COMPARISON BETWEEN CONCENTRATED BONE MARROW ASPIRATE AND CORTICOID IN GLUTEAL TENDINOPATHY.

OBJECTIVE: To compare bone marrow aspirate concentrate (BMAC) with the standard treatment for gluteal tendinopathies. METHODS: 48 patients diagnosed with gluteal tendinopathy at a university hospital were selected by a randomized clinical trial and divided into two groups: (G1) bone marrow aspirate concentrate and (G2) corticosteroid injections. RESULTS: 40 of the 48 selected patients were monitored for six months and both groups showed better scores. Visual analog scale (VAS) scores and Lequesne index were statistically significant higher in patients submitted to BMAC treatment when compared to standard treatment. Both groups improved their quality of life, without statistically significant difference. CONCLUSION: BMAC constitutes an alternative to gluteal tendinopathy standard treatment, proving to be a safe technique with promising results when combined with multidisciplinary team behavioral therapy. Level of Evidence II, Randomized Clinical Trial.

OBJETIVO: Estudo comparativo entre tratamento com corticóide e aspirado de medula óssea concentrado (BMAC) para o tratamento de tendinopatias glúteas. MÉTODOS: O ensaio clínico randomizado selecionou pacientes diagnosticados com tendinopatia glútea e os dividiu em dois grupos: (G1) aspirado de medula óssea concentrada e (G2) injeção de corticosteróide. RESULTADOS: Foram selecionados 48 pacientes, dos quais 40 foram monitorados por 6 meses, com melhora nos escores nos dois grupos. Os pacientes que foram submetidos ao tratamento com BMAC tiveram uma melhora estatisticamente significativa nos escores de EVA e nos escores de Lequesne em comparação ao tratamento padrão. Houve uma melhora na avaliação da qualidade de vida em ambos os grupos, sem diferença estatisticamente significativa. CONCLUSÃO: O aspirado de medula óssea concentrada surge como uma alternativa ao tratamento padrão da tendinopatia glútea, provando ser uma técnica segura e com resultados promissores quando combinada à terapia comportamental de equipe multidisciplinar. Nível de Evidência II, O ensaio clínico randomizado.

Comparison between concentrated bone marrow aspirate and corticoid in gluteal tendinopathy / Comparação entre o aspirado de medula óssea concentrado e o corticóide na tendinopatia glútea

ABSTRACT Objective: To compare bone marrow aspirate concentrate (BMAC) with the standard treatment for gluteal tendinopathies. Methods: 48 patients diagnosed with gluteal tendinopathy at a university hospital were selected by a randomized clinical trial and divided into two groups: (G1) bone marrow aspirate concentrate and (G2) corticosteroid injections. Results: 40 of the 48 selected patients were monitored for six months and both groups showed better scores. Visual analog scale (VAS) scores and Lequesne index were statistically significant higher in patients submitted to BMAC treatment when compared to standard treatment. Both groups improved their quality of life, without statistically significant difference. Conclusion: BMAC constitutes an alternative to gluteal tendinopathy standard treatment, proving to be a safe technique with promising results when combined with multidisciplinary team behavioral therapy. Level of Evidence II, Randomized Clinical Trial.

RESUMO Objetivo: Estudo comparativo entre tratamento com corticóide e aspirado de medula óssea concentrado (BMAC) para o tratamento de tendinopatias glúteas. Métodos: O ensaio clínico randomizado selecionou pacientes diagnosticados com tendinopatia glútea e os dividiu em dois grupos: (G1) aspirado de medula óssea concentrada e (G2) injeção de corticosteróide. Resultados: Foram selecionados 48 pacientes, dos quais 40 foram monitorados por 6 meses, com melhora nos escores nos dois grupos. Os pacientes que foram submetidos ao tratamento com BMAC tiveram uma melhora estatisticamente significativa nos escores de EVA e nos escores de Lequesne em comparação ao tratamento padrão. Houve uma melhora na avaliação da qualidade de vida em ambos os grupos, sem diferença estatisticamente significativa. Conclusão: O aspirado de medula óssea concentrada surge como uma alternativa ao tratamento padrão da tendinopatia glútea, provando ser uma técnica segura e com resultados promissores quando combinada à terapia comportamental de equipe multidisciplinar. Nível de Evidência II, O ensaio clínico randomizado.

