[Effects of physical training in patients with type 2 diabetes mellitus: a systematic review]. / Hemoglobina glicada y ejercicio: una revisión sistemática.

Physical training is recommended in several studies and guidelines for the control of type 2 diabetes mellitus (DM2) and its complications. We performed a systematic review about the effects of aerobic training (AT), resistance (RT) or the combination of both (AT/ RT), on glycated hemoglobin (HbA1c) in patients with DM2. Therefore, we included 15 clinical trials with at least 12 weeks duration about training program or recommendations of physical exercise, that evaluated the reduction in HbA1c levels in patients with DM2. Information was obtained on training modality (AT, RT or AT / RT), training parameters, duration and weekly training frequency. The results showed increases in peak or maximal oxygen uptake, exercise tolerance time and muscle strength, depending on the type of training, and a reduction in HbA1c levels. We conclude that exercise training is associated with reductions of HbA1c in patients with DM2. Thus, it can be a complementary tool in the management of these patients.

Hemoglobina glicada y ejercicio: una revisión sistemática / Effects of physical training in patients with type 2 diabetes mellitus: a systematic review

Physical training is recommended in several studies and guidelines for the control of type 2 diabetes mellitus (DM2) and its complications. We performed a systematic review about the effects of aerobic training (AT), resistance (RT) or the combination of both (AT/ RT), on glycated hemoglobin (HbA1c) in patients with DM2. Therefore, we included 15 clinical trials with at least 12 weeks duration about training program or recommendations of physical exercise, that evaluated the reduction in HbA1c levels in patients with DM2. Information was obtained on training modality (AT, RT or AT / RT), training parameters, duration and weekly training frequency. The results showed increases in peak or maximal oxygen uptake, exercise tolerance time and muscle strength, depending on the type of training, and a reduction in HbA1c levels. We conclude that exercise training is associated with reductions of HbA1c in patients with DM2. Thus, it can be a complementary tool in the management of these patients.

DIFFERENCES IN KNEE SENSORIMOTOR CONTROL BY PHYSICAL ACTIVITY LEVEL AND SEX.

OBJECTIVE: The aim of this study was to compare the differences in knee sensorimotor control between healthy men and women by measuring the joint position sense (JPS), sensation of muscle tension (steadiness), and onset of muscle activation (OMA). METHODS: Twenty-four healthy women and 27 healthy men were tested. Knee sensorimotor control was assessed using the JPS test with electrogoniometers in 3 different ranges of motion, sensation of muscle tension using the isometric steadiness technique, and OMA against a mechanical perturbation. Each assessment was compared by sex, physical activity level, and right or left lower limb. RESULTS: The men obtained better values in the JPS test between 90º and 60º and between 30º and 0º than the women. The subjects with higher levels of physical activity also showed better values, between 90º and 60º and between 30º and 0º. The best results for steadiness were found in the women and the subjects with higher levels of physical activity. In the OMA test, no significant differences were found in the studied variables. CONCLUSION: The results suggest that higher levels of physical activity may determine better sensorimotor control. Men have better articular sensation, and women have better muscle strength control. Level of evidence III, Cross sectional study.

OBJETIVO: O objetivo desse estudo foi comparar as diferenças no controle sensório-motor de joelho entre mulheres e homens saudáveis medindo o sensação da posição articular (SPA), Coeficiente de variações da força (Steadiness) e inicio ou ativação muscular (IAM). MÉTODOS: Foi avaliado 24 mulheres saudáveis e 27 homens saudáveis, realizando avaliações de SPA, o Sensação de tensão muscular (Steadiness) e o IAM, comparadas segundo sexo, nível de atividade física e extremidades inferiores direita ou esquerda. RESULTADOS: SPA: Os homens obtiveram melhores valores nessa prova entre 90-60° (p=0,0127) e em 30-0° (p=0,0017) ao comparado com as mulheres. as pessoas com maior nível de atividade física também se encontram melhores resultados entre 90-60° (p=0,0328) e 30-0° (p=0,0173). STEADINESS: Os melhores resultados foram para as mulheres em ambas extremidades (direita p=0,0002 e esquerda p=0,0009) e pessoas com maior nível de atividade física (direita p=0,0065 e esquerda p=0,0173). Para IAM não foi encontrado diferenças significativas nas variáveis estudadas. CONCLUSÃO: Os resultados sugerem que tanto maior nível de atividade física puderam determinar maior resultado no controle sensório-motor. Os homens tiveram maior sensação articular e as mulheres maior controle steadiness. Nível de evidência III, Estudo transversal.

