Avaliação e fatores associados à incapacidade funcional de idosos residentes em Instituições de longa permanência / Assessment and factors associated with functional disability of elderly residents in long-term care facilities

Introdução: O envelhecimento cursa com alterações funcionais que predispõe o idoso à perda funcional, que associada ao processo de institucionalização é potencializada. Objetivo: Avaliar o nível de incapacidade funcional de idosos residentes em instituições de longa permanência em Maceió (AL). Métodos: Estudo transversal realizado com os idosos residentes nas nove instituições da cidade de Maceió. Foram coletados dados socioeconômicos e demográficos e realizada a avaliação da capacidade funcional através do índice de Katz. Resultados: A amostra final foi de 270 indivíduos. A média de idade foi de 78,9 anos, com predomínio do sexo feminino e baixo nível de escolaridade. A análise estatística evidenciou associação significativa entre uso de bengala/muleta (p <0,01), síndrome do imobilismo (p <0,01), menor frequência de visitas (p <0,01) e menor circunferência da panturrilha (p <0,01). Conclusão: Este estudo permite concluir que há um alto déficit funcional, diminuição da circunferência da panturrilha, apresentar imobilismo, receber menos visitas e usar bengala/muleta mostraram associação direta com maiores déficits.

Strategies to improve the medical device life cycle in Mexico / Estrategias para mejorar el ciclo de vida de dispositivos médicos en México

Abstract Objective To analyze the role of stakeholders to three alternative strategies to improve processes and practices regarding the regulation, assessment, and management of orthopaedic medical devices in Mexico. Materials and methods The study was based on document analysis and 17 structured interviews with multiple key actors within the Mexican health system to inform a stakeholder analysis aiming at assessing the political feasibility of these strategies. Results Central level government agencies, those with a relation to quality of care, were identified as most relevant stakeholders to influence the adaption and application of the strategies. Major barriers identified are financial and human resources, and organisational culture towards reform. Conclusion Discussed strategies are political feasible. However, solving identified barriers is crucial to achieve changes directed to improve outputs and outcomes of medical device life cycle and positively influence the quality of health care and the health system's performance.

Resumen Objetivo Analizar el papel de actores clave ante tres estrategias para mejorar los procesos y prácticas relacionados con la regulación, evaluación y gestión de dispositivos médicos ortopédicos en México. Material y métodos Análisis de grupos de interés (stakeholder analysis) basado en un análisis documental y 17 entrevistas estructuradas con actores clave, dirigido a evaluar la viabilidad política de las estrategias. Resultados El papel de las agencias federales de gobierno, principalmente las relacionadas con calidad de atención, fue identificado como central y con mayor poder para influenciar la adaptación y aplicación de las estrategias. Como barreras se identificaron los recursos financieros y humanos, y reorientar la cultura organizacional hacia la reforma. Conclusión Las estrategias discutidas son políticamente viables. Resolver las barreras es importante para lograr cambios que optimicen el ciclo de vida de los dispositivos médicos e influyan positivamente en la calidad de atención y el desempeño del sistema de salud.

Physics behind the implants used for high strain fractures: literature review / A física por trás dos implantes utilizados para fraturas de alto strain: revisão de literatura

Whenever bone fractures occur, external forces produce continuous interfragmentary motion and a stabilization method is necessary. It is known that the mechanical conditions at the fracture site influence bone callus formation during healing process. To achieve primary (direct) bone healing, absolute stability at the fracture site is necessary. Perren's concept of strain determines that relative deformation at the fracture gap depends on the original gap's conformation. Simple fractures (without comminution) are considered high strain fractures since a small force applied to the fracture site results in great movement with deleterious effects on the healing process. The purpose of this study is to review the available literature regarding factors that influence the mechanics of high strain fractures in veterinary medicine, its treatment methods and implants available. Each fracture configuration requires special attention and critical care in choosing the osteosynthesis method and the type of stability required for consolidation to occur within the expected time. One must know the strain theory to become an orthopedic surgeon.(AU)

Quando fraturas ósseas ocorrem, forças externas produzem movimentação interfragmentária continuamente e um método de estabilização se faz necessário. É sabido que as condições mecânicas no local de fratura influenciam a formação de calo durante o processo de cicatrização óssea e para que cicatrização óssea primária seja obtida é necessária estabilidade absoluta no foco de fratura. O conceito de strain de Perren determina que a deformação relativa no foco de fratura estabilizado depende do tamanho da lacuna de fratura original. Fraturas redutíveis (sem cominuição) são consideradas de alto strain, pois uma pequena força aplicada a linha de fratura resulta em grande movimentação com efeito deletério ao processo de consolidação. O presente trabalho revisa a literatura disponível a respeito de fatores que influenciam a mecânica de fraturas de alto strain em medicina veterinária, seus métodos de tratamento e a física por trás dos implantes disponíveis. Cada configuração de fratura requer atenção especial e cuidado crítico na escolha do método de osteossíntese e no tipo de estabilidade necessária para que a consolidação ocorra no tempo esperado. Conhecimento da teoria do strain é mandatório para a formação de cirurgiões ortopédicos.(AU)

