Aquatic therapy in congenital malformation during the use of external fixator for bone lengthening: It is possible?

OBJECTIVES: The objective of this study is to describe the rehabilitation of individuals with Congenital Malformations (CMF) during the use of an External Fixator (EF) in Aquatic Therapy (AT) and to analyze the association between diagnosis, EF type and location with rehabilitation process outcomes, surgical intervention, and adverse effects. METHODS: This retrospective study included 29 medical records from which the personal and rehabilitation data of the patient were collected. The AT used was described and the outcome variables were associated. The medical records were selected by screening the database of the CMF clinic at the AACD. The inclusion criteria were participants with CMF who used EF treated between 2011 and 2019 of both genders and without age restriction. The exclusion criteria were incomplete medical record data or not undergoing AT while using EF. The extracted data included diagnosis, gender, age, EF type and location, objective of the surgery, adverse events, surgical interventions, time of rehabilitation in AT, physiotherapeutic objectives, and rehabilitation process outcomes in AT. RESULTS: The mean age of the participants was 12.1 ± 3.99 years, with male predominance (55 %) and hemimelia cases (37 %). The most used EF was circular (51 %), located in the femur (37 %), and the main objective of surgery was bone lengthening (52 %). The most recurrent adverse effect was infection (62 %) and 76 % completed AT. There was no association between the variables analyzed. CONCLUSIONS: It was possible to describe CMF rehabilitation with EF in AT. There was no association between the variables analyzed.

3D printing feasibility of a controlled dynamization device for external circular fixation.

AIM: to assess the small-scale 3D printing feasibility and cost estimation of a device for controlled dynamization. MATERIALS AND METHOD: The two-part device previously developed by our research group was printed with a carbon fiber-reinforced nylon filament (Gen3 CarbonX™ PA6+CF, 3DXTECH Additive Manufacturing) by a professional 3D printer (FUNMAT HT, Intamsys). Electricity, material, and labor costs for production in a Brazilian city in the Santa Catarina state were calculated. RESULTS: The devices for controlled dynamization were successfully printed in accordance with the planned design and dimensions. Six out of 38 printed devices presented defects in the bolt hole and were discarded. The average printing time per device was 1.9 h. The average electricity, material, and labor costs per printed device were respectively US$0.71, US$13.55, and US$3.04. The total production cost per device reaches approximately US$20 by adding the average cost of defective devices (15 %). CONCLUSION: 3D printing of the controlled dynamization device is feasible and its cost seems affordable to most healthcare services, which could optimize the consolidation of diaphyseal fractures and reduce treatment time for patients.

Treatment of Tibial Plateau Fractures with a Circular External Fixator: A Comparative Analysis of Two Assembly Methods / Tratamento de fraturas do planalto tibial com fixador externo circular: Uma análise comparativa de duas formas de montagem

Abstract Objective To compare the functional outcomes of two circular external fixation techniques to treat complex fractures of the proximal end of the tibia. Materials and Methods The present is a retrospective cohort study with 51 patients who underwent surgical treatment for complex fractures of the tibial plateau with a circular external fixator. There were two groups of patients: 12 subjects underwent treatment with the classic assembly technique, and 39 subjects underwent treatment with the simplified technique. The variables analyzed included age, sex, injury mechanism, trauma energy, associated injuries, fixator type, time of fixator use, and clinical-radiographic outcomes. The classic technique mainly uses transfixing Kirschner wires, while the simplified one replaces the Kirschner wires with Schanz pins in the distal block of the circular external fixator. Result There were no statistically significant differences (p> 0.05) between the two groups concerning the clinical-radiographic outcomes, including fracture consolidation, quality of joint fracture reduction, range of motion, lower limbs residual discrepancy, and postoperative pain. Conclusion We suggest that the simplified technique, using Schanz pins instead of Kirschner wires, can be a viable and effective alternative to treat complex fractures of the proximal end of the tibia with a circular external fixator. This simplified approach can offer benefits, such as a lower infection rate and greater patient comfort, without compromising clinical and radiographic outcomes, thus justifying its use.

Resumo Objetivo Comparar os resultados funcionais entre duas técnicas de fixação externa circular utilizadas no tratamento de fraturas complexas da extremidade proximal da tíbia. Materiais e Métodos Trata-se de um estudo de coorte retrospectivo, com 51 pacientes submetidos ao tratamento cirúrgico de fraturas complexas do planalto tibial com fixador externo circular. Os pacientes foram divididos em dois grupos: 12 pacientes tratados com a técnica clássica e 39 pacientes tratados com a técnica simplificada. As variáveis analisadas incluíram idade, sexo, mecanismo da lesão, energia do trauma, lesões associadas, tipo de fixador, tempo de uso do fixador e resultados clínico-radiográficos. A técnica clássica lança mão principalmente de fios de Kirschner transfixantes, e a simplificada substitui os fios de Kirschner por pinos de Schanz no bloco distal do fixador externo circular. Resultados A partir da comparação das montagens, não encontramos diferenças estatisticamente significativas (p> 00,5) entre os dois grupos em relação aos resultados clínico-radiográficos, incluindo a consolidação da fratura, a qualidade da redução da fratura articular, a amplitude de movimento, a discrepância residual na medida dos membros inferiores e a dor do paciente no pós-operatório. Conclusão Sugerimos que a técnica simplificada, utilizando pinos de Schanz no lugar dos fios de Kirschner, pode ser uma alternativa viável e eficaz no tratamento de fraturas complexas da extremidade proximal da tíbia com fixador externo circular. Essa abordagem simplificada pode oferecer benefícios, como menor taxa de infecção e maior conforto para o paciente, sem comprometer os resultados clínicos e radiográficos, o que justifica, o seu uso.

