Análise econômica dos gastos diretos com internações hospitalares por vítimas de trauma do Sistema Único de Saúde em um município de Minas Gerais, 2011-2021 / Economic analysis of direct expenses with hospital admissions for victims of trauma in the United Health System in a municipality of Minas Gerais, 2011-2021

Objetivo: Determinar o perfil epidemiológico de pacientes atendidos pelo Sistema Único de Saúde (SUS), em determinado município do interior de Minas Gerais, bem como os gastos financeiros e o repasse financeiro para os centros de atendimento de traumas. Material e métodos: Trata-se de um estudo ecológico, descritivo, realizado a partir da coleta de dados pelo SIH-SUS, no período de janeiro de 2011 a dezembro de 2021, em um município do interior de Minas Gerais. Resultados: Foi identificado um total de 14.138 pacientes, com maior acometimento de pessoas do sexo masculino, com idade entre 15 e 44 anos. Como causas mais frequentes, destacaram-se os traumatismos de quadril e coxa, seguidos de traumatismos de membros superiores (ombro, antebraço, braço, punho e mão) e cabeça. Como tempo médio de permanência hospitalar, houve 4.693 diárias entre 2011 e 2021 secundárias a complicações em enfermarias e unidade de terapia intensiva, elevando cerca de 2,37% os valores repassados pelo SUS no período estudado. Em resumo, a análise da incidência de traumas nas emergências de um município do interior de Minas Gerais revela uma preocupante tendência em que homens na faixa etária de 15 a 44 anos emergem como as principais vítimas. Esse padrão pode ser influenciado por fatores como ocupação, comportamentos de risco e mobilidade. Conclusão: A compreensão dessa demografia específica é crucial para direcionar estratégias de prevenção e resposta adequadas. A implementação de medidas educativas, segurança no trânsito e promoção da saúde mental pode contribuir para mitigar os impactos dos traumas nesse grupo demográfico, melhorando sua qualidade de vida e a saúde geral da comunidade.

Objective: To determine the epidemiological profile of patients assisted by the unified health system, in a certain municipality in the interior of Minas Gerais, as well as the financial expenses and the financial transfer to trauma care centers. Material and methods: This is an ecological, descriptive study, carried out from data collection by SIH-SUS, from January 2011 to December 2021 in a municipality in the interior of Minas Gerais. Results: a total of 14,138 patients were identified, with greater involvement of male people aged between 15 and 44 years. As the most frequent causes, trauma to the hip and thigh stood out, followed by trauma to the upper limbs (shoulder, forearm, arm, wrist and hand) and head. As for the average length of hospital stay, there were 4,693 daily stays between 2011 and 2021 secondary to complications in wards and the intensive care unit. Increasing about 2.37% in the values transferred by the unified health system between the studied decade. In summary, the analysis of the incidence of trauma in emergencies in a municipality in the interior of Minas Gerais reveals a worrying trend in which men aged 15 to 44 years emerge as the main victims. This pattern can be influenced by factors such as occupation, risky behavior and mobility. Conclusion: Understanding this specific demographic is crucial to targeting appropriate prevention and response strategies. The implementation of educational measures, road safety and mental health promotion can help to mitigate the impacts of trauma in this demographic group, improving their quality of life and the general health of the community.

Bone protective effect of sinomenine against monosodium iodoacetate induced knee and hip injury in rat model: an inflammatory pathway

Purpose: Osteoarthritis (OA) is a degenerative joint disease which is categorized via destruction of joint cartilage and it also affects the various joints, especially knees and hips. Sinomenine active phytoconstituents isolated from the stem of Sinomenium acutum and already proof anti-inflammatory effect against the arthritis model of rodent. In this experimental protocol, we scrutinized the anti-osteoarthritis effect of sinomenine against monosodium iodoacetate (MIA) induced OA in rats. Methods: MIA (3 mg/50 µL) was used for inducing the OA in the rats, and rats received the oral administration of sinomenine (2.5, 5 and 7.5 mg/kg body weight) up to the end of the experimental study (four weeks). The body and organs weight were estimated. Aggrecan, C-terminal cross-linked telopeptide of type II collagen (CTX-II), glycosaminoglycans (GCGs), monocyte chemoattractant protein-1 (MCP-1), Interferon gamma (IFN-γ), antioxidant, inflammatory cytokines, inflammatory mediators and matrix metalloproteinases (MMP) were analyzed. Results: Sinomenine significantly (P < 0.001) boosted the body weight and reduced the heart weight, but the weight of spleen and kidney remain unchanged. Sinomenine significantly (P < 0.001) reduced the level of nitric oxide, MCP-1 and improved the level of aggrecan, IFN-γ and GCGs. Sinomenine remarkably upregulated the level of glutathione, superoxide dismutase and suppressed the level of malonaldehyde. It effectually modulated the level of inflammatory cytokines and inflammatory mediators and significantly (P < 0.001) reduced the level of MMPs, like MMP-1, 2, 3, 9 and 13. Conclusions: Sinomenine is a beneficial active agent for the treatment of OA disease.

