Artigos e Materiais de Revistas Científicas - HC/IOT

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A coleção de Artigos e Materiais de Revistas Científicas engloba artigos originais, artigos de revisão, artigos de atualização, artigos técnicos, relatos de experiências, resenhas, ensaios, editoriais, cartas ao editor, debates, notas científicas e técnicas, depoimentos, entrevistas e pontos de vista. Consideram-se como artigos científicos originais os trabalhos redigidos para divulgação de informações e resultados sobre determinada pesquisa científica, publicados em periódico científico após avaliação por outros pesquisadores.

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Patient demographic and magnetic resonance imaging evaluation of isolated posterolateral corner knee injuries
(2023) COSTA, Joao Pedro de Guimaraes Fernandes; NETO, Jair Antunes Eleterio; RODRIGUES, Marcelo Bordalo; HELITO, Camilo Partezani; HELITO, Paulo Victor Partezani
Background: Posterolateral stability of the knee is maintained by capsular, ligamentous and tendinous structures, which collectively are known as the posterolateral corner (PLC). Injuries to the PLC of the knee rarely occur without associated anterior (ACL) or posterior cruciate (PCL) ligament tears. The main objectives of our study were to report patient demographics and magnetic resonance imaging (MRI) findings of patients with isolated PLC injuries. Methods: This study consists of a retrospective analysis of knee MRI from January 2011 to June 2016, in two hospitals in Sao Paulo, Brazil, where PLC injuries without associated ACL and PCL injuries were identified in MRI by two radiologists specialized in musculoskeletal injuries. Relative and absolute frequencies were used to describe the injuries of each of the PLC structures in the study cases. Results: A total of 23 cases of PLC injuries without associated cruciate ligament injuries were identified. The mean age of patients was 32.0 +/- 8.1 years and 91% patients were male. The main sport associated with isolated PLC injury was Brazilian Jiu-Jitsu (48%), followed by soccer (35%). MRI evaluations of the knees showed lateral collateral ligament (LCL) injuries in 70% of cases, popliteus tendon injuries in 26% of cases and distal biceps tendon injuries in 30% of cases. The popliteofibular ligament (PFL) was damaged in 83% of cases. An associated ALL injury was observed in 43% of cases. Conclusions: Isolated PLC injuries occurred mainly in young men when practicing Brazilian Jiu-Jitsu and soccer. The LCL was the most frequently injured larger structure in association, and the capsuloligamentous structures (PFL) were the most frequently injured structures overall. ALL injuries occurred in approximately half of the cases, most often concomitantly with LCL injuries.
Anterolateral Ligament and Kaplan Fiber Injury Both Occur Frequently in Acute Anterior Cruciate Ligament-Injured Knees
(2024) LEAO, Renata Vidal; HELITO, Paulo Victor Partezani; SAITHNA, Adnan; CORREA, Marcos Felippe de Paula; HELITO, Camilo Partezani
Background and objectives: The association of ALL and KF injuries in anterior cruciate ligament (ACL)-deficient knees remain topics of conflicting research despite improved magnetic resonance imaging (MRI). We aimed to evaluate the rate of the anterolateral ligament (ALL) and Kaplan fibers (KF) injuries in adults with acute ACL injuries using MRI. Methods: We retrospectively reviewed 64 patients with clinical and MRI diagnoses of acute ACL tears. Two radiologists analyzed and categorized the status of the ALL and KF in all patients as intact, partially injured, or completely injured. Interobserver agreement was assessed. Injuries to the collateral ligaments, ITB and posterior cruciate ligament (PCL) were also evaluated. Results: The mean age of the patients was 33 years. ALL injuries were observed in 46 (71%) patients, among whom 33 (71%) had partial and 13 (28%) had complete injuries. KF injuries were identified in 32 (50%) patients, with 28 (87.5%) of them having partial and 4 (12.5%) having complete injuries. Combined injuries of both ALL and KF were found in 25 (32.4%) patients (p-value of 0.266). The agreement between the examiners ranged from moderate to substantial (Kappa between 0.55 and 0.75), with the highest agreement observed in cases of KF injuries (Kappa = 0.75). Conclusions: ALL and KF injuries were prevalent in acute ACL-injured knees with rates of injury of 71% and 50%, respectively. ALL injuries were more frequent and more frequently severe compared to KF injuries.
