BlueShaper: un nuevo sistema multialeación para la instrumentación mecanizada en endodoncia: comunicación breve / BlueShaper: a new multialloy system for mechanized instrumentation in endodontics: brief communication

El objetivo de esta comunicación es describir y analizar el sistema BlueShaper para la preparación quirúrgica mecaniza- da de los conductos radiculares. El sistema dispone de un set básico de 4 limas: Z1, Z2, Z3 y Z4, con un D0 de 0,14 mm, 0,17 mm, 0,19 mm y 0,25 mm respectivamente y conicidad variable que oscila entre el 2 y 10 %. La lima Z1 posee una aleación Pink, que le confiere mayor resistencia a la torsión y una gran capacidad de corte. Las limas Z2, Z3 y Z4 presentan una aleación Blue que aumenta la resistencia a la fatiga cíclica e incrementa su flexibilidad. Para conductos radiculares más amplios se incluyen, además, las limas Z5, Z6 y Z7. La empresa comer- cializa conos de gutapercha BlueShaper que se corresponden con las limas Z3, Z4, Z5, Z6 y Z7. El sistema de limas mul- tialeación Blue Shaper podría considerarse como un nuevo aporte clínico para la preparación mecánica de los conductos radiculares (AU)

The aim of this communication was to describe and analyze the BlueShaper system for the mechanized surgical preparation of root canals. The system has a basic set of 4 files: Z1, Z2, Z3 and Z4, with 0.14 mm, 0.17 mm, 0.19 mm and 0.25 mm DO respective- ly, and variable conicity ranging between 2 and 10 %. Z1 file has a Pink alloy, which gives it greater resistance to torsion and great cutting capacity. The Z2, Z3 and Z4 files feature a Blue alloy that increases resistance to cyclic fatigue and increases their flexibility. For larger root canals, the Z5, Z6 and Z7 files are also included. The company supplies specific BlueShaper ́s gutta-percha cones for Z3, Z4, Z5, Z6 and Z7 files. The BlueShaper multialloy file system could be consid- ered as a new clinical contribution for the mechanical prepa- ration of root canals (AU)

Fractura triplanar de tibia distal: Reporte de un caso y revisión de la literatura / Triplanar fracture of proximal tibia: A case report and literature review

Las fracturas triplanares de tibia distal, son fracturas complejas caracterizadas por afectación multiplanar, clasificándose como Salter Harris tipo IV, en el periodo de cierre fisiario. Son poco frecuentes, representando el 5-15% de las fracturas pediátricas. El mecanismo de lesión que ocurre con mayor frecuencia, consiste en supinación y rotación externa. La tomografía computarizada es actualmente el Gold Standard para el diagnóstico de este tipo de fractura, nos permite evaluar todos los planos, siendo la radiografía simple insuficiente para el diagnóstico ya que puede pasar desapercibida. Paciente de 14 años de edad con fractura triplanar en 2 partes de tibia distal, con resolución quirúrgica. Nuestro caso es un ejemplo de una fractura triplanar de tibia distal, la cual es de baja frecuencia, difícil diagnostico e interpretación. Presentamos imágenes preoperatorias, intraoperatorias y postoperatorias del manejo de esta lesión, obteniendo resultados satisfactorios clínicos, funcionales y en estudios de imágenes. Es indispensable lograr una reducción anatómica de la superficie articular para lograr una evolución satisfactoria. Se recomienda una tomografía computarizada para diagnosticar y manejar esta lesión de manera adecuada. El seguimiento postoperatorio es crucial para el manejo de este paciente, ya que se espera una discrepancia en la longitud de las extremidades y/o deformidad(AU)

Triplane fractures of the distal tibia are complex fractures characterized by multiplane effects. They are classified in the Salter-Harris system as type IV in the period of physeal closure. These fractures are rare and represent 5-15% of pediatric fractures. The most common mechanism of injury is supination and external rotation. Computed tomography is currently the Gold Standard for the diagnosis of this type of fracture since it allows us to evaluate all planes, while plain radiography is insufficient because the fracture can go unnoticed. The objective is to report the clinical case of a 14-year-old patient with triplanar fracture in 2 parts of the distal tibia with surgical resolution. This case is an example of a triplanar fracture of the distal tibia, which is of low frequency, and difficult to diagnose and interpret. Preoperative, intraoperative and postoperative images of the management of this lesion are presented, obtaining satisfactory clinical, functional and imaging study results. It is essential to achieve an anatomical reduction of the joint surface to achieve a satisfactory evolution. A CT scan is recommended to properly diagnose and manage this injury. Postoperative follow-up is crucial for the management of this patient, as a limb length discrepancy and/or deformity is expected(AU)

Musculoskeletal multibody dynamics investigation for the different medial-lateral installation position of the femoral component in unicompartmental knee arthroplasty / 生物医学工程学杂志

The surgical installation accuracy of the components in unicompartmental knee arthroplasty (UKA) is an important factor affecting the joint function and the implant life. Taking the ratio of the medial-lateral position of the femoral component relative to the tibial insert (a/A) as a parameter, and considering nine installation conditions of the femoral component, this study established the musculoskeletal multibody dynamics models of UKA to simulate the patients' walking gait, and investigated the influences of the medial-lateral installation positions of the femoral component in UKA on the contact force, joint motion and ligament force of the knee joint. The results showed that, with the increase of a/A ratio, the medial contact force of the UKA implant was decreased and the lateral contact force of the cartilage was increased; the varus rotation, external rotation and posterior translation of the knee joint were increased; and the anterior cruciate ligament force, posterior cruciate ligament force and medial collateral ligament force were decreased. The medial-lateral installation positions of the femoral component in UKA had little effect on knee flexion-extension movement and lateral collateral ligament force. When the a/A ratio was less than or equalled to 0.375, the femoral component collided with the tibia. In order to prevent the overload on the medial implant and lateral cartilage, the excessive ligament force, and the collision between the femoral component and the tibia, it is suggested that the a/A ratio should be controlled within the range of 0.427-0.688 when the femoral component is installed in UKA. This study provides a reference for the accurate installation of the femoral component in UKA.

