Alargamiento óseo con clavo intramedular magnético experiencia preliminar y lecciones aprendidas / Bone lengthening with magnetic intramedullary nail preliminary experience and learned lessons

OBJETIVOS: Mostrar resultados, complicaciones y lecciones aprendidas utilizando el clavo intramedular magnético (IML, Intramedullary Magnetic Lengthener) en un grupo de pacientes sometidos a alargamiento óseo. PACIENTES Y MÉTODOS: Entre enero 2017 y diciembre 2019, 9 pacientes (15 segmentos), edad entre 15 y 39 años, fueron sometidos a alargamiento óseo con IML: 5 pacientes tuvieron alargamiento femoral bilateral por talla baja, 1 paciente se sometió a alargamiento de Piernas bilateral por Tibia vara y acortamiento mesomélico y 3 recibieron alargamientos femorales unilaterales por discrepancia de longitud de extremidades. Todos fueron operados por el mismo cirujano, con técnica standard. Se indicó kinesiterapia al menos 5 veces por semana durante la fase de distracción. RESULTADOS: En todos se logró el objetivo de alargamiento planteado. No hubo complicaciones intra ni postoperatorias graves (TVP, TEP, Embolia grasa), ni fallas del sistema distractor. Un paciente desarrolló contracturas articulares de ambas rodillas por no adhesión a Kinesiterapia. Ninguno requirió aporte de injerto óseo, sin embargo en 2 pacientes de alargamiento de Fémur bilateral, se presentó deformidad en varo, que hizo necesario recambio a clavo convencional y un paciente desarrolló una parálisis transitoria del Nervio Peroneo común. CONCLUSIONES: El advenimiento de los IML significó un gran avance en el campo de la osteogénesis por distracción, sin embargo, aún se trata de un procedimiento complejo, que debe ser planificado cuidadosamente para minimizar los riesgos y complicaciones. Una selección meticulosa del paciente y la evaluación física y psicológica previa, son fundamentales para el éxito del procedimiento. Los casos bilaterales requieren de un seguimiento cercano, por el riesgo de falla del implante.

objective: We show our results, complications and lessons learned using the Intramedullary Magnetic Lengthener (IML) in a group of patients who were subjected to bone lengthening. PATIENTS AND METHODS: Between January 2017 and December 2019, 9 patients (15 segments), aged between 15 and 39 years, underwent bone lengthening with IML: 5 patients had bilateral femoral lengthening due to short stature, 1 patient had bilateral leg lengthening due to Tibia vara and mesomelic shortening and 3 had unilateral femoral lengthening for limb length discrepancy. All were operated by the same surgeon, with standard technique. Physical therapy was indicated at least 5 times per week during the distraction phase. RESULTS: In every case, the proposed lengthening amount was achieved. There were no serious intraoperative or postoperative complications (DVT, Pulmonary Embolism, Fat Embolism), nor failures of the distractor system. One patient developed knee joint contracture due to non-adherence to Physical therapy. None required bone grafting, however, in 2 patients with bilateral Femur, a varus deformity appeared, which required nail exchange with a conventional trauma nail. One case developed a transit common Peroneal Nerve palsy. CONCLUSIONS: IMLs represent a great advance in the bone lengthening realm, however, it is still a complex procedure, which must be carefully planned to minimize risks and complications. Meticulous patient selection and prior physical and psychological evaluation are essential to the success of the procedure. Bilateral cases need a closer follow up, because implant failure is a potential risk.

Comparison of femoral and axillary artery cannulation in acute type a aortic dissection surgery

Abstract Introduction: One of the most important points of the acute type A aortic dissection surgery is how to perform cannulation regarding cerebral protection concerns and the conditions of arterial structures as a pathophysiological consequence of the disease. Objective: In this study, femoral and axillary cannulation methods were compared in acute type A aortic dissection operations. Methods: The study retrospectively evaluated 52 patients who underwent emergency surgery for acute type A aortic dissection. Patients without malperfusion according to Penn Aa classification were chosen for preoperative standardization of the study groups. The femoral arterial cannulation group was group 1 (n=22) and the axillary arterial cannulation group was group 2 (n=30). The groups were compared in terms of perioperative and postoperative results. Results: There was no statistically significant difference in terms of preoperative data. In terms of postoperative parameters, especially early mortality and new-onset cerebrovascular event, there was no statistically significant difference. Mortality rates in group 1 and group 2 were 13.6% (n=3) and 10% (n=3), respectively (P=0.685). Postoperative new-onset cerebral events ratio was found in 5 (22.7%) in the femoral cannulation group and 6 (20%) in the axillary cannulation group (P=0.812). Conclusion: Both femoral and axillary arterial cannulation methods can be safely performed in patients with acute type A aortic dissection, provided that cerebral protection strategies should be considered in the first place. The method to be performed may vary depending on the patient's current medical condition or the surgeon's preference.

