Efecto del shiatsu sobre el dolor en personas con fracturas de extremidades: ensayo clínico / Efeito do shiatsu sobre a dor de pessoas com fraturas nos membros: ensaio clínico / Effects of shiatsu on pain in people with limb fractures: clinical trial

The postoperative period for limbs fractures is characterized by different levels of pain intensity. Shiatsu is a therapy applied with the hands on meridians and tsubos (points similar to acupuncture) related to pain. Objective: To evaluate the effect of shiatsu on postoperative pain in men with arm and leg fractures. Method: Non-randomized and uncontrolled clinical trial, with assessment of pain levels using the Visual Numerical Scale (VNS) (0­10) and measurement of salivary cortisol. The R software and the Wilcoxon test and Fisher's exact test were used. Results: 41 people participated in the research; the initial mean value of salivary cortisol concentration was 0.39 µg/dl and, after shiatsu intervention, it decreased to 0.32 µg/dl (p<0.0001). The Mean pain value was 4.93 (VNS) before the intervention and 3.90 (p<0.0001) after. Conclusion: The application of shiatsu contributed to reducing pain and cortisol levels in people undergoing orthopedic surgery. (AU)

O pós-operatório de fraturas dos membros superiores e inferiores é caracterizado por diversos níveis de intensidade dolorosa. O shiatsu é uma terapia aplicada com as mãos nos meridianos e tsubos (pontos similares aos da acupuntura) relacionados à dor. Objetivo: Avaliar o efeito do shiatsu sobre a dor no pós-operatório de homens com fraturas dos braços e pernas. Método: Ensaio clínico não randomizado e não controlado, com avaliação dos níveis de dor por meio da Escala Numérica Visual (ENV) (0­10) e de mensuração do cortisol salivar. Foi utilizado o software R e o teste de Wilcoxon e o teste exato de Fisher. Resultados: 41 pessoas participaram da pesquisa; o valor médio inicial da concentração salivar de cortisol foi de 0,39 µg/dl e, depois da intervenção com shiatsu, diminuiu para 0,32 µg/dl (p<0,0001). O valor médio da dor foi 4,93 (ENV) antes da intervenção e 3,90 (p<0,0001) depois. Conclusão: A aplicação do shiatsu contribuiu para reduzir os níveis de dor e cortisol em pessoas submetidas a cirurgias ortopédicas. (AU)

El postoperatorio de fracturas de miembros superiores e inferiores se caracteriza por diferentes niveles de intensidad del dolor. El Shiatsu es una terapia que se aplica con las manos sobre meridianos y tsubos (puntos similares a la acupuntura) relacionados con el dolor. Objetivo: Evaluar el efecto del Shiatsu sobre el dolor postoperatorio en hombres con fracturas de brazo y pierna. Método: ensayo clínico no aleatorizado y no controlado, con evaluación de los niveles de dolor mediante la Escala Numérica Visual (ENV) (0­10) y medición de cortisol salival. Se utilizó el software R, la prueba de Wilcoxon y la prueba exacta de Fisher. Resultados: Participaron de la investigación 41 personas y el valor medio inicial de la concentración de corti-sol salival fue de 0,39 µg/dl y después de la intervención de Shiatsu disminuyó a 0,32 µg/dl (p<0,0001). El valor promedio del dolor fue de 4,93 (ENV) antes de la intervención y de 3,90 (p<0,0001) después de la intervención. Conclusión: La aplicación de Shiatsu contribuyó a reducir el dolor y los niveles de cortisol en personas sometidas a cirugía ortopédica. (AU)

Caracterização da ocorrência de fratura em idosos: estudo epidemiológico em um hospital público / Characterization of the occurrence of fractures in the elderly: an epidemiological study in a public hospital / Caracterización de la aparición de fracturas en ancianos: estudio epidemiológico en un hospital público

RESUMO: Objetivo: conhecer as principais complicações pós-operatórias e o desfecho clínico de idosos após cirurgia corretiva de fratura. Método: estudo descritivo e transversal realizado em um hospital público em Minas Gerais - Brasil, entre agosto e outubro de 2021. Os dados foram obtidos por meio de entrevista e do prontuário e analisados através dos testes de Qui-Quadrado e Exato de Fisher. Resultados: as principais complicações pós-operatórias foram dor, sangramento e confusão mental. As variáveis correlacionadas à quantidade de complicações foram o desfecho (p=0,016), a classificação ASA (p=0,047) e tempo de pós-operatório (p=0,002). Quanto ao tipo de fratura, foram o setor de destino (p=0,002) e o tempo de internação (p>0,0001). Conclusão: esse estudo permite um maior conhecimento à equipe acerca do perfil de idosos, a fim de melhorar o planejamento cirúrgico e reduzir os fatores correlacionados à presença de complicações pós-operatórias.

ABSTRACT Objective: To find out about the main postoperative complications and the clinical outcome of elderly people after corrective fracture surgery. Method: a descriptive, cross-sectional study carried out in a public hospital in Minas Gerais, Brazil, between August and October 2021. Data was obtained through interviews and medical records and analyzed using the Chi-square and Fisher's exact tests. Results: The main postoperative complications were pain, bleeding, and mental confusion. The variables correlated with the number of complications were outcome (p=0.016), ASA classification (p=0.047) and postoperative time (p=0.002). As for the type of fracture, it was the destination sector (p=0.002) and length of stay (p>0.0001). Conclusion: This study provides the team with greater knowledge about the profile of the elderly, to improve surgical planning and reduce the factors correlated with the presence of postoperative complications.

RESUMEN: Objetivo: conocer las principales complicaciones postoperatorias y el resultado clínico de los ancianos tras la cirugía correctora de fracturas. Método: estudio descriptivo, transversal, realizado en un hospital público de Minas Gerais - Brasil, entre agosto y octubre de 2021. Los datos se obtuvieron a través de entrevistas e historias clínicas y se analizaron mediante las pruebas de chi cuadrado y exacta de Fisher. Resultados: las principales complicaciones postoperatorias fueron dolor, hemorragia y confusión mental. Las variables correlacionadas con el número de complicaciones fueron el resultado (p=0,016), la clasificación ASA (p=0,047) y el tiempo postoperatorio (p=0,002). En cuanto al tipo de fractura, fueron el sector de destino (p=0,002) y la duración de la hospitalización (p>0,0001). Conclusión: Este estudio proporciona al equipo un mayor conocimiento sobre el perfil del anciano, con el fin de mejorar la planificación quirúrgica y reducir los factores correlacionados con la presencia de complicaciones postoperatorias.

Reports of Maltreatment in a Children's Hospital: Evaluation of the Epidemiological Profile and Its Relationship with the Outcome in Fractures / Notificações de maus-tratos em um hospital infantil: Avaliação do perfil epidemiológico e sua relação com o desfecho em fraturas

Abstract Objective To describe suspected/confirmed cases of child maltreatment related to fractures in a pediatric hospital in southern Brazil. Method Study of the Information System of Notifiable Diseases notifications and the victims' medical records between January/2016 and December/2020. Variables related to the victim, the perpetrator, the type of abuse, the presence of fractures, and their anatomical location and death were evaluated. Logistic regression was performed to identify fracture-related variables, adjusted for sex and age. The results were expressed in odds ratios and their respective 95% confidence intervals. It was considered significant p < 0.05. Results There were 276 cases, 73 infants (26.4%), male predominance (151, 54.7%), with authorship of the mistreatment by relatives (245, 96,0%), 85 (31,5%), they presented fractures, with five deaths (1.9%). Factors related to the presence of fracture: age of the victim (less than two years old; n = 82; or 2.48; 95% CI: 1.45 - 4.25), having more than two aggressors involved (n = 144; or 2.09; 95% CI: 1.16-3.75), the medium being traffic/automobile accident, (n = 52; or 2.65; 95% CI: 1.04-6.75), consult an orthopedist (n = 91; or 6.77 / 95% CI: 3.66-12.51), and the need for surgical intervention (n = 15; OR 36.72; 95% CI: 8.22-164.03). Conclusions The importance of suspicion, early identification of aggression, and the correct completion of notifications for activating the system of guaranteeing rights and removal of the aggressor was emphasized.

