Hiperqueratosis plantar / Plantar hyperkeratosis

RESUMEN La hiperqueratosis es un trastorno caracterizado por el engrosamiento de la capa externa de la piel, que está compuesta de queratina, una fuerte proteína protectora. Puede ser causada por fricción, conllevando la aparición de callosidades, inflamación crónica, eccema o trastornos genéticos, como la ictiosis ligada al cromosoma X. Se presentó el caso de un paciente de 47 años, que acudió al Servicio de Ortopedia por lesión escamosa a nivel de ambas regiones plantares con dificultad para la marcha. El tratamiento quirúrgico fue el empleado en este paciente para la obtención de la biopsia exerética. La evolución fue favorable en el postoperatorio mediato e inmediato, y el paciente se incorporó de forma rápida a su vida normal. Con este caso se identificaron las características clínicas de la hiperqueratosis plantar, así como el uso de la biopsia exerética como estándar de oro para el diagnóstico positivo en los tumores periféricos. Un diagnóstico adecuado por el médico inicial, la interrelación del Servicio de Ortopedia con la consulta de tumores periféricos, y el tratamiento quirúrgico seleccionado, constituyen factores determinantes en la evolución favorable de los pacientes con este diagnóstico (AU).

ABSTRACT Hyperkeratosis is a disorder characterized by thickening of the outer layer of the skin, which is composed of keratin, a strong protective protein. It can be caused by friction, leading to callosities, chronic inflammation, eczema or genetic disorders such as X chromosome-linked ichthyosis. We presented the case of a patient, aged 47 years, who attended the Orthopedic Service for scaly lesion at the level of both plantar regions with difficulties to walk. Surgical treatment was used in this patient to obtain an exeretic biopsy. The evolution was favorable in both the mediate and immediate postoperative period, and the patient quickly returned to his normal life. This case identified the clinical characteristics of plantar hyperkeratosis and the use of exeretic biopsy as a gold standard for positive diagnosis in the peripheral tumors. An adequate diagnosis by the initial physician, the interrelation of the orthopedic service with the consultation of peripheral tumors, and the chosen surgical treatment are determining factors in the favorable evolution of patients with this diagnosis (AU).

Tratamiento del Fisurado Labio Alvéolo Palatino (FLAP): casos clínicos y tratamiento interdisciplinario / Treatment of the cleft lip and palate (CLP) patient: case reports and interdisciplinary treatment

Objetivo: Describir el plan de tratamiento completo para el manejo de pacientes con fisura labio alvéolo palatina (F.L.A.P.), basado en nuestra experiencia clínica de más de 40 años. Casos clínicos: En nuestro protocolo consideramos fundamental el tratamiento ortopédico, teniendo en cuenta los tiempos de crecimiento y desarrollo del maxilar superior de cada paciente, para luego aplicar las técnicas quirúrgicas en un maxilar armónico, con un éxito más predecible. Se describirá una serie de casos clínicos con seguimiento de pacientes. Conclusión: Con este protocolo que pregonamos desde hace muchos años, nos diferenciamos principalmente de otras propuestas por considerar los tiempos biológicos de cada paciente en cuanto a crecimiento y desarrollo, y no por basarnos en tiempos quirúrgicos preestablecidos. Aplicando este protocolo obtenemos resultados predecibles que entendemos que solo son posibles de evaluar, al realizar el seguimiento del paciente hasta completar su desarrollo (AU)

Objective: To describe the comprehensive treatment plan aimed at managing patients with cleft lip and palate (CLP) on the basis of our more than forty years of clinical experience. Case reports: e orthopedic treatment is deemed fundamental in the present protocol, which takes into account the maxilla growth and development periods of each individual patient, to later perform a surgical technique in a harmonized maxilla, with a more predictable success. Clinical cases with the patient follow-up shall be described. Conclusion: e main difference between the present protocol that has been held for many years and others proposed approaches mainly lies in considering the unique growth and developmental biological stages of each patient and not in drawing on pre-established surgical timing. When applying this protocol, predictable results are achieved and they are only meant possible to be assessed during the thorough patient follow-up (AU)

Melanoma subungueal: un reto diagnóstico para los médicos / Subungual melanoma: a diagnostic challenge for doctors

El melanoma subungueal es un subgrupo del melanoma acral lentiginoso. Con frecuencia se diagnostica en etapa avanzada, dada la escasez de síntomas; de ahí que la evaluación y el tratamiento oportuno mejoran el pronóstico. Se presenta el caso de un paciente de 44 años de edad, que acude a consulta de Ortopedia con melanoniquia de tres meses de evolución. Había sido tratado en la atención primaria de salud por un hematoma secundario a un trauma directo sobre la falange distal del primer artejo del pie izquierdo. Fue seguido por consulta externa de Ortopedia y, al no experimentar una evolución adecuada, fue evaluado por la Comisión Provincial de Tumores Periféricos. Se le realizó una biopsia por punch (sacabocado), que arrojó el resultado de melanoma subungueal. Se realizó la amputación del primer artejo y del proximal del primer metatarsiano, una vez verificada la no existencia de lesiones metastásicas, con excelente resultado estético y funcional, sin mostrar recidiva en su seguimiento, a dos años de su intervención(AU)