Percutaneous Suspensory Stabilization of Chronic Distal Radioulnar Joint (DRUJ) Dislocation Using an Adjustable Loop Endobutton Construct: Case Report / Fixação suspensiva percutânea de luxação crônica da articulação radioulnar distal (ARUD) usando um dispositivo de endobutton de laço ajustável: Relato de caso

Abstract Chronic distal radioulnar joint (DRUJ) dislocation has been treated historically with complex osteotomies and reconstructive procedures, often resulting in intractable stiffness and loss of function. It is desirable to use a technique of fixation that will not only restore the wrist biomechanics but also be cosmetically appealing to the individual. We present a novel technique of reduction and fixation of a chronically dislocated DRUJ in a 26-year-old male using a minimally invasive approach, with successful restoration of DRUJ function and no postoperative complications.

Resumo Luxação crônica da articulação radioulnar distal (ARUD) foi tratada historicamente com osteotomias complexas e procedimentos reconstrutivos, geralmente resultando em rigidez intratável e perda de função. É desejável usar uma técnica de fixação que não apenas restaure a biomecânica do punho, mas também seja esteticamente atraente para o indivíduo. Apresentamos uma nova técnica de redução e fixação de uma ARUD deslocada cronicamente em um homem de 26 anos, usando uma abordagem minimamente invasiva, com restauração bem-sucedida da função da ARUD e sem complicações pós-operatórias.

Hydroxyapatite-coated compared with stainless steel external fixation pins did not show impact in the rate of pin track infection: a multicenter prospective study.

PURPOSE: Infection at the pin site remains the most common complication of external fixators (EFs). It is known that hydroxyapatite (HA)-coated pins increase bone adhesion and may lead to reduced rates of reported infections. The present study compares the rates of pin track infection associated with stainless steel and HA-coated pins. METHODS: This is a prospective, multicenter, nonrandomized, comparative intervention study among patients undergoing surgical treatment with EFs of any type between April 2018 and October 2021. Patients were followed up until the removal of the EF, or the end of the study period (ranging from 1 to 27.6 months). The definition of pin track infection was based upon the Maz-Oxford-Nuffield (MON) pin infection grading system. RESULTS: Overall, 132 patients undergoing external fixation surgery were included. Of these, 94 (71.2%) were male, with a mean age of 36.9 years (SD ± 18.9). Infection of any type (score > 1) was observed in 63 (47.7%) patients. Coated and uncoated-pin track-infection occurred in 45.7% and 48.5% of patients, respectively (P= 0.0887). The probability of developing infection (defined as a score ≥ 2) adjusted for comorbidities and follow-up time was not statistically higher among those who received uncoated pins compared to those who received pins coated with HA (odds ratio (OR) = 1.56, 95% confidence interval (95% CI): 0.67-3.67, p <0.05). CONCLUSION: In the present study, the external fixator pin infection rates were similar when using HA coating and standard steel pins.

Effects of multiwavelength photobiomodulation for the treatment of traumatic soft tissue injuries associated with bone fractures: A double-blind, randomized controlled clinical trial.

This study evaluated the efficacy and safety of multiwavelength photobiomodulation (MPBM) in healing soft tissue injuries associated with tibial and/or ankle fractures. Participants were randomized into the MPBM or control group. Primary outcome was wound healing, measured by the Bates-Jensen scale. Assessments were performed daily. Twenty-seven hospitalized adults were included. MPBM showed an improvement in the daily mean Bates-Jensen scale (MPBM 32.1 vs. control 34.2; p = 0.029), daily mean pain score change (MPBM 0.5 vs. control 0.2; p = 0.04) and occurrence of infection at the site of the external fixator pins (MPBM 15.3% vs. control 57.1%; p = 0.02). MPBM group also showed faster-wound resolution (MPBM 13.1 vs. control 23.1 days). Subgroup analysis showed improvement in the MPBM group among less severe patients on the Bates-Jensen scale (MPBM 27.4 vs. control 34.7; p = 0.0081) and mean time for wound resolution (MPBM 7.0 vs. control 14.6 days; p = 0.03). MPBM appears safe and effective in reducing wound resolution time, infection in the surgical pin sites, reported pain and time before definitive surgery.

Transporte sobre clavo respetando la membrana de Masquelet en defectos segmentarios severos. Serie de casos / Distraction osteogenesis technique using an intramedullary nail and an external fixator in large bone defects

Introducción: El adecuado tratamiento de los defectos óseos se presenta como un desafío para el cirujano ortopedista, en cuanto a la dificultad en la restitución de un miembro alineado, sin discrepancia ni infección. Se han descrito múltiples técnicas para reconstruir estos defectos, como el injerto óseo autólogo o de banco, la técnica de membrana inducida, la osteogénesis por distracción y los cilindros de titanio trabecular, pero ninguna ha demostrado ser significativamente superior a otra. materiales y métodos: Entre 2018 y 2021, 10 pacientes con defectos óseos de la tibia fueron tratados mediante transporte óseo guiado con osteosíntesis endomedular. Se realizó un estudio retrospectivo descriptivo analizando la magnitud de los defectos, el tiempo de transporte, las complicaciones y cirugías adicionales durante el proceso, si hubo consolidación y las deformidades residuales. Al final del proceso, se midió el puntaje de la ASAMI (óseo y funcional). Resultados: La longitud promedio de los defectos tratados fue de 9,75 cm y el índice de fijación externa promedio, de 40,62 días/cm. El 50% tenía un puntaje de la ASAMI óseo bueno; el 10%, excelente y el 40%, pobre al final del proceso reconstructivo. El 20% tenía un puntaje de la ASAMI funcional excelente; el 30%, bueno y el 50%, pobre. Conclusiones: El uso de tutores externos guiados mediante osteosíntesis es un método fiable para tratar defectos óseos, al mismo tiempo que se trata la infección de manera local y sistémica, acortando los tiempos de tutor externo y, por lo tanto, de internación y reintervención. Nivel de Evidencia: IV