Desenvolvimento e avaliação de equipamento de tração, para redução de fraturas de ossos longos de cães / Development and evaluation of a traction device for reducing long bone fractures in dogs

Fraturas costumam ocorrer com encavalgamento das extremidades ósseas, dificultando, assim, sua redução. Esta pesquisa teve como objetivo desenvolver um equipamento de tração esquelética a ser utilizado em caninos acometidos de fraturas de ossos longos. Foram utilizados 21 cães de raças variadas, pesando entre dois e 27kg, com idade entre dois meses e 11 anos, com fraturas diafisárias ou metafisárias ocorridas entre três e 24 dias. Enquanto a fixação do corpo do paciente à mesa foi efetuada com cintas de náilon, a força de tração aplicada ao longo do eixo ósseo do membro fraturado foi realizada mediante cintas de náilon ou pinos transfixados e estribos (sendo os pinos implantados na epífise distal do osso fraturado), com a força de tração medida por um dinamômetro, não sendo aplicada carga maior que 25kg. Em todos os casos, a força de tração iniciava com o valor de cinco quilogramas, exceto em animais com peso inferior a esta, a qual começava com carga equivalente a esse peso; e em todos, se necessário, era aumentada a cada cinco minutos para se manter tração igual ao peso ou aos valores que oscilavam do seu peso até cinco quilogramas, dependendo do tamanho do animal, até se atingir a tração necessária para se proceder à redução. Para essa progressão de distensão, o equipamento possuía haste rosqueada de 25mm de diâmetro, uma porca com sistema timão e cilindro deslizante por fora da haste, este conectado ao animal por uma corrente, e o dinamômetro. Todos os animais tiveram as fraturas reduzidas sem haver perda óssea, o que evidencia que o aparelho se mostrou eficiente tanto na redução como na manutenção da redução da fratura, e eles não apresentaram, no pós-operatório, sinais de prejuízos neurológicos, vasculares, cutâneos e articulares. O distensor ósseo aqui desenvolvido tem como características: ser de simples confecção, ter baixo custo, não gerar danos ao paciente e facilitar a redução dos fragmentos tanto em fraturas recentes quanto em antigas.(AU)

Fractures usually occur with overriding of bone fragments, thus hindering fracture reduction. The aim of this research was to develop and test a skeletal traction device for use in dogs with long bone fractures. Twenty-one dogs were included, regardless of breed or gender, weighing between two and 27kg, and between two months and 11 years of age, with metaphyseal or diaphyseal fractures that had occurred between three and 24 days prior to intervention. While fixation of the patient's body to the table was performed using nylon straps, the traction force applied along the bone axis of the fractured limb was performed using nylon straps or transfixed pins and stirrups (with the pins implanted in the distal epiphysis of the fractured bone). Tensile strength was measured by a dynamometer, and the maximum load applied was no greater than 25kg. In all cases, the distraction force began at five kilograms except in dogs below this weight, where the starting load was equivalent to the weight of the animal. If necessary, in all dogs, force was increased every five minutes to maintain equal traction to the dog's weight or values which ranged from the dog's weight to five kilograms depending on the size of the animal, until the necessary traction for reduction was obtained. For this progression of distension, the equipment had a 25-milimeter-diameter threaded rod, a nut with a rudder system and sliding cylinder outside the rod, which connected to the dog via a chain and the dynamometer. Fracture reduction was achieved in all dogs without bone loss, and the device was shown to be efficient in both allowing and maintaining fracture reduction, with no neurologic, vascular, cutaneous, or articular damage. The developed bone distractor has the following characteristics: simple to construct, low cost, does not harm the patient, and facilitates reduction of the fragments in recent and old fractures.(AU)

Estudo comparativo da resistência mecânica da força de compressão entre biomateriais naturais, sintéticos e mistos / Comparative study of mechanical strength of compression between natural, synthetic and mixed biomaterials

