Application of modern rehabilitation techniques combined with external application of Traditional Chinese Medicine in the treatment of knee stiffness / 国际中医中药杂志

Objective:To explore the clinical efficacy of modern rehabilitation techniques combined with Traditional Chinese Medicine (TCM) external application in the treatment of knee stiffness.Methods:Prospective cohort study. A total of 80 patients with knee stiffness meeting the entry criteria admitted to the People's Hospital of Bozhou from January 2019 to December 2021 were selected and divided into the observation group ( n=40) and the control group ( n=40) according to the random ball touching method. Both groups were given routine physiotherapy. The control group was treated with TCM external application on the basis of the physiotherapy, and the observation was treated with modern rehabilitation techniques on the basis of the treatment of the control group. The goniometer was used to measure the knee flexion and extension before and after treatment, and the VAS scale was used to assess the knee pain. Fug l-Meyer motor function score was used to evaluate lower extremity motor function. Results:After treatment, the knee flexion [(96.43 ± 4.63) ° vs. (89.58 ± 4.67) °, t=6.59] in the observation group was higher than that of the control group ( P<0.01), and the extension [(8.32 ± 2.03) ° vs. (11.69 ± 2.37) °, t=6.83] in the control group was lower than that of the control group ( P<0.01); VAS score (2.06 ± 0.49 vs. 3.65 ± 0.76, t=11.12) was lower than that of the control group ( P<0.01), and Fugl Meyer motor function score (28.97 ± 3.76 vs. 20.43 ± 3.04, t=11.17) was higher than that of the control group ( P<0.01). Conclusion:The application of modern rehabilitation techniques combined with TCM external application in the treatment of knee stiffness can improve the range of motion of the knee joint, reduce the VAS score of pain, and improve the motor function.

Standardization of the Radiographic Study of the Foot Using the Niza Box / Padronização do estudo radiográfico do pé pela caixa Niza

Abstract Objective This study proposes the Niza box, a device created to reduce interpretive errors among professionals and facilitate the correct positioning of structures by standardizing orthopedic radiography of the foot in anteroposterior, loaded, and Saltzman views. Methods Descriptive study based on material collected at an Orthopedics Ambulatory from a tertiary service in a large Brazilian city. The X-ray device was a Lotus X, model HF 500 M, 500 milliamperes and 125 kilovolts capacity, 100 cm focus-film distance, and 24 × 30 cm radiographic chassis. Device controls were set at 100 mA, 5 mA/sec, and 60 kilovolts, depending on the variable size of the foot. The same team of previously trained radiography technicians performed the tests under the authors' supervision. The chassis were positioned in three specific Niza box spaces per the proposed incidence. Data from 50 images from people between 18 and 70 years old were analyzed. Results Radiographs taken using the proposed device usually had a satisfactory quality, allowing correct identification of the anatomical elements of the foot and ankle and angular reconstruction. Small image variations due to foot size were acceptable and expected, allowing radiograph standardization. Conclusion The Niza box is a good method for minimizing interference and avoiding radiographic interpretation errors, providing quality and agility to the examination, and reducing cost and unnecessary repetitions. It is an innovative, low-cost device made of recyclable and biodegradable material.

Resumo Objetivo Este estudo propõe a utilização da Caixa Niza, dispositivo criado com a finalidade de diminuir os erros interpretativos entre profissionais e facilitar o correto posicionamento das estruturas radiografadas ao padronizar as incidências radiográficas ortopédicas do pé anteroposterior, perfil com carga e Saltzman. Métodos Pesquisa descritiva, material coletado em Ambulatório de Ortopedia em serviço terciário de cidade brasileira de grande porte. Utilizado aparelho de radiografia marca Lotus X, modelo HF 500M, capacidade de 500 miliamperes e 125 quilovolts, distância foco-filme de 100cm, chassi radiográfico 24×30 cm e os comandos do aparelho ajustados para 100 mA, 5mA/seg e 60 quilovolts dependendo do tamanho variável dos pés. Exames realizados pela mesma equipe de técnicos em radiografia previamente treinados com supervisão dos autores. O chassi é posicionado em três espaços específicos da Caixa conforme a incidência proposta. Foram analisados dados de 50 imagens de pessoas entre 18 e 70 anos. Resultados A avaliação das radiografias após utilização do dispositivo proposto ocorreu de modo geral com qualidade satisfatória, permitindo correta identificação dos elementos anatômicos do pé e tornozelo e reconstrução angular. Pequenas variações nas imagens devido ao tamanho dos pés são aceitáveis e esperadas, sendo possível perceber padronização das radiografias. Conclusão A Caixa proposta se mostra um bom método de minimizar as interferências e evitar erros de interpretação radiográfica, proporcionando qualidade e agilidade ao exame, diminuindo custo e repetições desnecessárias. É inovador, um dispositivo de baixo custo, de material reciclável e biodegradável.

Effects of bariatric surgery on knee joint pain / Efeitos da cirurgia bariátrica na dor da articulação do joelho

ABSTRACT The World Health Organization (WHO) estimates that by 2025 about 2.3 billion adults will be overweight, with more than 700 million obese. Obese patients with joint pain and reduced physical function represent a challenging group to treat effectively. Objective: To evaluate patients undergoing bariatric surgery and the implications of this surgery on knee joint pain and to conduct anamnesis and apply specific questionnaires to deepen the discussion and elucidate the knee joint symptoms related to obesity. Methods: Observational cross-sectional study with tabulation and analysis of collected data. Results: We obtained a significant result when comparing knee pain pre and post-surgery, in which pain increased by 15.8%. Conclusion: Although worsening or maintenance of pain may occur, this fact is associated to factors such as the increase of functional activities of a joint that was previously in disuse and the loss of muscle mass as a sustainer. We concluded that the improvement of joint pain complaints were mainly due to the reduction of joint overload. Level of Evidence IV, Case Series.