Introduction: The proper treatment of bone defects represents a challenge for the orthopedic surgeon given the difficulty in restoring limb alignment without discrepancy nor infections. Multiple techniques have been described for the reconstruction of these defects. These include bone grafting, whether autologous or from a bank, the induced membrane technique, distraction osteogenesis, and, recently, the use of trabecular titanium cylinders, but none has been shown to be significantly superior to another. materials and methods: Between 2018 and 2021, ten patients with tibial bone defects were treated by guided bone transport with intramedullary osteosynthesis. We carried out a descriptive retrospective study of this series, analyzing the magnitude of the defects, the transport time, the complications and additional surgeries that took place during the process, whether there was con-solidation, and the residual deformities. The bone and functional ASAMI scores were measured at the end of the process. Results: The average length of the treated defects was 9.75 cm and the average external fixation index was 40.62 d/cm. At the end of the reconstructive process, 50% of the patients presented a good bone ASAMI score, 10% presented an excellent score, and 40% had a poor score. Regarding the functional ASAMI score, 20% were excellent, 30% were good, and 50% were poor. Conclusion: The use of fixators guided by intramedullary nails constitutes a reliable method to treat bone defects that allows treating the infection locally and systemically, shortens the times of external fixation and hospitalization, and reduces the need for reinterventions. Level of Evidence: IV

Manejo ortoplástico de fractura expuesta de pierna grave: a propósito de un caso / Orthoplastic management of severe open fractures: case report / Tratamento ortoplástico das fraturas expostas grave: relato de caso

Las fracturas expuestas de pierna son lesiones frecuentes, sus principales complicaciones son la infección y la dificultad en la consolidación ósea. El abordaje ortoplástico implica llevar a cabo principios y prácticas de ambas especialidades en forma conjunta, evitando el tratamiento por separado de los problemas que surgen de estas lesiones graves y así intentar disminuir al mínimo las complicaciones. Nuestro objetivo es transmitir la importancia del enfoque ortoplástico en las fracturas expuestas. Se reporta el caso de un paciente adulto, con una fractura de pierna, tibia y peroné expuesta, que requirió múltiples procedimientos quirúrgicos en vistas a preservar el miembro. Fueron necesarias variadas estrategias para controlar la infección ósea y reconstruir las partes blandas y óseas. Con el estímulo de la movilidad del tobillo y pie, se logró comenzar a restituir la función del miembro desde el inicio; permitiendo, a las 6 semanas de evolución, el apoyo del miembro mediante una fijación ósea estable. A los 24 meses de seguimiento clínico y radiográfico evidenciamos paciente y familia satisfechos con un excelente resultado funcional según score ASAMI. Se concluye que en pacientes con fracturas expuestas graves, es clave el abordaje ortoplástico para lograr mejores resultados.

Open leg fractures are frequent injuries; the infection and difficulty in bone healing are their main complications. The orthoplastic approach involves carrying out principles and practices of both specialties together, avoiding separate treatment of the problems that arise from these serious injuries and thus minimizing complications. The objective of the article is to convey the importance of the orthoplastic approach in open fractures. We report the case of an adult patient, with an open fractured leg, to required multiple surgical procedures to preserve the limb. Various strategies were necessary to cure the bone infection and reconstruct the soft tissue and bone. The limb function restore was possible promoting the ankle and foot mobility from the beginning and it allowed weight-bearing on the limb through stable bone fixation, at 6 weeks of evolution. We evidenced a patient and family satisfied with an excellent functional result according to the ASAMI score, at 24 moths of clinical and radiographic follow-up. It is concluding that in patients with severe open fractures, the orthoplastic approach is key to obtain better results.

As fraturas expostas da perna são lesões frequentes, suas principais complicações são infecção e dificuldade de consolidação óssea. A abordagem ortoplástica envolve a realização conjunta de princípios e práticas de ambos ases especialidades, evitando o tratamento separado dos problemas decorrentes dessas lesões graves e minimizando assim as complicações. Nosso objetivo é transmitir a importância da abordagem ortoplástica nas fraturas expostas. É relatado o caso de um paciente adulto, com fratura de perna, tíbia e fíbula expostas, necessitando de múltiplos procedimentos cirúrgicos para preservação do membro. Várias estratégias foram necessárias para curar a infecção óssea e reconstruir os tecidos moles e o osso. Foi possível começar a restaurar a função do membro desde o início, com a estimulação da mobilidade do tornozelo e do pé; com 6 semanas de evolução, concedendo cargas ao membro por meio de fixação óssea estável. Apresentou boa evolução, aos 24 meses de acompanhamento clínico y radiográfico, constatamos a satisfação do paciente e família. com um excelente resultado funcional de acordo a pontuação ASAMI. Conclui-sé que em pacientes com fraturas expostas graves, a abordagem ortoplástica é fundamental para obter melhores resultados.