Radiographic findings in the coxofemoral joint of Australian Cattle Dogs / Achados radiográficos em articulação coxofemoral de cães da raça Australian Cattle Dog

Australian Cattle Dogs (ACD) are medium-sized animals widely used in fieldwork for managing cattle and sheep. There needs to be more information about the conditions these dogs can develop despite being well-characterized animals since the beginning of the 20th century. Hip dysplasia (HD) is a developmental abnormality between the femoral head and the acetabular fossa, which can be debilitating. However, the available literature has no studies on the prevalence of this condition in dogs of this breed. This study aimed to evaluate radiographs of ACD qualitatively and quantitatively. For this purpose, 49 dogs considered healthy without clinical signs of HD were radiographically assessed, and the animals were classified as dysplastic (D) and non-dysplastic (ND). A frequency of 46.9% of dysplastic dogs was observed, with males being more affected. The cortical index (CI) and angle of inclination (AI) could not differentiate D from ND animals; only the Norberg angle (NA) was effective in this differentiation. No correlation was observed between AI, CI, and AN.(AU)

Os cães da raça Autralian Cattle Dog (ACD) são animais de porte médio, muito utilizados no trabalho de campo para manejo de gado e ovelha. Apesar de serem animais bem caracterizados desde o início do século XX, há poucas informações sobre afecções que esses cães podem desenvolver. A displasia coxofemoral (DCF) é uma anormalidade do desenvolvimento entre a cabeça do fêmur e a fossa acetabular podendo ser debilitante. Contudo, não há estudos, na literatura disponível, sobre a prevalência desta afecção em cães dessa raça. O objetivo deste trabalho foi avaliar qualitativamente e quantitativamente radiografias de cães da raça ACD. Para tanto, foram avaliados radiograficamente 49 cães considerados hígidos e sem sinais clínicos de DCF. Os animais foram classificados em displásicos (D) e não displásicos (ND). Observou-se a frequência de 46,9% de cães displásicos, sendo os machos mais acometidos. O índice cortical (IC) e o ângulo de inclinação (AI) não foram capazes de diferenciar os animais D dos ND, apenas o ângulo de Norberg (AN) foi eficaz nessa diferenciação. Não houve correlação entre AI, IC e AN.(AU)

Hip Tendinopathies: An Update of Concepts and Approaches / Tendinopatias do quadril: Uma atualização de conceitos e abordagens

Abstract The present update was based on new scientific evidence of major hip-related tendinopathies. Themes were addressed that involve the principles of the onset of tendinopathies through, mainly, the principle of capacity versus demand and the biomechanical aspects involved in its onset, its main characteristics, and clinical presentations. Associated with this, treatment-related updates were presented, with exercise therapy being the focus of conservative treatment and surgical approaches necessary for the control or resolution of these cases.

Resumo A presente atualização foi embasada nas novas evidências científicas das principais tendinopatias relacionadas ao quadril. Foram abordadas temáticas que envolvem os princípios do aparecimento das tendinopatias através, principalmente, do princípio da capacidade versus demanda e os aspectos biomecânicos envolvidos no seu aparecimento, suas principais características e apresentações clínicas. Associadas a isso, foram expostas as atualizações voltadas ao tratamento, coma terapia por exercício sendo o foco do tratamento conservador e as abordagens cirúrgicas necessárias para o controle ou resolução desses casos.

Síntomas osteomusculares en galponeros de granjas avícolas asociados a condiciones del trabajo / Osteomuscular symptoms in poultry farm workers associated with working conditions

INTRODUCCIÓN. Según datos de la Organización Mundial de Salud los trastornos musculoesqueléticos son la principal causa de discapacidad en el mundo; retrasar su diagnóstico provocaría una discapacidad prevenible. OBJETIVO. Determinar la prevalencia de síntomas osteomusculares en galponeros de granjas avícolas asociados a condiciones del trabajo. MATERIALES Y MÉTODOS. Estudio descriptivo transversal. Muestra aleatoria estratificada de 223 trabajadores, divididos en 106 galponeros y 117 personal administrativo de granjas avícolas de la provincia de Manabí. Criterios de inclusión: trabajadores mayores de 18 años de edad con al menos un año en la misma actividad. Para el análisis de datos, se utilizó Epi Info versión 7. RESULTADOS. La prevalencia de síntomas osteomusculares en los últimos 12 meses fue mayor en los galponeros en: hombro 81,69% y columna lumbar 56,96%. Mediante un análisis a través de regresión logística se determinó que los galponeros que trabajan por más de 10 años y que realizan movimientos repetitivos en menos de un minuto, tienen mayor riesgo de presentar dolor en el hombro (IC del 95% 1,26 ­ 4,98) e (IC del 95% 1,65 ­ 5,29). CONCLUSIÓN. Se registró la prevalencia de síntomas osteomusculares en galponeros de granjas avícolas asociados a condiciones del trabajo. RECOMENDACIÓN. Es necesario contar con sistemas de vigilancia a fin de proponer estrategias públicas en la industria avícola del Ecuador