Use of autologous bone marrow stem cell implantation for osteonecrosis of the knee in sickle cell disease: a preliminary report.

BACKGROUND: The purpose of our study was to evaluate safety, feasibility and clinical results of bone marrow mononuclear cell (BMC) implantation for early-stage osteonecrosis of the knee (OK) secondary to sickle cell disease. METHODS: Thirty-three SCD patients (45 knees) with OK treated with BMC implantation in the osteonecrotic lesion were clinically and functionally evaluated through the American Knee Society Clinical Score (KSS), Knee Functional Score (KFS) and Numeric Rating Scale (NRS) pain score. MRI and radiographic examinations of the knee were assessed during a period of five years after intervention. RESULTS: No complications or serious adverse event were associated with BMC implantation. From preoperative assessment to the latest follow-up, there was a significant (p < 0.001) improvement of clinical KSS (64.3 ± 9.7, range: 45-80 and 2.2 ± 4.1, range: 84-100, respectively), KFS (44.5 ± 8.0, range: 30-55 and 91.6 ± 5.8, range: 80-100, respectively) and reduction of NRS pain score (6.7 ± 1.2, range: 4-9 and 3.4 ± 1.0, range: 2-5, respectively). In total, 87% of patients (29/33) consistently experienced improvements in joint function and activity level as compared to preoperative score. No patient had additional surgery following BMC implantation. Radiographic assessment showed joint preservation and no progression to subchondral collapse at most recent follow-up. CONCLUSIONS: The technique of BMC implantation is a promising, relatively simple and safe procedure for OK in SCD patients. Larger and long-term controlled trials are needed to support its clinical effectiveness. TRIAL REGISTRATION: ClinicalTrials.gov NCT02448121 . Retrospectively registered 19 May 2015.

Osteonecrosis in sickle cell disease patients from Bahia, Brazil: a cross-sectional study.

PURPOSE: The aim of this study was to describe the clinical features of osteonecrosis (ON) in sickle cell disease (SCD) patients in Bahia, a Northeast state with the highest prevalence of the disease in Brazil. METHODS: Between 2006 and 2017, 283 cases of osteonecrosis in SCD patients were enrolled to analyse the age at diagnosis, genotype, gender, pain, distribution of the lesions and disease staging. MRI and radiograph were obtained at the participation. RESULTS: Of the 283 SCD cases, 120 (42.4%) were haemoglobin SS genotype while 163 (57.6%) were SC genotype. Two hundred and forty-six cases were bilateral and 37 were unilateral, with an average age at diagnosis of 33.7 (range 10-67) years. The most frequent identified ON site not only was the hip (74.6%), but also affected shoulder, knee and ankle. Most cases presented at early stage I (172, 60.8%) disease. No significant differences on the features of osteonecrosis were identified between haemoglobin SS and haemoglobin SC cases. CONCLUSIONS: Given the relatively high prevalence of bilateral osteonecrosis at early stages, painful symptoms and rather late age at diagnosis, SCD patients should have radiological examination of their joints more often in order to prevent severe functional disability and increase patient's life quality.

Subtotal Calcanectomy for the Treatment of Chronic Ulcer Associated with Osteomyelitis: A Case Report.

INTRODUCTION: Subtotal calcanectomy is a therapeutic option for the treatment of chronic ulcer associated with calcaneal osteomyelitis. Closure of the surgical wound can be difficult due to the lack of local cutaneous coverage. We present the first case of subtotal calcanectomy in which the ankle was positioned in plantar flexion allowing the primary closure of the surgical wound without the need for flap. CASE REPORT: We present a case of 62-year-old female patient with a foot ulcer associated with osteomyelitis. After an initial assessment, a subtotal calcanectomy with primary wound closure was performed. After healing of the surgical wound, the patient started rehabilitation with recovery of dorsiflexion and independent gait without support after 12 weeks. CONCLUSION: The result shows that subtotal calcanectomy with the ankle in plantar flexion allows primary closure of the operative wound, without causing difficulty for rehabilitation.

VISCOSUPPLEMENTATION IN ANKLE OSTEOARTHRITIS: A SYSTEMATIC REVIEW.