¿Efectividad de la técnica de liberación miofacial en el aumento del rango articular en restricción glenohumeral? Una comparación con la kinesioterapia tradicional / Effectiveness of the myofascial release technique in increasing joint range in glenohumeral restriction? A comparison with traditional kinesiotherapy

OBJETIVO: comparar la kinesioterapia tradicional con la técnica miofacial en pacientes con restricción articular interna glenohumeral. MÉTODO: estudio comparativo de 8 pacientes en un grupo de intervención (GI) y kinésico (GC), durante 8 semanas. Se comparó el pre y post test del ROM interno glenohumeral en ambos grupos mediante t de student. RESULTADOS: el grupo de la técnica miofascial demostró una amento significativo de ROM interno glenohumeral de 15,2º (p < 0,001), mientras que el grupo control no fue significativo (p > 0,05) sólo de de 6,4º. CONCLUSIONES:Un tratamiento de terapia con la Técnicas Liberación Miofascial en pacientes con déficit rotacional interno de hombro es más eficaz para aumentar el rango de movimiento articular de rotación interna glenohumeral que una técnica tradicional y conservadora.

OBJETIVE: to compare traditional kinesiotherapy with myofacial technique in patients with glenohumeral internal joint restriction. METHODS: comparative study of 8 patients in an intervention (IG) and kinesiotherapy (CG) group for 8 weeks. The pre- and post-test of glenohumeral internal ROM in both groups was compared using Student's t-test. RESULTS: the myofascial technique group showed a significant increase in glenohumeral internal ROM of 15.2º (p < 0.001), while the control group was not significant (p > 0.05) only 6.4º. CONCLUSIONS: A therapy treatment with Myofascial Release Techniques in patients with shoulder internal rotational deficit is more effective in increasing glenohumeral internal rotational joint range of motion than a traditional, conservative technique.

Lineamientos técnicos para la rotación del personal de enfermería, del área hospitalaria / Technical guidelines for the rotation of nursing staff in the hospital area

Los presentes Lineamientos pretenden estandarizar el proceso de rotación interna del personal de enfermería en los hospitales del MINSAL, que permita un equilibrio entre las necesidades del usuario, el hospital y el personal de enfermería

These Guidelines aim to standardize the process of internal rotation of nursing staff in MINSAL hospitals, which allows a balance between the needs of the user, the hospital and the nursing staff

Rotating Scarf osteotomy in treating hallux valgus combined with the first metatarsal rotation / 中国骨伤

OBJECTIVE@#To explore clinical effect of rotational Scarf osteotomy in treating hallux valgus (HV) with rotation of the first metatarsal bone.@*METHODS@#From January 2018 to October 2019, 35 patients (40 feet) with HV and rotation deformity of the first metatarsal were treated with rotational Scarf osteotomy, including 5 males and 30 females;aged from 25 to 76 years old with an average of (40.32±5.43) years old. Hallux valgus angle(HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), the first metatarsal length (FML) were observed and compared, American Orthopedic Foot and Ankle Society(AOFAS) of hallux metatarsophalangeal interphalangeal joint score and visual analogue scale (VAS) were used to evaluate functional evaluation.@*RESULTS@#Thirty-five patients(40 feet) were followed up from 12 to 36 months with an average of (14.35±3.62) months. HVA, IMA and DMAA were corrected from (36.32±4.51) °, (14.21±3.22) ° and (28.35±4.32) ° before operation to (14.32±5.71) °, (5.83±3.97) ° and (7.32±2.14) ° after operation respectively (P<0.05). There was no satistical difference in FML before and after operation (P>0.05). AOFAS score and VAS improved from (57.00±4.31) and (6.00±1.21) before operation to (90.31±3.28) and (1.42±0.83) after operation, respectively, and had significant difference(P<0.05);according to AOFAS score, 23 feet got excellent results, 15 feet good and 2 feet fair.@*CONCLUSION@#Rotational Scarf osteotomy with strong correction and high dimension could effectively correct HV combined with rotation deformity of the first metatarsal bone, improve function of the forefoot, and obtain good clinical results.

