Assessment of interobserver reliability for the letournel and judet classification / Avaliação da confiabilidade interobservadores para a classificação de letournel e judet

ABSTRACT Introduction: The Judet and Letournel classification is the most widely used classification system for acetabular fractures. Some complex fractures couldn't be classified according to this classification. The main purpose of this study was to evaluate the reliability of the Letournel and Judet classification system for acetabular fractures. Material and methods: 10 acetabular fractures were analyzed among 17 orthopedic surgeons. The surgeons were asked to classify the fractures according to the Judet and Letournel classification. Their experience, the number of surgeries, and the incision type that the surgeon uses for the anterior part of the acetabulum were recorded. Results: The overall interobserver agreement for the Letournel classification was found to be poor, with a Kappa value of 0.287. The Kappa value for interobserver agreement was 0.224 for plain radiographs, 0.293 for 2D-CT, and 0.321 for 3D-CT scans. There was no significant difference between the incision types used by the surgeons. The highest reliability was determined among the surgeons who operate on 10-20 acetabular fractures per year, with a Kappa value of 0.309. Conclusion: This results revealed that the Judet and Letournel Judet classification is not sufficient to classify acetabular fractures because of unclassified fractures and the complex algorithm of the system. Level of Evidence III; Comparative Retrospective Study.

RESUMO Introdução: A classificação de Judet e Letournel é o sistema de classificação mais amplamente utilizado para fraturas acetabulares. Algumas fraturas complexas, porém, não puderam ser classificadas de acordo com esta classificação. O principal objetivo deste estudo foi avaliar a confiabilidade do sistema de classificação de Judet e Letournel para fraturas acetabulares. Material e métodos: Foram selecionadas aleatoriamente 10 fraturas acetabulares de um banco de dados. Participaram do estudo 17 cirurgiões ortopédicos. Foi solicitado aos cirurgiões que classificassem as fraturas de acordo com a classificação de Judet e Letournel. Suas experiências, o número de cirurgias e o tipo de incisão que o cirurgião utiliza para a parte anterior do acetábulo foram registrados. Resultados: A concordância interobservadores geral para a classificação de Judet e Letournel foi considerada fraca, com um valor de Kappa de 0,287. O valor de Kappa para a concordância interobservadores foi de 0,224 para radiografias simples, 0,293 para tomografias computadorizadas em 2D e 0,321 para tomografias computadorizadas em 3D. Não houve diferença significativa entre os tipos de incisão utilizados pelos cirurgiões. A maior confiabilidade foi determinada entre os cirurgiões que operam de 10 a 20 fraturas acetabulares por ano, com um valor de Kappa de 0,309. Conclusão: Os resultados revelaram que a classificação de Judet e Letournel não é suficiente para classificar fraturas acetabulares devido a fraturas não classificadas e ao algoritmo complexo do sistema. Nível de Evidência III; Estudo Comparativo Retorpectivo.

Leadership development training for brazilian orthopedic surgeons / Treinamento de desenvolvimento de liderança para cirurgiões ortopédicos brasileiros

ABSTRACT Objective: To report on the experience and impressions of the Brazilian orthopedic trauma surgeons attending the Leadership Development Program (LDP) hosted by the Sociedade Brasileira do Trauma Ortopédico (SBTO) in Sao Paulo, Brazil on November 4, 2022. Methods: Forty-eight orthopedic trauma surgeons from five different regions throughout Brazil were provided a link to complete The Big Five Test, a validated online personality assessment. The questionnaire was available in Portuguese and was intended to provide a background on individual personality traits and their influence on interpersonal interactions. The LDP integrated content from literature reviews specific to Latin America, established leadership programs from leading business schools, and various subject matter experts. Prior to the start of the LDP, participants received a pre-course survey evaluating demographic information, a needs assessment, and the prioritization of leadership topics utilizing a 5-point Likert-scale. Attendees participated in the one-day, interactive LDP focusing on the fundamental principles of leadership development, communication, personal development, emotional intelligence and negotiation. Following the LDP, a post-course evaluation was administered to determine the participants' overall experience, and suggestions for LDP improvement. Results: Forty-one of the forty-eight course participants completed the pre-course evaluation, whereas forty-six of the forty-eight participants completed the post-course evaluations. Overwhelmingly, the lack of opportunity was most prevalently reported as the main obstacle to attending a leadership course, as cited by 56% of respondents. Conclusion: Expanding the accessibility, diversity, and customizability of leadership programs can facilitate the development of personal tools needed to move healthcare forward. Critical topics include emotional intelligence and other differentiating leadership qualities that distinguish true transformational and servant leaders. Advancing leadership skills can stimulate networking, expose learners to experiential learning styles, inspire others to create positive change, and engender creative solutions for systematic improvements and health outcomes. Level of Evidence III; Individual Case-Control Studies.

