Utility of 3d printing in orthopaedic: a systematic review

The use of 3-Dimensional (3D) printing in orthopaedics keeps pace with technical advancements. However, due to its novelty, few research have examined its application. Therefore, our study aimed to assess the utility of 3D printing in orthopaedics use. We conducted a systematic review study during the period of April-May. Article search was conducted in Google Scholar, National Center for Biotechnology Information, Clinical Key, Pubmed, and Science Direct. We included five publications with a total of 99 patients. Our findings indicate that the orthopaedic application and utilization of 3D printing technologies are expanding. Despite the relative paucity of evidence, these findings suggest the utility of 3D printing technology in a variety of intraoperative deformity correction applications.

El uso de la impresión tridimensional (3D) en ortopedia sigue el ritmo de los avances técnicos. Sin embargo, debido a su novedad, pocas investigaciones han examinado su aplicación. Por lo tanto, el estudio tuvo como objetivo evaluar la utilidad de la impresión 3D en el uso ortopédico. Se realizó un estudio de revisión sistemática durante el período de abril a mayo. La búsqueda de artículos se realizó en Google Scholar, National Center for Biotechnology Information, Clinical Key, Pubmed y Science Direct. Se incluyeron cinco publicaciones con un total de 99 pacientes. Nuestros hallazgos indican que actualmente se expanden la aplicación ortopédica y la utilización de las tecnologías de impresión 3D. A pesar de la relativa escasez de evidencia, estos hallazgos sugieren la utilidad de la tecnología de impresión 3D en una variedad de aplicaciones de corrección de las deformidades intraoperatorias.

Zapato de suela rígida versus zapato de suela invertida en la cirugía de hallux valgus: análisis clínico, funcional y radiológico / Rigid sole shoe versus inverted sole shoe in hallux valgus surgery: clinical, functional and radiological analysis

Resumen: Introducción: el calzado ortopédico suele prescribirse en el postoperatorio de cirugía de hallux valgus para proteger la osteotomía y mantener la funcionalidad al paciente. En este sentido, la superioridad del zapato de suela rígida en comparación con el zapato de suela invertida sigue siendo controvertido. El objetivo de este estudio es comparar los resultados clínicos, funcionales y radiológicos entre el uso del zapato de suela rígida (ZSR) y el zapato de suela invertida (ZSI) después de la cirugía de hallux valgus. Material y métodos: un total de 57 pacientes intervenidos de hallux valgus fueron incluidos y analizados retrospectivamente. En un grupo se incluyeron 28 pacientes que usaron el ZSR, mientras que el segundo grupo incluyó a 29 pacientes que usaron el ZSI. El zapato ortopédico se usó durante seis semanas tras la cirugía. Se recogieron datos clínicos (dolor lumbar y articular de las extremidades inferiores, necesidad de muletas y problemas para subir y bajar escaleras), datos radiológicos (AIM, AHV), así como complicaciones postoperatorias (desplazamiento de osteotomía, fractura del primer metatarsiano o seudoartrosis). Resultados: el zapato de suela rígida mostró menor dificultad para subir y bajar escaleras (OR 3.8 (IC 95% 1.2-12.8), p 0.02), sólo para subir (OR 3.2 (IC 95% 1.1-10), p 0.03), así como una disminución de la necesidad de muletas (OR 1.7 (IC 95% 1.04-2.6), p < 0.03). El dolor de columna lumbar o articular de extremidades inferiores no mostró diferencias estadísticas. No se encontraron diferencias estadísticas en los datos epidemiológicos y radiológicos entre los grupos. Conclusiones: el zapato de suela parece aportar más comodidad a los pacientes sin aumentar las complicaciones radiológicas.

Abstract: Introduction: the orthopedic shoe is usually prescribed during postoperative care after hallux valgus surgery to protect the osteotomy and provide functional comfort to the patient. In this regard, the superiority of rigid sole shoe (RSS) compared to the reverse camber shoe (RCS) remains controversial. The aim of this study is to compare the clinical, functional and radiological outcomes from using the rigid sole shoe (RSS) vs. the reverse camber shoe (RCS) after hallux valgus surgery. Material and methods: fifty-seven hallux valgus surgery patients were included and analyzed retrospectively. The 1st group included 28 patients using the RSS and the 2nd group included 29 patients using the RCS. The orthopedic shoe was used for six weeks postoperatively. Clinical data (lumbar and lower limb pain, need of crutches and problems with going up and down stairs), radiological data (IMA, HVA) and postoperative complications (displacement of osteotomy, metatarsal fracture or non-union) were collected. Results: the RSS showed less difficulty going up and down stairs (OR 3.8 (CI 95% 1.2-12.8), p 0.02), only going upstairs (OR 3.2 (CI 95% 1.1-10), p 0.03), as well as a decreased need for crutches (OR 1.7 (CI 95% 1.04-2.6), p < 0.03). Lumbar spine or lower limb pain did not show any statistical differences. No statistical differences in the epidemiological and radiological data were found between the groups. Conclusions: the RSS seems to provide more comfort to the patients without worsening the radiological results.

