Hook assisted reduction in cephalomedullary nailing without traction table / Redução assistida por gancho em haste cefalomedular sem mesa de tração

ABSTRACT Introduction: Proximal femoral nailing for intertrochanteric femur fracture is sometimes a challenging procedure without a traction table, especially if complicated fracture pattern. We aimed to overcome this difficulty with the hook. Materials and Methods: A retrospective study of 60 patients. 28 of the patients reduction was necessitated with a hook (group 1). The other patients did not need to use this technique (group 2, n=32). The collo-diaphyseal angle, lag screw placement, and tip-apex distance were measured using radiographs. Results: There were statistically significant differences between the two groups regarding the Garden Alignment Index, postoperative collo-diaphyseal angle measurements, and tip-apex distance. The Garden Alignment Index was found as 163.92 degrees (dg.) In the frontal plane in group 1, and 154.78 dg in group 2, respectively. In group 1, the tip-apex distance was 16.05 cm, whereas it was 25.32 cm in group 2. The collo-diaphyseal angle was 133.1º in group 1, and 128.65º in group 2. Conclusions: The hook-assisted reduction is beneficial when operating without a traction table; however, it can also be a part of the surgeons' equipment even when operating on a traction table. When difficulties in obtaining an ideal anatomical reduction in displaced intertrochanteric femoral fractures, we suggest using the hook-assisted reduction technique. Level of Evidence III; Case-control Study.

RESUMO Introdução: Frequentemente, a fixação do fêmur proximal para fratura intertrocantérica do fêmur sem uma mesa de tração é um procedimento desafiador, especialmente se o padrão da fratura for complicado. O objetivo foi superar essa dificuldade utilizando um gancho. Materiais e métodos: Trata-se de um estudo retrospectivo de 60 pacientes. Em 28 desses, a redução foi necessária com um gancho (grupo 1). Os outros pacientes não precisaram usar essa técnica (grupo 2, n=32). O ângulo colo-diafisário, a colocação do parafuso lag e a distância ponta-ápice foram medidos por meio de radiografias. Resultados: Houve diferenças estatisticamente significativas entre os dois grupos com relação ao Índice de Alinhamento de Garden, às medidas do ângulo colo-diafisário pós--operatório e à distância ponta-ápice. O índice de alinhamento de Garden foi de 163,92 graus (dg.) No plano frontal no grupo 1 e 154,78 dg no grupo 2, respectivamente. No grupo 1, a distância ponta-ápice foi de 16,05 cm, enquanto no grupo 2 foi de 25,32 cm. O ângulo colo-diafisário foi de 133,1 graus no grupo 1 e 128,65 graus no grupo 2. Conclusão: A redução assistida por gancho é benéfica quando se opera sem uma mesa de tração; no entanto, ela também pode fazer parte do equipamento do cirurgião mesmo quando se opera em uma mesa de tração. Quando houver dificuldades em obter uma redução anatômica ideal em fraturas femorais intertrocantéricas deslocadas, sugerimos o uso da técnica de redução assistida por gancho. Nível de Evidência III; Estudo de Caso-controle.

Low infection and non-union rates in polytrauma femoral fractures: a retrospective study / Baixas taxas de infecção e não união em fraturas femorais em politraumatizados: um estudo retrospectivo

ABSTRACT Objective: Assess complications and risks in staged femoral shaft fracture treatment using external fixation and intramedullary nailing (DCO). Methods: Analysis involved 37 patients with 40 fractures, mostly male (87.5%), average age 32.9 years. Data included ASA score, AO/OTA and Gustilo classifications, Glasgow Coma Score, Injury Severity Score, times to external fixation and conversion, ICU duration, nail type, and reaming status. Complications tracked were mortality, deep infection, and non-union. Results: Predominant fracture type was AO/OTA A (45%), with 40% open (Gustilo A, 93.8%). Average ISS was 21; GCS was 12.7. Median ICU stay was 3 days; average time to conversion was 10.2 days. Retrograde nails were used in 50% of cases, with reaming in 67.5%. Complications included deep infections in 5% and non-union in 2.5%. Conclusion: DCO strategy resulted in low infection and non-union rates, associated with lower GCS and longer ICU stays. Level of Evidence III; Retrospective Cohort Study.

RESUMO Objetivo: Analisar taxa de complicações e riscos no tratamento estagiado de fraturas diafisárias do fêmur com fixador externo e conversão para haste intramedular (DCO). Métodos: Estudo com 37 pacientes, 35 masculinos, idade média de 32,9 anos, abordando escores ASA, classificação AO/OTA, Gustilo, Glasgow e ISS, tempo até a fixação externa, na UTI e tipo de haste. Complicações como mortalidade, infecção profunda e não união foram registradas. Resultados: Fraturas tipo AO/OTA A foram as mais comuns (45%), com 40% expostas (Gustilo A, 93,8%). ISS médio de 21 e ECG de 12,7. Média de 3 dias na UTI e 10,2 dias até a conversão. Uso de haste retrógrada em 50% dos casos e fresagem em 67,5%. As complicações incluíram infecção profunda em 5% e não união em 2,5%. A não união correlacionou-se com baixo ECG e tempo prolongado na UTI. Conclusão: A estratégia de DCO mostrou-se eficaz com baixas taxas de infecção e não união, associada a baixo ECG e tempo na UTI. Nível de Evidência III; Estudo de Coorte Retrospectivo.

Stability of Proximal Femoral Osteotomies in Pediatric Bone Models Fixed with Flexible Intramedullary Nails and Evaluated by the Finite Element Method / Estabilidade de osteotomias proximais em modelos do fêmur pediátrico fixadas por hastes intramedulares flexíveis e avaliadas pelo método dos elementos finitos

Abstract Objective To evaluate the stability of osteotomies created in the subtrochanteric and trochanteric regions in a pediatric femur model fixed by flexible intramedullary rods. Methods Tomographic sections were obtained from a pediatric femur model with two elastic titanium rods and converted to a three-dimensional model. This model created a mesh with tetrahedral elements according to the finite element method. Three virtual models were obtained, and osteotomies were performed in different regions: mediodiaphyseal, subtrochanteric, and trochanteric. A vertical load of 85N was applied to the top of the femoral head, obtaining the displacements, the maximum and minimum main stress, and the equivalent Von Mises stress on the implant. Results With the applied load, displacements were observed at the osteotomy site of 0.04 mm in the diaphyseal group, 0.5 mm in the subtrochanteric group, and 0.06 mm in the trochanteric group. The maximum stress in the diaphyseal, subtrochanteric, and trochanteric groups was 10.4 Pa, 7.52 Pa, and 26.4 Pa, respectively. That is around 40% higher in the trochanteric group in regards to the diaphyseal (control). The minimum stress of the bone was located in the inner cortical of the femur. The equivalent Von Mises stress on the implants occurred at osteotomy, with a maximum value of 27.6 Pa in the trochanteric group. Conclusion In both trochanteric and subtrochanteric osteotomies, fixation stability was often lower than in the diaphyseal model, suggesting that flexible intramedullary nails are not suitable implants for proximal femoral fixations.