RESUMO Objetivo: Relatar a experiência e as impressões de cirurgiões de trauma ortopédico brasileiros participantes do Programa de Desenvolvimento de Liderança (PDL), organizado pela Sociedade Brasileira do Trauma Ortopédico (SBTO), em São Paulo, Brasil, em 4 de novembro de 2022. Métodos: Quarenta e oito cirurgiões de trauma ortopédico de cinco regiões diferentes do Brasil receberam um link para preencher o The Big Five Test, uma avaliação de personalidade on-line validada. O questionário estava disponível em português e pretendia fornecer informações básicas sobre traços de personalidade individuais e sua influência nas interações interpessoais. O PDL integrou conteúdo de análises de literatura específicas da América Latina, e programas de liderança estabelecidos pelas principais escolas de negócios e por vários especialistas no assunto. Antes do início do PDL, os participantes receberam uma pesquisa pré-curso solicitando informações demográficas, uma avaliação de necessidades e a priorização de tópicos de liderança utilizando uma escala Likert de 5 pontos. Os participantes participaram do PDL interativo de um dia com foco nos princípios fundamentais de desenvolvimento de liderança, comunicação, desenvolvimento pessoal, inteligência emocional e negociação. Após o PDL, foi realizada uma avaliação pós-curso para determinar a experiência geral dos participantes e sugestões para melhoria do PDL. Resultados: Quarenta e um dos quarenta e oito participantes do curso concluíram a avaliação pré-curso, enquanto quarenta e seis dos quarenta e oito participantes concluíram a avaliação pós-curso. A falta de oportunidade foi relatada com maior prevalência como o principal obstáculo para frequentar um curso de liderança, conforme citado por 56% dos entrevistados. Conclusão: Expandir a acessibilidade, a diversidade e a personalização dos programas de liderança podem facilitar o desenvolvimento de ferramentas pessoais necessárias para fazer avançar os cuidados de saúde. Os tópicos críticos incluem inteligência emocional e outras qualidades de liderança diferenciadas, que distinguem verdadeiros líderes transformacionais e servidores O avanço das competências de liderança pode estimular o networking, expor os alunos a estilos de aprendizagem experiencial, inspirar outros a criar mudanças positivas e gerar soluções criativas para melhorias sistemáticas dos resultados na saúde. Nível de Evidência III; Estudos de caso-controle individuais.

The use of adhesive radiopaque grids in genicular nerve block by radioscopy / O uso de máscara localizadora no bloqueio de nervos geniculares por radioscopia

ABSTRACT The performance of genicular nerve block requires an imaging method to guide the procedure. Radioscopy has the disadvantage of being radiation dependent. Objective: To assess whether the use of adhesive radiopaque grids reduce radiation exposure in these cases. Methods: This is a cross-sectional study conducted with 23 orthopedists in which needles were positioned in a model with and without the use of adhesive radiopaque grids. The number of fluoroscopy shots necessary for proper positioning in three points (superior lateral, superior medial, and inferior medial) were registered. Results: A statistical difference was observed in the three blocking points studied. The number of radioscopies required for these three points were 12.1 ± 2.5 in the group without grid and 5.0 ± 1.8 in the group with grid. The superior medial point presented the greatest numerical difference and the inferior medial point the smallest. Conclusion: The use of adhesive radiopaque grids led to a statistically significant reduction in the number of radioscopies/fluoroscopies required to perform the genicular block. The use of this device increases the safety of the physician and patient by reducing radiation exposure in this procedure. Level of Evidence III, Level of Evidence II, Random Clinical Trial.

RESUMO Para a realização do bloqueio de nervos geniculares é necessário guiar o procedimento por um método de imagem. A radioscopia possui a desvantagem de ser dependente de radiação. Objetivo: Avaliar se o uso de máscaras localizadoras diminui a exposição à radiação nesses casos. Métodos: Estudo transversal realizado com 23 ortopedistas, que realizaram o posicionamento de agulhas em um modelo com e sem o uso da máscara localizadora. Foi registrado o número de escopias necessárias para o posicionamento adequado em três pontos: superior lateral, superior medial e inferior medial. Resultados: Foi observada diferença estatística nos três pontos de bloqueio analisados. O número de radioscopias necessárias nos três pontos somados foi de 12,1 ± 2,5, no grupo sem máscara, e 5,0 ± 1,8, no grupo com máscara. O ponto superior medial foi o que apresentou a maior diferença numérica, e o inferior medial a menor. Conclusão: O uso da máscara localizadora reduziu de forma estatisticamente significativa o número de escopias necessárias para a realização do bloqueio genicular. O uso desse dispositivo aumenta a segurança do médico e do paciente por diminuir a exposição à radioscopia nesse procediment. Nível de Evidência III, Ensaio clínico randomizado aberto - Nível de recomendação B - nível de evidência 2b.