INTRODUCTION. According to data from the World Health Organization musculoskeletal disorders are the leading cause of disability in the world; delaying their diagnosis would result in preventable disability. OBJECTIVE. To determine the prevalence of musculoskeletal symptoms in poultry farm workers associated with working conditions. MATERIALS AND METHODS. Cross-sectional descriptive study. Stratified random sample of 223 workers, divided into 106 poultry sheds workers and 117 administrative personnel of poultry farms in the province of Manabí. Inclusion criteria: Workers over 18 years of age with at least 1 year in the same activity. Fort he data analysis, Epi Info version 7 was used. RESULTS. The prevalence of musculoskeletal symptoms in the last 12 months was higher in sheds workers in: shoulder 81,69% and lumbar spine 56,96%. Using logistic regression analysis, it was determined that the sheds workers who have been working for more than 10 years and who perform repetitive movements in less than one minute have a greater risk of presenting shoulder pain (95% CI 1,26 ­ 4,98) and (95% CI 1,65 ­ 5,29). CONCLUSION. The prevalence of osteomuscular symptoms in poultry farm workers associated with working conditions was recorded. RECOMMENDATION. It is necessary to have surveillance systems in order to propose public strategies in the Ecuadorian poultry industry

Lesiones de cadera relacionadas con la actividad deportiva / Sports-Related Hip Injuries

Introducción: Las lesiones de la cadera relacionadas con las actividades deportivas han sido poco abordadas; sin embargo, han ido en aumento y su diagnóstico suele ser difícil o retardado. Incluyen múltiples afecciones y su recuperación suele ser larga. Objetivo: Actualizar conocimientos sobre algunas de las afecciones deportivas que afectan la cadera. Métodos: Se realiza una revisión bibliográfica sistemática y detallada sobre el tema, para lo cual se emplearon métodos teóricos, analítico-sintético, histórico-lógico e inductivo-deductivo y el análisis documental como método empírico. Se hizo una búsqueda sistemática sobre la temática en las bases de datos PubMed, Medscape y Google Academics desde junio de 2016 hasta la fecha. Se revisaron 500 artículos referentes al tema, de los cuales se seleccionaron 45 artículos para este trabajo. Análisis y síntesis de la información: Las lesiones de la cadera relacionadas con el deporte ocurren entre 5 y 9 por ciento de atletas adultos. Las actividades con movimientos rápidos, aceleraciones, desaceleraciones, y los cambios direccionales son la principal causa de tales lesiones. Provocan daños corporales provocados por una transferencia de energía, que excede la capacidad para mantener la estructura y/o la función íntegra, durante el entrenamiento o competición. Conclusiones: Las lesiones de la cadera relacionadas con el deporte pueden ser múltiples y son responsables de dolor en un gran número de atletas, fundamentalmente en el fútbol, la gimnasia y el beisbol. El diagnóstico precoz es fundamental para evitar la progresión de la lesión. Las mejoras en el diagnóstico radiológico y las posibilidades del uso de la artroscopia han mejorado la evolución y el pronóstico para los atletas(AU)

Introduction: Sports injuries of the hip have been little addressed; however, they have been increasing and their diagnosis is often difficult or delayed. They include multiple conditions and their recovery is usually long. Objective: To bring up to date knowledge on some of the sports conditions that affect the hip, which is particularly important to improve medical care. Methods: A systematic and detailed bibliographic review is carried out on the subject, for which theoretical, analytical-synthetic, historical-logical and inductive-deductive methods were used, as well as documentary analysis as an empirical method. A systematic search on the subject was carried out in PubMed, Medscape and Google Academics databases from June 2016 to date. Five hundred articles referring to the topic were reviewed. Forty-five articles the total were selected for this paper. Analysis and synthesis of the information: Sports-related hip injuries occur between 5 and 9 percent of adult athletes. Activities with rapid movements, accelerations, decelerations, and directional changes are the main cause of such injuries. They cause bodily harm produced by a transfer of energy, which exceeds the capacity to maintain the entire structure and, or function, during training or competition. Conclusions: Sports injuries of the hip can be multiple and are responsible for pain in a large number of athletes, mainly in soccer, gymnastics and baseball. Early diagnosis is essential to avoid progression of the lesion. Improvements in radiological diagnosis and the possibilities of the use of arthroscopy have improved the evolution and prognosis for athletes(AU)

