A Novel Approach to Training Monotony and Acute-Chronic Workload Index: A Comparative Study in Soccer.

Load is a multifactorial construct, but usually reduced to parameters of volume and intensity. In the last decades, other constructs have been proposed for assessing load, but also relying on relationships between volume and intensity. For example, Foster's Training Monotony has been used in athletes' load management simply by computing mean weekly load divided by its standard deviation, often multiplied by session rate of perceived exertion. Meanwhile, the Acute to Chronic Workload Ratio (ACWR) has been debated by the sport scientists as a useful monitoring metric and related to so-called injury prevention. None of these models includes parameters that are representative of training specificity, namely load orientation. The aim of this study is to present broader conceptual approaches translated by new indices for assessing Intraweek Training Monotony (ITM) and Acute to Chronic Workload Index (ACWI) while incorporating load orientation, session duration and weekly density (frequency normalized) in addition to parameters related to proxies of external and/or internal load. Our ITM and Foster's Training Monotony were similar in terms of average values, but very different for individualized analysis, illustrating how average values may be deceiving. While Foster's model provided clusters of values, ITM provided more scattered, individualized data. ACWI and ACWR provided very distinct qualitative information, and the two models were uncorrelated. Therefore, the models incorporating training load orientation presented in this study provide distinct and not redundant information when compared to previous models. More importantly, ITM and ACWI are metrics that are compatible to each other and might fit to coaches' monitoring targets in the short and medium terms, respectively. Because our models include several parameters, including load orientation, we contend that might provide a more complete monitoring tool. However, we suggest they are used for intraindividual comparisons and not so strongly for interindividual comparisons.

The Role of Liquid Biopsy in Early Diagnosis of Lung Cancer.

Liquid biopsy is an emerging technology with a potential role in the screening and early detection of lung cancer. Several liquid biopsy-derived biomarkers have been identified and are currently under ongoing investigation. In this article, we review the available data on the use of circulating biomarkers for the early detection of lung cancer, focusing on the circulating tumor cells, circulating cell-free DNA, circulating micro-RNAs, tumor-derived exosomes, and tumor-educated platelets, providing an overview of future potential applicability in the clinical practice. While several biomarkers have shown exciting results, diagnostic performance and clinical applicability is still limited. The combination of different biomarkers, as well as their combination with other diagnostic tools show great promise, although further research is still required to define and validate the role of liquid biopsies in clinical practice.

Computed Tomography vs Standard Radiograph in Preoperative Planning of Distal Radius Fractures with Articular Involvement.

INTRODUCTION: Distal radius fractures with articular involvement are more likely to require surgical management. Treatment decisions are based on parameters which are obtained from plain radiographs. This study aims to determine the differences between computed tomography and standard radiographs in the preoperative planning of distal radius fractures with articular involvement. This was performed by measuring the intraobserver and interobserver reliability between three systems used to interpret the main fracture characteristics and two treatment decisions. MATERIALS AND METHODS: Forty-three cases of distal radius fractures with articular involvement were included. Fracture displacement was measured using plain radiographic and computed tomography. Five orthopedic surgeons evaluate the images to determine the AO/OTA classification, the articular fragments, the biomechanical columns involved, and recommend a surgical approach and implant for fracture fixation. RESULTS: An articular step-off was identified in 13 cases (30%) with the standard radiographs and in 22 (51%) cases with the computed tomography (p = 0.00). Interobserver variation for preoperative planning was slight when evaluated using the standard radiographs. Computed tomography improves reliability for AO/OTA classification and articular fragments but not for the biomechanical columns. Intraobserver variation for preoperative planning was slight to moderate for AO/OTA classification and slight to fair for identification of articular fragments and biomechanical columns. With regard to selection of the surgical approach, there was slight to moderate variation and, finally, for fracture fixation it was slight to fair. CONCLUSION: Information provided by conventional radiography and computed tomography are sufficiently different as to induce the surgeon to select different treatments for the same fracture. HOW TO CITE THIS ARTICLE: Azi ML, Teixeira MB, de Carvalho SF, et al. Computed Tomography vs Standard Radiograph in Preoperative Planning of Distal Radius Fractures with Articular Involvement. Strategies Trauma Limb Reconstr 2019;14(1):15-19.

Bone union with an in situ spacer after the first stage of the induced membrane technique.