What is the degree of variability in formal training for pediatric orthopedic surgeons performing scoliosis surgery? / ¿Cuál es el grado de variabilidad en la educación formal de los cirujanos ortopédicos pediátricos que realizan intervenciones quirúrgicas de escoliosis?

Abstract: Introduction: although pediatric orthopedic surgeons worldwide perform scoliosis surgery, the training received is variable and poorly understood. By surveying the European Pediatric Orthopedic Society (EPOS) and the Sociedad Latinoamericana de Ortopedia (SLAOTI), we aim to characterize this variability. Material and methods: in 2021, we distributed an anonymous online questionnaire to EPOS and SLAOTI. Results: 43% EPOS and 22% SLAOTI perform scoliosis procedures (p < 0.05). 18% EPOS and 2% SLAOTI performed > 35 procedures annually (p < 0.05). 70% EPOS and 27% SLAOTI received formal training in spinal deformity surgery (p < 0.005). Conclusions: results show significant differences in training and performance of scoliosis procedures between societies.

Resumen: Introducción: aunque muchos cirujanos ortopédicos pediátricos alrededor del mundo realizan cirugías para la escoliosis, el entrenamiento es variable y poco conocido. A través de encuestar a la Sociedad Europea de Ortopedia Pediátrica (EPOS) y a la Sociedad Latinoamericana de Ortopedia (SLAOTI) queremos caracterizar esta variabilidad. Material y métodos: distribuimos un cuestionario anónimo en 2021 a los miembros de EPOS y SLAOTI. Resultados: realizan las cirugías de escoliosis 43% de EPOS, en comparación con 22% de SLAOTI (p < 0.05); 18% de EPOS realizó > 35 cirugías al año, en comparación con 2% de SLAOTI (p < 0.05); 70% de EPOS y 27% de SLAOTI recibieron capacitación formal en cirugía de deformidades de la columna (p < 0.005). Conclusiones: los resultados de este estudio subrayan las diferencias en el entrenamiento de las cirugías de escoliosis entre diferentes sociedades.

Profilaxia do tromboembolismo venoso nas cirurgias ortopédicas / Venous thromboprophylaxis in orthopedic surgeries