Histological Compatibility in Distal Neurotizations: A Systematic Review
(2023) CAVALHEIRO, Cristina Schmitt; NAKAMOTO, Joao Carlos; WEI, Teng Hsiang; SORRENTI, Luiz; WATAYA, Erick Yoshio
Considering the importance of defining the minimum number of axons between recipient and donor branches, that is, the definition of histological compatibility in distal neurotizations for the success of the procedure and the surgeon's freedom to choose individualized strategies for each patient, this systematic review was conducted to find out the most recent studies on the subject. The objective of this systematic review was to determine the importance of the number of axons and the relationship between axon counts in the donor and recipient nerves in the success of nerve transfer. A literature review was performed on five international databases: Web of Science, Scopus, Wiley (Cochrane Database), Embase, and PubMed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed (2020 version), a guide designed to guide the elaboration of systematic literature reviews. One hundred and fifty-seven studies were found, and 23 were selected based on the eligibility criteria. The articles presented were conclusive in determining the importance of the number of axons in the success of nerve transfer. Still, the relationship between the number of axons in the donor and recipient nerves seems more relevant in the success of transfers and is not always explored by the authors. The review of the articles has provided compelling evidence that the number of axons is a critical determinant of the success of nerve transfer procedures. However, the relationship between the number of axons in the donor nerve and that in the recipient nerve appears to be even more crucial for successful transfers, a factor that is not always adequately explored by authors in the existing literature.
Comparative study of patients with midshaft clavicle fracture fixed with a locked plate via an open versus percutaneous approach
(2023) AMARAL, Felipe Machado do; MALAVOLTA, Eduardo Angeli; SILVA, Fernando Brandao Andrade e; GARCIA JR., Jose Carlos; MOURA, Jakson da Silva; ASSUNCAO, Jorge Henrique; PECORA, Jose Ricardo
Objective: To compare the results of surgical treatment of midshaft clavicle fractures, treated with the technique of minimally invasive plate osteosynthesis (MIPO) with locking compression plate versus open reduction and internal fixation (ORIF) with locked plate. Methods: Quasi-randomized comparative study, evaluating displaced midshaft clavicle fractures treated with MIPO versus ORIF, with procedures performed by a single surgeon. We evaluated patients at 12 months using the University of California at Los Angeles (UCLA) scale and radiographically at 8, 12, 26 and 52 weeks, in addition to describing complications. Results: We evaluated 44 patients; 22 submitted to MIPO and 22 to ORIF. The median UCLA scores at 12 months were 35 in the ORIF group and 35 in the MIPO group (p = 0.712). All patients had fracture healing at 3 months (p > 0.999). The mean surgery time was 87.5 min in the ORIF group and 47.5 in the MIPO (p < 0.001) group. As complications, 1 suture dehiscence (4.5%), 2 protruding plates (9.1%) and 1 change in sensitivity around the surgical wound (4.5%) were observed in the MIPO group, while in the ORIF group, 15 changes in sensitivity (68.2%) and 3 hypertrophic scars (13.6%) were observed. The only complication that showed a difference between the groups was the change in sensitivity (p < 0.001). No cases of pseudarthrosis or failure of osteosynthesis were identified in either technique. Conclusion: This study demonstrated that the two treatments, ORIF and MIPO, are equally effective in the treatment of displaced middle third clavicle fractures. However, MIPO is superior to ORIF in regard to reduced surgical time and preservation of supraclavicular nerve sensitivity.
