Efficacy and safety of loxoprofen sodium topical patch for the treatment of pain in patients with minor acute traumatic limb injuries in Brazil: a randomized, double-blind, noninferiority trial.

Posttraumatic injury pain is commonly treated with oral nonsteroidal anti-inflammatory drugs. However, oral nonsteroidal anti-inflammatory drugs cause several adverse events, with topical formulations arising as an important alternative. Therefore, we aimed at evaluating the efficacy and safety of loxoprofen patch (LX-P) in the treatment of patients with posttraumatic pain. This phase III, randomized, double-blind, noninferiority study enrolled Brazilian patients aged 18 to 65 years diagnosed with lower and upper limb posttraumatic injury who were experiencing moderate or severe pain. Patients were assigned to active LX-P or to loxoprofen tablet (LX-T), and pain intensity was measured based on a visual analog scale score variation after 7 days of treatment. Data on clinical symptoms, rescue medication use, and adverse events were also collected. Visual analog scale score variation was compared using a 10% noninferiority margin. Two hundred forty-two patients were randomly assigned to LX-P (n = 123) or to LX-T (n = 119). The results showed a reduction in pain after 7 days of treatment: -49.96 (n = 118; SE 1.7) in the LX-P and -47.71 (n = 117; SE 1.6) in the LX-T groups (difference of -2.25; 95% CI: -5.97 to 1.47; P = 0.23). On the safety analysis, the LX-T group presented twice as many patients with treatment-emergent adverse events as the LX-P group (30.8% and 14.2%, respectively). A sensitivity analysis demonstrated that rescue medication use has not affected the primary end point. This study showed that LX-P has a comparable efficacy to LX-T, but with a better safety profile, being a therapeutic option for the treatment of posttraumatic injury pain.

Pain and quality of life in patients undergoing radiotherapy for spinal metastatic disease treatment.

BACKGROUND: Radiotherapy is an important tool in the control of pain in patients with spinal metastatic disease. We aimed to evaluate pain and of quality of life of patients with spinal metastatic disease undergoing radiotherapy with supportive treatment. METHODS: The study enrolled 30 patients. From January 2008 to January 2010, patients selection included those treated with a 20 Gy tumour dose in five fractions. Patients completed the visual analogue scale for pain assessment and the SF-36 questionnaire for quality of life assessment. RESULTS: The most frequent primary sites were breast, multiple myeloma, prostate and lymphoma. It was found that 14 spinal metastatic disease patients (46.66%) had restricted involvement of three or fewer vertebrae, while 16 patients (53.33%) had cases involving more than three vertebrae. The data from the visual analogue scale evaluation of pain showed that the average initial score was 5.7 points, the value 30 days after the end of radiotherapy was 4.60 points and the average value 6 months after treatment was 4.25 points. Notably, this final value was 25.43% lower than the value from the initial analysis. With regard to the quality of life evaluation, only the values for the functional capability and social aspects categories of the questionnaire showed significant improvement. CONCLUSION: Radiotherapy with supportive treatment appears to be an important tool for the treatment of pain in patients with spinal metastatic disease.

Tomographic index as auxiliary criteria for surgery indication in fracture dislocation of acetabulum posterior wall.

There are situations which the tomographic exam is done on the affected hip or situations where the contralateral hip presents abnormalities that make it impossible to compare. In this study we aimed to evaluate a tomographic index that does not require comparison between the both hips. Twenty two patients with unilateral acetabular fracture dislocation with fracture of posterior wall were studied. We established the relationship between the remaining posterior wall and the femoral head diameter (head/wall index-H/W index). We evaluated 45 two-dimensional computed tomography scan in normal hips and established the H/W index. In 45 normal hips we simulated a posterior wall fracture with involvement of 25% and 30% of the posterior wall and calculated the H/W index. We divided into five groups with five different H/W index (fractured group with non surgical treatment; fractured group; normal group; normal group with simulated fracture of 25% and; 30% of the posterior wall). 2.4 was the lowest limit of confidence interval of the group with 25% of the posterior wall fracture. When we analyzed the confidence interval of the 30% fracture group the upper limit of the confidence interval was 2.7, close to the lower limit of the surgical group that was 2.9. Thus, we suggest the 2.4 the H/W index limit as an auxiliary criteria to indicate whether or not to operate. H/W index is helpful to decide whether or not surgery indication in the fracture dislocation of the posterior wall of the acetabulum.

