ObjectiveTo evaluate the clinical and radiographic response of the lumbar curve after fusion of the main thoracic, in patients with adolescent idiopathic scoliosis of Lenke type 1.MethodsForty-two patients with Lenke 1 adolescent idiopathic scoliosis who underwent operations via the posterior route with pedicle screws were prospectively evaluated. Clinical measurements (size of the hump and translation of the trunk in the coronal plane, by means of a plumb line) and radiographic measurements (Cobb angle, distal level of arthrodesis, translation of the lumbar apical vertebral and Risser) were made. The evaluations were performed preoperatively, immediately postoperatively and two years after surgery.ResultsThe mean Cobb angle of the main thoracic curve was found to have been corrected by 68.9% and the lumbar curve by 57.1%. Eighty percent of the patients presented improved coronal trunk balance two years after surgery. In four patients, worsening of the plumb line measurements was observed, but there was no need for surgical intervention. Less satisfactory results were observed in patients with lumbar modifier B.ConclusionsIn Lenke 1 patients, fusion of the thoracic curve alone provided spontaneous correction of the lumbar curve and led to trunk balance. Less satisfactory results were observed in curves with lumbar modifier B, and this may be related to overcorrection of the main thoracic curve.
Objective: Given the epidemiological importance of malleolar fractures and differences in treatment choices, this study provides an update on the multiprofessional treatment of these fractures by mapping systematic reviews available in the scientific literature. Methods: The search was performed in the electronic databases Cochrane Database of Systematic Reviews (CDSR), Medline and Lilacs and in the PROSPERO international prospective register of systematic reviews, with no language or publication date restriction. The most recent search was performed on June 1, 2018. The term “ankle fracture” was used in those databases. Pubmed was also searched, using the [Mesh] term. The inclusion criteria were systematic reviews on the treatment of malleolar ankle fractures in adults. Results: Twenty-two systematic reviews were identified in the searched databases. Systematic reviews on the multiprofessional treatment of patients with malleolar fractures addressed the selection of metallic syndesmotic screw rather than absorbable screw without indicating its removal in the absence of symptoms. Furthermore, the Adelaide Fracture in the Diabetic Ankle (AFDA) algorithm was established for the diagnosis and treatment of diabetic patients. There is still no evidence that arthroscopically assisted open reduction and internal fixation (ORIF) is the best therapeutic method, nor is there biomechanical evidence that the locking plate is better than the conventional plate for treating lateral malleolar fracture in elderly people. There is strong evidence that mobility and early weight-bearing directly affect the functional prognosis of patients. Conclusion: This study was extremely important for identifying and selecting the most recent systematic reviews on the topic, thereby guiding practices regarding the best therapeutic regimen for patients with malleolar fractures.
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