Clinical data or scoring system for predicting mortality in elderly patients with hip fracture: A prospective study
(2023) SOUZA, Ricardo Machado Castanheira de; FRASSEI, Renan Dias; SILVA, Luiza de Campos Moreira da; RAHAL, Miguel Antonio; SILVA, Jorge dos Santos; KOJIMA, Kodi Edson
Introduction: Hip fracture in elderly individuals is frequent and is related to a high rate of mortality. Finding the best predictor of death will help to develop better patient care. Aim - To analyze the reliability of the clinical data and assessment scores to predict mortality in acute hip fracture in elderly patients. Patient and Methods: Prospective data were collected from all patients > 65 years with acute hip fracture from May to October 2020. The clinical data collected were age, sex, comorbidities, medication, type of fracture and presence of delirium. The assessment scores were ASA, Lee, ACP and Charlson. Results: The statistically significant results were age > 80 years (OR 1.121 IC95% [1.028-1.221] p = 0.0101) and number of medications (OR5.991 95% CI [2.422-14.823] p <0.001). Three scores showed a correlation with mortality: ASA score (p = 0.017), Lee score (p = 0.024) and ACP score (p = 0.013). The Charlson Comorbidity Index did not correlate with mortality (p = 0.172). Conclusion: To stratify the risk of death, both clinical data and scores should be used. The best clinical indicators are age and number of medications, and the scores are ASA, Lee and ACP.
MESENCHYMAL CELLS IN ROTATOR CUFF REPAIR -TECHNIQUE DESCRIPTION AND CASE REPORTS
(2023) MALAVOLTA, Eduardo Angeli; MICELI, Vinicius Lamboglia; ASSUNCAO, Jorge Henrique; ANDRADE-SILVA, Fernando Brandao; GRACITELLI, Mauro Emilio Conforto; TATSUI, Nelson Hidekazu; ESPIRANDELLI, Luiz Cesar; NETO, Arnaldo Amado Ferreira
Objective: To describe a protocol of obtention of mesenchymal stem cells and to report their use as a biological adjuvant in three patients undergoing arthroscopic rotator cuff repair. Methods: Case series of patients who underwent arthroscopic repair of isolated full-thickness supraspinatus tear using mesenchymal stem cells obtained from the bone marrow as a biological adjuvant. All patients were operated on at the same institution, by a surgeon with 13 years of experience. The cells were applied at the end of the procedure, at the tendon-bone interface, at an approximate concentration of 2,000,000 mesenchymal cells/mm3 and a total volume of 5 ml. Results: All patients improved with the procedure, with one excellent and two good results. All cases overcame the minimally important clinical difference. All cases reached tendon healing, without partial or complete re-tears. We observed no complications. Conclusion: Arthroscopic rotator cuff repair with added mesenchymal cells obtained from bone marrow and submitted to a cell expansion process led to good functional results and healing in all cases in the sample, with no complications. Level of Evidence IV, Case Series.
Protected immediate weight-bearing is safe after fixation of ankle fractures with syndesmosis injury fixed with position screw. A retrospective case-series study
(2023) LINHARES JUNIOR, Milton da Silva; CIARDULLO, Marcos Broggi; NETO, Orlando Colavolpe; HERRERA, Yasmin Estefania Gonzalez; OCHOA, Pablo Gabriel Garcia; SILVA, Jorge dos Santos; KOJIMA, Kodi Edson
Background: About 10% of ankle fractures are located above the syndesmosis, which causes injury to the ligament structure of the syndesmosis. There is no consensus regarding when to allow weight-bearing on the operated limb of patients who suffered ankle fractures requiring intraoperative fixation. Objective: The aim of this study is the evaluation of radiographic parameters of syndesmosis reduction and fixation in patients with ankle fracture who underwent immediate protected weight-bearing (use of walking-boot and crutches). Patient and methods: Retrospective case series from January 2015 to December 2020. Evaluation of the tibiofibular clear space, tibiofibular overlap, and medial clear space in the preoperative x-ray, immediate postoperative, 3-, 6- and 12-month after syndesmosis fixation and rehabilitation with protected immediate weight-bearing with crutches and walking-boot. Results: Out of 137 ankle fractures 39 were included. There was no significant difference in the tibiofibular clear space between the immediate x-ray and after 12 months (4.5 mm +/- 1.1 vs. 4.6 mm +/- 1.8; p > 0.999). Tibiofibular overlap hasn't shown significant difference between immediate and 12-month x-ray (6.2 mm +/- 2.6 vs. 6.6 mm +/- 2.6; p > 0.999). Medial clear space also has shown no worsening from immediate to 12-month x-ray (3.1 mm +/- 0.9 vs. 2.8 mm +/- 0.9; p > 0.999). There were no fixation failure nor postoperative infection. Conclusion: Immediate weight-bearing for patients with ankle fractures with syndesmosis injury and treated with intraoperative fixation with positioning screw proved to be safe with good maintenance of the reduction, no failures of the synthesis material observed and no reports of postoperative infection in the period. Level 3 evidence: therapeutic retrospective case-series.