RESUMO A estimativa da Organização Mundial da Saúde é que, em 2025, cerca de 2,3 bilhões de adultos estarão com excesso de peso e, destes, mais de 700 milhões com obesidade. Pacientes obesos com dor nas articulações e função física reduzida representam um grupo desafiador para o tratamento efetivo. Objetivo: Avaliar pacientes submetidos à cirurgia bariátrica e as implicações dessa cirurgia na dor da articulação do joelho, assim como realizar anamnese e aplicação de questionários específicos para aprofundar a discussão e elucidar os sintomas articulares no joelho relacionados à obesidade. Métodos: Estudo transversal observacional com tabulação e análise de dados coletados. Resultados: Obteve-se um resultado significativo na comparação da dor no joelho pré e pós-cirurgia, havendo um aumento da dor de 15,8%. Conclusão: Ainda que resultados de piora ou manutenção da dor possam ocorrer, associados ao aumento das atividades funcionais de uma articulação até então em desuso e à perda da massa muscular como sustentador, por exemplo, a maioria dos participantes relatou melhora das queixas álgicas articulares, principalmente em decorrência da diminuição da sobrecarga articular. Nível de Evidência IV, Série de Casos.

Joint injuries in martial arts and their preventive measures / Lesões articulares nas artes marciais e suas medidas preventivas / Lesiones articulares en las artes marciales y sus medidas preventivas

ABSTRACT Introduction: Martial arts athletes are highly prone to joint injuries during training or sports events. These injuries can affect professional performance and cause deleterious psychological damage to athletes. Objective: Explore the current status of joint injuries in martial arts and propose effective preventive measures. Methods: Martial arts athletes were selected to evaluate the types of joint injuries and the method of training in rehabilitating these injuries (n=32). They were randomly divided into an experimental group and a control group. The experimental group received a specific functional preventive training protocol based on updated scientific findings, while the control group received traditional physical training. Range of motion and functional FMS tests were performed before and after the interventions. The results were compared statistically. Results: The most common type of injury for athletes in martial arts is joint injury, followed by ligament and synovial inflammation. The probability of a joint injury rises when athletes are in continuous action training; the FMS test results of the athletes in the experimental group were significantly improved, with a very significant effect. Conclusion: The preventive functional training proposed in this paper can improve athletes' fitness, improve coordination and joint stability, and prevent sports injuries. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução: Os atletas de artes marciais são altamente propensos a lesões articulares durante o treinamento ou em eventos esportivos. Essas lesões podem afetar o desempenho profissional, além de causar danos psicológicos deletérios aos atletas. Objetivo: Explorar a condição atual das lesões articulares nas artes marciais propondo medidas preventivas eficazes. Métodos: Atletas de artes marciais foram selecionados para avaliar os tipos de lesões articulares e o método do treinamento na reabilitação dessas lesões (n=32). Eles foram divididos aleatoriamente em grupo experimental e grupo de controle. O grupo experimental recebeu um protocolo específico de treinamento preventivo funcional baseado nos achados científicos atualizados, enquanto o grupo controle recebeu o treinamento físico tradicional. Foram efetuados os testes de amplitude de movimento e FMS funcional antes e após as intervenções. Comparou-se os resultados estatisticamente. Resultados: O tipo de lesão mais comum dos atletas nas artes marciais é a lesão articular, seguida da ligamentar e a inflamação sinovial. A probabilidade de uma lesão articular eleva-se quando os atletas estão em treinamento de ação contínua; os resultados do teste FMS dos atletas do grupo experimental foram significativamente melhorados, com um efeito muito significativo. Conclusão: O treinamento funcional preventivo proposto neste trabalho pode efetivamente melhorar a aptidão física dos atletas, melhorar a coordenação e estabilidade das articulações, prevenindo as lesões esportivas. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

Resumen Introducción: Los atletas de artes marciales son muy propensos a sufrir lesiones articulares durante los entrenamientos o las pruebas deportivas. Estas lesiones pueden afectar al rendimiento profesional, además de causar daños psicológicos deletéreos a los deportistas. Objetivo: Explorar la situación actual de las lesiones articulares en las artes marciales proponiendo medidas preventivas eficaces. Métodos: Se seleccionaron atletas de artes marciales para evaluar los tipos de lesiones articulares y el método de entrenamiento en la rehabilitación de estas lesiones (n=32). Se dividieron aleatoriamente en grupo experimental y grupo de control. El grupo experimental recibió un protocolo específico de entrenamiento funcional preventivo basado en hallazgos científicos actualizados, mientras que el grupo de control recibió entrenamiento físico tradicional. Se realizaron pruebas de amplitud de movimiento y de FMS funcional antes y después de las intervenciones. Los resultados se compararon estadísticamente. Resultados: El tipo de lesión más común en los deportistas de artes marciales es la lesión articular, seguida de la inflamación de ligamentos y sinovial. La probabilidad de una lesión articular aumenta cuando los deportistas realizan un entrenamiento de acción continua; los resultados de las pruebas FMS de los deportistas del grupo experimental mejoraron significativamente, con un efecto muy significativo. Conclusión: El entrenamiento funcional preventivo propuesto en este trabajo puede mejorar eficazmente la forma física de los deportistas, mejorar la coordinación y la estabilidad de las articulaciones, previniendo las lesiones deportivas. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Design, sensitivity and validity of wrist patient self-evaluation instrument / 中华骨科杂志