Custos das internações de pacientes com trauma ortopédico em uma unidade hospitalar / Costs of admissions of patients with orthopedic trauma to a hospital unit

Objetivo: Analisar os custos das internações de pacientes com traumas ortopédicos internados em um hospital de referência. Métodos: Estudo quantitativo analítico. A pesquisa teve amostra de 200 prontuários. Foram utilizados testes de Mann-Whitney e Kruskal-Wallis e correlação de Spearman para a comparação dos valores médios das Autorizações de Internação Hospitalar (AIHs) e as características sociodemográficas e clínicas; significância de 5% e confiança de 95%. Resultados: Em relação aos resultados obtidos do valor médio das AIHs, segundo as características sociodemográficas e clínica, o sexo de maior custo foi o feminino (1.673,2) (p = 0,0016), com lesão localizada no quadril (1.973,8) (p = 0,0002), na parte anatômica do fêmur (2.595,3) (p = 0,0001). Houve destaque para a prevalência de pacientes com possíveis sequelas (1.924,2) (p = 0,0185) e óbito (3.919,4) (p = 0,1015). Conclusão: No estudo, foi identificado que os maiores custos de internações foram relacionados a pacientes do sexo feminino, com lesões em fêmur, tendo como etiologia a queda; ademais, fraturas expostas e localizadas na região do quadril possuem custos elevados. Possíveis sequelas e óbitos também têm valores maiores em relação aos custos das AIHs.

Objective: To analyze the costs of hospitalizations of patients with orthopedic trauma admitted to a referral hospital. Methods: Analytical quantitative study. The research had a sample of 200 medical records. The Mann-Whitney, Kruskal-Wallis and Spearman correlation tests were used to compare the mean values of Hospital Admission Authorizations (HAAs) and the sociodemographic and clinical characteristics; 5% significance and 95% confidence. Results: The results obtained from the average value of HAAs according to sociodemographic and clinical characteristics, the sex with the highest cost was female (1,673.2) (p = 0.0016), with location in the hip (1,973.8) (p = 0.0002 ), in the anatomical part of the femur (2,595.3) (p = 0.0001). The prevalence of patients with possible sequelae (1,924.2) (p = 0.0185) and death (3,919.4) (p = 0.1015) was highlighted. Conclusion: In the study, it was identified that the highest costs of hospitalizations were female patients, with injuries to the femur and whose etiology was the fall; in addition, open fractures located in the hip region have high costs. Possible sequelae and deaths also have higher values in relation to the costs of HAAs.

Lesiones osteoarticulares en cirujanos ortopédicos. ¿Cómo lo afrontamos? / Osteoarthicular injuries in orthopedic surgeons. How do we deal with it?

Resumen: Introducción: La toma de decisiones terapéuticas es un proceso complejo en la cual deben considerarse múltiples variables. Existe una tendencia cada vez mayor hacia la indicación quirúrgica, aunque no siempre la evidencia científica sea contundente. Entender cómo los cirujanos toman decisiones puede mejorar nuestra comprensión de la variabilidad de los tratamientos. Objetivos: exponer la situación demográfica de las lesiones osteoarticulares en los cirujanos ortopédicos de Uruguay y cómo afrontan su propia lesión e identificar aquellas variables que influyen en la toma de decisiones terapéuticas en el ortopedista. Material y métodos: Utilizando la base de datos de la Sociedad de Ortopedia y Traumatología del Uruguay se identificaron residentes y cirujanos que presentaron al menos una lesión osteoarticular. Se entrevistó telefónicamente a cada uno de los seleccionados, obteniendo las variables de interés. Resultados: En un total de 274 residentes y traumatólogos, incluimos 56 profesionales y 69 lesiones osteoarticulares. Destacamos la existencia de múltiples lesiones de tratamiento controvertido, según la evidencia científica actual. El cirujano no siempre indicó el mismo tratamiento a sí mismo respecto al que indicaría a un paciente con la misma lesión. Miedo a las complicaciones, rápida reintegración laboral, opinión de un colega experto, entre otras, fueron algunas de las variables halladas en la decisión terapéutica. Conclusiones: Cuando la lesión asienta en el propio cirujano, se observó un accionar distinto con respecto a un paciente con igual lesión.

Abstract: Introduction: Therapeutic decision-making is a complex process in which multiple variables must be considered. There is a growing trend towards surgical indication, although scientific evidence is not always blunt. Understanding how surgeons make decisions can improve our understanding of treatment variability; Objectives: To expose the demographic situation of osteoarticular injuries in orthopedic surgeons in Uruguay and how they deal with their own injury and identify those variables that influence therapeutic decision-making in the orthopedist. Material and methods: Using the Uruguayan Society of Orthopedics and Traumatology database, residents and surgeons who had at least one osteoarticular injury were identified. Each of the selected ones was interviewed by telephone, obtaining the variables of interest. Results: In a total of 274 residents and Orthopedic surgeons, we include 56 professionals and 69 osteoarticular injuries. We highlight the existence of multiple injuries of controversial treatment, according to current scientific evidence. The surgeon did not always indicate the same treatment to himself, in respect of the one that would indicate a patient with the same injury. Fear of complications, rapid job reimbursement, opinion of an expert colleague, among others were some of the variables found in the therapeutic decision. Conclusions: When the lesion settles on the surgeon itself, a different action was observed with respect to a patient with equal injury.