The first metatarsophalangeal joint fusion combined with lateral toe rotation Weil osteotomy for hallux valgus with severe metatarsal adduction / 中国骨伤

OBJECTIVE@#To explore clinical effect of the first metatarsophalangeal joint fusion combined with lateral toe rotation Weil osteotomy in treating hallux valgus with severe metatarsal adduction.@*METHODS@#From March 2017 to August 2021, 37 patients ( 69 feet ) with severe plantar adductor hallux valgus were treated with the first metatarsophalangeal joint fusion combined with rotational Weil osteotomy were retrospectively analyzed, including 8 males(11 feet) and 29 females (58 feet), aged from 67 to 83 years old with an average of (70.03±2.87) years old;3 cases on the left side, 2 cases on the right side and 32 cases on both sides. Visual analogue scale(VAS) was used to evaluate degree of pain relief before operation, 6 weeks after operation and at the final follow-up. American Orthopaedic Foot and Ankle Surgery (AOFAS) forefoot score was used to evaluate function of the affected foot before operation and final follow-up. Hallux valgus angle(HVA) and intermetatarsal angle(IMA) were measured before operation and at the final follow-up.@*RESULTS@#Thirty-seven patients(69 feet) were followed up from 12 to 48 months with an average of(22.8±0.6) months. Bone healing was achieved at the first metatarsophalangeal joint from 7 to 10 weeks with an average of (8.00±1.21) weeks after operation, without delay and nonunion. HVA was increased from (44.30±2.84)° before operation to (15.20±2.13) °at the final follow-up, and had statistical difference(t=65.781, P<0.05);while no difference in IMA before and after operation(P>0.05). VAS was decreased from (6.73±1.48) points to (2.78±0.71) points at 6 months after operation(t=3.279, P<0.05), and had difference compared with the latest follow-up(1.16±1.12)(t=4.859, P<0.05). AOFAS forefoot score increased from (52.14±5.78) preoperatively to (86.70±4.86) at the fonal follow-up, and 25 feet got excellent results, 40 feet good and 4 feet fair.@*CONCLUSION@#The first metatarsophalangeal joint fusion combined with lateral toe rotation Weil osteotomy in treating severe plantar adduction hallux valgus could significantly relieve pain and appearance of forefoot, stabilize the first sequence, and significantly improve walking function.

La rotación axial de la clavícula que plantea la maniobra de Mulligan ¿produce una reducción de la presión en el espacio subacromial? Un estudio ex vivo exploratorio / Does the axial rotation of the clavicle posed by the Mulligan maneuver produce a pressure reduction in the subacromial space? An exploratory ex vivo study

RESUMEN: El pinzamiento de hombro es la principal causa del hombro doloroso. Dentro de las estrategias terapéuticas propuestas se encuentra la terapia manual. En este contexto, la maniobra de Mulligan, implica una rotación axial en sentido anterior de la clavícula, emulando la acción del músculo subclavio, lo cual hipotéticamente aumentaría el espacio subacromial. Sin embargo, no existen antecedentes que proporcionen sustento experimental a dicha hipótesis. El objetivo del presente estudio fue explorar si la rotación axial de la clavícula, producida por la maniobra de Mulligan, tiene efecto sobre la presión registrada en el espacio subacromial, con el propósito disponer de antecedentes metodológicos que puedan contribuir al diseño de futuros estudios que aborde la problemática expuesta y consideren un mayor tamaño de muestra. Mediante un estudio exploratorio ex-vivo, se evaluaron dos preparados anatómicos que comprendían la escapula, la clavícula y los dos tercios proximales del humero, ambos con indemnidad de la articulación glenohumeral y acromioclavicular. En estos se registraron la presión en el espacio subacromial y la rotación axial de la clavícula, todo durante la realización de una maniobra de rotación axial clavicular en sentido anterior. Se analizaron las diferencias de presión entre una condición basal y durante la maniobra, como también la máxima rotación axial de clavícula. Dichas variables fueron registradas mediante un sensor de presión y un sistema de análisis de movimiento. La presión en el espacio subacromial durante la maniobra, disminuyó en todas las repeticiones en un rango comprendido entre el 21-51 % de la presión basal. La máxima rotación axial registrada estuvo entre los 3.9-10°. Los resultados de este estudio exploratorio, dan pie para hipotetizar que la maniobra de rotación axial anterior de la clavícula produce una disminución de la presión subacromial, en el área comprendida inmediatamente bajo el acromion.

SUMMARY: Shoulder impingement is the main cause of shoulder pain. Manual therapy is one of the proposed therapeutic strategies. In this context, the Mulligan maneuver implies anterior axial rotation of the clavicle, emulating the action of the subclavius muscle, which hypothetically would increase the subacromial space. However, there are no antecedents that provide experimental support for this hypothesis. The objective of the present study was to explore whether the axial rotation of the clavicle, produced by the Mulligan maneuver, has an effect on the pressure registered in the subacromial space, with the purpose of having methodological antecedents that can contribute to the design of future studies that address the problem exposed and consider a larger sample size. Through an ex-vivo exploratory study, two anatomical preparations comprising the scapula, clavicle, and proximal two-thirds of the humerus, both with glenohumeral and acromioclavicular joint sparing, were evaluated. In these, the pressure in the subacromial space and the axial rotation of the clavicle were recorded, all during the performance of an anterior clavicular axial rotation maneuver. Pressure differences between a basal condition and during the maneuver were analyzed, as well as the maximum axial rotation of the clavicle. These variables were recorded using a pressure sensor and a movement analysis system. The pressure in the subacromial space during the maneuver decreased in all repetitions in a range between 21-51% of the basal pressure. The maximum axial rotation recorded was between 3.9-10°. The results of this exploratory study give rise to the hypothesis that the anterior axial rotation maneuver of the clavicle produces a decrease in subacromial pressure, in the area immediately below the acromion.