Protrusio acetabular en artroplastía total de cadera: diez tácticas para un buen resultado quirúrgico / Total hip arthroplasty in protrusio acetabuli: ten tips to improve surgical outcomes

Los pacientes candidatos a artroplastía total de cadera con protrusio acetabular asociada generan distintos desafíos en los equipos quirúrgicos. Múltiples estrategias han sido utilizadas a lo largo de los años para optimizar los resultados. Mediante una revisión de la evidencia actualizada disponible, proponemos diez tácticas a realizar en el manejo de estos pacientes que pueden mejorar y hacer predecible el tratamiento de un paciente con protrusio acetabular al que se le realiza una artroplastía total de cadera. Nivel de Evidencia V.

Patients with acetabular protrusio and osteoarthritis are a challenge for the surgical team. Many strategies have been developed to anticipate, plan and optimize the surgical results of these patients. Based on the current available clinical evidence, we propose ten tips to improve the surgical management of hip arthroplasty patients with protrusio acetabuli. Level of Evidence V.

Streptococcus agalactiae: causa de artritis séptica inusual a partir de los 3 meses de edad. Caso clínico / Streptococcus agalactiae: an unusual cause of septic arthritis beyond 3 months of age. Case report

La artritis séptica es una patología poco frecuente, pero con una alta morbilidad, debido a las importantes secuelas que puede originar. La etiología varía según la edad, y Staphylococcus aureus es el microorganismo más frecuente en todas ellas. Streptococcus agalactiae odel grupo B es una causa infrecuente de infección fuera del período neonatal; se asocia, a partir de los 3 meses de edad, con infecciones graves en pacientes inmunocomprometidos. El tratamiento de elección es penicilina G o ampicilina.Aquí se describe el caso de un niño de cuatro meses y medio de edad que desarrolló una artritis séptica por Streptococcus agalactiae odel grupo B, con inicio insidioso de la clínica. El diagnóstico etiológico obligó a descartar meningitis y una inmunodeficiencia asociada. La frecuencia extremadamente baja de dicha artritis a esta edad y la importancia de descartar una enfermedad diseminada son importantes puntos de aprendizaje en este caso.

Septic arthritis is not a very frequent disease, but with a high morbidity due to the important sequelae that it can cause. The etiology is age-specific, with Staphylococcus aureus being the most frequent microorganism in all ages. Streptococcus agalactiae or group B Streptococcus is an uncommon cause of infection outside the neonatal period. Beyond 3 months of age, infections by this pathogen are associated with serious infections in immunocompromised patients. The treatment of choice is penicillin G or ampicillin. A 4.5-month-old child who developed a group B Streptococcus septic arthritis is reported. The onset was insidious, and the etiological diagnosis prompted us to rule out meningitis and associated immunodeficiency. The extremely low frequency of group B Streptococcus septic arthritis at this age and the importance of ruling out a disseminated disease are crucial learning points in this case

Comparison between the Dominant and Non-dominant Sides of Athletes with Groin Pain / Comparação funcional entre membro dominante e não dominante em atletas com dor inguinal

Abstract Objective To compare the difference in range of motion (ROM) between the dominant and nondominant hips of the athletes and to correlate the results with groin pain, as well as to compare the differences in ROM among the main hip injuries. Methods The participants included 75 athletes, 56 males and 19 females, aged between 20 and 46 years old, who were diagnosed with hip injury. These individuals were subdivided according to the pathologies (femoroacetabular impact or labral lesion, adductor and pubic lesions and trochanteric syndrome) and characteristics of each hip were analyzed. Results A total of 150 hips (right and left) were measured for the present analysis. When comparing the ROM of the injured hip with the healthy hip, no statistically significant differences were found. There were also no significant differences between the amplitudes of hip movement when the main pathologies were compared. Conclusion The present study did not find differences in ROM rotation between the various pathologies of the hip.