Resumo Objetivo Descrever os casos suspeitos/confirmados de maus-tratos infantis relacionados a fraturas, atendidos em um hospital pediátrico no Sul do Brasil. Método Estudo das notificações do Sistema de Informação de Agravos de Notificação e dos prontuários das vítimas, entre janeiro/2016 e dezembro/2020. Avaliadas variáveis relacionadas à vítima, ao autor, à tipologia de maus-tratos, à presença de fraturas e sua localização anatômica e óbito. Regressão logística foi realizada para identificar as variáveis relacionadas à fratura, ajustada para sexo e idade, expressa em razão de chance e seus respectivos intervalos de confiança de 95%. Foi considerado significativo p < 0.05. Resultados Houve 276 casos, 73 lactentes (26,4%), predomínio do sexo masculino (151, 54,7%), com autoria dos maus-tratos por parentes (245, 96,0%), 85 (31,5%), apresentaram fraturas, sendo cinco óbitos (1,9%). Fatores relacionados à presença de fratura: idade da vítima (menor de dois anos; n = 82; RC 2,48; IC 95%: 1,45 - 4,25), ter mais de dois agressores envolvidos (n = 144; RC 2,09; IC 95%: 1,16 - 3,75), o meio ser trânsito/acidente automobilístico, (n = 52; RC 2,65; IC 95%: 1,04-6,75), consultar com ortopedista (n = 91; RC 6,77 / IC 95%: 3,66-12,51), e necessidade de intervenção cirúrgica (n = 15; RC 36,72; IC 95%: 8,22-164,03). Conclusões Ressaltada a importância da suspeição e identificação precoce da agressão, o preenchimento correto das notificações, para o acionamento do sistema de garantia de direitos e afastamento do agressor.

Prevention of osteoporosis in population older than 50 from Colombia: An intervention model from a nutrieconomics perspective

Introduction: Osteoporosis is a chronic disease characterized by a decrease in the density of bone mass, making bone more porous, less resistant and of lower quality than normal bone. This leads to the deterioration of its microstructure, making the bone more fragile and therefore increasing the risk of fracture. It has been found that high concentrations of Lactobacillus and Bifidobacterium promote the absorption of minerals such as calcium, magnesium, and phosphorus and thus increase mineral density. Due to the great social and economic impacts of osteoporosis, it is necessary to develop interventions that can be easily adopted at the population level, improving the quality of life of individuals without significantly affecting the health system. Objective: Assessing the impact of increased dairy consumption on the Colombian population diagnosed with osteoporosis between 2015 and 2020 through the simulation of the potential impact fraction (PIF). Methods: Using data from the Integrated Social Protection Information System (SISPRO) and National Nutritional Situation Survey (ENSIN), the incidence, the frequency of milk consumption, the potential impact fraction (PIF), and disability-adjusted life years (DALYs) were estimated. Results: A total of 63,640 cases of osteoporosis were identified. The highest incidence was observed in 2019. Seventeen food groups were identified in the ENSIN, and the most frequent products consumed by respondents over 50 years of age were milk, cheese, and yogurt. The PIF was then analysed, with a calcium intake of 600 mg/ day, and a significant difference in the decrease in the number of cases was observed. In 2019, a higher estimated DALY loss of 9.9 was observed. In women, years of life lost due to fractures were the highest in the 65-69 age group. In men, they were highest in the 75-79 age group. Discussion: We observed that the departments with the highest consumption of dairy products were the capital of the country and regions where dairy products factories are located. It was not possible to establish an association between socioeconomic strata and low dairy intake. Nevertheless, some authors have proposed that westernization of diets and low income reduce access to fresh fruits and milk derivates. Conclusion: Years lost due to disability increased in the population over 60 years of age. In the PIF analysis, a decrease in cases was observed when the population increased consumption of dairy products.

Introducción: La osteoporosis es una enfermedad crónica caracterizada por una disminución de la densidad de la masa ósea que hace que el hueso sea más poroso, menos resistente y de menor calidad que el hueso normal. Esto conduce al deterioro de su microestructura, por lo que el hueso se hace más frágil y, por lo tanto, aumenta el riesgo de fractura. Se ha encontrado que las altas concentraciones de Lactobacillus y Bifidobacterium promueven la absorción de minerales como calcio, magnesio y fósforo y, por lo tanto, aumentan la densidad mineral. Debido a los grandes impactos sociales y económicos de la osteoporosis, es necesario desarrollar intervenciones que puedan ser fácilmente adoptadas a nivel poblacional con el fin de mejorar la calidad de vida de los individuos sin afectar significativamente el sistema de salud. Objetivo: Evaluar el impacto del aumento del consumo de lácteos en la población colombiana con diagnóstico de osteoporosis entre 2015 y 2020 mediante la simulación de la fracción de impacto potencial (PIF). Materiales y métodos: Estudio ecológico realizado en adultos mayores de 50 años con diagnóstico de osteoporosis. A partir de los registros del Sistema Integrado de Información de Protección Social (SISPRO) y la Encuesta Nacional de Situación Nutricional (ENSIN), se estimó la incidencia, la frecuencia de consumo de leche, el PIF y los años de vida ajustados por discapacidad (AVAD). Resultados: Se identificaron un total de 63 640 casos de osteoporosis en SISPRO, la mayor incidencia se observó en 2019. Se establecieron 17 grupos de alimentos en la ENSIN, los productos más frecuentes consumidos en población mayor de 50 años fueron leche, queso y yogur. En el cálculo del PIF se encuentra que con una ingesta de calcio de 600 mg/día se reduciría significativamente el número de casos. En 2019 se observó una mayor pérdida estimada de AVAD de 9,9. En las mujeres, los años de vida perdidos debido a fracturas fueron más altos en el grupo de edad de 65 a 69 años. En los hombres, fue más alta en el grupo de edad de 75-79 años. Discusión: Observamos que los departamentos con mayor consumo de productos lácteos fueron la capital y las regiones donde se encuentran las fábricas de productos lácteos. No fue posible establecer una asociación entre los estratos socioeconómicos y la baja ingesta de lácteos. Sin embargo, algunos autores han propuesto que la occidentalización de las dietas y los bajos ingresos reducen el acceso a frutas frescas y derivados de la leche. Conclusión: Los años perdidos por discapacidad aumentaron en la población mayor de 60 años. En el análisis PIF, se observó una disminución en los casos (reducción de 2329 casos/ año) cuando la población aumentó el consumo de productos lácteos.

Comparación Placas de Titanio vs. Placas Reabsorbibles en Fracturas de Orbita: Revisión de literatura / Comparison of Titanium Plates vs. Resorbable Plates in Orbital Fractures: Literature Review

RESUMEN Introducción: Los tratamientos para fracturas de órbita se basan en la corrección del defecto de las lesiones orbitarias de tipo blow in y blow out (o de estallido), mediante diversas placas y mallas biocompatibles con el organismo, dándose una cicatrización de primera generación evitando un callo óseo y una fijación más rígida. Para el diagnóstico de este tipo de lesiones tenemos inflamación periorbitaria, enoftalmos, diplopía, equimosis, hemorragia subconjuntival. Existen diversos materiales reconstructivos siendo estos compuestos por distintas materias primas, como son los aloplásticos y autógenos; donde encontramos varios tipos como placas de titanio y las placas reabsorbibles siendo estas las más comunes y usadas actualmente, por su bajo estímulo a reabsorciones óseas y evitando efectos secundarios a largo plazo. Estas placas presentan diversos grados de ductilidad y resistencia. Se informó sobre varias complicaciones según el tipo de placas como es la cicatrización, las cirugías postquirúrgicas en caso de placas de titanio, etc. El objetivo de esta revisión es la evaluación de la eficacia las placas reabsorbibles versus placas de titanio en fracturas de órbita. Materiales y métodos: La investigación es de carácter documental, descriptivo y no experimental. En el cual se emplea una metodología de identificación e inclusión de artículos científicos tipo prisma. Resultados y conclusiones: Se verificaron las ventajas y desventajas tanto de las placas reabsorbibles como las de titanio siendo estas similares en la biocompatibilidad con el organismo humano, así como también varias diferencias como el soporte, fuerzas, resistencia de estas, concluyendo que es debatible el material ideal para tratar fracturas de órbita. Se seleccionaron artículos tomando en cuenta el título y objetivos; considerando estudios comparativos, revisiones sistemáticas, revisiones de literatura, los cuales comprendían criterios con respecto a fracturas de órbita y tratamientos quirúrgicos. La búsqueda arrojó 55 artículos en PubMed, 65 en Google, 4 en Scielo y 29 en Science direct, de los cuales se excluyeron libros, monografías, estudios experimentales, dando como resultado 21 artículos para el desarrollo de esta revisión bibliográfica. Y que fueron leídos y analizados en su totalidad, estudiando los objetivos, metodología y conclusión de cada uno de ellos para la posterior comparación.