Objective:To design a patient self-rating wrist scale suitable for Chinese patients, and evaluate its reliability and validity.Methods:The primary entry pool was established by referring to the existing foreign scales and the opinions of domestic experts. Opinions of 11 hand surgeons and 10 patients with wrist diseases were referred to select better items into the primary scale. During September 2015 to November 2016, 100 inpatients with wrist diseases in the hand surgery department of Beijing Jishuitan Hospital were selected by convenient sampling method, and the primary scale was conducted on them. Eight indices including item response rate, item differentiation, item-dimension attribution, variability, responsiveness, overall item attribution, internal consistency and factor loading were summarized. All the 8 indices were evaluated to establish the wrist patient self-evaluation instrument for Chinese. Test-retest reliability, Cronbach coefficient, expert score, KMO value, explanatory power, χ 2/df, root mean square error of approximation (RMSEA) and comparative fit index (CFI) were used to evaluate the reliability and validity of the scale. Results:A total of 40 subjective items in the primary entry pool were selected to form the primary scale, including 32 items (A1-D4), and 4 dimensions (physiology, safety, pain and emotion). There were 92 valid scale results in 100 cases. All cases' response rate were over 90%. In terms of item differentiation, only the high grouping score [3.20±0.577 points (range, 1-3 points)] and the low grouping score [2.68±0.627 points (range, 2-5 points)] of item B10 had no statistical significance ( t=5.11, P=0.340). There were 17 items: A1, A2, A5, A6, A7, A8, A9, A10, A11, A12, B4, B6, B7, C5, D1, D2, and D3 were considered to be deleted according to the result of item-dimension attribution. A total of 11 items had a variation less than 0.65: A4 (0.645), A7 (0.593), B1 (0.590), B5 (0.617), B8 (0.578), B9 (0.612), B10 (0.526), D1 (0.644), D2 (0.320), D3 (0.169), D4 (0.526). A2, A4, A6, A8, B4, B6, D1, D2, D3, C2, C3, C4, C5, C6 did not meet the reactivity requirements. Items with factor loads less than 0.4: D2 (-0.051), D3 (-0.127), and D4 (0.267). C4 (0.026), C5 (0.023), D1 (0.103), D2 (0.434), D3 (0.387), D4 (0.062) did not meet the internal consistency requirements. In multiple linear regression analysis, 19 items were not included in the final regression equation. Based on the above analysis, D1, D2, and D3 were finally deleted and the rest 29 valid items were remained to form the wrist patient self-evaluation instrument for Chinese. Reliability and validity of the scale: the test-retest reliability of physiology, safety, pain, emotion dimensions were 0.984, 0.976, 0.985 and 0.802 ( P<0.001), respectively. Except for there was only one item in emotion dimension, the Cronbach coefficients of total score, physiology, safety and pain dimensions were 0.943, 0.973, 0.944 and 0.881, respectively. KMO was 0.894 ( P<0.001). Except for there was only one item in emotion dimension, whose validity could not be evaluated. The χ 2/df, CFI, RMSEA results were as follows, physiology: 5.152, 0.817, 0.022, respectively; safety: 5.378, 0.795, respectively; pain: 7.439, 0.865, 0.028, respectively. Conclusion:The wrist patient self-evaluation instrument for Chinese is consisted of 4 dimensions and 29 items. As a subjective wrist self-rating scale suitable for modern Chinese patients, the scale has good reliability and validity, and can be one of the choices of the subjective evaluation for Chinese patients with wrist diseases.

Reconstruction of the calcaneocuboid and calcaneonavicular ligaments with the autologous semitendinosus in patients with chronic bifurcate ligament injury / 中华创伤骨科杂志

Objective:To explore the clinical efficacy of reconstructing the calcaneocuboid and calcaneonavicular ligaments with the autologous semitendinosus for chronic bifurcate ligament injury.Methods:A retrospective study was conducted to analyze the clinical data of 12 patients with chronic bifurcate ligament injury who had been treated by anatomical reconstruction with the autologous semitendinosus from March 2018 to January 2021 at Department of Foot and Ankle Surgery, The Fourth Hospital of Wuhan. There were 4 males and 8 females with an age of (41.4±9.6) years. Seven left and 5 right feet were affected; the time from injury to surgery was (9.3±4.3) months. The surgical efficacy was evaluated based on anteroposterior and lateral imaging assessments of foot weight-bearing at 6 months postoperation, comparison of the visual analogue scale (VAS) pain scores for foot weight-bearing walking and the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scores between preoperation and the last follow-up, stress test for stability of the transverse tarsal joint, recovery of movement, and occurrence of complications.Results:All patients were followed up for (18.4±4.0) months. Their sports activities were completely resumed after postoperative (6.8±3.9) months. Primary wound healing was achieved in all patients. One patient suffered from cutaneous nerve lesion and skin numbness, the symptoms of which disappeared after conservative treatment. Double harmonic curves were observed on the anteroposterior and lateral imaging films of foot weight-bearing in all patients. The spaces in the calcaneocuboid and the calcaneonavicular joints were normal, the articular positions were matched, and the calcaneocuboid joint was stable without recurrence or worsening of displacement. The VAS decreased significantly from preoperative 6.5 (5.6, 7.0) to 0.0 (0.0, 1.0) at the last follow-up, and the AOFAS mid-foot score increased significantly from preoperative (55.6±8.8) points to (92.3±2.6) points at the last follow-up ( P<0.05). The stress test for the stability of the transverse tarsal joint showed joint stability. Conclusion:Reconstruction of the calcaneocuboid and calcaneonavicular ligaments using the autologous semitendinosus is an alternative treatment for patients with chronic bifurcate ligament injury, because it can restore the stability of the bifurcate ligament and obviously improve the foot and ankle functions with limited postoperative complications.

Precise flap surgery for reconstruction of knee defects / 中华创伤骨科杂志

Objective:To introduce the concept and procedures of precise flap surgery in construction of knee defects and to report the preliminary clinical outcomes.Methods:The data of 16 patients with knee defects at 17 sides were retrospectively analyzed who had been treated under the guidance of the concept of precise flap surgery at Department of Orthopedic Surgery, The 920th Hospital of Joint Logistic Support Force of PLA from August 2014 to March 2022. There were 12 males and 4 females, aged 44(34, 54) years. The wounds were at the left side in 8 cases, at the right side in 7 ones and at bilateral sides in one, and their sizes ranged from 5 cm×3 cm to 15 cm×11 cm. The time from injury to surgery was 8.5(6.0, 13.0) days. Optimal repair protocols were chosen after the donor and recipient sites were evaluated according to the methods of precise flap surgery: a retrograde anterolateral thigh flap in 7 sides, a descending genicular artery perforator flap in 3 ones, a saphenous artery flap in 2 ones, and a superior genicular lateral artery perforator flap, a popliteal artery perforator flap, a medial sural perforator propeller flap, a peroneal artery perforator propeller flap, and a randomized flap in one, respectively. The flap sizes ranged from 10 cm×6 cm to 15 cm×15 cm. The outcomes and complications of skin flap repair, and functional recovery of the affected limb were recorded.Results:All the flaps at 17 sides survived after surgery; 3 cases developed distal edge necrosis which responded to dressing change. The follow-ups for the 16 patients were 14.5(10.0, 28.0) months. All the flaps presented with good color, texture and contour. Flap bulking, local osteomyelitis, and scar ulcer was found in one case respectively. According to the revascularization assessments in the digital replantation criteria by Hand Surgery Society, Chinese Medical Association, all the flaps at 17 sides were excellent. Accoding to the knee functional evaluation of Hospital for Special Surgery (HSS) at the last follow-up, the 17 affected limbs scored 86(80,91) points, yielding 9 excellent, 7 good and 1 fair sides.Conclusion:Although the defects and donor sites around the knee vary greatly, precise flap surgery may lead to effective control of the variations, choice of an optimal reconstruction protocol, and precise wound repair.