Resumo Objetivo Avaliar a estabilidade de osteotomias criadas nas regiões subtrocantérica e trocantérica em modelo de fêmur pediátrico, fixadas por hastes intramedulares flexíveis. Método A partir de um modelo de fêmur pediátrico com duas hastes elásticas de titânio, foram obtidos cortes tomográficos que foram convertidos para um modelo tridimensional. Neste modelo foi criado uma malha com elementos tetraédricos, de acordo com o método dos elementos finitos. Foram obtidos três modelos virtuais, e realizadas osteotomias em regiões diferentes: mediodiafisária, subtrocantérica e trocantérica. Foi aplicado um carregamento vertical de 85N no topo da cabeça do fêmur, obtidos os deslocamentos, a tensão máxima e mínima principal e tensão equivalente de Von Mises no implante. Resultados Com o carregamento aplicado foram observados deslocamentos no local da osteotomia de 0,04mm no grupo diafisário, 0,5mm no subtrocantérico e 0,06mm no trocantérico. A tensão máxima principal foi 10,4Pa, 7,52Pa e 26,4Pa nos grupos diafisário, subtrocantérico e trocantérico, respectivamente. Ou seja, a tensão máxima foi em torno de 40% maior no grupo trocantérico, em relação ao diafisário (controle). A face de tensão mínima do osso localizou-se na cortical interna do fêmur. A tensão equivalente de Von Mises nos implantes ocorreu na osteotomia, com valor máximo de 27,6Pa no grupo trocantérico. Conclusão Tanto nas osteotomias no nível trocantérico, quanto subtrocantérico, a estabilidade da fixação foi muitas vezes menor que no modelo diafisário, sugerindo que as hastes intramedulares flexíveis não são implantes adequados para as fixações proximais do fêmur.

Factors Associated with Readmission within 30 Days after Discharge and In-Hospital Mortality after Proximal Femoral Fracture Surgery in the Elderly: Retrospective Cohort / Fatores associados à reinternação em até 30 dias após a alta e à mortalidade intra-hospitalar após cirurgia por fratura do fêmur proximal em idosos: coorte retrospectiva

Abstract Objective To evaluate the factors associated with readmission within 30 days after discharge (R30) and in-hospital mortality (IHM) in elderly patients undergoing proximal femur fracture surgery (PFF). Methods Retrospective cohort with data from 896 medical records of elderly (≥ 60 years) patients submitted to PFF surgery in a Brazilian hospital between November 2014 and December, 2019. The patients included were followed-up from the date of hospitalization for surgery up to 30 days after discharge. As independent variables, we evaluated gender, age, marital status, pre- and postoperative hemoglobin (Hb), international normalized ratio, time of hospitalization related to the surgery, door-surgery time, comorbidities, previous surgeries, use of medications, and the American Society of Anesthesiologists (ASA) score. Results The incidence of R30 was 10.2% (95% confidence interval [CI]: 8.3-12.3%), and the incidence of IHM was 5.7% (95%CI: 4.3-7.4%). Regarding R30, hypertension (odds ratio [OR]: 1.71; 95%CI: 1.03-2.96), and regular use of psychotropic drugs (OR: 1.74; 95%CI: 1.12-2.72) were associated in the adjusted model. In the case of IHM, higher chances were associated with chronic kidney disease (CKD) (OR: 5.80; 95%CI: 2.64-12.31), longer hospitalization time (OR: 1.06; 95%CI: 1.01-1.10), and R30 (OR: 3.60; 95%CI: 1.54-7.96). Higher preoperative Hb values were associated with a lower chance of mortality (OR: 0.73; 95%CI: 0.61-0.87). Conclusion Findings suggest that the occurrence of these outcomes is associated with comorbidities, medications, and Hb.

Resumo Objetivo Avaliar os fatores associados à reinternação em até 30 dias após a alta (R30) e à mortalidade intra-hospitalar (MIH) em idosos submetidos a cirurgia por fratura do fêmur proximal (FFP). Métodos Coorte retrospectiva com dados de 896 prontuários de idosos (≥ 60 anos) submetidos a cirurgia de FFP em hospital brasileiro, no período entre novembro de 2014 a dezembro de 2019. Os pacientes incluídos foram acompanhados desde a data de internação para a cirurgia até 30 dias após a alta. Como variáveis independentes, foram avaliados o sexo, idade, estado civil, hemoglobina (Hb) pré e pós-operatória, razão normalizada internacional, tempo da internação relacionada à cirurgia, tempo porta cirurgia, comorbidades, cirurgias prévias, uso de medicamentos e escore da American Society of Anesthesiologists (ASA). Resultados A incidência de R30 foi de 10,2% (intervalo de confiança [IC] 95%: 8,3-12,3%) e a de MIH foi 5,7% (IC95%: 4,3-7,4%). Referente a R30, no modelo ajustado, associaram-se ter hipertensão (odds ratio [OR]: 1,71; IC95%: 1,03-2,96), uso regular de medicamentos psicotrópicos (OR: 1,74; IC95%: 1,12-2,72). Tratando-se da MIH, maiores chances estiveram associadas à doença renal crônica (DRC) (OR: 5,80; IC95%: 2,64-12,31), maior tempo de internação (OR: 1,06; IC95%: 1,01-1,10) e R30 (OR: 3,60; IC95%: 1,54-7,96). Maiores valores de Hb pré-operatória associaram-se à menor chance de mortalidade (OR: 0,73; IC95%: 0,61-0,87). Conclusão Os achados sugerem que a ocorrência destes desfechos está associada à comorbidades, medicamentos e Hb.

Early efficacy of rotational femoral neck osteotomy with preservation of the round ligament in treating subchondral insufficiency fracture of the femoral head in young and middle-aged population / 中华创伤杂志

Objective:To investigate the short-term efficacy of rotational femoral neck osteotomy with preservation of the round ligament in the treatment of subchondral insufficiency fracture of the femoral head (SIFFH) in young and middle-aged people.Methods:A retrospective case series study was used to analyze the clinical data of 13 patients with SIFFH, who were admitted to 920th Hospital of Joint Logistics Support Force from January 2017 to January 2022. The patients included 10 males and 3 females, aged 22-49 years [(33.5±8.3)years]. There were 6 patients with fracture on the left hip and 7 on the right hip. All the patients were treated by rotational femoral neck osteotomy with preservation of the round ligament. Postoperatively, standardized joint functional training was given. The operative time and intraoperative bleeding were recorded. The modified Harris hip score and visual analogue score (VAS) were compared preoperatively, at 3, 6 months postoperatively and at the final follow-up. Radiological examinations were used to observe the occurrence of any collapse of the femoral head, non-union at osteotomy site or other complications.Results:The patients were followed up for 13-24 months [(17.9±3.1)months]. The operative time was (127.3±9.8)minutes, with the intraoperative bleeding of (393.9±21.9)ml. The values of modified Harris hip score were (61.6±3.3)points, (80.2±4.4)points, and (91.9±4.1)points at 3, 6 months postoperatively and at the final follow-up, respectively, being significantly higher than the preoperative (51.4±3.5)points (all P<0.05), and there were significant differences between different postoperative timepoints (all P<0.05). The values of VAS were (4.9±1.1)points, (3.0±0.9)points, and (1.4±0.5)points at 3, 6 months postoperatively and at the final follow-up, respectively, being significantly lower than preoperative (6.7±0.9)points (all P<0.05), and there were significant differences between different postoperative timepoints (all P<0.05). Imaging examination showed no femoral head collapse, with all the bones healed at the osteotomy site. There were no serious complications such as bone non-union, incision infection or peripheral nerve injury. Conclusion:Rotational femoral neck osteotomy with preservation of the round ligament in treating SIFFH in the young and middle-aged population has the advantages of shortened operative time, less intraoperative bleeding, promoted hip function recovery, attenuated pain and decreased complications, showing a satisfactory early effect.