ABSTRACT Introduction: Treatments for orbit fractures are based on the correction of the defect of blow in and blow out orbital injuries, by means of various plates and meshes biocompatible with the organism, giving a first-generation healing avoiding a bony callus and a more rigid fixation. For the diagnosis of this type of lesions we have periorbital inflammation, enophthalmos, diplopia, ecchymosis, subconjunctival hemorrhage. There are several reconstructive materials being these composed of different raw materials, such as alloplastic and autogenous, where we find several types such as titanium plates and resorbable plates being these the most common and currently used, for its low stimulus to bone resorption and avoiding long-term side effects. These plates have different degrees of ductility and resistance. Several complications have been reported depending on the type of plates, such as scarring, post-surgical surgeries in the case of titanium plates, etc. The objective of this review is to evaluate the efficacy of resorbable versus titanium plates in orbital fractures. Materials and methods: This research are a documentary, descriptive and non-experimental nature. A prism-type methodology of identification and inclusion of scientific articles was used. Results and conclusions: The advantages and disadvantages of both resorbable and titanium plates were verified, being these similar in biocompatibility with the human organism, as well as several differences such as support, forces, resistance of the same, concluding that it is debatable. The ideal material to treat orbital fractures. Articles were selected considering the title and objectives; considering comparative studies, systematic reviews, literature reviews, which included criteria regarding orbital fractures and surgical treatments. The search yielded 55 articles in PubMed, 65 in Google, 4 in Scielo and 29 in Science direct, from which books, monographs, experimental studies were excluded, resulting in 21 articles for the development of this bibliographic review. The 21 articles were read and analyzed in their entirety, studying the objectives, methodology and conclusion of each one of them for subsequent comparison.

Relación entre hormona paratiroidea alterada y fracturas óseas en pacientes en hemodiálisis

Contexto: Las fracturas óseas en pacientes en hemodiálisis son frecuentes y agregan una grave incapacidad y morbimortalidad; se han relacionado a alteraciones óseo-minerales, aunque su asociación con las alteraciones de la hormona paratiroidea es controversial. Objetivo: determinar la relación entre hormona paratiroidea intacta (PTH) alterada y fracturas óseas en pacientes en hemodiálisis. Metodología: se realizó un estudio transversal y analítico en 250 pacientes en hemodiálisis atendidos en el Hospital Víctor Lazarte Echegaray (La Libertad, Perú) entre el 2015 y el 2020. Los pacientes se clasificaron de acuerdo con su valor de PTH (alterada si PTH 300 pg/ml) y la presentación de fracturas óseas. La asociación entre PTH alterada y la presencia de fracturas óseas se determinó al usar un análisis bivariado y multivariado; los resultados se presentan como odds ratio (OR) considerando un valor p significativo si < 0,05. Resultados: se evaluaron 250 pacientes, 69 tuvieron PTH alterada (27,6 %) y 181 tuvieron PTH normal (72,4 %); asimismo, 42 tenían fracturas óseas (16,8 %) y 208 no tenían fracturas óseas (83,2 %). De los 42 pacientes con fracturas óseas, 22 presentaron PTH alterada (52,4 %) y 20 PTH normal (47,6 %); de los 208 pacientes sin fracturas óseas, 47 presentaron PTH alterada (22,6 %) y 161 PTH normal (p = 0,001) (77,4 %). Así, tener PTH alterada se asoció a la presencia de fracturas óseas con un OR de 3,77 (IC 95 %: 1,90-7,49) en el análisis bivariado y un OR de 2,85 (IC 95 %: 1,19-6,82) en el análisis multivariado. Las covariables que se asociaron a presencia de fracturas óseas fueron: tener más de 60 años (OR: 2,74, IC 95 %: 1,12-6,69) y tener más de cinco años en hemodiálisis (OR: 6,72, IC 95 %: 2,98-15,13). Conclusiones: la hormona paratiroidea alterada se relaciona con fracturas óseas en pacientes en hemodiálisis.

Background: Bone fractures in patients on dialysis are frequent and impose a high burden of disability and multimorbidity. They have been linked to mineral-bone disorders but its association with parathyroid hormone remains controversial. Purpose: To determine the relationship between altered parathyroid hormone (PTH) and bone fractures in hemodialysis patients. Metthodology: A cross-sectional, analytical study was conducted in 250 hemodialysis patients attending Hospital Víctor Lazarte Echegaray from 2015 to 2020. Patients were classified according to whether their PTH was altered (PTH 300 pg/ml) and whether bone fractures were present. The association between altered PTH and the presence of bone fractures was determined using bivariate and multivariate analysis; the results are presented as odds ratio (OR) considering a significant p-value if <0.05. Results: 250 patients were evaluated in which 69 (27.6%) had altered PTH, 181 (72.4%) had normal PTH; likewise, 42 (16.8%) had bone fractures and 208 (83.2%) had no bone fractures. Of the 42 patients with bone fractures, 22 (52.4%) had altered PTH and 20 (47.6%) had normal PTH; of the 208 patients without bone fractures, 47 (22.6%) had altered PTH and 161 (77.4%) had normal PTH (p=0.001). Altered PTH was associated with the presence of bone fractures with OR: 3.77 (95% CI: 1.90-7.49) in the bivariate analysis and with OR: 2.85 (95% CI: 1.19-6.82) in the multivariate analysis. The covariates that were associated with the presence of bone fractures were being over 60 years (OR: 2.74, 95% CI: 1.12-6.69) and having been on hemodialysis for more than 5 years (OR: 6.72, 95% CI: 2.98-15.13). Conclusions: Altered parathyroid hormone is related with bone fractures in hemodialysis patients.

Comparação da fragilidade gerada por 3 diferentes osteotomias sagitais de mandíbula: estudo in vitro / Comparison of fragility generated by 3 different sagittal mandible osteotomies: in vitro study / Comparación de la fragilidad generada por 3 osteotomías mandibulares sagitales diferentes: estudio in vitro

A osteotomia sagital bilateral de mandíbula (OSBM) foi publicada por Trauner e Obwegeser em 1957, desde então sofreu várias modificações a fim de diminuir as complicações e tornar o procedimento mais simples e previsível. Sendo assim objetivo do presente trabalho foi avaliar e comparar a fragilidade causada na mandíbula por 3 tipos de OSBM. Para isso, foram realizadas as osteotomias propostas por Trauner e Obwegeser modificada por Hunsuck e Epker (I), a de Sant'Ana (II) e de Wolford (III), em 24 hemimandibulas de poliuretano e foi realizado o ensaio mecânico para gerar a fratura sagital. Os dados foram coletados e tabulados, e obteve como resultado que, a maior quantidade de força máxima aplicada foi observada no grupo III, e a menor quantidade no grupo II; com relação à deflexão, apresentou significância estatística entre o grupo II e grupo III; com relação à rigidez, a maior média, foi encontrada no grupo I. Sendo assim, foi possível concluir que dentro deste modelo de estudo a osteotomia II foi capaz de gerar maior fragilidade à hemimandibula de poliuretano com menor quantidade de força. As OBMD dos grupos I e a III também apresentaram ótimos resultados, entretanto necessitaram mais força para alcançar a fratura... (AU)

The bilateral sagittal split osteotomy of the mandible (BSSO) was published by Trauner and Obwegeser in 1957, since then it has undergone several modifications in order to reduce complications and make the procedure simpler and more predictable. Therefore, the objective of this study was to evaluate and compare the fragility caused in the mandible by 3 types of BSSO. For this, the osteotomies proposed by Trauner and Obwegeser modified by Hunsuck and Epker (I), Sant'Ana (II) and Wolford (III) were performed on 24 polyuretha ne hemimandibles, a mechanical test to generate the sagittal fracture. Data were collected and tabulated, and the result was that, the highest amount of maximum force applied was observed in group III, and the lowest amount in group II; with regard to deflection, it was statistically significant between group II and group III; with regard to stiffness, the highest average was found in group I. Therefore, it was possible to conclude that within this study model, osteotomy II was able to generate greater fragility to the polyurethane hemimandible with less force. The BSSO of the groups I and III also showed excelent results, however they required more force to reach the fracture... (AU)