As afecções ortopédicas com perda de tecido ósseo são um desafio tanto na medicina veterinária quanto na medicina humana. Portanto, não é raro ortopedistas se depararem com fraturas cominutivas irredutíveis de ossos longos, neoplasias ósseas ou não-uniões, que necessitam de procedimentos cirúrgicos reparadores, por meio da substituição de segmento ou preenchimento de falha óssea com o uso de biomateriais. Pretende-se com esta pesquisa avaliar e comparar a resistência mecânica entre biomateriais naturais, sintéticos e mistos. Foram utilizados sete grupos experimentais compostos por seis corpos de provas cada: Grupo 1 , tecido ósseo cortical de coelho (OSSO - controle); Grupo 2, cimento ósseo (CO); Grupo 3, cimento ósseo autoclavado (COA); Grupo 4, cimento ósseo e macrofragmento ósseo cortical de cão (COMaFO); Grupo 5, cimento ósseo e macrofragmento ósseo autoclavado de cortical de cão (COMaFOA); Grupo 6, cimento ósseo e microfragmento ósseo cortical de cão (COMiFO) e Grupo 7, cimento ósseo e microfragmento ósseo cortical de cão (COMiFOA). Os corpos de prova foram submetidos a ensaios mecânicos de compressão axial controlada em máquina universal de ensaio Emic®. O teste era interrompido quando ocorria queda brusca na curva do gráfico indicando falência da amostra. Em relação à Força máxima, os grupos COA, COMaFOA e COMiFOA não diferiram estatisticamente do grupo controle (OSSO; p>0,01). Já os grupos CO, COMaFO e COMiFO diferiram estatisticamente do grupo controle (OSSO; p<0,01). Quanto a rigidez relativa, os grupos COMaFOA e COMiFOA não diferiram estatisticamente do grupo controle (OSSO; p>0,01). Já os grupos CO, COA, COMaFO e COMiFO diferiram estatisticamente do grupo controle (OSSO; p<0,01). Comparando a deformação, os grupos COMaFo, COMaFOA e COMiFO não diferiram estatisticamente do grupo controle (OSSO; p>0,01). Já os grupos CO, COA e COMiFOA diferiram estatisticamente do grupo controle (OSSO; p<0,01). Conclui-se que apenas os grupos COMaFOA e COMiFOA apresentaram propriedades mecânicas muito semelhantes às do grupo controle (OSSO). Por isso, devido a essas características, esses dois biomateriais (COMaFOA e COMiFOA) seriam os mais indicados como substitutos na reparação de falhas ósseas.(AU)

The orthopedic diseases with bone loss are the challenge in both veterinary and human medicine. Therefore, the orthopedist commonly deal with irreducible comminuted fractures of long bones, bone tumors or non-unions, which require repairers surgical procedures, through the segment replacement or bone defect filling with biomaterials. The aim of this research is to evaluate and compare the mechanical strength of natural, synthetic and mixed biomaterials. Seven experimental groups of six test samples each were used: Group 1 rabbit cortical bone (BONE - control); Group 2, bone cement (CO); Group 3, bone cement autoclaved (COA); Group 4, bone cement and dog cortical bone macrofragment (COMaFO); Group 5, bone cement and bone autoclaved macrofragment dog cortical (COMaFOA); Group 6, bone cement and dog cortical bone microfragment (COMIFO) and Group 7, bone cement and dog cortical bone microfragment (COMiFOA). The specimens were subjected to axial compression mechanical tests controlled universal testing machine EMIC®. The test was stopped when there was sharp decline in the graph curve indicating failure of the sample. In relation to the maximum force, the COA groups COMaFOA and COMiFOA not statistically different from the control group (BONE; p> 0.01). Already the CO groups, COMaFO and COMIFO difeririram statistically the control group (BONE; p <0.01). The relative rigidity, the COMaFOA and COMiFOA groups did not differ statistically from the control group (BONE; p>0.01). Already the CO groups, COA, COMaFO and COMIFO differed significantly from the control group (BONE; p<0.01). Comparing the deformation, the COMaFo groups COMaFOA and COMIFO not statistically different from the control group (BONE; p>0.01). Already the CO groups, COA and COMiFOA differed significantly from the control group (BONE; p<0.01). It is concluded that only COMaFOA and COMiFOA groups showed very similar mechanical properties to the control group (BONE). Therefore, due to these characteristics, these two biomaterials (COMaFOA e COMiFOA) would be the most suitable as a substitute in the repair of bone defects.(AU)

Osteoporosis y osteosíntesis / Osteoporosis and osteosynthesis

Introducción: las manifestaciones clínicas de las osteoporosis incluyen las fracturas debido a pérdida de masa ósea y cambios estructurales en las trabéculas. En estos casos la osteosíntesis se ve afectada por los factores mecánicos inherentes al proceder y los implantes. Objetivo: mostrar las precauciones que el ortopédico necesita tener en mente al seleccionar el tipo de osteosíntesis (interna o externa) y los implantes que vaya a utilizar. Métodos: se realizó una revisión de las distintas precauciones en cirugía ortopédica sobre fracturas vertebrales y de huesos largos, así como su osteosíntesis de acuerdo a instrumental, implante y proceder operatorio. Resultados: se enfatiza en los avances incorporados, en especial, los sistemas mínimo invasivos de estabilización ósea, el uso de implantes con cerrojos"y el recubrimiento de clavos con hidroxiapatita de calcio y alambres para fijación externa. Conclusión: la osteosíntesis precoz, definitiva y eficaz, es el tratamiento de elección en las fracturas poróticas

