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There is insufficient evidence from randomised controlled trials to determine when surgical treatment is indicated for acromioclavicular dislocation in adults in current practice. Sufficiently powered, good quality, well-reported randomised trials of currently-used surgical interventions versus conservative treatment for well-defined injuries are required.

Objective: To evaluate the prevalence of lesions associated with traumatic anterior shoulder instability and the relationships between the prevalence of these lesions and the number of episodes and time since symptoms started. Method: Fifty-seven patients aged 18 to 40 years, with traumatic anterior shoulder instability, more than one episode of shoulder dislocation and at least six months since the first dislocation, who required surgery to treat the instability, were selected. Arthroscopic inspection was performed on all the patients to assess any associated lesions. Results: The prevalence of lesions was assessed, and Bankart lesions were the most prevalent, followed by Hill-Sachs lesions, while rotator cuff injuries were the least prevalent. There was no correlation from comparison between the number of episodes of dislocation and the prevalence of associated lesions. On the other hand, in relation to the time since symptoms started, the patients who had had symptoms for longer times had fewer Hill-Sachs lesions. Conclusion: It was not possible to affirm that, in patients with chronic shoulder instability, the numbers of associated lesions increased with the time since symptoms started, or with the number of episodes of dislocation.

Watson & Ballet and Vender staging systems are widely known for classifying SNAC wrist osteoarthritis. Despite of its day-to-day use, no assessment for its agreement was performed. To Evaluate the intra and interobserver agreement for these classification systems. Forty-eight posteroanterior wrist radiographs from patients with osteoarthritis due to scaphoid nonunion were evaluated at two occasions-in a 1 week interval-by five observers with different expertise-hand surgeons, hand surgery residents, orthopedic surgeons and orthopedic surgery residents. They rated osteoarthritis stages according to the above-cited systems. Kappa statistics were performed for measuring agreement. Unsatisfactory (Cohen's Kappa <0.5) agreement was found for all intra and inter observer measures for both systems. There was no clear correlation between expertise and kappa values. Unsatisfactory agreement was found for both classifications, despite the evaluator expertise. A rationale of a more reliable classification is needed.

Declaramos inexistência de conflito de interesses neste artigo RESUMOObjetivo: A entorse lateral aguda do tornozelo (ELAT) é uma afecção frequente cujo tratamento ainda não se encontra totalmente estabelecido. O objetivo do estudo foi verificar a conduta do médico ortopedista brasileiro (incluindo residentes) em relação ao diagnóstico, classificação, tratamento e complicações da entorse lateral aguda do tornozelo (ELAT). Métodos: Um questionário de múltipla escolha foi elaborado com objetivo de abordar os principais aspectos do tratamento da ELAT. O questionário foi veiculado na página eletrônica oficial da Sociedade Brasileira de Ortopedia e Traumatologia, no período de 15 de junho a 1º de agosto de 2004. Resultados: Foram incluídos para análise um total de 444 questionários. Os resultados demonstraram concordância da maioria dos entrevistados em relação aos seguintes aspectos: 90,8% utilizam alguma classificação para nortear o tratamento da entorse; 59% classificam a ELAT com segurança; 63,7% utilizam imobilização rígida nas lesões ligamentares completas; 60,6% utilizam medicação anti-inflamatória na ruptura ligamentar parcial; 75,9% relataram que a dor residual é a complicação mais frequente. Não houve consenso quanto ao método de imobilização da ELAT parcial visto que imobilização e tratamento funcional foram escolhidos com a mesma frequência (47%). Não houve diferenças significativas entre as respostas dos residentes e a dos ortopedistas (p = 0,81). Conclusões: Os ortopedistas e residentes em ortopedia do Brasil têm dificuldade em classificar a ELAT e não há consenso quanto à melhor opção para a ELAT parcial. descritores -Ligamentos Laterais do