La osteotomía sagital bilateral de la mandíbula (OSBM) fue publicada por Trauner y Obwegeser en 1957, desde entonces ha sufrido varias modificaciones con el fin de reducir las complicaciones y hacer el procedimiento más simple y predecible. Por lo tanto, el objetivo de este estudio fue evaluar y comparar la fragilidad causada en la mandíbula por 3 tipos de OSBM. Para eso, se realizaron las osteotomías propuestas por Trauner y Obwegeser modificadas por Hunsuck y Epker (I), Sant'Ana (II) y Wolford (III) en 24 hemimandíbulas de poliuretano y se realizó un ensayo mecánico para generar la fractura sagital. Los datos fueron recolectados y tabulados, obteniendo como resultado que, la mayor cantidad de fuerza máxima aplicada se observó en el grupo III, y la menor cantidad en el grupo II; en cuanto a la deflexión, fue estadísticamente significativa entre el grupo II y el grupo III; en cuanto a la rigidez, la media más alta se encontró en el grupo I. Por lo tanto, se pudo concluir que, dentro de este modelo de estudio, la osteotomía II logró generar mayor fragilidad a la hemimandíbula de poliuretano con menor fuerza. El OSBM de los grupos I y III también mostró excelentes resultados, pero requirieron mayor fuerza para llegar a la fractura... (AU)

Abordaje posterior en fracturas de meseta tibial complejas en pacientes tratados quirúrgicamente en el IAHULA / Posterior approach in complex tibial plateau fractures IAHUL A Surgically treated patients

Las fracturas de meseta tibial compleja se asocian a traumatismo de alta energía, principalmente en accidentes de motocicleta, siendo un desafío para el cirujano ortopedista. En la década de 1970, Schatzker propuso una clasificación radiológica para las fracturas de la meseta tibial, que destacaba la morfología de los seis tipos principales. Las imágenes de tomografía computarizada y tridimensional, han cambiado la comprensión y el tratamiento de las fracturas de la meseta tibial. Recientemente, esa clasificación original se complementó con una más amplia; puesto que, se introdujo el fragmento en cuña dividida y la continuidad de la columna posterior como determinantes de la estabilidad articular y el papel fundamental que desempeña en el tratamiento de las fracturas de la meseta tibial, con ellos también la importancia de abordajes quirúrgicos que permitan la visualización posterior para una adecuada reducción. El estudio documenta las técnicas de fijación interna y abordajes posteriores realizadas en el IAHULA, valorando los resultados clínicos en cuanto a dolor y satisfacción del paciente, como consolidación, pseudoartrosis o falla en la técnica de osteosíntesis realizada. El resultado a partir de las escalas de evaluación de la AO y KOOS, arrojaron que, con un efecto excelentes se agrupa un 28,6% y bueno a un 42,9%, indicando la importancia de la fijación de la columna posterior, para prevenir artrosis postraumática temprana e inestabilidad articular(AU)

A complex fracture of the posterior tibial plateau are related to high energy traumatisms, mainly during motorcycle accidents, becoming a challenge to the ortopedic surgen. During the seventies, Stchatzker proposed a radiologic classification for the tibial plateau fractures that pointed the morphology of six main types. The computarized and tridimensional tomographic images have changed the comprehension and treatment of these fractures. Recently, the original classification was complemented with a more broaded approach due to the introduction of the fragment in divided crib and the continuity of the posterior column as factors determining the articular stability and the fundamental roll played in the treatment of fractures of the tibial plateau, as well as the important roll of surgical approaches that allow the posterior visualization for a correct reduction. This research documents the technics of internal fixation and posterior approach developed in the IAHULA, evaluating the clinic results about patients' pain level and comfort, as well as the radiologic findings of consolidation, pseudoarthrosis, or fail in the technic of osteosynthesis developed. The results from a point of view of the evaluation scales of the AO and KOOS, show 28.6% with excellent outcomes, and 42.9% with good outcomes, indicating the importance of the fixation of the posterior column to prevent early start of posttraumatic arthrosis and articular instability(AU)

Repair of soft tissue defect of the middle and lower leg with island flap / 中华医学美学美容杂志

Objective:To investigate the methods and effect of wound repair after partial skin and soft tissue necrosis of middle and lower leg fracture surgery.Methods:Three kinds of island flaps were used to repair the wound after skin and soft tissue necrosis of middle and lower leg fracture surgery in 22 patients. Nine patients were repaired with sural neurotrophic fascial flaps, 7 patients with posterior tibial artery perforator flaps, and 6 patients with peroneal artery perforator flaps. The area of wound defect was 3.0 cm×3.8 cm to 12.0 cm×9.0 cm. The donor area was directly sutured, or free skin grafted.Results:All patients were the cases after partial skin and soft tissue necrosis of middle and lower leg fracture surgery, with bone, internal fixation plate or tendon exposed. The skin flaps in 21 patients were survived, and the wound healed by first intention. The sural neurotrophic fascial flap necrosis in one patient was due to hematoma and entrapment in vascular pedicle. After 5 to 24 months (mean 9 months) follow-up, texture of flaps was good, no ulcer occured, and outlook of the repaired wound was satisfied. The sutured wound of donor site and skin-grafting had healed by first stage intention.Conclusions:Repair with island flap is an ideal way to the defect wound after skin and soft tissue necrosis of middle and lower leg fracture surgery.

Spinal fractures and thoracoabdominal injuries in polytraumatized patients: epidemiological evaluation / Fraturas da coluna vertebral e lesões toracoabdominais em pacientes politraumatizados: avaliação epidemiológica / Fracturas vertebrales y lesiones toracoabdominales en pacientes politraumatizados: evaluación epidemiológica

ABSTRACT Objective: Establish the frequency of incidences, management, and description of the relationship between thoracic and abdominal trauma and spinal injury. Methods: Observational, retrospective study of quantitative analysis carried out through the analysis of medical records of patients who presented spinal fractures and associated thoracoabdominal injuries. The participants were treated at a reference hospital in trauma care in Curitiba-PR from 2019 to 2021. The data were from patients with spine fractures referring to gender, age, trauma mechanism, fracture classification, associated injuries, Frankel neurological scale, and proposed treatment. Results: There was a predominance of male patients (84.5%) and young, with a mean age of 37.3 years, victims of car accidents. The main vertebrae affected were the lumbar spine (36.8%) and thoracic spine (36.2%). The most prevalent associated injuries were extra vertebral and cervical spine fractures. The most observed thoracic injuries were hemothorax, chest contusion, and fracture of multiple costal arches, while the most observed abdominal injuries were kidney injury, hemoperitoneum/abdominal hematoma, and liver injury. Of the total patients analyzed, 68% had fractures with associated thoracoabdominal injuries. Conclusion: Abdominal and thoracic injuries are frequently associated with spine fractures, with an association of 14.6% and 53.4%, respectively. The production of knowledge on the subject contributes to creating action plans to optimize the management and reduce the morbidity and mortality of these cases. Levels of evidence III; Systematic Review.

Resumo: Objetivos: Estabelecer a frequência de incidências, manejo e descrição da relação entre traumas torácicos e abdominais com a lesão da coluna vertebral. Métodos: Estudo observacional, retrospectivo de análise quantitativa realizado através da análise de prontuários de pacientes que apresentaram fraturas da coluna vertebral e lesões toracoabdominais associadas. Os participantes incluídos foram atendidos em um hospital referência no atendimento ao trauma em Curitiba-PR no período de 2019 a 2021. Os dados foram de pacientes com fratura de coluna referente a sexo, idade, mecanismo de trauma, classificação da fratura, lesões associadas, escala neurológica de Frankel e tratamento proposto. Resultados: Houve predomínio de pacientes masculinos (84,5%) e jovens, sendo a média de idade de 37,3 anos, vítimas de acidentes automobilísticos. As principais vértebras acometidas foram de coluna lombar (36,8%) e torácica (36,2%). As lesões associadas mais prevalentes foram as fraturas extravertebrais e de coluna cervical. As lesões torácicas mais observadas foram o hemotórax, contusão torácica e fratura de múltiplos arcos costais, enquanto as lesões abdominais mais observadas foram lesão renal, hemoperitônio/ hematoma abdominal e lesão hepática. Sendo do total de pacientes analisados 68% apresentavam fraturas com lesões toracoabdominais associadas. Conclusão: Lesões abdominais e torácicas frequentemente estão associadas a fraturas de coluna, com associação de 14,6% e de 53,4% respectivamente. A produção de conhecimento sobre o assunto, contribui para criação de planos de ação para a otimização do manejo e redução da morbimortalidade desses casos. Nível de evidência III; Revisão sistemática.