Efectos del ranelato de estroncio sobre la densidad mineral ósea en hombres / Effect of strontium ranelate on bone mineral density in men

La osteoporosis afecta al 6-7% de la poblaciónmasculina. Es alta la proporción de pacientes confractura osteoporótica sin diagnóstico previo de estaenfermedad. La mortalidad luego de una fracturaes mayor en hombres que en población femenina;a pesar de esto, la mayoría de los pacientes no reciben tratamiento. Los fármacos aprobados, en nuestro medio, para tratar la osteoporosis masculina son:bifosfonatos, teriparatida y ranelato de estroncio. Elobjetivo de este estudio fue evaluar el efecto del ranelato de estroncio sobre la densidad mineral ósea enhombres después de 1 año de tratamiento. Se incluyeron los registros de 20 hombres de 67.8±3.0 años,tratados con ranelato de estroncio (2 g/día) durante 1año. Todos los pacientes presentaban un T-score inferior a -2.5 en cadera o columna vertebral o un T-scoreinferior a -2.0 y factores de riesgo de fractura. Nohubo modificación de parámetros de laboratorio luego del tratamiento (calcemia, calciuria, fósforo sérico,parathormona, 25(OH)vitamina D, fosfatasa alcalinay desoxipiridinolina). Luego de 1 año de tratamiento con ranelato de estroncio se observó incrementode la densidad mineral ósea en columna lumbar:0.953±0.029 versus 0.997±0.030 g/cm2 (p=0.0068),cuello femoral: 0.734±0.013 versus 0.764±0.016 g/cm2 (p=0.0084) y cadera total: 0.821±0.02 versus0.834±0.02 g/cm2 (p=0.0419). Conclusión: luego de1 año de tratamiento el ranelato de estroncio produjoun incremento significativo de la densidad mineralósea en columna lumbar y fémur proximal en hombres con osteoporosis (AU)

Osteoporosis affects 6-7% of the male population. The proportion of patients with fragility fractures but without diagnosis of the disease is high. Mortality after hip fracture is higherin men than in women; in spite of this, mostpatients are left without treatment for osteoporosis. Drugs approved, for the treatment ofosteoporosis in our country are bisphosphonates, teriparatide, and strontium ranelate (SrR).The objective of this study was to evaluate theeffect of SrR on axial BMD in men after one yearof treatment. We obtained pertinent data frommedical registries of 20 men aged 67,8±3,0 years,treated with oral SrR (2 g/day) for 12 months. All patients had a T-score below -2,5 at the hipor the lumbar spine, or a T-score below -2,0and one or more risk factors for fracture. Thelevels of serum calcium, phosphate, alkalinephosphatase, 25-hydroxyvitamin D, or PTH,or urinary calcium and desoxipyridinoline remained unchanged following SrR administration. After treatment with SrR there weresignificant increases in BMD at the lumbarspine: 0,953±0,029 versus 0,997±0,030 g/cm2(p=0,0068), femoral neck: 0,734±0,013 versus 0,764±0,016 g/cm2 (p=0.0084), and total hip: 0,821±0,02 versus 0,834±0,02 g/cm2(p=0,0419). Conclusion: in osteoporotic men,treatment with SrR significantly increases BMDin the lumbar spine and the proximal femur (AU)

Perfil epidemiológico de idosos com fraturas diversas, atendidos nos hospitais brasileiros: uma revisão de literatura / Epidemiological profile of elderly with diversified fractures, attended to in Brazilian hospitals: a literature review / Perfil epidemiológico de ancianos con fracturas varias, atendidosen hospitales brasileños: una revisión de literatura

Objetivou-se demonstrar o perfil epidemiológico de idosos com fraturas diversas, hospitalizados no Brasil, assim como a caracterização dessas fraturas. Trata-se de revisão de literatura mediante publicações no período entre 2007 e 2018, compondo uma amostra de 20 estudos selecionados. Evidenciou-se a fratura do fêmur em idosas, decorrente de queda da própria altura, com período de internação hospitalar entre uma e três semanas. Concluiu-se que é fundamental conhecer o perfil epidemiológico de idosos hospitalizados com fraturas para direcionar políticas públicas e dotação orçamentária.

The objective was to demonstrate the epidemiological profile of elderly with various fractures, hospitalized in Brazil, as well as the characterization of these fractures. It is a review of the literature through publications in the period between 2007 and 2018, composing a sample of 20 selected studies. The fracture of the femur in the elderly was evidenced due to fall of the height itself with a hospital stay of between one and three weeks. It was concluded that it is fundamental to know the profile of elderly hospitalized with fractures to direct public policies and budget allocation.

Se objetivó demostrar el perfil epidemiológico de los ancianos com fraturas diversas hospitalizados en Brasil, así como la caracterización de estas fracturas. Se trata de uma revisión de literatura mediante publicaciones en el período entre 2007 y 2018, componiendo una muestra de 20 estudios seleccionados. Se evidenció la fractura del fémur en ancianas derivada de caída de la propia altura con período de internación hospitalaria entre una y tres semanas. Se concluyó que es fundamental conocer el perfil de ancianos hospitalizados con fracturas para direccionar políticas públicas y dotación presupuestaria.

