OBJECTIVE: Evaluation of postoperative results of repair of distal biceps brachii ruptures through a two anterior mini-incisions. METHODS: Nine patients with clinical and imaging (MRI) diagnosis of total lesion of the biceps brachii at its insertion were operated with a surgical technique with two mini-incisions between 2008 and 2011. The patients were evaluated after three months of evolution and all of them recovered the fully flexion-extension arch. RESULTS: Two patients (22.2%) presented a limitation of 20 degrees of supination. One patient (11.1%) had radial nerve palsy, but was totally recovered after five months. In one patient (11.1%) the muscle remained retracted, but the insertion was recovered. In three patients (33.3%) adhesion was observed on the proximal scar. There was no clinical or radiographic evidence of radioulnar synostosis after six months of evolution. All patients reported satisfaction with the treatment. CONCLUSIONS: We conclude that the presented method shows good results as well as other techniques, with less risk of adhesion on the flexor fold of the elbow. Level of Evidence IV, Case Series.
Citation: Teodoro RL, Nishimi AY, Pascarelli L, Bongiovanni RR, Velasco MA, Dobashi ET. Surgical treatment of acromioclavicular dislocation using the endobutton. Acta Ortop Bras. [
Introdução: As fraturas supracondilianas do úmero são frequentes na infância e correspondem a 50 ou 60% das fraturas do cotovelo. A redução anatômica associada ou não à osteossíntese é a chave para o sucesso do tratamento independentemente do método terapêutico. Objetivo: Este trabalho teve como objetivo avaliar os resultados funcionais e radiográficos de 129 crianças cujas fraturas foram classificadas de acordo com o método de Gartland. Método: Utilizamos o protocolo prospectivo desenvolvido pela Comissão de Educação Continuada da Sociedade Brasileira de Ortopedia e Traumatologia. Resultados: Obtivemos bons resultados na avaliação final nas fraturas do tipo I e II quando aplicado o método conservador e incruento com baixos índices de complicações (3,4%). Nas do tipo III, observamos maior número de complicações, entre elas lesões nervosas traumáticas (16,2%) e o cúbito valgo (3,2%). Conclusões: Para tratamento preconizamos a redução incruenta com fixação percutânea com fios de Kirschner cruzados. A redução aberta está indicada nos casos em que a redução fechada não foi bem sucedida, e a tração pré-operatória teria indicação restrita. Não preconizamos a fisioterapia para todos os pacientes, a não ser quando estes não apresentaram recuperação espontânea após um mês da retirada do gesso ou na vigência de complicação neurológica.
Objective: To evaluate a possible increase of adhesive capsulitis incidence during the COVID-19 pandemic. Methods: A total of 1,983 patients with shoulder disorders were retrospectively analyzed regarding gender, age, development of adhesive capsulitis and comorbidities (systemic arterial hypertension, diabetes mellitus, dyslipidemia, hypothyroidism, hyperthyroidism, depression, and anxiety) in two different periods: from March 2019 to February 2020 and from March 2020 to February 2021. Descriptive and quantitative variables were statistically analyzed. The program used for the calculations was SPSS 17.0 for Windows. Results: During the pandemic, there was a 2.41-fold increase (p < 0.001) in cases of adhesive capsulitis (compared to the previous year). Patients with depression and anxiety had a significantly increased risk by 8.8 (p < 0.001) and 14 (p < 0.001) times, respectively, of developing frozen shoulder (regarding the two periods studied). Conclusion: A significant increase in the incidence of frozen shoulder was observed after the onset of the COVID-19 pandemic in addition to a simultaneous increase of psychosomatic disorders. Prospective studies would help to ratify the idea contained in this research. Level of Evidence III, Observational Cross-Sectional Study.
Objective:To determine whether training on shoulder and elbow surgery influences the orthopedist surgeons' preferred technique to address acute acromioclavicular joint dislocation (ACD). Methods:A survey was conducted with shoulder and elbow specialists and general orthopedists on their preferred technique to address acute ACD. Results:Thirty specialists and forty-five general orthopedists joined the study. Most specialists preferred the endobutton technique, while most general orthopedists preferred the modified Phemister procedure for coracoclavicular ligament repair using anchors. We found no difference between specialists and general orthopedists in the number of tunnels used to repair the coracoclavicular ligament; preferred method for wire insertion through the clavicular tunnels; buried versus unburied Kirschner wire insertion for acromioclavicular temporary fixation; and time for its removal; and regarding the suture thread used for deltotrapezoidal fascia closure. Conclusion:Training on shoulder and elbow surgery influences the surgeons' preferred technique to address acute ACD. Level of Evidence V, Expert Opinion.
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