Subungual melanoma is a subgroup of lentiginous acral melanoma. It is often diagnosed in an advanced stage by a shortage of symptoms, so timely evaluation and treatment improve prognosis. This is the case of a 44-year-old patient who goes to orthopedics with melanonichia 3 months of evolution. He had been treated for a bruise secondary to direct trauma to the distal phalanx of the first left foot ailre in primary health care. It was followed by external orthopedic consultation and by not following an adequate evolution was evaluated by the provincial commission of peripheral tumors. He was given a punch biopsy resulting in a subungual melanoma. The amputation of the first artejo and proximal first metatarsal was carried out, once verified the non-existence of metastatic lesions, with excellent aesthetic and functional result, without showing relapse in its follow-up to two years(AU)

Control de daños ortopédicos en pacientes politraumatizados pediátricos. Hospital Pediátrico "Eliseo Noel Caamaño" / Control of orthopedic damages in pediatric politraumatized patients. Pediatric Hospital "Eliseo Noel Caamaño"

RESUMEN Introducción: el control de daños en Ortopedia es aplazar la reparación definitiva de lesiones traumáticas, con el objetivo de la recuperación fisiológica deteriorada por lesiones y/o complicaciones que pueden poner en peligro la vida, realizando entonces procedimientos quirúrgicos sencillos, como una estabilización quirúrgica externa de las fracturas. Objetivo: determinar el comportamiento del control de daños ortopédicos en politraumatizados pediátricos. Materiales y método: se realizó un estudio observacional, descriptivo, prospectivo, de corte transversal, de enero del 2015 a diciembre del 2018. El universo estuvo constituido por 22 pacientes menores de 19 años de edad, politraumatizados en el período; la muestra por 15 pacientes, a los que se les aplicó control de daños ortopédicos, según criterios de selección. Resultados: se aplicó control de daños ortopédicos a 15 infantes. El más afectado fue el sexo masculino con el 73,3 %. Prevalecieron los traumatismos de los miembros inferiores con el 58,3 % y las fracturas cerradas con un 53,8 %. La osteomielitis crónica fue la complicación que predominó, en el 20 % de la muestra. En el 73,3 % de los casos se evaluó como satisfactoria la aplicación del control de daños ortopédicos en los politraumatizados. Conclusiones: a la totalidad de los traumatizados se le aplicó control de daños ortopédicos. Predominó el sexo masculino y el grupo de edad de 9 -14 años. Los miembros inferiores aportan la mayor cantidad con el fémur y la tibia. El control de daños ortopédicos se evaluó satisfactoriamente en la mayoría de los pacientes estudiados (AU).

ABSTRAC Introduction: the control of damages in Orthopedics is to postpone the definitive repair of traumatic lesions, with the objective of the physiologic recovery deteriorated by lesions and/or complications that can put in danger the life, carrying out simple surgical procedures, like an external surgical stabilization of the fractures at that time. . Objective: to determine the behavior of the orthopedic damage control in pediatric politraumatized patients. Material and method: a cross-sectional, prospective, descriptive, observational study was carried out from January 2015 to December 2018. The universe was formed by 22 patients younger than 19 years politraumatized in the period and the sample formed 15 patients; they underwent orthopedic damage control, according to the selection criteria. Results: the orthopedic damage control, was applied to 15 children. Male sex was the most affected one. Trauma in the lower limbs with 58.3 % and closed fractures with 53.8 prevailed. The predominating complication was chronic poliomyelitis in 20 % of the sample. The orthopedic damage control in politraumatized patients was assessed as successful in 73.3 % of the cases. Conclusions: the orthopedic damage control was applied to the total of traumatized patients. The male sex and the 9-14 years-old age group predominated. Lower limbs contributed with the biggest quantity of trauma, in femur and tibia. The orthopedic damage control was assessed as successful in most of studied patients (AU).

La vertical verdadera al punto A´(blando), al Pg´(blando), al Labrale superior y al Labrale inferior en posición ideal asistida de la cabeza (PIAC) / The true vertical from point A´(soft), to Pg´ (soft), to superior Labrale and inferior Labrale in Ideal Assisted Head Position (PIAC)

El 81,3% de una encuesta realizada a 96 ortodoncistas y ortopedistas calificados y técnicos radiólogos consultados informan que ubican la cabeza del paciente en una posición ideal, subjetiva del profesional instruido que lo asiste, ya que muchas de sus fotografías y telerradiografías no son posiciones naturales de la cabeza genuinas. Se ha utilizado la vertical verdadera como parámetro para mediciones, todas angulares, para definir la disposición ánteroposterior del punto A´ (de construcción) para el cuerpo del labio superior, el punto Pg´para el mentón, el Labrale superior y el Labrale inferior para el bermellón de cada labio, con la finalidad de planificar correcciones ortopédicas, ortodóncicas u ortodóncicas-quirúrgicas de acuerdo a la anomalía detectada (AU)