Fijadores externos para tratar fractura mandibular causada por herida de arma de fuego. Reporte de caso / External fxators as treatment for mandibular fracture caused by gunshot wound. Case report

Introducción: las heridas por proyectil de arma de fuego en la región craneofacial provocan daños funcionales devastadoras y deformidades estéticas, que se suman al trauma psicológico al momento del regreso a la vida cotidiana de un paciente. Por esta razón, la reconstrucción adecuada es esencial para una rehabilitación integral. La fijación externa es un método de reducción cerrada de fracturas que implica el uso de tornillos para manipular segmentos sueltos de hueso, que luego se fijan mediante conexiones externas. Es importante recalcar que las fracturas mandibulares causadas por proyectil de arma de fuego son un reto para este tipo de tratamiento. Objetivo: presentar el caso de un paciente con fractura mandibular por proyectil de arma de fuego tratado con fijadores externos y revisión de la literatura sobre este tipo de tratamiento. Caso clínico: paciente masculino de 19 años que presentó fractura de rama mandibular izquierda causado por proyectil de arma de fuego; la fractura se manejó mediante la colocación de fijación intermaxilar con arcos barra tipo Erich y fijación externa durante 3 meses. Como parte del resultado, el paciente presentó una correcta oclusión dentaria y mantiene sus movimientos mandibulares sin ninguna limitación. Esto demuestra que la reducción cerrada y fijación externa debe mantenerse en el arsenal terapéutico debido a sus adecuados resultados comprobados en la literatura y en este caso. Ahora bien, aunque la reducción abierta y fijación interna con material de osteosíntesis hace parte del manejo idóneo para todo tipo de fractura, todos los casos requieren ser individualizados.

Background: wounds from a frearm projectile in the craniofacial region cause devastating functional damage and aesthetic deformities, along with psychological trauma when returning to daily life. This is why proper reconstruction is essential for comprehensive rehabilitation. External fxation is a method of closed fracture reduction that involves the use of screws to manipulate loose segments of bone that are then fxed using external connections. Objective: to present the case of a patient with a mandibular fracture caused by a frearm projectile treated with external fixators and review the literature. Clinical case: a 19-year-old male patient who presented a fracture of the left mandibular ramus caused by a frearm projectile, the fracture was managed by placing intermaxillary fxation with Erich-type bar arches and external fixation for 3 months. The patient presented a correct dental occlusion and maintains his mandibular movements without any limitation. Conclusion: mandibular fractures caused by frearm projectiles are a challenge for treatment. Open reduction and internal fixation with osteosynthesis material is the ideal management for all types of fractures, however, all cases must be individualized, and it must be considered that closed reduction and external fxation must remain in our therapeutic arsenal due to their adequate results verifed in the literature and in our case.

Experiencia en el manejo del trauma de guerra con un enfoque de control de daños en el hospital para pacientes con fracturas de fémur o tibia / Experience in managing war trauma with a damage control approach in the hospital for patients with femur or tibia fractures

Introducción: El Hospital Militar Central cuenta con un grupo especial para la atención de pacientes con trauma de guerra que incluye una evaluación inicial y manejo urgente de las lesiones que amenacen la vida, mediante un enfoque de control de daños que busca preservar la vida del paciente, salvar la extremidad y conservar su función. Materiales y Métodos: Estudio observacional, descriptivo, transversal de pacientes de las fuerzas militares de Colombia, que sufrieron fracturas de fémur o tibia por trauma de guerra entre 2012 y 2020; y tratados mediante fijación externa en este Hospital. Objetivos: Describir las complicaciones del trauma de guerra tras un año de manejo de pacientes con fracturas de fémur o tibia utilizando un protocolo de control de daños en el Hospital Militar Central, centro de referencia para este tipo de trauma en el país. Resultados: Se realizó una revisión retrospectiva de pacientes con fracturas femorales o tibiales por traumas de guerra entre 2012 y 2020, manejados con un protocolo de control de daños. Se seleccionaron 72 soldados, el 96% de las fracturas eran abiertas, el 91% (66 casos) sufrió alguna complicación, como lesión nerviosa, lesión vascular, defecto de cobertura, infección, falta de consolidación. Conclusiones: El trauma de guerra continúa representando una de las etiologías de politraumatismo en pacientes jóvenes de nuestro país que, a su vez, sigue teniendo grandes implicaciones clínicas y económicas. Las lesiones óseas de las extremidades requieren un manejo por etapas basado en la fijación externa según los principios de control de daños. Nivel de Evidencia: IV

Introduction: The Central Military Hospital of Bogotá, Colombia has a specialized team for treating war trauma patients. They conduct an initial assessment of patients and promptly manage potentially fatal injuries using a damage control approach that aims to save the patient's life, save the limb, and preserve its function. Materials and Methods: An observational, descriptive, cross-sectional study was conducted on patients from the Colombian armed forces who, between 2012 and 2020, had femur or tibia fractures as a result of war trauma; these patients were treated using external fixation by the orthopedics and traumatology service of the Central Military Hospital in Bogotá, Colombia. Objectives: To describe the complications associated with war trauma following a year of treatment for femur and/or tibia fractures under a damage control protocol at the Central Military Hospital, the nation's reference facility for this kind of trauma. Results:A retrospective review of war trauma patients between 2012 and 2020 with femoral or tibial fractures treated with DCO was performed. Fisher's Exact tests were used for comparisons. Seventy-two soldiers were selected, 96% of fractures were open, 91% (66 cases) had some type of complication such as nerve injury, vascular injury, coverage defect, infection, and nonunion. Conclusions: In our country, war trauma persists as one of the causes of polytrauma in young patients, which has significant clinical and financial implications. Bone injuries of severely affected extremities require staged management based on external fixation according to damage control principles. Level of Evidence: IV

Outcomes of the Management of Distal Radius Fractures in the Last 5 Years: A Meta-analysis of Randomized Controlled Trials / Resultados do manejo de fraturas do rádio distal nos últimos 5 anos: metanálise de ensaios clínicos controlados e randomizados