Espondilitis anquilosante. Presentación de caso

La espondilitis anquilosante es una enfermedad sistémica caracterizada por inflamación del esqueleto axial, las grandes articulaciones periféricas y los dedos, así como dolor, rigidez de la espalda y manifestaciones a otros niveles del organismo como puede ser en el ojo. Se presenta el caso de una paciente de 46 años de edad que acudió al Hospital Gustavo Aldereguía Lima, de Cienfuegos, por dolor lumbar y sintomatología urinaria refractaria a terapéutica habitual, por lo cual fue ingresada para estudio. Fue evaluada según su cuadro clínico y a través del empleo de exámenes complementarios, lo que permitió el diagnóstico de una espondilitis anquilosante. Se le impuso tratamiento con antinflamatorios no esteroideos y fue dada de alta médica con seguimiento por su área de salud. Por lo importante que resulta confirmar el diagnóstico temprano, antes de que ocurran deformidades irreversibles y así evitar secuelas e impotencia en los pacientes que la padecen, con lo cual se les garantiza una mayor calidad de vida, se decidió la presentación de este caso.

Ankylosing spondylitis is a systemic disease characterized by inflammation of the axial skeleton, large peripheral joints, and fingers, as well as pain, stiffness of the back, and manifestations at other levels of the body, such as the eye. We present the case of a 46-year-old patient who attended the Gustavo Aldereguía Lima Hospital, in Cienfuegos, due to lumbar pain and urinary symptoms refractory to usual therapy, for which she was admitted for study. She was evaluated according to her clinical picture and through the use of complementary tests, which allowed the diagnosis of ankylosing spondylitis. Treatment with non-steroidal anti-inflammatory drugs was prescribed and she was discharged with follow-up by her health area. Due to the importance of confirming the early diagnosis, before irreversible deformities occur and thus avoiding sequelae and impotence in patients who suffer from it, to guarantee them a better quality of life, it was decided to present this case.

Fracturas de la base del quinto metatarsiano: ¿es útil mi tornillo de esponjosa con rosca parcial? Experiencia de 10 años / Fractures of the base of the fifth metatarsal bone: is my partially-threaded cancellous screw useful? 10-year experience

OBJETIVO Evaluar el resultado quirúrgico de fracturas de las zonas 2 y 3 de la base del quinto metatarsiano usando tornillos de esponjosa de diámetro de 4,0 mm con rosca parcial. MATERIALES Y MÉTODOS Evaluación retrospectiva de pacientes operados entre 2010 a 2019. Incluimos todos los casos sintetizados con este dispositivo con seguimiento mínimo de tresmeses, y excluimos casos operados con otros dispositivos y seguimiento menor a tres meses. Evaluamos la consolidació n y la presencia de complicaciones. Determinamos el largo del tornillo, el diámetro del canal endomedular, la distancia entre el borde proximal de la tuberosidad y la fractura, y la distancia de paso de la rosca sobre el rasgo de la fractura en radiografías anteroposterior (AP) y oblicua del pie. RESULTADOS Evaluamos 39 casos, y la muestra tenía una edad promedio de 27 años, y predominio del sexo masculino. El largo de tornillo más usado fue el de 45 mm, y los diámetros promedios del canal endomedular medidos en las radiografías AP y oblicua fueron de 4,6 mm y 3,96 mm, respectivamente. La distancia del borde de la tuberosidad hasta la fractura fue de 25,8 mm, y la distancia de paso de la rosca sobre el rasgo de la fractura fue en promedio de 24 mm. Hubo 100% de consolidación, en un promedio de 9,4 semanas, y 3 casos de retardo de consolidación, 2 de retroceso de tornillo, 1 de rosca intrafoco, y 1 de fractura cortical superior. No hubo retiros de tornillos a la fecha. DISCUSION No existe consenso respecto al tornillo ideal. La literatura internacional recomienda dispositivos intramedulares de diámetro de al menos 4,5 mm. Existen pocos reportes del uso de tornillos de diámetro de 4,0 mm. CONCLUSIONES El tornillo de esponjosa de diámetro de 4,0 mm con rosca parcial es una alternativa eficaz, segura y con baja tasa de complicaciones para el manejo de estas fracturas en nuestra población.

OBJETIVE To evaluate the surgical result of zone-2 and -3 fractures of the base of the fifth metatarsal bone using partially-threaded cancellous screws with a diameter of 4.0 mm. MATERIALS AND METHODS A retrospective evaluation of patients submitted to surgery between 2010 and 2019. We included all of the cases synthesized with this device with a minimum follow-up of three months, and excluded the cases operated on with other devices and follow-up shorter than three months. We evaluated the consolidation and the presence of complications, and determined, screw length, diameter of the endomedullary canal, the distance between the proximal edge of tuberosity and the fracture, and thread pitch over the fracture line on anteroposterior (AP) and oblique radiographs. RESULTS We evaluated 39 cases, and the sample had an average age of 27 years and male predominance. The most used screw length was 45 mm, and the average diameters of the medullary canal measured on the AP and oblique radiographs were of 4.6 mm and 3.96 mm respectively. The distance from the edge of the tuberosity to the fracture was of 25.8 mm, and the thread pitch over the fracture line was on average 24 mm. The rate of consolidation was of 100%, occurring in an average of 9.4 weeks, and there were 3 cases of consolidation delay, 2 of screw recoil, 1 of intrafocus thread, and 1 of superior cortex fracture. To date, there have been no cases of screw removal. DISCUSSION There is no consensus regarding the ideal screw. The international literature recommends intramedullary devices with a diameter of at least 4.5 mm. There are few reports of the use of screws with 4.0 mm in diameter. CONCLUSIONS The partially-threaded cancellous screw with a diameter of 4.0 mm is an effective and safe option, with a low complication rate for the management of these fractures.