Re-understanding the value of the tip-apex distance theory in guiding treatment of intertrochanteric femoral fracture / 中华创伤杂志

Intertrochanteric femoral fracture occurs frequently in elderly osteoporotic patients, with high disability and mortality, for which surgical treatment is necessary. Common surgical modalities for intertrochanteric femoral fracture include intramedullary and extramedullary internal fixation systems, but neither can avoid the complications like internal fixation cut-out or internal fixation cut-through of the femoral head after surgery. The tip-apex distance theory was once considered to be of great significance in avoiding internal fixation cut-out, with the mainstream view was that screw cut-out could be avoided to the maximum extent when the tip-apex distance was ≤25 mm. However, internal fixation that meets the criteria of the tip-apex distance theory may also show cut-out and "Z-effect" in clinical practice, which lacks a reasonable explanation. Based on the lever balance reconstruction theory and the buttress-stretch effect, the author re-understands the value of the tip-apex distance theory in guiding treatment of intertrochanteric femoral fracture, hoping to propose an enlightenment for the treatment of intertrochanteric femoral fracture.

Predictive value of anticardiolipin antibody and D-dimer combined with risk assessment profile for thromboembolism for deep vein thrombosis in elderly postoperative patients with intertrochanteric fracture of femur / 中国医师进修杂志

Objective:To investigate the predictive value of anticardiolipin antibody (ACA) and D-dimer (D-D) combined with risk assessment profile for thromboembolism (RAPT) for deep vein thrombosis (DVT) in elderly postoperative patients with intertrochanteric fracture of femur (IFF).Methods:The clinical data of 123 elderly patients with IFF in Suzhou Hospital Affiliated to Anhui Medical University from January 2019 to March 2022 were retrospectively analyzed. All patients underwent closed reduction intramedullary nail fixation. The patients were divided into DVT group (27 cases) and non-DVT group (96 cases) according to the presence or absence of DVT 7 d after surgery. Before surgery and 3, 5 d after operation, the ACA was detected by enzyme-linked immunosorbent assay, the D-D was detected by automatic coagulation analyzer, and RAPT was performed. The correlation among ACA, D-D and RAPT was analyzed by Spearman method. Multivariate Logistic regression was used to analyze the independent risk factors of DVT in elderly postoperative patients with IFF. Receiver operating characteristic (ROC) curve was used to analyze the efficacy of ACA, D-D and RAPT in predicting DVT in elderly postoperative patients with IFF. The incidences of postoperative DVT in patients with different ACA, D-D and RAPT patients were compared.Results:There were no statistical difference in ACA, D-D and RAPT before operation between the two groups ( P>0.05); the ACA, D-D and RAPT 3 and 5 d after operation in DVT group were significantly higher than those in the non-DVT group, 3 d after operation: (12.44 ± 3.25) × 10 3 RU/L vs. (8.67 ± 2.81) × 10 3 RU/L, (7.29 ± 1.49) mg/L vs. (4.70 ± 1.23) mg/L and (9.79 ± 1.15) scores vs. (9.21 ± 1.32) scores; 5 d after operation: (10.28 ± 2.16) × 10 3 RU/L vs. (6.45 ± 2.04) × 10 3 RU/L, (5.49 ± 1.26) mg/L vs. (3.63 ± 1.05) mg/L and (9.57 ± 1.08) scores vs. (9.12 ± 0.70) scores, and there were statistical differences ( P<0.01 or <0.05). Since ACA, D-D and RAPT in the two groups all reached their peak 3 d after operation, this time point was selected for analysis. Three days after operation, Pearson correlation analysis result showed that ACA and D-D were positively correlated with RAPT ( r = 0.635 and 0.630, P<0.01), and ACA was positively correlated with D-D ( r = 0.657, P<0.01). ROC curve analysis result showed that the area under the curve (AUC) of ACA and D-D combined RAPT 3 d after operation in predicting DVT in elderly postoperative patients with IFF was greater than that predicted by the 3 indexes alone (0.982 vs. 0.894, 0.870 and 0.868), the optimal cut-off values were 11.48 × 10 3 RU/L, 6.75 mg/L and 9 scores. According to the optimal cut-off value of ROC curve analysis at 3 d after operation, the patients were divided into ACA low expression (≤11.48 × 10 3 RU/L, 92 cases) and ACA high expression (>11.48 × 10 3 RU/L, 31 cases), D-D low expression (≤6.75 mg/L, 99 cases) and D-D high expression (>6.75 mg/L, 24 cases), low RAPT (≤9 scores, 93 cases) and high RAPT (>9 scores, 30 cases). The incidences of postoperative DVT in patients with ACA high expression, D-D high expression and high RAPT were significantly higher than those in patients with ACA low expression, D-D low expression and low RAPT: 43.39% (15/31) vs. 13.04% (12/92), 54.17% (13/24) vs. 14.14% (14/99) and 53.33% (16/30) vs. 11.83% (11/93), and there were statistical differences ( χ2 = 16.91, 18.06 and 22.81; P<0.01). After controlling for diabetes and other factors, multivariate Logistic regression analysis result showed that ACA, D-D and RAPT 3 d after operation were independent risk factors for DVT in elderly postoperative patients with IFF ( OR = 2.156, 2.276 and 6.106; 95% CI 1.356 to 3.429, 1.240 to 4.177 and 1.564 to 23.840; P<0.01). Conclusions:The ACA, D-D combined with RAPT can improve the predictive value of DVT in elderly postoperative patients with IFF, which has important reference significance for taking timely and effective intervention measures in early clinical stage.

