Summary Background Global development goals increasingly rely on country-specific estimates for benchmarking a nation’s progress. To meet this need, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 estimated global, regional, national, and, for selected locations, subnational cause-specific mortality beginning in the year 1980. Here we report an update to that study, making use of newly available data and improved methods. GBD 2017 provides a comprehensive assessment of cause-specific mortality for 282 causes in 195 countries and territories from 1980 to 2017. Methods The causes of death database is composed of vital registration (VR), verbal autopsy (VA), registry, survey, police, and surveillance data. GBD 2017 added ten VA studies, 127 country-years of VR data, 502 cancer-registry country-years, and an additional surveillance country-year. Expansions of the GBD cause of death hierarchy resulted in 18 additional causes estimated for GBD 2017. Newly available data led to subnational estimates for five additional countries—Ethiopia, Iran, New Zealand, Norway, and Russia. Deaths assigned International Classification of Diseases (ICD) codes for non-specific, implausible, or intermediate causes of death were reassigned to underlying causes by redistribution algorithms that were incorporated into uncertainty estimation. We used statistical modelling tools developed for GBD, including the Cause of Death Ensemble model (CODEm), to generate cause fractions and cause-specific death rates for each location, year, age, and sex. Instead of using UN estimates as in previous versions, GBD 2017 independently estimated population size and fertility rate for all locations. Years of life lost (YLLs) were then calculated as the sum of each death multiplied by the standard life expectancy at each age. All rates reported here are age-standardised. Findings At the broadest grouping of causes of death (Level 1), non-communicable diseases (NCDs) comprised the greatest fraction of deaths, contributing to 73·4% (95% uncertainty interval [UI] 72·5–74·1) of total deaths in 2017, while communicable, maternal, neonatal, and nutritional (CMNN) causes accounted for 18·6% (17·9–19·6), and injuries 8·0% (7·7–8·2). Total numbers of deaths from NCD causes increased from 2007 to 2017 by 22·7% (21·5–23·9), representing an additional 7·61 million (7·20–8·01) deaths estimated in 2017 versus 2007. The death rate from NCDs decreased globally by 7·9% (7·0–8·8). The number of deaths for CMNN causes decreased by 22·2% (20·0–24·0) and the death rate by 31·8% (30·1–33·3). Total deaths from injuries increased by 2·3% (0·5–4·0) between 2007 and 2017, and the death rate from injuries decreased by 13·7% (12·2–15·1) to 57·9 deaths (55·9–59·2) per 100 000 in 2017. Deaths from substance use disorders also increased, rising from 284 000 deaths (268 000–289 000) globally in 2007 to 352 000 (334 000–363 000) in 2017. Between 2007 and 2017, total deaths from conflict and terrorism increased by 118·0% (88·8–148·6). A greater reduction in ...

SummaryBackgroundEfforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of “leaving no one behind”, it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990–2017, projected indicators to 2030, and analysed global attainment.MethodsWe measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0–100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator.FindingsThe global median health-related SDG index in 2017 was 59·4 (IQR 35·4–67·3), ranging from a low of 11·6 (95% uncertainty interval 9·6–14·0) to a high of 84·9 (83·1–86·7). SDG index values in countries assessed at the subnational level...