A biomechanical study on proximal junctional kyphosis following long-segment posterior spinal fusion

Posterior long-segment spinal fusion may lead to proximal junctional kyphosis (PJK). The present study sought to identify the appropriate fusion levels required in order to prevent PJK using finite element analysis. A finite element model was constructed based on the whole-spine computed tomography findings of a healthy adult. Nine commonly used posterior spinal fusion methods were selected. Stress on the annulus fibrosis fibers, the posterior ligamentous complex, and the vertebrae after various spinal fusions in the upright position were compared. This study was divided into two groups: non-fusion and fusion. In the former, the stress between the T10 and the upper thoracic vertebrae was higher. Comparing thoracic and lumbar segments in the fusion group, the peak stress values of the upper instrumented vertebrae (UIV) were mainly observed in T2 and L2 whilst those of the UIV+1 were observed in T10 and L2. After normalization, the peak stress values of the UIV and UIV+1 were located in T2 and L2. Similarly, the peak stress values of the annulus fibrosus at the upper adjacent level were on T10 and L2 after normalization. However, the peak stress values of the interspinal/supraspinal complex forces were concentrated on T11, T12, and L1 after normalization whilst the peak stress value of the pedicle screw was on T2. Controversy remains over the fusion of T10, and this study simulated testing conditions with gravitational loading only. However, further assessment is needed prior to reaching definitive conclusions.

Caracterización de trauma por accidente en motocicleta, pacientes del Hospital de Lempira. Primer semestre 2016 / Characterization of trauma by accident in motorcycles, Patients from Hospital of Lempira at first

Cada año muchos hondureños mueren a causa de accidentes por motocicleta. En el 2015 fallecieron 259 personas a nivel nacio- nal. Objetivo: Describir las características clínicas-traumatológicas y región anatómica con mayores lesiones provocadas por trauma debido a accidente en motocicleta, pacientes adultos del Hospital Juan Manuel Gálvez en el primer semestre de 2016. Pacientes y métodos: Estudio descriptivo, de corte transversal, se aplicó instrumento de recolección de datos (cuestionario) a pacientes hospitalizados por trauma por motocicleta de enero a junio de 2016; la población/muestra de 59 pacientes. Resul- tados: 50 (84.7%) casos fueron hombres y 9 (15.3%) mujeres, con edad promedio de 29.6 años. 16 (27%) pacientes afirmó haber con- sumido alcohol previo al accidente. Se manejó quirúrgicamente 21 (35%) pacientes, las cirugías ortopédicas representaron 87%. El promedio de hospitalización de los pacien- tes quirúrgicos fue mayor de 4 días. La mor- talidad fueron 2 casos (3.4%), provocado por trauma cráneo encefálico (TEC). Los tipos de traumas fueron: osteomuscular (37.3%), TEC (34%), politraumatismo (13.5%), contu- siones (6.8%), traumas faciales (3.4%) y traumas torácicos (5%). Conclusiones: Los hombres en edad reproductivas representa- ron el mayor número de casos. La región anatómica más lesionada fue osteomuscu- lar, sin embargo la mortalidad fue mínima. Las lesiones osteomusculares ameritaron manejo quirúrgicos en su mayoría. Siendo un problema de importancia socioeconómica y de salud local..(AU)

Topical vs. intravenous administration of tranexamic acid in knee arthroplasty and prevalence of deep venous thrombosis: a randomized clinical trial / Uso tópico versus intravenoso de ácido tranexâmico na artroplastia de joelho e prevalência de trombose venosa profunda: estudo clínico randomizado

BACKGROUND: Tranexamic acid (TXA) is widely used in orthopedic surgery to reduce perioperative bleeding. Since TXA inhibits fibrinolysis, there is concern that it may increase the risk of thromboembolic events. OBJECTIVES: To verify the prevalence of deep venous thrombosis (DVT) in patients receiving TXA during total knee arthroplasty and to compare topical with intravenous administration of the drug. METHODS: All patients admitted for total knee arthroplasty due to primary arthrosis between June and November of 2014 were recruited consecutively. Thirty patients were randomized to a "topical group&" (1.5 g TXA diluted in 50ml saline sprayed over the area operated, before tourniquet release), 30 to an intravenous; (20mg/kg TXA in 100 ml of saline, given at the same time as anesthesia), and 30 to a control group (100 ml of saline, given at the same time as anesthesia). All patients had duplex ultrasound scans of the legs on the 15th postoperative day. RESULTS: Deep venous thrombosis events occurred in five of the 90 patients operated (one out of 30 in the topical group [3.3%], four out of 30 in the control group [13.3%], and zero in the intravenous group). All were confirmed by duplex ultrasound scans and all were asymptomatic. Prevalence rates of DVT were similar between groups (p = 0.112 for control vs. intravenous; p = 0.353 for control vs. topical; and p =1.000 for intravenous vs. topical, according to two-sided exact tests). CONCLUSIONS: Both topical and intravenous administration of TXA are safe with regard to occurrence of DVT, since the number of DVT cases in patients given TXA was not different to the number in those given placebo.