Differences in knee sensorimotor control by physical activity level and sex / Diferenças no controle sensorimotor do joelho por nível atividade física e sexo

ABSTRACT Objective: The aim of this study was to compare the differences in knee sensorimotor control between healthy men and women by measuring the joint position sense (JPS), sensation of muscle tension (steadiness), and onset of muscle activation (OMA). Methods: Twenty-four healthy women and 27 healthy men were tested. Knee sensorimotor control was assessed using the JPS test with electrogoniometers in 3 different ranges of motion, sensation of muscle tension using the isometric steadiness technique, and OMA against a mechanical perturbation. Each assessment was compared by sex, physical activity level, and right or left lower limb. Results: The men obtained better values in the JPS test between 90º and 60º and between 30º and 0º than the women. The subjects with higher levels of physical activity also showed better values, between 90º and 60º and between 30º and 0º. The best results for steadiness were found in the women and the subjects with higher levels of physical activity. In the OMA test, no significant differences were found in the studied variables. Conclusion: The results suggest that higher levels of physical activity may determine better sensorimotor control. Men have better articular sensation, and women have better muscle strength control. Level of evidence III, Cross sectional study.

RESUMO Objetivo: O objetivo desse estudo foi comparar as diferenças no controle sensório-motor de joelho entre mulheres e homens saudáveis medindo o sensação da posição articular (SPA), Coeficiente de variações da força (Steadiness) e inicio ou ativação muscular (IAM) Métodos: Foi avaliado 24 mulheres saudáveis e 27 homens saudáveis, realizando avaliações de SPA, o Sensação de tensão muscular (Steadiness) e o IAM, comparadas segundo sexo, nível de atividade física e extremidades inferiores direita ou esquerda. Resultados: SPA: Os homens obtiveram melhores valores nessa prova entre 90-60° (p=0,0127) e em 30-0° (p=0,0017) ao comparado com as mulheres. as pessoas com maior nível de atividade física também se encontram melhores resultados entre 90-60° (p=0,0328) e 30-0° (p=0,0173). STEADINESS: Os melhores resultados foram para as mulheres em ambas extremidades (direita p=0,0002 e esquerda p=0,0009) e pessoas com maior nível de atividade física (direita p=0,0065 e esquerda p=0,0173). Para IAM não foi encontrado diferenças significativas nas variáveis estudadas. Conclusão: Os resultados sugerem que tanto maior nível de atividade física puderam determinar maior resultado no controle sensório-motor. Os homens tiveram maior sensação articular e as mulheres maior controle steadiness. Nível de evidência III, Estudo transversal.

Knee sensorimotor control following anterior cruciate ligament reconstruction: A comparison between reconstruction techniques.

The sensorimotor system helps to maintain functional joint stability during movement. After anterior cruciate ligament (ACL) injury and reconstruction, several sensorimotor deficits may arise, including altered proprioception and changes in neuromuscular control. It is still unknown whether the type of autograft used in the reconstruction may influence knee sensorimotor impairments. The aim of this study was to comparatively assess the effects of the hamstring tendon (HT) and bone-patellar tendon-bone (BPTB) ACL reconstruction techniques on knee sensorimotor control 6-12 months post-operation. A total of 83 male subjects participated in this study: 27 healthy participants, 30 BPTB-operated patients and 26 HT-operated patients. Active joint position sense in 3 ranges of motion (90-60°, 60-30°, and 30-0° of knee flexion), isometric steadiness, and onset of muscle activation were used to compare sensorimotor system function between groups. Both operated groups had a small (< 5°) but significant joint position sense error in the 30-0° range when compared to the healthy group. No significant differences were found between the operated and the control groups for isometric steadiness or onset of muscle activation. The results of this study suggest that operated patients present knee proprioceptive deficits independently of surgical technique. Nevertheless, the clinical implications of this impairment are still unknown. It seems that selected surgical approach for ACL reconstruction do not affect functioning of the sensorimotor system to a large degree.

Somatotypes of schoolchildren from Chile: higher endomorphic components among adolescent girls.