Resumen: Objetivos: Establecer la frecuencia de incidencias, manejo y descripción de la relación entre trauma torácico y abdominal y lesión medular. Métodos: Estudio observacional, retrospectivo de análisis cuantitativo realizado a través del análisis de historias clínicas de pacientes que presentaron fracturas de columna y lesiones toracoabdominales asociadas. Los participantes incluidos fueron atendidos en un hospital de referencia en atención de trauma en Curitiba-PR de 2019 a 2021. Los datos fueron de pacientes con fracturas de columna con referencia a sexo, edad, mecanismo de trauma, clasificación de fractura, lesiones asociadas, escala neurológica de Frankel y tratamiento propuesto. Resultados: Predominaron los pacientes del sexo masculino (84,5%) y jóvenes, con una edad media de 37,3 años, víctimas de accidentes automovilísticos. Las principales vértebras afectadas fueron la columna lumbar (36,8%) y la columna torácica (36,2%). Las lesiones asociadas más prevalentes fueron las fracturas extra vertebrales y de columna cervical. Las lesiones torácicas más observadas fueron hemotórax, contusión torácica y fractura de múltiples arcos costales, mientras que las lesiones abdominales más observadas fueron lesión renal, hemoperitoneo/ hematoma abdominal y lesión hepática. Del total de pacientes analizados, el 68% presentaba fracturas con lesiones toracoabdominales asociadas. Conclusión: Las lesiones abdominales y torácicas se asocian con frecuencia a las fracturas de columna, con una asociación del 14,6% y 53,4% respectivamente. La producción de conocimiento sobre el tema contribuye a la creación de planes de acción para optimizar el manejo y disminuir la morbimortalidad de estos casos. Nivel de evidencia; Revisión sistemática.

Atypical Tibial Fracture Treated with Osteosynthesis Associated with Total Knee Arthroplasty: Case Report / Fratura atípica de tíbia tratada com osteossíntese associada a artroplastia total do joelho: Relato de caso

Abstract Bisphosphonates are widely used in the treatment of osteoporosis but predispose the patient to the appearance of atypical fractures. The femoral subtrochanteric region is usually affected, but other bones can be as well. Atypical tibia fractures in patients with severe gonarthrosis is a therapeutic challenge. The present work reports the case of an elderly patient with advanced gonarthrosis who presented atypical tibial fracture. The patient made prolonged use of bisphosphonates for osteoporosis, presenting with pain and functional limitation resulting from gonarthrosis, which progressed to sudden pain in the right tibial metaphysis, preventing ambulation. The radiographs showed bilateral severe arthrosis; marked varism; tibial and femoral medial erosion; and fracture in the proximal third of the right tibial diaphysis. The fracture and arthrosis on the right side were treated by osteosynthesis with blocked plaque and total knee arthroplasty with posterior stabilization and fixed base. After physical rehabilitation, significant improvement of pain and function was reported, independent gait was reacquired and a range of motion of 0 to 100º was reached. After one year, the radiographs showed fracture consolidation and satisfactory alignment of the lower limbs' axes. The coexistence of severe arthrosis and atypical fracture made treatment difficult. However, the result was satisfactory and the approach with simultaneous osteosynthesis and arthroplasty proved to be adequate.

Resumo Bifosfonatos são amplamente usados no tratamento da osteoporose; porém, predispõem ao surgimento de fraturas atípicas. A região subtrocantérica femoral é usualmente acometida, mas outros ossos também são afetados. Fraturas atípicas da tíbia em pacientes portadores de gonartrose grave são um desafio terapêutico. O presente trabalho relata o caso de uma paciente idosa com gonartrose avançada que apresentou fratura atípica tibial. A paciente fazia uso prolongado de bifosfonatos para osteoporose, com quadro de dor e limitação funcional decorrentes da gonartrose, que progrediu para dor súbita na metáfise tibial à direita, impedindo a deambulação. Radiografias evidenciaram artrose grave bilateral; varismo acentuado; erosão medial tibial e femoral; e fratura no terço proximal da diáfise tibial direita. Trataram-se a fratura e a artrose à direita por osteossíntese com placa bloqueada e artroplastia total do joelho com estabilização posterior e base fixa. Após reabilitação física, relatou-se melhora significativa da dor e da função, readquiriu-se a marcha independente e alcançou-se arco de movimento de 0 a 100º. Após um ano, as radiografias mostraram consolidação da fratura e alinhamento satisfatório dos eixos dos membros inferiores. A coexistência de artrose grave e fratura atípica dificultou o tratamento. Contudo, o resultado foi satisfatório e a abordagem com osteossíntese e artroplastia simultâneas mostrou-se adequada.

Manejo de las fracturas maxilofaciales y sus complicaciones / Management of maxillofacial fractures and its complications

RESUMEN Antecedentes: el trauma maxilofacial corresponde a toda lesión traumática del macizo facial. Actualmente representa uno de los problemas de salud más importantes en el mundo. Nuestro objetivo es realizar un análisis de nuestra experiencia en las intervenciones realizadas en pacientes internados y sus complicaciones. Material y métodos: se realizó un estudio descriptivo, retrospectivo y observacional de 205 pacientes con fracturas maxilofaciales desde el año 2011 hasta el año 2019. Resultados: el 81,46% fueron hombres (n: 167) y el rango etario más afectado osciló entre los 21 y 30 años con el 38,54% (n:79). El accidente de tránsito 56,1% (n:115) fue el mecanismo de trauma más frecuente. Los tipos de fracturas faciales fueron: panfaciales 12,2% (n: 25), tercio superior 1,46% (n:3), tercio medio 72,2% (n:148) y tercio inferior 14,15% (n:29). Dentro del tercio superior, el 66,67% (n:2) fueron fracturas del seno frontal asociadas al hueso frontal, en el tercio medio las combinadas en un 54,73% (n:81) y en el tercio inferior, las complejas en el 34,48% (n:10). Fueron intervenidos 199 pacientes (97,07%). Solo el 11,56% (n:23) presentó alguna complicación. No se observaron complicaciones graves. Discusión: según nuestra serie, la mayoría de los pacientes fueron hombres jóvenes; la causa más frecuente, el accidente de tránsito, y el tercio medio, el más afectado, resultados estos similares a los de otros estudios publicados. El tratamiento quirúrgico fue principalmente reducción abierta y fijación con material de osteosíntesis de titanio, un procedimiento seguro y fiable, que permite restablecer la funcionalidad previa al traumatismo, con un índice muy bajo de complicaciones posoperatorias.

ABSTRACT Background: Maxillofacial trauma corresponds to all traumatic injuries affecting the facial bones. Nowadays, it represents one of the main healthcare issues worldwide. The aim of this study is to analyze our experience in the interventions performed in hospitalized and their complications. Material and methods: We performed a retrospective and observational study of 205 patients with maxillofacial fractures from 2011 to 2019. Results: 81.46% were men (n = 167) and 38.54% (n = 79) of the patients were between 21 and 30 years of age. Traffic collision was the most common mechanism of trauma (56,1%, n = 115). The types of facial fractures were panfacial (12.2%; n = 25), of the upper-third (1.43%; n = 3), of the middle-third (72.2%; n = 148) and of the lower third (14.15%; n = 29). In the upper third of the face frontal sinus fractures associated with the frontal bone were the most common (66.67%; n =2); in the middle-third combined fractures were most prevalent (54.73%; n = 81) while complex fractures were most frequent in the lower third (34,48%; n = 10). One-hundred and ninety-one patients were operated on (97.07%). Complications occurred in only 11.56% (n = 23) and were not serious. Discusion: In our series, most patients were young men, traffic collisions were the most common cause of trauma, and the middle third of the face was the most affected region. These results are similar to our publications. Surgical management, mostly by open reduction and fixation with titanium-based osteosynthesis material, is an effective, safe and reliable procedure, which allows the restoration of pre-trauma function, with very low rate of postoperative complications.