A trombose venosa profunda (TVP) e o tromboembolismo pulmonar (TEP) são as principais manifestações clínicas do tromboembolismo venoso (TEV). O TEV é uma complicação comum e potencialmente grave das cirurgias ortopédicas, uma vez que pode levar à limitação funcional e morte pós-operatória. O uso da tromboprofilaxia reduz acentuadamente a incidência de TEV relacionado às intervenções ortopédicas, e seu uso é recomendado por diversas diretrizes. Entretanto, a indicação e o tipo de tromboprofilaxia para algumas intervenções ortopédicas, assim como o uso de ferramentas de predição de risco, ainda não estão bem estabelecidos e constituem pontos de debate. Os objetivos deste trabalho foram identificar os fatores de risco para TEV e suas interações nas cirurgias ortopédicas e avaliar a aplicabilidade do escore de risco de Caprini na predição de TEV em pacientes ortopédicos. Além disso, devido à escassez de conhecimento e recomendações sobre tromboprofilaxia nas intervenções ortopédicas de tornozelo e pé, realizaram-se uma revisão narrativa e uma enquete internacional sobre o assunto. Para analisar a interação de fatores de risco de TEV e a aplicabilidade preditiva do escore de Caprini nas cirurgias ortopédicas, foram utilizados os dados do Multiple Environmental and Genetic Assessment of risk factors for venous thrombosis (MEGA), um estudo caso-controle holandês de base populacional cujo desfecho de interesse é o TEV. Neste, 263 indivíduos que tiveram TEV e 94 controles foram submetidos à cirurgia ortopédica. O risco de TEV foi maior nos primeiros 30 dias após a cirurgia [odds ratio ajustada (ORadj) 17,5; intervalo de confiança (IC) 95%, 9,2-33,4] e manteve-se aumentado até 90 dias (ORadj 11,5; IC 95%, 7,3-17,7). Houve interação entre cirurgia ortopédica e mutação fator V Leiden (ORadj 17,5; IC 95%, 4,1-73,6), tipo de sangue não-O (ORadj 11,2; 95% IC, 3,4-34,0) e níveis séricos de fator VIII maiores que 150 mg/dl (ORadj 18,6; IC, 7,4-46,9). Quanto ao escore de Caprini, foram avaliados 357 indivíduos com TEV submetidos à cirurgia ortopédica. Um total de 20,9% dos casos e 41,5% dos controles foram classificados no grupo de menor risco (Caprini < 5 pontos). Pacientes com um escore de Caprini maior que 11 pontos tiveram um risco de TEV seis vezes maior (OR 6,3; IC 95%, 1,7-22,9), e pacientes com um escore de 9 a 10 tiveram um risco três vezes maior (OR 3,5; IC 95% 1,2-10,3). A área sob a curva (AUC) do escore de Caprini foi de 0,64, evidenciando uma discriminação de predição de TEV moderada. Na enquete internacional sobre tromboprofilaxia de pé e tornozelo, 693 cirurgiões ortopédicos de pé e tornozelo de 49 países participaram. Aproximadamente 50% informaram prescrever tromboprofilaxia durante a imobilização do paciente. Quando utilizada, as escolhas preferidas em ordem decrescente foram ácido acetilsalicílico (AAS), heparina de baixo peso molecular (HBPM) e anticoagulantes orais diretos. AAS e HBPM foram predominantemente prescritos na América do Norte e Europa, respectivamente. TVP prévia, imobilidade, obesidade e trombofilia hereditária foram considerados os principais fatores de risco indicativos do uso de tromboprofilaxia. Concluiu-se que: houve risco aumentado de TEV e interação entre os fatores de risco fator V Leiden, níveis elevados de fator VIII e grupo sanguíneo não- O com cirurgia ortopédica; o escore de Caprini é uma ferramenta que pode auxiliar os cirurgiões ortopédicos a classificarem o risco de TEV no pós-operatório, embora seu desempenho preditivo discriminativo tenha sido moderado; apesar de a maioria dos cirurgiões ortopédicos de tornozelo e pé considerarem que a tromboprofilaxia está indicada para cirurgias de tornozelo e pé (principalmente na presença de fatores de risco como TVP prévia, imobilidade, obesidade e trombofilia hereditária), a prescrição, o tipo e a duração apresentam grande discrepância intercontinental. Assim, este trabalho contribui para a identificação de pacientes sob alto risco de TEV, ponto estratégico para o uso individualizado e seguro da tromboprofilaxia como ferramenta para redução do risco de TEV relacionado às cirurgias ortopédicas.

Deep vein thrombosis (DVT) and pulmonary embolism are the main clinical manifestations of venous thromboembolism (VTE). VTE is a common and potentially serious complication of orthopedic surgeries, as it can lead to functional limitation and postoperative death. The use of thromboprophylaxis markedly reduces the incidence of VTE related to orthopedic interventions, and its use is recommended by several guidelines. However, the indication and type of thromboprophylaxis for some orthopedic interventions, as well as the use of risk prediction tools are still not well established and is debatable. The objectives of this study were to identify risk factors for VTE and their interactions in orthopedic surgeries and to evaluate the applicability of the Caprini risk score in predicting VTE in orthopedic patients. In addition, due to the lack of knowledge and recommendations on thromboprophylaxis in foot and ankle surgeries, a narrative review and an international survey on the subject were carried out. Data from the MEGA Study (Multiple Environmental and Genetic Assessment of risk factors for venous thrombosis) which is a Dutch population-based case-control study whose outcome of interest is VTE were used. A total of 263 subjects who had VTE and 94 controls underwent orthopedic surgery. The risk of VTE was the highest in the first 30 days after surgery (adjusted odds ratio [ORadj] 17.5; 95% CI [confidence interval], 9.2-33.4) and remained increased up to 90 days (ORadj, 11.5; 95% CI, 7.3- 17.7). There was interaction between orthopedic surgery and factor V Leiden mutation (ORadj 17.5, 95%CI 4.1-73.6), non-O blood type (ORadj 11.2; 95%CI 3.4-34.0) and factor VIII plasma levels greater than 150 mg/dl (ORadj 18.6; CI 7.4-46.9). To assess the applicability of the Caprini Score, 357 individuals with VTE undergoing orthopedic surgery in the MEGA were evaluated. A total of 20.9% of cases and 41.5% of controls were classified in the lowest risk group (Caprini <5 points). Patients with a Caprini score greater than 11 points had a six-fold increased risk of VTE (OR 6.3, 95% CI 1.7- 22.9) and patients with a score of 9-10 had about three-fold increased risk (OR 3.5, 95% CI 1.2-10.3). The area under curve for the Caprini score was 0.64, evidencing a moderate VTE prediction discrimination. In the international survey on foot and ankle thromboprophylaxis, 693 orthopedic foot and ankle surgeons from 49 countries participated. Approximately 50% reported prescribing thromboprophylaxis during patient immobilization that, when used, the preferred choice, in descending order, was acetylsalicylic acid (ASA), low molecular weight heparin (LMWH) and direct oral anticoagulants. ASA and LMWH were predominantly prescribed in North America and Europe, respectively. Previous DVT, immobility, obesity and hereditary thrombophilia were considered the main risk factors indicative of the use of thromboprophylaxis. It is concluded that there was increased risk of VTE and interaction between factor V Leiden, high plasma levels of factor VIII or non-O blood group and orthopedic surgery; that the Caprini score is a tool that can help orthopedic surgeons to classify the risk of postoperative VTE, although its discriminative predictive performance was moderate and that although most ankle and foot orthopedic surgeons consider that thromboprophylaxis is indicated for ankle and foot surgeries (especially in the presence of risk factors such as previous DVT, immobility, obesity and hereditary thrombophilia), the prescription, type and duration present a large intercontinental discrepancy. Thus, this work contributed to the identification of patients at high risk of VTE, a strategic point for the individualized and safe use of thromboprophylaxis as a tool to reduce the risk of VTE related to orthopedic surgeries.