OBJECTIVE: this investigation describes the somatotype components and somatotype as a whole in Chilean children and adolescents. METHODS: a cross-sectional study was conducted in Valparaiso, Chile. The somatotypes of 1,409 schoolchildren (747 males) aged 6 to 18 yearswere assessed using the Heath-Carter anthropometric method. Comparative category analyses (endomorph, mesomorph, and ectomorph) were performed using t-tests. To analyze whole somatotypes along two and three dimensions, the somatotype dispersion mean (SDM) and somatotype attitudinal mean (SAM), respectively, were used in addition to a somatochart representation. RESULTS: the somatotype of the male sample showed a marked mesomorph-endomorph biotype (4.9-4.8-2.1), whereas that for the female sample showed a mesomorphic endomorph classification (5.8-4.3-1.8). The samples differed significantly by sex, with an increased endomorphic component observed in females aged 13 to 18 years old. These sex differences were primarily evident in adolescents with high somatotype values in two or three dimensions (SDM ≥ 3.0; SAM ≥ 1.2), indicating high between-group dispersion. The somatocharts showed displacement of the endomorphic components for both sexes, particularly females. CONCLUSIONS: the results provide strong evidence that biotype changes have increased, primarily in terms of relative adiposity (i.e., the endomorphiccomponent) and predominantly in adolescent girls.

Somatotypes of schoolchildren from chile: higher endomorphic components among adolescent girls / El somatotipo de escolares chilenos: altos componentes endomórfi cos en mujeres adolescentes

Objective: this investigation describes the somatotype components and somatotype as a whole in Chilean children and adolescents. Methods: a cross-sectional study was conducted in Valparaiso, Chile. The somatotypes of 1,409 schoolchildren (747 males) aged 6 to 18 years were assessed using the Heath-Carter anthropometric method. Comparative category analyses (endomorph, mesomorph, and ectomorph) were performed using t-tests. To analyze whole somatotypes along two and three dimensions, the somatotype dispersion mean (SDM) and somatotype attitudinal mean (SAM), respectively, were used in addition to a somatochart representation. Results: the somatotype of the male sample showed a marked mesomorph-endomorph biotype (4.9-4.8-2.1), whereas that for the female sample showed a mesomorphic endomorph classification (5.8-4.3-1.8). The samples differed significantly by sex, with an increased endomorphic component observed in females aged 13 to 18 years old. These sex differences were primarily evident in adolescents with high somatotype values in two or three dimensions (SDM ≥ 3.0; SAM ≥ 1.2), indicating high between-group dispersion. The somatocharts showed displacement of the endomorphic components for both sexes, particularly females. Conclusions: the results provide strong evidence that biotype changes have increased, primarily in terms of relative adiposity (i.e., the endomorphic component) and predominantly in adolescent girls

Objetivo: esta investigación tiene por objetivo describir los componentes del somatotipo en niños y adolescentes chilenos. Métodos: se realizo un estudio transversal en la región de Valparaiso, Chile. Se evaluó el somatotipo de 1.409 escolares (747 hombres) de 6 a 18 anos de edad utilizando el método antropometrico de Heath-Carter. Los análisis comparativos por componentes (endomorfia, mesomorfia y ectomorfia) fueron realizados mediante pruebas t. Para analizar el somatotipo como un todo se realizó el cálculo en dos y tres dimensiones, se utilizaron la distancia de dispersión del somatotipo medio (DSM) y la dispersión morfogenica media (DMM) respectivamente, además de una representación en la somatocarta. Resultados: el somatotipo de la muestra masculina mostro un marcado biotipo mesomorfo-endomorfo (4,9-4,8-2,1), mientras que el de la muestra femenina mostro una clasificación meso-endomorfica (5,8-4,3-1,8). Las muestras difirieron significativamente según sexo, con un elevado componente endomorfico observado en mujeres de 13 a 18 años de edad. Estas diferencias en adolescentes por sexo tambien fueron observadas en el análisis del somatotipo en dos y tres dimensiones (DSM ≥ 3,0, DMM ≥ 1,2), lo que indica una alta dispersión entre grupos. Además, las somatocartas mostraron un desplazamiento hacia componentes endomorficos para ambos sexos, principalmente en mujeres. Conclusiones: los resultados proporcionan una fuerte evidencia de que los cambios en los biotipos han aumentado, principalmente en términos de adiposidad relativa (componente endomorfico) y predominantemente en adolescentes mujeres

Evaluation of the thickness of the proximal femoral canal in patients living at altitude.