Evaluation of movements of lower limbs in non-professional ballet dancers: hip abduction and flexion.

BACKGROUND: The literature indicated that the majority of professional ballet dancers present static and active dynamic range of motion difference between left and right lower limbs, however, no previous study focused this difference in non-professional ballet dancers. In this study we aimed to evaluate active movements of the hip in non-professional classical dancers. METHODS: We evaluated 10 non professional ballet dancers (16-23 years old). We measured the active range of motion and flexibility through Well Banks. We compared active range of motion between left and right sides (hip flexion and abduction) and performed correlation between active movements and flexibility. RESULTS: There was a small difference between the right and left sides of the hip in relation to the movements of flexion and abduction, which suggest the dominant side of the subjects, however, there was no statistical significance. Bank of Wells test revealed statistical difference only between the 1st and the 3rd measurement. There was no correlation between the movements of the hip (abduction and flexion, right and left sides) with the three test measurements of the bank of Wells. CONCLUSION: There is no imbalance between the sides of the hip with respect to active abduction and flexion movements in non-professional ballet dancers.

Pectoralis major tendon reference (PMT): a new method for accurate restoration of humeral length with hemiarthroplasty for fracture.

For hemiarthroplasty reconstruction of a proximal humeral fracture, accurate restoration of humeral head position is challenging, and incorrect prosthetic placement is associated with a poor outcome of surgical treatment. The purpose of this study was to validate the pectoralis major tendon as a reproducible landmark for accurate restoration of humeral length with hemiarthroplasty reconstruction. We dissected 20 cadavers (40 shoulders), and the distance between the upper border of the pectoralis major tendon insertion on the humerus and the top of the humeral head was measured (PMT). The PMT averaged 5.6 +/- 0.5 cm (with a confidence level of 95%). In only 4 of 40 shoulders did this distance exceed 6.0 cm, and there was no correlation between the size of the patient and this measurement. The PMT is a useful landmark that will aid in accurate restoration of humeral length when reconstructing complex proximal humeral fractures where landmarks are otherwise lost because of fracture comminution.

Sugioka's Modified Hungria-Kramer intertrochanteric osteotomy in the treatment of severe slipped capital femoral epiphysis.

From May 1990 to November 1997, 24 cases of severe slipped capital femoral epiphysis were treated by an osteotomy that is a modification of the Hungria-Kramer intertrochanteric osteotomy proposed by Sugioka (Hungria-Kramer-Sugioka osteotomy or HKS osteotomy). The degree of displacement as seen on the frog-leg lateral radiograph of the proximal femur was measured according to the deviation of the longitudinal axis of the epiphysis from the center line of the neck (Fish classification). All hips were considered as grade III and underwent HKS osteotomy. Sugioka's radiographic study (true AP view with the limb internally rotated until the patella is perpendicular to the x-ray beam, and lateral view with the hip in 90 degrees flexion and 45 degrees abduction) was performed before surgery to show that the real direction of the slip was posterior in relation to the neck. Clinical results were assessed according to Merle-D'Aubigné and Postel system modified by Charnley (hip score system that takes into consideration pain, gait, and joint motion). Roentgenographic results were considered good if none of the following was present: joint space decreased by more than 2 mm (chondrolysis), avascular necrosis of the femoral head, neck-shaft angle of less than 120 degrees, nonunion at the osteotomy site, and a epiphyseal plate still open. Follow-up varied from 31 to 120 months (average 65.1 months).