To evaluate the efficacy of viscosupplementation in patients with osteoarthritis of the ankle. A systematic review to evaluate the evidence in the literature on the use of viscosupplementation for osteoarthritis of the ankle. For this review, we considered blind randomized prospective studies involving the use of viscosupplementation for osteoarthritis of the ankle. A total of 1,961 articles were identified in various databases. After examining each of the articles, five articles were included in this review. Treatment with intraarticular hyaluronic acid is a safe treatment modality that significantly improves functional scores of patients, with no evidence of superiority in relation to other conservative treatments. Further clinical trials with larger numbers of patients are needed so that we can recommend its use and address unanswered questions . Systematic Review of Randomized Clinical Trials.

VISCOSUPPLEMENTATION IN ANKLE OSTEOARTHRITIS: A SYSTEMATIC REVIEW

ABSTRACT To evaluate the efficacy of viscosupplementation in patients with osteoarthritis of the ankle. A systematic review to evaluate the evidence in the literature on the use of viscosupplementation for osteoarthritis of the ankle. For this review, we considered blind randomized prospective studies involving the use of viscosupplementation for osteoarthritis of the ankle. A total of 1,961 articles were identified in various databases. After examining each of the articles, five articles were included in this review. Treatment with intraarticular hyaluronic acid is a safe treatment modality that significantly improves functional scores of patients, with no evidence of superiority in relation to other conservative treatments. Further clinical trials with larger numbers of patients are needed so that we can recommend its use and address unanswered questions . Systematic Review of Randomized Clinical Trials.

Repruducibility of tronzo and ao/asif classifications for transtrochanteric fractures.

OBJECTIVE: To assess the reproducibility of Tronzo and AO/ASIF classifications for transtrochanteric fractures, in order to determine the most appropriate classification for clinical application, and to evaluate the influence of the level of experience of the observers in the agreement between evaluations. METHODS: We selected 30 radiographic images of transtrochanteric fractures of the femur, which were presented to two groups of observers, one formed by expert physicians and the other by resident physicians. RESULTS: When evaluated together, Tronzo classification obtained a Kappa value of 0.44. The same classification assessed by the expert group obtained a value of 0.46, while the group of residents' value was 0.44. Evaluating the AO/ASIF classification of the complete pool analysis the value found was 0.42. For the same classification, analyzed by the expert group, obtained a value of 0.41, and by the group of residents, the Kappa value achieved was 0.42. However, when analyzed in its simplified form, the AO/ASIF classification obtained Kappa values of 0.70 (pooled analysis), 0.68 (experts) and 0.72 (residents), considered concurrent. CONCLUSION: The AO/ASIF simplified classification showed substantial reproducibility and is, therefore, recommended as the most suitable for clinical application. The level of experience of the observers did not influence significantly the agreement between evaluations. Level of Evidence III, Diagnostic Study - Investigating a Diagnostic Test.

Repruducibility of TRONZO and AO/ASIF classifications for transtrochanteric fractures

Avaliar a reprodutibilidade das classificações de Tronzo eAO/ASIF para fraturas transtrocanterianas, determinar a classificaçãomais adequada para aplicação clínica, e avaliar a influência do nívelde experiência do avaliador na concordância das classificações.Métodos: Uma seleção de 30 imagens radiográficas de fraturastranstrocanterianas de fêmur foram apresentadas a dois grupos deobservadores, um formado por especialistas e o outro por residentes.Resultados: Quando avaliada em conjunto, a classificação de Tronzoobteve um valor de Kappa de 0,44. A mesma classificação avaliadapelo grupo de especialistas obteve um valor de 0,46, enquantoque pelo grupo de residentes, o valor foi de 0,44. Na avaliação daclassificação AO/ASIF completa em conjunto, o valor encontradofoi de 0,42. Para a mesma classificação analisada pelo grupo deespecialistas, o valor obtido foi de 0,41, e no grupo de residentes,o valor de Kappa foi de 0,42. Quando analisada em sua forma simplificada,a classificação AO/ASIF obteve os valores de Kappa de0,70 (análise em conjunto), 0,68 (especialistas) e 0,72 (residentes),sendo consideradas concordantes. Conclusão: A classificação AO/ASIF simplificada apresentou substancial reprodutibilidade, sendo,portanto recomendada como a mais adequada para aplicação clí-nica. O nível de experiência dos observadores não influenciou deforma significativa a concordância. Nível de Evidência III, EstudoDiagnóstico – Investigação de Um Exame Para Diagnóstico...