CONTEXTO: O ácido tranexâmico é amplamente utilizado em cirurgia ortopédica para reduzir a hemorragia perioperatória. Como o ácido tranexâmico inibe a fibrinólise, há uma preocupação de que ele possa aumentar o risco de eventos tromboembólicos. OBJETIVOS: Verificar se o uso do ácido tranexâmico é seguro em relação à prevalência de trombose venosa profunda em pacientes submetidos a artroplastia total do joelho, e comparar as administrações tópica e intravenosa desse medicamento. MÉTODOS: Todos os pacientes consecutivamente admitidos para artroplastia total do joelho devido a artrose primária entre junho e novembro de 2014 foram recrutados. Os pacientes foram randomizados em um "grupo tópico" (1,5 g de ácido tranexâmico diluído em 50 ml de solução salina cobrindo toda a área operada antes de liberar o torniquete), um "grupo intravenoso" (20 mg/kg de ácido tranexâmico em 100 ml de solução salina no momento da anestesia) e um "grupo controle" (100 ml de solução salina com a anestesia). No 15º dia de pós-operatório, todos os pacientes foram submetidos a ultrassonografia vascular com Doppler de membros inferiores, independentemente de sintomas. RESULTADOS: Dos 90 pacientes operados, apenas cinco apresentaram trombose venosa profunda (um no grupo tópico e quatro no grupo controle). CONCLUSÕES: Tanto a administração tópica quanto a intravenosa de ácido tranexâmico são seguras em termos de ocorrência de trombose venosa profunda, pois o número de casos de trombose venosa profunda foi semelhante quando comparamos os pacientes que receberam ácido tranexâmico e os que receberam placebo. Novos estudos, com amostras maiores, são necessários para confirmar esse achado.

Cirugía asistida por computador en tumores óseos: principios generales / Computer assisted surgery in bone tumours: general principles

La mayoría de los tumores óseos primarios pueden ser tratados mediante una resección amplia —muchas veces asociada a terapias adyuvantes— sin comprometer la sobrevida del paciente. La posibilidad de una resección conservadora depende de la localización y tamaño del tumor y de las partes blandas circundantes. Una cuidadosa evaluación de estudios imagenológicos permite al cirujano elaborar un plan quirúrgico que permita una resección con márgenes adecuados, al mismo tiempo que conservar la mayor cantidad de tejido sano, de modo de obtener una extremidad funcional. A veces, la ejecución quirúrgica de lo planeado se hace muy difícil, y la precisión de esta puede resultar afectada. La cirugía guiada por computador se ha constituido en una herramienta útil en estas situaciones. Está basada en la creación de un plan virtual en 3 dimensiones mediante el procesamiento de imágenes de tomografía computada (TC) y resonancia nuclear magnética (RNM). Este plan puede ser reproducido en el escenario quirúrgico mediante la correspondencia entre este escenario virtual y la anatomía real del paciente. Esta tecnología puede permitir una mayor precisión en la ejecución de osteotomías en zonas difíciles como la pelvis, minimizando la resección innecesaria de tejido sano, pero manteniendo un margen oncológico adecuado. Describiremos los principios y el razonamiento que fundamentan el uso de la cirugía guiada por computador en la cirugía de tumores óseos, la cual se ha constituido en una herramienta útil para el manejo de situaciones clínicas específicas...

The majority of primary bone tumours can be effectively treated with wide resection —frequently associated with adjuvant therapy— without compromising the outcome of the patient. The feasibility of limb-sparing surgery in a particular scenario is dependent on the location and size of the tumour, as well as the involvement of the host bone and surrounding soft tissues. Careful evaluation of imaging studies allows the surgeon to plan the resection with adequate margins, while preserving as much normal tissues as possible, in order to achieve a functional limb. At times, the surgical execution of what was planned as resection becomes very difficult, and precision may be less than optimal. Computer-guided surgery has become a useful tool in these situations. It is based on the creation of a three-dimensional virtual plan by means of image processing from computed tomography (CT) and magnetic resonance (MRI) of the clinical situation. This plan is reproduced in the surgical field by means of the interaction between this virtual scenario and the actual anatomy of the patient. This technology could allow better precision in the execution of osteotomies in difficult areas, such as the pelvis, minimising unnecessary resection of normal tissue, while maintaining wide margins. A description is presented of the principles and rationale of computer-guided surgery for bone tumours, which has become a useful tool for the management of selected clinical situations...