Lean mass as a determinant of bone mineral density of proximal femur in postmenopausal women

ABSTRACT Objective: To verify which component of body composition (BC) has greater influence on postmenopausal women bone mineral density (BMD). Subjects and methods: Four hundred and thirty women undergoing treatment for osteoporosis and 513 untreated women, except for calcium and vitamin D. Multiple linear regression analysis was performed in order to correlated BMD at lumbar spine (LS), total femur (FT), femoral neck (FN) with body mass (BM), total lean mass (LM) and total fat mass (FM), all determined by DXA. Results: BM significantly correlated with all bone sites in untreated and treated women (r = 0.420 vs 0.277 at LS; r = 0.490 vs 0.418 at FN, r = 0.496 vs 0.414 at FT, respectively). In untreated women, the LM correlated better than FM with all sites, explaining 179% of LS; 32.3% of FN and 30.2% of FT; whereas FM explained 13.2% of LS; 277% of FN, 23.4% of FT In treated women, correlations with BC were less relevant, with the LM explaining 6.7% of BMD at LS; 15.2% of FN, 16% of FT, whereas the FM explained 8.1% of LS; 179% of FN and 176% of FT. Conclusion: LM in untreated women was better predictor of BMD than FM, especialy for distal femur, where it explained more than 30% of the BMD, suggesting that maintaining a healthy muscle mass may contribute to decrease osteoporosis risk. Treatment with anti-osteoporotic drugs seems to mask these relationships. Arch Endocrinol Metab. 2018;62(4):431-7

Utilización de los vástagos metafisarios «Próxima¼ DePuy: nuestra experiencia a más de cinco años / Use of metaphyseal stems «Proxima¼ DePuy: our experience to more than five years

Resumen: La artroplastía total de cadera con los vástagos cortos encaminada a preservar el hueso es una buena opción en pacientes jóvenes a quienes se les prevé futuras cirugías de revisión. También es una buena elección cuando se utilizan cirugías con abordajes miniinvasivos. En este estudio clínico y radiológico hemos evaluado nuestra experiencia en el uso de artroplastía total de cadera con vástagos cortos de anclaje metafisario tipo DePuy Próxima. En total se han intervenido 23 pacientes con una edad media de 50.2 años (rango de 45 a 69 años) en el momento de la cirugía. El seguimiento medio fue de más de cinco años. Hubo un ligero varo del tallo femoral en tres casos, uno de ellos en varo severo. Este último caso presentó dolor continuo en las caras laterales del muslo que aumentó con el tiempo junto con una reacción diafisaria y un aumento en el tallo que requirió cirugía de revisión a los 12 meses postoperatorios. Se requiere un seguimiento más prolongado para analizar los resultados y confirmar la durabilidad de los resultados clínicos observados. Los pacientes fueron evaluados radiológica y clínicamente utilizando el baremo de Merle d'Aubigné (MD).

Abstract: The total hip arthroplasty with short stems to preserve bone is a good choice in young patients that expected future revision surgery, it is also a good choice when we use approaches for minimal invasive surgeries. In this study, we have evaluated, clinically and radiologically, our experience in total hip arthroplasty with the use of short stems and metaphyseal anchorage. In total we have involved 23 patients with a mean age of 50.2 years (range 45 to 69 y/o) at the time of surgery. The median follow-up was greater than five years. There was a slight Varus femoral stem in three cases, one of them in severe varus. The latter presented continuous pain in the lateral aspect of the thigh that increased with time, with a diaphyseal reaction and an increase in radiolucencies around the stem that required revision surgery 12 months postoperative. A longer follow-up is required to analyze the results and confirm the durability of the observed clinical findings. Patients were evaluated radiological and clinically using the scale of Merle d'Aubigné (MD).

Evaluación de score de hueso trabecular (TBS) en pacientes menopáusicas con fracturas y sin ellas / Trabecular bone score evaluation in postmenopausal women with or without fractures

El score de hueso trabecular (TBS, Trabecular Bone Score) es una medición de la textura de los grises derivada de la evaluación del raquis por DXA y proporciona un índice de la microarquitectura ósea. Se ha demostrado que los valores bajos presentan capacidad para predecir fracturas. Nuestro objetivo fue evaluar si existían diferencias entre los valores de TBS de pacientes con fracturas frente a no fracturadas. Materiales y métodos: se revisaron 159 historias clínicas de mujeres menopáusicas que consultaron para evaluación de su salud ósea. Se consideraron los antecedentes autorreferidos de fracturas (Fx), la DMO de raquis, cuello femoral y fémur total y TBS. Resultados: treinta pacientes (18,9%) presentaron fracturas y en ellas se observó menor TBS (con Fx: 1,295±83 vs. sin Fx: 1,366±84, p<0,0001), menor índice de masa corporal (IMC) (con Fx: 23,7±1,9 vs. sin Fx: 25,7±4,2, p=0,02), sin diferencias en la edad (p=0,39), ni en valores de DMO (L1-L4 p=0,11, cuello femoral p=0,20 y fémur total p= 0,12). Muchas de las fracturas ocurrieron en pacientes sin osteoporosis por DXA. Conclusiones: el TBS aumentaría la capacidad de DXA para identificar a mujeres argentinas en riesgo de padecer fracturas sin tener osteoporosis densitométrica. Este es el primer trabajo realizado en la Argentina con medición de TBS. (AU)

