Prevalence of labrum and articular cartilage injuries of the hip on 3T magnetic resonance imaging of asymptomatic elite soccer players. / Prevalencia de lesiones del labrum y del cartílago articular de la cadera en imagen por resonancia magnética simple 3 T de futbolistas profesionales asintomáticos.

OBJECTIVE: To establish the prevalence of lesions of the labrum and articular cartilage of the hip in asymptomatic elite soccer players by performing 3T magnetic resonance imaging. METHODS: Eighty-four asymptomatic hips of 42 professional soccer players were evaluated. Male subjects older than 18 years were included. Cam and pincer deformity were defined as an alpha angle greater than 55 degrees and a lateral centre edge angle greater than 39 degrees, respectively. Labral injuries were classified with the Czerny classification and cartilage damage was classified with the Outerbridge classification. Specific statistical tests were used to establish the relationship between anatomical variances of the hip and the presence of chondral and labral injuries. RESULTS: FAI morphology prevalence was 25%. Abnormalities such as cam (22.5%) and labral injuries (33.8%) were found. Those cases with reported labral injury were predominantly intrasubstance damage (18.8%). Anatomical features of FAI were found to be related to lesions of the femoral cartilage (P<.001), chondrolabral damage (P=.042), or both injuries (P<.001). CONCLUSION: Asymptomatic labral or cartilaginous injuries of the hip were reported in 25% of the included professional soccer players. These injuries were associated with anatomical features of FAI.

Are there any risk factors for developing complications with the use of retrievable vena cava filters in orthopaedic surgery?

BACKGROUND: In high-risk patients, common prophylaxis may be insufficient to prevent thromboembolic events after orthopaedic procedures. In this scenario, a retrievable vena cava filter (VCF) could be considered as an alternative, although it's use remains controversial. Therefore, we asked: (1) what is the overall mechanical complication rate associated with the use of retrievable VCFs in orthopaedic surgery?, (2) what is the association with thromboembolic disease (TED) recurrence, post-thrombotic syndrome and/or major bleeding according to different surgical characteristics?, (3) What is the overall mortality rate attributed to VCF use? METHODS: We retrospectively analyzed a cohort of 68 patients who underwent orthopaedic surgery with a previous diagnosis of TED, in whom a retrievable VCF was placed. Permanent filters were excluded. We studied the filter's mechanical complications and considered as possible outcomes death and 3 hematologic complications: TED recurrence, post-thrombotic syndrome and major bleeding. To estimate association with risk factors, we subclassified surgeries into 5 groups: 1, arthroplasty/non-arthroplasty; 2, primary/revision; 3, elective/urgent; 4, oncologic/non-oncologic; 5, preoperative/postoperative filter. RESULTS: Mechanical complications were 16% and required a filter revision. Sixty-four percent of the revised VCFs developed a mechanical failure and could not be retrieved. Overall prevalence of TED recurrence, post-thrombotic syndrome and hemorrhage was 33%, 15% and 4.5%, respectively. Spinal surgeries were a risk factor for developing TED recurrences.  Only 4% of patients died of a TED recurrence. CONCLUSIONS: Orthopaedic procedures had a high risk of mechanical and hematologic complications after using a retrievable VCF. However, mortality was low due to these complications.

Hip Pain in Athletes - When It is Not the Labrum.

Hip pain is a relatively common complaint in sports. It is tempting to blame the athlete's symptoms on labral pathology. However, there is a high incidence of asymptomatic labral disease. Therefore, even when a labral tear is present, it may not be the underlying cause of the patient's pain. Clinicians should familiarize themselves with the large differential diagnosis for hip and pelvis pain to include nonmusculoskeletal pathology. This article reviews nonlabral causes of hip pain in athletes. For ease of classification, the hip is divided into anterior, lateral, and posterior regions.

Factors that influence in the turnout in ballet dancers with knee pain / Factores que influyen en el turnout em bailarinas com dolor em lãs rodillas / Fatores que influenciam no turnout em bailarinas clássicas com dor nos joelhos

The turnout, primary gesture in classical ballet, refers the 180º of the feet. The lateral rotation provides the greatest amount of degrees necessary to perform the position perfectly. If performed improperly, it can generate problems, specialy in the knees, causing pain. The aim of this study was to evaluate the factors that influence the implementation of turnout in adolescents ballet dancers with knee pain and to compare them to the dancers without pain. Twenty three (23) ballet dancers with knee pain and 26 ballet dancers without pain were evaluated for range of motion of external rotation of the hip, muscle strength, femoral neck anteversion and static and dynamic turnout. The angles were measured with a manual goniometer, and the strength of the abductor muscle groups, external rotators and hip extensors with isometric dynamometer. The analysis was performed using ANOVA and Mann-Whitney. Range of motion of external rotation of the hip, femoral neck anteversion and muscle strength were similar between groups. The dynamic turnout was lower in ballet dancers with knee pain (p=0.02) and ballerinas with angular deficits above 10% over the static group had lower turnout under the bilateral extensor muscle group (p=0.04 and 0.03, right left) and right abductor (p=0.03). Although anatomical factors can influence the lateral rotation of the turnout, the angle decreased dynamic turnout was related to the group of dancers with pain. This suggests that training based on proximal awareness of movement can prevent and minimize burdens on the knees of classical dancers teens.