Reliability of shoulder rotation movement measured by the smartphone clinometer application / Confiabilidade da medida de movimento de rotação do ombro mensurada pelo aplicativo clinômetro para smartphone

Goniometry is widely used to measure range of motion (ROM), but requires skill and training. In this sense, smartphone apps appear as an alternative. The objective was to assess the reliability and validity of shoulder rotation measurements using a smartphone clinometer app. This study approved by Ethical and Research Committee of the University of Pernambuco. Thirty six (36) healthy and physically active adolescents and young adults participated in the study. In the measurement each volunteer performed external (ER) and internal (IR) rotation of the shoulder in the supine and side lying positions. The shoulder rotation ROM was measured by a goniometer and an application. ER and IR were measured in two days by two evaluators. Reliability was determined using intraclass correlation coefficient (ICC), standard error of measurement (SEM) and minimum detectable change (MDC). Validity was assessed using Pearson's correlation coefficients. Both devices had excellent intra- and inter-examiner reliability levels in most evaluations. However, the goniometer showed moderate inter-examiner reliability in measuring the internal rotation performed in the lying position (ICC 0.61 to 0.67). The app showed inter-examiner reliability ranging from fair to moderate for the same measurements (ICC 0.35 to 0.61). Significant differences were observed between the values recorded by the two instruments for all measurements performed (p <0.001). A strong correlation was observed between measurements in the supine and side lying positions with the goniometer and a smartphone clinometer app (r> 0.85). The application presented excellent reliability levels as well as demonstrated a high correlation with the goniometer. However, the assessment of IR lying down position should be avoided. (AU)

A goniometria é muito usada para medir a amplitude de movimento (ADM), mas requer habilidade e treinamento. Nesse sentido, os aplicativos para smartphones aparecem como uma alternativa. O objetivo foi avaliar a confiabilidade e a validade das medidas de rotação do ombro usando um aplicativo clinômetro de smartphone. Este estudo foi provado pelo Comitê de Ética da Universidade de Pernambuco. Participaram do estudo trinta e seis (36) adolescentes e adultos jovens, saudáveis e fisicamente ativos. Na intervenção, cada voluntário realizou rotação externa (RE) e interna (RI) do ombro nas posições em supino e decúbito lateral. A ADM de rotação do ombro foi medida por um goniômetro e um aplicativo. RE e RI foram medidas em dois dias por dois avaliadores. A confiabilidade foi determinada usando coeficiente de correlação intraclasse (CCI), erro padrão de medição (EPM) e mudança mínima detectável (MMD). A validade foi avaliada usando os coeficientes de correlação de Pearson. Ambos os dispositivos apresentaram excelentes níveis de confiabilidade intra e interexaminadores na maioria das avaliações. No entanto, o goniômetro apresentou confiabilidade interexaminadores moderada na medição da rotação interna realizada na posição deitada (ICC 0,61 a 0,67). O aplicativo mostrou confiabilidade interexaminadores variando de ruim a moderada para as mesmas medidas (ICC 0,35 a 0,61). Diferenças significativas foram observadas entre os valores registrados pelos dois instrumentos para todas as medidas realizadas (p <0,001). Uma forte correlação foi observada entre as medidas nas posições supina e deitada de lado com o goniômetro e o aplicativo clinômetro para smartphone (r> 0,85). O aplicativo apresentou excelentes níveis de confiabilidade, bem como demonstrou uma alta correlação com o goniômetro. No entanto, a avaliação da RI na posição deitada deve ser evitada. (AU)

Effect of adduction during glenohumeral external rotation exercises in the scapulohumeral muscles / Efecto de la adducción durante ejercicios de rotación externa glenohumeral en los músculos escapulohumerales

SUMMARY: The effect of adduction during glenohumeral external rotation (ER) exercises on the scapulohumeral muscles is controversial. The aim of this study was to evaluate the effect of carrying out adduction during external rotation exercises in low and high shoulder positions on the electromyographic (EMG) activity of the infraspinatus (IS), middle deltoid (MD), and posterior deltoid (PD) muscles. EMG activity of the IS, MD, and PD muscles of 20 healthy participants was evaluated. Subjects performed 6 ER exercises that combined two factors: i) different adduction pressures according to biofeedback unit (0, 5 and 10 mmHg), and ii) low and high shoulder position. The pressure was controlled using a biofeedback unit. The low and high shoulder positions were 20? and 90? of abduction. In the low shoulder position, the activity of the IS muscle increased as the pressure on the biofeedback unit increased and the MD and PD muscles presented the highest activity at 10 mmHg. In the high shoulder position, the activity of the IS muscle was higher at 0 and 10 mmHg, the MD muscle presented higher activity at 5 mmHg, and PD muscle activity did not vary with the pressure. The addition of adduction at a pressure of 5 mmHg in the low shoulder position promotes is activity. Likewise, adduction at a pressure of 10 mmHg will promote activity of the IS, MD, and PD.

RESUMEN: El efecto de la aducción durante los ejercicios de rotación externa (RE) glenohumeral sobre los músculos escapulohumerales es controversial. El objetivo de este estudio fue evaluar el efecto de la realización de la aducción durante los ejercicios de rotación externa en posiciones bajas y altas del hombro sobre la actividad electromiográfica (EMG) delos músculos infraespinoso (IS), deltoides medio (DM) y deltoides posterior (DP). Se evaluó la actividad EMG de los músculos IS, MD y PD de 20 participantes sanos. Los sujetos realizaron 6 ejercicios de RE que combinaron dos factores: i) diferentes presiones de aducción de acuerdo con la unidad de biorretroalimentación (0, 5 y 10 mmHg), y ii) posición del hombro baja y alta. La presión se controló mediante una unidad de biorretroalimentación. Las posiciones del hombro baja y alta fueron de 20? y 90? de abducción. En la posición del hombro bajo, la actividad del músculo IS aumentó a medida que aumentaba la presión sobre la unidad de biorretroalimentación y los músculos MD y PD presentaron la actividad más alta a 10 mmHg. En la posición del hombro alto, la actividad del músculo IS fue mayor a 0 y 10 mmHg, el músculo MD presentó mayor actividad a 5 mmHg y la actividad del músculo PD no varió con la presión. La adición de aducción a una presión de 5 mmHg en la posición baja del hombro promueve la actividad del músculo IS. Asimismo, la aducción a una presión de 10 mmHg promoverá la actividad del IS, MD y PD.