Tratamento das epifisiólises graves pela osteotomia intertrocanterica de Hungria-Kramer modificada por Sugioka / Intertrochanteric osteotomy for severe slipped capital femoral epiphysis

Os autores descrevem uma tecnica cirurgica que denominam osteotomia de Hungria e Kramer modificada por Sugioka (HKS). Apresentam os métodos radiogr ficos que permitem estudar a real posição da cabeça femoral nos escorregamentos graves. Acreditam no principio de que a maioria das epifisi¢lises apresenta desvio para posterior, sendo raros os casos associados com o desvio em varo. Analisam 24 quadris com epifisiolise grave, cronica ou cronica agudizada, operados com essa tecnica, encontrando, respectivamente, 83 por cento de resultados clinicos e radiogr ficos satisfatorios, com acompanhamento medio de 65 meses. Comparativamente a outros métodos operatorios, os resultados são considerados bons, com dois casos de condrolise, uma consolidação em varo, uma pseudartrose e nenhum caso de necrose

Fratura-luxaçäo transescafoperilunar volar do carpo em paciente de 15 anos: relato de um caso / Carpal volar transescaphoid perilunate fracture-luxation in a 15 year old patient: report of a case

Os autores relatam caso de um jovem de 15 anos que, em conseqüência de uma queda de cerca de três metros de altura, teve um traumatismo craniencefálico e uma fratura-luxaçäo transescafoperilunar volar do carpo. Foi submetido a reduçäo cruenta e fixaçäo com fios de Kirschner. Evoluiu de maneira satisfatória, recuperando a mobilidade total da mäo e do punho. Chamam a atençäo para o fato de a fratura-luxaçäo volar ser pouco comum e para o fato de ter sido num paciente de 15 anos de idade.

Hemocramatose, artropatia e prótese total de quadril: relato de um caso / Hemochomatosis, arthropathy, and total hip prosthesis: report of a case

Os autores relatam um caso de hemocromatose associado a artropatia, tecem comentários sobre a raridade da doença, diagnóstico, exames complementares, quadro clínico, evoluçäo e o tratamento artroplástico realizado

Síndrome do túnel do carpo conseqüente a um cisto sinovial intracanal: relato de um caso / Carpal tunnel syndrome due to an intracanal synovial cyst: report of a case

Os autores relatam um caso de síndrome do túnel do carpo em uma paciente do sexo feminino, de 43 anos, com quadros clínico e eletromiográfico característicos. Trata-se de um cisto sinovial intracanal, similar aos reportados por Brooks (1952), Phalen (1966 e Harvey (1981

Estudo experimental da reparaçäo da cartilagem articular em coelhos, após implantaçäo de parafuso em nível subcondral, comparado a uma perfuraçäo controle / Experimental study of articular cartilage repair in rabbits after implantation of screw at the subchondral level, compared to a control perforation

Os autores realizaram estudo experimental em 30 coelhos adultos, tendo o intuito de observar as alteraçöes da superfície articular, após a implantaçäo de um parafuso de 2mm, abaixo da cartilagem articular do côndilo medial em sua zona de carga. Uma perfuraçäo de 1,5mm de diâmetro e 6mm de profundidade foi realizada na área correspondente do côndilo lateral, para fins de controle. Os estudos anatomopatológicos realizaram-se duas, oito e 16 semanas após as cirurgias

Luxaçäo metacarpofalangiana do polegar associada a fratura extra-articular da base do 1§ metacarpiano: relato de um caso / Metacarpophalangeal dislocation of the thumb associated with injury of the first metacarpal base: report of a case

Os autores descrevem um caso de luxaçäo metacarpofalangiana associada a uma fratura transversa da base do metacarpiano de um polegar. Trata-se de uma associaçäo incomum, mas cujo tratamento näo apresentou dificuldade. Alguns aspectos da fisiopatogenia e do resultado funcional säo discutidos