INTRODUCTION: We report a case of an infected bone defect in the tibia in which the treatment was stopped in the first stage of the induced membrane technique. The polymethylmethacrylate (PMMA) spacer, retained in the bone defect, was encapsulated by the bone regeneration. CASE REPORT: A 37-year-old male patient with a 7-cm infected bone defect in the tibia was submitted to the first stage of the induced membrane technique with debridement and implantation of a PMMA spacer with antibiotics. The patient refused the second stage of the procedure and achieved bone union with the spacer in situ. There was no recurrence of infection at the 6-year follow-up. CONCLUSION: his is the first report of a case in which bone union was achieved with the spacer in situ after the first stage of the induced membrane technique. Keeping the spacer in the bone defect could be an option in some exceptional situations.

Reliability of the radiographic union scale in tibial fractures (RUST).

OBJECTIVE: This study aimed to evaluate the inter- and intra observer reproducibility of the radiographic score of consolidation of the tibia shaft fractures. METHODS: Fifty-one sets of radiographs in anteroposterior (AP) and profile (P) of the tibial shaft treated with intramedullary nail were obtained. The analysis of X-rays was performed in two stages, with a 21-day interval between assessments by a group of nine evaluators. To evaluate the reproducibility of RUST score between the evaluators, the intra-class correlation coefficient (ICC) with a 95% confidence interval was used. ICC values range from +1, representing perfect agreement, to -1, complete disagreement. RESULTS: There was a significant correlation among all evaluators: ICC = 0.87 (95% CI 0.81 to 0.91). The intraobserver agreement proved to be substantial with ICC = 0.88 (95% CI 0.85 to 0.91). CONCLUSION: This study confirms that the RUST scale shows a high degree of reliability and agreement.

OBJETIVO: Avaliar a reprodutibilidade inter e intraobservador do escore radiográfico de consolidação das fraturas (RUST) da diáfise da tíbia. MÉTODOS: Foram obtidos 51 conjuntos de radiografias nas incidências anteroposterior (AP) e perfil (P) da diáfise da tíbia tratadas com haste intramedular. A análise das radiografias foi feita em dois momentos, com intervalo de 21 dias entre as avaliações, por nove avaliadores. Para avaliar a reprodutibilidade do escore RUST entre os avaliadores foi usado o coeficiente de correlação intraclasse (CCI) com intervalo de confiança de 95%. O valor do CCI varia de +1, que representa concordância perfeita, a −1, que corresponde a total discordância. RESULTADOS: Houve uma concordância significativa entre todos os avaliadores: CCI = 0,87 (IC 95% 0,81 a 0,91). A concordância intraobservador mostrou-se substancial, com CCI = 0,88 (IC 95% 0,85 a 0,91). CONCLUSÃO: Este trabalho confirma que a escala RUST apresenta um elevado grau de confiabilidade e concordância.

Reliability of the radiographic union scale in tibial fractures (RUST) / Reprodutibilidade do escore radiográfico de consolidação das fraturas da tíbia (RUST)

ABSTRACT OBJECTIVE: This study aimed to evaluate the inter- and intra observer reproducibility of the radiographic score of consolidation of the tibia shaft fractures. METHODS: Fifty-one sets of radiographs in anteroposterior (AP) and profile (P) of the tibial shaft treated with intramedullary nail were obtained. The analysis of X-rays was performed in two stages, with a 21-day interval between assessments by a group of nine evaluators. To evaluate the reproducibility of RUST score between the evaluators, the intra-class correlation coefficient (ICC) with a 95% confidence interval was used. ICC values range from +1, representing perfect agreement, to -1, complete disagreement. RESULTS: There was a significant correlation among all evaluators: ICC = 0.87 (95% CI 0.81 to 0.91). The intraobserver agreement proved to be substantial with ICC = 0.88 (95% CI 0.85 to 0.91) . CONCLUSION: This study confirms that the RUST scale shows a high degree of reliability and agreement.

RESUMO OBJETIVO: Avaliar a reprodutibilidade inter e intraobservador do escore radiográfico de consolidação das fraturas (RUST) da diáfise da tíbia. MÉTODOS: Foram obtidos 51 conjuntos de radiografias nas incidências anteroposterior (AP) e perfil (P) da diáfise da tíbia tratadas com haste intramedular. A análise das radiografias foi feita em dois momentos, com intervalo de 21 dias entre as avaliações, por nove avaliadores. Para avaliar a reprodutibilidade do escore RUST entre os avaliadores foi usado o coeficiente de correlação intraclasse (CCI) com intervalo de confiança de 95%. O valor do CCI varia de +1, que representa concordância perfeita, a -1, que corresponde a total discordância. RESULTADOS: Houve uma concordância significativa entre todos os avaliadores: CCI = 0,87 (IC 95% 0,81 a 0,91). A concordância intraobservador mostrou-se substancial, com CCI = 0,88 (IC 95% 0,85 a 0,91) . CONCLUSÃO: Este trabalho confirma que a escala RUST apresenta um elevado grau de confiabilidade e concordância.

