Estimated exposure of spine surgeons to radiation / Estimativa da exposição de cirurgiões de coluna vertebral à radiação / Estimativa de la exposición de cirujanos de columna vertebral a la radiación

ABSTRACT Objective To estimate the amount of radiation received and accumulated in the bodies of two surgeons, one being the responsible surgeon and the other the assistant, performing spine surgery procedures over a period of 25 years. Methods Seventy-two spinal surgeries were performed during a seven-month period and the radiation loads were measured in both surgeons. The measurement of radiation was captured in fluoroscopy in anteroposterior and lateral incidences. The surgeon and the assistant used two dosimeters, one in the cervical region protecting the thyroid and the other on the lead apron in the genital region. The radioactive loads were measured in millisieverts and the accumulated charges were recorded monthly in both regions of the body in the two surgeons for seven months and the means for the work periods (1, 5, 10, 15, 20 and 25 years) were estimated. Results It was observed that in the surgeon the average accumulated radiation loads were 131.9% and 176.92% higher than those of the assistant in the cervical and genital regions, respectively. Conclusion While the use of X-rays is indispensable in routine orthopedic surgery, we have to consider the development of techniques of protection, rigor and discipline in the use of safety materials for surgeons. Preventive exposure reduction measures such as using thyroid protection equipment and turning the head away from the patient during fluoroscopy, among others, should be mandatory to promote less radiation exposure. Level of evidence II; Comparative prospective study.

RESUMO Objetivo Estimar a quantidade de radiação recebida e acumulada no corpo de dois cirurgiões, durante período de 25 anos de trabalho, sendo um o cirurgião responsável e outro, assistente, nos procedimentos de cirurgia da coluna vertebral. Métodos Foram realizadas 72 cirurgias de coluna vertebral em um período de sete meses, e as cargas de radiação foram medidas nos dois cirurgiões. A medição da radiação foi captada em fluoroscópio nas incidências anteroposterior e de perfil. O cirurgião e o auxiliar utilizaram dois dosímetros, sendo um na região cervical protegendo a tireoide e outro sobre o avental de chumbo, na região genital. As cargas radioativas foram medidas em milisievert e as cargas acumuladas foram registradas mensalmente em ambas as regiões do corpo nos dois cirurgiões, durante sete meses, foram estimadas as médias no período (1, 5, 10, 15, 20 e 25 anos) de trabalho. Resultados Observou-se que no cirurgião as médias das cargas de radiação acumulada foram 131,9% e 176,92% superiores às do assistente nas regiões cervical e genital, respectivamente. Conclusão Enquanto o uso dos raios X for indispensável na rotina da cirurgia ortopédica, há de se considerar o desenvolvimento de técnicas de proteção, rigor e disciplina no uso materiais de segurança para os cirurgiões. Medidas preventivas de redução da exposição, como uso de equipamento para proteção da tireoide e girar a cabeça para se afastar do paciente durante a fluoroscopia, entre outras, devem ser obrigatórias para promover menor exposição à radiação. Nível de evidência II; Estudo prospectivo comparativo.

RESUMEN Objetivo Estimar la cantidad de radiación recibida y acumulada en el cuerpo de dos cirujanos, durante 25 años de trabajo, siendo uno el cirujano responsable y el otro, asistente, en los procedimientos de cirugía de columna vertebral. Métodos Se realizaron 72 cirugías de columna vertebral en un período de siete meses, y las cargas de radiación fueron medidas en los dos cirujanos. La medición de la radiación fue captada en fluoroscopio en las incidencias anteroposterior y de perfil. El cirujano y el auxiliar usaron dos dosímetros, siendo uno en la región cervical protegiendo la tiroides y otro sobre el delantal de plomo, en la región genital. Las cargas radiactivas se midieron en milisievert, y las cargas acumuladas se registraron mensualmente en ambas regiones del cuerpo, en los dos cirujanos, durante siete meses, y se estimaron los promedios durante el período (1, 5, 10, 15, 20 y 25 años) de trabajo. Resultados Se observó que en el cirujano los promedios de las cargas de radiación acumulada fueron de 131,9% y 176,92% superiores a las del asistente en las regiones cervical y genital, respectivamente. Conclusión Mientras el uso de rayos X sea indispensable en la rutina de la cirugía ortopédica, hay que considerar el desarrollo de técnicas de protección, rigor y disciplina en el uso de materiales de seguridad para los cirujanos. Las medidas preventivas de reducción de la exposición, como uso de equipamiento para protección de la tiroides y girar la cabeza para alejarse del paciente durante la fluoroscopia, entre otras, deben ser obligatorias para promover menor exposición a la radiación. Nivel de evidencia II; Estudio prospectivo comparativo.

