[Evaluation of the pain in older people]. / Evaluación del dolor en el adulto mayor.

OBJECTIVE: To compare the information obtained of the percentage of improvement declared orally with the improvement marked in the visual analogical scale (VAS) in patients under and over 65 years of age. PATIENTS AND METHODS: Ninety-five individuals with acute shoulder pain (enthesitis) were evaluated. The subjects were requested to mark the pain intensity in the VAS before a treatment with corticosteroid injection in the shoulder and were evaluated again through the VAS one week after the procedure. They were also requested to declare orally the pain intensity. Then, the information was compared between patients aged under and over 65 years of age. RESULTS: 29.8% of those younger than 65 years, and 60.95% of those older than that age presented more than 10% difference between orally stated and calculated pain relief percentage based on the VSA. CONCLUSION: The difference between the orally stated and the calculated pain relief percentage based on the VSA was significantly higher in the group of those older than 65 years. This finding proved that the VAS is a poor method to evaluate pain relief in the senior population.

Comparar las informaciones obtenidas del porcentaje verbal de mejoría declarada verbalmente con la escala visual analógica (EVA) en personas con edad menor y mayor o igual de 65 años.

Medial Malleolar Fractures: An Anatomic Survey Determining the Ideal Screw Length.

BACKGROUND: Medial malleolar fractures are frequent, and their treatment is familiar to the orthopedic surgeon. Lag screw fixation using partially threaded screws remains the standard treatment method for medial malleolar fractures. However, the literature lacks a defined method for selecting lag screw length, relying more so on the empiric choice of the surgeon. AIM: The aim of this study is to help define the ideal lag screw length for medial melleolar fracture fixation. MATERIALS AND METHODS: One hundred and sixteen anatomic specimens were included in the study. A transverse cut was performed in the distal third of the tibia, roughly 1 and a half times the distal tibial plafond width from the ankle joint. A coronal cut was then performed using the center of the medial malleolus. Three observers measured the distance between the medial malleolus tip and beginning of the medullary canal in all anatomic specimens. Differences in measurements were statistically compared, level of (P ≤ 0.05). Interclass correlation coefficient (ICC) significance level was set at P < 0.05. RESULTS: Measurement average was 55 mm between the medial malleolus tip and the medullary canal, with a standard deviation of 10 mm. High concordance (ICC: 0.819) was achieved among all pairs of observers (P < 0.01). The systematic difference among measurements was absent, and random distribution around general measurements was observed. CONCLUSION: The authors recommend a screw length of no more than 45 mm to optimize the location of the screw threads in the best cancellous bone in an effort to obtain the most compression.

Subtrochanteric and Distal Femur Fractures in a Patient with Femoral Shaft Fracture Malunion and Knee Disarticulation: A Rare and Challenging Case Report.

This study aims to describe a rare and challenging case of a patient who presented ipsilateral subtrochanteric and distal femur fractures due to low-energy trauma. The peculiarity of this case is the presence of femoral shaft fracture malunion and knee disarticulation in the same limb resulting from an accident suffered 30 years ago. The patient underwent femoral diaphyseal osteotomy and fixation of the subtrochanteric and distal femur fractures with a long cephalomedullary nail and distal femur locking plate, respectively. Despite the magnitude of the surgical procedure, all fractures healed, preserving the femoral length with the absence of infection and clinical complications. There was an improvement of the preinjury function attributed to the osteotomy of the femoral diaphyseal, which alleviated the anterior thigh discomfort.

Intrapartum Pubic Symphysis Disruption.

During pregnancy, high progesterone and relaxin levels produce physiological ligament relaxation on the pelvis. Therefore, moderate pubic symphysis and sacroiliac joints relaxing provide birth canal widening, thereby facilitating vaginal delivery. Sometimes, functional pain or pelvic instability may occur during pregnancy or puerperium, which is defined as symptomatic pelvic girdle relaxation. In rare cases, a pubic symphysis disruption can occur during the labor, causing severe pain and functional limitations. The early recognition of this injury is crucial to prevent complications and improve clinical and functional outcomes. This study reports an acute symphyseal disruption resulting from childbirth in a primiparous patient who underwent open reduction and internal fixation with plate and screws. After a 6 months follow-up, the patient presented no pain and satisfactory functional recovery.