Resumo Objetivo Comparar a diferença do arco de movimento (ADM) entre o quadril com lesão e o não lesionado de atletas com as principais patologias femoroacetabulares. Além disso, analisar a diferença da ADM do quadril em cada patologia considerada. Métodos Os participantes do presente estudo foram 75 atletas de diversas modalidades esportivas, sendo 56 mulheres e 19 homens, com idades entre 20 e 46 anos, os quais tinham diagnóstico de lesão do quadril. Esses indivíduos foram subdivididos em três grupos de acordo com as patologias (impacto femoroacetabular ou lesão labral, pubalgia ou lesão dos adutores e síndrome trocantérica) e as características de cada quadril foram analisadas. Resultados Um total de 150 quadris (direito e esquerdo) foram mensurados para a presente análise. Comparou-se o ADM do quadril lesado e do quadril saudável de cada atleta e não foram encontradas diferenças estatísticas. Da mesma forma, não houve diferença significativa entre a ADM do quadril entre as principais injúrias. Conclusão O presente estudo não encontrou diferenças no arco de movimento entre o quadril lesionado e o contralateral, bem como não houve diferença na amplitude dos movimentos entre as patologias femoroacetabulares analisadas.

Post-Treatment Classification for Acetabular Chondral Lesions in Hip Arthroscopy / Classificação pós-tratamento para lesões condrais acetabulares na artroscopia de quadril

Abstract Objective To describe a postarthroscopic treatment classification system for acetabular chondral damage in the hip and to report the intraobserver and interobserver reliability of such classification. Methods This is a retrospective review of ninety-nine digital video recordings made during arthroscopic surgery. Patients who underwent arthroscopic treatment for femoroacetabular impingement and evaluated at the hip arthroscopy outpatient clinic between March 2015 and March 2016 were included in the study. Patients with a history of previous hip surgery, radiologic evidence of advanced osteoarthritis (Tönnis grade > 2), who underwent labral resection, or whose digital recordings were incomplete or of insufficient quality for adequate review were excluded. Two orthopedic surgeons, who did not participate in the surgery, independently reviewed the video recordings and classified the remaining acetabular cartilage using the post-treatment classification system. Intraobserver and interobserver analysis was then conducted using intraclass correlation coefficient (ICC). Results Excellent intraobserver reliability (ICC = 0.790; p < 0.001) and interobserver reliability (ICC = 0.882; p < 0.001) were observed. Both ICC values were statistically significant. Conclusion The posttreatment classification of the remaining acetabular cartilage has excellent intra and interobserver reliability.

Resumo Objetivo Descrever um sistema de classificação de tratamento pós-artroscópico para as lesões condrais acetabulares no quadril e relatar as confiabilidades intra e interobservador deste sistema. Métodos Esta é uma revisão retrospectiva de 99 gravações de vídeo digital realizadas durante artroscopia. Os pacientes submetidos a tratamento artroscópico para impacto femoroacetabular e avaliados no ambulatório de quadril entre março de 2015 e março de 2016 foram incluídos no estudo. Os pacientes com histórico de cirurgia anterior do quadril, evidência radiológica de osteoartrose avançada (Tönnis > 2), pacientes submetidos à ressecção labral ou cujas gravações digitais estavam incompletas ou de qualidade insuficiente para avaliação adequada foram excluídos. Dois ortopedistas, que não participaram da cirurgia, revisaram de forma independente as gravações de vídeo e classificaram a cartilagem acetabular remanescente usando o sistema de classificação pós-tratamento. A análise intra e interobservador foi então realizada utilizando o coeficiente de correlação intraclasse (CCI). Resultados Excelente confiabilidade intraobservador (CCI = 0,790; p < 0,001) e confiabilidade interobservador (CCI = 0,882; p < 0,001). Ambos os valores de CCI foram estatisticamente significativos. Conclusão a classificação pós-tratamento da cartilagem acetabular remanescente possui excelente confiabilidade intra e interobservador.

Prevalence of Radiographic Signs of Femoroacetabular Impingement in Asymptomatic Patients and Non-Athletes / Prevalência de sinais radiográficos de impacto femoroacetabular em indivíduos assintomáticos e não atletas

Abstract Objective Femoroacetabular impingement has been described as an anatomical variation of the proximal femur and/or acetabular rim, impinging the hip joint. A portion of the population asymptomatic in the hip may present radiographic changes from femoroacetabular impingement. The aim of the present study was to evaluate the prevalence of these signs in asymptomatic and sedentary males. Methods This was a clinical, observational, primary, cross-sectional, controlled study. A total of 32 male volunteers aged between 18 and 40 years, asymptomatic in the hip and sedentary, were selected from a university hospital orthopedic emergency room. All patients underwent standard anteroposterior pelvic radiographs. The measurements of the alpha angle, the retroversion index, the ischial spine signal, and the posterior wall sign were analyzed. Results The mean age was 29 years (18-40 years old). The prevalence of radiographic signs of femoroacetabular impingement using an alpha angle of 67o was of 53.1%; with an alpha angle of 82o, it was of 31.2%. The mean alpha angle was 67o (52.4-88.2o), with 35.9% of the hips classified as borderline and 6.3% as pathological. The mean alpha angle for the right side was 67.5o (52.5-88.2o), and, for the left, it was 66.6o (53.1- 86.9o). The mean retroversion index was 0.048 (right side: 0.044; left side: 0.052). The spine signal was positive in 15.6%, and the posterior wall sign, in 20.3% of the cases. Conclusion This study showed that the prevalence of radiographic signs in a population of asymptomatic and sedentary adult men was high (31.2%). New studies are required to explian the actual clinical significance of this finding.