Estimated exposure of spine surgeons to radiation / Estimativa da exposição de cirurgiões de coluna vertebral à radiação / Estimativa de la exposición de cirujanos de columna vertebral a la radiación

ABSTRACT Objective To estimate the amount of radiation received and accumulated in the bodies of two surgeons, one being the responsible surgeon and the other the assistant, performing spine surgery procedures over a period of 25 years. Methods Seventy-two spinal surgeries were performed during a seven-month period and the radiation loads were measured in both surgeons. The measurement of radiation was captured in fluoroscopy in anteroposterior and lateral incidences. The surgeon and the assistant used two dosimeters, one in the cervical region protecting the thyroid and the other on the lead apron in the genital region. The radioactive loads were measured in millisieverts and the accumulated charges were recorded monthly in both regions of the body in the two surgeons for seven months and the means for the work periods (1, 5, 10, 15, 20 and 25 years) were estimated. Results It was observed that in the surgeon the average accumulated radiation loads were 131.9% and 176.92% higher than those of the assistant in the cervical and genital regions, respectively. Conclusion While the use of X-rays is indispensable in routine orthopedic surgery, we have to consider the development of techniques of protection, rigor and discipline in the use of safety materials for surgeons. Preventive exposure reduction measures such as using thyroid protection equipment and turning the head away from the patient during fluoroscopy, among others, should be mandatory to promote less radiation exposure. Level of evidence II; Comparative prospective study.

RESUMO Objetivo Estimar a quantidade de radiação recebida e acumulada no corpo de dois cirurgiões, durante período de 25 anos de trabalho, sendo um o cirurgião responsável e outro, assistente, nos procedimentos de cirurgia da coluna vertebral. Métodos Foram realizadas 72 cirurgias de coluna vertebral em um período de sete meses, e as cargas de radiação foram medidas nos dois cirurgiões. A medição da radiação foi captada em fluoroscópio nas incidências anteroposterior e de perfil. O cirurgião e o auxiliar utilizaram dois dosímetros, sendo um na região cervical protegendo a tireoide e outro sobre o avental de chumbo, na região genital. As cargas radioativas foram medidas em milisievert e as cargas acumuladas foram registradas mensalmente em ambas as regiões do corpo nos dois cirurgiões, durante sete meses, foram estimadas as médias no período (1, 5, 10, 15, 20 e 25 anos) de trabalho. Resultados Observou-se que no cirurgião as médias das cargas de radiação acumulada foram 131,9% e 176,92% superiores às do assistente nas regiões cervical e genital, respectivamente. Conclusão Enquanto o uso dos raios X for indispensável na rotina da cirurgia ortopédica, há de se considerar o desenvolvimento de técnicas de proteção, rigor e disciplina no uso materiais de segurança para os cirurgiões. Medidas preventivas de redução da exposição, como uso de equipamento para proteção da tireoide e girar a cabeça para se afastar do paciente durante a fluoroscopia, entre outras, devem ser obrigatórias para promover menor exposição à radiação. Nível de evidência II; Estudo prospectivo comparativo.