Acromioplastía y fricción subacromial 2021. Perspectiva latinoamericana / Acromioplasty and subacromial decompression 2021. Latinoamerican perspective

Introducción: Si bien la acromioplastia es uno de los procedimientos más realizados por los cirujanos de hombro, numerosas publicaciones recientes han cuestionado su eficacia. El objetivo del siguiente estudio fue investigar las tendencias actuales en la utilización de la acromioplastia entre cirujanos de hombro de Latinoamérica.Materiales y métodos: se diseñó un cuestionario mediante Google Forms, con quince preguntas para recolectar información sobre la utilización de la acromioplastia en la práctica cotidiana. En total se convocaron sesenta y cinco cirujanos de dieciséis países de Latinoamérica. La modalidad de las respuestas fue de opción múltiple y anónimas.Resultados: la tasa de respuestas fue del 100% (65/65). La edad promedio de los encuestados fue de cuarenta y siete años (rango 32-68). El 84% de los cirujanos respondió que utiliza la acromioplastia asociada a las reparaciones del manguito rotador (MR) y de estos el 91% la realiza en forma artroscópica. Las ventajas de la acromioplastia referidas con mayor frecuencia fueron que mejora el campo operatorio (55%) y que descomprime el MR (48%) y la desventaja más citada fue la inestabilidad anterosuperior de hombro (46%). La forma más frecuente para determinar la cantidad de acromion a resecar fue la experiencia personal del cirujano (42%). El 67% de los cirujanos libera el ligamento coracoacromial cuando realiza la acromioplastia y el 57% expresó realizar la resección de la clavícula distal asociada a la descompresión. El 56.5% de los cirujanos no efectúa nunca coracoplastia al reparar el subescapular. En cuanto a la etiopatogenia de las rupturas del manguito rotador, el 55% dijo que las causas de las rupturas son intrínsecas (degenerativas).Conclusión: existe una alta variabilidad en la indicación y en la técnica quirúrgica utilizada para realizar la acromioplastia entre los cirujanos de hombro de Latinoamérica. No hay acuerdo entre las ventajas y desventajas ni en las contraindicaciones del procedimiento. A cincuenta años de la teoría de Neer, solo el 1.5% de los encuestados considera como principal productor de patología del MR la compresión extrínseca de los tendones. Finalmente, algunos de los argumentos referidos por los participantes para justificar la utilización de la acromioplastia no se ajustan a los preceptos propuestos por Neer sino a causas tales como liberar factores de crecimiento o mejorar la visión en el campo operatorio.Identificar los aspectos de mayor controversia y desacuerdo sirven de base para investigaciones futuras que permitan consensos que guíen la práctica diaria según el mejor nivel de evidencia disponible.

Introduction: Although acromioplasty is one of the procedures most performed by shoulder surgeons, numerous recent publications have questioned its efficacy. The objective of the following study was to investigate current trends in the use of acromioplasty among shoulder surgeons in Latin America. Materials and methods: a questionnaire was designed with the Google Forms methodology, with fifteen questions to collect information on the use of acromioplasty in daily practice. In total, sixty-five surgeons from sixteen Latin American countries were summoned. The modality of the answers was multiple choice and anonymous. Results: the response rate was 100% (65/65). The average age of the respondents was forty-seven years (range 32-68 years). Eighty four percent of surgeons responded that they use acromioplasty associated with rotator cuff (RC) repairs and of these 91% perform it arthroscopically. The most frequently reported advantages of acromioplasty were that it improves the operative field (55%) and that it decompresses the RC (48%), and the disadvantage most often referred was anterosuperior shoulder instability (46%). The most frequent way to determine the amount of acromion to resect was the personal experience of the surgeon (42%). Sixty seven percent of surgeons release the coracoacromial ligament when performing acromioplasty and 57% referred to perform decompression associated with the distal clavicle resection. Fifty six percent of surgeons never perform coracoplasty when repairing the subscapularis. Regarding the etiopathogenesis of rotator cuff tears, 55% reported that the causes of the tears are intrinsic (degenerative).Conclusion: there is a high variability in the indication and in the surgical technique used to perform acromioplasty among shoulder surgeons in Latin America. There is no agreement between the advantages and disadvantages or the contraindications of the procedure. Fifty years after Neer's theory, only 1.5% of those surveyed consider extrinsic tendon compression as the main etiology of RC pathology. Finally, some of the arguments referred to by the participants to justify the use of acromioplasty do not conform to the precepts proposed by Neer, but rather to causes such as releasing growth factors or improving visibility in the operative field.Identifying the aspects of greatest controversy and disagreement serve as the basis for future research that allows consensus to guide daily practice according to the best level of available evidence.