Resumo Objetivo O impacto femoroacetabular foi descrito como uma variação anatômica do fêmur proximal e/ou da borda acetabular, causa impacto na articulação do quadril. Uma parcela da população assintomática quanto ao quadril pode apresentar alterações radiográficas de impacto femoroacetabular. O objetivo do estudo é avaliar a prevalência desses sinais em indivíduos do sexo masculino assintomáticos e sedentários. Métodos Estudo clínico, observacional, primário, transversal, controlado. Foram selecionados 32 voluntários masculinos, de 18 a 40 anos, assintomáticos quanto ao quadril, sedentários, atendidos em um Pronto-Socorro de Ortopedia de Hospital Universitário. Todos fizeram radiografias anteroposteriores da pelve padronizadas. Foram analisadas as medidas de ângulo alfa, índice de retroversão, sinal da espinha isquiática e sinal da parede posterior. Resultados A média de idade foi de 29 anos (18-40). A prevalência de sinais radiográficos de impacto femoroacetabular com o uso do ângulo alfa de 67o foi de 53,1%; como ângulo alfa de 82o, essa prevalência foi de 31,2%. A média do ângulo alfa foi de 67o (52,4-88,2o), 35,9% dos quadris foram classificados como limítrofes e 6,3% como patológicos. Amédia do ângulo alfa para o lado direito foi de 67,5o (52,5-88,2o) e para o esquerdo, 66,6o (53,1-86,9o). O índice de retroversão médio foi de 0,048 (lado direito - 0,044 e lado esquerdo - 0,052). O sinal da espinha foi positivo em15,6% e da parede posterior em 20,3%. Conclusão O presente estudo demonstrou que a prevalência de sinais radiográficos numa população de homens adultos, assintomáticos e sedentários foi elevada (31,2%). O real significado clínico desse achado ainda carece de novos estudos.

Diagnosis and treatment of labral tear / 中华医学杂志(英文版)

OBJECTIVE@#To review the literature regarding diagnosis and treatment of labral tear.@*DATA SOURCES@#A systematic search was performed in PubMed using various search terms and their combinations including hip, labrum, acetabular labral tear, arthroscopy, diagnosis, and anatomy.@*STUDY SELECTION@#For each included study, information regarding anatomy, function, etiology, diagnosis, and management of acetabular labral tear was extracted.@*RESULTS@#Five hundred and sixty abstracts about anatomy, function, etiology, diagnosis, and management of acetabular labral tear were reviewed and 66 selected for full-text review. The mechanism of labral tear has been well explained while the long-term outcomes of various treatment remains unknown.@*CONCLUSIONS@#Labral tear is generally secondary to femoroacetabular impingement, trauma, dysplasia, capsular laxity, and degeneration. Patients with labral tear complain about anterior hip or groin pain most commonly with a most consistent physical examination called positive anterior hip impingement test. Magnetic resonance arthrography is a reliable radiographic examination with arthroscopy being the gold standard. Conservative treatment consists of rest, non-steroidal anti-inflammatory medication, pain medications, modification of activities, physical therapy, and intra-articular injection. When fail to respond to conservative treatment, surgical treatment including labral debridement, labral repair, and labral reconstruction is often indicated.

Mixed-type femoroacetabular impingement associated with subspine impingement: recognizing the trifocal femoropelvic impingement / Impacto femoroacetabular misto associado a impacto subespinhal: reconhecimento do impacto femoropelvico trifocal

ABSTRACT To describe the arthroscopic surgical technique for subspine impingement (SSI) of the anterior inferior iliac spine (AIIS) associated with mixed type femoroacetabular impingement (FAI), through two standard arthroscopic portals (anterolateral and distal mid-anterior) in two patients with trifocal impingement. The authors report the cases of two young male patients, aged 32 and 36 years old, with trifocal femoropelvic impingement (TFPI). The technique consists of segmental capsulectomy, arthroscopic dissection of the AIIS, partial release of the direct head of the rectus femoris, resection of the AIIS projection with a burr and with fluoroscopic aid, correction of the pincer deformity, repair of the labrum with bioabsorbable anchors, and femoral osteoplasty. Details of the diagnostic workup and of the surgical technique are provided and discussed. In these cases, full range of motion was regained after surgery, as well as complete relief of pain, which was sustained in the last follow-up, one year post-operatively. Radiographs show adequate correction of the deformities in all three impingement sites. Simultaneous correction of the three sites (cam, pincer, and subspinal) provided full relief of symptoms and allowed return to work and sports. The authors propose that when approaching the symptomatic SSI, the possibility of concomitant FAI should always be considered and, in those cases, the approach must be comprehensive.