Rehabilitación robótica en espasticidad de mano y muñeca / Robotic rehabilitation in hand and wrist spasticity

Introducción. El presente estudio es una serie de casos clínicos que describe los resultados en el tratamiento de la espasticidad de mano y muñeca mediante órtesis robóticas realizado por el grupo de investigación F-Ciber-Rehabilitación en Manizales (Colombia). Materiales y métodos. Se seleccionaron cinco (5) pacientes con espasticidad de mano y muñeca secundaria a lesión de neurona motora superior de diferente etiología, a quienes se les practicó terapia física y movilización pasiva con la órtesis robótica PRO-DWix®. Resultados. Los pacientes presentaron mejoría de la espasticidad según la escala Ashworth Modificada, disminución de la intensidad del dolor según la escala EVA y recuperación gradual del arco de movilidad articular según goniometría; además, luego de tres meses de rehabilitación robótica presentaron beneficios en su calidad de vida. Discusión. Se requieren ensayos clínicos aleatorizados para determinar las ventajas de la terapia física convencional complementada con terapia robótica, frente a la sola terapia convencional. Conclusiones. La movilización pasiva con órtesis robóticas en pacientes con espasticidad de mano y muñeca por lesiones de neurona motora superior, favorece la modulación de la espasticidad, la disminución del dolor, la recuperación del arco de movilidad articular y la calidad de vida. Nivel de evidencia. El propósito del estudio es generar evidencia clínica de nivel III respecto de las ventajas de la movilización pasiva con órtesis robóticas en la rehabilitación de pacientes con espasticidad de mano y muñeca

Introduction. The present study is a clinical case series describing the results in the treatment of hand and wrist spasticity by means of robotic orthoses carried out by the F-Ciber-Rehabilitation research group in Manizales (Colombia). Materials and methods. Five (5) patients with hand and wrist spasticity secondary to upper motor neuron lesion of different etiology were selected and underwent physical therapy and passive mobilization with the PRO-DWix® robotic orthosis. Results. The patients presented improvement of spasticity according to the Modified Ashworth scale, decrease of pain intensity according to the VAS scale and gradual recovery of joint mobility arc according to goniometry; furthermore, after three months of robotic rehabilitation they presented benefits in their quality of life. Discussion. Randomized clinical trials are required to determine the advantages of conventional physical therapy supplemented with robotic therapy, versus conventional therapy alone. Conclusions. Passive mobilization with robotic orthoses in patients with hand and wrist spasticity due to upper motor neuron lesions favors spasticity modulation, pain reduction, recovery of joint range of motion, and quality of life. Level of evidence. The purpose of the study is to generate level III clinical evidence regarding the advantages of passive mobilization with robotic orthoses in the rehabilitation of patients with hand and wrist spasticity.

Manejo ortopédico de la esclerodermia lineal localizada en niños: reporte de un caso / Orthopedic management of localized linear scleroderma in children: a case report

Resumen: Introducción: La esclerodermia localizada es la forma de presentación de esclerosis más frecuente en niños; tiene una incidencia de 2.7 por cada 100,000 habitantes, con predilección por la raza caucásica y el sexo femenino con relación de 2.4 a 4.1 por cada varón. El común denominador es la afección a nivel de tejido conectivo, genera una variedad de presentación clínica que va desde placas escleróticas localizadas circunscritas que afectan la piel hasta afecciones más profundas que atacan al tejido muscular y óseo, dejando secuelas estéticas y/o deformidades incapacitantes en el paciente. Objetivo: Presentación de caso y su manejo quirúrgico. Los datos expuestos se obtuvieron del expediente clínico físico y electrónico, entrevista directa con paciente y familiares y seguimiento y valoración de estudios radiográficos, desde Enero de 2012 hasta Noviembre de 2017. Discusión: El tratamiento quirúrgico está indicado cuando las deformidades y contracturas condicionan incapacidad en el paciente. Los mejores resultados se obtendrán una vez que la enfermedad haya dejado de progresar.

Abstract: Introduction: Localized scleroderma is the most common form of sclerosis in children; it has an incidence of 2.7 per 100,000 inhabitants, with a predilection for the Caucasian and female races of 2.4 to 4.1 per male. The common denominator is the connective tissue-level condition, causing a variety of clinical presentation ranging from localized sclerotic circumscribed plaques affecting the skin, to deeper conditions that attack muscle and bone tissue, leaving aesthetic consequences and/or disabling deformities in the patient. Objective: Case presentation and surgical management. The data presented were obtained from the physical and electronic clinical record, direct interview with patients and family members and monitoring and evaluation of radiographic studies, from January 2012 to November 2017. Discussion: Surgical treatment is indicated when deformities and contractures condition incapacity in the patient. The best results will be obtained once the disease has stopped progressing.

Manejo no quirúrgico del Hallux Valgus / Non-surgical management of Hallux Valgus

El manejo ortopédico del Hallux Valgus hace parte importante del tratamiento de ésta patología, es la alternativa inicial de manejo como el cambio de calzado, uso de ortesis, terapia fisica y medidas locales en los pies. El tratamiento ortopedico debe proveer al paciente de un alivio en su dolor y evitar el aumento de la deformidad. Este manejo conservador comienza con una adecuada explicacion al paciente de su patología asi como los cambios que debe realizar en su calzado ya sea deportivo o de trabajo. Asi como el uso de la ortesis apropiada y los ejercicios que recomendados en la terapia fisica. Cuando el dolor no se controla con el manejo ortopedico y la deformidad se incrementa hay que pensar en tomar la opcion del tratamiento quirúrgico.

The orthopedic management of Hallux Valgus is an important part of the treatment of this pathology, it is the initial alternative of management such as footwear change, use of orthotics, physical therapy and local measurements on the feet. Orthopedic treatment must provide the patient with relief in your pain and avoid increasing the deformity. This conservative management begins with an adequate explanation to the patient of his pathology as well as the changes he must make in his footwear, either sporting or work. As well as the use of the appropriate orthosis and the exercises recommended in physical therapy. When the pain is not controlled with the orthopedic management and the deformity increases, we must think about taking the option of the surgical treatment.