To assess the reproducibility of Tronzo and AO/ASIF classificationsfor transtrochanteric fractures, to determine the mostappropriate classification for clinical application, and to evaluate theinfluence of the level of experience of the observers in the agreementbetween evaluations. Methods: We selected 30 radiographicimages of transtrochanteric fractures of the femur, which were presentedto two groups of observers, one formed by expert physiciansand the other by resident physicians. Results: When evaluated together,Tronzo classification obtained a Kappa value of 0.44. Thesame classification assessed by the expert group obtained a valueof 0.46, while the group of residents’ value was 0.44. Evaluatingthe AO/ASIF classification of the complete pool analysis the valuefound was 0.42. For the same classification, analyzed by the expertgroup, obtained a value of 0.41, and by the group of residents, theKappa value achieved was 0.42. However, when analyzed in itssimplified form, the AO/ASIF classification obtained Kappa valuesof 0.70 (pooled analysis), 0.68 (experts) and 0.72 (residents), consideredconcurrent. Conclusion: The AO/ASIF simplified classificationshowed substantial reproducibility and is therefore recommendedas the most suitable for clinical application. The level of experienceof the observers did not influence significantly the agreementbetween evaluations. Level of Evidence III, Diagnostic Study– Investigating a Diagnostic Test...

Necessidade de movimentar-se e manter uma boa postura no idoso cirúrgico: quase-experimento / Necesidad del anciano quirúrgico de moverse y mantener una buena postura: casi-experimento / Need to move and maintain a good posture in elderly on surgery: quasi-experimental study

Objective: To identify in elderly people on surgery the need to move and maintain desirable postures; to evaluate the outcome of interventions for the need in a study group. Method: This is a quantitative and quasi-experimental study, conducted with 30 elderly in the postoperative in hospital in Rio de Janeiro. It was used for data collection the protocol for evaluation of basic needs second Virginia Henderson and for the experimental group was used the healthcare. Results: The main needs identified were painful to jogging, decreased joint flexibility, bed restriction, balance disorders, decreased strength and muscular endurance. From the 40 identified needs in the experimental group could be reduced 8 and in the control group from 35 were reduced to 3, obtained Oddis Ratio (0R) of 2,66. Conclusion: There was significant improvement in the experimental group and the reduction of the identified problems when compared to the control group.

Objetivos: Identificar em idosos cirúrgicos a necessidade de movimentar-se e manter uma boa postura; avaliar o desfecho das intervenções para a necessidade de movimentar-se em um grupo experimento e controle. Método: Trata-se de uma pesquisa quantitativa, quase experimental, aplicada a 30 idosos em pós-operatório num hospital localizado no Rio de Janeiro. Utilizou-se como instrumento de coleta dos dados um protocolo de avaliação das necessidades básicas segundo Virginia Henderson e ao grupo experimento aplicou-se intervenções. Resultados: As principais necessidades identificadas foram dores ao movimentar, diminuição da flexibilidade das articulações, restrição ao leito, déficit de equilíbrio, diminuição da força e da resistência muscular. Das 40 necessidades identificadas no grupo experimento conseguiu-se reduzir 8 e no controle das 35 necessidades identificadas houve redução de 3, obtendo-se Oddis Ratio (0R) de 2,66. Conclusão: Houve melhora significativa no grupo experimento quanto a redução dos problemas identificados quando comparado ao grupo controle.

Objetivo: Identificar en ancianos quirúrgicos la necesidad de moverse y mantener una Buena Postura; evaluar la conclusión de las intervenciones para la necesidad de moverse en los grupos. Método: Investigación cuantitativa, casi-experimental, aplicada a 30 ancianos en pos-operatorio en un hospital de Rio de Janeiro. Como instrumento de recolecta se empleó un protocolo de evaluación de necesidades básicas según Virginia Henderson y se aplicaron las intervenciones al grupo experimento. Resultados: Se identificaron como principales necesidades: dolores al moverse, reducción de flexibilidad articular, restricción al lecho, déficit de equilibrio, reducción de fuerza y resistencia muscular. De las 40 necesidades identificadas en el grupo experimento, se consiguió reducir 8 y en el control, de las 35 se redujo a 3, obtuvo una Oddis Ratio (OR) de 2,66. Conclusión: Se verificó mejoría en el grupo experimento respecto a la reducción de los problemas identificados cuando se comparó al grupo-control.