Infection after intramedullary nailing of femoral and tibial diaphyseal fractures
(2023) OLIVEIRA, Priscila R.; LEONHARDT, Marcos C.; PANICO, Caroline T.; SILVA, Julia B.; CARVALHO, Vladimir C.; KOJIMA, Kodi E.; SILVA, Jorge S.; LIMA, Ana Lucia L.
Purpose: Management of fracture-related infection (FRI) after intramedullary fixation (IF) is a challenge. The aim of the present study is to describe a series of 26 patients with FRI after IF and to evaluate factors possibly related to the outcome. Methods: Baseline variables were obtained at the time of IF: age, sex, body mass index, affected bone, open fracture, substance abuse, use of an external fixator, type of nail, reaming, soft-tissue reconstruction and surveillance culture result. After diagnosis of the infection, information was obtained about the time interval between IF and diagnosis and classification according to both the Willeneger and Roth and Makridis systems. Treatment modalities were grouped and analysed according to: use of antimicrobials, surgical debridement, nail removal or retention and spacer use. Cultures of bone or deep soft tissues were performed. Patients were followed up for 12 months, and outcomes (remission, relapse, death and loss of follow-up) were evaluated, as well as fracture consolidation. Results: Remission was observed in 42.3% of patients. There was no significant association between any baseline variable and outcome. There was a significant association between Makridis stage 2 classification and recurrence or death. Treatment strategy was not significantly associated with outcome, and 65.4% of cases had positive culture results, with Enterobacter cloacae as the predominant agent. Consolidation was observed in 81.8% of patients and was not significantly related to the outcome. Conclusion: There was a significant association between Makridis classification and the outcome. Consolidation rate was not associated with the outcome regarding the treatment of the infection.
Does metatarsus primus elevatus really exist in hallux rigidus? A weightbearing CT case-control study
(2023) LEE, Hee Young; MANSUR, Nacime S.; LALEVEE, Matthieu; MALY, Connor; IEHL, Caleb J.; HEMBREE, Walter C.; GODOY-SANTOS, Alexandre; NETTO, Cesar de Cesar
Background Elevated first metatarsal, Metatarsus primus elevatus (MPE), has been a topic of controversy. Recent studies have supported a significantly elevated first metatarsal in hallux rigidus on weight-bearing radiographs (WBR). However, conventional radiographs have limitations for accurate measurement. Our objective was to comparatively assess MPE and other variables which can affect the spatial relationship of the forefoot in the HR group compared to controls using weight-bearing CT (WBCT). Methods In this single-center, retrospective, case-control study, 25 patients (30 feet) with symptomatic HR and 30 controls were selected. WBCT parameters were measured by two independent investigators. Inter-observer reliabilities were assessed using intra-class correlation coefficients (ICCs). MPE was evaluated by measuring the direct distance between 1st and 2nd metatarsals. Independent t tests were performed to compare the two groups. A threshold of MPE to diagnose HR was calculated using the Receiver Operating Characteristic (ROC) curve. Results HR groups had increased hallux valgus angle (HVA) (8.52 degrees in control vs 11.98 degrees in HR) and MPE (2.92 vs 5.09 mm), decreased 1st metatarsal declination angle (21.09 degrees vs 19.07 degrees) 1st/2nd metatarsal declination ratio (87.45 vs 79.71) indicating elevated first metatarsal compared to controls. Dorsal translation of the first metatarsal at the first tarsometatarsal joint was observed in 21 (70%) patients of the HR group when defined as a step-off or discontinuation of the curvature along the first TMT joint. The threshold of MPE for diagnosis of HR was 4.19 mm with 77% sensitivity and 77% specificity. Conclusion Our results confirmed a significantly elevated first metatarsal in the HR group compared to controls on WBCT. A MPE greater than 4.19 mm was found to be diagnostic for symptomatic HR. Significant number of patients in the HR group (70%) had dorsal translation of the first metatarsal at the first TMT joint which can contribute to increased MPE.