Research on clinical efficacy of robot navigation assistance in the treatment of elderly femoral tuberosity fractures / 国际外科学杂志

Objective:To compare the clinical effects robot navigation assisted and conventional proximal femoral nail antirotation (PFNA) implantation and fixation in the treatment of elderly femoral trochanteric fractures.Methods:A total of 86 elderly patients with tuberosity fracture of the femur were admitted as research samples from January to March in 2022 in the Department of Trauma Orthopaedic, Xi′an Honghui Hospital Affiliated to Xi′an Jiaotong University, including 37 males and 49 females, who aged from 63 to 92 years, with an average age of (79.6 ± 6.9) years. All patients were treated with intramedullary nails (PFNA), 32 with dimensity robotic-assisted therapy (robot group) and 54 with traditional methods (conventional group). The length of incision, the number of intraoperative fluoroscopy, the amount of intraoperative blood loss, and the operation time were recorded. The occurrence of postoperative complications in the two groups was observed. The rate of excellent hip Harris score at 3 month after surgery was compared between the two groups. Measurement data with normal distribution were represented as mean ± standard deviation( ± s), and the comparison between groups was conducted using the t-test; the comparison of count data were represented as [ n(%)], and was conducted by Chi-square test or Fisher exact probability between groups. Results:All patients were followed up for 9 to 12 months, with an average of (10.6 ± 0.9) months. The incision length and tip apex distance (TAD) of the robot group were (3.40±0.82) cm and (21.85±1.44) mm, which were smaller than (4.82±0.75) cm and (26.83±1.75) mm in the conventional group ( P<0.05 for all). The number of intraoperative fluoroscopy and guide needle adjustment [(14.53±3.26) and 0 times] in the robot group were less than those in the conventional group [(20.67±4.84) and (2.83±1.42)] ( P<0.05). The intraoperative blood loss and drainage rate of the robot group were (87.03±9.41) and (46.40±8.91) mL, which were smaller than that of the conventional group [(110.00±12.52) and (69.62±10.22) mL] ( P<0.05). There was no significant difference in the number of days of hospitalization and operation time between the two groups ( P>0.05). The postoperative complication rate in the robot group was 9.4%, which was lower than that in conventional group (42.6%), and the difference was statistically significant ( χ2=11.88, P=0.036). The excellent rate of postoperative hip joint function in the robot group was 75.0%, and the conventional group was 66.7%, and there was no significant difference between the two groups ( χ2=0.66, P=0.416). Conclusion:Robot-assisted navigation downward PFNA surgery can have good clinical effect in the treatment of femoral tuberosity fracture in the elderly, which can reduce the number of surgical incisions and intraoperative fluoroscopy, and reduce the incidence of postoperative complications, which is helpful to achieve minimally invasive surgery and rapid recovery of elderly patients with femoral tuberosity fracture.

A medium term analysis on of therapeutic effects of bio-lengthend stem hemiarthroplasty in the treatment of unstable osteoporotic intertrochanteric fractures in elderly patients / 中国骨伤

OBJECTIVE@#To retrospectively study medium term follow up outcomes effects of effect of bio-lengthend stem hemiarthroplasty in the treatment of unstable osteoporotic intertrochanteric fractures in elderly patients.@*METHODS@#Total of 32 elderly patients with the osteoporotic intertrochanteric fractures were treated with bio-lengthend stem hemiarthroplasty from Jan. 2016 to Jan. 2019 including 14 males and 22 females, aged from 85 to 95 years old with an average of (89.5±4.5) years old. According to classification of Evans, there were 12 cases with type Ⅲ, 11 with type Ⅳ and 9 with type Ⅳ. The time from injury to operation ranged from 0.5 to 9 days with an average of (4.5±3.9) days. The operation time, blood loss and postoperative complications were analyzed. Functional outcome was assessed by Parker Palmer mobility score(PPMS) and Harris hip score.@*RESULTS@#Four patients died within one year after operation, and the mortality was 12.5%. The follow up time for the rest 28 patients ranged from 24 to 60 months with an average of (28.5±4.5) months. The mean operative time was (54.2±22.5) min;the mean blood loss (hidden blood loss+obvious blood loss) was (450±140) ml;the first weight bearing was (3.35±1.35) days. No perioperative death occurred. PPMS were(6.63±1.25), (6.94±1.18), (7.11±0.83), (7.32±1.11) and Harris scores were(67.85±6.19), (71.42±5.57), (73.41±5.62), (77.32±5.24) respectively at 1, 3, 6 months and the final follow-up after operation. There were no significant difference in PPMS and Harris score at 1, 3, 6 months after operation and the final follow-up(P>0.05). There were no complications such as joint dislocation and prosthesis loosening occure at the final follow-up.@*CONCLUSION@#On the premise of strictly mastering the case selection criteria, the bio-lengthend stem hemiarthroplasty in the treatment of unstable osteoporotic intertrochanteric fractures in elderly patients has a satisfied medium term follow-up outcomes. It can restore hip function in the early stage and improve the quality of life of patients.

Treatmen of distal femoral fracture of Müller type A with homeopathic bidirectional-traction reduction device unite with internal fixation / 中国骨伤

OBJECTIVE@#To investigate the effect of treatment of Müller A fracture of distal femur with small incision internal fixation assisted by homeopathic bidirectional-traction reduction device.@*METHODS@#From January 2018 to December 2019, 22 patients (14 males and 8 females) with Müller type A distal femoral fractures were treated with homeopathic bidirectional-traction assisted reduction and minimally invasive small incision locking plate internal fixation;The age ranged from 29 to 58 years old with an average of (41.23±7.03) years. The time from injury to operation was 1 to 7 days with an average of (3.41±1.71) days. According to Müller classification, there were 4 cases of type A1, 10 cases of type A2, and 8 cases of type A3. The postoperative knee joint function was evaluated by Schatzker Lambert fracture criterion of distal femur.@*RESULTS@#All the incisions healed in one stage without infection, osteomyelitis and other complications. All the fractures healed without malunion and nonunion. All of 22 patients were followed up for 12 to 18 months with an average of (14.50±2.02) months. The healing time was 3 to 6 months with an average of (4.64±1.14) months. According to Schatzker Lambert criteria for distal femoral fracture, 12 cases were excellent, 6 good, and 4 medium.@*CONCLUSION@#It is an ideal method to treat Müller type A fracture of distal femur with homeopathic bidirectional-traction assisted reduction device and minimally invasive small incision locking plate internal fixation.

An unusual case of symmetric quadruple limb fractures / 中华创伤杂志(英文版)

A 19-year-old man had an accidental fall from the 2nd floor and sustained multiple injuries. On radiological evaluation, the patient had symmetrical quadruple limb involvement with bilateral humerus shaft, bilateral olecranon, bilateral femur shaft, and bilateral patella fractures. The patient was actively managed using damage control orthopaedics, and a sequence of skeletal fixation was planned based on the hemodynamic stability and periodical serum lactate assessment. Symmetrical quadruple limb fractures are very rare, which could be associated with higher mortality. A meticulous clinical evaluation, periodical blood parameter assessment and strict adherence to the principles of damage control orthopaedics can be conducive to prevent life-endangering complications.