Relationship of the hip and trunk muscles with the dynamic knee valgus in asymptomatic young women / Relação dos músculos do quadril e tronco com o valgo dinâmico de joelho em mulheres jovens assintomáticas

The presence of severe dynamic knee valgus in asymptomatic women may be a factor related to future complaints of pain in this joint. The aim of this study is to correlate the strength levels of hip and trunk stabilizer muscles with knee valgus angles, pelvic and trunk tilt in asymptomatic young women. 22 young women with no history of lower limb pain or injury participated in this study. In the first visit to the laboratory, the volunteers performed anamnesis, kinematic evaluation of the dynamic knee valgus angle, pelvic and trunk tilt. Afterwards, familiarization with muscle strength tests was made. On the second day, the evaluation of the maximal isometric muscle strength of the hip stabilizer muscles (lateral rotators, hip abductors and extensors) and trunk extensors was performed, using a hand dynamometer. For analysis of muscle strength data, the joint torque peak was used and, in relation to the kinematic data, the knee projection angles in the frontal plane, pelvis and trunk tilt, through the Kinovea software. Pearson's Correlation test showed no relationship between the hip and trunk muscle torque and the kinematic angles during the frontal and lateral step down. The muscle torque of the hip stabilizers and trunk extensors are not related to the movement pattern of the volunteers during the step down.(AU)

O valgo dinâmico de joelho em mulheres assintomáticas pode ser um fator de risco relacionado com queixas futuras de dor nessa articulação. O objetivo deste estudo é investigar a relação entre torque articular da musculatura estabilizadora do quadril e tronco com a cinemática do teste step down em mulheres jovens assintomáticas. Participaram deste estudo 22 mulheres, com idade média de 22,5 anos (±2,06), sem histórico de dor ou lesão em membros inferiores. Na primeira visita ao laboratório, as voluntárias realizaram anamnese, avaliação cinemática durante o teste step down frontal e lateral. No segundo dia, foi realizada a avalia ção do torque articular isométrico máximo de rotação lateral, abdução e extensão do quadril e extensão de tronco, utilizando um dinamometro manual. Para análise dos dados, foi utilizado o pico de torque articular dos movimentos avaliados e em relação aos dados cinemáticos, foi calculado os ângulos de projeção de joelho no plano frontal, inclinação da pelve e tronco, por meio do software Kinovea. O teste de Correlação de Pearson não mostrou relação entre o torque muscular de quadril e tronco com os ângulos cinemáticos durante o step down frontal e lateral. Portanto, concluímos que o torque muscular máximo dos estabilizadores lombo pélvicos não estão correlacionados com o padrão de movimento cinemático durante o teste step down.(AU)

Problemas rotacionales de las extremidades inferiores en niños y adolescentes / Rotational problems of lower limbs in children and adolescents

Las deformidades torsionales de las extremidades inferiores corresponden a una de las causas de visita más frecuente al ortopedista infantil. En la mayoría de los casos, estas consultas son innecesarias, pues se trata de condiciones normales del esqueleto en desarrollo, que suelen corregir espontáneamente. El médico no especialista debe estar familiarizado con los cambios fisiológicos que ocurren en las extremidades inferiores del niño, de manera de identificar aquellos casos severos o aquellos que producen alteraciones funcionales.Estas deformidades, pueden ocurrir en cualquier nivel, desde la pelvis a los pies, por lo que un examen físico sistemático permitirá identificar la causa y proponer un tratamiento de acuerdo a los hallazgos. El único tratamiento eficaz, cuando la situación lo requiere, es la cirugía ortopédica. El uso de plantillas, calzado ortopédico y órtesis no cumplen ninguna función en el manejo de estas alteraciones

Torsional deformities of lower limbs are one of the most frequent causes to visit a pediatric orthopedic surgeon. In most cases, these are unnecessary, as they represent a normal stage of the developing skeleton, which usually correct spontaneously. The nonspecialist physician must be familiar with the physiological changes that occur in children's lower limb, in order to identify those cases that are severe, or cause functional disabilities.These deformities can occur at any level, from the pelvis to the feet, so a systematic physical examination will allow the cause to be identified and treated to be proposed according on to the findings. The only effective treatment, when the situation requires it, is orthopedic surgery. The use of insoles, orthopedic footwear, and orthoses have no role in the management of these alterations

Reliability of tibial anterior crest as the anatomical reference of rotating alignment for tibial component in total knee arthroplasty / 中国骨伤

