First MTP joint instability - Expanding the concept of "Turf-toe" injuries.

BACKGROUND: Although the classic definition of the Turf-toe injury refers to a very specific clinical and pathological picture, we think that the concept can be broadened to encompass a wide variety of traumatic lesions of the first metatarsophalangeal joint (MTP1). These are lesions typically difficult to diagnose, with a large variation of outcomes and a potential to impair patients' functional performance on a definitive and perennial basis. The objective of this study is to present the result obtained by treating 24 cases of traumatic injuries to the MTP1 joint in a midterm follow-up time. METHODS: In the period from 1999 to 2016, 24 patients were treated with MTP1 joint instability - "Expanded Turf-toe" - diagnosis. All patients were performing sports activities when they were injured: soccer (33%); martial arts (17%); running (13%); tennis (8%); olympic gymnastics (8%) and others (basketball, slalom, motorcycling, surfing, and ballet) (21%). Injuries were classified as Grade I (2 patients - 8%), Grade II (8 patients - 33%) and Grade III (14 patients - 59%) lesions. All patients with grades I and II were treated conservatively whereas those classified as grade III were treated surgically. RESULTS: After an average follow-up of 4.5 years we observed an improvement in the AOFAS hallux score from 42 to 82 points after treatment (p<0.001). The most frequent cause was axial load with various direction of stress at the first MTP. The mechanism of lesion varied among extension with hallux varism (42%), pure hyperextension (25%), extension with hallux valgism (21%), pure hyperflexion (8%) and hyperflexion with hallux valgism (4%). A separate analysis of each group showed a significant improvement in AOFAS Hallux scores after treatment: 51-84 (p<0.001) and 36-81 (p<0.001) for conservative and surgical groups, respectively. Four patients with GIII injuries (29%) and two with GII injuries (20%) did not resume their previous activities. Although pre-treatment AOFAS hallux scores were significantly different between groups, post-treatment scores were similar (p=0.615). CONCLUSIONS: Turf-toe is a serious injury that may prevent a high percentage of patients from resuming their previous physical activities. Mechanism of lesion might be varied generating a wide range of lesions that fit into the expanded concept of the Turf-toe injury. Both forms of treatment lead to satisfactory results if well conducted. The correct identification, classification, and grading of first metatarsophalangeal joint (MTP) instability helps in decision making and selection of the adequate treatment. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Translation and validation of the Brown attention-deficit disorder scale for use in Brazil: identifying cases of attention-deficit/hyperactivity disorder among samples of substance users and non-users. Cross-cultural validation study.

BACKGROUND: The Brown Attention-Deficit Disorder Scale (BADDS) was developed as a self-report assessment that was designed to screen for presence of symptoms of attention deficit hyperactivity disorder (ADHD). The objective here was to translate and validate the adult self-report BADDS for use in Brazil. DESIGN AND SETTING: Cross-cultural validation study conducted in an addiction unit at a public university hospital. METHODS: This study included a control group (n = 100) and a drug-user group (n = 100). Both groups included subjects aged 18 to 60 years old. The control group had no prior diagnosis of drug addiction and the drug-user group included participants with a diagnosis of addiction. Each participant answered Brazilian Portuguese translations of both the BADDS and the Adult Attention Deficit Hyperactivity Disorder Self-Report Scale (ASRS) questionnaires, in paper-and-pencil format. RESULTS: The drug-user group scored higher than the control group on both scales. The mean scores on ASRS were 27.26 (standard deviation, SD: 11.99) and 25.85 (SD: 8.65) respectively (P > 0.05). The mean scores on BADDS were 79.56 (SD: 29.61) and 79.31 (SD: 18.09), respectively (P > 0.05). Cronbach's alpha for BADDS was 0.95. BADDS presented fair sensitivity (72% accuracy) and fair specificity (88% accuracy). CONCLUSION: This study provides discriminative validity evidence for use of BADDS among Brazilian adults with substance-use disorders.