Análise das propriedades psicométricas do American Orthopaedic Foot and Ankle Society Score (Aofas) em pacientes com artrite reumatoide: aplicação do modelo Rasch / Analysis of the psychometric properties of the American Orthopaedic Foot and Ankle Society Score (AOFAS) in rheumatoid arthritis patients: application of the Rasch model

Resumo Objetivo: Testar a confiabilidade e a validade do escore Aofas em uma amostra de pacientes com artrite reumatoide. Métodos: A escala foi aplicada a pacientes com artrite reumatoide, duas vezes pelo entrevistador 1 e uma vez pelo entrevistador 2. O Aofas foi submetido a exame de confiabilidade teste-reteste (com 20 indivíduos com artrite reumatoide). As propriedades psicométricas foram investigadas pela análise Rasch em 33 pacientes com artrite reumatoide. Resultados: O coeficiente de correlação intraclasse (CCI) foi de 0,90 < CCI < 0,95 (p < 0,001) para a confiabilidade intraexaminador e 0,75 < CCI < 0,91 (p < 0,001) para a confiabilidade interexaminador. O índice de separação dos indivíduos foi de 1,9 e 4,75 para os itens. Isso demonstra que os pacientes se dividiam em três níveis de habilidade e os itens foram divididos em seis níveis de dificuldades. A análise Rasch mostrou que oito itens foram satisfatórios. Foi identificado um item errôneo, que mostrou percentuais acima dos 5% permitidos pelo modelo estatístico. Além disso, o modelo Rasch sugeriu a revisão do item 8 original. Conclusões: Os resultados sugerem que a versão brasileira do Aofas apresenta confiabilidade adequada, validade de constructo e estabilidade de resposta. Esses resultados indicam que a escala de tornozelo-retropé Aofas apresenta um potencial significativo de aplicabilidade clínica em indivíduos com artrite reumatoide. Outros estudos em populações com outras características já estão em andamento.

Abstract Objective: To tested the reliability and validity of Aofas in a sample of rheumatoid arthritis patients. Methods: The scale was applicable to rheumatoid arthritis patients, twice by the interviewer 1 and once by the interviewer 2. The Aofas was subjected to test-retest reliability analysis (with 20 Rheumatoid arthritis subjects). The psychometric properties were investigated using Rasch analysis on 33 Rheumatoid arthritis patients. Results: Intra-Class Correlation Coefficient (ICC) were (0.90 < ICC < 0.95; p < 0.001) for intra-observer reliability and (0.75 < ICC < 0.91; p < 0.001) for inter-observer reliability. Subjects separation rates were 1.9 and 4.75 for the items, showing that patients fell into three ability levels, and the items were divided into six difficulties levels. The Rasch analysis showed that eight items was satisfactory. One erroneous item have been identified, showing percentages above the 5% allowed by the statistical model. Further Rasch modeling suggested revising the original item 8. Conclusions: The results suggest that the Brazilian versions of Aofas exhibit adequate reliability, construct validity, response stability. These findings indicate that Aofas Ankle-Hindfoot scale presents a significant potential for clinical applicability in individuals with rheumatoid arthritis. Other studies in populations with other characteristics are now underway.

Concordância intra e interobservadores do sistema de classificação AO para fraturas dos ossos longos na população pediátrica / Intra and interobserver concordance of the AO classification system for fractures of the long bones in the pediatric population

A classificação AO para fraturas dos ossos longos na população pediátrica foi desen volvida e validada em 2006. Entretanto, a complexidade desse sistema tem limitado o seu uso na prática clínica. Poucos estudos na literatura avaliam sua reprodutibilidade e aplicabi lidade. Este trabalho teve como objetivo determinar a concordância intra e interobservadores com o uso do sistema de classificação AO pediátrica entre médicos de diferentes níveis de experiência. Métodos: Após a feitura do cálculo amostral, foram selecionadas 108 radiografias consecuti vas de fraturas de ossos longos de pacientes de 0-16 anos, provenientes do arquivo digital de um hospital de nível quaternário. As radiografias foram classificadas por cinco examina dores com diferentes níveis de experiência após uma explicação prévia sobre o sistema. Foi mostrada uma planilha que continha as imagens da classificação para consulta. As avaliações foram feitas em dois momentos distintos por cada observador. O índice Kappa de Fleiss foi usado para verificar a concordância intra e interobservadores. Resultados: Foram obtidas concordâncias intraobservadores no mínimo substanciais em todos os itens da classificação, alcançaram níveis excelentes por todos os observadores em cinco dos sete itens considerados. A avaliação interobservadores apresentou níveis de concordância excelentes em dois itens, substancial em dois itens, moderada a substancial em um item e pobre a moderada em um dos itens. Não se observou influência da experi ência do observador na obtenção de maiores ou menores níveis de concordância, intra ou interobservadores. Conclusões: Neste estudo, a concordância intra e interobservadores foi considerada boa ou excelente para o sistema de classificação AO pediátrico para os parâmetros: osso, seg mento, osso pareado, subsegmento, padrão e desvio. No entanto, a concordância intra e interobservadores foi estatisticamente insatisfatória no parâmetro gravidade/lado da avulsão. Os níveis de concordância obtidos independem da experiência do observador em ortopedia pediátrica.