OBJECTIVE@#This study aimed to research whether anterior tibial crest is a reliable anatomical reference for rotational alignment of tibial component in TKA.@*METHODS@#The study included 122 patients who underwent computed tomography angiography (CTA) examination for unilateral lower extremity trauma with normal contralateral lower extremities, including 89 males and 33 females, with an average age of(51.4±16.4) years old(ranged 18 to 81 years old). Picture archiving and communication system (PACS) was used to mark 11 lines including the surgical epicondylar axis (SEA) connecting the most prominent points of the lateral epicondyle and the deepest point of the sulcus on the medial epicondyle of the femur, axis of medial border of patellar tendon (MEPT)connecting the middle of the posterior cruciate ligament (PCL) and medial border of the patellar tendon at the level of a standard tibial cut from 8 mm distal of the lateral tibial joint surface, transverse axis of tibia (TAT) at the level of a standard tibial cut from 8 mm distal of the lateral tibial joint surface, Akagi line connecting the projected middle of the PCL and medial border of the patellar tendon at the tibial attachment, the axis of the medial 1/3 of patellar tendon(M1/3) connecting the projected middle of PCL and the medial 1/3 of the patellar tendon at the patellar tendon attachment level, Insall line connecting the projected middle of the PCL and the medial 1/3 of tibial tubercle, the axis of medial border of tibial tubercle (MBTT) connecting the projected middle of the PCL and medial border of tibial tubercle, as well as the axis of the proximal anterior tibial crest (PATC), axis 1 of the middle anterior tibial crest (MATC1), axis 2 of the middle anterior tibial crest (MATC2) and the axis of the distal anterior tibial crest (DATC) which were marked by connecting the 4 equidistant points on the sharp anterior tibial crest and the projected middle of the PCL. The angles between TAT and SEA as well as the angles between other axes and the perpendicular to SEA were measured. Pairwise differences among the 10 tibial axes were examined using One-Way ANOVA and paired @*RESULTS@#The angles between the axes of MEPT, Akagi line, M1/3, Insall line, MBTT, PATC, MATC1, MATC2, DATC and the perpendicular to SEA were (-1.6 ±4.5)° , (1.4 ±5.0)° , (10.2±5.1)°, (11.9±5.4)°, (3.6±4.8)°, (12.0±6.9)°, (7.2±8.6)°, (7.1±10.4)°, (6.6±13.5)°, respectively. The angle between TAT and SEA was (4.1±5.3)°. MEPT was external rotation compared to SEA. M1/3, Insall line and PATC were significantly greater than Akagi line, MBTT, TAT (@*CONCLUSION@#The middle tibial anterior crest can be used as a reference for rotational alignment of tibial component in TKA, and its reliability is better than Insall line, but worse than Akagi line, TAT and MBTT.

Development of on-line lateral stiffness measurement system for anterior cruciate ligament and its influence on anterior cruciate ligament reconstruction / 生物医学工程学杂志

The anterior cruciate ligament (ACL) reconstruction mostly relies on the experience of surgeons. To improve the effectiveness and adaptability of the tension after ACL reconstruction in knee joint rehabilitation, this paper establishes a lateral force measurement model with relaxation characteristics and designs an on-line stiffness measurement system of ACL. In this paper, we selected 20 sheep knee joints as experimental material for the knee joint stability test before the ACL reconstruction operation, which were divided into two groups for a comparative test of single-bundle ACL reconstruction through the anterolateral approach. The first group of surgeons carried out intraoperative detection with routine procedures. The second group used ACL on-line stiffness measurement system for intraoperative detection. After that, the above two groups were tested for postoperative stability. The study results show that the tension accuracy is (- 2.3 ± 0.04)%, and the displacement error is (1.5 ± 1.8)%. The forward stability, internal rotation stability, and external rotation stability of the two groups were better than those before operation (

Subspine Hip Impingement: Clinical and Radiographic Results of its Arthroscopic Treatment / Impacto subespinhal do quadril: Resultados clínicos e radiográficos do tratamento artroscópico

Abstract Objective To evaluate the clinical and radiographic results as well as complications related to patients undergoing arthroscopic treatment of subspine hip impingement. Methods We retrospectively evaluated 25 patients (28 hips) who underwent arthroscopic treatment of subspine impingement between January 2012 and June 2018. The mean follow-up was 29.5 months, and the patients were evaluated clinically by using the Harris hip score modified by Byrd (MHHS), the non-arthritic hip score (NAHS), and in terms of internal rotation and hip flexion. In addition, the following items were evaluated by imaging exams: the center-edge (CE) acetabular angle, the Alpha angle, the presence of a sign of the posterior wall, the degree of arthrosis, the presence of heterotopic hip ossification, and the Hetsroni classification for subspine impingement. Results There was an average postoperative increase of 26.9 points for the MHHS, 25.4 for the NAHS (p < 0.0001), 10.5° in internal rotation (p < 0.0024), and 7.9° for hip flexion (p < 0.0001). As for the radiographic evaluation, an average reduction of 3.3° in the CE angle and of 31.6° for the Alpha angle (p < 0.0001). Eighteen cases (64.3%) were classified as grade 0 osteoarthritis of Tönnis, and 10 (35.7%) were classified as Tönnis grade 1. Two cases (7.1%) presented grade 1 ossification of Brooker. Most hips (n = 15, 53.6%) were classified as type II of Hetsroni et al. Conclusion In the present study, patients undergoing arthroscopic treatment with subspine impingement showed improvement in clinical aspects and radiographic patterns measured postoperatively, with an average follow-up of 29.5 months.