Translation and validation of the Brown attention-deficit disorder scale for use in Brazil: identifying cases of attention-deficit/hyperactivity disorder among samples of substance users and non-users. Cross-cultural validation study

ABSTRACT BACKGROUND: The Brown Attention-Deficit Disorder Scale (BADDS) was developed as a self-report assessment that was designed to screen for presence of symptoms of attention deficit hyperactivity disorder (ADHD). The objective here was to translate and validate the adult self-report BADDS for use in Brazil. DESIGN AND SETTING: Cross-cultural validation study conducted in an addiction unit at a public university hospital. METHODS: This study included a control group (n = 100) and a drug-user group (n = 100). Both groups included subjects aged 18 to 60 years old. The control group had no prior diagnosis of drug addiction and the drug-user group included participants with a diagnosis of addiction. Each participant answered Brazilian Portuguese translations of both the BADDS and the Adult Attention Deficit Hyperactivity Disorder Self-Report Scale (ASRS) questionnaires, in paper-and-pencil format. RESULTS: The drug-user group scored higher than the control group on both scales. The mean scores on ASRS were 27.26 (standard deviation, SD: 11.99) and 25.85 (SD: 8.65) respectively (P > 0.05). The mean scores on BADDS were 79.56 (SD: 29.61) and 79.31 (SD: 18.09), respectively (P > 0.05). Cronbach's alpha for BADDS was 0.95. BADDS presented fair sensitivity (72% accuracy) and fair specificity (88% accuracy). CONCLUSION: This study provides discriminative validity evidence for use of BADDS among Brazilian adults with substance-use disorders.

Intra and interobserver concordance of the AO classification system for fractures of the long bones in the pediatric population.

OBJECTIVE: The AO classification for fractures of the long bones in the pediatric population was developed and validated in 2006. However, the complexity of this system has limited its use in clinical practice and few studies in the literature have evaluated its reproducibility and applicability. The present study had the objective of determining the intra and interobserver agreement using the pediatric AO system, among physicians with different levels of experience. METHODS: After making the sample calculation, 108 consecutive radiographs on long-bone fractures in patients aged 0-16 years, coming from the digital files of the quaternary-level hospital, were selected. The radiographs were classified by five examiners with different levels of experience after prior explanations about the system. A chart containing images from the classification was made available for consultation. The evaluations were made at two different times by each observer. The Fleiss kappa index was used to ascertain the intra and interobserver agreement. RESULTS: Intraobserver agreement that was at least substantial was obtained for all the items of the classification and it reached excellent levels for all observers in relation to five of the seven items considered. The interobserver evaluation presented excellent levels of agreement in two items, substantial in two items, moderate to substantial in one item and poor to moderate in one item. No influence from the observer's experience was observed with regard to obtaining higher or lower levels of agreement, either in the intraobserver or in the interobserver evaluation. CONCLUSIONS: In this study, the intra and interobserver agreement was considered to be good or excellent for the pediatric AO classification system, for the parameters of bone, segment, paired bone, subsegment, standard and deviation. However, the intra and interobserver agreement was statistically unsatisfactory for the parameter of severity/side of avulsion. The levels of agreement obtained did not depend on the observer's level of experience within pediatric orthopedics.

OBJETIVO: A classificação AO para fraturas dos ossos longos na população pediátrica foi desenvolvida e validada em 2006. Entretanto, a complexidade desse sistema tem limitado o seu uso na prática clínica. Poucos estudos na literatura avaliam sua reprodutibilidade e aplicabilidade. Este trabalho teve como objetivo determinar a concordância intra e interobservadores com o uso do sistema de classificação AO pediátrica entre médicos de diferentes níveis de experiência. MÉTODOS: Após a feitura do cálculo amostral, foram selecionadas 108 radiografias consecutivas de fraturas de ossos longos de pacientes de 0­16 anos, provenientes do arquivo digital de um hospital de nível quaternário. As radiografias foram classificadas por cinco examinadores com diferentes níveis de experiência após uma explicação prévia sobre o sistema. Foi mostrada uma planilha que continha as imagens da classificação para consulta. As avaliações foram feitas em dois momentos distintos por cada observador. O índice Kappa de Fleiss foi usado para verificar a concordância intra e interobservadores. RESULTADOS: Foram obtidas concordâncias intraobservadores no mínimo substanciais em todos os itens da classificação, alcançaram níveis excelentes por todos os observadores em cinco dos sete itens considerados. A avaliação interobservadores apresentou níveis de concordância excelentes em dois itens, substancial em dois itens, moderada a substancial em um item e pobre a moderada em um dos itens. Não se observou influência da experiência do observador na obtenção de maiores ou menores níveis de concordância, intra ou interobservadores. CONCLUSÕES: Neste estudo, a concordância intra e interobservadores foi considerada boa ou excelente para o sistema de classificação AO pediátrico para os parâmetros: osso, segmento, osso pareado, subsegmento, padrão e desvio. No entanto, a concordância intra e interobservadores foi estatisticamente insatisfatória no parâmetro gravidade/lado da avulsão. Os níveis de concordância obtidos independem da experiência do observador em ortopedia pediátrica.