Introduction: the clinical manifestations of osteoporosis include fractures due to a loss of bone mass and structural changes in trabeculae. In these cases the osteosynthesis is affected by the mechanical factors inherent to procedure and to implants. Objective: to show the cautions that orthopedist must to take into account at selecting the type of osteosynthesis (internal or external) and the implants to be used. Methods: a review of the different cautions in orthopedic surgery on vertebral fractures and long bones was carried out as well as its osteosynthesis according to the instrumental, the implant and operative procedure. Results: it is emphasize on the incorporated advances, specially the minimally invasive systems of bone stabilization, the use of implants with bolts and nails covering or coating with calcium hydroxyapatite and wires for external fixation. Conclusion: the early, definitive and effective osteosynthesis is the choice treatment in porous fractures

Study on the efficacy of orthopedic footwear in treating lumbar intervertebral disc herniation with spinal manipulation / 中国骨伤

<p><b>OBJECTIVE</b>To observe the efficacy and mechanism of orthopedic footwear in treating lumbar intervertebral disc herniation with spinal manipulation.</p><p><b>METHODS</b>From September 2009 to September 2010, 44 patients with the lumbar intervertebral disc herniation with posture change were selected in the study. There were 28 males (aged from 24 to 58 years) and 16 females (aged from 21 to 60 years). Firstly, the average EMG (AEMG) and spectrum area (SPA) of bilateral lumbar erector spinae of the patients were tested by surface electromyogram (sEMG), and then absolute value of the difference between AEMG and SPA (larAEMG and larSPA) were compared. After that, they were randomly divided into two groups (experiment group and control group), each group had 22 cases. The patients of experiment group received the spinal manipulation treatment assisted with orthopedic footwear and the other group received the spinal manipulation treatment only. Orthopedic footwear was put on by leg with lower iliac crest line, sole thickness of which depended on the degree of pelvic tilt. According to mitigation degree of symptom and sign, sole thickness was modified till removal of orthopedic footwear. Manipulative therapeutic method which was manipulative by doctors set spinal process to normal anatomical position. Manipulative treatment was 2 - 3 times every week. The clinical healing time were observed in the two groups.</p><p><b>RESULTS</b>The larSPA was 0.12 +/- 0.73, 0.65 +/- 0.61 and the larAEMG was 3.43 +/- 25.56, 21.74 +/- 20.34 in standing 1 minute of two positions of patients with orthopedic footwear and without orthopedic footwear, respectively; the larSPA was 0.15 +/- 0.36, 0.57 +/- 0.24 and the larAEMG was 4.65 +/- 12.87, 25.18 +/- 16.58 in walking 1 minute of two positions of patients with orthopedic footwear and without orthopedic footwear. There were significant difference between the two groups (P < 0.01). The time of healing well in experiment group and control group were respectively (20.36 +/- 4.92) d and (28.14 +/- 7.13) d, experiment group was shorter than that of control group (P < 0.01).</p><p><b>CONCLUSION</b>Orthopedic footwear can obviously improve the unsymmetrical shrink of bilateral lumbar erector spinae and balance lumbar muscle. Therefore,orthopedic footwear can create favourable conditions for the spinal manipulation in treatment of lumbar intervertebral disc herniation, which can shorten the healing well.</p>

Novo sistema para acoplamento de parafusos de interferência: ensaio biomecânico de torção / New coupling system for interference screws: biomechanical resistance to torsion

OBJETIVO: Apresentar um novo sistema de acoplamento solidário entre chave e parafuso de interferência, assim como ensaios biomecânicos que avaliem a segurança de sua utilização. MÉTODOS: O novo sistema foi submetido a ensaios biomecânicos de torção. Foram realizados dois tipos de análise: torque máximo de inserção manual dos parafusos em osso bovino; ensaios destrutivos de torção do sistema em máquina INSTRON 55MT. Os mesmos testes foram realizados em um grupo controle utilizando um sistema de acoplamento já disponível no mercado. (Acufex®) RESULTADOS: Nos ensaios de inserção em fêmures bovinos as médias de valores aferidos com torquímetro digital foram 1,958 N/m para Acufex® e 2,563 N/m para FMRP. Considerando p<0,05, não houve diferença significativa (p=0,02) nos valores de torque máximo de inserção nos dois sistemas estudados. Os valores médios de torque máximo para deformar o parafuso foram de 15 N/m para o parafuso Acufex® e 13 N/m para o parafuso FMRP, portanto, sem diferença estatística (p>0,05). Ao avaliar a deformação angular, não houve diferença significativa entre os grupos de parafuso (p=0,15). CONCLUSÃO: O novo sistema de acoplamento para parafusos de interferência desenvolvido na FMRP-USP revelou resistência à torção comparável a sistema já disponível no mercado e regulamentado para uso internacional.