El turnout, principal gesto del ballet clásico, se refiere a la posición de 180º entre los pies. La rotación lateral de la cadera proporciona una mayor cantidad de grados necesarios para realizar la posición perfectamente. Si se realiza de forma inadecuada, puede generar compensaciones, preferentemente en las rodillas, generando dolor. El objetivo de este estudio fue evaluar los factores que influyen en la ejecución del turnout en bailarinas clásicas adolescentes con dolor en las rodillas y comparar las bailarinas y sin dolor. Se evaluaron a 23 bailarinas con dolor y 26 bailarinas sin dolor en cuanto al rango de movimiento de rotación lateral de la cadera, la fuerza muscular, a la anteversión del cuello femoral y al turnout estático y dinámico. Los ángulos fueron medidos con un goniómetro manual, y la fuerza de los grupos musculares abductores, rotadores externos y extensores de la cadera con dinamómetro isométrico. El análisis se realizó por medio del ANOVA y Mann-Whitney. El rango de movimiento, la anteversión del cuello femoral y la fuerza del músculo fueron similares entre los grupos. El turnout dinámico fue menor en el grupo de bailarinas con dolor (p=0,02), y las bailarinas con déficits angulares superiores a 10% en relación al turnout estático presentaron menor fuerza del grupo muscular de los extensores bilaterales (p=0,04 y 0,03, derecha e izquierda) y abiductores derecho (p=0,03). Aunque los factores anatómicos pueden influir en la rotación lateral del turnout, la disminución del ángulo del turnout dinámico se relacionó con el grupo de bailarinas con dolor. Tal hecho sugiere que el entrenamiento basado en la conciencia proximal del movimiento puede prevenir y minimizar las sobrecargas en las rodillas de bailarinas clásicas adolescentes.

O turnout, gesto principal do balé clássico, refere-se à posição de 180º entre os pés. A rotação lateral do quadril fornece a maior quantidade de graus necessários para realizar a posição com perfeição. Se executada de forma inadequada, pode gerar compensações, preferencialmente nos joelhos, ocasionando dor. O objetivo deste estudo foi avaliar fatores que influenciam na execução do turnout em bailarinas clássicas adolescentes com dor nos joelhos e comparar a bailarinas sem dor. Foram avaliadas 23 bailarinas com dor e 26 bailarinas sem dor quanto à amplitude de movimento de rotação lateral do quadril, força muscular, à anteversão do colo femoral e ao turnout estático e dinâmico. Os ângulos foram mensurados com goniômetro manual, e a força dos grupos musculares abdutores, rotadores laterais e extensores do quadril com dinamômetro isométrico. A análise foi feita por meio do ANOVA e Mann-Whitney. A amplitude de movimento, a anteversão do colo femoral e a força muscular foram semelhantes entre os grupos. O turnout dinâmico foi menor no grupo de bailarinas com dor (p=0,02), e bailarinas com déficits angulares acima 10% em relação ao turnout estático apresentaram menor força do grupo muscular dos extensores bilateral (p=0,04 e 0,03, direita e esquerda) e abdutores direito (p=0,03). Embora fatores anatômicos possam influenciar na rotação lateral do turnout, a diminuição angular do turnout dinâmico esteve mais relacionada ao grupo de bailarinas com dor. Tal fato sugere que o treinamento baseado na conscientização proximal do movimento pode prevenir e minimizar as sobrecargas nos joelhos de bailarinas clássicas adolescentes.

[Traumatic hip dislocation in children. Case report of a 4 year-old girl]. / Luxación traumática de cadera en niños: reporte de un caso de una niña de 4 años.

Traumatic hip dislocation with a history of high energy trauma is infrequent in children. The incidence rate in our country has not been determined in the literature. Everything depends on the patient's age group, the type of trauma and the ligament laxity of children. We report herein the case of a 4 year-old girl with this condition and a history of high energy trauma. She was seen at Aragón Pediatric Hospital, SSDF, 8 hours after the injury and received conservative treatment. She has done well so far and has been followed-up monthly for 18 months, without complications. Avascular necrosis of the femoral head is the most frequent complication and has irreversible sequelae. After the follow-up period the patient is totally functional and independent.

Complicações decorrentes do posicionamento cirúrgico de clientes idosos submetidos à cirurgia de quadril / Complications arising from surgical positioning in elderly clients submitted to hip surgery / Complicaciones derivadas de la colocación quirúrgica de clientes ancianos sometidos a cirugía de cadera

Este estudo de revisão sistemática da literatura, segundo as recomendações sugeridas pela Colaboração Cochrane, teve como objetivo buscar nas publicações das bases de dados consultadas as evidências disponíveis sobre complicações decorrentes do posicionamento cirúrgico em idosos submetidos à cirurgia de quadril. Nesta revisão, os estudos identificados e discutidos apresentaram aspectos importantes no desenvolvimento de uma prática efetiva, possibilitando maior compreensão da necessidade de elaboração de pesquisas melhores delineadas que proporcionem validade interna de estudos futuros, para que seus resultados possam ser utilizados na prática clínica.

