Anterior Slope Correction-Flexion Osteotomy in Traumatic Genu Recurvatum.

A decreased posterior tibial slope has been associated with an increased risk of posterior cruciate ligament failure, anterior knee pain, and premature knee osteoarthritis. Trauma is a common cause of osseous genu recurvatum. Surgical management is recommended to correct the tibial slope and prevent knee pain and osteoarthritis progression. This article discusses our preferred treatment using a proximal tibial opening-wedge osteotomy for surgical management of genu recurvatum secondary to significant anterior tibial slope.

Validation of the Ottawa ankle rules: Strategies for increasing specificity.

INTRODUCTION: The majority of patients with ankle injuries undergo radiological examinations of the foot, ankle or both. The objective of this study was in the first place to validate the Ottawa Ankle Rules (OARs) for the population of our centre. Secondly, an attempt was made to identify parameters that contribute to improve the specificity of the method, with a view to reduce the need for patients to be exposed to radiation as well as optimizing the expenses of the Emergency Ward (EW). MATERIALS AND METHODS: This was a prospective study conducted during a 9-month period. The study population included 148 patients, in 54 (36%) of the patients a fracture was present on the exams performed. Patients were submitted to a sequential protocol in the EW with a form completion, evaluation of OARs, application of the Visual Analog Pain Scale (VAS) and radiographic exams. RESULTS: We found a sensitivity of OARs in ankle injuries of 100%, specificity of 26% and in midfoot injuries of 100% and 62% respectively. All patients with fractures had a VAS of 5 or more points in any of the tested sites. With the VAS criterium, we found a significant increase of global specificity (38% vs 15%), as well as when applied only to the ankle (26% to 47%) or to midfoot trauma (62% to 67%). In both, there would have been a 100% reduction of CT scans. Patients with a fracture or with fractures who required surgical treatment had a mean VAS significantly higher than patients with no fracture or fractures submitted to conservative treatment respectively. Although there was a lower percentage of fractures in the group of injuries in Work Accidents (31% vs 37% Sports Activity and 38% Leisure Activity), there was a statistically significant increase in the sum of average VAS in Accidents at Work vs Leisure Activities and vs Sports Activities. CONCLUSION: We seek to confirm the usefulness of OARs for our population and we investigated strategies to further reduce the need for unnecessary radiographs. The introduction of parameters for grading pain and adapting to the context of the accident seem promising.

Percutaneous Scaphoid Fixation: Experience Value among Different Approaches.

Background Percutaneous scaphoid osteosynthesis is an attractive and increasingly popular option, as a treatment for acute scaphoid fractures in selected cases, and as an alternative to conservative treatment. The purpose of this study is to assess the radiographic positioning of the screw in percutaneous scaphoid fixation, taking into consideration the surgeons' experience, and the difference between volar and dorsal approaches. Methods We retrospectively assessed patients undergoing percutaneous scaphoid fixation from 2013 to 2019. Inclusion criteria are as follows: (1) scaphoid waist fractures (Herbert's B2), (2) a minimum of 18 years of age and a maximum of 55 years of age, (3) dominant hand, (4) manual work, (5) minimum follow-up time of 6 months, and (6) without associated lesions. Criteria for correct positioning are as follows: (1) on the axis or parallel to the scaphoid axis with a maximum deviation of 1.5 mm volar/dorsal, (2) without proximal/dorsal prominence, (3) correct scaphoid alignment/reduction, and (4) absence of threads in the fracture site. Radiographs were evaluated separately by a hand surgeon, a general orthopaedic surgeon, and an orthopaedic resident. Results With a total of 39 patients, a dorsal approach was performed in 10 patients and a palmar approach in 29 patients. We verified a very good interobserver reliability. The hand surgeon's team correctly positioned 15 (83.3%, 15/18), while the other team did 9 correctly (42.9%, 9/21). Comparing teams according to the approach used, the dorsal approach did not show a statistical difference, while the same was not true for the volar approach ( p < 0.05). Conclusion This points to a positive impact on the team's experience in the positioning of the screws, and therefore in the benefit of treatment by teams dedicated to the area, while daring to suggest that less-experienced surgeons should utilize the dorsal approach.

Hip Arthroscopy With Initial Access to the Peripheral Compartment: A Detailed Step-by-Step Technique Description.

