Reconstruction plates and elastic stable intramedullary nailing yielded similar functional results, time to union, level of postoperative pain, and patient satisfaction rates. Both methods were safe in terms of major complications.

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Although the biomechanical importance of the subscapularis tendon has been recognized in biomechanical 1 and clinical studies, 2 it has long received little attention in the medical literature, 3 and has been called the "forgotten tendon". 4 Only 1% of rotator cuff tears affect only the subscapularis, 5,6 but more than half of all patients with supraspinatus tears present an associated tear of this tendon. 7,8 The accuracy of magnetic resonance imaging (MRI) is usually lower for detection of subscapularis tears than for rotator cuff tears overall, 9,10 with sensitivity ranging from 25% to 94% 5,11 and specificity from 67% to 100%. [12][13][14] Studies evaluating the diagnosis of subscapularis tears are important for clinical practice, with implications for prognosis and surgical planning. Among the published studies, some have included low magnetic field MRI, 7,13,15,16 small samples, 15,17 diagnosis not restricted to rotator cuff disorders, 7,12,14-16,18-21 and use of intra-articular 11,14,19 or intravenous 15,20 contrast. These factors can generate bias in data interpretation. OBJECTIVEThe objective of the present study was to evaluate the accuracy of preoperative high magnetic field MRI without the use of contrast, compared with arthroscopic inspection, for identifying subscapularis tears, in cases undergoing rotator cuff repair. METHODSThis was a diagnostic test study comparing the findings from preoperative MRI (index test) with those from shoulder arthroscopy (reference standard) for diagnosing subscapularis tears.Operative data were collected in a standardized manner from consecutive patients between January 2013 and August 2017, by three surgeons at the same institution.

Objective: To investigate the existence of a causal association between orthopedic treatment and the occurrence of in hospital death. Methods: 338 patients with proximal femoral fracture were evaluated, of whom 27 faced in hospital death. Patients who faced in hospital death (case group) were compared to patients who did not (control group) regarding exposure to risk factors prior to injury and factors related to orthopedic treatment. Results: The factors related to higher in hospital mortality rate were: male sex (case group: 52%, control: 26%; p = 0.005), lower Parker’s score (case group: 5.0 points, control: 6.2; p = 0.048), delirium on admission (case group: 26%, control: 10%; p = 0.011); delirium developed during hospitalization (case group: 77%, control: 35%; p <0.001), and time until surgery (13.3 days, 9.1; p = 0.049). Conclusion: The in hospital mortality rate of patients with proximal femoral fracture was 8%, and the main associated risk factors were male sex, reduced Parker’s score, delirium diagnosed on hospital admission or developed during hospitalization, and time until surgery. Level of Evidence III, Case control study.

Objectives:To describe the clinical utility of the Manchester triage scale adapted for orthopedic emergency departments and to evaluate its validity in identifying patients with the need for hospital care and its reliability when reproduced by different professionals.Methods:Five triage flowcharts were developed based on the Manchester scale for the following orthopedic disorders: traumatic injuries, joint pain, vertebral pain, postoperative disorders, and musculoskeletal infections. A series of patients triaged by two orthopedists was analyzed to assess the concordance between the evaluators (reliability) and the validity of the Manchester scale as predictive of severity.Results:The reliability analysis included 231 patients, with an inter-observer agreement of 84% (Kappa = 0.77, p <0.001). The validity analysis included 138 patients. The risk category had a strong association with the need for hospital care in patients with trauma (OR = 6.57, p = 0.001) and was not significant for non-traumatic disorders (OR = 2.42; p = 0.208). The overall sensitivity and specificity were 64% and 76%, respectively.Conclusion:The evaluated system presented high reliability. Its validity was adequate, with good sensitivity for identifying patients requiring hospital care among those with traumatic lesions. However, the sensitivity was low for patients with non-traumatic lesions. Level of Evidence III, Retrospective Study.