RESUMO O objetivo deste trabalho foi descrever a abordagem cirúrgica artroscópica do impacto subespinhal (ISE) da espinha ilíaca anteroinferior (EIAI) associado ao impacto femoroacetabular (IFA) misto, por meio de dois portais artroscópicos padrão (anterolateral e medioanterior distal) em pacientes com impacto trifocal. Os autores relatam os casos de dois pacientes do sexo masculino, de 32 e 36 anos, com impacto femoropelvico trifocal (IFPT). A técnica consiste na ressecção segmentar da cápsula, dissecção artroscópica da EIAI com liberação parcial do reto femoral, osteoplastia com ressecção da proeminência com lâmina óssea e auxílio radioscópico, correção do pincer, reparo da lesão condrolabial com âncoras e osteoplastia femoral. Detalhes sobre o diagnóstico e a técnica são apresentados e discutidos. Nos casos operados, foi observada recuperação do arco de movimento normal do quadril e ausência de dor, que se mantiveram por um ano pós-operatório. Radiografias demonstram boa correção dos três focos de impacto em ambos os pacientes. A simultânea correção do IFPT nos seus três componentes (came, pincer e subespinhal) promoveu alívio completo dos sintomas e o retorno ao trabalho e aos esportes. Propõe-se que, na abordagem do ISE sintomático, sempre seja considerada a possibilidade da presença de IFA associado; nesses casos, a abordagem deve ser completa.

Fall behaviors and risk factors among elderly patients with hip fractures

Abstract Objective The aim of this study was to investigate fall preventive behaviors in elderly patients who suffered hip fractures as a result of falling. Methods This descriptive and cross-sectional study was performed at a university hospital in Izmir, Turkey between January 2014 and December 2015. Data were collected using the Fall Behaviors Scale for Old People. This study was conducted with 103 patients who had a hip fracture caused by falling. Descriptive statistics, Mann Whitney U and Kruskal-Wallis tests were used. Results There was a significant difference between age groups in this score (KW = 6.85, p = 0.03). The patients aged 85-96 years obtained significantly higher scores for the sub-scales of protective mobility (KW = 8.71, p = 0.01) and avoidance (KW = 6.03, p = 0.04) than patients in the other age groups. There was not a significant difference in fall prevention behaviors between the elderly with a history of a repeated falls and those without a repeated fall history. Conclusion Although elderly people with hip fractures due to falling has highly protective behavior, they have fallen. Advanced age patient has showed more protective behavior for falling.

Extracción de un proyectil de arma de fuego de la cadera. luxación controlada anterior. reporte de dos casos / Bullet removal from the hip with a safe surgical anterior dislocation. report of two cases

El aumento de la prevalencia de las heridas por arma de fuego determina que sea cada vez más frecuente observar pacientes con fragmentos de proyectiles retenidos en el cuerpo. En la mayoría de los casos se consideran inertes para el paciente; sin embargo, está indicada su extracción cuando se encuentran alojados dentro de la articulación. De esta forma, se busca evitar el daño provocado por la sinovitis reactiva, la lesión condral y la posible progresión a una artrosis postraumática. El objetivo de este trabajo es presentar a dos pacientes con fragmentos de proyectiles alojados a nivel de la articulación coxofemoral, uno impactado sobre la cabeza femoral y el otro en el fondo acetabular. En ambos casos, se realizó una luxación controlada anterior a través de un abordaje posterolateral asociado a una osteotomía trocantérica según Ganz, para extraerlos; de esta manera, se logra una visualización completa de la cabeza femoral y un acceso al acetábulo, resguardando al máximo la perfusión vascular. Se evaluaron los resultados clínicos de ambos pacientes. Nivel de Evidencia: IV.

The increased prevalence of gunshot wounds makes it increasingly common to see patients with projectile fragments retained in the body. In most cases they are considered inert for the patient, but surgery is indicated to extract them, if they are located within the joint. In this way, we prevent damage from reactive synovitis, chondral injury and posible progression to post-traumatic osteoarthritis. The aim of this study is to report two cases in which the projectile fragments were at the level of the hip joint, one on the femoral head and the other in the acetabular fundus. In both patients, an anterior dislocation was performed through a postero-lateral approach associated with a trochanteric osteotomy described by Ganz. In this way a complete visualization of the femoral head and access to the acetabulum is achieved, thus protecting vascular perfusion. Clinical results were evaluated. Level of Evidence: IV.