The study of this systematic literature review according to the recommendations suggested by Cochrane's Collaboration, had the aim to search in the publications listed in the databases consulted, the available evidences about complications arising from surgical positioning in elderly clients submitted to hip surgery. The studies identified and discussed in this review presented important aspects in the development of an effective practice, enabling greater understanding of the need to elaborate better delineated researches that provide internal validity for future studies, enabling the use of their results in clinical practice.

El estudio de revisión sistemática de la literatura, siguiendo las recomendaciones de la Colaboración Cochrane, tuvo como objetivo buscar en las publicaciones que figuran en las bases de datos consultadas, las evidencias disponibles para las complicaciones causadas por la colocación quirúrgica en ancianos sometidos a cirugía de cadera. Los estudios identificados y discutidos en esta revisión presentan aspectos importantes en el desarrollo de una práctica eficaz, permitiendo una mayor comprensión de la necesidad de desarrollar estudios mejores delineados que proporcionan validez interna de los futuros estudios, a fin de que sus resultados puedan ser utilizados en la práctica clínica.

Complicações em artroscopia de quadril / Complications in hip arthroscopy

OBJETIVOS: Determinar a prevalência de complicações ocorridas em uma série de casos consecutivos de artroscopia de quadril; avaliar a evolução da casuística através de uma curva de aprendizado; reconhecer as causas das complicações nas cirurgias do quadril por via artroscópica. MÉTODOS: Foram avaliados 150 casos consecutivos submetidos à artroscopia de quadril no período de maio de 2004 a dezembro de 2008. As complicações encontradas foram classificadas sob três aspectos: sistema orgânico acometido, gravidade, grupos de 50 casos de acordo com a ordem de realização do procedimento. Utilizaram-se para a análise dos dados obtidos a estatística descritiva e o teste exato de Fisher. RESULTADOS: Observaram-se 15 complicações (10 por cento) neste estudo. Dez foram complicações neurológicas, duas osteoarticulares, uma vásculo-isquêmica e duas cutâneas. Na classificação de gravidade, três foram classificadas como maiores, 12 intermediárias e nenhuma considerada menor. A incidência das complicações ao longo da curva de aprendizado não apresentou diferença estatística significativa (p = 0,16). CONCLUSÕES:A artroscopia de quadril é um procedimento cirúrgico de baixa morbidade, que cursa, em alguns casos, com complicações. Essas são, frequentemente, neurológicas e transitórias. Elas ocorrem, principalmente, devido à tração articular. A taxa de complicações não diminuiu com o evoluir da casuística.

OBJECTIVES: to determine the prevalence of complications in a series of consecutive cases of hip arthroscopy; to assess the progression of the casuistic through a learning curve; and to recognize the causes of complications in arthroscopic hip surgeries. METHOD: 150 consecutive cases were evaluated, who were submitted to hip arthroscopy from May 2004 through December 2008. All the surgical complications described were classified according to three aspects: organic system involved, severity, and every 50 consecutive cases. The data obtained were analyzed, and statistical analysis was carried out using Fischer's exact test. RESULTS: We observed 15 complications (10 percent) in this study; two osteoarticular, one ischemic vascular and two cutaneous. In the classification of severity, 3 were classified as very severe, 12 as intermediary and none as not severe. The incidence of complications through our learning curve showed no statistical significance (p=0.16). CONCLUSIONS: Hip arthroscopy is a surgical procedure that involves low morbidity, but that still presents complications in some cases. These complications are frequently neurological and non-permanent, and are mainly due to the joint traction. The complication rate did not decrease with the progression of our casuistic.

[Blunt trauma in kidney transplant with preservation of renal function]. / Trauma contuso en un riñón trasplantado con preservación de la función renal.

A 35-year-old male received a living related kidney transplant. At 184 months posttransplantation he suffered a direct right iliac fossa blunt trauma while working on a machine in a steel factory. Graft pain, dysuria and gross hematuria were observed and CT showed a periallograft hematoma. Because of his anemia and graft function deterioration, surgical exploration was warranted. A 500-cc perigraft hematoma was compressing the kidney and ureter, a 5-cm long, 5-mm in depth linear laceration in the lateral aspect of the superior pole of the graft and a 15-mm long, 2-mm in depth linear laceration in the medial aspect of the superior pole were actively bleeding. Major renal arteries and veins were not injured. Both lacerations were closed by suturing the renal parenchyma over gelfoam pledgets with absorbable suture in a buttress fashion. The kidney was salvaged. Serum creatinine was maintained at 1.5 mg/dl during follow-up. A review of the literature showed that few cases of traumatic renal graft rupture with kidney salvage have been reported. Our case is one of them.