Objetivo: Avaliar o perfil epidemiológico das fraturas do rádio distal em hospitais de referência em Ribeirão Preto(SP), Brasil. Não existem dados suficientes na literatura nacional que corroborem com o perfil epidemiológico das fraturas do rádio distal. Métodos: 245 pacientes apresentaram 254 fraturas do rádio distal, ocorridas entre 2014 a 2017 foram avaliadas retrospectivamente para obtenção do perfil epidemiológico. Os fatores analisados foram idade e sexo, mecanismo do trauma, sazonalidade, tipo de fratura baseada na Classificação AO, presença de exposição óssea, lesões associadas, tipo de tratamento realizado (conservador ou cirúrgico) e o tipo de implante utilizado nos tratamentos cirúrgicos. Resultados: 60,2% dos pacientes participantes eram do sexo masculino e 39,8% do sexo feminino, distribuídos de forma bimodal. A média de idade foi 45,4 anos. Fraturas expostas corresponderam a 92,1% das fraturas e 7,9% representaram as expostas. Pacientes politraumatizados representaram 62,6%. O tempo médio de internação foi 8,09 dias. Conclusão: Apesar do padrão de fraturas mostrar semelhanças com outros estudos, o padrão apresentado pode não traduzir, de forma homogênea, o padrão obtido em outras metrópoles e grandes centros.Descritores: Fraturas do Rádio; Traumatismos do Punho; Epidemiologia; Hospitais Especializados.ReferênciasBruce KK, Merenstein DJ, Narvaez MV, Neufeld SK, Paulus MJ, Tan TP et al. Lack of Agreement on Distal Radius Fracture Treatment. J Am Board Fam Med. 2016;29(2):218-25.MacIntyre NJ, Dewan N. Epidemiology of distal radius fractures and factors predicting risk and prognosis. J Hand Ther. 2016;29(2):136-45.Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury. 2006;37(8):691-97.Nellans KW, Kowalski E, Chung KC. The epidemiology of distal radius fractures. Hand Clin. 2012;28(2):113-25. Flinkkilä T, Sirniö K, Hippi M, Hartonen S, Ruuhela R, Ohtonen P et al. Epidemiology and seasonal variation of distal radius fractures in Oulu, Finland. Osteoporos Int. 2011;22(8):2307-312.Lindau TR, Aspenberg P, Arner M, Redlundh-Johnell I, Hagberg L. Fractures of the distal forearm in young adults. An epidemiologic description of 341 patients. Acta Orthop Scand. 1999;70(2):124-28.Diamantopoulos AP, Rohde G, Johnsrud I, Skoie IM, Hochberg M, Haugeberg G. The epidemiology of low- and high-energy distal radius fracture in middle-aged and elderly men and women in Southern Norway. PLoS One. 2012;7(8):e43367.Wilcke MK, Hammarberg H, Adolphson PY. Epidemiology and changed surgical treatment methods for fractures of the distal radius: a registry analysis of 42,583 patients in Stockholm County, Sweden, 2004–2010. Acta Orthop. 2013;84(3):292-96.Sigurdardottir K, Halldorsson S, Robertsson J. Epidemiology and treatment of distal radius fractures in Reykjavik, Iceland, in 2004. Comparison with an Icelandic study from 1985. Acta Orthop. 2011;82(4):494-98.Solgaard S, Petersen VS. Epidemiology of distal radius fractures. Acta Orthop Scand. 1985;56(5):391-93.Brogren E, Petranek M, Atroshi I. Incidence and characteristics of distal radius fractures in a southern Swedish region. BMC Musculoskelet Disord. 2007;8:48. Tsai CH, Muo CH, Fong YC, et al. A population-based study on trend in incidence of distal radial fractures in adults in Taiwan in 2000-2007. Osteoporos Int. 2011;22(11):2809-815.Koo OT, Tan DM, Chong AK. Distal radius fractures: an epidemiological review. Orthop Surg. 2013;5(3):209-13. Dóczi J, Renner A. Epidemiology of distal radius fractures in Budapest. A retrospective study of 2,241 cases in 1989. Acta Orthop Scand. 1994;65(4):432-33.Chen NC, Jupiter JB. Management of distal radial fractures. J Bone Joint Surg Am. 2007;89(9):2051-62.Pagano M, Gauvreau K. Princípios de Bioestatística. 2. ed. São Paulo: Pioneira Thompson Learning; 2004.                                  Court-Brown CM. Epidemiologia das fraturas e luxações. In: Court-Brown CM et al. (ed.); Fraturas em adultos de Rockwood Green. 8. ed. Barueri, SP: Manole; 2016.Fanuele J, Koval KJ, Lurie J, Zhou W, Tosteson A, Ring D. Distal radial fracture treatment: what you get may depend on your age and address. J Bone Joint Surg Am. 2009;91(6):1313-19.Jupiter JB, Marent-Huber M; LCP Study Group. Operative management of distal radial fractures with 2.4-millimeter locking plates: a multicenter prospective case series. Surgical technique. J Bone Joint Surg Am. 2010;92(Suppl 1 Pt 1):96-106.