Membrane Induced Osteogenesis in the Management of Posttraumatic Bone Defects.

OBJECTIVE: To evaluate the union rate of posttraumatic bone defects treated with the induced membrane technique. DESIGN: Single-center retrospective case series. SETTING: Level I trauma center. PATIENTS/PARTICIPANTS: Thirty-three patients who sustained 34 posttraumatic bone defects (19 tibia, 15 femur). INTERVENTION: Staged management using the induced membrane technique described by Masquelet. After extensive debridement at the fracture site, a polymethylmethacrylate (PMMA) spacer was inserted into the resulting void. After soft tissue recovery, the spacer was removed, and the void, now enveloped by an induced membrane, was filled with an autologous iliac crest bone graft. MAIN OUTCOME MEASURES: Bone union rate, time to achieve bone union, length of hospital stay, number of surgeries, infection resolution, range of motion, musculoskeletal tumor society system functional score, and limb shortening. RESULTS: The mean defect size was 6.7 cm, and infection was present in 23 (68%) of the bone defects. Bone union was evident in 91% of cases (31/34). The average time to union was 8.5 months. In 7 of 23 (30%) of infected cases, the infection recurred, and in 3 of them, the graft was resorbed, resulting in treatment failure. CONCLUSION: The induced membrane technique was effective for managing posttraumatic bone defects. A recurrence of infection was associated with treatment failure. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Fixaçäo externa na emergência para o tratamento das fraturas metafisárias da tíbia proximal / External fixation in emergency treatment of proximal tibil metaphysis fractures

Os traumas envolvendo alto grau de energia determinam fraturas peculiares na metáfise proximal das tíbias. Esses pacientes necessitam de tratamento na emergência, visando a estabilizaçao de suas lesoes, viabilizando o tratamento ulterior que requer a mobilizaçao precoce, no leito, dos politraumatizados, ou articular dos que têm condiçoes de executá-la. Seguindo os conceitos atuais de osteossíntese, a opçao encontrada foi a utilizaçao do fixador externo monolateral modular. Foram tratados 21 pacientes, dos quais 15 eram politraumatizados. Oito pacientes foram tratados de forma definitiva com o fixador externo. Sete completaram o tratamento fazendo uso de aparelho gessado após a soluçao das lesoes iniciais. Dois necessitaram de outro medio de osteossíntese (um com placa e enxerto ósseo e outro com o fixador de Ilizarov) para a resoluçao de suas fraturas. Quatro pacientes nao puderam ser acompanhados até a consolidaçao óssea. Conclui-se que o tratamento, conforme proposto, é alternativa adequada nas fraturas instáveis da metáfise proximal das tíbias.

Tratamento das fraturas com falha óssea dos ossos da mäo pelo método de Ilizarov: relato de caso / Treatment of hand fractures with bone loss using Ilizarov's method: report of a case

As lesoes músculo-esqueléticas ocasionadas por traumatismos de alta energia têm sido mais e mais frequentes no nosso meio. Essas lesoes possuem como características a extensa perda tecidual. Neste trabalho é apresentado o tratamento com transporte ósseo, por meio do método de Ilizarov, para a perda óssea segmentar da metade distal da falange proximal, da articulaçÝo interfalangiana proximal e da metade proximal da falange média do quinto dedo da mao de um paciente, vítima de acidente do trabalho.

Uso do fixador externo modular AO simplificado no atendimento de emergencia dospolitraumatizados / Use of AO-light modular external fixator in the emergency treatment ofpolytraumatized patients

Analisamos os resultados do tratamento cirúrgico ortopédico de 40 pacientes politraumatizados, através da utilizaçao do fixador externo modular AO. Foram fixadas 47 fraturas, tratadas na emergência pelo Grupo do Trauma - Departamento de Ortopedia e Traumatologia da Santa Casa de Sao Paulo, pavilhao Fernandinho Simonsen - no período de maio de 1994 a maio de 1995. O seguimento variou de dez a 48 semanas. Neste estudo pudemos comprovar a versatilidade e rapidez na aplicaçao deste fixador, com agressao mínima às partes moles e ósseas. Obtivemos a estabilizaçao necessária dos fragmentos ósseos. Mantivemos o fixador como tratamento definitivo, ou seja, até a consolidaçao das fraturas em 90 por cento dos casos que o utilizaram por mais do que duas semanas (excluídos os óbitos e as amputaçoes).