Acute Isolated Tear of Gluteus Medius in Young Male / 대한고관절학회지

The hip rotator cuff tear usually develops in the middle-aged through gradual degenerative changes, similar to rotator cuff tears in the shoulder. An acute tear in the hip abductor by a traumatic event in young ages is very uncommon. The authors experienced an unusual case of an acute traumatic tear isolated to the gluteus medius in a young male; thus, we report the treatment results in this rare case with a review of the literature.

Giant cell tumor of the femoral neck: case report / Tumor de células gigantes do colo do fêmur: relato de caso

ABSTRACT The authors present the case of a patient with a giant cell tumor of the left femoral neck, with adjacent progressive invasion of bone tissue. Initial treatment was done with local curettage and autologous bone graft from fibula, electrocauterization and filling with methyl methacrylate. A local tumoral relapse was present after one year; therefore a new surgical procedure was necessary, with proximal femoral wide resection and unconventional endoprosthesis fixation. The article discusses the clinical aspects and surgical treatment. This report aimed to demonstrate the necessity to perform wide resection for giant cell tumor of the femoral neck, prioritizing total resection of the tumor and its local extension, preserving limb integrity and demonstrating the complete failure of preserving surgery in cases of femoral neck involvement.

RESUMO Os autores apresentam um caso de uma paciente portadora de tumor de células gigantes do colo do fêmur esquerdo com invasão progressiva de tecido ósseo adjacente. Foi tratado inicialmente com esvaziamento por meio de curetagem local e enxertia autóloga com tabiques da fíbula, eletrofulguração e preenchimento com metilmetacrilato. A paciente evoluiu com recidiva da lesão tumoral local após um ano, foi necessária uma nova intervenção cirúrgica, com ressecção em bloco da parte proximal do fêmur e fixação de endoprótese não convencional. São discutidos os aspectos clínicos e a abordagem terapêutica. O relato tem por função demonstrar a necessidade de abordar o tumor de células gigantes do colo do fêmur, em obediência aos princípios oncológicos de ressecção óssea, com prioridade para a total exérese do tumor e sua extensão local, preservação da integridade do membro e demonstração da total falha de tentativas preservadoras no caso de acometimento do colo femoral.

Ligamento teres de la cadera. Revisión bibliográfica / Ligamentun teres of the hip. Bibliographic revision

Resumen: La función del ligamento teres de la cadera ha llamado la atención en los últimos años debido al incremento y a la realización de la artroscopía de cadera, la información en la literatura es escasa, por ello nos propusimos realizar una revisión bibliográfica sobre los conceptos actuales, su anatomía, función, biomecánica, diagnóstico y rupturas del ligamento de teres de la cadera.

Abstract: The role and function of the ligamentum teres has drawn our attention in the last years due to the increasing and performance in hip arthroscopy, few is written in the literature, this is why we proposed to perform and assessed a review on the current literature of the anatomy, function, diagnose and rupture of the ligamentum teres of the hip.

Unstable posterior acetabular fractures: Early results of delayed reduction and fracture fixation using the Kocher-Langenbeck approach with trochanteric flip osteotomy

@#<p style="text-align: justify;">Unstable posterior acetabular fractures resulting from high energy trauma present major challenges to any orthopedic surgeon especially if the treatment has been delayed.<br /><strong>OBJECTIVE:</strong> The purpose of this paper is to describe the early results of delayed treatment of a series of patients with posterior acetabular fractures with concomitant hip dislocations, surgically approached using the Kocher-Langenbeck with a trochanteric flip osteotomy.<br /><strong>METHODS:</strong> Five (5) male patients (mean age 35.6 years, range 23-58 years) who sustained unstable posterior acetabular fractures, underwent surgical treatment using the Kocher-Langenbeck approach with the trochanteric flip osteotomy, during the period of May 2014 to October 2015. Clinical and radiographic evaluations of each patient were performed, while complications were documented.<br /><strong>RESULTS:</strong> Mean follow-up was 8 weeks (range 2-12 weeks). There was adequate exposure of the posterior and superior acetabulum in all patients. Post-operative radiographs in four of five patients were graded "anatomic" while hip range of motion of these four patients averaged 78.7% of the uninjured hip. One patient with "poor" reduction underwent a second operation to reserve a failure of the initial fixation using the same surgical approach. No other complications were reported.<br /><strong>CONCLUSION:</strong> This modified approach provides adequate exposure of both posterior and superior acetabulum and also allows inspection of the articular surfaces of both acetabulum and femoral head, which are limited in the standard Kocher-Lagenbeck approach. With excellent exposure, congruent reduction can readily be achieved while permitting early hip range of motion post-surgery.</p>