Controversias en el manejo de la fractura de cadera en el adulto mayor. Encuesta nacional a Traumatólogos especialistas en cirugía de cadera / Management of hip fractures in the elderly. A national survey among Chilean orthopaedic surgeons

Background: As the population ages, patients exposed to osteoporotic fractures increase, especially hip fracture, which is the most severe and costly. Aim: To characterize surgical practices in the management of hip fractures in older patients through a nationwide survey of specialized hip surgeons dedicated to the care of these patients. Material and Methods: A survey composed of 32 questions was formulated, including demographic factors, preoperative evaluation, definitive treatment, and postoperative management. It was sent to 140 specialists. 84 of them replied (61%), and 71 answers were included. Results: Eighty six percent of respondents agreed that orthogeriatric management is fundamental in the outcome of these patients, but only 73% had the collaboration of an internist or a geriatrician. Although 97% considered 72 hours or less the ideal time to perform surgery, only 52% of the respondents declared performing surgery within that timeframe, with differences between private and public system. Regarding surgical treatment, 94-98% of femoral neck fractures are treated with an arthroplasty and 98-99% of per-subtrochanteric fractures are treated with internal fixation and osteosynthesis. Osteoporosis treatment is only carried out by 51% of the respondents and with significant variation. Conclusions: This survey shows that there is agreement in surgical practice between specialists treating these patients, but clear differences in preoperative optimization, treatment timeframe, and post fracture medical treatment.

Preferences of orthopedic surgeons for treating midshaft clavicle fracture in adults / Preferências dos cirurgiões ortopédicos para o tratamento da fratura do terço médio da clavícula em adultos

ABSTRACT Objective To determine the current clinical practice in Latin America for treating midshaft clavicle fractures, including surgical and non-surgical approaches. Methods A cross-sectional study using a descriptive questionnaire. Shoulder and elbow surgeons from the Brazilian Society of Shoulder and Elbow Surgery and from the Latin American Society of Shoulder and Elbow were contacted and asked to complete a short questionnaire (SurveyMonkey®) on the management of midshaft fractures of the clavicle. Incomplete or inconsistent answers were excluded. Results The type of radiographic classification preferably used was related to description of fracture morphology, according to 41% of participants. Allman classification ranked second and was used by 24.1% of participants. As to indications for surgical treatment, only the indications with shortening and imminence of skin exposure were statistically significant. Conservative treatment was chosen in cortical contact. Regarding immobilization method, the simple sling was preferred, and treatment lasted from 4 to 6 weeks. Although the result was not statistically significant, the blocked plate was the preferred option in surgical cases. Conclusion The treatment of midshaft clavicle fractures in Latin America is in accordance with the current literature.

RESUMO Objetivo Determinar a prática clínica atual na América Latina para o tratamento das fraturas do terço médio da clavícula, incluindo abordagens cirúrgicas e não cirúrgicas. Métodos Estudo transversal com aplicação de questionário descritivo. Cirurgiões de ombro e cotovelo da Sociedade Brasileira de Cirurgia do Ombro e Cotovelo e da Sociedade Latino-Americana de Ombro e Cotovelo foram contatados e convidados a completar um breve questionário (SurveyMonkey®) sobre o manejo das fraturas do terço médio da clavícula. Foram excluídas as respostas incompletas ou inconsistentes. Resultados O tipo de classificação radiográfica utilizada de preferência esteve de acordo com a descrição da morfologia da fratura, representando 41% do total dos participantes. Em segundo lugar, apareceu a classificação de Allman, que foi utilizada por 24,1% dos participantes. Nas indicações de tratamento cirúrgico, as indicações com encurtamento e iminência de exposição da pele foram estatisticamente significativas. Tratamento conservador foi prescrito em caso de contato entre as corticais. Como método de imobilização, a tipoia simples foi a preferência, e o tempo de tratamento foi de 4 a 6 semanas. Apesar do resultado sem significância estatística, a placa bloqueada foi a opção preferencial nos casos cirúrgicos. Conclusão A metodologia de tratamento das fraturas do terço médio da clavícula nos países da América Latina é semelhante, assim como com a literatura atual.