Hip arthroscopy with initial access to the peripheral compartment represents a specific technique to approach the hip that can be particularly useful. This technique is suitable for both the arthroscopic treatment of femoroacetabular impingement syndrome and other pathologies that can be addressed by classic arthroscopy with central compartment initial access. Minimal capsulotomies preserve the fluid pressure in the peripheral compartment, which allows the "ballooning" of the capsule and improved joint exposure with decreased risk of fluid extravasation. In the vast majority of cases, the hip joint can be accessed by any technique depending on the surgeon preference/expertise. Interestingly, access to the central compartment under direct arthroscopic visualization decreases the risk of iatrogenic labral and chondral damage. This is particularly important when access to the central compartment is technically challenging (e.g., acetabular overcoverage, labral hypertrophy, and limited joint distraction). Such a technique is also preferable if the pathology is mainly located in the peripheral compartment. Despite several advantages, hip arthroscopy with initial access to the peripheral compartment is not a commonly performed technique. Our purpose is to perform a step-by-step explanation of a previously described technique.

A giant hand lipoma as a rare cause of secondary carpal tunnel syndrome - A case report.

INTRODUCTION: Lipomas are a rare cause of compressive neuropathy and they lead to atypical clinical presentation that can mimic carpal tunnel syndrome. CASE PRESENTATION: The authors describe a rare presentation of a carpal tunnel syndrome recurrence after a hand giant lipoma, presenting with rapidly compression neuropathy of the median nerve, 6 months after de primary surgery. DISCUSSION: Lipomas are common benign soft tumours. Their occurrence in the hand remains rare and they rarely cause secondary entrapment neuropathies. Carpal tunnel syndrome is mostly idiopathic and bilateral. Local factors should be suspected when these neuropathies present with atypical symptomatology or even when they recur after primary conventional surgical release. Investigation should consider images studies as this correct preoperative assessment leads to successful diagnosis and treatment.

Discursos dos psicólogos no contexto da comissão de orientação e ética / Psychologists's speech within the context of orientation and ethics comission / Discursos de psicólogos en el contexto de la orientación y la ética

Buscamos, neste artigo, analisar os discursos escritos, e encaminhados porpsicólogos, denunciados à Comissão de Orientação e Ética em denúncias e/ou processos éticos, tramitados no Conselho Regional de Psicologia do Riode Janeiro. Nosso objetivo, ao problematizar práticas/discursos veiculados pelos psicólogos denunciados em seu conselho de classe, consiste emcolocar em análise alguns argumentos, lógicas e premissas que atravessamos discursos desses profissionais num momento em que sua atuação/intervenção é questionada. Pautadas nas contribuições de Foucault,Bakhtin, Guattari e outros teóricos, as autoras em suas indagações transpõem o universo do psicólogo denunciado levantando discursos/práticas para além dos argumentos desses profissionais, colocando em cena aprópria constituição da comissão de orientação e ética. Esse trabalho, demodo algum, pretende expor, rechaçar ou mesmo intimidar colegas de profissão, mas contribuir por meio de reflexões para a construção de umapsicologia mais comprometida com a população, ao tentar desconstruirconceitos e pilares que ainda sustentam uma psicologia dita neutra, objetivae científica e, por efeito, psicólogos descontextualizados. (AU)

This article aims to analyse the speeches written and submitted bypsychologists to the Regional Psychology Council of the State of Rio de Janeiro in relation to allegations and/or law suits forwarded through legal channels by the Regional Psychology Council of the State of Rio de Janeiro. Our goal is to bring into light problematic practices/speeches used by the psychologists denounced by their class councils consists of analyzing some arguments, logics and premises contained in the speech of suchprofessionals in a moment where their actions/interventions are beingquestioned. Based on the contributions by Foulcault, Bakhtin, Guattari andothers, the authors in their enquiries transpose the denounced psychologist'suniverse by raising speeches/practices to a point beyond these professionals'arguments, placing them in the realm of the contitution of the orientationand ethics comission. This work does not intend to expose, defy or intimidate colleagues in any way, but to contribute through considerations to the formation of psychology as a field concerned with the population by bringing down concepts and foundations that still sustain psychology said to be neutral, objective and scientific and as a result, such professionals. (AU)