Fraturas supracondilianas do úmero nas crianças: avaliaçäo do resultado do tratamento cirúrgico / Supracondylar fractures of the humerus in children: a proposal analysis of the surgical treatment

Neste estudo fazemos uma análise prospectiva de 20 pacientes em crescimento, que apresentaram fraturas supracondilianas do úmero, submetidos a tratamento cirúrgico. Em janeiro de 1992 foi instituído protocolo de tratamento, padronizando o procedimento e acompanhamento. Esse grupo foi comparado com o de outras 29 crianças tratadas cirurgicamente antes dessa data, quando ainda nao havia padronizaçao da conduta. Este segundo grupo havia sido submetido a procedimentos diversos: 18 reduçoes cruentas por via posterior e fixaçao com fios de Kirschner, oito reduçoes incruentas e fixaçao percutânea, e três reduçoes cruentas por via anterior e fixaçao com fios de Kirschner. O resultado do tratamento desses dois grupos foi classificado e avaliado pelo método de Innocenti. Nao observamos diferença estatisticamente significante no resultado final entre os diferentes tipos de procedimentos cirúrgicos empregados.

Desvio progressivo em valgo nas fraturas metafisárias proximais da tíbia nas crianças: "um desafio à lei de Wolff" / Progressive valgus deformity in proximal tibial metaphysis fractures in children: a challenge to Wolff principle

Trabalho baseado na reavaliaçao de oito pacientes, em idade de crescimento, que apresentaram fratura da metáfise proximal da tíbia e que, no acompanhamento tardio, evoluíram com deformidade em valgo progressivo. Em todos os casos, o tratamento inicial foi o incruento através da reduçao dos fragmentos e imobilizaçao gessada. Após 12 meses de acompanhamento, constatava-se deformidade em valgo da tíbia, de intensidade variável. Os autores revisaram a bibliografia existente, discutem as hipóteses etiológicas e alertam para a possibilidade da ocorrência, propondo condutas terapêuticas.

Seqüela da fratura de Monteggia na criança: tratamento tardio da luxaçäo da cabeça do rádio: apresentaçäo de dois casos / Sequelae of Monteggia's fracture in child: late treatment of radius head luxation: report of two cases

A principal sequela de fratura de Monteggia na criança é a luxaçäo da cabeça do rádio, que muitas vezes é o resultado da falta de diagnósticodas lesöes na fase aguda. Säo lesöes raras porém graves. Estudamos duas crianças com luxaçäo inveterada da cabeça do rádio tratadas em 1991 no Departamento de Ortopedia e Traumatologia da Santa Casa de Säo Paulo. O método utilizado para o tratamento foi a osteotomia de ulna e fixaçäo com placa, reduçäo aberta da cabeça do rádio com fixaçäo provisória com fio de Kirschner, além de imobilizaçäo com gesso axilopalmar, näo sendo realizada nenhuma reparaçäo do ligamento anular. Foram avaliadas as condiçöes funcionais pré e pós-operatórias, bem como as complicaçöes do tratamento

Fraturas subtrocantéricas do fêmur tratadas com placa condilar 95 graus A0: estudo prospectivo / Subtrochanteric femoral fractures trated by AO condylar plates: retrospective study

Este trabalho é um estudo retrospectivo das fraturas subtrocantéricas do fêmur tratadas no Pavilhäo Fernandinho Simonsen, no período de 1983 a 1991, com placa condilar AO de 95 graus. Säo 41 pacientes, apresentando-se a utilizaçäo de técnicas com reduçäo cruenta e anatômica, sempre que foi possível, ou a estabilizaçäo dos fragmentos nos casos de grande cominuiçäo. A idade média foi de 54,5 anos, sendo 56,0 por cento homens. Durante o acompanhamento ambulatorial, foi permitida carga parcial numa média de nove semanas e carga total com 17 semanas. O seguimento foi de 12 meses e verificou-se consolidaçäo numa média de quatro meses em 95,3 por cento dos pacientes. Conclui-se que o método utilizado para o tratamento destas fraturas foi satisfatório, quando bem indicado, embora se deva ter em conta os detalhes técnicos e a experiência cirúrgica para o sucesso do mesmo.