Resumo Objetivo Avaliar os resultados clínicos e radiográficos assim como as complicações relacionadas a pacientes submetidos ao tratamento artroscópico do impacto subespinhal do quadril. Métodos Foram avaliados retrospectivamente 25 pacientes (28 quadris) submetidos ao tratamento artroscópico de impacto subespinhal entre janeiro de 2012 e junho de 2018. O seguimento médio foi de 29,5 meses, e os pacientes foram avaliados clinicamente pelo Harris hip score modificado por Byrd (MHHS), o non-arthritic hip score (NAHS), e quanto à rotação interna e flexão do quadril. Além disso, foram avaliados por exames de imagem: o ângulo center-edge (CE) acetabular, o ângulo alfa, a presença de sinal da parede posterior, o grau de artrose, a presença de ossificação heterotópica do quadril e a classificação de Hetsroni para Impacto Subespinhal. Resultados Observou-se aumento médio pós-operatório de 26,9 pontos para o MHHS, 25,4 para o NAHS (p < 0,0001), 10,5° na rotação interna (p < 0,0024) e 7,9° para flexão do quadril (p < 0,0001). Quanto à avaliação radiográfica, observou-se redução média de 3,3° no ângulo CE e de 31,6° para o ângulo alfa (p < 0,0001). Foram classificados 18 casos (64,3%) como artrose grau 0 de Tönnis e 10 (35,7%) como Tönnis 1. Dois casos (7,1%) apresentaram ossificação grau 1 de Brooker. A maioria dos quadris (n = 15; 53,6%) foi classificada como tipo II de Hetsroni et al. Conclusão No presente estudo, os pacientes submetidos a tratamento artroscópico de impacto subespinhal apresentaram melhora nos aspectos clínicos e nos padrões radiográficos aferidos pós-operatoriamente, com seguimento médio de 29,5 meses.

Correction of the spinal sagittal plane: the application of convergent or divergent screws / Correção do plano sagital da coluna vertebral: aplicação de parafusos convergentes ou divergentes / Corrección del plano sagital de la columna vertebral: aplicación de tornillos convergentes o divergentes

ABSTRACT Objective To present a new principle for correction of the sagittal plane of the spine through the convergent or divergent placement of monoaxial pedicle screws in this plane, associated with compression or distraction, to provide lordotizing or kyphotizing leverage force. Method A statistical mechanical study of twenty-eight fixations in synthetic spine segments was performed. In fifteen pieces, pedicle screws were applied to the ends of the segments with positioning convergent to the center of the fixation. They were attached to the straight rods and subjected to compression force. The other thirteen segments were fixed with pedicle screws in a direction divergent to the center of the fixation, attached to the straight rods, and subjected to distraction force. Results To create kyphosis in the 15 synthetic segments of the spine, the mean pre-fixation Cobb angle was - 0.7° and the mean post-fixation angle was +15°. To create lordosis in the 13 segments, the mean pre-fixation Cobb angle was +1° and the mean post-fixation angle was +18°. The difference was confirmed by statistical mechanical tests and considered significant. However, there is no relevant difference between the mean angles for lordosis and kyphosis formation. Conclusions It was concluded that the correction of the sagittal plane of the spine by applying the new instrumentation method is efficient. A statistical mechanical test confirmed that the difference in Cobb degrees between pre- and post-fixation of the synthetic spine segments was considered significant in the creation of both kyphosis and lordosis. Level of evidence II C; Statistical mechanical study of synthetic spine segments.

RESUMO Objetivo Apresentar um novo princípio para correção do plano sagital da coluna vertebral, posicionando os parafusos pediculares monoaxiais nesse plano de forma convergente ou divergente, associados à compressão ou distração, para proporcionar força em alavanca lordotizante ou cifotizante. Métodos Realizou-se um estudo de mecânica estatística de 28 fixações em segmentos de coluna sintética. Em quinze peças, foram aplicados parafusos pediculares monoaxiais nos extremos dos segmentos abordados com posicionamento no sentido convergente à fixação. Foram agregados às hastes retas e submetidos à força de compressão. Em outros treze segmentos, a fixação foi feita com parafusos pediculares monoaxiais, no sentido divergente ao centro da fixação, integrados às hastes retas e submetidos à força de distração. Resultados Para criar cifose nos 15 segmentos sintéticos da coluna vertebral, a média do ângulo de Cobb na pré-fixação foi de -0,7° e a média pós-fixação foi de +15°. Para cria lordose em 13 segmentos, a média do ângulo de Cobb na pré-fixação foi de +1° e a média pós-fixação foi de +18°. A diferença foi confirmada por testes de mecânica estatística e considerada significativa. Contudo, não existe diferença relevante entre os ângulos médio para formação da lordose e da cifose. Conclusões Conclui-se que a correção do plano sagital da coluna aplicando o novo método de instrumentação é eficiente. Confirmou-se com teste de mecânica estatística que a diferença em graus de Cobb entre o período pré e o pós-fixação dos segmentos de coluna sintética fixados foi considerada significativa, tanto na criação da cifose quanto da lordose. Nível de evidência II C; Estudo mecânico estatístico de segmentos de coluna sintética.