En este artículo analizamos los discursos escritos y transmitidos por lospsicólogos denunciados a la Comisión de Orientación y Ética en los informes o procesos éticos que tramitan en el Consejo Regional de Psicología de Ríode Janeiro. Nuestra meta, al problematizar prácticas y discursos presentados por psicólogos denunciados en el colegio de su asociación, consiste en analizar algunos argumentos, razonamientos y suposiciones que semuestran a través de los discursos de estos profesionales en un momentoen que se cuestiona su acción e intervención. Basadas en las aportaciones de Foucault, Bakhtin, Guattari y otros teóricos, las autoras en sus indagaciones transponen el universo del psicólogo denunciado y enseñan discursos y prácticas más allá de los argumentos de estos profesionales, lo que pone en tela de juicio la propia constitución de la Comisión de Orientación y Ética. Este trabajo no pretende de manera alguna exponer, defender o incluso intimidar a colegas de profesión, sino contribuir a través de reflexiones a la institución de una psicología más comprometida con lapoblación, mientras que intenta deshacer conceptos y pilares que aúnmantienen una psicología dicha neutral, objetiva y científica y, por consiguiente, psicólogos alejados del contexto profesional. (AU)

Discursos dos psicólogos no contexto da comissão de orientação e ética / Psychologists's speech within the context of orientation and ethics comission / Discursos de psicólogos en el contexto de la orientación y la ética

Buscamos, neste artigo, analisar os discursos escritos, e encaminhados por psicólogos, denunciados à Comissão de Orientação e Ética em denúncias e/ou processos éticos, tramitados no Conselho Regional de Psicologia do Rio de Janeiro. Nosso objetivo, ao problematizar práticas/discursos veiculados pelos psicólogos denunciados em seu conselho de classe, consiste em colocar em análise alguns argumentos, lógicas e premissas que atravessam os discursos desses profissionais num momento em que sua atuação/intervenção é questionada. Pautadas nas contribuições de Foucault, Bakhtin, Guattari e outros teóricos, as autoras em suas indagações transpõem o universo do psicólogo denunciado levantando discursos/práticas para além dos argumentos desses profissionais, colocando em cena a própria constituição da comissão de orientação e ética. Esse trabalho, de modo algum, pretende expor, rechaçar ou mesmo intimidar colegas de profissão, mas contribuir por meio de reflexões para a construção de uma psicologia mais comprometida com a população, ao tentar desconstruir conceitos e pilares que ainda sustentam uma psicologia dita neutra, objetiva e científica e, por efeito, psicólogos descontextualizados

This article aims to analyse the speeches written and submitted by psychologists to the Regional Psychology Council of the State of Rio de Janeiro in relation to allegations and/or law suits forwarded through legal channels by the Regional Psychology Council of the State of Rio de Janeiro. Our goal is to bring into light problematic practices/speeches used by the psychologists denounced by their class councils consists of analyzing some arguments, logics and premises contained in the speech of such professionals in a moment where their actions/interventions are being questioned. Based on the contributions by Foulcault, Bakhtin, Guattari and others, the authors in their enquiries transpose the denounced psychologist's universe by raising speeches/practices to a point beyond these professionals' arguments, placing them in the realm of the contitution of the orientation and ethics comission. This work does not intend to expose, defy or intimidate colleagues in any way, but to contribute through considerations to the formation of psychology as a field concerned with the population by bringing down concepts and foundations that still sustain psychology said to be neutral, objective and scientific and as a result, such professionals

En este artículo analizamos los discursos escritos y transmitidos por los psicólogos denunciados a la Comisión de Orientación y Ética en los informes o procesos éticos que tramitan en el Consejo Regional de Psicología de Río de Janeiro. Nuestra meta, al problematizar prácticas y discursos presentados por psicólogos denunciados en el colegio de su asociación, consiste en analizar algunos argumentos, razonamientos y suposiciones que se muestran a través de los discursos de estos profesionales en un momento en que se cuestiona su acción e intervención. Basadas en las aportaciones de Foucault, Bakhtin, Guattari y otros teóricos, las autoras en sus indagaciones transponen el universo del psicólogo denunciado y enseñan discursos y prácticas más allá de los argumentos de estos profesionales, lo que pone en tela de juicio la propia constitución de la Comisión de Orientación y Ética. Este trabajo no pretende de manera alguna exponer, defender o incluso intimidar a colegas de profesión, sino contribuir a través de reflexiones a la institución de una psicología más comprometida con la población, mientras que intenta deshacer conceptos y pilares que aún mantienen una psicología dicha neutral, objetiva y científica y, por consiguiente, psicólogos alejados del contexto profesional