Primer reporte de una cirugía ortopédica en Cienfuegos, historia de un caso del siglo XIX / First Report Of An Orthopedic Surgery In Cienfuegos, History Of A Case Of The XIX Century

En el trabajo se describe una desarticulación escápulo-humeral y probablemente la primera cirugía ortopédica realizada en Cienfuegos. La operación fue dirigida por Luis Perna de Salomó en un período con grandes avances en la rama de la medicina. En el estudio se emplean métodos de la investigación histórica como el heurístico, para la búsqueda de información documental relacionada con el suceso; el histórico-lógico, junto al inductivo-deductivo y el analítico-sintético, entre otros. Esta intervención quirúrgica fue de relevancia local por el alto nivel científico que precisaba su ejecución y confirma la necesidad de estudiar las técnicas y prácticas médicas empleadas en Cienfuegos durante el siglo XIX(CU)

The paper describes the performance of what was probably the first orthopedic surgery in Cienfuegos: a scapulo-humeral disarticulation. The surgery was performed by a group of doctors headed by Luis Perna de Salomó, in a period in which great advances were taking place in the branch of medicine. In this study, historical research methods are used, such as the heuristic -in search of locating primary and secondary documentary information related to the event-, the historical-logical, together with the inductive-deductive and the analytical-synthetic, among others. The surgical intervention carried out, due to its local relevance and the high scientific level that needed to be mastered to perform it, evidences the need to study the medical techniques and practices used in Cienfuegos on that date, which, as can be seen, were at the height of those carried out in the capital of the island. Due to the local relevance it had, and the high scientific level that needed to be mastered to perform it, this surgical intervention evidences the need to study the medical techniques and practices used in Cienfuegos on that date, which, as can be seen, were at the height of those made in the capital of the island(CU)

Principios y recursos clásicos y modernos: combinación en el manejo de fracturas tipo Le Fort / Classical and modern principles and resources: their combination in the management of Le Fort fractures

Introducción: Las lesiones traumáticas maxilofaciales son un problema de salud importante en todo el mundo. Suponen una carga para la salud pública. Objetivo: Reflexionar sobre la necesidad de combinar en el contexto cubano principios y recursos clásicos y modernos en el manejo de fracturas tipo Le Fort. Comentarios principales: El tratamiento de las fracturas faciales ha evolucionado mucho a lo largo de los años. Tradicionalmente, el alambre de acero inoxidable se utilizaba para la osteosíntesis en cirugía maxilofacial hasta la aparición de las miniplacas. Los sistemas de osteosíntesis de titanio son actualmente los de elección en cirugía maxilofacial. A pesar de sus ventajas indiscutibles, en los países en desarrollo ocasionalmente no se cuenta con todo el equipamiento necesario para su empleo. Consideraciones globales: El manejo del trauma maxilofacial se centra en la reobtención de la forma y la función original de la región afectada. Sin vulnerar los principios teóricos de manejo de fracturas tipo Le Fort, se impone de los profesionales cubanos la búsqueda de soluciones en concordancia con la disponibilidad de recursos. La unión de técnicas clásicas y recursos modernos como las suspensiones craneofaciales alámbricas, los arcos barra y los tornillos de fijación maxilomandibular puede ser una alternativa terapéutica confiable(AU)

Introduction: Traumatic maxillofacial lesions are an important global health problem, as well as a public health burden. Objective: Reflect on the need to combine classical and modern principles and resources in the management of Le Fort fractures in the Cuban context. Main remarks: Treatment of facial fractures has evolved considerably through the years. Before the appearance of miniplates, stainless steel wire was used for osteosynthesis in maxillofacial surgery. Titanium osteosynthesis systems are currently the systems of choice in maxillofacial surgery. Despite their undeniable advantages, developing countries occasionally do not have all the equipment required for their use. General considerations: Management of maxillofacial trauma is aimed at recovering the original form and function of the affected area. Without disregarding the theoretical principles of the management of Le Fort fractures, Cuban professionals should search for solutions in keeping with the resources available. The combination of classical techniques and modern resources, such as wired craniofacial suspensions, bar arches and maxillomandibular fixation screws, may be a reliable therapeutic alternative(AU)

A farmacoterapia intra-hospitalar e as potenciais interações medicamentosas em pacientes geriátricos com fraturas

Objetivo: analisar o perfil da farmacoterapia intra-hospitalar quanto à ocorrência de polifarmácia, potenciais interações medicamentosas e prescrição de medicamentos potencialmente inapropriados em idosos hospitalizados por fraturas ósseas. No período de janeiro de 2019 a janeiro de 2020, com pacientes idosos internados por fraturas em qualquer segmento corporal, candidatos ao tratamento cirúrgico, que se encontravam em terapia farmacológica no Hospital Municipal de Imperatriz (HMI), Maranhão. Metodologia: as prescrições foram analisadas por meio do banco de dados Lexi-Interact® para identificar possíveis interações medicamentosas em potencial e os critérios de Beers atualizados em 2019 pela American Geriatrics Society para classificar os medicamentos potencialmente inapropriados. Para verificação de associações foram utilizados o teste de Qui-Quadrado e o teste exato de Fisher. Resultados: o estudo incluiu 29 participantes. A polifarmácia ocorreu em 75,8% dos pacientes. 25 pacientes (86,2%) faziam uso de pelo menos um medicamento potencialmente inapropriado para idosos. 45,3% das 115 potenciais interações medicamentosas possuíam ação deletéria sob a condição clínica do paciente. Conclusão: o perfil da farmacoterapia se caracterizou pela elevada taxa de polifar-mácia, prescrição de medicamentos potencialmente inapropriados pertencentes às classes farmacológicas dos AINEs, analgésico, antibiótico e protetor gástrico, que as potenciais interações medicamentosas foram de grande risco clínico em idosos com fraturas ósseas, cujo predomínio foi de fêmur. Espera-se contribuir para tomada de medidas em consenso para as prescrições de idosos e que outras pesquisas nessa abordagem sejam realizadas para endossar esses achados.

SUMMARY Aim: To evaluate the drug profile concerning occurrence of the polypharmacy, potential drug-drug interactions and potentially inappropriate medication prescribed to aging adults admitted for bone fractures. Cross-sectional, quantitative and analytical study, conducted in January 2019 to January of 2020 with patients attended for bone fractures in any body segment, candidates for surgical treatment, under drug therapy in the Hospital Municipal de Imperatriz (HMI), Maranhão. Methodology: The prescriptions were analyzed with the assistance of Lexi-Interact" database to verification potential drug-drug interactions and the Beers criteria updated in 2019 by the American Geriatrics Society to classify potentially inappropriate medications. The chi-square test and Fisher's exact test were used to verify associations. Results: A total of 29 geriatric patients were included in this study. The prevalence of polypharmacy was 75.8%. 25 patients (86.2%) used at least one medication potentially inappropriate for the aging adults. Of the 115 potential drug-drug interactions, 45.3% had a deleterious effect on the patient clinical condition. Conclusion: The frequency of polypharmacy, potential drug interactions with deleterious action on clinical condition, and prescription of potentially inappropriate medications for geriatric patients during hospitalization was high. The most prevalent pharmacological classes were NSAIDs, analgesic, antibiotic, and gastric protector. Proximal femur fractures were the most prevalent in this research. Thus, it is hoped to contribute to taking consensus measures for prescribing in this population.

Objetivo: analizar el perfil de la farmacoterapia intrahospitalaria en cuanto a la ocurrencia de polifarmacia, posibles interacciones medicamentosas y prescripción de medicamentos potencialmente inapropiados en ancianos hospitalizados por fracturas óseas. De enero de 2019 a enero de 2020, con ancianos hospitalizados por fracturas en cualquier segmento del cuerpo, candidatos a tratamiento quirúrgico, que estaban en tratamiento farmacológico en el Hospital Municipal de Imperatriz (HMI), Maranhão. Metodología: las recetas se analizaron utilizando la base de datos Lexi-Interact " para identificar posibles interacciones farmacológicas y los criterios de Beers actualizados en 2019 por la Sociedad Estadounidense de Geriatria para clasificar los fármacos potencialmente inapropiados. Para verificar las asociaciones se utilizó la prueba Chi-Cuadrado y la prueba exacta de Fisher. Resultados: el estudio incluyó a 29 participantes. La polifarmacia se presentó en el 75,8% de los pacientes. 25 (86,2%) pacientes utilizaban al menos un fármaco potencialmente inapropiado para ancianos. El 45,3% de las 115 posibles interacciones medicamentosas tuvo un efecto deletéreo sobre el estado clínico del paciente. Conclusión: el perfil farmaco-terapéutico se caracterizó por la alta tasa de polifarmacia, prescripción de medicamentos potencialmente inapropiados pertenecientes a las clases farmacológicas de los AINEs, analgésicos, antibióticos y protectores gástricos, las potenciales interacciones medicamentosas resultaron de gran riesgo clínico en ancianos con fracturas óseas. Las fracturas de fémur proximal fueron las más prevalentes en esta investigación. Se espera contribuir a la toma de medidas en consenso para las prescripciones de los ancianos y que se realicen más investigaciones en este enfoque para avalar estos hallazgos.