Fraturas do esqueleto apendicular e critérios de manejo cirúrgico: ensaio iconográfico / Fractures of the appendicular skeleton and criteria for their surgical management: pictorial essay

Resumo A elevada prevalência de fraturas e o importante papel dos exames de imagem nesse contexto requerem que o radiologista esteja familiarizado com seus principais padrões, especialmente as fraturas com manejo essencialmente cirúrgico. Este estudo apresenta uma série de casos ilustrativos e uma breve revisão da literatura, com o objetivo de demonstrar algumas das principais fraturas do esqueleto apendicular com manejo cirúrgico, agrupadas didaticamente por articulação. Foram selecionadas radiografias e tomografias computadorizadas de casos didáticos ilustrativos do arquivo de imagens do nosso serviço.

Abstract The high prevalence of fractures and the essential role that imaging examinations play in this scenario require the radiologist to be familiar with their main patterns, especially those of fractures for which the management is essentially surgical. This pictorial essay presents a series of illustrative cases and a brief review of the literature, the aim being to demonstrate some of the main fractures of the appendicular skeleton that require surgical management, grouped, didactically, by the joint affected. Radiographic and computed tomography studies of illustrative cases were selected from the imaging archives of our facility.

Artrogriposis múltiple congénita. Caso clínico

RESUMEN La artrogriposis múltiple congénita es una enfermedad de baja frecuencia, esporádica, no progresiva, que aparece en el período prenatal y se caracteriza por varias contracturas articulares presentes al nacimiento en los cuatro miembros. Se estima una incidencia de 1/10 000 nacidos vivos. El diagnóstico es posible al realizar los ultrasonidos en un feto que tiene posiciones viciosas y que no se mueve. La prevalencia de la artrogriposis múltiple congénita es variable, resultando la más frecuente la artrogriposis múltiple clásica (amioplasia), presente entre el 40 y el 50 % de los afectados. La búsqueda ultrasonográfica en el tercer trimestre del embarazo es fundamental con fines diagnósticos, para brindar asesoramiento genético y preparar un equipo para el nacimiento. Es importante tener sospecha diagnóstica para sugerir la vía alta por cesárea, para bienestar fetal. Un grupo multidisciplinario debe llevar a cabo el manejo y tratamiento de estos enfermos. Se presenta el caso de un neonato nacido a las 39 semanas por parto eutócico prolongado por presentación de cara, con sufrimiento fetal agudo, meconio ++++, apgar 5-7, con peso de 3 300 g, que presentó luxación y contractura generalizada de hombros, codos, así como de caderas, rodillas y tobillos, con dedos de manos y pies en flexión.

ABSTRACT Congenital multiple arthrogryposis is a low-frequency, sporadic, non-progressive disease that appears in the prenatal period, and is characterized by several contractures present at birth in the four limbs. The estimated incidence is 1/10 000 born alive. The diagnosis is possible performing ultrasounds on a fetus that has vicious positions and does not move. The prevalence of congenital multiple arthrogryposis is variable, being classical multiple arthrogryposis (amyoplasia) the most frequent one, present in between 40 and 50 % of the affected persons. Ultrasonographic search in the third semester of pregnancy is essential for diagnostic purposes to provide genetic counseling and to prepare a ream for birth. It is important to have diagnostic suspicion to suggest the high cesarean way for fetal well-being. A multidisciplinary group should carry out the management and treatment of these patients. The case of a newborn is presented, who was born at 39 weeks by prolonged eutocic delivery due to presenting face, with acute fetal suffering, meconium ++++, apgar 5-7, weighing 3 300 g, that presented luxation and general contracture of shoulders, elbows, and also hips, knees and ankles, with fingers and toes in flexion.

Does range of motion measurement and reference values differ?: a multi-centered study

This study is aimed to estimate and measure reference values in the normal range of motion of extremity joints in females and to provide a database for the assessment of impairments related to the mobility of the joints. This observational cross-sectional study was conducted at seven major educational institutes areas of Rawalpindi and Islamabad in Pakistan from January to June 2020 with a sample size of 600 healthy females aged 15 to 45 years and divided into three groups through non-probability sampling technique. In study Instruments, an electronic Goniometer was used for the measurement of the range of motions for different joints and then those ranges were recorded. The questionnaire had two sections demographic characteristics and ROM for both upper and lower limbs. Data was analyzed using SPSS V21. A p < 0.05 was considered statistically significant.In the result,Out of 600 participants,there was a statistically significant difference of (p < 0.001) in both upper and lower extremities motion between all the three groups for the measurements and noticeably no significant difference (p > 0.005) between group 1, 2 comparisons for the knee joint extension.To conclude, In most joints, the range of motion increases with age. The transition from group 1 to group 2 was aided by increased hormone participation in growth, an active lifestyle, and generally good health. Because of degenerative changes and joint stiffness, group 3's range of motion deteriorated, leading to a sedentary lifestyle and lack of physical activity. Standardized biomechanical measurements can help health practitioners, such as physiotherapists, choose appropriate therapy interventions to assess musculoskeletal disorders. To resolve the inconsistencies in the reliability and validity of goniometry values, more research is required.