Trabecular Bone Score (TBS) is a measure of the grey scale derived from DXA lumbar image and provides information about microarchitecture. It has been shown that low TBS values can predict fractures. Our objective was to evaluate if there are any differences between the TBS values in patients with fractures vs. non-fractures. Materials and methods: We reviewed 159 medical records of menopausal women who consulted for evaluation of their bone health. Self-reported fractures (Fx), spine BMD, femoral neck and total femur and TBS were evaluated. Results: thirty patients (18.9%) presented fractures and they showed lower TBS (with Fx: 1,295±0,083 vs. without Fx: 1,366±0,084, p<0.0001), lower body mass index (BMI) (with Fx: 23.7±1.9 vs. without Fx 25.7±4.2, p=0.02), without differences in ages (p=0.39) or in BMD values (L1-L4 p=0.11, femoral neck p=0.20 and total femur p=0.12). Some fractures occurred in patients without osteoporosis, as determined by DXA. Conclusions: TBS would increase the ability of DXA to identify Argentine women at risk for fractures without densitometric osteoporosis. This is the first work done in Argentina with TBS measurement. (AU)

The elderly recognizing themselves as vulnerable to falls in the concreteness of the femoral fracture / El anciano reconociéndose vulnerable a caídas en la realidad de la fractura femoral / Idoso reconhecendo-se vulnerável a quedas na concretude da fratura do fêmur

ABSTRACT Objectives: understand the experience of the elderly with falls followed by femoral fracture and elaborate theoretical model of this process of lived experience. Method: qualitative research with theoretical saturation through analysis of the ninth nondirected interview of elderly who underwent such experience. Interviews were recorded, transcribed, and analyzed according to Grounded Theory. Results: three categories emerged (sub-processes): evaluating signs and symptoms of fracture after the fall; feeling sad and insecure with the new condition; and finding oneself susceptible to fractures. From realignment of these categories (sub-processes) we could abstract the central category (process), recognizing oneself as vulnerable to falls in the concreteness of the fracture. Conclusion: the theoretical model considering the Symbolic Interactionism signals the implementation of continued program for fall prevention, with teaching strategies that encourage the elderly to reflect on the concreteness of contexts in which there is risk of occurring injury to their health.

RESUMEN: Objetivos conocer la experiencia de ancianos con caídas seguidas por las fracturas del fémur y elaborar un modelo teórico de la experiencia de este proceso. Método: investigación cualitativa con la saturación teórica, mediante el análisis de la novena entrevista no directiva de ancianos que experimentaron esta experiencia. Las entrevistas fueron audio grabadas, transcritas y analizadas según la Teoría Fundamentada en los Datos. Resultados: surgieron tres categorías (sub): la evaluación de los signos y síntomas de la fractura después de la caída; sentirse triste e inseguro con la nueva condición; y descubrirse susceptible a las fracturas. Después de la realineación de estas categorías (subproceso), fue posible abstraer la categoría central (proceso), reconociéndose vulnerable a caídas en la realidad de la fractura. Conclusión: el modelo teórico a la luz de la interacción simbólica señala la aplicación del programa continuo de prevención de caídas, con estrategias de enseñanza que fomentan los ancianos a reflexionar sobre los contextos concretos en los que existe un riesgo de daño a su salud.

RESUMO Objetivos: compreender a experiência de idosos com quedas seguidas de fraturas do fêmur e elaborar modelo teórico desse processo de vivência. Método: pesquisa qualitativa com saturação teórica mediante análise da nona entrevista não diretiva de idosos que vivenciaram tal experiência. As entrevistas foram audiogravadas, transcritas e analisadas segundo a Teoria Fundamentada nos Dados. Resultados: emergiram três categorias (subprocessos): avaliando sinais e sintomas de fratura após a queda; sentindo-se triste e inseguro com a nova condição; e descobrindo-se suscetível a fraturas. Do realinhamento dessas categorias (subprocessos), foi possível abstrair a categoria central (processo), reconhecendo-se vulnerável a quedas na concretude da fratura. Conclusão: o modelo teórico à luz do Interacionismo Simbólico sinaliza a implementação de programa continuado de prevenção de quedas, com estratégias de ensino que estimulem o idoso a refletir sobre a concretude de contextos nos quais haja risco de ocorrências do agravo à sua saúde.

Incidencia de fracturas patológicas por metástasis en el fémur proximal en un hospital de concentración / Incidence of proximal femur pathologic fractures secondary to metastasis in a national reference orthopedic hospital

Resumen: Objetivo: Reportar la incidencia de fracturas en terreno patológico secundarias a metástasis que se presentaron en un hospital de referencia nacional en un período de cinco años. Métodos: Se registraron los ingresos totales a nuestro centro, así como los pacientes que satisficieran la condición de presentar una fractura de fémur proximal en terreno patológico. Con base en información oficial, se calculó el tamaño de población derechohabiente potencial de acuerdo al área de influencia. Con base en los datos se hizo el cálculo de la incidencia anual y de la densidad de incidencia. Resultados: Se identificaron 98 fracturas en 95 individuos. El cálculo de la densidad de incidencia fue de 0.70/100,000 personas durante el período de observación. Se incluyeron 54 sujetos femeninos y 41 masculinos con un promedio de edad de 65.3 años, aunque el rango fue muy variable (de 18 a 90 años). La mayor parte de las personas presentó metástasis por tumores sólidos. De los casos, 29% fue tratado de manera conservadora y el resto requirió tratamiento quirúrgico que incluyó desde osteosíntesis hasta artroplastía protésica. El promedio de estancia hospitalaria fue ligeramente mayor a una semana. Conclusiones: La incidencia reportada es relativamente baja. Encontramos una gran variedad de orígenes y localizaciones anatómicas. No se puede, al momento, generalizar tratamientos o predecir supervivencia.

