Gerald Kuntcher in 1939. From the first Kuntcher's study in 1939, to the creation of interlocking nail, a long and some minor developments were described around the world. However, a major development is missing: the first nail to have a rotational and vertical stability locking system was described by Flavio Godoy Moreira, but was never published on an indexed journal for the correct historical reference. Level of Evidence V, Therapeutics Studies, Expert Opinion.

RESUMO A história da haste intramedular bloqueada nas fraturas do fêmur se inicia com os Astecas no século 16, mas o uso moderno que a tornou o padrão ouro no tratamento destas fraturas se inicia com Gerald Kuntcher em 1939. Do estudo inicial de Kutcher até o desenvolvimento da haste bloqueada muitos pequenos desenvolvimentos foram descritos ao redor do mundo. Dentro deste desenvolvimento, a primeira haste a ter um controle vertical e rotacional foi descrito por Flavio Pires de Camargo, e nunca foi publicado em um jornal indexado que permita sua correta referência histórica. Nível de Evidência V, Estudos Terapêuticos, Opinião de especialista.