The woman's hand
(2023) NEDER FILHO, Antonio Tufi; COSTA, Antonio Carlos da; BARROS, Rui Sergio Monteiro de; NAKACHIMA, Luis Renato; SOUZA, Sandro Castro Adeodato de; RODRIGUES, Mauricio Pinto; OLIVEIRA, Ricardo Kaempf de; GAMA, Sergio Augusto Machado da
Effect of Peritalar Subluxation Correction for Progressive Collapsing Foot Deformity on Patient-Reported Outcomes
(2023) CESAR NETTO, Cesar de; MANSUR, Nacime Salomao Barbachan; LALEVEE, Matthieu; CARVALHO, Kepler Alencar Mendes de; GODOY-SANTOS, Alexandre Leme; KIM, Ki Chun; LINTZ, Francois; DIBBERN, Kevin
Background: Peritalar subluxation (PTS) is part of progressive collapsing foot deformity (PCFD). This study aimed to evaluate initial deformity correction and PTS optimization in PCFD patients with flexible hindfoot deformity undergoing hindfoot joint-sparing surgical procedures and its relationship with improvements in patient-reported outcome measures (PROMs) at latest follow-up. We hypothesized that significant deformity/PTS correction would be observed postoperatively, positively correlating with improved PROMs.Methods: A prospective comparative study was performed with 26 flexible PCFD patients undergoing hindfoot joint-sparing reconstructive procedures, mean age 47.1 years (range, 18-77). We assessed weightbearing computed tomography (WBCT) overall deformity (foot and ankle offset [FAO]) and PTS markers (distance and coverage maps) at 3 months, as well as PROMs at final follow-up. A multivariate regression model assessed the influence of initial deformity correction and PTS optimization in patient-reported outcomes.Results: Mean follow-up was 19.9 months (6-39), and the average number of procedures performed was 4.8 (2-8). FAO improved from 9.4% (8.4-10.9) to 1.9% (1.1-3.6) postoperatively (P < .0001). Mean coverage improved by 69.6% (P = .012), 12.1% (P = .0343) and 5.2% (P = .0074) in, respectively, the anterior, middle, and posterior facets, whereas the sinus tarsi coverage decreased by an average 57.1% (P < .0001) postoperatively. Improvements in patient-reported outcomes were noted for all scores assessed (P < .03). The multivariate regression analysis demonstrated that improvement in both FAO and PTS measurements significantly influenced the assessed PROMs.Conclusion: This study demonstrated significant improvements in the overall 3D deformity, PTS markers, and PROMs following hindfoot joint-sparing surgical treatment in patients with flexible PCFD. More importantly, initial 3D deformity correction and improvement in subtalar joint coverage and extraarticular impingement have been shown to influence PROMs significantly and positively. Addressing these variables should be considered as goals when treating PCFD.Level of Evidence: Level II, prospective cohort study.