Fatores de risco associados à fratura de coluna lombossacra e seu comprometimento na qualidade de vida em cirróticos / Risk factors associated with fracture of the lumbosacral spine and its compromise in the quality of life of cirrhotics

ABSTRACT Background Chronic hepatic disease is associated with osteoporosis, osteopenia or osteomalacia. Osteoporosis and fractures due to bone fragility present high prevalences and are more frequent in patients with liver cirrhosis than in the general population. The search for a diagnosis of osteopenia and osteoporosis in this population may allow early intervention and modify unfavorable outcomes. Objective To know the prevalence of osteopenia or osteoporosis and of fracture due to bone fragility in individuals with liver cirrhosis, the associated risk factors, and its compromise in their quality of life (QoL). Methods Observational, transversal study performed with 71 liver cirrhosis patients of the Hepatology Service of the Hospital de Base do Distrito Federal, Brasília, DF, Brazil, between July 2017 and December 2018. The patients were submitted to bone densitometry (DXA) of the lumbar spine and of the femoral neck, to x-ray of the lumbosacral spine and to the Chronic Liver Disease Questionnaire (CLDQ) for the evaluation of quality of life (QoL). The Fracture Risk Assessment (FRAX) major was calculated for patients >50 years old. The analyses were performed for the evaluation of the risk factors associated with lumbosacral spine fracture. Results The majority (62%) of the 71 evaluated patients was diagnosed with osteoporosis or osteopenia on DXA. Of the 44 patients with osteopenia or osteoporosis, 52.3% were female, with a mean age of 62.6±9.51 years old, with the majority (72.7%) being Child A, cirrhotics of alcoholic etiology (36.4%), and with an intermediate QoL according to the CLDQ (3.3). Regarding the patients with lumbosacral spine fracture, the mean age was 61.6±11.1 years old, 60% were female, most of them Child A (66.7%), of alcoholic etiology (46.7%), and with an intermediary QoL according to the CLDQ (3.5). The presence of osteopenia and/or osteoporosis was associated with lumbosacral fracture (P<0.001), without correlation with the other analyzed variables: age, body mass index, gender, presence and absence of ascites, Child-Pugh classification, vitamin D, calcium, and phosphorus serum concentration, cirrhosis etiology and FRAX major. Conclusion The prevalence of hepatic osteodystrophy was high, and the occurrence of lumbosacral spine fracture was more associated with osteoporosis and/or osteopenia among the cirrhotic patients studied. The QoL was intermediate and with no differences between cirrhotics with and without fracture.

RESUMO Contexto A doença hepática crônica associa-se com osteoporose, osteopenia ou osteomalácia. A osteoporose e as fraturas por fragilidade óssea têm altas prevalências e são mais frequentes em pacientes com cirrose hepática do que na população geral. A busca por osteopenia e osteoporose nesta população pode permitir a intervenção precoce e modificar os desfechos desfavoráveis. Objetivo Conhecer a prevalência de osteopenia ou osteoporose e de fraturas por fragilidade óssea em portadores de cirrose hepática, fatores de risco associados e seu comprometimento na qualidade de vida. Métodos Estudo observacional e transversal realizado com 71 pacientes portadores de cirrose hepática do Serviço de Hepatologia do Hospital de Base do Distrito Federal, Brasília, DF, Brasil, no período de julho de 2017 a dezembro de 2018. Os pacientes foram submetidos à densitometria óssea de coluna lombar e colo de fêmur, raio-x de coluna lombo sacra e ao questionário Chronic Liver Disease Questionnaire (CLDQ, na sigla em inglês) para avaliação de qualidade de vida. Foi calculado o escore de Fracture Risk Assessment Tool "FRAX Maior" nos pacientes >50 anos. As análises foram realizadas para a avaliação dos fatores de risco associados à fratura de coluna lombo sacra. Resultados Dos 71 pacientes avaliados, a maioria (62%) foi diagnosticada com osteoporose ou osteopenia à densitometria. Dos 44 portadores de osteopenia ou osteoporose, 52,3% eram do sexo feminino, com idade média de 62,6±9,51 anos, sendo a maioria (72,7%) Child A, cirróticos de etiologia alcoólica (36,4%) e com qualidade de vida intermediária ao CLDQ (3,3). Dos pacientes com fratura de coluna lombo sacra, a média de idade foi de 61,6±11,1 anos, 60% eram do sexo feminino, a maioria Child A (66,7%), de etiologia alcoólica (46,7%), e apresentaram qualidade de vida intermediária ao CLDQ (3,5). A presença de osteopenia e/ou osteoporose esteve associada à fratura lombo sacra (P<0,001), sem correlação com as demais variáveis analisadas: idade, índice de massa corporal (IMC), gênero, presença e ausência de ascite, classificação de Child-Pugh, concentrações séricas de vitamina D, cálcio e fósforo, etiologia da cirrose e "FRAX maior". Conclusão A prevalência de osteodistrofia hepática foi elevada, e a ocorrência de fratura de coluna lombo sacra esteve mais associada à osteoporose e/ou osteopenia entre cirróticos estudados. A qualidade de vida se mostrou intermediária e sem diferença entre cirróticos com e sem fratura.

Does ulna fixation alter the outcome for distal-third forearm fractures in children? / A fixação da ulna altera o desfecho das fraturas do terço distal do antebraço?

ABSTRACT Introduction Fractures of the distal third of the forearm are common in the pediatric population. Conservative treatment of an ipsilateral fracture of the distal ulna metaphysis is one of the risk factors for loss of reduction. Percutaneous fixation of the fracture with K-wires is recommended. This study aims to evaluate the outcome of percutaneous fixation of both bones performed as the primary treatment. Materials and Methods A randomized, open, prospective, clinical trial was conducted, including skeletally immature patients who underwent surgery for fractures of the distal radius and ulna. They were randomized into two groups, one with fixation only of the radius fracture and the other with fixation of both the radius and the ulna fractures, and they were followed clinically and radiologically for up to 12 weeks postoperatively. Results Sixteen children were selected. In the intraoperative period, fluoroscopy was activated for a longer time when fixing the ulna (p = 0.011) and the surgical time was longer in this group (p = 0.014). In the postoperative evaluations, the group whose surgery involved the fixation of both bones had a lower postoperative pain score (p <0.001) and less time away from school (p <0.001). Conclusions In this study, postoperative pain and absence from school were both less when fixation of the radius and ulna was performed. Evidence Level II; Randomized Controlled Study.

RESUMO Introdução As fraturas do terço distal do antebraço são comuns na população pediátrica. O tratamento conservador da fratura ipsilateral da metáfise distal da ulna é um dos fatores de risco para a perda da redução. Recomenda-se a fixação percutânea da fratura com fios K. Este estudo tem como objetivo avaliar o resultado da fixação percutânea de ambos os ossos realizada como tratamento primário. Materiais e Métodos Foi realizado um estudo clínico randomizado, aberto e prospectivo, que incluiu pacientes com esqueleto imaturo que foram submetidos à cirurgia para fraturas da parte distal do rádio e a ulna. Os participantes foram randomizados em dois grupos, um com fixação apenas da fratura do rádio e outro com fixação das fraturas do rádio e da ulna, e foram acompanhados clínica e radiologicamente por até 12 semanas de pós-operatório. Resultados Dezesseis crianças foram selecionadas. No intraoperatório, a fluoroscopia foi ativada por mais tempo na fixação da ulna (p = 0,011) e o tempo cirúrgico foi maior nesse grupo (p = 0,014). Nas avaliações pós-operatórias, o grupo cuja cirurgia envolveu a fixação de ambos os ossos teve escore de dor menor depois da cirurgia (p < 0,001) e menos tempo de afastamento da escola (p < 0,001). Conclusões Neste estudo, a dor pós-operatória e o afastamento da escola foram menores quando se realizou fixação do rádio e da ulna. Nível de Evidência II; Estudo randomizado controlado.

Heterotopic ossification in acetabular fractures: systematic review and meta-analysis of prophylaxis / Ossificação heterotópica nas fraturas do acetábulo: revisão sistemática e metanálise da profilaxia

ABSTRACT Objective: Heterotopic ossification is defined as the formation of trabecular bone in soft tissues. It is a common complication after surgical treatment of acetabular fractures. However, its prophylaxis and treatment are still controversial. The objective of this research is to evaluate the effectiveness of actions to prevent the development of heterotopic ossification after surgical correction of acetabular fractures. Methods: A systematic review was carried out with research in the databases PubMed/MEDLINE, Embase, LILACS and Cochrane until August 4, 2020, without restrictions on language and year of publication. Only randomized clinical studies carried out in humans without restrictions based on the dosage of treatments, use and duration of prophylaxis were included in this review. Results: Two studies compared the use of radiotherapy and indomethacin and three compared the use of indomethacin with a placebo or non-indomethacin group. The meta-analysis calculations did not indicate statistical differences between radiotherapy versus indomethacin (RR 1.45, IC 95% 0.97 to 2.17, p = 0,55) and indomethacin versus placebo or not indomethacin (RR 0.85, IC 95% 0.68 to 1.06, p = 0,59). Conclusion: There is insufficient evidence to affirm that the use of radiotherapy or indomethacin are effective to prevent the formation of heterotopic ossification after surgery for fractures of the acetabulum. In addition, the number of complications was higher in the indomethacin group when compared to placebo or no intervention. Level of Evidence I, Systematic Review.