Abstract: Objective: To report the incidence of pathological fractures secondary to metastasis at a national referral hospital during a 5-year period. Methods: Total admissions to our center were recorded, together with the patients who met the requirement of having a proximal femur fracture in a pathological area. The potential number of beneficiaries was estimated based on official figures and the hospital's area of influence. The annual incidence rate and the incidence density were calculated using the latter data. Results: 98 fractures were identified in 95 patients. The calculated incidence density was 0.70/100,000 population during the observation period. Fifty-four female patients and 41 male patients were included. Mean age was 65.3 years, with a very wide age range (18-90 years). Most patients had metastasis of solid tumors. Twenty-nine percent of patients were treated conservatively and the rest of them required surgery that included from osteosynthesis to prosthetic arthroplasty. The mean length of stay was over one week. Conclusions: The reported incidence of this type of fractures is relatively low. We found a wide variety of anatomical origins and locations. As of now, it is not possible to generalize the treatment or predict the survival.

Tres roturas sucesivas de los vástagos protésicos de cadera implantados en una paciente / Three successive fractures of different hip femoral stems on the same patient

Resumen: Se presenta el caso clínico de una paciente de 80 años que sufrió tres roturas de vástagos protésicos no cementados implantados en su cadera derecha en un período de tres años. Una rotura ocurrió en el cuello protésico y las otras dos en la unión de la porción cónica y cilíndrica del vástago, coincidiendo con la zona metafiso-diafisaria del fémur. La causas principales del fallo han sido un incremento de la concentración de fuerzas a nivel del implante como consecuencia del aumento de la longitud del cuello y de la lateralización femoral (offset). Se analizan otras causas que han podido contribuir a dicho fallo protésico.

Abstract: The clinical case of an 80-year-old female who suffered three fractures in uncemented stems implanted in her right hip in a period of three years is presented. A fracture occurred in the prosthetic neck and the other two at the juncture of the conical and cylindrical stem portion, coinciding with the metaphyseal-diaphyseal junction of the femur. The main causes of the failure were an increasing concentration of forces at the level of the implant as a consequence of the increased length of the neck and lateralization of the femur (offset). Other causes that have contributed to this prosthetic failure are analyzed.

Cirurgias de salvamento do quadril em paralisia cerebral: revisão sistemática / Hip salvage surgery in cerebral palsy cases: a systematic review

O desequilíbrio e a espasticidade muscular, associados à coxa valga e à anteversão femoral persistente, comprometem o desenvolvimento do quadril na paralisia cerebral e podem resultar em dor crônica e até luxação. Alguns desses quadris são submetidos a cirurgias de salvamento decorrentes do grave impacto das suas alterações na qualidade de vida. Fizemos uma revisão sistemática da literatura para comparar os resultados das principais técnicas aplicadas para salvamento do quadril nesses indivíduos. A busca na literatura teve como foco estudos que avaliaram resultados de cirurgias de salvamento do quadril em paralisia cerebral, publicados de 1970 a 2011, presentes nas bases de dados Embase, Medline, Pubmed, Scielo e Cochrane Library. Apesar de os resultados obtidos não serem estatisticamente comparáveis, essa revisão sistemática demonstra que as cirurgias de salvamento do quadril devem ser indicadas após avaliação individual de cada paciente, decorrente do amplo espectro de apresentações da paralisia cerebral. Logo, aparentemente, não há uma técnica cirúrgica superior às outras, mas sim indicações diferentes.

Imbalance and muscle spasticity, in association with coxa valga and persistent femoral anteversion, compromises hip development in cases of cerebral palsy and may result in chronic pain and even dislocation. Some of these hips undergo salvage surgery because of the severe impact of their abnormalities in these patients' quality of life. We conducted a systematic review of the literature to compare the results from the main hip salvage techniques applied to these individuals. The literature search focused on studies that evaluated results from hip salvage surgery in cases of cerebral palsy, published from 1970 to 2011, which are present in the Embase, Medline, PubMed, Cochrane Library and SciELO databases. Although the results were not statistically comparable, this systematic review demonstrates that hip salvage surgery should be indicated after individual evaluation on each patient, due to the wide spectrum of presentations of cerebral palsy. Therefore, it seems that no surgical technique is superior to any other. Rather, there are different indications.

Association between bone mass and functional capacity among elderly people aged 80 years and over / Associação entre massa óssea e capacidade funcional de idosos com 80 anos ou mais

Objective: Analyzed the association of bone mass with the functional capacity of elderly aged 80 or more. Methods: The sample consisted of 93 elderly aged 80 and 91 years (83.2±2.5 years) being 61 women (83.3±2.7 years) and 32 men (83.1±2.2 years) living in the city of Presidente Prudente - São Paulo/Brazil. The assessment of bone mass was realized by absorptiometry dual-energy X-ray (DXA), where have been measured values bone mineral content (BMC) and bone mineral density (BMD) of the femur and spine (L1 -L4). The functional capacity was evaluated by means of walking speed tests, static equilibrium and strength of lower limbs contained in the questionnaire Wellness Health and Aging (SABE). The variables of bone mass and functional capacity were categorized according to the median values and score tests, respectively. For statistical analysis we carried out the chi-square test, the software used was SPSS (13.0) and the significance level was set at 5%. Results: Elderly male with higher performance in the functional tests showed higher femur BMC compared to lower performance, result not found when evaluated women. Conclusion: Thus, the bone of the femur for the oldest old male is associated with functional capacity. The constant assessment of the bone mineral mass and practive of physical activity throughout life would be measures to prevent falls in the elderly. .

