Minimally invasive surgical treatment for unstable fractures of the proximal phalanx: intramedullary screw / Tratamento cirúrgico minimamente invasivo das fraturas instáveis da falange proximal: parafuso intramedular

To analyze the clinical-functional parameters and quality of life of patients undergoing minimally invasive surgical treatment for extra-articular fractures of the proximal phalanx, using an intramedullary screw (Acutrak(r)). METHODS: Between January 2011 and September 2014, a prospective study was conducted on 41 patients (48 fingers) with unstable extra-articular fractures of the proximal phalanx, who underwent minimally invasive surgical treatment using an intramedullary screw (Acutrak(r)). These patients were evaluated 12 months after the surgery by means of the DASH quality-of-life questionnaire, VAS pain scale, measurement of range of motion (ROM, in degrees) and radiographic assessment. RESULTS: All the patients achieved adequate reduction and consolidation of their fractures. There were statistically significant improvements in quality of life on the DASH scale, pain on the VAS scale and range of motion. CONCLUSION: The minimally invasive technique for treating unstable extra-articular fractures of the proximal phalanx using an intramedullary screw (Acutrak(r)) is effective and safe, and it presents satisfactory clinical-functional results.

Analisar os parâmetros clínico-funcionais e a qualidade de vida de pacientes submetidos ao tratamento cirúrgico minimamente invasivo das fraturas extra-articulares da falange proximal com uso do parafuso intramedular (Acutrak(r)). MÉTODOS: Um estudo prospectivo foi feito de janeiro de 2011 a setembro de 2014 e incluiu 41 pacientes e 48 dedos acometidos com fratura da falange proximal extra- articular e instável submetidos ao tratamento cirúrgico minimamente invasivo com parafuso intramedular (Acutrak(r)). Esses pacientes foram avaliados 12 meses após a cirurgia por meio do questionário DASH de qualidade de vida, escala de dor VAS, arco de movimento (adm em graus) e avaliação radiográfica. RESULTADOS: Todos os pacientes obtiveram redução adequada e consolidação das fraturas. Houve melhoria estatisticamente significativa da qualidade de vida (DASH), escala de dor (VAS) e arco de movimento. CONCLUSÃO: A técnica minimamente invasiva no tratamento das fraturas instáveis e extra-articulares da falange proximal com o parafuso intramedular Acutrak(r) é eficaz e segura e apresenta resultados clínico-funcionais satisfatórios.

Robotic-assisted radical prostatectomy learning curve for experienced laparoscopic surgeons: does it really exist?

ABSTRACT Background Robotic-assisted radical prostatectomy (RALP) is a minimally invasive procedure that could have a reduced learning curve for unfamiliar laparoscopic surgeon. However, there are no consensuses regarding the impact of previous laparoscopic experience on the learning curve of RALP. We report on a functional and perioperative outcome comparison between our initial 60 cases of RALP and last 60 cases of laparoscopic radical prostatectomy (LRP), performed by three experienced laparoscopic surgeons with a 200+LRP cases experience. Materials and Methods Between January 2010 and September 2013, a total of 60 consecutive patients who have undergone RALP were prospectively evaluated and compared to the last 60 cases of LRP. Data included demographic data, operative duration, blood loss, transfusion rate, positive surgical margins, hospital stay, complications and potency and continence rates. Results The mean operative time and blood loss were higher in RALP (236 versus 153 minutes, p<0.001 and 245.6 versus 202ml p<0.001). Potency rates at 6 months were higher in RALP (70% versus 50% p=0.02). Positive surgical margins were also higher in RALP (31.6% versus 12.5%, p=0.01). Continence rates at 6 months were similar (93.3% versus 89.3% p=0.43). Patient’s age, complication rates and length of hospital stay were similar for both groups. Conclusions Experienced laparoscopic surgeons (ELS) present a learning curve for RALP only demonstrated by longer operative time and clinically insignificant blood loss. Our initial results demonstrated similar perioperative and functional outcomes for both approaches. ELS were able to achieve satisfactory oncological and functional results during the learning curve period for RALP.

Resultados do tratamento cirúrgico das fraturas do rádio distal: estudo clínico com técnica de osteossíntese percutânea e minimamente invasiva / Clinical results of surgical treatment of distal radius fractures: a clinical study with minimally invasive percutaneous osteosynthesis

INTRODUÇÃO: A utilização de técnicas minimamente invasivas para o tratamento de fraturas do rádio distal teve um aumento significativo nos últimos três anos. Isso é explicado devido ao aumento na incidência de fraturas em pacientes economicamente ativos e à necessidade destes retornarem precocemente ao trabalho. OBJETIVO: Analisar os resultados clínico-funcionais dos pacientes com diagnóstico de fratura com desvio redutível e instável da extremidade distal do rádio submetidos ao tratamento cirúrgico pela técnica de osteossíntese percutânea e minimamente invasiva utilizando haste intramedular bloqueada. MÉTODOS: Foram avaliados 53 pacientes submetidos ao tratamento cirúrgico da fratura da extremidade distal do rádio, redutível e instável, classificadas segundo Rayhack como Tipo IIB, pelo método minimamente invasivo, com haste intramedular bloqueada no período entre janeiro de 2011 e dezembro de 2012. O tempo de seguimento foi de seis a 24 meses, avaliando periodicamente parâmetros radiográficos, dor, medida do arco demovimento, força de preensão palmar e qualidade de vida através do questionário DASH. RESULTADOS: Através da análise dos valores obtidos observamos uma melhora estatisticamente significante em todos os parâmetros clínicos analisados. O grau de força de preensão palmar e a medida do arco de movimento apresentaram melhora importante desde a terceira semana de pós-operatório, assim como a escala de dor e a avaliação do questionário DASH. CONCLUSÃO: A técnica minimamente invasiva é eficaz e segura, com melhora clínica e funcional e apresenta resultados superiores quando comparada a outros métodos descritos na literatura.

INTRODUCTION: The use of minimally invasive techniques for the treatment of the distal radius fractures has been increasing significantly over the past three years. This increase can be explained by the rising incidence of fractures in economically active patients and their need to early return to work activities. OBJECTIVE: To analyze the clinical and functional results of patients diagnosed with distal radius fracture with reducible and unstabledeviation, who underwent surgical treatment by the minimally invasive percutaneous osteosynthesis technique using a locked intramedullary nail. METHODS: We evaluated 53 patients who underwent surgical treatment of reducible and unstable distal radius fractures, classified according to Rayhack as type IIB, using the minimally invasive method with intramedullary locked nail in the period between January 2011 and December 2012. The follow-up time was 6 to 24 months, periodically evaluating radiographic parameters, pain, range of motion, grip strengthand quality of life through the DASH questionnaire. RESULTS: Through the analysis of data obtained, we observed a statistically significant improvement in all clinical parameters analyzed. The degree of grip strength and range of motion presented an important improvement since the third week of the postoperative period, so did the pain scales and evaluation through the DASH questionnaire. CONCLUSION: The minimally invasive technique is a safe and effective procedure, presenting clinical and functional improvement and presenting superior results when compared toother methods described on the literature.