Abstract Objective Over the last decades, volar locking plates (VLPs) have been the mainstay treatment for distal radius fractures (DRFs). With the growing body of evidence, we systematically reviewed studies on recent VLP modifications. Methods A systematic search was performed in the PubMed/MEDLINE database for studies published in English in the past five years. The inclusion criteria were randomized controlled trials (RCTs) on the operative treatment of DRFs. We excluded ongoing trials and studies not directly addressing DRF. The primary outcomes assessed were subjective (such as the scores on the Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire, the Patient-rated Wrist Evaluation [PRWE], the European Quality of Life-5 Dimensions [EQ-5D], the 36-item Short Form Health Survey [SF-36], and the Visual Analog Scale [VAS]) and objective clinical outcomes (the complication rate). Results We identified 29 articles published from 2016 to 2020 with high quality of evidence, except for one, which had evidence of moderate quality. In total, 3,079 DRFs were analyzed in the present study. All studies except one had a greater proportion of female participants, and only in 1 study the mean age of the sample was < 40 years old. There were no significant differences between the VLP and external fixation (EF) in terms of the scores on the DASH (p= 0.18) and PRWE (p= 0.77). The VLP alone without pronator quadratus (PQ) repair yielded significantly better outcomes. Conclusion In unstable fractures, the VLP and EF yielded comparable long-term results. There is no clear benefit of adding PQ repair to current the VLP surgical technique. Level of EvidenceLevel I

Resumo Objetivo Nas últimas décadas, a placa volar bloqueada (PVB) tem sido o tratamento principal para fraturas do rádio distal (FRDs). Com o crescente conjunto de evidências, revisamos sistematicamente estudos sobre modificações recentes na PVB. Métodos Uma pesquisa sistemática foi realizada utilizando o banco de dados PubMed/MEDLINE por estudos publicados em inglês nos últimos cinco anos. Os critérios de inclusão foram ensaios clínicos controlados e randomizados (ECCRs) sobre o tratamento cirúrgico de FRDs. Excluímos ensaios e estudos em andamento que não abordavam diretamente a FRD. Os desfechos primários avaliados foram desfechos clínicos subjetivos (como as pontuações no questionário de Deficiências do Braço, Ombro e Mão [Disabilities of the Arm, Shoulder and Hand, DASH, em inglês], na Avaliação do Punho Classificada pelo Paciente [Patient-rated Wrist Evaluation, PRWE, em inglês], no questionário Qualidade de Vida Europeia - 5 Dimensões [European Quality of Life-5 Dimensions, EQ-5D, em inglês], na Pesquisa de Saúde por Formulário Curto de 36 Itens [36-item Short Form Health Survey, SF-36, em inglês], e na Escala Visual Analógica [EVA]) e objetivos (taxa de complicações). Resultados Identificamos 29 artigos publicados entre 2016 e 2020 com alta qualidade de evidência, exceto por um, de qualidade moderada. Ao todo, foram analisadas 3.079 FRDs neste estudo, Todos os estudos analisados, exceto por um, tinham maior proporção de participantes do gênero feminino, e somente em 1 estudo a idade média da amostra foi < 40 anos. Não houve diferença significativa entre a PVB e fixação externa (FE) em termos das pontuações no DASH (p= 0,18) e na PRWE (p= 0,77). Os resultados da PVB isolada, sem qualquer reparo do pronador quadrado (PQ), foram significativamente melhores. Conclusão Em fraturas instáveis, a PVB e a FE produziram resultados comparáveis no longo prazo. Não há um benefício claro em se adicionar reparo do PQ à técnica cirúrgica atual da PVB. Nível de EvidênciaNível I

Ilizarov Ring External Fixation for Complex Tibial Plateau Fractures / Fixação externa do anel de Ilizarov para fraturas complexas do platô tibial

Abstract Objective To analyze the results of clinical, radiological, and functional outcomes of tibial plateau fracture (Schatzker Type V, VI) treated with Illizarov ring external fixator with or without minimum opening. Methods A total of 52 tibial plateau fractures of type V, VI were treated with Ilizarov ring external fixator with or without mininum internal fixation were studied. Functional outcome assessment was done using the American Knee Society (AKS) score with clinical, radiological union, and complications were analyzed. Results There were 37 (71.15%) male and 15 (28.84%) female patients, with a mean age of 39.07 ± 12.58 years old. Road traffic accidents (RTAs) were the major cause of fracture, accounting for 32 cases (61.53%) followed by fall injury, with 16 cases (30.76%), and direct impact, with 4 cases (7.69%). Twenty-one (40.38%) cases were type V and 31 (59.61%) cases were type VI fractures, and there were 24 (46.15%) cases of open fracture. The mean AKS score of Type V and Type VI fractures were 82.8 and 80.70, respectively, but this was statistically not significant at p<0.05. The mean AKS score of closed and open fractures were also statistically not significant at p<0.05. Conclusions For Schatzker Types V and VI complex tibial plateau fractures, Ilizarov external fixation is a safe, cost-effective and efficient treatment method that presents a satisfactory outcome.

Resumo Objetivo Analisar os resultados clínicos, radiológicos e funcionais da fratura do planalto tibial (Schatzker Tipo V, VI) tratada com fixador externo do anel Illizarov com ou sem abertura mínima. Métodos Um total de 52 fraturas do planalto tibial dos tipos V e VI foram tratadas com fixador externo do anel Ilizarov com ou sem fixação interna mínima. A avaliação do desfecho funcional foi feita utilizando-se o escore da American Knee Society (AKS, na sigla em inglês) com consolidação clínica, radiológica e complicações encontradas. Resultados Foram 37 (71,15%) pacientes do sexo masculino e 15 (28,84%) do sexo feminino, com idade média de 39,07 ± 12,58 anos. Acidentes de trânsito (ATs) foram a principal causa das fraturas, contabilizando 32 casos (61,53%), seguidos por lesão por queda, com 16 casos (30,76%), e impacto direto, com 4 casos (7,69%). Foram 21 (40,38%) casos de fraturas tipo V, 31 (59,61%) casos do tipo VI e 24 (46,15%) casos de fratura exposta. Os escores médios da AKS para as fraturas tipo V e VI foram de 82,8 e 80,70, respectivamente, mas não foi estatisticamente significativo em p <0,05. O escore médio da AKS para fraturas fechadas e abertas também não foi estatisticamente significativo em p <0,05. Conclusões Para a fratura do planalto tibial complexa dos tipos V e VI de Schatzker, a fixação externa de Ilizarov é um método de tratamento seguro, econômico e eficiente que resulta em resultados satisfatórios.