Objetivo: Analisar a associação entre a massa óssea e capacidade funcional de idosos com 80 anos ou mais. Métodos: A amostra foi composta por 93 idosos entre 80 e 91 anos (83,2 ± 2,5 anos), 61 mulheres (83,3 ± 2,7 anos) e 32 homens (83,1 ± 2,2 anos) da cidade de Presidente Prudente. A avaliação da massa óssea foi feita pela absorptiometria de dupla energia de raios X (DXA), na qual foram mensurados os valores de conteúdo mineral ósseo (BMC) e densidade mineral óssea (BMD) do fêmur e da coluna (L1-L4). A capacidade funcional foi avaliada por meio dos testes de velocidade para caminhar, equilíbrio estático e força de membros inferiores contidos no questionário Saúde, Bem-Estar e Envelhecimento (Sabe). As variáveis da massa óssea e capacidade funcional foram categorizadas de acordo com os valores de mediana e a pontuação obtida nos testes, respectivamente. Para tratamento estatístico fez-se o teste qui-quadrado, o software usado foi SPSS (13.0) e o nível de significância estabelecido foi de 5%. Resultados: Os idosos do sexo masculino com maior desempenho nos testes funcionais apresentaram maiores valores de BMC de fêmur comparados com os de menor desempenho, resultado não encontrado quando avaliadas as mulheres. Conclusão: Dessa forma, a massa óssea do fêmur para idosos longevos do sexo masculino está associada à capacidade funcional. A avaliação constante da massa mineral óssea e a prática de atividade física ao longo da vida seriam medidas para prevenção das quedas em idosos. .

Efeitos de um programa de exercícios em grupo sobre a força de preensão manual em idosas com baixa massa óssea / Effects of a group exercise program on handgrip strength of elderly women with low bone mass

OBJETIVOS: Avaliar os efeitos de um programa de exercícios sobre a força de preensão ma­nual (FPM) em idosas com baixa massa óssea. SUJEITOS E MÉTODOS: Trinta e seis idosas foram randomizadas em: grupo intervenção - GI (n = 18) e grupo controle - GC (n = 18), avaliadas pelo teste de FPM, utilizando-se um dinamômetro de mão. O GI realizou exercícios de força muscular, equilíbrio e mobilidade funcional. O GC realizou alongamentos. Ambos os grupos realizaram duas sessões semanais de 50 minutos, durante quatro meses. RESULTADOS: O GI apresentou aumento da FPM em 31,38% (p = 0,00). O GC não mostrou diferença. Houve correlações entre a FPM e a densidade mineral óssea (DMO) do colo do fêmur (r = 0,582, p = 0,003) e do fêmur total (r = 0,485, p = 0,01). CONCLUSÃO: Os resultados sugerem uma tendência ao incremento da FPM de idosas e mostraram correlações significantes entre a FPM e a DMO.

OBJECTIVES: To evaluate the effects of an exercise program on handgrip strength (HS) in elderly women with low bone mass. SUBJECTS AND METHODS: Thirty-six elderly women were randomized to the intervention group - GI (n = 18) and control group - GC (n = 18). Participants were evaluated by means of a HS test, using a handgrip dynamometer. GI performed strength, balance and functional mobility exercises, and GC performed stretching exercises. Both groups had sessions twice a week for 50 minutes, during 4 months. RESULTS: GI had a significant increase in handgrip strength equal to 31.38%. No differences were observed in GC. There were correlations between HS test and bone mineral density (BMD) of the femoral neck (r = 0.582, p = 0.003) and total femur (r = 0.485, p = 0.01). CONCLUSION: Results indicate a propensity to increase elderly HS, and showed significant correlations between HS and BMD.

Pinzamiento femoroacetabular: Conceptos básicos en una nueva causa de dolor inguinal: [revisión] / Femoroacetabular impingement as a cause of inguinal pain: [review]

Femoro-acetabular impingement is an anatomical disturbance of the hip, caused by a deformity of the acetabulum, femur or both that causes an abnormal contact between both structures during certain movements. Its prevalence is 10 to 15 percent and causes chronic inguinal pain. It can be confused with several other causes of inguinal pain such as hernias, facet syndromes, a renal colic, etc. Patients with this condition are usually young individuals with inguinal pain that may appear after a minor trauma. During examination, pain may be elicited by infernal rotation and abduction movements of hip, flexed in 90°. Plain hip X ray is the most commonly used diagnostic method. Non-steroidal anti-inflammatory drugs and physical therapy can be used to alleviate pain, but the definitive treatment is surgical.