RESUMO Objetivo: A profilaxia e o tratamento da ossificação heterotópica ainda são controversos. O objetivo desta pesquisa foi avaliar a efetividade das intervenções para prevenir o desenvolvimento da ossificação heterotópica após a fixação cirúrgica das fraturas do acetábulo. Métodos: Foi realizada uma revisão sistemática com pesquisa nas bases de dados PubMed/MEDLINE, Embase, LILACS e Cochrane até 4 de agosto de 2020, sem restrições quanto ao idioma e ano de publicação. Foram incluídos apenas ensaios clínicos randomizados realizados em humanos sem restrições com base na dosagem dos tratamentos, no uso e na duração da profilaxia. Cálculos de metanálise foram realizados utilizando o software Review Manager desenvolvido pela Cochrane. Resultados: Dois estudos compararam o uso de radioterapia e indometacina e três compararam o uso de indometacina com um grupo placebo ou não indometacina. Os cálculos de metanálise não indicaram diferenças estatísticas entre radioterapia versus indometacina (RR 1.45, IC de 95% 0.97 a 2.17, p = 0,55) e indometacina versus placebo ou não indometacina (RR 0.85, IC de 95% 0.68 a 1.06, p = 0,59). Conclusão: Não há evidências suficientes para afirmar que a utilização da radioterapia ou da indometacina é efetiva para prevenir a formação da ossificação heterotópica após cirurgias por fraturas do acetábulo. Além disso, o número de complicações foi maior no grupo indometacina quando comparado ao placebo ou à não intervenção. Nível de Evidência I, Revisão Sistemática.

Factores de riesgo de fracturas no vertebrales en receptores de trasplante renal: ¿Una realidad compleja? / Risk factors for nonvertebral bone fractures in kidney transplant recipients: a complex reality?

RESUMEN Introducción: Las fracturas en el postrasplante renal representan una de las complicaciones que aumentan la morbimortalidad en los pacientes. Objetivo: Determinar los factores de riesgo de trasplante de fracturas no vertebrales en receptores de trasplante renal. Material y métodos: Se analizaron los datos de historias clínicas de 737 pacientes trasplantados renales desde 2009-2015, donde se evaluaron los factores de riesgo de fracturas. Se determinaron como factores generales: edad, sexo; y factores específicos: etiología de la enfermedad renal crónica (ERC), tiempo en diálisis, modalidad de diálisis, características del donante:edad, sexo, tipo de donante vivo y cadavérico (DV, DC), diferentes esquemas de inmunosupresión, rechazos, tratamiento con pulsos de esteroides, uso de bifosfonatos y analitos como parathormona intacta (PTHi), pro-vitamina D (25OHD) y creatininemia (Creats). Criterios de exclusión: pacientes <18 años, retrasplante o trasplantes dobles y menos de 1 año de seguimiento. Resultados: 44 pacientes presentaron 50 fracturas no vertebrales. El 62% de las fracturas se presentaron en los 3 primeros años del trasplante. En el modelo Multivariado se pudo observar que los factores de riesgo generales asociados con riesgo de fracturas fueron la edad avanzada del receptor (aHR por año aumenta 1,03, 95% CI: 1,00-1,05] y el sexo femenino (aHR= 1,60, 95% CI: 0,85-2,99), mientras que los factores de riesgo específicos fueron el tiempo en diálisis (1,07 IC95%:1,02- 1,12), la mayor edad del donante (1,03 IC95:1,00- 1,05) y el déficit de 25OHD (3,17 IC95:1,57- 6,41). Conclusiones: Este estudio permitió evaluar los factores predictivos de fractura en nuestros pacientes con trasplante renal.

ABSTRACT Introduction: Fractures in renal postransplantation represent one of the complications that increase morbidity and mortality in patients. Objective: To determine the risk factors for transplantation of non- vertebral fractures in renal transplant recipients. Methods: The data of clinical histories of 737 renal transplanted patients since 2009 2015 were analyzed, where the risk factors of fractures were evaluated. They were determined as general factors: age, sex; and specific factors: etiology of chronic kidney disease (ERC), dialysis time, dialysis modality, donor characteristics: age, sex, type of donor, living or cadaveric (DV, DC), different immunosuppression treatments, rejections, treatment with steroid pulses, use of bisphosphonates and biochemical parameters like intact parathormone (PTHI), Pro-Vitamin D (25OHD) and Creatininemia (CREATS). Exclusión criteria: patients <18 years, retransplantation or double transplants and follow- up less than 1 year. Results: 44 patients presented 50 non-vertebral fractures. 62% of the fractures were presented in the first 3 years of the transplant. In the multivariate model it was observed that the general risk factors associated with fracture risk were the advanced age of the receptor (aHR per year increases 1.03, 95% CI: 1.00-1.05] and the female sex (aHR = 1.60, 95% CI: 0.85-2.99), while the specific risk factors were dialysis time (1.07 IC95%: 1.02-1.12), the higher age of the donor (1.03 IC95: 1,00-1,05) and the deficit of 25OHD (3.17 IC95: 1.57-6.41). Conclusions: This study allowed to evaluate predictive factors of fracture in our patients with kidney transplantation.

Comparación del tratamiento de las fracturas supracondíleas de húmero Gartland II y III con técnica de Dorgan versus técnica Cruzada. Hospital General del Sur "Dr. Pedro Iturbe"+ / Treatment Comparison of Gartland II and III supracondylar humerus fractures with Dorgan technique vs Cross technique. del Sur General Hospital "Dr. Pedro Iturbe"

Se comparó la osteodesis por técnica lateral de Dorgan con la técnica Cruzada tradicional o de "Banderillero" en fracturas supracondíleas de húmero Gartland II y III. Se realizó un estudio descriptivo correlacional con diseño experimental. Se incluyeron 24 pacientes, los cuales se distribuyeron en 2 grupos: Grupo A (13 pacientes): técnica de Dorgan y Grupo B (11 pacientes): la técnica Cruzada. La mayor frecuencia de pacientes se encontró entre los 10 y 14 años para el Grupo A y 6 a 9 años para el Grupo B. Se encontró predominio del sexo masculino con 78% de los casos. El mecanismo de producción de la fractura más frecuente fue el indirecto. Mayor frecuencia de las fracturas Gartland III en 62,5% casos y desplazamiento posterior en 66,66%. Según los Criterios de Flynn, los resultados post operatorios para el Grupo A: Pérdida del Ángulo de Acarreo: 7,7% Excelente, 53,8% Bueno y 38,5% Regular, y Pérdida de Movilidad: 7,7% Excelente, 38,5% Bueno y 53,8% Regular; para el Grupo B: Pérdida del Ángulo de Acarreo: 54,5% Bueno, 27,3% Regular y 18,2% Malo, y Pérdida de Movilidad: 9,1% Excelente, 81,8% Bueno y 9,1% Malo. La tasa de complicaciones fue de 7,7% para el Grupo A y 18,2% para el Grupo B (p<0,05). La osteodesis con técnica de configuración lateral de Dorgan presentó menor tasa de complicaciones comparada con la técnica Cruzada, sin embargo, ésta última tuvo mejor recuperación de los rangos articulares(AU)

Osteodesis using the Dorgan lateral technique was compared with traditional crossover or "Banderillero" technique in Gartland II and III supracondylar humerus fractures. A descriptive correlational study with experimental design was made. 24 patients were included, and distributed into 2 groups: Group A (13 patients): Dorgan's technique and Group B (11 patients): crossover technique. The highest frequency of patients was found between 10 and 14 years for Group A and 6 to 9 years for Group B. A predominance of the masculine sex was found with 78% of the cases. The most frequent mechanism for producing the fracture was indirect. Higher frequency of Gartland III fractures in 62,5% cases and posterior displacement in 66,66%. According to Flynn Criteria, the postoperative results for Group A: Loss of Motion: 7,7% Excellent, 53,8% Good and 38,5% Fair, and Angle of Movement: 7,7% Excellent, 38,5% Good and 53,8% Regular; for Group B: Angle of load: 54,5% Good, 27,3% Regular and 18,2% Bad, and Angle of Movement: 9,1% Excellent, 81,8% Good and 9,1% Bad. The complication rate was 7,7% for Group A and 18,2% for Group B (p <0,05). Osteodesis with the Dorgan lateral configuration technique presented a lower rate of complications compared to the Cross technique, however, the latter had better recovery of the joint ranges(AU)