Tratamientos ortopédicos y ortodóncicos de pacientes con síndromes poco comunes: protocolo / Orthopedic and orthodontic treatments of patients with unusual syndromes: a protocol

Son muchos los síndromes que manifiestan alteraciones dento-esqueletales y, a su vez, manifiestan diferentes complicaciones, no permitiendo tener un protocolo definido para cada síndrome. Para establecer un adecuado protocolo de tratamiento, basado en tratamientos realizados exitosamente y tomando en cuenta los fracasos para no incurrir en el mismo error, se hizo una revisión bibliográfica desdemayo hasta septiembre de 2012, de artículos publicados en los últimos diez (10) años, de revistas internacionales de ortodoncia, ortopedia y cirugía maxilofacial que registraban estudios de investigación y casuística, en buscadores científicos como PubMed, Scielo, Medline. Posteriormente, se tomó la clasificación de Kenneth Lyons Jones, MD, en su obra literaria Patrones Reconocibles de Malformaciones Humanas (2007), tomando en cuenta para la elaboración de este trabajo, los que presentan craneosinostosis, defectos faciales mayores y defectos faciales y de las extremidades como características mayores, que ameritan tratamiento para corregir problemas dento-esqueletales. De los 39 artículos se seleccionaron 11 que tenían relevancia con su tema. Conocer y describir todos los síndromes, mencionando cada característica, es de suma importancia para los profesionales de la salud, ya que de ellos depende no sólo el correcto diagnóstico, sino el tratamiento más adecuado...

Cuidado perioperatório ortopédico: olhar do paciente, equipe de enfermagem e residentes médicos / Orthopedic perioperative care: viewpoint of the patient, nursing staff and medical residents

O objetivo deste estudo foi identificar as ações de cuidado perioperatório realizadas com o paciente cirúrgico ortopédico na visão da equipe cirúrgica e do próprio paciente. Pesquisa qualitativa descritiva e exploratória, realizada com 20 profissionais da saúde e oito pacientes submetidos à cirurgia ortopédica, no período de outubro de 2009 a julho de 2011. A coleta de dados deu-se por meio de entrevista semiestruturada abordando questões relacionadas ao cuidado e ao autocuidado com pacientes submetidos à cirurgia ortopédica. Os resultados foram organizados em três categorias: (a) Significado de cuidado: abrangeu assistência integral, prevenção de prejuízos e cuidados subjetivos; (b) Necessidades dos pacientes ortopédicos percebidas pela equipe de saúde: evidenciou as necessidades humanas básicas e específicas; (c) Ações de cuidado: revelou indicação cirúrgica, avaliação do tempo de espera, utilização de materiais especiais e risco cirúrgico. A partir das necessidades percebidas é que o cuidado acontece, seu significado é dinâmico e atemporal. Este estudo evidenciou que o significado de cuidado permaneceu relacionado ao processo saúde-doença.

The aim of this study was to identify the actions of perioperative care taken with the orthopedic surgical patient in view of the surgical team and the patient. Qualitative descriptive and exploratory research, conducted with 20 professionals, in the period from October 2009 to July 2011. Data collection took place by means of a semi-structured interview addressing issues related to care and self-care to patients under going orthopedic surgery. Results were arranged into three categories: (a) Meanings of perioperative care: covered integral assistance, prevention of damage and care subjective; (b) patients’ needs perceived by health team: evidenced basic and specific human needs; (c) Actions of care: surgical indication, evaluation revealed the wait, use of special materials and surgical risk. From the perceived needs is that care happens, its meaning is dynamic and timeless. This study showed that the meaning of care remained related to the health-disease process.

Efectos de los aparatos propulsores mandibulares fijos en la articulación temporomandibular / Effects of fixed mandibular propulsive appliances on the temporomandibular joint

Resumen Los aparatos propulsores mandibulares fijos son una alternativa en el tratamiento de la maloclusión Clase II con deficiencia mandibular. La propiedad de ser fijo, condiciona a la mandíbula a una posición anterior forzada en reposo y durante todas las funciones mandibulares. Cuando se utiliza un aparato de propulsión, la mandíbula se desplaza hacia delante y hacia abajo. Este movimiento conduce a una nueva posición al cóndilo, que puede afectar el funcionamiento normal de la articulación temporomandibular (ATM). El objetivo de este trabajo fue realizar una revisión de tema sobre los efectos de los aparatos propulsores mandibulares fijos en la ATM. Fueron incluidos estudios con animales o estudios con seres humanos, utilizando radiografías de la ATM, electromiografía postural, tomografía computarizada y resonancia magnética. Los estudios confirman una relación favorable entre el cóndilo y la cavidad glenoidea después de un tratamiento con aparatos fijos de propulsión mandibular.

Abstract Fixed mandibular propulsion appliances are an alternative for the treatment of Class II malocclusion in individuals with mandibular deficiency. Since they are fixed appliances, said devices keep the mandible in an anterior-forced position during rest and during all mandibular functions. When a propulsive appliance is used, the lower jaw is displaced forward and downward. This movement leads to a new position of the condyle, which can, ultimately affect the normal functioning of the temporomandibular joint (TMJ). The aim of this paper was to review effects of fixed mandibular propulsive appliance on TMJ. Inclusion criteria considered studies on animals or humans using TMJ radiography, computed tomography, and magnetic resonance imaging. Studies confirm a favorable relation between condyle and glenoid fossa following treatment with fixed mandibular propulsion appliances.