OBJECTIVE: To introduce a new coupling system between screw driver and interference screw, and biomechanical tests that validate the safety of its application. METHODS: The new system was submitted to biomechanical torsion assays. Two types of analysis were performed: maximum torque of manual insertion of the screws into bovine bone; destructive assays of torsion of the system using an INSTRON 55MT machine. The same tests were also performed on a control group, using a commercially available interference screw coupling system (Acufex®). RESULTS: In the tests on manual insertion of screws in bovine femurs, the average values found with a digital torque meter were 1.958 N/m for Acufex® and 2.563 N/m for FMRP. Considering p>0.05, there were no statistical differences between the two groups (p=0.02) in the values for maximum torque of insertion, in the two systems studied. The average values for maximum torque of torsion resisted by the screw were 15N/m for the Acufex® screw and 13N/m for the FMRP screw, again with no statistical differences between the two groups (p>0.05). In the evaluation of angular deformation, there was also no significant difference between the two screw types (p=0.15). CONCLUSION: The new coupling system for interference screws developed at FMRP-USP revealed a torsion resistance that is comparable with the system already available on the market and regulated for international use.

Tratamiento de maloclusion clase II con aparatología ortopédica funcional: Bionator: reporte de un caso / Treatment of malocclusion class II with orthopedic functional apliances: Bionator: a case report

La eficiencia en la corrección de la maloclusión de clase II, mediante la utilización de aparatos ortopédicos funcionales se ha reportado en la literatura desde tiempo atrás. Diferentes estudios han permitido esclarecer la forma en que los aparatos ortopédicos funcionales actúan sobre las estructura óseas, musculares, y dentales en pacientes que se encuentran en estadios previos al pico máximo puberal. Los aparatos ortopédicos funcionales aprovechan las fuerzas naturales del crecimiento y desarrollo, lo que logra una función normal del sistema estomatognático que garantiza adecuada masticación, deglución, fonación, mejora la estética y el autoestima del paciente en edades tempranas. El objetivo de este reporte de caso es mostrar los resultados satisfactorios que se logran con el tratamiento de maloclusiones clase II división 1 en pacientes jóvenes utilizando un aparato ortopédico funcional como el Bionator del Dr. Balters, también dar a conocer los cambios favorables tanto faciales, como dentales y cefalométricos, que fueron el resultado del diagnostico apropiado, selección adecuada del aparato ortopédico y excelente cooperación del paciente.

The efficiency of correction of Class II malocclusion, using functional appliances have been reported in the literature some time ago. Several studies have showed how functional orthopedic appliances act on bone, muscle, and dental structures of patients who are at stages prior to the pubertal growth peak. Functional appliances take advantage of the natural forces of growth and development which achieves a normal function of the stomatognathic system that ensures adequate chewing, swallowing, speech, aesthetics and improving patient’s selfesteem at early age. The purpose of this case report is to show how satisfactory results are achieved with the treatment of Class II division 1 malocclusion in young patients using a functional appliance as Dr. Balters Bionator. Also to present the positive facial, dental and cephalometric changes, which were the result of proper diagnosis, proper selection of the appliance and excellent cooperation of the patient.

Treatment of thoracolumbar fractures by rehabilitation exercise using knee pads on the orthopedic traction bed / 中国骨伤

<p><b>OBJECTIVE</b>To discuss the clinical effectiveness in treating thoracolumbar fractures adopting the rehabilitation exercise utilizing knee pads on the orthopedic traction bed.</p><p><b>METHODS</b>From June 1996 to June 2006, we studied the clinical effectiveness of thoracolumbar fractures utilizing knee pads on the orthopedic traction bed for rehabilitation exercise. The cases surveyed total 209, 163 of which had full data. There were 98 males and 65 females with the age from 17 to 74 years (mean, 14.5 years). Consulting time after injury from 30 min to 7 days. Fracture site in T11 had 8 cases, in T12 24 cases, in L1 73 cases, in L2 33 cases, in L3 8 cases, in L4 3 cases, in T12 and L1 14 cases. Compression degree of vertebral anterior border: full compression had 1 case,more than 4/5 had 23, more than 2/3 had 67, more than 1/2 had 40, in 1/3 had 46.</p><p><b>RESULTS</b>Among them, 8 cases with legs paresis no recovery in nerval function or stopping recovery changed methods, and underwent surgical treatment. Others 155 cases were followed up from 2 to 12 years with an average of 3 years and 4 months. The average height of vertebral anterior borders of the 169 injured compressed had increased from 1.55 cm before treatment to 2.70 cm after treatment with an average of 1.15 cm. The height of the injured vertebral anterior borders had recovered from 50.5% (1.55/3.07) before treatment to 89.4% (2.70/3.02) after treatment. Kyphosis angle of the injured vertebral bodies had recovered from 13.25 degrees to -1.6 degrees in average. Twenty-three cases associated with dislocation basic reduction.</p><p><b>CONCLUSION</b>Rehabilitation exercise using knee pads on the orthopedic traction bed can obtain satisfactory clinical effect in treating thoracolumbar fractures, the method is easy. At 3, 7, 10 days after treatment, the height of bed should be adjusted according X-ray.</p>

A ventilação de furadeiras elétricas constitui fonte de contaminação para a cirurgia? / Is ordinary eletric drills' venting port a potencial source of surgical infection?