RESUMEN Objetivo Estimar la cantidad de radiación recibida y acumulada en el cuerpo de dos cirujanos, durante 25 años de trabajo, siendo uno el cirujano responsable y el otro, asistente, en los procedimientos de cirugía de columna vertebral. Métodos Se realizaron 72 cirugías de columna vertebral en un período de siete meses, y las cargas de radiación fueron medidas en los dos cirujanos. La medición de la radiación fue captada en fluoroscopio en las incidencias anteroposterior y de perfil. El cirujano y el auxiliar usaron dos dosímetros, siendo uno en la región cervical protegiendo la tiroides y otro sobre el delantal de plomo, en la región genital. Las cargas radiactivas se midieron en milisievert, y las cargas acumuladas se registraron mensualmente en ambas regiones del cuerpo, en los dos cirujanos, durante siete meses, y se estimaron los promedios durante el período (1, 5, 10, 15, 20 y 25 años) de trabajo. Resultados Se observó que en el cirujano los promedios de las cargas de radiación acumulada fueron de 131,9% y 176,92% superiores a las del asistente en las regiones cervical y genital, respectivamente. Conclusión Mientras el uso de rayos X sea indispensable en la rutina de la cirugía ortopédica, hay que considerar el desarrollo de técnicas de protección, rigor y disciplina en el uso de materiales de seguridad para los cirujanos. Las medidas preventivas de reducción de la exposición, como uso de equipamiento para protección de la tiroides y girar la cabeza para alejarse del paciente durante la fluoroscopia, entre otras, deben ser obligatorias para promover menor exposición a la radiación. Nivel de evidencia II; Estudio prospectivo comparativo.

Surgical Gloves in Orthopedic Trauma Procedures: How Many Lose Their Integrity? / Luvas cirÚrgicas em procedimentos ortopédicos de trauma: Quantas perdem a integridade?

Abstract Introduction The possibility of perforation of gloves during orthopedic surgeries can reach 56.8%, and it mainly related to the manipulation of blunt instruments. Surgeries for the treatment of fractures and trauma present additional risk due to contact with bone spires. Objective Analysis of the prevalence of loss of integrity of surgical gloves in orthopedic trauma procedures, especially fractures, and evaluation of the surgeon's exposure and contact with secretions from the patient. Methods Macroscopic inspection of the gloves of two surgeons specialized in trauma, over a period of 4 months. Both used two gloves for all procedures and, at the end of the surgery, analyzed the presence or absence of blood stains on the internal gloves and/or fingers. The procedures were categorized according to the time and type of surgery. The intercurrence investigated was the perforation of one or two gloves; if the tear was perceived immediately or only at the end of the surgery, and the location of and reason for the tear, if identified. Results A total of 210 surgeries were included, 87 of which presented perforations, with 17 cases occurring in both gloves and 70 only in the outer glove. Finally, there was a more significant relationship with open focus surgeries and duration > 60 minutes. Conclusion Our results suggest that greater care and inspection of gloves to look for damage are needed in prolonged surgeries with an open focus.

Resumo Introdução Cirurgias ortopédicas apresentam a possibilidade de perfuração das luvas, que pode chegar a 56,8%, relacionada principalmente à manipulação de instrumentos cortantes. O tratamento de fraturas e cirurgias de trauma apresenta risco adicional pelo contato com espiculas ósseas. Objetivo Análise da prevalência de perda de integridade das luvas cirÚrgicas em procedimentos ortopédicos de trauma, principalmente fraturas, avaliando a exposição do cirurgião e o contato com secreções provenientes do paciente. Métodos Inspeção macroscópica das luvas de dois cirurgiões especializados em trauma, durante um período de 4 meses. Ambos usaram duas luvas para todos os procedimentos e, ao término da cirurgia, analisaram a presença ou ausência de manchas de sangue nas luvas internas e/ou nos dedos. Os procedimentos foram categorizados quanto ao tempo e tipo de cirurgia. A intercorrência investigada foi a perfuração de uma ou duas luvas; se a perfuração foi percebida imediatamente ou apenas ao final da cirurgia, e qual o local e o motivo do rasgo, se identificado. Resultados Foram incluídas 210 cirurgias, das quais 87 apresentaram perfurações, sendo 17 casos em ambas as luvas e 70 apenas na luva externa. Um total de 27,5% dos danos foram descobertos apenas no final da cirurgia; os rasgos se concentraram no indicador esquerdo em 62,5% dos casos. Por Último, houve uma relação mais significativa com cirurgias de foco aberto e com duração superior a 60 minutos. Conclusão O nosso resultado sugere que em cirurgias prolongadas e com foco aberto, é necessário maior cuidado e inspeção à procura de danos nas luvas.