OBJECTIVE:The assessment of fracture union includes physical examination and radiographic imaging, which depend on the examiner's experience. The development of ancillary methods may avoid prolonged treatments and the improper removal of implants. Quantitative bone ultrasonometry has been studied for this purpose and will soon be included in clinical practice. The aims of the present study were to assess the feasibility of using this technique on the clavicle and to standardize its in vivo application.METHODS:Twenty adult volunteers, including 10 men and 10 women without medical conditions or a previous history of clavicle fracture, underwent axial quantitative ultrasonometric assessment using transducers in various positions (different distances between the transducers and different angulations relative to the clavicle).RESULTS:Similar values of wave propagation velocity were obtained in the different tested set-ups, which included distinct distances between the transducers and angular positions relative to the clavicle. There were significant differences only in the transducers positioned at 0° and at 5 or 7 cm apart.CONCLUSIONS:The use of bone ultrasonometry on the clavicle is feasible and the standardization of the technique proposed in this study (transducers placed at 45° and at 7 cm apart) will allow its future application in clinical trials to evaluate the healing process of diaphyseal fractures of the clavicle.

Introdução: As fraturas da extremidade distal do rádio representam uma das fraturas mais comuns. Diversos fatores descritos na literatura influenciam nos seus resultados após manejo cirúrgico; como a fragmentação articular, a restauração cirúrgica da anatomia do rádio, a reabilitação pós-operatória, entre outros. Objetivo: analisar o resultado funcional dos pacientes operados de fraturas articulares completas da extremidade distal do rádio e correlacionar estes resultados com os parâmetros radiológicos comumente utilizados. Métodos: 18 pacientes entre 18 a 65 anos, submetidos ao tratamento cirúrgico das fraturas do rádio distal do tipo AO 23C, no período de janeiro de 2014 a julho de 2016. Os seguintes parâmetros clínicos e radiográficos foram avaliados e submetidos a análise estatística: ADM (amplitude de movimento) do punho e antebraço, força de pinças e de preensão, PRWE (Patient Rated Wrist Evaluation), classificação AO da fratura e parâmetros radiográficos pós-operatórios. Resultados: A análise de regressão linear mostrou correlação estatisticamente significativa considerando a inclinação radial e o desvio ulnar. Conclusão: Correlação estatisticamente significativa entre os parâmetros radiográficos e resultados funcionais é de difícil determinação. Novos estudos com maior amostragem e que correlacionem os parâmetros radiográficos e idade são necessários para melhor estudo do tema abordado.Descritores: Fraturas do Rádio; Traumatismos do Punho; Fraturas Intra-Articulares.ReferênciasCourt-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury. 2006;37(8):691-97. Wolf WS. Distal Radius Fracture. In: Green’s Operative Hand Surgery 7. ed. Philadelphia, PA: Elsevier.Alluri RK, Hill JR, Ghiassi A. Distal Radius Fractures: Approaches, Indications, and Techniques. J Hand Surg Am. 2016;41(8):845-54.McQueen MM. Fractures oh the distal radius and ulna. In: Rockwood and Green's fractures in adults 8. ed. Philadelphia, PA: Wolters Kluwer Health.Brogren E, Petranek M, Atroshi I. Incidence and characteristics of distal radius fractures in a southern Swedish region. BMC Musculoskelet Disord. 