Descripción epidemiológica y evaluación de los desenlaces de interés de las fracturas de platillos tibiales / Epidemiological description and evaluation of the interesting outcomes of tibial plateau fractures

Antecedentes. Las fracturas de platillos tibiales suceden con alta frecuencia en grupos especiales como el personal de la policía, por su mayor exposición a mecanismos de trauma de alta energía y las características anatómicas y biomecánicas propias de la extremidad proximal de la tibia, que atribuyen a este tipo de fracturas una variabilidad importante en cuanto a abordaje terapéutico y su pronóstico. Materiales y métodos. Estudio tipo de serie de casos (nivel de evidencia IV), en pacientes adultos con fracturas de platillos tibiales, con atención inicial en el Hospital Central de la Policía desde enero de 2005 hasta diciembre de 2010, con diagnóstico confirmado por ortopedista y seguimiento mínimo de un año, a quienes se les aplicó una ficha de recolección de datos, con las variables estipuladas en el estudio. Resultados. De 93 pacientes seleccionados, el 82% fueron de sexo masculino y el 91% presentaron fracturas cerradas. A quienes se les realizó fijación interna más externa suplementaria tuvieron mayores tiempos de consolidación radiológica (180 días). Las secuelas más frecuentes fueron Artrosis (24%) y meniscopatía (21%), y las principales complicaciónes fueron las infecciones en un 6,4% de los pacientes, siendo las fracturas abiertas grado III (33%) las más afectadas. El promedio de consolidación radiológica fue de 125 días. Fueron manejadas quirúrgicamente el 69,9% de los casos. El grupo etáreo de 30 a 39 años fue el más comprometido. El principal mecanismo de trauma fueron los accidentes en moto (40%) y el tipo de fractura con mayor frecuencia fue la Shatzker tipo IV (28%) y las abiertas tipo Gustilo III (75%). Discusión. Las características propias del trabajo como agente de policía, en cuanto a su rango de edad, sexo predominante y actividades de riesgo como desplazamiento en moto, porte y utilización de armas de fuego, así como las actividades de riesgo propias de su trabajo, determinan mecanismos de trauma de moderada y alta energía predominantes en este tipo de fracturas, y en esto radica que la mayor parte de fracturas fueron tipo Shatzker IV. Conclusión. Se relacionaron mayores porcentajes de infección, complicaciones, secuelas y necesidad de manejo quirúrgico, con el grado de severidad de la fractura y compromiso de tejidos blandos, así como un mayor tiempo de consolidación.

Background. The fractures of tibial plateau happens with high frequency in special groups as well as the police, due to their greater exposition to mechanisms of trauma of high energy and its own anatomical and biomechanical characteristics of the proximal extremity of the tibia. These features acquire an important variability as far as therapeutic boarding and its prognosis. Materials and methods. A Study type is series of cases (level of evidence IV), in adult patients with fractures of tibial plateau, with initial attention in the Hospital Central de la Policía - Bogotá, from January of 2005 to December of 2010, with diagnosis confirmed by orthopaedist and minimum pursuit of a year, to those who had a card of data collection applied to them, with the variables stipulated in the study. Results. From 93 selected patients, 82% were of male gender and 91% presented closed fractures. Those who were practiced external and internal fixation had better times of radiological consolidation (180 days). The most frequent sequels were Arthrosis (24%) and meniscopathy (21%), and the main complication was the infections in a 6.4% of the patients. The open fractures degree III (33%) were the most affected. The average of radiological consolidation was of 125 days. Operative management happens in 69.9% of the cases. The age group of 30 to 39 years was the most affected. The main mechanism of trauma (40%) were the accidents in motorcycle, and the type of fracture most frequently were the Shatzker type IV (28%) and the Gustilo type III open fracture (75%). Discussion. The own characteristics of the police agent job, as far as their rank of age, predominant sex and activities of risk like motorcycle transportation, carry and use of firearms, as well as the own activities of risk of their job, determine mechanisms of moderate and high trauma of predominant magnitudes in this type of fractures, being the most frecuent fractures type the Shatzker IV. Conclusion. The percentage of infection, complications, sequels and necessity of surgical management, were related with the degree of severity of the fracture and soft weave commitment, as well as a greater time of consolidation.

Vulnerabilidad de los implantes dentales y ortopédicos / Vulnerability of dental and orthopedic implant

La colocación de implantes en diferentes partes del cuerpo ha sido realizada desde hace muchotiempo atrás. Se ha identificado diferentes factores de riesgo y complicaciones que pueden alterarlos tejidos perimplantares posterior a la colocación de estos. No existe evidencia científica que realice la comparación entre diferentes implantes colocados en diferentes partes del cuerpo.

The placement of implants on different body parts has been practiced since long ago. Variousrisk factors and complications that can alter perimplant tissue after placement of these have beenidentified. There is no scientific evidence to make the comparison among different implants placed indifferent parts of the body.

O aparelho APMMC (aparelho de protrusão mandibular de Morales e Carvalho) / The APMMC appliance(Morales and Carvalho mandibular protucion appliance)

O presente trabalho visa mostrar o desenvolvimento clínico de um aparelho ortopédico fixo criado pelos autores, para o tratamento da classe II por retrusão mandibular. O aparelho é de fácil construção É formado em duas partes, uma para cada lado da boca, paralelas entre si e sem nenhum meio de união entre elas. O aparelho tem como principal característica a sua fixação por palatino nos segundos pré-molares e primeiros molares do arco dentário superior. Quando colocamos na boca, o aparelho obriga o paciente a protrair sua mandíbula sem a possibilidade de levá-la de volta para trás, Devido ao fato de ser um aparelho fixo, este age as 24 horas do dia. Em caso de haver uma discrepância entre maxila e mandíbula muito grande, o avanço da mandíbula pode ser feito em dois tempos. Esse novo posicionamento da mandíbula, mantido aproximadamente por um ano ou mais, acarreta uma série de mudanças de ordem dentária, muscular e especialmente esquelética, que levarão á correção da retrusão mandibular de forma permanente. O aparelho pode agir sozinho na boca ou associado ao aparelho ortodôntico fixo como no presente caso. Apresentamos um caso clinico de uma má-oclusão classe II divisão 2ª com mandíbula curta, tratada com este aparelho, associado ao aparelho ortodôntico fixo.