OBJECTIVE: Our goal is to confirm the hypothesis that people who were born and raised on cities at altitude have a smaller proximal femoral canal. METHODS: Prospective study with 169 participants, divided into two groups. Group A: 99 patients who were born and raised at altitude and group B: 70 patients who were born and raised at low altitude. All patients underwent panoramic radiographs of the pelvis, where we marked three measure and checked the thickness of the cortical and the lateral and medial cortical, as well as the thickness of the femoral canal. RESULTS: We noticed that the first measure showed no significant difference in both groups, but the second measure, the lateral cortex, is thicker in group A, and the femoral canal is smaller in comparison to group B. CONCLUSION: We concluded that patients who were born and raised at altitude have a smaller femoral canal. This may help in proper planning of future surgical procedures, especially in total hip arthroplasty cases.

Evaluation of the thickness of the proximal femoral canal in patients living at altitude

OBJECTIVE: Our goal is to confirm the hypothesis that people who were born and raised on cities at altitude have a smaller proximal femoral canal. METHODS: Prospective study with 169 participants, divided into two groups. Group A: 99 patients who were born and raised at altitude and group B: 70 patients who were born and raised at low altitude. All patients underwent panoramic radiographs of the pelvis, where we marked three measure and checked the thickness of the cortical and the lateral and medial cortical, as well as the thickness of the femoral canal. RESULTS: We noticed that the first measure showed no significant difference in both groups, but the second measure, the lateral cortex, is thicker in group A, and the femoral canal is smaller in comparison to group B. CONCLUSION: We concluded that patients who were born and raised at altitude have a smaller femoral canal. This may help in proper planning of future surgical procedures, especially in total hip arthroplasty cases. Level of Evidence II, Development of Diagnostic Criteria in Consecutive Patients (with universally applied reference "gold" standard).

Análise biomecânica e histológica de tendões flexores reparados em coelhos usando três técnicas de sutura (quatro e seis passadas) com mobilização ativa precoce / Biomechanics and histological analysis in rabbit flexor tendons repaired using three suture techniques (four and six strands) with early active mobilization

OBJETIVO: Analisar o tempo das suturas, a biomecânica (deformidade entre os cotos tendíneos) e a histologia dos três grupos de reparo cirúrgico tendíneo: Brasil-2 (quatro passadas), com técnica de sutura central em que o nó final se encontra fora do tendão; Indiana (quatro passadas); e Tsai (seis passadas), com técnicas de sutura central em que o nó final se encontra no interior do tendão reparado, associados de mobilização ativa precoce. MÉTODOS: O tendão calcâneo direito de 36 coelhos da raça New Zealand foi escolhido para a análise. Este apresenta calibre semelhante ao tendão flexor humano, o qual tem aproximadamente 4,5mm (variando 2mm para mais ou menos). A amostra selecionada apresentava a mesma massa (2,5 a 3kg) e eram adultos machos ou fêmeas (a partir de 8½ meses de idade). RESULTADOS: Na análise biomecânica, não houve diferença estatisticamente significativa (p > 0,01). Não houve diferença estatística com relação ao tempo cirúrgico na realização das três técnicas de suturas (p > 0,01). Evidenciou-se, qualitativamente e quantitativamente, com a mobilidade ativa precoce, um espessamento da fibra de colágeno em 38,9% dentro do 15º dia e de 66,7% dentro do período do 30º dia (p = 0,095). CONCLUSÃO: Esta investigação serviu para demonstrar que não houve diferença histológica do nó final da sutura central dentro ou fora do tendão reparado, bem como o número de passadas, no que diz respeito à cicatrização, vascularização ou deformidade do tendão no túnel osteofibroso com as técnicas de reparo aplicadas, associados de mobilização ativa precoce.