OBJETIVO: Avaliar o risco de contaminação operatória pela ventilação do motor de furadeiras elétricas (FE) durante a perfuração óssea em cirurgias ortopédicas. MATERIAIS E MÉTODOS: estudo experimental, laboratorial, randomizado analisou FE da prática clínica e FE novas (limpas e esterilizadas) submetidas à contaminação com esporos de Bacillus atrophaeus na concentração 84 x 10(6) UFC. O ar gerado pelo acionamento do motor da FE foi coletado e cultivado. RESULTADOS: Foram identificadas apenas duas culturas positivas para as FE da prática clínica, assim como uma cultura positiva para o Bacillus atrophaeus com crescimento de 1UFC (1,19 x 10(8)). CONCLUSÃO: nas condições do estudo, pode-se afirmar que o ar gerado pela ventilação do motor da FE não consiste em fonte de contaminação para o sítio cirúrgico.

OBJECTIVE: To evaluate the potential risk of surgical contamination by the venting port of ordinary electric drills (ED) employed in orthopaedic surgeries. MATERIALS AND METHODS: an experimental laboratory, randomized study was developed to analyze EDs in surgical practice and new cleaned and sterilized equipment, which were contaminated with Bacillus atrophaeus spores at a concentration of 84 X 10(6) UFC. The air generated by the engine of each drill was collected and cultivated on sterile agar plates. RESULTS: Positive culture was identified in two ED in surgical practice, as well as a positive culture to Bacillus atrophaeus with 1 CFU growth (1,19 X 10-8). CONCLUSION: In the conditions of the experiment, the airgenerated by the venting port of the ED's engine does not consist of a source of contamination for the surgical site.

Tumores del esqueleto: 20 años de experiencia (1984-2003) / Tumors of the skeleton: 20 years of experience (1984-2003)

Se presenta la experiencia del Servicio de Partes Blandas y Tumores Oseos del Hospital Oncológico Padre Machado, de Caracas, en el manejo de los tumores del esqueleto, por un período de 20 años (1984-2003). la evaluación de la experiencia fue retrospectiva, con un análisis objetivo estadístico lineal, presentándose el espectro de la patología atendida, y la diversidad de alternativas terapéuticas quirúrgicas utilizadas. Se reporta una incidencia preferencial de esta patología en los miembros inferiores (58,58 por ciento), particularmente alrededor de la rodilla (fémur distal y tibia proximal). El grupo de tumores más frecuentemente observado fue el de formadores de tejido óseo (20,95 por ciento, seguido de los formadores de tejido cartilaginoso (14,79 por ciento), tumor de células gigantes (9,93 por ciento), y las lesiones pseudotumorales (5,85 por ciento). Entre los tumores formadores de tejido óseo llama la atención la alta incidencia de las variedades malignas (90,52 por ciento); miemtras que en los formadores de tejido cartilaginoso, las variedades benignas fueron las más frecuentes (69,80 por ciento). Entre los tipos de cirugía realizadas, una proporción importante tuvo finalidad diagnóstica (58,41 por ciento), aunque en muchas de ellas la intención fue simultánea o adicionalmente terapéutica (escisión, drenaje, relleno, etc.). Entre las cirugías con finalidad terapéutica, hay una amplia diversidad de opciones, destacándose, la posibilidad de la práctica de una cirugía preservadora, siempre que se respeten los principios oncológicos quirúrgicos. se resalta la importancia del manejo de esta patología en centros espeializados.

The experience of the Service of Solft Tissue and Bone Tumors, of the Oncology Hospital Padre Machado, Caracas, in the management of the tumors affecting the skeleton, for a period of 20 years (1984-2003), is presented. The evaluation of this experience was a retrospective revision, with an objective statistics lineal analysis, showing the spectrum of the pathology, and the therapeutic surgical alternatives utilized. The report shows a higher incidence of this pathology affecting the lower limbs (58,58 per cent), particular..around the knee joint (distal femur and proximal tibia). The most frequent type of tumor was the bone forming tumors group (20.95 per cent), followed by the cartilaginous tissue forming tumors group (14.79 per cent, giant cell tumors (9.93 per cent), and pseudotumoral lesions (5.85 per cent). Among the bone forming tumor group, called our attention the prevalence of the malignant variety (90.52 per cent); whereas in the cartilaginous tissue forming type, the bening options were seen more frequently (69.80 per cent). Looking at the performed surgeries, an important proportion had a diagnostic goal (58.41 per cent), although many of them allowed a therapeutic solution at the same time (resection, drainage, folling defects, etc). Among the surgical options with a therapeutic goal, we performed a very large variety of them, proposing limb presenvation when the surgical oncology principles could be respected. The importance of treating this pathology in specialized centers is underlined.