RESUMEN Objetivo Presentar un nuevo principio para corrección del plano sagital de la columna vertebral, posicionando los tornillos pediculares monoaxiales en ese plano de forma convergente o divergente, asociados a la compresión o distracción, para proporcionar fuerza en palanca lordotizante o cifosante. Métodos Se realizó un estudio de mecánica estadística de 28 fijaciones en segmentos de columna sintética. En quince piezas, fueron aplicados tornillos pediculares monoaxiales en los extremos de los segmentos abordados con posicionamiento en el sentido convergente a la fijación. Fueron agregados a las varillas rectas y sometidos a la fuerza de compresión. En otros trece segmentos, la fijación fue hecha con tornillos pediculares monoaxiales, en el sentido divergente del centro de la fijación, integrados a las varillas rectas y sometidos a la fuerza de distracción. Resultados Para crear cifosis en los 15 segmentos sintéticos de la columna vertebral, el promedio del ángulo de Cobb en la prefijación fue de -0,7° y el promedio de postfijación fue de +15°. Para crear lordosis en 13 segmentos, el promedio del ángulo de Cobb en la prefijación fue de +1° y el promedio de postfijación fue de +18°. La diferencia fue confirmada mediante tests de mecánica estadística y considerada significativa. Sin embargo, no existe diferencia relevante entre los ángulos promedios para la formación de lordosis y de cifosis. Conclusiones Se concluye que la corrección del plano sagital de la columna aplicando el nuevo método de instrumentación es eficiente. Se confirmó con test de mecánica estadística que la diferencia en los grados de Cobb entre el período de pre y postfijación de los segmentos de columna sintética fijados fue considerada significativa, tanto en la creación de cifosis como de la lordosis. Nivel de evidencia II C; Estudio mecánico estadístico de segmentos de columna sintética.

Evaluation of Apical Transportation by Three Rotary Systems in Extracted Teeth with Curved Canals / Evaluación de la transportación apical con tres sistemas rotatorios en dientes extraídos con conductos curvos

Abstract The aim of this study was to compare the apical transportation in extracted teeth using three different rotary nickel-titanium systems (Mtwo, Hyflex CM, and Typhoon). Sixty extracted first molars were randomly divided into three groups (n=20 in each group) with similar root canal curvatures (25-52 degrees). All root canals were prepared to size 30 using a crown-down preparation technique for each rotary system. Loss of working length and apical transportation were determined by X-ray evaluation. Comparisons between the groups were performed using one-way analysis of variance (ANOVA) or Kruskal-Wallis tests, and the post hoc analyses employed were Dunn´s or Tukey´s multiple comparison tests. No significant differences were detected between the different rotary systems in the loss of working length and apical transportation. This in vitro study showed that the use of these three rotary systems are safe and useful for instrumentation in curved canals; however, further in vivo research is essential to compare the effectiveness and safety of these systems for use in curved canals.

Resumen El objetivo del presente estudio fue comparar la transportación apical en dientes extraídos utilizando tres sistemas rotatorios de níquel-titanio (Mtwo, Hyflex CM y Typhoon). Sesenta primeros molares extraídos se dividieron aleatoriamente en tres grupos (n=20 en cada grupo) con curvaturas del conducto radicular similares (25-52 grados). Todos los conductos radiculares se prepararon usando una técnica corono apical para cada sistema rotatorio. La pérdida de la longitud de trabajo y la transportación apical se determinaron mediante evaluación radiográfica. Las comparaciones entre los grupos se realizaron utilizando análisis de varianza de una vía (ANOVA) o Kruskal-Wallis, y los análisis post hoc empleados fueron las pruebas de comparación múltiple de Dunn o Tukey. No se detectaron diferencias significativas entre los diferentes sistemas rotatorios en la pérdida de la longitud de trabajo y transportación apical. Este estudio demostró que el uso de estos tres sistemas es seguro y útil para su instrumentación en conductos curvos; sin embargo, investigación in vivo es necesaria para comparar la efectividad y seguridad de estos sistemas para su uso en conductos curvos.

Microtornillos como método de control vertical en desprogramación muscular / Vertical control with miniscrews in muscular deprogramming treatment

Una de las consecuencias de la desprogramación neuromuscular es la rotación mandibular en sentido horario, evidenciando el punto prematuro de contacto y aumentando la dimensión vertical del paciente. En pacientes clase II con componente vertical, es un problema realizar este tipo de tratamiento, ya que por lo general este efecto de posterorrotación mandibular hace el perfil más convexo, y en algunos casos genera mordida abierta anterior, la cual se debe corregir posteriormente con el tratamiento de ortodoncia, cirugía o prótesis, lo que alarga el tiempo total de tratamiento por la necesidad de control vertical. El presente caso se trata de una mujer de 45 años de edad, dolicofacial, con tendencia a mordida abierta, mordida dual, sobremordida vertical y horizontal disminuidas, motivo de consulta dolor articular, el cual no le permite continuar con sus labores diarias, el tratamiento realizado fue desprogramación neuromuscular con un guarda oclusal inferior con el propósito de aliviar sintomatología articular y control vertical con microtornillos palatinos previo a tratamiento ortodóncico (AU)

One of the effects of the neuromuscular deprogramming treatment is the mandibular clockwise rotation, making the light premature occlusal contact more evident and increasing the patient vertical dimension. In Class II patients with vertical component is difficult to treat them due to profile worsening as an effect of the clockwise rotation creating in some patient's anterior open bite, this has to be corrected later in treatment with orthodontic intrusion, surgery or prosthodontic treatment, increasing the total time of treatment with the vertical control necessity. This case report is a 45 years old patient, dolichofacial, with anterior open bite tendency, dual bite, decreased overjet and overbite, her chief complaint was temporomandibular joint dysfunction which dont allow her to do her daily duties, the treatment for her was neuromuscular deprogramming splint for the temporomandibular joint pain, and vertical control with temporary anchorage devices (miniscrews) before the orthodontic treatment (AU)