OBJECTIVE: analyzing suture time, biomechanics (deformity between the stumps) and the histology of three groups of tendinous surgical repair: Brazil-2 (4-strands) which the end knot (core) is located outside the tendon, Indiana (4-strands) and Tsai (6-strands) with sutures technique which the end knot (core) is inner of the tendon, associated with early active mobilization. METHODS: the right calcaneal tendons of 36 rabbits of the New Zealand breed were used in the analysis. This sample presents similar size to human flexor tendon that has approximately 4.5 mm (varying from 2mm). The selected sample showed the same mass (2.5 to 3kg) and were male or female adults (from 8 ½ months). RESULTS: in the biomechanical analysis, there was no statistically significant difference (p>0.01). There was no statistical difference in relation to surgical time in all three suture techniques (p>0.01). With the early active mobility, there was qualitative and quantitative evidence of thickening of collagen in 38.9% on the 15th day and in 66.7% on the 30th day, making the biological tissue stronger and more resistant (p=0.095). CONCLUSION: this study demonstrated that there was no histological difference between the results achieved with an inside or outside end knot with respect to the repaired tendon and the number of strands did not affect healing, vascularization or sliding of the tendon in the osteofibrous tunnel, which are associated with early active mobility, with the repair techniques applied.

BIOMECHANICS AND HISTOLOGICAL ANALYSIS IN RABBIT FLEXOR TENDONS REPAIRED USING THREE SUTURE TECHNIQUES (FOUR AND SIX STRANDS) WITH EARLY ACTIVE MOBILIZATION.

OBJECTIVE: Analyzing suture time, biomechanics (deformity between the stumps) and the histology of three groups of tendinous surgical repair: Brazil-2 (4-strands) which the end knot (core) is located outside the tendon, Indiana (4-strands) and Tsai (6-strands) with sutures technique which the end knot (core) is inner of the tendon, associated with early active mobilization. METHODS: The right calcaneal tendons (plantar flexor of the hind paw) of 36 rabbits of the New Zealand breed (Oryctolagus cuniculus) were used in the analysis. This sample presents similar size to human flexor tendon that has approximately 4.5 mm (varying from 2mm). The selected sample showed the same mass (2.5 to 3kg) and were male or female adults (from 8 ½ months). For the flexor tendons of the hind paws, sterile and driven techniques were used in accordance to the Committee on Animal Research and Ethics (CETEA) of the University of the State of Santa Catarina (UDESC), municipality of Lages, in Brazil (protocol # 1.33.09). RESULTS: In the biomechanical analysis (deformity) carried out between tendinous stumps, there was no statistically significant difference (p>0.01). There was no statistical difference in relation to surgical time in all three suture techniques with a mean of 6.0 minutes for Tsai (6- strands), 5.7 minutes for Indiana (4-strands) and 5.6 minutes for Brazil (4-strands) (p>0.01). With the early active mobility, there was qualitative and quantitative evidence of thickening of collagen in 38.9% on the 15(th) day and in 66.7% on the 30(th) day, making the biological tissue stronger and more resistant (p=0.095). CONCLUSION: This study demonstrated that there was no histological difference between the results achieved with an inside or outside end knot with respect to the repaired tendon and the number of strands did not affect healing, vascularization or sliding of the tendon in the osteofibrous tunnel, which are associated with early active mobility, with the repair techniques applied.

Complicações em artroscopia de quadril / Complications in hip arthroscopy

OBJETIVOS: Determinar a prevalência de complicações ocorridas em uma série de casos consecutivos de artroscopia de quadril; avaliar a evolução da casuística através de uma curva de aprendizado; reconhecer as causas das complicações nas cirurgias do quadril por via artroscópica. MÉTODOS: Foram avaliados 150 casos consecutivos submetidos à artroscopia de quadril no período de maio de 2004 a dezembro de 2008. As complicações encontradas foram classificadas sob três aspectos: sistema orgânico acometido, gravidade, grupos de 50 casos de acordo com a ordem de realização do procedimento. Utilizaram-se para a análise dos dados obtidos a estatística descritiva e o teste exato de Fisher. RESULTADOS: Observaram-se 15 complicações (10 por cento) neste estudo. Dez foram complicações neurológicas, duas osteoarticulares, uma vásculo-isquêmica e duas cutâneas. Na classificação de gravidade, três foram classificadas como maiores, 12 intermediárias e nenhuma considerada menor. A incidência das complicações ao longo da curva de aprendizado não apresentou diferença estatística significativa (p = 0,16). CONCLUSÕES:A artroscopia de quadril é um procedimento cirúrgico de baixa morbidade, que cursa, em alguns casos, com complicações. Essas são, frequentemente, neurológicas e transitórias. Elas ocorrem, principalmente, devido à tração articular. A taxa de complicações não diminuiu com o evoluir da casuística.