Construction and evaluation of 3D printing simulation model for lumbar surgery / 中国组织工程研究

BACKGROUND: 3D printed bone model was widely used in clinical teaching and simulated surgery training, but it did not pay enough attention to the construction of soft tissue, and the simulation was poor, which cannot reflect the soft tissue exposure process. OBJECTIVE: To explore the feasibility of constructing a simulated lumbar spine surgery model based on 3D printing technology for the training of lumbar pedicle screw placement in junior orthopedic surgeons. METHODS: The solid model of the lumbar spine was printed at the same proportion based on 3D printing technology, and the model of simulated lumbar spine surgery was constructed with plasticine and cloth. Thirty orthopedic residents performed lumbar pedicle screw placement alone on the simulated model, and performed once a day for 10 consecutive days. They recorded the operation time, and evaluated the accuracy of screw placement by postoperative CT scan. By comparing the operation time and screw placement accuracy of the operators in the early stage (the first 5 times) and the later stage (the last 5 times), all above parameters were statistically analyzed. This study was approved by the Ethics Committee of Zigong Fourth People's Hospital. RESULTS AND CONCLUSION: (1) In the early stage (the first 5 times), the average operation time was (100. 00+12. 67) minutes. In the later stage (the last 5 times), the average operation time was (83. 50+10. 14) minutes, and the difference was statistically significant (f=20. 67, P=0. 00). (2) The success rate of former screw placement (including grade I and II screw placement) was 88. 53%, and the failure rate (grade III screw placement) was 11. 47%. The success rate and failure rate of latter screw placement were 97. 47% and 2. 53%, respectively, with statistically significant difference (x2-20. 68, P=0. 00). (3) The simulated model of lumbar spine surgery based on 3D printing technology has high simulation and feasibility, and can be used for the training of lumbar pedicle screw placement in junior orthopedic surgeons.

Metástasis óseas: enfoque ortopédico / Bone metastasis: orthopedic point of view

RESUMEN Fundamento: el cáncer constituye una causa frecuente de morbi-mortalidad a nivel internacional y nacional. Dentro de las formas de presentación se encuentran las metástasis óseas. Objetivo: profundizar los conocimientos de la enfermedad ósea metastásica enfocada en el manejo desde el punto de vista de la especialidad de Ortopedia y Traumatología. Métodos: la búsqueda de la información se realizó en un periodo de tres meses (primero de enero de 2018 al 31 de marzo de 2018) y se emplearon las siguientes palabras: bone metastasis, pathologic fracture, y metastasic bone disease, a partir de la información obtenida se realizó una revisión bibliográfica de un total de 259 artículos publicados en las bases de datos PubMed, Hinari, SciELO y Medline mediante el gestor de búsqueda y administrador de referencias EndNote, de ellos se utilizaron 50 citas seleccionadas para realizar la revisión, de ellas 41 de los últimos cinco años, se incluyeron diez libros. Desarrollo: se describen las metástasis óseas de acuerdo a su aspecto radiográfico en blásticas, líticas y mixtas; así como los principales sitios de origen. Se hace referencia a los principales estadios, con especial énfasis en el riesgo de fractura patológica, para lo que se plasman criterios, que permiten definir la conducta a seguir. Se mencionan las indicaciones y variantes del tratamiento quirúrgico, así como el pronóstico de estos enfermos. Conclusiones: la enfermedad ósea metastásica es un reto para el cirujano ortopédico, tiene indicaciones quirúrgicas específicas y uno de los elementos de más importancia es definir el riesgo de fractura patológica.

ABSTRACT Background: cancer is a common cause of morbidity-mortality affecting many people internationally and nationally. One way of presentation is bone metastases. Objective: to deepen the knowledge about the management of patients suffering from bone metastasis from a point of view of the Orthopedics and Traumatology specialties. Methods: a search of information was carried out in a period of three months (January 1st, 2018 to March 31st, 2018) in the databases PubMed, Hinari, SciELO and Medline through the information locator EndNote by using the words bone metastasis, pathologic fracture, and metastatic bone disease, resulting in a total of 259 articles which 50 of them were selected for the review, 41 of them of the last five years, including ten books. Development: bone metastasis types were described according to radiographic aspects as: litic, blastic and mix, so like the most common origin sites. The main stages were shown, specially the one related to the risk of pathologic fracture, so that criteria were stated to define treatment. Indication and treatment modalities were described, as well as prognostic factors. Conclusions: metastatic bone disease is a great challenge for orthopedic surgeon, there are specific indications for surgery and one of the most important aspects to take in mind is the risk of pathologic fracture.