Escala de puntuación para evaluar la osteoartritis de la rodilla / Rating scale for osteoarthritis knee assessment

Objetivo: desarrollar un índice para la evaluación clínica de la osteoartritis de rodilla, basados en la escala de puntuación de Bristol. Material y métodos: se realizó un estudio clinimétrico, prospectivo, controlado, observacional, transversal y analítico, en el periodo de agosto a noviembre de 2004. La muestra se integró con 55 pacientes mayores de 35 años que reunieron los criterios clínico-radiográficos para osteoartritis de la rodilla, según la Academia Americana de Reumatología. De forma estandarizada, dos ortopedistas aplicaron la escala de puntuación de Bristol a 25 pacientes, realizando análisis de sensibilidad, consistencia y validez. Con base en dicha escala, se diseñó el índice modificado para el estado clínico de la rodilla con osteoartritis Magdalena de las Salinas H- 1(MSH1). De forma estandarizada, dos ortopedistas aplicaron a 30 pacientes el MSH1, comparando el análisis de sensibilidad, consistencia y validez de ambos índices. Resultados: el coeficiente de correlación intraclase interobservador para la escala de puntuación de Bristol fue: total 0.62, función 0.84, dolor 0.40, movimiento 0.89. Para MSH1: total 0.91, función 0.92, dolor 0.79, movimiento 0.86 (p < 0.0001). La kappa ponderada para las categorías clínicas interobservador de la escala de Bristol fue de 0.51 (p = 0.002), con 80 % de acuerdo. Para MSH1 los valores de kappa ponderada fueron de 0.81 (p < 0.0001), con 90 % de acuerdo. La r de Pearson entre la puntuación total de Bristol y la puntuación radiográfica de osteoartritis fue de –0.29 (p = 0.049); entre la puntuación total del MSH1 y la puntuación radiográfica de osteoartritis fue de –0.62 (p < 0.01). Conclusiones: se diseñó el índice clinimétrico MSH1, con mejor sensibilidad, consistencia y validez que el estándar, que lo hace un instrumento útil y confiable para la evaluación funcional de la osteoartritis de la rodilla.

BACKGROUND: We undertook this study to develop a grading scale to assess knee osteoarthritis using the Bristol Score. METHODS: Between August and November 2004, a clinimetrical, prospective, group-controlled, observational, cross-sectional and analytical study was done. The study sample was comprised of 55 patients, 35 years old and over, with clinical-radiographic diagnosis of knee osteoarthritis following the American Academy of Rheumatology criteria. The Bristol Score was used in 25 patients by two standardized orthopedic surgeons. Sensitivity, consistency and validity of the Bristol Score were determined. The new grading scale to assess osteoarthritis Magdalena de las Salinas H-1(MSH1) was used in 30 patients. Sensitivity, consistency and validity of the MSH1 were also determined. Both indexes were compared in these terms. An osteoarthritis radiographic score was developed to assess the validity of the MSH1. RESULTS: Inter-observer intraclass correlation coefficient (ICC) for the Bristol Score in its categories was total 0.62, function 0.84, pain 0.40 and movement 0.89. Inter-observer ICC for MSH1 in its categories was total 0.91, function 0.92, pain 0.79 and movement 0.86 (p <0.0001). Inter-observer weighed kappa of the Bristol Score was 0.51 (p = 0.002), with 80% agreement. The weighed kappa for the MSH1 was 0.81 (p <0.0001) with 90% agreement. Correlation between the Bristol Score and the osteoarthritis radiographic score was -0.29 (p = 0.049). Correlation between the MSH1 and the radiographic score of osteoarthritis was -0.62 (p <0.01). CONCLUSIONS: MSH1 achieved better validity than the Bristol Score and can be considered a reliable instrument to assess knee osteoarthritis.

Pattern of angular change of the anterior cruciate ligament across the range of knee flexion and the related anatomical dimensions.

Improper femoral and/or tibial tunnel placements are major causes of failure in anterior cruciate ligament (ACL) reconstruction. The 52 embalmed cadaveric knees were measured the dimensions of the surgical related structures using vernier caliper and goniometer. The intercondylar notch width was 17.4 +/- 2.3 mm and slope of the roof was 31.3 +/- 3.4 degrees. The average length of ACL was 21.6 +/- 2.5 mm. The relation of tibial attachment was 47.98% of the width of the lateral tibial plateau and 49.8% anteriorly, when it was measured through ACL attachment. Angle of ACL in sagittal plane was decreased during knee flexion. On the contrary, angle of ACL in coronal plane was increased during knee flexion. According to this study), The expected femoral tunnel at 10.00 am to 10.30 am could be performed by arthroscopic transtibial technique using the 48% of tibial width anteriorly for intraartricular tibial-tunnel drill-guide placement and aiming for sagittal and coronal plane of 52.0+/-4.6 / 20.9+/-3.9, 46.2+/-5.1 / 26.8+/-4.6 degrees, and 41.6+/-5.1 / 32.0+/-4.3 degrees while knee flexion degree were as 60, 90, and 120 degrees, respectively.

Reliability of foot caliper.