OBJECTIVES: to determine the prevalence of complications in a series of consecutive cases of hip arthroscopy; to assess the progression of the casuistic through a learning curve; and to recognize the causes of complications in arthroscopic hip surgeries. METHOD: 150 consecutive cases were evaluated, who were submitted to hip arthroscopy from May 2004 through December 2008. All the surgical complications described were classified according to three aspects: organic system involved, severity, and every 50 consecutive cases. The data obtained were analyzed, and statistical analysis was carried out using Fischer's exact test. RESULTS: We observed 15 complications (10 percent) in this study; two osteoarticular, one ischemic vascular and two cutaneous. In the classification of severity, 3 were classified as very severe, 12 as intermediary and none as not severe. The incidence of complications through our learning curve showed no statistical significance (p=0.16). CONCLUSIONS: Hip arthroscopy is a surgical procedure that involves low morbidity, but that still presents complications in some cases. These complications are frequently neurological and non-permanent, and are mainly due to the joint traction. The complication rate did not decrease with the progression of our casuistic.

INTRA ARTICULAR CALCANEAL FRACTURES: A CLINICAL AND BIOMECHANICAL ANALYSIS.

OBJECTIVE: Verify the variables of plantar pressure distribution of patients submitted to surgical procedure for calcaneal fracture, and correlate them with two different surgical approaches. METHOD: The authors studied 15 patients between 20 and 53 years of age (average 40.06 yrs.) who had intra-joint calcaneal fractures, submitted to surgical treatment by means of two different approaches: the lateral and the sinus tarsi. The authors checked the plantar pressure distribution by correlating these variables with the two different surgical approaches. The plantar pressure distribution was assessed using the Pedar System (Novel, Gmbh, Munich, Germany), by checking the maximum peak of the hindfoot and forefoot pressure on the affected and the normal sides. RESULTS: the mean maximum pressure of the hindfoot plantigram in both approaches showed no statistical difference (t=0.11; p=0.91), as well as the mean maximum pressure of the forefoot plantigram (t=-0,48; p=0,64). CONCLUSION: The authors have concluded that there were no significant statistical differences between the average maximum peak of the hindfoot and forefoot pressure on the affected side as compared to the normal side, and these variables have showed no differences when compared to the surgical approach used.

Fraturas intra-articulares do calcâneo: análise clínica e biomecânica / Intraarticular calcaneal fracture: a clinical and biomechanical analysis

OBJETIVO: Verificar as variáveis de distribuição da pressão plantar de pacientes submetidos a tratamento cirúrgico de fratura de calcâneo e correlacioná-las com duas diferentes vias de acesso cirúrgico. Métodos: Os autores estudaram 15 pacientes com idade entre 20 e 53 anos (média de 40,06 anos) que apresentaram fraturas intra-articulares do calcâneo, submetidos ao tratamento cirúrgico por duas vias de acesso cirúrgico, a via lateral e a via do seio do tarso. Avaliaram a distribuição da pressão plantar, correlacionando essas variáveis com as duas vias de acesso. A avaliação da distribuição da pressão plantar foi rea-lizada através do sistema Pedar (Novel, GmbH, Munique, Alemanha), verificando o pico máximo de pressão do retropé e do antepé do lado fraturado e do lado normal. RESULTADOS: A média das pressões máximas dos plantigramas do retropé dos pés operados pela via de acesso lateral e pela via curta não apresentou diferença estatística entre as duas vias de acesso (t = 0,11; p = 0,91), bem como a média das pressões máximas dos plantigramas do antepé também não mostrou diferença estatística significativa (t = -0,48; p = 0,64). CONCLUSÃO: Os autores concluíram que não houve diferença estatística entre as médias dos picos máximos de pressão do retropé e do antepé do lado operado, comparados com o lado normal, bem como não houve diferença estatística dessas variáveis comparadas com a via de acesso cirúrgico utilizada.