Movable surface models of hand joints using visible korean / Modelos de superficies móviles de articulaciones de manos utilizando visible Korean

SUMMARY: The human hand can make precise movements utilizing several joints of various articular types. To understand hand movements more accurately, it is essential to view the actual movements of bones and muscles considering the X, Y, and Z axes in the joints. This study aimed to investigate the joint movements in a hand using movable surface models, including these axes. These movable surface models of the hand will improve medical students' understanding of hand movements around the joints. To achieve this aim, 70 surface models were adopted from a Visible Korean model. Using Maya software, 20 virtual joints with X, Y, and Z axes included nine distal and proximal interphalangeal joints, five metacarpophalangeal joints, five carpometacarpal joints, and one wrist joint were created. Bone surface models were elaborately polished to maintain their original shape during movement. Muscle surface models were also processed to display the deformation of the muscle shape during movement. The surface models of the hand joints were moved by virtual control of the joints. We saved 87 movable surface models of the hand, including bones, muscles, and joint axes in stereolithography format, and compiled a Portable Document Format (PDF) file. Using the PDF file, the joint movements in a hand could be observed considering the X, Y, and Z axes alongside the stereoscopic shapes of the bones and muscles. These movable surface models of the hand will improve medical students' understanding of hand movements around the joints.

RESUMEN: La mano humana puede realizar movimientos precisos utilizando varias articulaciones de diferentes tipos articulares. Para comprender los movimientos de las manos con mayor precisión, es esencial ver los movimientos reales de los huesos y los músculos considerando los ejes X, Y y Z de las articulaciones. Este estudio tuvo como objetivo investigar los movimientos articulares en una mano utilizando modelos de superficies móviles, incluidos estos ejes. Estos modelos de superficie móvil de la mano mejorarán la comprensión de los estudiantes de medicina de los movimientos de la mano alrededor de las articulaciones. Para lograr este objetivo, se adoptaron 70 modelos de superficie de un modelo coreano visible. Con el software Maya, se crearon 20 articulaciones virtuales con ejes X, Y y Z que incluyeron nueve articulaciones interfalángicas distales y proximales, cinco articulaciones metacarpofalángicas, cinco articulaciones carpometacarpianas y una articulación de muñeca. Los modelos de superficie ósea se pulieron minuciosamente para mantener su forma original durante el movimiento. También se procesaron modelos de superficie muscular para mostrar la deformación de la forma del músculo durante el movimiento. Los modelos de superficie de las articulaciones de las manos se movieron mediante el control virtual de las articulaciones. Guardamos 87 modelos de superficies móviles de la mano, incluidos huesos, músculos y ejes articulares en formato de estereolitografía, y compilamos un archivo en formato de documento portátil (PDF). Usando el archivo PDF, los movimientos de las articulaciones en una mano se pueden observar considerando los ejes X, Y y Z junto con las formas estereoscópicas de los huesos y músculos. Estos modelos de superficie móvil de la mano mejorarán la comprensión de los estudiantes de medicina sobre los movimientos de la mano alrededor de las articulaciones.

Research progress in application of neutrophil to lymphocyte ratio in bone and joint injury and related complications / 中华创伤骨科杂志

The neutrophil-to-lymphocyte ratio (NLR), the ratio of inflammatory cell counts in the blood, reflects the changes of neutrophils and lymphocytes in the inflammatory system in the peripheral blood. More and more scholars have found that NLR increases in patients with bone and joint injury, which can be used to predict postoperative mortality, infection, deep vein thrombosis, pain and other complications. This article is intended to review the application of NLR in bone and joint injury and related complications, providing reference for clinical application of NLR.

Selective column arthrodesis based on three-column theory for malunion of Lisfranc injury / 中华创伤骨科杂志

Objective:To investigate the mid-term clinical outcomes of selective column arthrodesis based on the three-column theory in the treatment of malunion of Lisfranc injury.Methods:The 28 patients with malunion of Lisfranc injury were analyzed retrospectively who had been treated by selective column arthrodesis at Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine from January 2011 to January 2020.They were 18 males and 10 females, with an average age of 37.2 years(from 18 to 65 years). Twelve left and 16 right sides were affected. According to Myerson's three-column classification, one case was medial column injury (type A), 4 ones middle column injury (type B), 7 ones medial plus middle columns injury and 16 ones three-column injury. Medial column arthrodesis was conducted in 7, middle column arthrodesis in 4 and medial plus middle columns arthrodesis in 17. The American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score and visual analogue scale (VAS) were compared between preoperation and the last follow-up to evaluate the improvements in foot function and pain. The operation-related complications were recorded.Results:All patients were followed up for an average of 35.6 months (from 18 to 60 months). The AOFAS midfoot score increased from 43.1±4.1 at pre-operation to 84.1± 7.4 at the last follow-up and the VAS score decreased from 5.7±1.3 at pre-operation to 2.0±0.9 at the last follow-up (both P<0.001). The wounds healed in 28 patients, 3 of whom had postoperative wound exudation but responded to dressing change. There were no such complications as injury to the deep peroneal nerve or deep venous thrombosis. The internal fixation was removed in 5 patients at about one year after arthrodesis. Conclusion:Selective column arthrodesis based on the three-column theory can result in satisfactory med-term clinical outcomes in the treatment of malunion of Lisfranc injury.

Two-stage repair of composite soft tissue defect of dorsal wrist: Free flap transfer followed by transplantation of allogeneic tendon / 中华显微外科杂志