Comparative study on anterior cruciate ligament reconstruction: determination of isometric points with and without navigation

OBJECTIVES: To compare the accuracy of tunnel placement and graft isometry for anterior cruciate ligament reconstruction performed using a computer-assisted navigation system (Orthopilot) and using traditional instruments. METHODS: The anterior cruciate ligament was removed intact from 36 pairs of human cadaver knees. From each pair, one knee was randomized to Group 1 (conventional) and the other to Group 2 (Orthopilot). An inelastic suture was then passed through the central points of the tibial and femoral tunnels. Neither of the tunnels was drilled. All knees were then dissected, and six parameters were obtained: distances from the tibial tunnel center to the 1) posterior cruciate ligament, 2) anterior horn of the lateral meniscus and 3) medial tibial spine; 4) distance from the femoral tunnel center to the posterior femoral cortex; 5) femoral tunnel coronal angle; and 6) variation of the distance from the femoral to the tibial tunnel with the knee extended and at 90 degrees of flexion. RESULTS: The variation of the distance from the femoral to the tibial tunnel during flexion and extension was smaller in the Orthopilot group (better isometry) compared to the conventional group. There were no statistical differences in any other parameters between the groups, and all tunnels were considered to be in satisfactory positions. DISCUSSION: The results obtained for anterior cruciate ligament reconstruction depend on precise isometric point positioning, and a navigation system is a precision tool that can assist surgeons in tunnel positioning. CONCLUSION: No differences in tunnel position were observed between the groups. Nonetheless, better isometry was achieved in the Orthopilot group than with conventional instruments.

Osteotomia trocanterea extendida para revisiones femorales: indicaciones, técnica y resultados: evaluación de 100 pacientes con 116 osteotomías / Extended trochanteric osteotomy for femoral revision: indications, surgical technique and results: evaluation of 100 patients with 116 osteotomies

Introducción: La revisión protésica de la cadera requiere no sólo una técnica de reconstrucción adecuada, sino también un apropiado abordaje que reduzca al mínimo las complicaciones y el daño agregado, producto de la extracción de los componentes y el cemento. La osteotomía trocantérea extendida aparece como una técnica eficiente, segura y confiable para este fin. Materiales y métodos: Desde 1997 hasta 2006 realizamos 116 osteotomías trocantéreas extendidas en 101 caderas de 100 pacientes. Las indicaciones de la revisión fueron aflojamiento aséptico (42,5 por ciento), infección (43,5 por ciento), fractura periprotésica (10,8 por ciento), inestabilidad (0,9 por ciento), desgaste del polietileno con osteólisis (0,9 por ciento) y hemiartroplastia fallida (0,9 por ciento). Se implantaron 67 tallos no cementados y 8 tallos cementados largos, 9 pacientes mantienen el espaciador en espera del segundo tiempo, 3 mantienen el espaciador y no se realizarán ninguna cirugía reconstructiva y en 5 casos se efectuó una artroplastia por resección. Resultados: Sólo se registró falta de consolidación en una de las 113 osteotomías (0,8 por ciento). Hubo 8 fracturas femorales (7 por ciento), 6 de ellas con trazos longitudinales sin desplazamiento, y 5 fracturas del fragmento osteotomizado. Conclusiones: La osteotomía trocantérea extendida es una técnica eficiente, segura y confiable para remover implantes del fémur, pero no está exenta de complicaciones que pueden prevenirse o tratarse, en su mayoría, sin compromiso del resultado funcional final.

Reemplazo total del fémur: indicaciones y técnica quirúrgica en una patología no tumoral / Total femoral replacement: surgical technique in non-neoplastic disorders

Introducción: Existen múltiples causas de origen no tumoral que generan déficit de capital óseo femoral. Las soluciones planteadas para este problema son diversas y deben analizarse de acuerdo con la causa y la magnitud del déficit óseo femoral y acetabular; el estado de la musculatura del paciente, en especial del músculo glúteo medio; la presencia de infección; la edad y los antecedentes del paciente y, por supuesto, la experiencia del cirujano y su ámbito quirúrgico. En ciertos casos, el déficit óseo femoral es de tal magnitud que debe optarse por la utilización de megaprótesis; su máxima expresión es el reemplazo total del fémur (RTF). Materiales y métodos: En este trabajo se analizan, en forma retrospectiva, 6 pacientes operados en nuestro centro, en los cuales se utilizó una prótesis de reemplazo total de fémur de fabricación nacional, con un seguimiento promedio de 3,8 años. Resultados: Un paciente falleció a los 45 días de operado por un cuadro séptico, otro fracasó por la persistencia de un cuadro infeccioso previo y los restantes 4 realizan una marcha útil y se encuentran satisfechos física y emocionalmente con el resultado. Conclusiones: Consideramos que, si bien el número de pacientes evaluados es escaso, debido a la poco habitual indicación de esta cirugía, este análisis nos permite hacer hincapié en las características técnicas del procedimiento, así como develar algunos aspectos de sus indicaciones y contraindicaciones.

Prevalência e fatores de risco para fraturas vertebrais em idosos da comunidade / Prevalence and risk factors of vertebral fractures in communitydwelling elderly