The AO classification for fractures of the long bones in the pediatric population was developed and validated in 2006. However, the complexity of this system has limited its use in clinical practice and few studies in the literature have evaluated its reproducibility and applicability. The present study had the objective of determining the intra and interobserver agreement using the pediatric AO system, among physicians with different levels of experience. METHODS: After making the sample calculation, 108 consecutive radiographs on long-bone fractures in patients aged 0-16 years, coming from the digital files of the quaternary-level hospital, were selected. The radiographs were classified by five examiners with different levels of experience after prior explanations about the system. A chart containing images from the classification was made available for consultation. The evaluations were made at two different times by each observer. The Fleiss kappa index was used to ascertain the intra and interobserver agreement. RESULTS: Intraobserver agreement that was at least substantial was obtained for all the items of the classification and it reached excellent levels for all observers in relation to five of the seven items considered. The interobserver evaluation presented excellent levels of agreement in two items, substantial in two items, moderate to substantial in one item and poor to moderate in one item. No influence from the observer's experience was observed with regard to obtaining higher or lower levels of agreement, either in the intraobserver or in the interobserver evaluation. CONCLUSIONS: In this study, the intra and interobserver agreement was considered to be good or excellent for the pediatric AO classification system, for the parameters of bone, segment, paired bone, subsegment, standard and deviation. However, the intra and interobserver agreement was statistically unsatisfactory for the parameter of severity/side of avulsion. The levels of agreement obtained did not depend on the observer's level of experience within pediatric orthopedics.

Perfil epidemiológico e análise microbiológica da infecção de sítio cirúrgico em pacientes humanos e animais de companhia / Epidemiological profile and microbiological analysis of surgical site infection in human and pet patients

A infecção de sítio cirúrgico (ISC) tem sido apontada como a terceira causa mais comum de infecção nosocomial. Este estudo objetivou determinar o perfil epidemiológico da ISC e sua associação aos fatores de risco descritos. Trata-se de um estudo transversal, realizado no Hospital São João Batista de Viçosa-MG e na Clínica Cirúrgica de Cães e Gatos do Hospital Veterinário da Universidade Federal de Viçosa-MG, no período de setembro de 2012 a fevereiro de 2013. As taxas globais de ISC foram de 0,7% no hospital humano e 3,46% no veterinário. No hospital veterinário, a taxa de ISC não mostrou relação com o potencial de contaminação, apresentando a maior taxa nos procedimentos classificados como limpos. Quanto ao tipo de cirurgia, as ortopédicas são as mais comuns em ambos os hospitais e também as que apresentam maior taxa de ISC. Cirurgias com duração maior que 120 minutos corresponderam a 15,25% do total de procedimentos no hospital humano e são ainda menos comuns no veterinário, com 1,26%. A taxa de ISC não parece estar relacionada à duração da cirurgia nesta estratificação. As bactérias isoladas das feridas cirúrgicas foram multirresistentes e os dados levantados indicam que não houve critério quanto ao emprego da antibioticoprofilaxia, principalmente nas cirurgias limpas. Este cenário mostra que é de extrema relevância a atuação de uma comissão de controle de infecção hospitalar, a fim de garantir obtenção de dados fidedignos, para que se possa avaliar a qualidade do serviço prestado e assim promover a redução dos riscos de complicações pós- operatórias...

Surgical site infection (SSI) has been indicated as the third cause of nosocomial infection. The present study aimed to determine the epidemiological profile of SSI and its association with the risk factors. It is a transversal study done at the São João Batista Hospital of Viçosa-MG and at the Surgery Service of the Small Animals Veterinary Hospital of the Universidade Federal de Viçosa-MG, from September 2012 to February 2013. Global SSI rates were 0.7% at the human and 3.46% at the veterinary hospitals. At the veterinary hospital, SSI rates were not related to contamination potential, with clean procedures presenting the greater rates. As for the type of surgery, orthopedic ones are the most common in both hospital and also the ones presenting the greater SSI rates. Surgeries during more than 120 minutes were 15.25% of the total of procedures at the human hospital and are even less common in the veterinary, with 1.26%. Rate of SSI does not seem to be related to surgery duration in this classification. Bacteria isolated from surgical wounds were multi-resistant and the obtained data indicated that no criteria of antibiotic prophylaxis existed, mainly for clean surgeries. This scenario shows that the action of a commission to control nosocomial infection are extremely relevant in order to guarantee reliable data so that the quality of service may be evaluated and thus, promoting a decrease the risk of in post-operative complications...

Avaliação da força isométrica e infiltração gordurosa do subescapular na cirurgia de latarjet / Evaluation of isometric strength and fatty infiltration of the subscapularis in latarjet surgery

Objetivo: Avaliar a função do músculo subescapular por meio da forçaisométrica, do exame clínico e da análise da infiltração gordurosa nospacientes com luxação anterior recidivante do ombro submetidos àcirurgia de Latarjet-Patte. Métodos: Foram avaliados 38 pacientesoperados entre março de 2011 e março de 2012, com seguimentomínimo de dois anos, 26 do gênero masculino e 12 do feminino, comidade média de 28,7 anos. A força isométrica foi aferida utilizando--se um dinamômetro portátil e medindo-se a distância da mão aodorso durante o teste lift-off.