Objective:To explore the clinical effect of a two-staged repair and reconstruction of composite soft tissue defect of dorsal wrist with transfer of free flap (in stage-one) repair and followed by transplantation of allogeneic tendon (in stage-two) reconstruction.Methods:From December 2018 to January 2021, 6 cases with dorsal wrist composite tissue injury and extensor tendon defect were treated in the Department of Hand and Microsurgery of the Fourth People's Hospital of Guiyang City. Four cases were treated with free anterolateral thigh flap (ALTF) combined with allogeneic tendon in the first stage to reconstruct finger dorsiflexion function, and 2 cases were treated with free ilioinguinal flap combined with allogeneic tendon in the second stage to reconstruct finger dorsiflexion function. The age of the patients ranged from 22 to 62 years old. The areas of defect were 5.0 cm×12.0 cm-8.0 cm×20.0 cm. Two cases had 2 extensor tendons defect, 1 had 3 extensor tendons defect, 2 had 4 extensor tendons defect, and 1 had 5 extensor tendons defect. The length of extensor tendon defects was 7.0-22.0 cm. In 5 cases, the wounds were covered by VSD for 5 to 7 days after complete emergenly debridement. Then, after the wounds had been cleared and clean, the wounds of 3 cases were covered with free ALTF, 2 with free ilioinguinal flap, and 1 with free ALTF after skin graft scar resection. At 3-4 months later, the extension function of digit was reconstructed with the transplantation of allogeneic tendons. Postoperative appearance of the flaps and functions of digits were observed at the outpatient clinics during the follow-up.Results:The postoperative follow-up lasted for 10 to 26 (15 in average) months. All 6 flaps surrived completely, and 1 case was further treated with flap thinning at 4 months after the second surgery. During the follow-up, all flaps healed well and were good in appearance and texture. Meanwhile, the donor areas were all healed well with no dysfunction nor sensory disorder. All the transplanted tendons were in good glide without adhesion. The active motion of metacarpophalangeal joints ranged from (10±10) ° to (80±10) °. According to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, at the final follow-up, 4 cases were excellent and 2 cases were good.Conclusion:It is safe and effective that using the two-staged procedure in repair of composite tissue defect of dorsal wrist with stage-one ALTF or ilioinguinal flap transfer combined with stage-two reconstruction with transplantation of allogeneic tendon. It can minimize the adhesion after tendon transplantation and donor site damage

Consideraciones sobre el síndrome de hipermovilidad articular benigna / Considerations for benign joint hypermobility syndrome

El síndrome de hipermovilidad articular benigna es la aparición de síntomas musculoesqueléticos en individuos hipermóviles en ausencia de enfermedad reumatológica sistémica. El propósito de este estudio es mostrar los resultados de una revisión bibliográfica sobre hipermovilidad de las articulaciones y sus manifestaciones clínicas. La hipermovilidad puede ocurrir en varios trastornos diferentes del tejido conectivo, incluidos el síndrome de Marfán, el síndrome de Ehlers-Danlos y la osteogénesis imperfecta. También se puede encontrar en ciertos trastornos cromosómicos, genéticos y metabólicos. Identificar de manera habitual la hipermovilidad articular, y el síndrome de hipermovilidad articular no resulta una tarea difícil, siempre que forme parte del pensamiento clínico, lo cual ayudaría a evitar sus complicaciones y las tardanzas diagnósticas, lo que solucionaría en una medida nada despreciable los casos que se atienden regularmente en la práctica médica diaria(AU)

ABSTRACT Benign joint hypermobility syndrome is the appearance of musculoskeletal symptoms in hypermobile individuals in the absence of systemic rheumatologically disease. To show the results of a bibliographic review on joint hypermobility and its clinical manifestations. Hypermobility can occur in several different connective tissue disorders, including Marfan syndrome, Ehlers-Danlos syndrome, and osteogenesis imperfect. It can also be found in certain chromosomal, genetic, and metabolic disorders. Identifying joint hypermobility on a regular basis, and JHS is not a difficult task, as long as it is part of clinical thinking, which would help to avoid its complications and diagnostic delays, which would solve a not inconsiderable measure of cases that they are regularly cared for in daily medical practice.

Translation and Cross-cultural Adaptation of the "Thumb Disability Exam - TDX" questionnaire into Brazilian Portuguese / Tradução e adaptação cultural do questionário "Thumb Disability Exam - TDX" para o português brasileiro

Abstract Objective To perform the translation, cultural adaptation and validation of the Thumb Disability Exam (TDX) questionnaire into Brazilian Portuguese. Method The questionnaire was translated, with reverse translation. The translations were evaluated and synthesized by a committee, resulting in the THUMB DISABILITY EXAM - BRASIL (TDX-BR). A total of 31 patients diagnosed with rhizarthrosis were selected and answered the questionnaire. Quality parameters were evaluated, such as internal consistency, reproducibility and ceiling and floor effect. Results The questionnaires were translated and adapted according to defined protocols. Internal consistency, through the Cronbach α coefficient for the TDX-BR, was 0.962. The reliability of the questionnaire, through intraclass correlation coefficient (ICC )also proved to be quite high, with κ = 0.953 (0.947-0.959). Agreement, measured using the standard error of measurement, remained with standard values < 5%. There was no ceiling and floor effect. Conclusion Through specific methodology, we consider TDX-BR as translated and valid for the Portuguese language of Brazil.

Resumo Objetivo Realizar a tradução, adaptação cultural e validação do questionário Thumb Disability Exam (TDX) para o português brasileiro. >Método O questionário foi traduzido, com tradução reversa. As traduções foram avaliadas e sintetizadas por um comitê, chegando ao THUMB DISABILITY EXAM - BRASIL (TDX-BR). Foram selecionados 31 pacientes com diagnóstico de rizartrose que responderam ao questionário. Foram avaliados parâmetros de qualidade, como consistência interna, reprodutibilidade e efeito teto e piso. Resultados Os questionários foram traduzidos e adaptados conforme protocolos definidos. A consistência interna, através do coeficiente α de Cronbach para o TDX-BR foi de 0,962. A confiabilidade do questionário, através do coeficiente de correlação intraclasse (CCI) também se mostrou bastante elevada, com κ = 0,953 (0,947-0,959). A concordância, medida através do erro padrão de medição manteve-se com valores padronizados < 5%. Não houve efeito teto e piso. Conclusão Através de metodologia específica, consideramos o TDX-BR como traduzido e válido para a língua portuguesa do Brasil.