OBJECTIVES: To determine the reliability of foot caliper DESIGN: Descriptive study. SETTING: Rehabilitation Medicine Outpatient Department, King Chulalongkorn Memorial Hospital. SUBJECT: Fifteen volunteers were recruited from Rehabilitation residents and health care professionals of Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital. MATERIAL AND METHOD: The authors created 3 sets of simple Foot Caliper and measured foot dimension including foot width, foot length and toe depth while subjects stood with equal weight bearing to both feet. The authors set 3 examiners to measure foot dimension by the same method. To determine reliability of 3 sets of foot caliper, one examiner was assigned to measure foot dimension of 30 feet with all calipers. To determine the reliability of examiners, all examiners measured foot dimension of the same 30 feet. All parameters were recorded in millimeters. The data was analyzed and presented as intraclass correlation coefficients (ICC) with 95% CI. RESULTS: There were fifteen volunteers (8 men and 7 women). The average age was 28.6 +/- 4.11 years (range 22-39). Average foot width,length and great toe depth (millimeters) were 9.64 +/- 0.63, 24.17 +/- 1.10 and 1.91 +/- 0.24 respectively. For reliability analysis of 3 sets off foot caliper, the intraclass correlation coefficients (ICC) with 95% CI were 0.985 (0.972-0.992), 0.996 (0.992-0.998) and 0.982 (0.968-991) for foot width, length and great toe depth, respectively. For Inter-examiner reliability, intraclass correlation coefficients (ICC) were 0.941 (0.864-0.969), 0.850 (0.46-0.920) and 0.834 (0.721-0.910) for foot width, length and great toe depth, respectively. These results showed high agreement of data. CONCLUSION: These simple foot calipers have high reliability forf oot measurement. These devices are appropriate for clinical use.

Charge couple device-based system for 3-dimensional real time positioning on the assessment of segmental range of motion of lumbar spine / 中国结合医学杂志

<p><b>OBJECTIVE</b>To observe the tested results of the segmental range of motion (ROM) of lumbar spine by charge couple device (CCD)-based system for 3-dimensional real-time positioning (CCD system), and to analyze its clinical significance.</p><p><b>METHODS</b>Seven patients with lumbar joint dysfunction and 8 healthy subjects were tested twice by the CCD-based system with an interval of 10 min.</p><p><b>RESULTS</b>The ROM of the patients was obviously lesser than that of the healthy subjects. The measuring data of segmental ROM of lumbar spine by CCD system is correlated significantly to the same data checked later on the same subjects in every direction of the movements. The differences between two checks are usually less than 1 degree.</p><p><b>CONCLUSION</b>Specially designed CCD based system for 3-dimensional real-time positioning could objectively reflect the segmental ROM of lumbar spine. The system would be of great clinical significance in the assessment of the biomechanical dysfunction of lumbar spine and the effect of the treatment applied.</p>

Avaliaçäo do tratamento cirúrgico da fratura toracolombar com material de terceira geraçäo / Evaluation of results obtained by the use of third generation instrumentation to treat thoracolumbar fractures

O material de terceira geraçäo foi preconizado, em1985, por Cotrel e Dubousset para o tratamento da escoliose idiopática, introduzindo o princípio da correçäo tridimensional e estabilizaçäo rígida sem a necessidade do uso de órtese no pós-operatório. Após 1990,outros autores mostraram a eficiência do instrumentalpara o tratamento das patologias vertebrais, inclusivenas fraturas toracolombares. Foram operados, desdenovembro de 1993, no Grupo de Afecções da ColunaVertebral do Departamento de Ortopedia e Traumatologia da Santa Casa de Sao Paulo (GACV-DOTSCSP), 47 pacientes portadores de fratura toracolombar tratados com instrumentaçäo de terceira geraçäo. Destes, foramanalisados 21 pacientes, operados no período entre novembro de 1993 a dezembro de 1999, com tempo de seguimento mínimo de um ano. Os autores avaliaram osresultados clínicos e radiográficos, ocorrendo correçäomédia da cifose de 11 sem perda significativa da correçäo no seguimento pós-operatório (4,5). Houve melhora do quadro neurológico na escala de Frankel em 63 por cento dos pacientes com lesäo neurológica. As complicações foram poucas e incluíram infecçäo, soltura do material e pseudartrose. Esses resultados mostraram que esse instrumental é eficiente para o tratamento dessa patologia

Veterinary orthopedic guidelines on a dog skeletal model in combination with educational multimedia interactive program

The present orthopedic guidelines represent a valuable educational aid for students and practitioners especially with the increasing student number and constrained resources. It includes a dog skeletal model on which variable orthopedic techniques were applied for stabilization and fixation of artificially induced fractures at different selected sites. Additionally, selected surgical anatomical approaches were done on dog cadavers for procuring the target bones, A multimedia interactive computer program has been developed. The program comprised various methods of internal fixation, selected surgical anatomical approaches, and digital images for each reconstructed bone and its corresponding contact radiograph. Quizzes were added for user self-evaluation