This article is intended to demonstrate the clinical performance of a fixed orthopedic device, created by the authors for the treatment of class II mandibular retrusion. The appliance is easy to construct and is comprised of two parts, for each side of the mouth, parallel to each other and without any point of connection between them. The primary characteristic of the appliance is that it is set in the palate at the second premolars and first molars of the upper dental arch. When it is placed in the mouth, the appliance obliges the patient to protrude their jaw, and it is impossible for them to move it back. Due to the fact that it is a fixed appliance, it acts 24 hours per day. In the event that the discrepancy between the maxilla and the mandible is very large, the mandibular advance can be done at two different stages. This new positioning of the jaw, when maintained for approximately one year or more, brings about a series of dental, muscular and especially skeletal modifications, which lead to the permanent correction of the mandibular retrusion. The appliance can act only in the mouth or can be associated with a fixed orthodontic appliance, as in this case. Here we present a clinical case of a Class II, 2nd division malocclusion with a short mandible treated with this appliance, associated with the fixed orthodontic device.

Efectos de los aparatos ortopédicos en el crecimiento y desarrollo del sistema estomatognático en niños con hendidura unilateral del labio y paladar: una revisión sistemática / Effect of bracing on the growth and development of the stomatognathic system in children with unilateral cleft lip and palate: a systematic review

Evaluar el efecto de los aparatos ortopédicos en el crecimiento y desarrollo del sistema estomatognático en niños con hendidura unilateral de labio y paladar. La búsqueda electrónica abarcó las bases de datos: Medline y Registro Cochrane Central de Ensayos Controlados. Ensayos clínicos aleatorios controlados (ECA) de intervenciones con aparatología ortopédica en niños con hendidura unilateral de labio y paladar (HULP), quienes recibieron el tratamiento ortopédico entre los 0 y 5 años de edad; que evaluaban como medida de resultado el crecimiento y desarrollo maxilar y mandibular, la morfología facial y nasal y la oclusión dentaria. Recopilación y análisis: Independientemente se evaluó un estudio con tres 3 reporte de resultados, se excluyeron 68 porque no cumplían con los criterios de inclusión. En el estudio se comparó la utilización de la placa Hotz versus ausencia de placa; valorándose la dimensión maxilar, la prevención del colapso de los segmentos alveolares y la oclusión en la dentición primaria. Este estudio muestra una evidencia débil acerca de que se produce inicialmente disminución de la anchura anterior del arco, no previene el colapso de los segmentos alveolares y no mejora la oclusión dentaria. No se hallo diferencia significativa entre el grupo que utilizó placa Hotz y los que no, en lo referente a la prevención del colapso de los segmentos alveolares, la oclusión y dimensión maxilar. No se hallaron pruebas para evaluar otros aparatos

Evaluate the effect of orthopedic appliances on estomathognatic system`growth and development, in children with unilateral cleft lip and palate. Search Strategies: The search included electronic databases: MEDLINE y Cochrane Central Register of Controlled Trials. Randomized controlled trials (RCTs) of orthopedics appliances interventions in children with unilateral cleft lip and palate, who's received orthopedic treatment between 0 and 5 years of age; evaluating as a result jaw and maxilar´s growth and development, nose and facial morphology and dental occlusion. Regardless assessed a study with three duplicated publications, 68 were excluded because they did not meet criteria for inclusion. In the study with 3 duplicate publications were compared using the plate Hotz versus absence of plate; valued dimension jaw, preventing the collapse of the alveolar segments and occlusion in the primary teeth, respectively. There is a weak evidence about that initially occurs a declining of the anterior width of the arc, does not prevent the collapse of the alveolar segments and does not improve dental occlusion. No significant differences were found between the group that used Hotz plate and those without, in terms of preventing the collapse of the alveolar segments, occlusion and jaw dimension. We found no evidence to evaluate other appliances

Tração reversa da maxila associada à mecânica intermaxilar no tratamento precoce do Padrão III: relato de caso / Maxillary protaction associated with intermaxillary mechanics for Pattern III early treatment: case report

Dentre as modalidades de tratamento precoce do Padrão III, a tração reversa associada à expansão rápida da maxila constitui a abordagem mais popular e estudada na literatura ortodôntica, produzindo os melhores resultados no menor período de tempo. Os aparelhos comumente usados para promover a protração maxilar envolvem um dispositivo intrabucal capaz de provocar a disjunção da maxila e uma máscara facial ou mentoneira modificada, capazes de aplicar forças ortopédicas sobre a maxila e estimular seu crescimento em direção anterior. Relatos recentemente publicados envolvem o uso de variados aparelhos intra e extra-bucais, implantes, platôs fixos de acrílico, ou outras abordagens que visam maximizar o efeito ortopédico da tração reversa da maxila. O foco do presente artigo consiste em avaliar as mudanças ocorridas no complexo dentofacial em uma paciente jovem com Padrão III tratada com tração reversa da maxila associada à mecânica intermaxilar.