Three fixation methods in the revision of medial defective intertrochanteric fractures with failed treatment: a finite element analysis / 中华骨科杂志

Objective:To compare the biomechanical differences of dynamic condylar screw (DCS), locking compression plate (LCP) combined with DCS and medial anatomic buttress plate (MABP) combined with DCS in the revision of medial defective intertrochanteric fractures by finite element analysis.Methods:The femoral CT imaging data provided by a healthy adult volunteer were used to reconstruct the solid three-dimensional model of femur by Mimics 21.0 and Geomagics Studio 12. Evans-Jensen II B intertrochanteric fracture was established by Ansys Workbench18.0. The three-dimensional models of proximal femoral nail antirotation (PFNA), DCS, LCP and MABP were reconstructed in Solidworks 2015. The PFNA was assembled with the fracture model, and then the PFNA was removed to establish the postoperative failure model of femoral intertrochanteric fracture and then simulated the fixation in the hip-preserving revision surgery of femoral intertrochanteric fractures: non-medial support reconstruction group (DCS); indirect medial support reconstruction group (DCS+LCP) and partial direct medial support reconstruction group (DCS+MABP). Finally, the forces on the hip joint of 70 kg normal people during standing (700 N), slow walking (1,400 N), brisk walking (1,750 N) and going up and down stairs (2,100 N) were simulated in Abaqus 6.14, the relative displacement and stress peak value of fracture end and stress distribution and stress peak value of internal fixation in different models were recorded.Results:At 700 N axial load, the relative displacement of fracture end fixed by DCS, DCS+LCP and DCS+MABP was 0.28, 0.13 and 0.09 mm; the peak stress of the fracture end was 49.01, 15.29 and 1.35 MPa; the peak stress of internal fixation was 230, 220 and 174 MPa, respectively. At 1,400 N axial load, the relative displacement of the fracture end of the three internal fixation methods was 0.56, 0.24 and 0.16 mm; the peak stress of fracture end was 108.49, 28.96 and 3.12 MPa; the peak stress of internal fixation was 469, 352 and 324 MPa, respectively. At 1,750 N axial load, the relative displacement of the fracture end of the three group was 0.70, 0.30 and 0.20 mm; the peak stress of the fracture end was 139.59, 37.57 and 4.17 MPa; the peak stress of internal fixation was 594, 421 and 393 MPa, respectively. At 2,100 N axial load, the relative displacement of the fracture end of the three internal fixation methods was 0.85, 0.35 and 0.23 mm; the peak stress of the fracture end was 170.05, 46.36 and 5.24 MPa; the peak stress of internal fixation was 724, 504 and 460 MPa, respectively.Conclusion:The partial direct reconstruction of medial support under the neck by DCS+MABP may have better biomechanical properties in the revision of medial defective intertrochanteric fractures.

Fixation with a 3D printed individualized custom-made plate for elderly patients with periprosthetic femoral fracture: an analysis of short-term efficacy / 中华创伤骨科杂志

Objective:To explore the short-term efficacy of fixation with a 3D printed individualized custom-made plate in the treatment of elderly patients with periprosthetic femoral fracture.Methods:Retrospectively analyzed were the 5 elderly patients with periprosthetic femoral fracture who had been treated by fixation with a 3D printed individualized custom-made plate from January 2022 to July 2022 at Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital. There were 3 males and 2 females, aged 81, 86, 77, 91 and 87 years, respectively. One left and 4 right limbs were affected. Vancouver classification: type B1 ( n=3), type B2 ( n=1), and type C ( n=1). The time from operation to injury was 5, 6, 10, 5 and 7 days, respectively. Preoperatively, the femur affected, prosthesis and individualized plate with a greater trochanteric hook, loop cable channel and bone-like trabecular microporous structure were custom-made by 3D printing according to 1:1 models. Virtual operations were simulated to formulate surgical protocols. The operation time, length of surgical incision, intraoperative blood loss and transfusion, hospital stay, hip function and complications at the last follow-up were recorded. Results:The 5 patients were followed up for 12, 7, 10, 3 and 6 months, respectively. There were no events of superficial incision or deep prosthesis infection. Respectively, the operation time was 1.8, 1.7, 2.3, 2.0 and 3.3 h; the length of surgical incision 31, 30, 38, 27 and 30 cm; the intraoperative bleeding volume 400, 300, 300, 500 and 600 mL; the length of hospital stay 8, 9, 15, 14 and 11 d. Four patients received intraoperative blood transfusion of 300, 900, 150 and 1, 050 mL, respectively. One patient died of a heart attack 3 months after discharge; another patient developed dyskinesia at the contralateral limb 3 months after discharge due to cerebral infarction and died of recurrent cerebral infarction 7 months after discharge. At the last follow-up, the Harris hip scores of 3 patients were 86, 77 and 69 points, respectively. None of the patients had complications like breakage or loosening of implants.Conclusion:In the treatment of elderly patients with periprosthetic femoral fracture, fixation with a 3D printed individualized custom-made plate may lead to fine limb function and good short-term curative efficacy.

Sedative use and incidence of falls and hip fractures among older adults in an outpatient geriatric clinic / Perfil de uso de sedativos e ocorrência de quedas e fratura de fêmur entre idosos em um ambulatório de geriatria

OBJECTIVE: To investigate the use of sedatives by older adults attending a private outpatient geriatric clinic in Belo Horizonte (MG), Brazil, and its association with falls and hip fractures. METHODS: Using a longitudinal design, the prevalence of benzodiazepine and nonbenzodiazepine ("z-drugs") intake by older adults was described and their association with the incidence of falls and fractures (30 days after the initial visit) was evaluated through logistic regression. RESULTS: A total of 7821 older adults were included in the study, most of them women (72.50%), with a mean age of 77.5 years and a mean Clinical-Functional Vulnerability Index (IVCF-20) score of 16.5. The overall prevalence of sedative use (any sedative) was 6.19%, with 4.48% benzodiazepines and 1.98% z-drugs. The most widely used sedatives were clonazepam (29.04%), zolpidem (28.65%), and alprazolam (23.44%). Falls were reported for 182 patients (2.33%), with a higher incidence among users of any sedatives (4.34; p = 0.002; OR = 1.94, adjusted for sex, age, and IVCF-20) and benzodiazepines (5.14%; p < 0.001; OR = 2.28) than among non-users (2.19%). Hip fractures occurred in 33 patients (0.42%), and again were more frequent among users of sedatives (1.03%; p = 0.032; OR = 2.57) and benzodiazepines (1.43%; p = 0.003; OR = 3.45) than among non-users (0.38%). CONCLUSIONS: The use of sedatives, especially benzodiazepines, is associated with an increased incidence of falls and hip fractures in older adults

OBJETIVO: Investigar a utilização de sedativos entre idosos atendidos em ambulatório privado de geriatria em Belo Horizonte (MG), bem como sua associação com quedas e fraturas de fêmur. METODOLOGIA: Trata-se de estudo longitudinal, no qual foi descrita a prevalência de uso de benzodiazepínicos e drogas Z entre idosos (60 anos ou mais) e avaliada sua associação com a incidência de queda e fratura (30 dias após consulta inicial) por meio de regressão logística. RESULTADOS: Foram incluídos no estudo 7821 idosos, com maioria feminina (72,50%), idade média de 77,5 anos e Índice de Vulnerabilidade Clínico Funcional (IVCF-20) médio de 16,5 pontos. A prevalência de uso de sedativos em geral foi de 6,19%, sendo 4,48% de benzodiazepínicos e 1,98% de drogas Z. Os medicamentos sedativos mais utilizados foram clonazepam (29,04%), zolpidem (28,65%) e alprazolam (23,44%). Relatou-se queda para 182 idosos (2,33%), com incidência maior entre usuários de sedativos (4,34; p = 0,002; OR = 1,94 ajustada por sexo, idade e IVCF-20) e de benzodiazepínicos (5,14%; p < 0,001; OR = 2,28) do que entre não usuários (2,19%). Identificou-se fratura de fêmur em 33 idosos (0,42%), sendo mais frequente entre usuários de sedativos (1,03%; p = 0,032; OR = 2,57) e de benzodiazepínicos (1,43%; p = 0,003; OR = 3,45) do que entre não usuários (0,38%). CONCLUSÃO: Concluiu-se que a incidência de quedas e fraturas de fêmur em idosos possui associação com o uso de medicamentos sedativos, em especial os benzodiazepínicos