2007;8:48. Flinkkilä T, Sirniö K, Hippi M, Hartonen S, Ruuheia R, Ohtonen P  et al. Epidemiology and seasonal variation of distal radius fractures in Oulu, Finland. Osteoporos Int. 2011;22(8):2307-12.Róbertsson GO, Jónsson GT, Sigurjónsson K. Epidemiology of distal radius fractures in Iceland in 1985. Acta Orthop Scand. 1990;61(5):457-59.Sigurdardottir K, Halldorsson S, Robertsson J. Epidemiology and treatment of distal radius fractures in Reykjavik, Iceland, in 2004. Comparison with an Icelandic study from 1985. Acta Orthop. 2011;82(4):494-98.Meena S, Sharma P, Sambharia AK, Dawar A. Fractures of distal radius: an overview. J Family Med Prim Care. 2014;3(4):325-32.Metz VM, Gilula LA. Imaging techniques for distal radius fractures and related injuries. Orthop Clin North Am. 1993;24(2):217-28.Reis FB, Faloppa F, Saone RP, Boni JR, Corvlo MC. Fraturas do terço distal do rádio: classificação e tratamento. Rev Bras Ortop. 1994;29(5):326-30.Isani A, Melone CP Jr. Classification and management of intra-articular fractures of the distal radius. Hand Clin. 1988;4(3):349-60.AO Surgery Reference. Disponível em: https://surgeryreference.aofoundation.org/. Acesso em: 04 de janeiro de 2020.Lafontaine M, Hardy D, Delince P. Stability assessment of distal radius fractures. Injury. 1989;20(4):208-10.Knirk JL, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am. 1986;68(5):647-59.Szabo RM, Weber SC. Comminuted intraarticular fractures of the distal radius. Clin Orthop Relat Res. 1988;(230):39-48.Trumble TE, Culp RW, Hanel DP, Geissler WB, Berger RA. Intra-articular fractures of the distal aspect of the radius. Instr Course Lect. 1999;48:465-80.Lipton HA, Wollstein R. Operative treatment of intraarticular distal radial fractures. Clin Orthop Relat Res. 1996;(327):110-24.Bradway JK, Amadio PC, Cooney WP. Open reduction and internal fixation of displaced, comminuted intra-articular fractures of the distal end of the radius. J Bone Joint Surg Am. 1989;71(6):839-47.Melone CP Jr. Distal radius fractures: patterns of articular fragmentation. Orthop Clin North Am. 1993;24(2):239-53.Xavier CRM, Molin DCD, Santos RMM, Santos RDT, Ferreira Neto JC. Tratamento cirúrgico das fraturas do rádio distal com placa volar bloqueada: correlação dos resultados clínicos e radiográficos. Rev Bras Ortop. 2011;46(5):505-13.Karnezis IA, Panagiotopoulos E, Tyllianakis M, Megas P, Lambiris E. Correlation between radiological parameters and patient-rated wrist dysfunction following fractures of the distal radius. Injury. 2005;36(12):1435-39.Schneiders W, Biewener A, Rammelt S, Rein S, Zwipp H, Amlang M. Die distale Radiusfraktur. Korrelation zwischen radiologischem und funktionellem Ergebnis [Distal radius fracture. Correlation between radiological and functional results]. Unfallchirurg. 2006;109(10):837-44Trumble TE, Schmitt SR, Vedder NB. Factors affecting functional outcome of displaced intra-articular distal radius fractures. J Hand Surg Am. 1994;19(2):325-40. Fernandez DL. Should anatomic reduction be pursued in distal radial fractures?. J Hand Surg Br. 2000;25(6):523-27.Kasapinova K, Kamiloski V. Outcome evaluation in patients with distal radius fracture. Prilozi. 2011;32(2):231-46.Paranaíba VF, Santos JBG, Raduan Neto J, Moraes VY, Belotti JC, Faloppa F. Aplicação do PRWE na fratura da extremidade distal do rádio: comparação e correlação dos desfechos consagrados.  Rev bras ortop. 2017;52(3):278-83.da Silva Rodrigues EK, de Cássia Registro Fonseca M, MacDermid JC. Brazilian version of the Patient Rated Wrist Evaluation (PRWE-BR): Cross-cultural adaptation, internal consistency, test-retest reliability and construct validity. J Hand Ther. 2015;28(1):69-76.