DISTAL FEMUR HEMIEPIPHYSIODESIS IN KNEE RECURVATUM •• A NEW SURGICAL TECHNIQUE
(2023) MONTENEGRO, Nei Botter; GENEROSO, Talissa Oliveira; SERAFIM, Barbara Lovia Correa; RAMALHO JUNIOR, Amancio
Introduction: The genu recurvatum is characterized by a hyper -extension deformity of the knee in the sagittal plane. Among its causes are conditions such as arthrogryposis, cerebral palsy, poliomyelitis, sequelae of tibial tuberosity fracture and some syndromes with generalized joint hypermobility. Treatment of this deformity can be challenging and, to date, aggressive methods such as femur or tibial osteotomies are the most used for its correction. Objective: This study aimed to describe a new surgical technique for correcting genu recurvatum. Methods: This is a prospective clinical study of children who underwent posterior hemiepiphysiodesis of the distal femur with transphyseal screws. Results: The approach proved to be safe and useful for genu recurvatum deformities, with femoral or articular apex. Conclusion: This approach shows great potential for correcting genu recurvatum in the developing skeleton, being an excellent alternative to the more aggres-sive methods currently used to treat this deformity. Level of evidence IV, Case Series.
Staged reconstruction of the hallux for infected non-uniion using bulk autograft and a customized implant: Case report
(2023) GODOY-SANTOS, A. L.; PIRES, E. A.; FONSECA, F. C.; CESAR-NETTO, C. de; AUCH, E. C.; RAMMELT, S.
This case report illustrates the outcome of a deep infection following internal fixation of a fracture of the big toe. Hallux amputation could be avoided through staged salvage procedure. This paper can assist readers on how to effectively and safely recognize and treat this type of injury.
Letter to the editor entitled “fairness and scientific correctness is needed in the debate on transgender athletes”
(2023) PITSILADIS, Y.; HAMILTON, B.; GEISTLINGER, M.; BERMON, S.; BIGARD, X.; MIGLIORINI, S.; WOLFARTH, B.; LUIGI, L. Di; IONESCU, A.; SCHNEIDER, C.; BACHL, N.; MILLER, M.; SHROFF, M.; SINGLETON, P.; CONSTANTINOU, D.; SWART, J.; BELTRAMI, G.; ARROYO, F.; BADTIEVA, V.; KAUX, J.-F.; ROZENšTOKA, S.; DIENSTBACH-WECH, L.; CASAJUS, J. A.; ZELEKOVA, I.; STEINACKER, J. M.; ÜLKAR, B.; PAPADOPOULOU, T.; WEBBORN, N.; CASASCO, M.; FOSSATI, C.; BARRETT, J.; BILZON, J. L. J.; DOHI, M.; LI, G.; AK, E.; PEDRINELLI, A.; PIGOZZI, F.
In the joint position statement signed by members of the International Federation of Sports Medicine (FIMS) and European Federation of Sports Medicine Associations (EFSMA) on the International Olympic Committee (IOC) framework on fairness, inclusion and non-discrimination based on gender identity and sex variations, more than 35 experts proposed approaches to integrate transgender women and female athletes with differences of sex development (DSD) into elite competition (1).
Rotator cuff repair in patients 50 years of age or younger: A comparative study of functional outcomes in relation to older patients
(2023) ASSUNçãO, J. H.; SILVEIRA, E. C.; TAKAYANAGI, O. M.; SILVA, F. B. de Andrade e; MALAVOLTA, E. A.; FERREIRA NETO, A. A.