OBJECTIVE: Verify the variables of plantar pressure distribution of patients submitted to surgical procedure for calcaneal fracture, and correlate them with two different surgical approaches. Method: The authors studied 15 patients between 20 and 53 years of age (average 40.06 yrs.) who had intra-joint calcaneal fractures, submitted to surgical treatment by means of two different approaches: the lateral and the sinus tarsi. The authors checked the plantar pressure distribution by correlating these variables with the two different surgical approaches. The plantar pressure distribution was assessed using the Pedar System (Novel, Gmbh, Munich, Germany), by checking the maximum peak of the hindfoot and forefoot pressure on the affected and the normal sides. RESULTS: the mean maximum pressure of the hindfoot plantigram in both approaches showed no statistical difference (t=0.11; p=0.91), as well as the mean maximum pressure of the forefoot plantigram (t=-0,48; p=0,64). CONCLUSION: The authors have concluded that there were no significant statistical differences between the average maximum peak of the hindfoot and forefoot pressure on the affected side as compared to the normal side, and these variables have showed no differences when compared to the surgical approach used.

Composição corporal de pacientes acamados por fraturas do quadril / Body composition in bed-ridden adult patients by hip fracture

As fraturas do quadril são a maior causa de hospitalização da terceira idade, e constituem um considerável encargo econômico e social. A taxa de mortalidade atual após um ano de fratura é acima de 33 por cento, e o risco de morte é maior do quarto ao sexto mês após a fratura. O objetivo deste estudo foi de avaliar alterações na composição corporal de pacientes idosos, durante sua hospitalização por fraturas fêmur proximal, através de métodos antropométricos e análise dos valores fisiológicos de gasto energético. Foi realizado um estudo prospectivo utilizando-se 45 pacientes consecutivos com diagnóstico de fratura do quadril. Em todos os casos, foram obtidas medidas diretas e avaliações antropométricas indiretas baseadas em estimativas, nas primeiras 24 horas e repetidas após uma semana de admissão hospitalar. Após uma semana de internação houve diminuição da média do perímetro do braço (0,73 cm, p=0.0052) e da espessura da prega tricipital (1.41 mm, p=0.0181), sem haver modificação das outras variáveis estudadas. A avaliação antropométrica como um meio de se fazer um mapa da composição corporal, em conjunto com as estimativas indiretas sugeridas neste estudo, podem ajudar a determinar o estado nutricional e necessidades calóricas de pacientes idosos.

Hip fractures are a major cause of hospitalization among the elderly, and constitute a considerable social and economic burden. The current mortality rate one year after hip fracture is over 33 percent, the risk of death is greatest 4 to 6 months after fracture. The objective of this study was to use anthropometric methods and physiological energy-expenditure values to assess changes in body composition during hospitalization, in elderly patients admitted for fractures of the proximal femur. A prospective study was performed using a consecutive sequence of 45 patients with diagnosed hip fracture. In all cases, direct measurements and indirect estimate-based anthropometric evaluation were performed in the first 24 hours following admission, and again one week after admission. By one week after admission, there was a decrease in mean arm girth (0.73 cm, p=0.0052) and in triceps fold thickness (1.41 mm, p=0.0181), but not in the other variables tested. Anthropometric evaluation as a means of charting body composition, in conjunction with the indirect estimates suggested here, may help to determine nutritional status and calorie requirements in elderly patients.

Fractures of osteochondroma during physical exercise.

BACKGROUND: The mechanism responsible and the best form of treatment for fractures of osteochondromas remain unclear. PURPOSE: We studied the incidence, cause, treatment, and outcome of fractures of osteochondroma over a 17-year period. STUDY DESIGN: Retrospective cohort study. METHODS: We retrospectively reviewed all cases of osteochondroma at one institution over 17 years (1985 to 2002) to identify cases of fractures. These patients were then contacted for follow-up. RESULTS: Seven cases of fracture through the stalk of a pedunculated osteochondroma were identified. All fractures were sustained during physical exercise. One fracture was due to a direct blow, and the others to indirect muscle or tendon injury. Five patients were treated surgically with excision of the osteochondroma, and the other two received nonoperative treatment consisting of restriction of physical activity and observation. In all cases, patients were able to resume sporting activity within 4 to 8 weeks. The recovery period was shorter for patients who received surgical treatment. CONCLUSIONS: Surgical excision of the fractured osteochondroma may be preferable for patients engaging in sport.