Uso de furadeiras elétricas domésticas em cirurgias ortopédicas / Use of domestic drilling machines in orthopedic surgeries

As furadeiras elétricas domésticas tem sido empregadas em cirurgias ortopédicas nos Hospitais Brasileiros, para a perfuração óssea. Entretanto, trata-se de um equipamento elétrico, termossensível, não específico para uso cirúrgico, não avaliado quanto à eficácia da esterilização e não investigada a ocorrência de infecções cirúrgicas relacionadas ao seu uso. O objetivo dessa revisão foi descrever o estado da arte do uso das furadeiras domésticas em cirurgias ortopédicas, tendo em vista as dificuldades de limpeza e esterilização do equipamento. As bases de dados LILACS e MEDLINE foram consultadas usando vocabulários controlados, livres e a combinação deles, sem restrição de tempo. Foram localizados dois artigos que abordavam o uso de furadeiras elétricas domésticas em cirurgias ortopédicas. No primeiro, o autor sugere o descarte do equipamento quando percebida a contaminação interna por sangue, considerando as dificuldades da limpeza e esterilização. O segundo artigo descreve a adaptação de uma furadeira para o uso em cirurgias, cujo método de esterilização é pastilha de formalina em condições ambientais. Estudos são necessários para avaliar a prática atual e recomendar condições seguras de uso ou o seu abandono.

Domestic ordinary drilling machines have been used in orthopedic surgeries in Brazilian hospitals, for bone drilling. However, it is an electric thermo-sensitive appliance, non-specific for surgical use, not assessed in terms of sterilization efficiency, as well as on potential surgical infections associated to its use. The objective of this review was to describe the state-of-the-art use of domestic drills in orthopaedic surgeries, considering the difficulties of cleaning and sterilization. The LILACS and MEDLINE databases were consulted using MeSH and free medical terms, without time restraints. Two specific articles were found about the use of domestic electric drills in orthopaedic surgeries. In the first article, the author suggests the disposal of the equipment in cases of any noticeable blood contamination that could result in difficulties to clean it. The second article describes how to adapt a domestic drilling machine for orthopaedic surgery, but the sterilization process is performed by using formalin tablets at room conditions. Further studies are required for evaluating the current practice and to recommend safe conditions for its use or towards giving it up.

Uso del taping (cinta adhesiva) como un tipo de tratamiento ortopédico prequirúrgico en pacientes con fisura labiopalatina / Use of taping (adhesive tape) as a type of presurgical orthopedic treatment in patients with cleft lip and palate

En nuestro país, la fisura del labio y/o paladar constituye una malformación de frecuencia considerable. Los pacientes que presentan estas anomalías necesitan asistencia desde la infancia o nacimiento hasta los primeros años, ya que existen diversos tratamientos con los cuales se pueden abordar en cada una de estas etapas. Dentro de los tratamientos tempranos empleados previo a la cirugía podemos mencionar el Taping (cinta adhesiva), el cual es una alternativa dentro de los diversos tratamientos prequirúrgicos existentes para la corrección de la protusión de la premaxila, es considerado además un procedimiento simple que se utiliza en niños recién nacidos que presentan fisura del labio y/o paladar con premaxila protuída, colocando la cinta adhesiva sobre los labios para poder reducir el tamaño de la fisura y la proyección de la premaxila. Con el propósito de dar a conocer lo sencillo que es la técnica del Taping y la participación del odontólogo en el tratamiento temprano de estos pacientes, se presenta el siguiente estudio: "Uso del Taping (Cinta Adhesiva) como un Tipo de Tratamiento Ortopédico Pre-Quirúrgico en Pacientes con Fisura Labiopalatina", que comprende básicamente cuatro capítulos, y se estructura como sigue: Primero, se plantean los objetivos generales y específicos de la investigación, así como el tipo de estudio, y los antecedentes de las fisuras labiopalatinas; para posteriormente dividirla en capítulos. El capítulo I consta de dos partes: la primera relata aspectos generales sobre la formación de la cara. La segunda parte enmarca los aspectos generales sobre la formación de las fisuras labiopalatinas. El siguiente Capitulo comprende la definición de una fisura labiopalatina, la clasificación de las fisuras así como la utilizada en el Hospital de Niños Benjamín Blomm (HNBB) y Hospital San Rafael donde se llevo a cabo el estudio; las causas que provocan el aparecimiento de las fisuras, las complicaciones asociadas a estas y las características de la fisura labiopalatina con premaxila protuída. En cuanto al III Capítulo aborda en la información sobre el taping: antecedentes, definición, metodología empleada, los resultados obtenidos y los problemas encontrados en la recolección de los datos. Posteriormente se plantean las conclusiones a que se llegó por medio de la investigación, así como también las recomendaciones que se proponen como un aporte a la Facultad de Odontología.

In our country, cleft lip and / or palate constitutes a considerable frequency malformation. Patients with these abnormalities need assistance from infancy or birth to the early years, as there are various treatments that can be addressed at each of these stages. Among the early treatments used prior to surgery we can mention Taping (adhesive tape), which is an alternative within the various existing pre-surgical treatments for the correction of the protrusion of the premaxilla, it is also considered a simple procedure that is used in newborn children with cleft lip and / or palate with protruding premaxilla, placing the adhesive tape over the lips to reduce the size of the cleft and the projection of the premaxilla. In order to show how simple the Taping technique is and the participation of the dentist in the early treatment of these patients, the following study is presented: "Use of Taping (Adhesive Tape) as a Type of Pre-Orthopedic Treatment Surgical in Patients with Cleft Labiapalatina ", which basically comprises four chapters, and is structured as follows: First, the general and specific objectives of the investigation are set out, as well as the type of study, and the antecedents of cleft lip and palate; to later divide it into chapters. Chapter I consists of two parts: the first relates general aspects about the formation of the face. The second part frames the general aspects about the formation of lip and palate fissures. The following Chapter includes the definition of a cleft lip, the classification of the clefts as well as the one used in the Benjamin Blomm Children's Hospital (HNBB) and San Rafael Hospital where the study was carried out; the causes that cause the appearance of the fissures, the complications associated with them and the characteristics of the cleft lip and palate with protruding premaxilla. Regarding the III Chapter, it addresses the information on taping: antecedents, definition, methodology used, the results obtained and the problems encountered in data collection. Subsequently, the conclusions reached through the investigation are raised, as well as the recommendations that are proposed as a contribution to the Faculty of Dentistry.