Conocimiento y preocupación sobre la artritis reumatoide en la población de Huacho, Perú, en el 2019

RESUMEN Introducción: La artritis reumatoide es una enfermedad que llega a afectar el sistema músculo-esquelético y daña tanto el tejido cartilaginoso como el tejido óseo, afecta a casi al 1 % de la población mundial, y cerca del 0,5 % de los latinoamericanos. Objetivo: Determinar el conocimiento que tiene sobre la artritis reumatoide la población del distrito de Huacho, provincia de Huaura, departamento de Lima, Perú. Métodos: Se diseñó un estudio de tipo observacional, descriptivo, de corte transversal y prospectivo. Se obtuvo una muestra probabilística mediante muestreo aleatorio simple en el distrito de Huacho, en el periodo agosto-diciembre del 2019. Resultados: Se incluyó en el análisis 170 encuestas recolectadas en la ciudad de Huacho. La media de edad fue de 56,13 ± 11,6 años. El sexo con mayor conocimiento sobre la artritis reumatoide fue el femenino (45,9 %) y el 9,4 % de los varones desconocía la enfermedad. Al 88,2 % de la población le preocupa si se presentara algún dolor grave, mientras que al 75,3 % le preocupa tener alguna incapacidad funcional. Al 88,3 % le preocupa presentar deformaciones por la artritis. El 70,6 % tiene el temor de que la artritis pueda llegar a ocasionar inflamación en las articulaciones. Conclusiones: Es necesario implementar un plan que se enfoque en mejorar el conocimiento de la ciudadanía sobre la artritis reumatoide para que se pueda diagnosticar a tiempo, oportunamente y tener un tratamiento eficaz, para poder reducir la morbilidad y mortalidad en esta población.

ABSTRACT Introduction: Rheumatoid arthritis is a disease that reaches the muscle-skeletal system harming the cartilaginous tissues and bone tissue, affects almost 1% of the world's population, and in Latin Americans near 0.5%. Objective: to determine the knowledge and concern about rheumatoid arthritis in the town of the Dura de Huacho, Province of Huaura, Lima Province, Peru. Methods: A study of type observational, descriptive of cross-sectional and prospective cutting, was performed, a simple probabilistic sample by simple random in the district of Huacho, in the August period - December 2019. Results: Results were included in the analysis 170 surveys collected in the city of Cuafo. The average age was 56.13 ± 11.6 years. Sex with more knowledge about rheumatoid arthritis were women with 45.9% and 9.4% of men are not known about the disease. 88.2% of the population cares to be able to present some severe pain. 75.3% are concerned about having a functional disability. 88.3% are concerned about presenting deformations that arthritis will cause 70.6% have the fear that arthritis can harbor inflammation in the joints. Conclusions: It is necessary to implement a plan that is focused on improving the knowledge of citizenship to be diagnosed on time, in a timely manner and having an effective treatment, in order to reduce morbi-mortality in this population.

Hallazgos ultrasonográficos en articulaciones de muñecas y manos de pacientes con sospecha clínica de artritis reumatoide en fase temprana / Ultrasonographic findings in wrists and hands of patients with clinical suspicion of early phase rheumatoid arthritis

La Artritis Reumatoide (AR) es una enfermedad crónica y autoinmune cuyo primer año de evolución es considerado por el Colegio Americano de Reumatología como su fase temprana. Con el objetivo de describir los hallazgos ultrasonográficos en las articulaciones de muñecas y manos de pacientes con sospecha clínica de AR en fase temprana referidos de la consulta de Reumatología del Hospital Central Universitario Dr. Antonio María Pineda durante el lapso junio-agosto de 2018, se realizó un estudio descriptivo transversal evaluando 126 articulaciones de 21 pacientes según la escala modificada del OMERACT. Los pacientes se caracterizaron por un promedio de edad de 51,4 ± 11,1 años, siendo el grupo etario más afectado el de 41-50 años y 51-60 años. Hubo un predominio del sexo femenino (85,7%) y una media de inicio de síntomas de 5,2 ± 2,8 meses. Las principales alteraciones encontradas fueron derrame sinovial (54,7%), engrosamiento sinovial (28,5%), tenosinovitis en el grupo extensor (28,5%), erosiones óseas (11,1%) y tenosinovitis en flexores (9,5%). Los hallazgos mostraron mayor afectación de las articulaciones radiocarpianas; 12,7% y 7,9% mostraron hipertrofia sinovial y sinovitis grado I, 15% derrame sinovial grado 1 y 2 y 7,9% erosiones óseas pequeñas. El 8,7% de las II metacarpofalángicas mostraron hipertrofia sinovial grado I, 6,3% sinovitis, 13,4% derrame sinovial y 1,5% erosiones óseas medianas; el 0,79% de las II interfalángicas proximales presentaron derrame sinovial grado 1. Se observó tenosinovitis grado 1 en 25,4% de extensores y 7,9% de flexores. En conclusión, la ultrasonografía es una herramienta complementaria en el diagnóstico y seguimiento de la enfermedad reumatoide en fase temprana por lo que se sugiere fomentar su uso evitando gastos innecesarios y retrasos en el inicio del tratamiento(AU)

Rheumatoid Arthritis (RA) is a chronic and autoimmune disease whose first year of clinical manifestations is considered the early phase of the disease according to the American College of Rheumatology. With the aim of describing the ultrasonographic findings in the wrists and hands of patients with clinical suspicion of early phase RA referred to the Rheumatology Service of the Hospital Central Universitario Dr. Antonio Maria Pineda during the period June-August 2018, a cross-sectional descriptive study was conducted evaluating 126 joints of 21 patients according to the modified scale of the OMERACT. Patients had an average age of 51.4 ± 11.1 years and the most affected age groups was the 41-50 years and 51-60 years. Predominance of female sex (85.71%) as well as an average of 5.2 ± 2.8 months of time of symptoms onset was observed. The main alterations observed were synovial effusion (54.7%), synovial thickening (28.5%), tenosynovitis in extensor tendons (28.5%), bone erosions (11.1%) and tenosynovitis in flexor tendons (9.52%). The radiocarpal joints were the most affected showing grade 1 synovial hypertrophy and synovitis in 12.7% and 7.9% of joints, respectively; grade 1 and 2 synovial effusion was observed in 15% of joints and small bone erosions in 7.9%. For the second metacarpophalangeal joint, grade I synovial hypertrophy was found in 8.7% of joints, synovitis in 6.3%, synovial effusion in 13.4% and medium-sized bone erosions in 1.5%; in 0.79% of the proximal interphalangeal joints grade I synovial effusion was observed. Tenosynovitis grade 1 was observed in 25.4% of extensor tendons and 7.9% flexors. The use of ultrasonography should be encouraged as a complementary tool for the diagnosis of RA, avoiding unnecessary expenses and delay in treatment(AU)