Concordância intra e interobservadores do sistema de classificação AO para fraturas dos ossos longos na população pediátrica / Intra and interobserver concordance of the AO classification system for fractures of the long bones in the pediatric population

A classificação AO para fraturas dos ossos longos na população pediátrica foi desen volvida e validada em 2006. Entretanto, a complexidade desse sistema tem limitado o seu uso na prática clínica. Poucos estudos na literatura avaliam sua reprodutibilidade e aplicabi lidade. Este trabalho teve como objetivo determinar a concordância intra e interobservadores com o uso do sistema de classificação AO pediátrica entre médicos de diferentes níveis de experiência. Métodos: Após a feitura do cálculo amostral, foram selecionadas 108 radiografias consecuti vas de fraturas de ossos longos de pacientes de 0-16 anos, provenientes do arquivo digital de um hospital de nível quaternário. As radiografias foram classificadas por cinco examina dores com diferentes níveis de experiência após uma explicação prévia sobre o sistema. Foi mostrada uma planilha que continha as imagens da classificação para consulta. As avaliações foram feitas em dois momentos distintos por cada observador. O índice Kappa de Fleiss foi usado para verificar a concordância intra e interobservadores. Resultados: Foram obtidas concordâncias intraobservadores no mínimo substanciais em todos os itens da classificação, alcançaram níveis excelentes por todos os observadores em cinco dos sete itens considerados. A avaliação interobservadores apresentou níveis de concordância excelentes em dois itens, substancial em dois itens, moderada a substancial em um item e pobre a moderada em um dos itens. Não se observou influência da experi ência do observador na obtenção de maiores ou menores níveis de concordância, intra ou interobservadores. Conclusões: Neste estudo, a concordância intra e interobservadores foi considerada boa ou excelente para o sistema de classificação AO pediátrico para os parâmetros: osso, seg mento, osso pareado, subsegmento, padrão e desvio. No entanto, a concordância intra e interobservadores foi estatisticamente insatisfatória no parâmetro gravidade/lado da avulsão. Os níveis de concordância obtidos independem da experiência do observador em ortopedia pediátrica.

The AO classification for fractures of the long bones in the pediatric population was developed and validated in 2006. However, the complexity of this system has limited its use in clinical practice and few studies in the literature have evaluated its reproducibility and applicability. The present study had the objective of determining the intra and interobserver agreement using the pediatric AO system, among physicians with different levels of experience. METHODS: After making the sample calculation, 108 consecutive radiographs on long-bone fractures in patients aged 0-16 years, coming from the digital files of the quaternary-level hospital, were selected. The radiographs were classified by five examiners with different levels of experience after prior explanations about the system. A chart containing images from the classification was made available for consultation. The evaluations were made at two different times by each observer. The Fleiss kappa index was used to ascertain the intra and interobserver agreement. RESULTS: Intraobserver agreement that was at least substantial was obtained for all the items of the classification and it reached excellent levels for all observers in relation to five of the seven items considered. The interobserver evaluation presented excellent levels of agreement in two items, substantial in two items, moderate to substantial in one item and poor to moderate in one item. No influence from the observer's experience was observed with regard to obtaining higher or lower levels of agreement, either in the intraobserver or in the interobserver evaluation. CONCLUSIONS: In this study, the intra and interobserver agreement was considered to be good or excellent for the pediatric AO classification system, for the parameters of bone, segment, paired bone, subsegment, standard and deviation. However, the intra and interobserver agreement was statistically unsatisfactory for the parameter of severity/side of avulsion. The levels of agreement obtained did not depend on the observer's level of experience within pediatric orthopedics.