Lombalgia na atividade policial militar: análise da prevalência, repercussões laborativas e custo indireto / Lumbagia en la actividad de la policía militar: análsis de la prevalencia, impacto laboral y el costo indirecto / Low ack pain in the military police activity: analyis of prevalencce, job impact and indirect cost

Introdução: A dor lombar crônica é uma importante causa de sofrimento e incapacitação. Na atividade policial militar, o indivíduo está exposto a uma série de fatores que podem interferir em sua saúde. Alguns exercem funções internas como as atividades administrativas, outros fazem o policiamento ostensivo, permanecendo por muitas horas em pé e utilizando equipamentos, que aliados às condições do trabalho, podem levar à sobrecarga da coluna. Objetivo: Determinar a prevalência de lombalgia incapacitante em policiais militares do Estado da Bahia e estimar o gasto com pagamento de salários a esses policiais. Metodologia: Trata-se de um estudo quantitativo, transversal, de caráter descritivo simples, por meio de um levantamento retrospectivo de dados. Resultados: A dorsalgia foi a principal queixa nas inspeções médicas realizadas pela Junta de Saúde da Polícia Militar da Bahia. No presente trabalho foi observado um gasto, apenas com pagamento de salários de policiais afastados, de R$ 1.500.000,00 ao ano, sem considerar os custos diretos (medicamentos, consultas, internações). Conclusão: Fica claro, portanto, que a lombalgia onera os cofres públicos estaduais de maneira significativa e diminui a disponibilidade de policiais para o policiamento ostensivo. Portanto, é preciso que o Poder Público Estadual desenvolva estratégias de prevenção e reforce as medidas de tratamento, visando reabilitar esses militares no menor tempo possível.

Introduction: Chronic low back pain is a major cause of suffering and disability. In the military police activity, the individual is exposed to a number of factors that could affect its health. Some perform internal functions such as administrative activities, others do the patrolling, remaining for many hours standing and using equipment, which together with the conditions of work, can lead to overloading of the column. Objective: To determine the prevalence and constraints generated by the tables of low back pain in military police of the State of Bahia and estimate the indirect cost of absenteeism caused by low back pain in military police. Methodology: This is a quantitative, cross-sectional, descriptive simple, done through a retrospective survey data. Results: Back pain was the main complaint in the medical inspections conducted by the Board of Health of the Military Police of Bahia. In this study, we observed an expense, just to pay salaries for police officers away from R$ 1.5 million a year without considering direct costs (drugs, consultations, hospitalizations). Conclusion: Clearly, therefore, low back pain is levied on the public state coffers significantly. Therefore, it is necessary to develop prevention strategies and strengthen treatment measures aimed at rehabilitating this military police in the shortest time possible.

Introducción: El dolor lumbar crónico es una causa importante de sufrimiento e incapacidad. En la actividad de la policía militar, el individuo está expuesto a una serie de factores que podrían afectar su salud. Algunos realizan funciones internas como las actividades administrativas, otros hacen el patrullaje, permaneciendo por muchas horas de pie y con el uso de equipos, que junto con las condiciones de trabajo, pueden conducir a una sobrecarga de la columna. Objetivo: Determinar la prevalencia y las limitaciones generadas por las tablas de dolor de la región lumbar en la policía militar del Estado de Bahía y estimar el costo indirecto del ausentismo de la Policía Militar. Metodología: Se trata de un análisis cuantitativo, transversal, descriptivo simple, a través de una base de datos retrospectiva. Resultados: El dolor de la región lumbar es la queja principal de las inspecciones médicas llevadas a cabo por la Junta de Sanidad de la Policía Militar de Bahía. En este estudio, se observó un gasto, sólo para pagar los salarios de los agentes de policía, de R$ 1,5 millones al año, sin tener en cuenta los costos directos (fármacos, consultas, hospitalizaciones). Conclusión: Es evidente, por tanto, que el dolor de la región lumbar afecta las arcas del Estado de manera significativa. Por lo tanto, es necesario desarrollar estrategias de prevención y fortalecer las medidas de tratamiento de estos militares en el menor tiempo posible.