Background: Few studies have evaluated the clinical results of surgical treatment of rotator cuff tears in young patients and most of the publications are only case series and with a small number of evaluated individuals. The aim of this study is to compare the clinical outcomes of patients undergoing arthroscopic rotator cuff repair according to age at the time of the procedure. Hypothesis: Patients with 50 years of age or younger undergoing surgical treatment of rotator cuff tear have similar clinical outcomes to older patients. Materials and methods: Retrospective cohort study comparing results obtained after surgical treatment of rotator cuff tears between patients aged 50 years or younger and the older patients by the ASES and UCLA functional scales. Patients undergoing arthroscopy full-thickness rotator cuff repair were included. Results: We evaluated 390 shoulders (377 patients), 94 aged 50 years or younger (median = 46.5 years) and 296 aged over 50 years (median = 60 years). Both groups significantly improved with the procedure after 24 months of follow-up, according to the ASES and UCLA scales (p < 0.001). The groups did not differ in the scores obtained in the preoperative assessments and at 24 months of follow-up. The scores obtained on the ASES scale at 24 months of follow-up had a median of 87.2 (IQR = 38) among patients aged 50 years or younger and 90 points (IQR = 26.4) among older patients (p = 0.253). The scores obtained by the UCLA scale were 31 points (IQR = 9) and 33 points (IQR =7) respectively (p = 0.156). Discussion: Our results showed that, after 24 months, the functional results of arthroscopic full-thickness rotator cuff repair did not differ between patients younger than 50 years and older patients. These results are similar to those found by others authors. Both groups of patients achieved significant improvement after the surgical procedure, achieving approximately 90 points on the ASES scale and 32 points on the UCLA scale. Level of evidence: III Retrospective cohort study.
Tibiotalocalcaneal Arthrodesis: A Retrospective Comparison Between Nails and Lateral Locking Plate Complications
(2023) ROSEMBERG, D. L.; MACEDO, R. S.; SPOSETO, R. B.; SAKAKI, M. H.; GODOY-SANTOS, A. L.; FERNANDES, T. D.
Background: Tibiotalocalcaneal arthrodesis is a well-established procedure to treat some hindfoot diseases. Currently, the most used implants are retrograde intramedullary nails and locking plates combined with lag screws, but there are few articles comparing differences regarding the complications. Methods: We have retrospectively analyzed the medical records and the radiographs of patients older than 18 years who underwent this procedure in our service between 2005 and 2019 through retrograde intramedullary nails or lateral locking plates and compression screws with at least 12 months of follow-up and with no history of osteomyelitis in these bones. Results: We evaluated a total of 67 patients; of these, 48 received retrograde intramedullary nail implants and 19 received locking plates and compression screws. The overall mean age was 48 years; the median follow-up time was 64.3 months. The complication rate was 60.4% for the intramedullary nail procedure and 52.6% for the locking plate combined with compression screws procedure. Conclusion: No significant differences were found in the complication rates between the 2 implants. Level of Evidence: Level V, Case series
The Influence of Whey Protein on Muscle Strength, Glycemic Control and Functional Tasks in Older Adults with Type 2 Diabetes Mellitus in a Resistance Exercise Program: Randomized and Triple Blind Clinical Trial
(2023) SOARES, A. L. D. S.; MACHADO-LIMA, A.; BRECH, G. C.; GREVE, J. M. D.; SANTOS, J. R. dos; INOJOSSA, T. R.; ROGERO, M. M.; SALLES, J. E. N.; SANTAREM-SOBRINHO, J. M.; DAVIS, C. L.; ALONSO, A. C.
Objectives: To evaluate the effect of whey protein (WP) supplementation associated with resistance training (RT) on glycemic control, functional tasks, muscle strength, and body composition in older adults living with type 2 diabetes mellitus (T2DM). Secondly, to evaluate the safety of the protocol for renal function. Methods: The population comprised twenty-six older men living with T2DM (68.5 ± 11.5 years old). The participants were randomly assigned to the Protein Group (PG) and the Control Group (CG). The handgrip test and evolution of exercise loads, according to the Omni Resistance Exercise Scale, evaluated muscle strength. Functional tasks were assessed by force platform in three different protocols: Sit-to-Stand, Step/Quick Turn, and Step Up/Over. Body composition was evaluated by bioimpedance and glycemic control and renal function were assessed by biochemical analyses. Both groups performed RT for 12 weeks, twice a week, prioritizing large muscle groups. Protein supplementation was 20 g of whey protein isolate and the CG was supplemented with an isocaloric drink, containing 20 g of maltodextrin. Results: There was a significant difference in muscle strength, according to the evolution of the exercise loads, but it was not confirmed in the handgrip test. However, there was no significant difference between the groups, regarding performance in functional tasks, glycemic control, or body composition. Renal function showed no alteration. Conclusion: The intake of 20 g of WP in older male adults living with T2DM did not increase the effect of RT on muscle strength, functional tasks, and glycemic control. The intervention was proven safe regarding renal function.