O cuidado do idoso com trauma ortopédico realizado pelo cuidador familiar no domicílio / The care of the lederly with orthopaedic trauma, carried out by of the family caregiver at home

O estudo foi realizado com cuidadores familiares de idosos que sofreram trauma ortopédico e que estavam vivenciando o seu papel no domicílio. Os objetivos foram caracterizar o cuidador familiar principal do idoso com dependência para deambulação após trauma ortopédico, identificar os cuidados realizados no domicílio pelo cuidador familiar, como também, identificar e descrever os sentimentos do cuidador principal relativos ao cuidar do idoso com dependência para deambulação. A amostra constituiu-se de vinte e três cuidadores familiares principais, na qual verificou-se o predomínio de mulheres filhas como cuidadoras e os cuidados por elas implementados em casa. Dentre os cuidados realizados no domicílio predominaram aqueles relacionados ao auxílio para alimentação, a higiene corporal, deambulação com acessórios tais como: muletas e andadores, para transferência do leito para cadeiras de rodas e de banho e retorno ao leito, vestuário para membros inferiores e calçados, cuidados com pele e com o local de cicatriz cirúrgica, oferta de medicamentos em horários prescritos e ainda auxílio para a eliminação urinária e fecal levando-o ao vaso sanitário ou oferecendo recipiente apropriado. Esses cuidados eram realizados conjuntamente com outras atividades domésticas ou laboratoriais. Estes cuidadores referiram estarem cansados e desgastados, mas que as questões de obrigação familiar, carinho e responsabilidade estavam dentre os motivos que os levaram a permanecerem ao lado do idoso.

The research was carried out with family caregivers who were looking after the elderly with orthopaedic trauma. The study purpose was to characterize the main family caregivers of the elderly suffering from deambulatory dependence due to orthopaedic trauma, identify the care carried out at home, by the family caregiver, and also, identify and describe the main caregiver feelings related to the elderly care with deambulatory dependence. The sample was formed by twenty three main family caregivers, in which was ascertained the predominance of women-daughters as the main caregivers, and the care implemented by them at home. This care was help with feeding, bathing, personal hygiene, deambulation with accessories such as: crutches and walkers, to assist the elderly to move from bed, to a wheelchair (or a wheelchair commode) and back to bed, to dress inferior limbs and shoes, skin care, surgical wound area care, to give medicines at the right time and also urinary and fecal elimination help, by taking the elderly to the bathroom by or providing the right recipient. This care was carried out along with domestic chores and other labour activities. The caregivers showed the aspect of tiredness and exhaustion however, the obligation with the family, love and responsibility were the reasons that obligated from to care for the elderly person within the family environment.

Acidentes de motocicleta: influência do novo código de trânsito brasileiro no atendimento a pacientes no Hospital João XXIII, em Belo Horizonte / Motorcycle accidents: influence of the new brasilian traffic code in patients attended at João XXIII Hospital, in Belo Horizonte

Com o objetivo de conhecer aspectos epidemiológicos dos acidentes de motocicleta atendidos no Hospital João XXIII, em Belo Horizonte, e a influência do novo Código Nacional de Transito (CNT) sobre os mesmos, foram analisadas 576 vitimas deste tipo de acidente nos períodos de 23 de janeiro a 22 de março dos anos 1997 e 1998. Os dados foram obtidos das fichas de atendimento ambulatorial e dos livros de óbitos. O número médio de acidentados de motocicleta foi 4,88 pacientes/dia e a média de idade foi de 27,08 ± 10,64 anos. Houve predomínio de pacientes do sexo masculino, dos atendimentos nos finais de semana, do horário das 18:00 às 23:59 horas, dos traumatismos na cabeça e das fraturas. O consumo de álcool foi identificado em 21 pacientes. Ocorreram 14 óbitos, sendo o traumatismo na cabeça a causa mais frequente. O número de atendimentos a acidentados de motocicleta diminuiu de forma significativa em 1998, após a implantação do novo CNT, porém sem repercussão em relação aos óbitos.

The authors analysed 576 patients victims of motorcycle accidents admitted to the João XXIII Hospital, from January, 23rd to March 22rd, 1997, and the same period in 1998. The objectives of this study were to determine the epidemiology of this kind of accident and the influence of the new National Traffic Code (NTC). This survey's data were collected from medical records and death certificates filed at the Medical and Statistical Archiv Service of the hospital. The hospital admitted 4.88 patients/day victims of motorcycle accidents. Mean age was 27.1 ± 10.6 years. Accidents were significantly more frequent among males, during the period between 6:00p.m. and 11:59p.m. and on weekends. The most observed injuries were head traumas and extremity fractures. Alcohol consumption was identified in 21 patients. Fourteen deaths were observed and head injury was the most frequent cause of them. lhe number of case admissions decrease in 1998, after the new NTC, however there was no repercussion in the number of deaths.