Factors associated with the outcomes of older patients operated due to hip fractures / Fatores associados aos desfechos de pacientes idosos operados por fraturas do quadril

ABSTRACT Objective: Evaluating clinical factors associated with mortality in older patients who underwent surgical correction of hip fractures. Methods: This observational and retrospective study analyzed the medical records of 67 patients (aged older than 60 years), both men and women, who underwent surgical correction of hip fractures from 2019 to 2020 at Hospital São Paulo. The following variables were analyzed: age, sex, presence of comorbidities, affected hip region, and trauma mechanism. Statistical analyses were performed using the SPSS software. Results: The mean age of patients was 78.12 ± 9.80 years and 80.6% of the sample were women. The prevalence of hip fractures on the right side (52.2%), in the transtrochanteric region (53.7%), and due to fall on the same level (88.1%) was higher. Systemic arterial hypertension (77.6%), diabetes mellitus (37.3%), and dementia (16.4%) were frequent comorbidities. The prevalence of death after fracture was 17.9% and it was associated with longer hospital stay after surgery (p = 0.028). Conclusion: The prevalence of mortality of patients with hip fractures who underwent surgery was 17.9%. A longer hospital stay due to pre-existing comorbidities was the main factor related to this outcome. Level of Evidence III, Retrospective Study.

RESUMO Objetivo: Avaliar os fatores clínicos associados à mortalidade em pacientes idosos submetidos ao tratamento cirúrgico para correção de fraturas do quadril. Métodos: Estudo observacional e retrospectivo de análise de prontuários de 67 pacientes (idade superior a 60 anos). Foram incluídos indivíduos de ambos os sexos, submetidos ao tratamento cirúrgico para correção de fraturas do quadril, entre 2019 e 2020, no Hospital São Paulo. Foram analisadas as variáveis: idade, sexo, presença de comorbidades, região do quadril acometido e mecanismo de trauma. As análises estatísticas foram realizadas pelo software SPSS. Resultados: A idade média dos participantes foi de 78,12 ± 9,80 anos, e 80,6% da amostra era constituída por mulheres. Houve maior prevalência de fraturas do quadril no lado direito (52,2%), na região transtrocantérica (53,7%) e causada por queda sem desnível (88,1%). Hipertensão arterial sistêmica (77,6%), diabetes mellitus (37,3%) e demência (16,4%) foram frequentes. A prevalência de óbito após a fratura foi de 17,9%, sendo associada a maior tempo de internação hospitalar após a cirurgia (p = 0,028). Conclusão: A prevalência de mortalidade dos pacientes com fratura do quadril submetidos à cirurgia foi de 17,9%. O tempo prolongando de internação hospitalar por comorbidades pré-existentes foi o principal fator relacionado a este desfecho. Nível de Evidência III, Estudo Retrospectivo.

Flexible intramedullary nails in pediatric subtrochanteric femur fracture: biomechanical study / Hastes flexíveis na fixação de fratura subtrocantérica de fêmur pediátrico: análise biomecânica

ABSTRACT Objective Evaluate the stability provided by two flexible intramedullary nails (FINs) in a simulation of fractures at the proximal levels in pediatric femur models. Methods Two FINs were inserted in 18 synthetic models of pediatric femurs. Fractures were simulated at one of three levels, and the models were divided into the following groups (n=6): diaphysis (control), subtrochanteric and trochanteric. Flex-compression tests were performed with force up to 85 N. Relative stiffness and the average deformation was obtained. Torsion tests were performed by rotating the proximal fragment until 20°, to obtain the average torque. Results At flex-compression, the set's average relative stiffness and average deformations were: 54.360x103 N/m and 1.645 mm in the control group, respectively. In the subtrochanteric group, the relative stiffness was 31.415x103 N/m (-42.2%) and the deformation was 2.424 mm (+47.3%) (p<0.05). For the trochanteric group, the relative stiffness was 30.912x103 N/m (+43.1%) and the deformation was 2.508 mm (+52.4%) (p<0.05). In torsion, the average torque was 1.410 Nm in the control group; 1.116 Nm in the subtrochanteric group (-20.8%), and 2.194 Nm in the trochanteric group (+55.6%) (p<0.05). Conclusion FINs do not seem to be biomechanically competent for the treatment of proximal femoral fractures. Level of Evidence I; Therapeutic Studies - Investigating the results of treatment.

RESUMO Objetivo avaliar a estabilidade proporcionada por duas hastes intramedulares flexíveis na simulação de fraturas nos níveis proximais em modelos pediátricos de fêmur. Métodos Duas hastes foram inseridas em 18 modelos sintéticos de fêmures pediátricos. As fraturas foram simuladas em um dos três níveis, e os modelos foram divididos nos seguintes grupos (n=6): diáfise(controle), subtrocantérico e trocantérico. Testes de flexão-compressão foram realizados com força de até 85N. A rigidez relativa e a deformação média foram obtidas. Os testes de torção foram realizados girando o fragmento proximal até 20°, para obter o torque médio. Resultados Na flexo-compressão, a rigidez relativa média e as deformações médias do conjunto foram: 54,360x103 N/m e 1,645 mm no grupo controle, respectivamente. No grupo subtrocantérico a rigidez relativa foi de 31,415x103 N/m (-42,2%) e a deformação foi de 2,424 mm (+47,3%) (p<0,05). Para o grupo trocantérico a rigidez relativa foi de 30,912x103 N/m (+43,1%) e a deformação foi de 2,508 mm (+52,4%) (p<0,05). Na torção, o torque médio foi de 1.410 Nm no grupo controle; 1,116 Nm no grupo subtrocantérico (-20,8%) e 2,194 Nm no grupo trocantérico (+55,6%) (p<0,05). Conclusão As hastes intramedulares flexíveis não parecem ser biomecanicamente competentes para o tratamento das fraturas proximais do fêmur. Nível de Evidência I; Estudos terapêuticos - Investigação dos resultados do tratamento.

Proximal humeral locking plate: a viable alternative for fixation of distal femoral fractures in children / Placa de fixação de úmero proximal: uma alternativa para fixação de fraturas do fêmur distal em criança

ABSTRACT Distal femoral metaphyseal fractures are rare in children, and the proximity of the fracture to the growth plate makes their approach challenging. Objective Evaluate outcomes and complications of treatment of distal femoral metaphyseal fractures in children with proximal humeral locking plates. Method Retrospective study between 2018 and 2021, including seven patients. The analysis included general characteristics, trauma mechanism, classification, clinical and radiographic outcomes, and complications. Results The mean follow-up was 20 months, the average age was nine years, five patients were boys, and six fractured on the right side. Five fractures were caused by car accidents, one by falling from their own height and one by playing soccer. Five fractures were classified as 33-M/3.2 and two as 33-M/3.1. Three fractures were open, Gustilo IIIA. All seven patients recovered mobility and resumed their pre-trauma activities. All seven healed, and one fracture was reduced to 5 degrees valgus, without any other complications. Six patients had the implant removed and did not present refracture. Conclusion Treatment of distal femoral metaphyseal fractures with proximal humeral locking plates is a viable option that offers good results and fewer complications, saving the epiphyseal cartilage. Level of Evidence II; Controlled study without randomization.

