Objectives:A retrospective statistical data gathering of wrist and hand complaints assisted over two years in the orthopedic emergency department of a regional referral hospital, seeking to know the profile of these patients. Methods:Information obtained by analysis of 31.356 orthopedic visits from May 2013 to April 2015, of which 6.754 related to hand complaints and/or wrist, at the Hospital Estadual Doutor Jayme dos Santos Neves (HDJSN) and analyzed by IBM SPSS Statistics software version 21. Results:The data revealed that the average age was 37,5 ± 15,7 years and the male gender was predominant (60,72%). Bruises (52,58%) and fractures (30,49%) were the most common diagnoses. Conclusion:The complaints of wrist and hand accounted for 21,44% of all orthopedic emergency room visits. Detailed data description and correct definition of the International Classification of Diseases (ICD-10) are needed to better define the epidemiological profile of patients seeking orthopedic emergency. Level of Evidence III, Retrospective Study.
First-rib fractures are uncommon and are generally related to major thoracic trauma: so much so that they serve to indicate the severity of the trauma. Isolated bilateral first-rib fractures without major thoracic trauma are rarely described in the literature. The symptoms may go unnoticed and be minimized, thus making this condition difficult to diagnose. The present report presents a case of direct trauma on the supraclavicular region with symptoms of contusion of the brachial plexus, caused by a fall from a jet ski while a life vest was being used. The literature was reviewed to show the various facets of the problem and the treatment for this condition was discussed.
RESUMOAs fraturas de primeira costela são incomuns e geralmente associadas a grandes traumas torácicos a ponto de servirem como associação com a gravidade do trauma. As fraturas isoladas bilaterais de primeira costela sem grandes traumas torácicos são raramente descritas na literatura. Os sintomas podem passar despercebidos e serem minimizados dificultando o diagnóstico desta condição. O presente relato mostra um trauma direto sobre a região supraclavicular com sintomas de contusão do plexo braquial numa queda de jet ski com uso de salva-vidas. É feita uma revisão da literatura mostrando as diversas faces do problema discutindo-se o tratamento desta condição. Keywords -Rib fractures, Thoracic injuries; Brachial plexus/ injuries INTRODUçãOA fratura isolada da primeira costela é um evento raro e a fratura bilateral da primeira costela é ainda mais rara. Geralmente essa fratura está relacionada com o trauma direto no tórax e em dorso superior e, também, com lesões de tecido mole, ossos e estruturas vasculares adjacentes. Na maioria das vezes está associada a grandes traumas torácicos. Pode estar relacionada ainda com contração muscular violenta ou trauma repetitivo, as chamadas fraturas de estresse. Essas fraturas são claramente relacionadas com eventos traumáticos que devem ser investigados, usando-se os meios diagnósticos apropriados, sendo o mais comum deles a avaliação radioló-gica. No caso do trauma de tórax, radiografia de tórax. Mas, algumas vezes, os sintomas não são relacionados com nenhum tipo de trauma. Sintomas inespecíficos, como a dor, podem levar à pesquisa de lesões despercebidas, diagnosticadas como estiramento muscular ou lesões articulares, devido à sua projeção em locais como ombro e escápula. Ainda que rara, quando não associada à grande trauma torácico, a fratura de primeira costela deve ser incluída no diagnóstico diferencial de pacientes que apresentem dor escapular, torácica superior, esternal ou no ombro. Relatamos um caso de fratura bilateral, simétrica, de primeira costela, consequência de um mergulho de alto impacto com uso de colete salva-vidas, devido a uma queda de jet ski em alta velocidade, e uma revisão da literatura para divulgar essa situação clínica pouco frequente, quando não associada à grande trauma da caixa torácica. Não existe, na literatura médica brasileira, relato de fratura de primeira costela.Rev Bras Ortop. 2010;45(3):302-5
Objective: To identify the patient profile that obtains better clinical and quality of life improvement after lumbar spinal stenosis surgery, comparing the results in the pre and postoperative periods. Methods: Thirty-seven patients with lumbar spine stenosis submitted to surgery were prospectively evaluated. Through the 36-Item Short Form General Health Survey (SF-36) questionnaire we performed a preoperative analysis to identify morbidities and social security benefit earning. The SF-36 is a subjective postoperative questionnaire to assess surgical success six months after the surgery. Results: There were unfavorable outcomes in patients who received social security benefits and in those who had morbidities. According to the SF-36 score, the surgical result is better when the patient is non-smoker (p=0.05), non-hypertense (p=0.040), non-diabetic (p =0.010) or non sedentary (p=0.019), respectively on mental health, pain, social aspects and general health domains. Conclusion: The patient profiles that best benefit from the surgery are those who do not have morbidities and had no social security benefit. Evidence Level II, Prospective Study.
Objective: To evaluate the postoperative analgesic efficacy in patients undergoing lumbar canal decompression using epidural morphine and clonidine at the Hospital Santa Casa de Vitória -ES, Brazil. Methods: Prospective, randomized study of 60 patients with stenosis of the lumbar canal up to two levels with surgical indication, in which decompression of the canal was performed in association with lumbar arthrodesis. In group 1 we performed conventional postoperative analgesia and in group 2, in addition to conventional analgesia, we associated epidural morphine and clonidine. We used VAS as a means of analyzing pain intensity at 1, 12, and 36 hours after surgery. The statistical analysis was performed using Microsoft Office/Excel and the software GraphPad Prism (San Diego, CA, USA). Results: The mean age of patients was 47 years, and 52% were female. The mean VAS in the first hour, 12th, and 36th hours after surgery in the control group was 5.44, 2.13, and 0.55 respectively. In the morphine-clonidine group it was 6.96; 2.21 and 0.60. Comparing one group with another in its absolute values through the Mann-Whitney test, as well as comparing the pain variations between the 1st and 12th hour (1h X 12h) and between the 12th hour and 36th hour (12h x 36h ) through Student's t test it became clear that there was no statistical difference between groups (p > 0.05). Conclusions: The addition of epidural morphine and clonidine to conventional analgesia is not beneficial to reduce postoperative pain in patients undergoing lumbar canal decompression.Keywords: Lumbar vertebrae; Analgesia, epidural; Morphine; Clonidine; Visual analog scale; Postoperative period. RESUMO
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