Bioinspired design proposal for a new external bone fixator device.

The article presents a new medical device through an authorial and interdisciplinary approach. It consists of a flexible external fixator, whose flexible property may bring advantages over rigid mechanisms. Its design was inspired by the DNA biological mechanism of condensation, while the modeling was based on the pseudo-rigid modeling technique. From the models obtained, this study conducted prototyping and computational tests to obtain a proof-of-concept of the bioinspired theory and dynamic functioning effectiveness. The prototyping relied on hot glue manufacturing and the computational simulations consisted of linear static analysis. The experimental analysis concluded that the prototype with fewer beams and thinner beams delivered better results in all three parameters: flexibility, height variation and rotation arc. In the computational analysis, among the design models with the variation of the number of beams, the model with 8 beams performed better. Concerning thickness variation, the one whose beams measured 8 mm in thickness showed better results. Among the models with length variation, the design made with 100 mm long beams better equilibrated the parameters.

The role of anterior supra-acetabular external fixator as definitive treatment for anterior ring fixation in unstable pelvic fractures.

PURPOSE: Management of anterior ring injuries is still a matter of discussion, and there are only few studies reporting anterior external fixator as definitive treatment for unstable pelvic injuries. This study aimed to describe the clinical and radiological outcomes of a consecutive series of mechanically unstable pelvic injuries that were treated with definitive anterior supra-acetabular external fixator for the anterior ring, and to identify risk factors for failure. METHODS: We included a consecutive series of patients with unstable pelvic ring fractures who underwent anterior supra-acetabular external fixation for definitive treatment, between January 2012 and January 2020. All demographics, associated injuries and procedures, injury mechanism, and complications were analysed. Pelvic fracture was classified based on Orthopaedic Trauma Association/Tile AO (OTA/AO) and Young-Burgess classifications. Complications associated with the external fixator were revised. All patients were functionally evaluated at final follow-up and asked to report their clinical outcomes using the Majeed score. RESULTS: A total of 47 patients were included, of which 25 were females. The median age was 44 years (interquartile range 23-59). Median follow-up duration was 14 months (interquartile range 6-31). The most frequent aetiology was motor vehicle accident (35), followed by fall from height (8). All fractures required posterior pelvic ring fixation. The median time during which patients had external fixation in situ was 11 weeks (interquartile range 9-13). All patients achieved healing of pelvic fracture at median time of 10 weeks (interquartile range 8-12). At final follow-up, the median displacement of the anterior pelvis was 6 mm (interquartile range 0-11). Superficial infection was the most common complication (n = 7). No washout procedures were needed. No major complication was reported. No patient required reoperation for anterior ring fracture. The median Majeed score was 88 points (range 60-95; interquartile range 80-90) at final follow-up. CONCLUSION: Our findings suggest that the use of supra-acetabular external fixator is safe and effective for definitive treatment of the anterior ring in unstable pelvic fractures. It is a method with high proportion of excellent results, regardless of the type of fracture. The rate of complications is low, and it does not compromise functional results.

Estudio comparativo entre fijador externo versus placa volar de estabilidad angular en las fracturas de radio distal / External fixator versus angular stability volar plates in distal radius fractures. A comparative study

Las fracturas del radio distal están entre las patologías más comunes en el área de la emergencia, actualmente los tratamientos más utilizados son la fijación con alambres de Kirschner y fijador externo (AKFE), o la osteosíntesis con placas volares de estabilidad angular (PVEA), realizamos un estudio comparativo de los resultados a corto plazo entre ambos métodos. Se realizó un estudio transversal, retrospectivo y descriptivo desde el 2005 al 2019, donde se revisaron las historias de los pacientes con fracturas de radio distal tratados con AKFE o PVEA, evaluando el alta después de la medición de la amplitud de movimiento articular funcional. Se incluyeron 68 pacientes, 47(69,11%) pacientes tratados con PVEA y 21(30,88%) con AKFE, la edad promedio fue de 53,07 años, la causa más común fue la caída de su altura en 60,29% casos, el alta médica por mejoría se realizó a las 15,95 semanas para AKFE y a las 9,86 semanas para PVEA (<0.05). La osteosíntesis con PVEA evidenció un menor tiempo de recuperación de la amplitud de movimiento articular con respecto a los pacientes tratados con AKFE(AU)

Fractures of the distal radius are among the most common pathologies in the emergency area, currently the treatment more frequently used are fixation with Kirschner wires and external fixator (KWEF), or osteosynthesis with angular stability volar plates (FAVP), we carried out a comparative study of the short-term results between both methods. This is a cross-sectional, retrospective and descriptive study from 2005 to 2019, where the histories of patients with distal radius fractures treated with KWEF or FAVP revised, evaluated, evaluating at discharge after functional joint range of motion was measured.68 patients were evaluated, 47 patients treated with FAVP and 21 with KWEF, average age of 53.07 years, the most common cause was the fall from his height with 60.29%, the medical discharge was made at 15,95 weeks for KWEF and 9,86 weeks for FAVP; with a t student<0.05 between them. Osteosynthesis with FAVP evidenced a shorter recovery time for joint range of motion compared to patients treated with KWEF(AU)

Limb Salvage after Lower-Leg Fracture and Popliteal Artery Transection-The Role of Vessel-First Strategy and Bone Fixation Using the Ilizarov External Fixator Device: A Case Report.