RESUMO As fraturas metafisárias distais do fêmur são raras em crianças, a proximidade da fratura com a placa de crescimento torna a sua abordagem desafiadora. Objetivo Avaliar resultados e complicações do tratamento das fraturas da metáfise distal do fêmur em crianças com placas de úmero proximal. Método Estudo retrospectivo entre 2018 e 2021 incluindo sete pacientes. A análise incluiu características gerais, mecanismo do trauma, classificação, resultados clínicos, radiográficos e complicações. Resultados A média do acompanhamento foi de 20 meses, a idade média foi de nove anos, cinco pacientes eram meninos e seis fraturas do lado direito. Cinco fraturas por acidentes automobilísticos, uma por queda da própria altura e uma jogando futebol. Cinco fraturas classificadas como 33-M/3,2 e duas como 33-M/3,1. Três fraturas foram expostas, Gustilo IIIA. Todos os sete pacientes recuperaram a mobilidade e retomaram às atividades anteriores ao trauma. Todas as sete fraturas consolidaram, uma fratura foi reduzida com valgo de 5 graus, e não houveram outras complicações. Seis pacientes tiveram o implante removido e não apresentaram refratura. Conclusão O tratamento das fraturas da metáfise distal do fêmur com placas de úmero proximal é uma opção viável que oferece bons resultados com poucas complicações, poupando a cartilagem epifisária. Nível de Evidência II; Estudo controlado sem randomização.

Efficacy and safety of knotless barbed sutures in capsular closure following distal femur fracture fixation / Eficácia e segurança das suturas farpadas sem nós no fechamento capsular após fixação de fratura distal do fêmur

ABSTRACT Introduction: Good wound closure is an important step in management of distal femur fracture to prevent infection and faster rehabilitation. Knotless barbed sutures can save time and distribute wound tension evenly. However, its role in terms of functional outcome, closure time, and postoperative complications has not been studied in a distal femur fracture. Material and methods: A total of 47 patients aged more than 18 years of distal femur fracture treated with distal femur locking plate were randomized either into either barbed or traditional suture groups. in the barbed group, capsular wound closure was carried out with 2-0 bidirectional barbed knotless sutures (Quill SRS® PDO, Angiotech, Vancouver, BC, Canada). In patients assigned to group B, capsular closure was done with 1-0 Vicryl® (Ethicon inc. Somerville, NJ) and 5-0 Ethibond® alternatively. Results: The mean flexion at the knee joint was 105.7±15.6 degrees in the study group while it was 110.4±13.7 in the control group (p= 0.2133). Mean estimated closure time was significantly shorter in the study group as compared to the control group (p<0.05). Cases of needle prick injury were higher in traditional suture group. Patients developed stitch abscess and superficial infection in both groups. However, the difference in incidence between the two was not statistically significant Conclusion: Barbed suture is an efficient method of wound closure. It reduces wound closure time with similar complication rate as with use of conventional sutures. Evidence Level II; Randomized Clinical Trial.

RESUMO Introdução: O fechamento adequado da ferida é um passo importante no manejo da fratura distal do fêmur a fim de evitar infecção e permitir uma rápida reabilitação. Suturas farpadas sem nós podem poupar tempo e distribuir uniformemente a tensão da ferida. Entretanto, seu papel em termos de resultado funcional, tempo de fechamento e complicações pós-operatórias não tem sido analisado em casos de fratura distal do fêmur. Material e métodos: Um total de 47 pacientes com mais de 18 anos de idade com fratura distal do fêmur tratados com placa de fixação distal do fêmur foram aleatorizados em grupos de sutura farpada ou tradicional. No grupo de farpados, o fechamento da ferida capsular foi feito com suturas sem nós farpados bidirecionais 2-0 (Quill SRS® PDO, Angiotech, Vancouver, BC, Canadá). Em pacientes designados para o grupo B, o fechamento capsular foi feito com Vicryl®1-0 (Ethicon inc. Somerville, NJ) e Ethibond® 5-0 respectivamente. Resultados: A flexão média na articulação do joelho foi de 105,7±15,6 graus no grupo de estudo e 110,4±13,7 no grupo controle (p= 0,2133). O tempo médio estimado de fechamento foi significativamente menor no grupo de estudo em comparação com o grupo controle (p<0,05). Os casos de ferimento por perfuração da agulha foram maiores no grupo de sutura tradicional. Os pacientes desenvolveram abscesso de pontos e infecção superficial em ambos os grupos. Entretanto, a diferença na incidência entre os dois não foi estatisticamente significative Conclusão: A sutura farpada é um método eficiente para o fechamento de feridas. Ele reduz o tempo de fechamento das feridas com uma taxa de complicação semelhante à utilização de suturas convencionais. Evidência Nível II; Ensaio Clínico Randomizado.

The relationship between fractures in pediatric polytrauma patients: evaluation of clinical outcomes / Relação das fraturas no paciente politraumatizado pediátrico: avaliação de desfechos clínicos

ABSTRACT Objective: To evaluate children and adolescents with polytrauma and fractures of the pelvis and proximal and diaphyseal femur and correlate the impact of these conditions and clinical outcomes. Methods: Retrospective study carried out in a public hospital in Taboão da Serra (SP), with pediatric patients with polytrauma from January 2012 to December 2021. In total, 44 patients were evaluated, 70.44% boys and 29.55% girls, aged from 12 to 17 years. Results: Diaphyseal fracture of the femur affected 70.44% of the patients, mainly caused by a fall from a height (56.81%). Linear external fixation was the most used treatment (45.45%). All patients were discharged from hospital. Conclusion: We found essential sociodemographic information: 84.11% of patients did not have associated injuries; 88.63% were hospitalized from 3 to 11 days; 90.91% did not need to be admitted to an ICU, 77.27% did not need reoperation, and 22.73% underwent another surgery; 45.45% used the external fixator to stabilize injuries; 11.36% converted the external fixator to the intramedullary nail; 9.09% needed an intramedullary nail remover; 2.27% converted to a plate (bilateral) and 2.27% to a rigid nail; 2.27% had loss of reduction and revision with rod; 2.27% underwent corrective osteotomy; 2.27% had clinical hospitalization; 2.27% had osteonecrosis of the femoral head and screws removed; 2.27% removed the plate. No deaths were recorded. Level of Evidence II, Retrospective Study.

