Protocol of BRICS: Brazilian multicentric pragmatic randomised trial of surgical interventions for displaced diaphyseal clavicle fracture study: MIPO versus ORIF for the treatment of displaced midshaft clavicle fractures.

INTRODUCTION: Fractures of the diaphysis of the clavicle are common; however, treatment guidelines for this condition are lacking. Surgery is associated with a lower risk of non-union and better functional outcomes but a higher risk of complications. Open reduction and internal fixation with plates and screws are the most commonly performed techniques, but they are associated with paraesthesia in the areas of incisions, extensive surgical exposure and high rates of implant removal. Minimally invasive techniques for treating these fractures have a lower rate of complications. The aim of this study is to evaluate which surgical treatment option (minimally invasive osteosynthesis or open reduction and internal fixation) has better prognosis in terms of complications and reoperations. METHODS AND ANALYSIS: The study proposed is a multicentric, pragmatic, randomised, open-label, superiority clinical trial between minimally invasive osteosynthesis and open reduction and internal fixation for surgical treatment of patients with displaced fractures of the clavicle shaft. In the proposed study, 190 individuals with displaced midshaft clavicle fractures, who require surgery as treatment, will be randomised. The assessment will occur at 2, 6, 12, 24 and 48 weeks, respectively. The primary outcome of the study will be the number of complications and reoperations. For sample size calculation, a moderate effective size between the techniques was considered in a two-tailed test, with 95% confidence and 90% power. Complications include cases of infection, hypertrophic scarring, non-union, refracture, implant failure, hypoesthesia, skin irritation and shoulder pain. Reoperations are defined as the number of surgeries for pseudoarthrosis, implant failure, infection and elective removal of the implant. ETHICS AND DISSEMINATION: Study approved by the institutional ethics committee (number 34249120.9.0000.5505-V.3). The results will be disseminated by publications in peer-reviewed journals and presentations in medical meetings. TRIAL REGISTRATION NUMBER: RBR-3czz68)/UTN U1111-1257-8953.

Is it advantageous to add epinephrine to the arthroscopic infusion solution for the treatment of rotator cuff injury? / E vantajosa a adicao de epinefrina na solucao de infusao artroscopica no tratamento da lesao do manguito rotador?

OBJECTIVE: To evaluate the use of epinephrine in arthroscopic infusion serum as a measure to improve the quality of surgical viewing during procedures for treating rotator cuff tears. METHODS: This was a prospective randomized double-blind comparative study in which 49 arthroscopic repair procedures on rotator cuff tears were evaluated. Patients presenting ASA I and II surgical risk were included. The patients were placed into two groups: the first with epinephrine (1 mg/L) in the infusion serum and the second with pure physiological solution. A single surgeon was responsible for the procedures, without knowledge of the medication usage. The surgeon rated his quality of viewing during the operation, on an increasing scale from 0 to 10. Interscalene block or suprascapular nerve block was chosen randomly and used in association with general anesthesia. The anesthetist issued final report relating to possible intercurrences. RESULTS: The group with epinephrine received an average score of 9.29 and the group without epinephrine received an average score of 7.16. The difference was statistically significant (p < 0.05). There was no important clinical alteration relating to use of this drug. CONCLUSION: As well as being safe, addition of epinephrine at a concentration of 1 mg/L to the infusion serum was shown to be effective for improving the visual field during arthroscopy to repair rotator cuff injuries.. .

OBJETIVO:Avaliar o uso da epinefrina no soro de infusão artroscópica como medida para melhorar a qualidade da visualização cirúrgica durante procedimentos de tratamento das rupturas do manguito rotador. MÉTODOS: Este é um estudo prospectivo, randomizado, comparativo e duplo cego, em que foram avaliados 49 procedimentos de reparo artroscópico da lesão do manguito rotador. Foram incluídos pacientes com risco cirúrgico ASA I e II. Os pacientes foram colocados em dois grupos, contendo o primeiro grupo epinefrina (1mg/L) no soro de infusão e o segundo grupo solução fisiológica pura. Um único cirurgião foi responsável pelos procedimentos sem conhecimento sobre o uso da medicação. O cirurgião atribuiu uma nota crescente (0-10) referente à sua visualização durante o ato operatório. O bloqueio interescalênico ou o bloqueio no nervo supraescapular foram associados à anestesia geral, escolhidos de forma aleatória. O anestesista emitiu um relatório final referente às possíveis intercorrências. RESULTADOS : O grupo que recebeu epinefrina obteve nota média de 9,29 e o grupo que não recebeu obteve a nota média de 7,16. A diferença foi estatisticamente significativa (p < 0,05). Não houve alteração clínica importante relacionada ao uso do fármaco. CONCLUSÃO : Além de segura, a adição da epinefrina na concentração de 1mg/L ao soro de infusão se mostrou eficaz quanto à melhoria do campo visual durante a artroscopia para reparo das lesões do manguito rotador. .

Ombro doloroso / Shoulder pain

A grande frequência de pacientes com dor no ombro torna obrigatório o atendimento das variedades de patologias que acometem a região. A anatomia complexa e a grande demanda funcional fazem o ombro suscetível a diversas afecções dolorosas, que podem variar entre processos inflamatórios, rupturas tendinosas e degenerações articulares. É importante a diferenciação entre essas situações, o que é feito com a rotina de avaliação clínica e exames complementares direcionados à hipótese diagnóstica. A grande maioria dos pacientes é tratada de forma conservadora, através de medicação, repouso e fisioterapia. Alguns casos específicos e aqueles que não respondem às medidas conservadoras têm indicação de tratamento cirúrgico.

Is it advantageous to add epinephrine to the arthroscopic infusion solution for the treatment of rotator cuff injury?

Objective: To evaluate the use of epinephrine in arthroscopic infusion serum as a measure to improve the quality of surgical viewing during procedures for treating rotator cuff tears. Methods: This was a prospective randomized double-blind comparative study in which 49 arthroscopic repair procedures on rotator cuff tears were evaluated. Patients presenting ASA I and II surgical risk were included. The patients were placed into two groups: the first with epinephrine (1 mg/L) in the infusion serum and the second with pure physiological solution. A single surgeon was responsible for the procedures, without knowledge of the medication usage. The surgeon rated his quality of viewing during the operation, on an increasing scale from 0 to 10. Interscalene block or suprascapular nerve block was chosen randomly and used in association with general anesthesia. The anesthetist issued final report relating to possible intercurrences. Results: The group with epinephrine received an average score of 9.29 and the group without epinephrine received an average score of 7.16. The difference was statistically significant (p < 0.05). There was no important clinical alteration relating to use of this drug. Conclusion: As well as being safe, addition of epinephrine at a concentration of 1 mg/L to the infusion serum was shown to be effective for improving the visual field during arthroscopy to repair rotator cuff injuries.