Open traumatic lesion of the popliteal artery is relatively rare. Ischemia time longer than 6 h and severity of limb ischemia have been shown to be associated with an increased risk of limb loss. Severe local infection is critical in the presence of major soft tissue trauma or open fractures. We report the case of a young female who suffered a traumatic transection of the popliteal artery associated with an open fracture of the distal tibia and fibula managed by direct vessel reconstruction with an end-to-end repair and skeletal stabilization initially with half-pin external fixation, then replaced by an Ilizarov circular frame. The patient had a very satisfactory outcome, but the fracture healed malunited, later corrected by open reduction and internal fixation with lag-screwing and a neutralization plate.

Management of Segmental Tibial Bone Defects With a Motorized Intramedullary Bone Transport Nail: A Case Review With Follow-Up.

SUMMARY: Large segment bone defects of the tibia are challenging problems. Although caused by a wide range of conditions, tibial critical bone loss defects often require complex reconstructive plans with prolonged inability to weight-bear on the effected extremity. Reconstruction options frequently require harvesting of autograft leading to further morbidity. Distraction osteogenesis allows reconstruction of large segmental defects of the tibia while avoiding donor site morbidity. Historically, distraction osteogenesis of tibia was most reliably performed with circler ring external fixation. This process allowed early weight-bearing but unfortunately has considerable drawbacks. Negative effects include pin tract irritation and inability to wear normal clothes. The advent of the bone transport nail now allows management of tibial critical bone loss defects through distraction osteogenesis negating the need for external fixation. This new technique allows treatment of large segmental tibial defects by means of distraction osteogenesis with an all-internal device avoiding the negative effects of external fixation while simultaneously allowing early weight-bearing.

Luxación traumática aguda de rodilla. Indicaciones del uso del fijador externo en la urgencia. Revisión bibliográfica sistematizada / Acute knee dislocation. Indications for the use of the external fixator at the emergency room / Deslocamento agudo traumático do joelho. Indicações para o uso do fixador externo na emergência

Resumen: Introducción: la luxación traumática de la rodilla constituye una lesión rara dentro de la patología ortopédica. En muchas ocasiones su diagnóstico pasa desapercibido dado que se dan en el contexto de pacientes politraumatizados, y la falla en el mismo puede derivar en un pronóstico potencialmente letal para el compromiso vital del miembro lesionado. Objetivo: realizar una revisión de la literatura disponible en los últimos veinte años acerca de cuáles son las indicaciones del uso del fijador externo (FFEE) en la luxación traumática aguda de rodilla en la urgencia. Materiales y métodos: se realizó una búsqueda sistematizada a través de los buscadores electrónicos Cochrane, Lilacs, Scielo, Pubmed, Science direct y el portal Timbó. La misma alcanzó un total de 6.495 artículos, y de acuerdo con los criterios de inclusión y exclusión se seleccionaron 14 trabajos para realizarla. Resultados: se destaca que la mayoría de los artículos encontrados son de nivel de evidencia IV. La utilización del uso de la fijación externa en la urgencia como parte de la estabilización temporal y el manejo inicial estaría indicado en los siguientes escenarios clínicos: pacientes politraumatizados, lesión vascular, luxación expuesta, inestabilidad de la articulación, luxación recidivante, luxofracturas, lesiones a nivel del aparato extensor, obesidad mórbida, intolerancia del uso de la férula u ortesis. Conclusión: la sistematización y protocolización a la hora de la toma de decisiones permite disminuir de forma mayoritaria las complicaciones vinculadas a la patología traumática; éstas deben estar dirigidas a la estabilización del paciente en primera instancia, y en segunda instancia a estabilizar la articulación de la rodilla. La fijación externa tiene indicaciones en escenarios clínicos puntuales; sin embargo algunas de estas indicaciones aún son objeto de debate.

Abstract: Introduction: traumatic dislocation of the knee constitutes an unusual lesion in orthopedic pathology, the diagnosis of which is often missed. This is because it occurs in the context of multiple trauma patients, and failure to diagnose it may result in a potentially fatal outcome for the life-threatening compromise of the injured limb. Objective: to perform a literature review of literature on indications for the use of the external fixator in the acute knee dislocation at the emergency room that has been available in the last twenty years. Method: we conducted a systematized search by means of electronic search engines Cochrane, Lilacs, Scielo, Pubmed, Science direct and the Timbó portal. The search included 6495 articles and according to the criteria of inclusion and exclusion 14 studies were selected. Results: the review highlights that most articles found are level of evidence IV. The use of the external fixator in the emergency room as part of the temporary stabilization and initial handling of the condition would be indicated in the following clinical scenarios: multiple trauma patients, vascular lesion, exposed dislocation, joint instability, recurrent dislocation, fracture dislocation, lesions of the extensor apparatus, morbid obesity, splint or orthosis intolerance. Conclusion: systematization and the observation of protocols when it comes to the making of decisions enables the decrease of most complications associated to trauma pathologies. Actions must be geared to stabilizing patients first and to stabilize the knee joint. The external fixator is indicated for specific clinical scenarios. However, some of these indications are still a matter of debate.