RESUMO Objetivo: Avaliar crianças e adolescentes politraumatizados com fraturas da pelve, proximal e diafisária do fêmur e correlacionar o impacto dessas condições e desfechos clínicos. Métodos: Estudo retrospectivo realizado em hospital público de Taboão da Serra (SP), com pacientes pediátricos politraumatizados entre janeiro de 2012 e dezembro de 2021. Avaliaram-se 44 pacientes, 70,44% meninos e 29,55% meninas, de 12 a 17 anos. Resultados: A fratura diafisária fechada do fêmur acometeu 70,44%, sendo causada principalmente por queda de altura (56,81%). A fixação externa linear foi o tratamento mais utilizado (45,45%). Todos os pacientes receberam alta hospitalar. Conclusão: Identificaram-se importantes informações sociodemográficas: 84,11% dos pacientes não apresentaram lesões associadas; 88,63% ficaram internados de 3 a 11 dias; 90,91% não necessitaram de internação em unidade de terapia intensiva (UTI), 77,27% não precisaram ser reoperados; 22,73% realizaram nova cirurgia; 45,45% utilizaram fixador externo para estabilização de lesões;11,36% converteram o fixador externo para a haste intramedular; 9,09% precisaram remover as hastes intramedulares; 2,27% converteram para placa (bilateral) e 2,27% para haste rígida; 2,27% tiveram perda de redução e revisão com haste; 2,27% realizaram osteotomia corretiva; 2,27% tiveram internação clínica; 2,27% tiveram osteonecrose da cabeça femoral e parafusos removidos; e 2,27% retiraram a placa. Não foram observados óbitos. Nível de Evidência II, Estudo Retrospectivo.

Artroplastia de quadril em Minas Gerais: análise dos dados do Sistema Único de Saúde / Hip arthroplasty in Minas Gerais: analysis of data from the Unified Health System

Artroplastia de quadril em Minas Gerais: análise dos dados do Sistema Único de Saúde. 2023. 109 f. Dissertação (Mestrado Profissional em Gestão de Serviços em Saúde) ­ Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, 2023. Introdução: o aumentando da longevidade está associado ao aumento de incidência e prevalência de doenças crônicas, como a artrose ou osteoartrite, além de ampliar a chance de ocorrência de fratura de colo do fêmur, mais frequente em indivíduos com idades avançadas, levando ao consequente aumento da necessidade de realização da cirurgia de artroplastia de quadril. Objetivo: analisar a incidência de artroplastias de quadril realizadas pelo Sistema Único de Saúde em Minas Gerais, no período de 2013 a 2022. Metodologia: este é um estudo ecológico em que as unidades de análise foram as Microrregiões de Saúde do estado de Minas Gerais. Foram descritas a frequência dos diferentes tipos de artroplastias de quadril, sua evolução temporal, a média de idade de realização relativa a cada um desses procedimentos (por tipo), além de estimadas as incidências anuais da cirurgia. Também foi realizada análise dos fatores associados à incidência da cirurgia nas diferentes Microrregiões. Como variável de desfecho foi considerada a taxa de incidência no ano de 2018. Os fatores investigados quanto à associação em relação à taxa da cirurgia por 100.000 habitantes foram: o Índice Mineiro de Responsabilidade Social (IMRS); proporção de habitantes do sexo feminino; porcentagem de habitantes maior que 50 anos; porcentagem de habitantes brancos; médicos especialistas da Sociedade Brasileira de Ortopedia e Traumatologia (SBOT)/1.000 habitantes; e número de leitos por Macrorregião de Saúde. Para analisar a correlação entre a incidência de artroplastia e as demais variáveis do estudo foi utilizado o coeficiente de correlação de Spearman. Foi empregado modelo de regressão Binomial Negativa, simples e múltiplo, considerando a ocorrência de artroplastia em 2018 como o desfecho, e os demais indicadores do estudo como variáveis explicativas, incluindo os subíndices do IMRS Saúde. Ao selecionar as variáveis para inclusão no modelo múltiplo, considerou-se um valor-p inferior a 0,10 como critério. Permaneceram no modelo final as variáveis significativas ao nível de 5% de significância. Resultados: no período de janeiro de 2013 a dezembro de 2022, foram identificadas em Minas Gerais 34.273 internações para artroplastia de quadril o que representou uma taxa de 15,5 internações para a cirurgia por 100 mil habitantes. Os tipos mais frequentes foram: artroplastia total primaria do quadril não cimentada/híbrida (36,8%), artroplastia parcial de quadril (34,8%) e artroplastia total primária do quadril cimentada (17,3%), respectivamente. Quanto à evolução temporal, a mediana dos valores de incidência da cirurgia se manteve quase constante entre os anos de 2013 e 2018, com aumento em 2019. Em 2020 a mediana alcançou o menor valor do período estudado, aumentando em 2021 e alcançando o maior valor do recorte histórico estudado em 2022. Os resultados do modelo múltiplo revelaram que os fatores que permaneceram associados ao aumento da incidência das artroplastia foram maiores IMRS Educação e maior proporção de pessoas com 50 anos ou mais. Conclusão: pode-se concluir que em regiões com melhor situação da educação da população possivelmente há mais acesso à artroplastia do quadril e que populações mais envelhecidas apresentam maior necessidade da cirurgia.

Introduction: increased longevity is associated with an increase in the incidence and prevalence of chronic diseases, such as arthrosis or osteoarthritis, in addition to increasing the chance of femoral neck fractures, which are more common in older individuals, leading to a consequent increase in the need for of hip arthroplasty surgery. Objective: to analyze the incidence of hip arthroplasties performed by the Unified Health System in Minas Gerais, from 2013 to 2022. Methodology: this is an ecological study in which the units of analysis were the Health Microregions of the state of Minas Gerais. The frequency of different types of hip arthroplasties, their temporal evolution, the average age of completion for each of these procedures (by type) were described, in addition to estimating the annual incidence of surgery. An analysis of factors associated with the incidence of surgery in different microregions was also carried out. The incidence rate in 2018 was considered as an evolution variable. The factors investigated regarding the association in relation to the surgery rate per 100,000 inhabitants were: the Minas Gerais Social Responsibility Index (IMRS); proportion of female inhabitants; percentage of inhabitants over 50 years old; percentage of white inhabitants; specialist doctors from the Brazilian Society of Orthopedics and Traumatology (SBOT)/1,000 inhabitants; and number of beds per Health Macroregion. To analyze the projection between the incidence of arthroplasty and the other study variables, the Spearman projection coefficient was used. A simple and multiple Negative Binomial regression model was used, considering the occurrence of arthroplasty in 2018 as the outcome, and the other study indicators as explanatory variables, including the IMRS Health sub-indices. When selecting the variables for inclusion in the multiple models, if a p-value less than 0.10 as selective. Significant variations at the 5% significance level remained in the final model. Results: from January 2013 to December 2022, 34,273 admissions for hip arthroplasty were identified in Minas Gerais, which represented a rate of 15.5 admissions for surgery per 100 thousand inhabitants. The most frequent types were: uncemented/hybrid primary total hip arthroplasty (36.8%), partial hip arthroplasty (34.8%) and cemented primary total hip arthroplasty (17.3%), respectively. Regarding temporal evolution, the median surgery incidence values remained almost constant between the years 2013 and 2018, with an increase in 2019. In 2020 the median reached the lowest value of the trained period, increasing in 2021 and reaching the highest value of the historical sample trained in 2022. The results of the multiple models revealed that the factors that occurred associated with the increase in the incidence of arthroplasty were higher IMRS Education and a higher proportion of people aged 50 or over. Conclusion: it can be concluded that in regions with a better population education situation there is possibly more access to hip arthroplasty and that older populations have a greater need for surgery.