Objective: To evaluate the function of the subscapularis muscle bymeans of isometric strength, clinical examination and analysis offatty infiltration in patients with recurrent anterior dislocation of theshoulder undergoing Latarjet-Patte surgery. Methods: 38 patientsoperated on from March 2011 to March 2012, with minimum follow--up of two years were evaluated, being 26 males and 12 females,with a mean age of 28.7 years old. Isometric strength was measuredusing a portable dynamometer and measuring the distance fromthe back of the hand during the lift-off test.

La ortogeriatría, una integración eficiente / The orthogeriatric, a efficient integration

The orthogeriatrics is the integration of two medical specializations: orthopedics and geriatrics, in conjunction with physical therapists, occupational therapists, nurses, etc., in order to give a fast and standardized assistance to the patient, emphasizing on the quality and opportunity. All this is done to diminish the morbid mortality, time spent at the hospital, and the functional recovery of the patient to the stages previous to the fracture. Examples of different assistance types are described with their advantages and disadvantages, resulting in ortho-geriatrics as the best option. The patient will be responsibility of the orthopedic surgeon, in conjunction with the geriatrician and other professionals, to reduce the waiting time to a minimum before the surgery and, after the surgery, it would be the geriatrician responsibility to apply the rehabilitation protocols, discharge from the hospital no more than five days after the surgery, and the subsequent monitoring at the general ortho-geriatrics hospital.

Pattern of Orthopaedic Injuries Among Patients Attending the Emergency Department in a Tertiary Care Hospital – An Analytical Study.

Introduction: Th is study was aimed at analyzing the pattern of Orthopaedic injuries among patients attending the Emergency department in a tertiary care hospital. Retrospective study was conducted in the Department of Orthopaedics, Teerthanker Mahaveer Medical College & Research Centre. Methods: Th e record analysis of injured patients seen at the emergency department over a 12 months period from June 2012 to may 2013 was done. Th e data was analyzed with special reference tothepattern of Orthopaedic injuries. Results: A total of 1110 records of injured patients that attended the emergency department were analyzed. Study showed that themajority of victims were in the age group of 11-44 years (n=909, 81.89 percent). 71.09 percent (n=789) were males and 28.9 percent (n=321) were females. Road traffi c accident was the most common cause of injuries being responsible for 59.72 percent, (n=663) followed by fall from height (22.5 percent, n=247). Study revealed that the most common presentation of injuries was fracture (68.64 percent, n=762) and the most common site was lower limbs in 48.16 percent cases, (n=367). Next most common site was upper limbs (28.08 percent, n=214) followed by pelvic fracture (10.01 percent, n=77), spine fractures (8.26 percent, n=63), facial fracture (2.88 percent, n=22) & Ribs fracture (2.49 percent, n=19). Th ere were 71.65 percent cases (n=546) of simple fracture and 28.34 percent cases (n=216) ofthecompound fracture. Th ere were 3.87 percent cases (n=43), of various dislocations, shoulder dislocation being the most common. Crush injury was seen in 7.5 percent cases. Most commonly associated visceral injury wasthehead injury in 17.20 percent cases (n=191). Conclusion: Fractures were the most common pattern of Orthopaedic injuries, frequently associated with head injuries. Research in to appropriate strategies for prevention of injuries, especially RTA is required in tertiary care hospitals.

Inhibición del crecimiento longitudinal en hemiepifisiodesis: análisis experimental en conejos / Longitudinal growth inhibition in hemiepiphysiodesis: experimental analysis in rabbits

Introducción: La modificación del eje de un miembro mediante la detención parcial del crecimiento (hemiepifisiodesis), es un procedimiento habitual en la cirugía ortopédica pediátrica. Sin embargo no está bien establecido cuánto afecta este procedimiento al crecimiento final del hueso. El objetivo del presente trabajo fue determinar en forma experimental la inhibición del crecimiento longitudinal producido por una hemiepifisiodesis. Materiales y métodos: Se utilizaron, 10 conejos de 8 semanas de vida, a los que se les colocó una grapa en el fémur distal externo derecho. En la 8ª semana del estudio (16 semanas de vida) se realizó la comparación radiológica e histológica de ambos fémures. Resultados: La longitud final media de los fémures con grapas a las 8 semanas finalizado el experimento fue de 89,6mm (rango 87mm-95mm) versus 95,7mm (rango 91mm-100mm) de los fémures sanos. El porcentaje de inhibición media del crecimiento fisario al final del experimento fue de 6,58% (rango 3.2%-10%). Conclusiones: Se demostró experimentalmente la disminución global de la actividad de la fisis durante la hemiepifisiodesis. Esto debe ser tenido en cuenta cuando indicamos una hemiepifisiodesis unilateral en un niño con una discrepancia previa de longitud.