Resumo: Introdução: a luxação traumática do joelho é uma lesão rara na patologia ortopédica. Em muitas ocasiões, seu diagnóstico passa despercebido, por ocorrer no contexto de pacientes politraumatizados, e que sua falha pode levar a um prognóstico potencialmente letal para o envolvimento vital do membro lesado. Objetivo: realizar uma revisão da literatura disponível nos últimos vinte anos sobre as indicações do uso do fixador externo na luxação traumática aguda do joelho em pronto-socorro. Materiais e métodos: foi realizada uma busca sistemática nas bases LILACS, SciELO, PubMed, Science Direct, na Biblioteca Cochrane e no portal Timbó. Foram obtidas 6.495 referencias dos quais 14 artigos foram selecionados de acordo com os critérios de inclusão e exclusão. Resultados: a maioria dos artigos encontrados apresentam evidência de nível IV. O uso de fixação externa na emergência como parte da estabilização temporária e manejo inicial, seria indicado nos seguintes cenários clínicos: pacientes politraumatizados, lesão vascular, luxação exposta, instabilidade articular, luxação recorrente, luxação, lesões ao nível do aparelho extensor, obesidade mórbida, intolerância ao uso de tala ou órtese. Conclusão: a sistematização e protocolização no momento da tomada de decisão é o que possibilita reduzir, em sua maioria, as complicações relacionadas à patologia traumática. Estas devem ter como objetivo em primeiro lugar estabilizar o paciente e, em segundo lugar, estabilizar a articulação do joelho. A fixação externa tem indicações em contextos clínicos específicos; no entanto, algumas delas ainda geram controvérsia.

Lesión traumática expuesta, compleja y grave de tibia, tratada con fijador externo Álvarez Cambras / Exposed, complex and severe traumatic injury of the tibia treated with Alvarez Cambra external fixation

RESUMEN Con el paulatino incremento de accidentes automovilísticos, de trabajo, y la violencia urbana, las fracturas expuestas y complejas constituyen traumatismos de creciente incidencia y de difícil solución, con largos períodos de convalecencia que ponen en peligro la vida o la conservación del miembro lesionado. Un gran número de ellas dejan secuelas invalidantes. Existen varios tratamientos, entre ellos la fijación externa, utilizando el sistema creado por el profesor Rodrigo Álvarez Cambras, con varias ventajas que proporcionan una mejor evolución. Se realizó este trabajo con el objetivo de mostrar la evolución y los resultados de un paciente ingresado y operado con el diagnóstico de lesión expuesta, compleja y grave de la extremidad inferior, específicamente de tibia. Este presentó varias complicaciones, por lo que se le colocó un aparato de osteosíntesis de fijación externa Álvarez Cambras en el Hospital Provincial Clínico Quirúrgico Docente José Ramón López Tabrane, de Matanzas (AU).

ABSTRACT With the gradual increase of automobile and work accidents as well as urban violence, exposed and complex fractures are traumas of increasing incidence and difficult solution, with long periods of convalescence that endanger the life or the conservation of the injured member. A large number of them leave invalidating sequels. There are several treatments, including external fixation using the system created by Professor Rodrigo Alvarez Cambra, with several advantages that provide a better evolution. The current work was carried out with the objective of showing the evolution and results of a patient who entered the Teaching Provincial Clinical-surgical Hospital Jose Ramon Lopez Tabrane, of Matanzas, and underwent a surgery with the diagnosis of exposed, complex and serious lesion in the lower limb, specifically of tibia. The patient had several complications and so he was put an Alvarez Cambra external fixation osteosynthesis devise (AU).

Functional Outcome of Patients Undergoing Knee Arthrodesis after Infected Total Arthroplasty / Resultado funcional dos pacientes submetidos a artrodese de joelho após artroplastia total infectada

Abstract Objective Retrospectively assess the functional outcome of patients undergoing arthrodesis after septic failure of total knee arthroplasty. Methods Eighteen patients were evaluated, with a mean time of 3.7 years of follow-up. Arthrodesis surgery was performed using a narrow anterior dynamic compression plate, and medial or external fixator in two planes of the joint (Orthofix Bone Growth Therapy, Lewisville, TS, USA), at the surgeon's discretion. Results The most frequent pathogen found was Staphylococcus aureus methicillin sensitive (38.9%). The mean lower limb discrepancy was 3.63 cm. The mean knee society score was 68 points. According to the visual analog scale for pain, 44% of the patients had a 0 score at the time of assessment, and 22.2% were very dissatisfied, despite the bone healing achieved. Patients were assessed for the ability to walk with or without assistance. Conclusion Knee arthrodesis surgery was effective in controlling the infectious process and decreasing pain complaints, but satisfaction with the procedure was low.

Resumo Objetivo Avaliar de modo retrospectivo o resultado funcional dos pacientes submetidos a artrodese após falha séptica da artroplastia total de joelho. Métodos Foram avaliados 18 pacientes com tempo médio de 3,7 anos de seguimento. A cirurgia de artrodese foi realizada com placa do tipo dynamic compression plate (DCP) estreita, anterior e medial, ou fixador externo em dois planos da articulação (Orthofix Bone Growth Therapy, Lewisville, TS, EUA), a critério do cirurgião. Resultados O patógeno mais frequentemente encontrado foi o Staphylococcus aureus sensível a meticilina (38,9%). A discrepância de membros inferiores média foi de 3,63 cm. O da knee society score (KSS) médio foi de 68 pontos. Segundo a escala analógica visual de dor, 44% dos pacientes apresentaram pontuação zero no momento da avaliação, e 22,2% estavam muito insatisfeitos a despeito da consolidação óssea obtida. Os pacientes foram avaliados quanto à capacidade de deambular com ou sem auxílio de apoio. Conclusão A cirurgia de artrodese do joelho se mostrou eficiente quanto ao controle do processo infeccioso e diminuição das queixas álgicas, porém a satisfação com o procedimento é baixa.