RESUMO
ABSTRACT Objective: Studies confirm the benefit of surgical treatment for fixation of displaced midshaft clavicle fractures. Plate fixation and intramedullary nail are the two most used techniques. Our study seeks to compare these two surgical techniques. Methods: This is a retrospective study, conducted by the evaluation of patients treated for displaced midshaft clavicle fracture with intramedullary nail, and plate and screws. Socioeconomic variables were collected, a visual pain scale questionnaire was applied, the shoulder function was measured using CONSTANT and UCLA scores, and radiography was performed to verify the consolidation and evaluation of the final clavicle shortening. Results: Sixty-five patients were evaluated, 36 (55.4%) of which were subjected to clavicle fixation with plate and screws and 29 (44.6%) with intramedullary nail. The median shortening was 0.1mm for plate and 5.8mm for nail (p = 0.001). The UCLA score shows an average of 35 in the plate group and 35 in the intramedullary group. The median CONSTANT scores were 96.5 for plate and 95 for nail, without significance. In all groups, 13 (20%) complications were registered, 9 fixed with plate and 4 fixed with intramedullary nail. The most common complication was skin erosion with exposure of the synthetic material. Conclusion: The two techniques present satisfactory results for the treatment of displaced midshaft clavicle fractures. Level of Evidence III, Therapeutic Studies Investigating the Results of Treatment.
RESUMO Objetivo: Trabalhos confirmam o benefício do tratamento cirúrgico para fixação de fraturas desviadas do corpo da clavícula. A fixação com placa e haste intramedular são as duas técnicas mais utilizadas. O objetivo deste estudo é comparar as duas técnicas cirúrgicas. Método: Estudo retrospectivo realizado por meio da avaliação de pacientes submetidos à fixação com haste intramedular e com placa e parafusos para o tratamento de fraturas desviadas do corpo da clavícula. Neste caso, foram avaliadas variáveis socioeconômicas, aplicado questionário da escala visual da dor, mensurado a função do ombro pelo escore de CONSTANT e UCLA, e realizada radiografia para verificação da consolidação e avaliação do encurtamento final da clavícula. Resultados: foram avaliados 65 pacientes, destes 36 (55,4%) foram submetidos à fixação da clavícula com placa e parafusos e 29 (44,6%) com haste intramedular. A mediana do encurtamento foi 0,1mm para placa e 5,8mm para haste (p = 0,001). O escore de UCLA apresentou mediana de 35 no grupo placa e 35 no grupo haste. O escore de Constant mostrou mediana de 96,5 no grupo placa e 95 no grupo haste, sem diferença significativa entre os grupos. Ao todo, foram registradas 13 (20%) complicações, 9 do grupo fixado com placa e 4 do grupo fixado com haste. A complicação mais comum foi a erosão da pele com exposição do material de síntese. Conclusão: as duas técnicas apresentam resultados satisfatórios para o tratamento das fraturas do corpo da clavícula. Nível de Evidência III, Estudos terapêuticos - Investigação dos resultados do tratamento.
RESUMO
Abstract Purpose To determine by histomorphometric analysis whether CO2 pneumoperitoneum interferes with collagen deposition in surgical wounds in the aponeurosis of rats. Methods This experiment involved 80 male Wistar rats, randomly allocated into four groups according to pneumoperitoneum period (PRE: 30 min preoperatively; POST: 30 min postoperatively; PP: 30 min pre- and postoperatively; C: control group). CO2 pneumoperitoneum was insufflated to 5 mmHg of pressure. A laparotomy was performed; 1 cm of the left colon was then resected, and an end-to-end anastomosis was performed to simulate surgical trauma, after which the abdominal wall was closed. On postoperative days 7 or 14, a sample of the abdominal wall was collected, stained with picrosirius red and observed under polarized light in an optical microscope. The amount of collagen was estimated by computerized histomorphometric analysis. Results There were no significant differences in collagen deposition between the control and experimental groups on postoperative days 7 (p=0.720) or 14 (p=0.933). The amount of collagen increased as expected in all groups between postoperative days 7 and 14 (p=0.0003). Conclusion At 5 mmHg, CO2 pneumoperitoneum does not interfere with collagen deposition in abdominal wall surgical wounds in rats.