Objetivo: Estimar a prevalência de fraturas vertebrais investigando os fatores de risco associados com esta última condição em idosos brasileiros da comunidade. Métodos: Este estudo de corte transversal incluiu 769 indivíduos idosos com 65 anos ou mais (462 mulheres e 307 homens) residentes em São Paulo, Brasil. Radiografias de coluna torácica e lombar foram obtidas e fraturas vertebrais foram avaliadas usando o método semiquantitativo de Genant. Densidade mineral óssea (DMO) foi mensurada por DXA e parametros bioquímicos foram também avaliados. Mulheres e homens foram analisados separadamente, e cada gênero foi dividido em 2 grupos com base na presença de fraturas vertebrais. Resultados: A prevalência de fraturas vertebrais foi de 16,7% (95% CI 13,3-20,1) nas mulheres e 21,2% (95% CI 16,6-25,7) nos homens. Análise de regressão logística usando as variáveis significantes na análise univariada no grupo feminino mostrou que a idade (OR=1,12, 95% CI 1,06-1,18; p<0,001) e o Tscore do colo femoral (OR=0,61, 95% CI 0,46-0,88; p=0,006) foram fatores de risco independentes na predição de fraturas vertebrais. No grupo masculino, a análise de regressão logística demonstrou que a condição de caidor crônico (OR=2,54 95% CI 1,1-5,9; p=0,031) e T-score do colo femoral (OR=0,72, 95% CI 0,53-0,96; p=0,025) foram independentes parâmetros na predição de fraturas vertebrais. Conclusão: Nossos resultados sugerem que fraturas vertebrais são comuns em idosos brasileiros e que o T-score do colo femoral baixo foi um importante fator de risco para esta condição em ambos homens e mulheres. Idade também foi significantemente correlacionada com a presença de fraturas vertebrais em mulheres, e a condição de caidor crônico foi correlacionada com fraturas vertebrais em homens.

Purpose: To estimate the prevalence of radiographic vertebral fracture and investigate factors associated with this condition in Brazilian communitydwelling elderly. Methods: This cross sectional study included 769 elderly subjects 65 years old and over (462 women and 307 men) living in São Paulo, Brazil. Thoracic and lumbar spine radiographs were obtained and vertebral fractures were evaluated using Genant´s semi-quantitative method. Bone mineral density (BMD) was measured by DXA and bone biochemical markers were also evaluated. Female and male subjects were analyzed independently, and each gender was divided into 2 groups, based on whether vertebral fractures were present. Results: The prevalence of vertebral fracture was 16.7% (95% CI 13.3-20.1) in women and 21.2% (95% CI 16.6-25.7) in men. Logistic regression analyses using variables that were significant in the univariate analysis, in female group showed that age (OR=1.12, 95% CI 1.06-1.18; p<0.001) and femoral neck T-score (OR=0.61, 95% CI 0.46-0.88; p=0.006) were independently factors in predicting vertebral fracture. In the male group, logistic regression analyzes demonstrated that chronic faller condition (OR=2.54 95% CI 1.1-5.9; p=0.031) and femoral neck T-score (OR=0.72, 95% CI 0.53-0.96; p=0.025) were independent parameters in predicting vertebral fractures. Conclusions: Our results suggest that radiographic vertebral fractures are common in Brazilian community-dwelling elderly and that a low femoral neck T-score was an important risk factor for this condition in both males and females. Age was also significantly correlated with the presence of vertebral fractures in women, and chronic faller was correlated with vertebral fractures in men.

Evolução funcional nas fraturas da extremidade proximal do fêmur / Functional evolution of proximal femoral end fractures

OBJETIVOS: analisar a evolução da capacidade funcional e do escore fisiológico em pacientes com fraturas da extremidade proximal do fêmur, assim como comparar os resultados finais do tratamento instituído com as diversas variáveis pré-fratura. MATERIAIS E MÉTODOS: estudo prospectivo com pacientes acima de 40 anos e diagnóstico de fratura do fêmur proximal. Os pacientes foram submetidos à aplicação de um protocolo pré-estabelecido e acompanhados ambulatorialmente por um período de um ano. RESULTADOS: foram acompanhados 68 pacientes (27 homens e 41 mulheres) com idade média de 75,84 anos. O tratamento cirúrgico foi instituído em 83,82 por cento dos casos. O escore fisiológico inicial médio foi de 17,16 pontos, sendo o valor de 17,58 pontos nos pacientes operados e 9,27 pontos naqueles submetidos a tratamento conservador. A mortalidade verificada em um ano após a fratura foi de 36,76 por cento. A capacidade deambulatória sem auxílio foi readquirida em 32,56 por cento dos pacientes. 25,58 por cento dos casos, cujo escore fisiológico inicial médio foi inferior à média geral, não deambularam após o seguimento de um ano. 27,90 por cento dos pacientes previamente independentes passaram a necessitar de cuidados de familiares e/ou do serviço social. CONCLUSÃO: o fator de maior influência no resultado final foi o escore fisiológico inicial.

OBJECTIVES: To assess the functional capacity evolution and the physiologic score in patients with proximal femoral end fractures, as well as to compare the final results of the treatment provided to the several pre-fracture variables. MATERIALS AND METHODS: A prospective study with patients over 40 years old diagnosed with proximal femoral fracture. The patients were submitted to a pre-established protocol and followed up on an outpatient basis for a period of one year. RESULTS: 68 patients were assessed (27 men and 41 women), with a mean age of 75,84 years. 83,82 percent were submitted to surgical treatment. The early mean physiologic score was 17,16 points (17,58 points for patients submitted to surgical treatment and 9,27 points for those not submitted to surgical treatment). The mortality rate found after one year of fracture was 36,76 percent. The free ambulation ability was achieved by 32,56 percent. 25,58 percent of the cases whose mean early physiologic score was lower compared to the overall mean score couldn't ambulate after one year of follow up. 27,90 percent of the patients who were previously independent, required family care and/or social service. CONCLUSION: the initial physiologic score was the most important influencing factor in the final result.