Profilaxis antimicrobiana en cirugía ortopédica: cefazolina vs cefadroxilo IV / Antimicrobial prophylaxis in orthopedic surgery: cefazolina vs cefadroxilo IV

Toda intervención quirúrgica está expuesta a infectarse. La necesidad de profilaxis antimicrobiana en cirugía ortopédica para casos quirúrgicos agudos o electivas de cirugías limpias ha sido establecida como procedimiento de rutina. En Cirugía Ortopédica y Traumatología cuando se requiere el uso de implantes metálicos con el fin de realizar osteosíntesis o sustitución de las superficies articulares, aumenta el riesgo de infección, por tratarse de materiales extraños que son introducidos en el organismo. En estos casos la antibióticoterapia preventiva es de primordial importancia. Se realizó un estudio de profilaxis antimicrobiana, multicéntrico, aleatorizado, prospectivo, doble ciego, comparativo de grupos paralelos, con el fin de evaluar la eficacia de Cefadroxilo I.V. Vs. Cefazolina I.V. como antibióticos profilácticos mediante la determinación del número de pacientes infectados en cirugía de fracturas cerradas en la cuales se colocó material de síntesis. Se completaron 58 pacientes, 34 en el grupo de cefadroxilo y 24 en el grupo de cefazolina, al inicio los grupos fueron similares en cuanto a edad, sexo, tipo de fractura, tiempo de intervención, tiempo entre la fractura y la intervención.Más pacientes en el grupo de cefadroxilo tenían el tiempo máximo autorizado entre la fractura y la intervención (p: 0,07). Se presentó en el grupo de cefadroxilo una infección de la herida operatoria y un caso de eritema leve que cedió con tratamiento oral con cefadroxilo, sin diferencias entre los grupos.Hubo tres casos de eventos adversos, reacción anafiláctica a las 48 horas en el grupo de cefazolina que ameritó finalización de protocolo y hematoma en miembro inferior derecho y, en el grupo de cefadroxilo, una elevación discreta de enzimas hepáticas. La respuesta terapéutica de profilaxis antimicrobianano mostró diferencia entre los grupos. El cefadroxilo es tan eficaz como la cefazolina para la profilaxis antimicrobiana en pacientes con fracturas...

Any operation is exposed to infection. The need for antimicrobial prophylaxis in orthopedic surgery for acute or elective surgical cases of clean surgery is established as a routine procedure. Orthopedic Surgery when required the use of metallic implants in order to perform internal fixation or replacement of the articular surfaces, increases the risk of infection because they are foreign materials are introduced into the body. In these cases, preventive antibiotic therapy is very important. We performed a study of antimicrobialprophylaxis multicenter, randomized, prospective, double-blind, parallel group comparison in order to evaluate the effectiveness of Cefadroxil IV vs. Cefazolin I.V. as prophylactic antibiotics by determining the number of infected patients after fracture surgery in which synthetic material was placed. Fifty eigth patients were completed, 34 in the cefadroxil group and 24 in the cefazolin group, at the beginning the groups were similar in age, sex, fracture type, operative time, time between fracture and surgery. More patients in the cefadroxil group had the maximum allo-wable time between the fracture and surgery. (P: 0.07). In the cefadroxil group we found a wound infection and one case of mild erythema which resolved with oral treatment with cefadroxil, without differences between groups. There were three cases of adverse events, anaphylactic reaction to cefazolin at 48 h in the group that required finalization of protocol and hematoma in right leg and in the cefadroxil group, a moderate increase in liver enzymes. The therapeutic response of antimicrobial prophylaxis showed no difference between groups. Cefadroxil is as effective as cefazolin for antimicrobial prophylaxis in patients with fractures that warrant placement of synthetic material

Pitfalls and Important Issues in Testing Reliability Using Intraclass Correlation Coefficients in Orthopaedic Research

BACKGROUND: Intra-class correlation coefficients (ICCs) provide a statistical means of testing the reliability. However, their interpretation is not well documented in the orthopedic field. The purpose of this study was to investigate the use of ICCs in the orthopedic literature and to demonstrate pitfalls regarding their use. METHODS: First, orthopedic articles that used ICCs were retrieved from the Pubmed database, and journal demography, ICC models and concurrent statistics used were evaluated. Second, reliability test was performed on three common physical examinations in cerebral palsy, namely, the Thomas test, the Staheli test, and popliteal angle measurement. Thirty patients were assessed by three orthopedic surgeons to explore the statistical methods testing reliability. Third, the factors affecting the ICC values were examined by simulating the data sets based on the physical examination data where the ranges, slopes, and interobserver variability were modified. RESULTS: Of the 92 orthopedic articles identified, 58 articles (63%) did not clarify the ICC model used, and only 5 articles (5%) described all models, types, and measures. In reliability testing, although the popliteal angle showed a larger mean absolute difference than the Thomas test and the Staheli test, the ICC of popliteal angle was higher, which was believed to be contrary to the context of measurement. In addition, the ICC values were affected by the model, type, and measures used. In simulated data sets, the ICC showed higher values when the range of data sets were larger, the slopes of the data sets were parallel, and the interobserver variability was smaller. CONCLUSIONS: Care should be taken when interpreting the absolute ICC values, i.e., a higher ICC does not necessarily mean less variability because the ICC values can also be affected by various factors. The authors recommend that researchers clarify ICC models used and ICC values are interpreted in the context of measurement.