Ultrasound-Guided Axillary Brachial Plexus Block, Performed by Orthopedic Surgeons / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to assess the effectiveness and complications of an ultrasound-guided axillary brachial plexus block performed by orthopedic surgeons. MATERIALS AND METHODS: From March to May 2017, an ultrasound-guided axillary brachial plexus block was performed on a total of 103 cases of surgery. A VF13-5 transducer from Siemens Acuson X300 was used. The surgical site was included in the range of the anatomic sensory distribution of the blocked nerve, except for the case where an operation time of more than 2 hours was expected due to multiple injuries and the operation of the upper arm. The procedure was performed by 2 orthopedic surgeons in the same method using 50 ml of solution (20 ml of lidocaine HCl in 2%, 20 ml of ropivacaine in 0.75%, 10 ml of normal saline in 0.9%). The success rate of anesthesia induction during surgery, anesthetic induction time, anatomical range of operation, duration of postoperative analgesia and complications were investigated. RESULTS: The results from the 2 practices were similar. The anesthesia was successful in 100 out of 103 patients (97.1%). In these patients, the average needling time was 5.5 minutes (2.5–13.2 minutes), the average induction time to complete anesthesia was 18.4 minutes (5–40 minutes), and the average duration of postoperative analgesia was 402.8 minutes (141–540 minutes). The post-anesthesia immediate complications were dizziness in 1 case, nausea and vomiting in 4 cases, and peri-oral numbness in 2 cases, but surgery was performed without problems. All these 7 cases with complications recovered on the same day. A total of 3 cases failed with anesthesia, and they were treated by an injection with local anesthesia in the operation room in 2 cases and switched to general anesthesia in 1 case. CONCLUSION: An ultrasound-guided axillary brachial plexus block, which was performed by orthopedic surgeons allows anesthesia in a brief period and the high success rates of anesthesia for certain surgeries of the elbow and surgeries on forearm, wrist and hand. Therefore, it can reduce the waiting time to the operating room. This technique is a relatively safe procedure and dose selective anesthesia is possible.

¿La imagen importa? Influencia de la vestimenta del traumatólogo en la elección y confianza del paciente / The impact of the orthopedic surgeons' attire on patient preferences

Background: The formal appearance of health care professionals may influence their trustworthiness. Aim: To determine the effect of the orthopedic surgeon's attire on patients' perceptions of credibility and reliability of professionals. Material and Methods: In a cross-sectional design, 351 patients (mean age 43 ± 17 years, 62% males) from the Department of Orthopedics and Traumatology of a Chilean regional hospital in southem of Chile were chosen to complete a questionnaire of attire preferences, in which five photographs with male and female orthopedic surgeons appeared (executive, formal attire, informal attire, scrubs and casual clothing). The influence of attire in the perception of physicians' trustworthiness to resolve medical situations was analyzed. Results: Forty four percent of patients had no physician gender predilection (p = 0.32). Forty three percent of male and 38% of female patients preferred the use of formal attire. In situations of credibility or confidence, all patients chose mostly the use of white coats with formal attire by professionals. The probability of choosing an orthopedic surgeon with a formal attire was significantly higher among patients who considered the attire and appearance of the professional to be very important (Odds ratio = 3.74; p < 0.01). Conclusions: Patients prefer orthopedic surgeons wearing white coats and formal attire, which improves credibility of these professionals to correctly solve medical situations.

Variations in Practice Patterns among Neurosurgeons and Orthopaedic Surgeons in the Management of Spinal Disorders

STUDY DESIGN: This is a case series. PURPOSE: We wanted to identify variations in the practice patterns among neurosurgeons and orthopedic surgeons for the management of spinal disorders. OVERVIEW OF LITERATURE: Spinal disorders are common in the clinical practice of both neurosurgeons and orthopedic surgeons. It has been observed that despite the availability of various guidelines, there is lack of consensus among surgeons about the management of various disorders. METHODS: A questionnaire was distributed, either directly or via e-mail, to the both the neurosurgeons and orthopedic surgeons who worked at 5 tertiary care centers within a single region of Korea. The surgeons were working either in private practice or in academic institutions. The details of the questionnaire included demographic details and the specialty (orthopedic/neurosurgeon). The surgeons were classified according to the level of experience as up to 5 years, 6-10 years and > 10 years. Questions were asked about the approach to lumbar discectomy (fragmentectomy or aggressive disc removal), using steroids for treating discitis, the fusion preference for spondylolisthesis, the role of an orthosis after fusion, the preferred surgical approach for spinal stenosis, the operative approach for spinal trauma (early within 72 hours or late > 72 hours) and the role of surgery in complete spinal cord injury. The data was analyzed using SPSS ver 16. p-values < 0.05 were considered to be significant. RESULTS: Of the 30 surgeons who completed the questionnaire, 20 were neurosurgeons and 10 were orthopedic surgeons. Statistically significant differences were observed for the management of spinal stenosis, spondylolisthesis, using an orthosis after fusion, the type of lumbar discectomy and the value of surgical intervention after complete spinal cord injury. CONCLUSIONS: Our results suggest that there continues to exist a statistically significant lack of consensus among neurosurgeons and orthopedic spine surgeons when considering using an orthosis after fusion, the type of discectomy and the value of intervention after complete spinal injury.