Crash Risk Predictors in Older Drivers: A Cross-Sectional Study Based on a Driving Simulator and Machine Learning Algorithms
(2023) SILVA, V. C.; DIAS, A. S.; GREVE, J. M. D.; DAVIS, C. L.; SOARES, A. L. D. S.; BRECH, G. C.; AYAMA, S.; JACOB-FILHO, W.; BUSSE, A. L.; BIASE, M. E. M. de; CANONICA, A. C.; ALONSO, A. C.
The ability to drive depends on the motor, visual, and cognitive functions, which are necessary to integrate information and respond appropriately to different situations that occur in traffic. The study aimed to evaluate older drivers in a driving simulator and identify motor, cognitive and visual variables that interfere with safe driving through a cluster analysis, and identify the main predictors of traffic crashes. We analyzed the data of older drivers (n = 100, mean age of 72.5 ± 5.7 years) recruited in a hospital in São Paulo, Brazil. The assessments were divided into three domains: motor, visual, and cognitive. The K-Means algorithm was used to identify clusters of individuals with similar characteristics that may be associated with the risk of a traffic crash. The Random Forest algorithm was used to predict road crash in older drivers and identify the predictors (main risk factors) related to the outcome (number of crashes). The analysis identified two clusters, one with 59 participants and another with 41 drivers. There were no differences in the mean of crashes (1.7 vs. 1.8) and infractions (2.6 vs. 2.0) by cluster. However, the drivers allocated in Cluster 1, when compared to Cluster 2, had higher age, driving time, and braking time (p < 0.05). The random forest performed well (r = 0.98, R2 = 0.81) in predicting road crash. Advanced age and the functional reach test were the factors representing the highest risk of road crash. There were no differences in the number of crashes and infractions per cluster. However, the Random Forest model performed well in predicting the number of crashes.
Outpatient parenteral antimicrobial therapy in Brazil
(2023) OLIVEIRA, Priscila R.; CARVALHO, Vladimir Cordeiro; UIP, David Everson; LIMA, Ana Lucia Lei Munhoz
Feasibility of the Oberlin Procedure in Late Presentation Cases of C5-C6 and C5-C7 Brachial Plexus Injuries in Adults
(2022) CHO, Alvaro B.; FERREIRA, Carlos H. V.; TOWATA, Fernando; ALMEIDA, Gabriel C.; SORRENTI, Luiz; KIYOHARA, Leandro Y.
Background: Oberlin et al presented a new technique for nerve transfer that completely changed the prognosis of patients with brachial plexus injury. Currently, most of the literature addresses cases submitted to early surgical intervention, before 12 months from injury, showing consistent good results. The aim of this study was to evaluate the feasibility of the Oberlin procedure in late presentation cases (>= 12 months), comparing the elbow flexion strength with patients operated earlier. Methods: We retrospectively reviewed 49 patients with partial brachial plexus injuries submitted to the Oberlin procedure. They were divided into 2 groups. Group A included 39 patients operated with <12 months of injury. The mean postoperative follow-up was 22.53 months. The interval from injury to surgery varied from 4 to 11 months (+/- 8.45 months). Group B included 10 patients with surgery >= 12 months after injury. The mean postoperative follow-up was 32 months. The interval from injury to surgery ranged from 12 to 19 months (+/- 15.4 months). Patients were evaluated monthly after surgery and the elbow flexion strength was measured using the British Medical Research Council scale. Results: In Group A, 24 patients presented with either good (M3) or excellent (M4) elbow flexion strength. In Group B, 9 patients presented with either good (M3) or excellent (M4) elbow flexion strength. A significant difference was not seen in the postoperative elbow flexion strength among the 2 groups. Conclusion: Biceps reinnervation with the Oberlin procedure is still feasible and should be attempted after more than 12 months of injury in partial brachial plexus injuries.

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