Objective: To analyze the influence of steel plates for osteosynthesis on the velocity of ultrasound propagation (VU) through the bone. Methods: The transverse coronal and sagittal velocity of ultrasound propagation underwater were measured on the intact bone and then on assemblies of the same bone with two types of osteosynthesis plates (DCP and semi tubular), fixed onto the dorsal side of the bones. The first arriving signal (FAS) was the ultrasound parameter used, taking the coronal and sagittal diameters as the distances to calculate velocity. Intergroup statistical comparisons were made at significance level of 1% (p<0.01). Results: Velocity was higher on the intact bones than on the bone-plate assemblies and higher for the semitubular than for the compression plates, although differences were not statistically significant for most comparisons (p=0.0132 to 0.9884), indicating that the steel plates do not interfere significantly with ultrasound wave propagation through the bone-plate assemblies. Conclusion: The velocity reduction effect was attributed to the greater reflection coefficient of the steel as compared to that of bone and water. Ultrasonometry can, thus, be used in the evaluation of healing of fractures fixed with steel plates. Experimental Study.

A tenossinovite piogênica é uma infecção da bainha do tendão flexor do dedo que pode resultar em necrose e aderência do tendão, perda de movimento, deformidade e, em último caso, acarretar perda do membro se o tratamento não for instituído rápido e adequadamente. O objetivo desse estudo é descrever o perfil epidemiológico e bacteriológico dos pacientes com o diagnóstico de tenossinovite infecciosa em um hospital terciário. Os dados foram coletados dos prontuários dos pacientes atendidos na instituição no período de janeiro de 2019 a junho de 2020 com o diagnóstico confirmado de tenossinovite infecciosa, e que tenham sido submetidos a tratamento clínico e cirúrgico. Os resultados encontrados foram: a prevalência de pacientes do sexo masculino, com média de 42 anos de idade, contaminados após ferimentos perfurocortantes. A bactéria mais encontrada foi Staphylococcus aureus e os resultados mais favoráveis foram nos pacientes que iniciaram o tratamento em menos de 72 horas do início dos sintomas. A suspeita clínica e o reconhecimento precoce do agente etiológico se mostraram fundamentais para minimizar as consequências potencialmente devastadoras do atraso no tratamento desta doença.

As infecções nosocomiais de sítio cirúrgico nas cirurgias ortopédicas ocorrem em cerca de 2% dos procedimentos, sendo a infecção de sítio cirúrgico a terceira causa de infecção nos serviços de saúde. Quando ocorrem, envolvem prejuízos ao paciente, profissional de saúde e hospital. Em um serviço de ortopedia de alta complexidade tanto os fatores do paciente quanto os relacionados ao seu quadro, como gravidade da lesão e internação prolongada, podem modificar o microrganismo presente nas infecções. Esse estudo tem como objetivo analisar o perfil epidemiológico das infecções nosocomiais nas cirurgias ortopédicas realizadas pela equipe de ortopedia do membro superior, mão e microcirurgia de um serviço de alta complexidade em Ribeirão Preto. Foram avaliados os pacientes operados pela equipe membro superior, mão e microcirurgia da Unidade de Emergência de Ribeirão Preto, no período de janeiro de 2019 a janeiro de 2020, com objetivo de determinar a taxa de infecção e o principal agente etiológico envolvido. No total 456 cirurgias ocorreram no intervalo citado, com uma taxa de infecção de 4,17%. O principal agente encontrado foi o Enterobacter cloacae e os Gram negativos foram os mais prevalentes nos casos avaliados, presentes em 55,56% das culturas. Esse perfil de agente etiológico está relacionado aos nossos pacientes, que apresentam lesões de alta energia e contaminadas, necessitando de internação hospitalar prolongada.