Edmilson Takehiro Takata

Elevada morbimortalidade e reduzida taxa de diagnóstico de osteoporose em idosos com fratura de fêmur proximal na cidade de São Paulo

OBJECTIVE To know the morbid-mortality following an osteoporotic hip fracture in elderly patients living in São Paulo. PATIENTS AND METHODS This study evaluated prospectively all patient over 60 years admitted in 2 school-hospitals in the city of São Paulo in a following 6-month period due to a osteoporotic proximal femur fracture. All of them filled up the Health Assessment Questionnaire (HAQ) and had their chart reviewed. After 6 months they were re-interviewed. Linear regression analysis was utilized to determine the factors related to functional ability. RESULTS 56 patients were included (mean age 80.7 +/- 7.9 years old, 80.4% females). After the 6-month follow up the mortality rate was 23.2%. Only 30% of the patients returned to their previous activities, and 11.6% became totally dependent. Factors related to worse functional ability after fracture were HAQ before fracture, institutionalization after fracture and age (r(2) 0.482). The diagnosis of osteoporosis was informed only by 13.9% of them, and just 11.6% received any treatment for that. CONCLUSION Our results showed the great impact of these fractures on mortality and in the functional ability of these patients. Nevertheless, many of our physicians do not inform the patients about the diagnosis of osteoporosis and, consequently, the treatment of this condition is jeopardized.

Fractures of the proximal femur: correlation with vitamin D receptor gene polymorphism

Fractures are the feared consequences of osteoporosis and fractures of the proximal femur (FPF) are those that involve the highest morbidity and mortality. Thus far, evaluation of bone mineral density (BMD) is the best way to determine the risk of fracture. Genetic inheritance, in turn, is one of the major determinants of BMD. A correlation between different genotypes of the vitamin D receptor (VDR) and BMD has been recently reported. On this basis, we decided to determine the importance of the determination of VDR genotype in the presence of an osteoporotic FPF in a Brazilian population. We studied three groups: group I consisted of 73 elderly subjects older than 65 years (78.5 +/- 7.2 years) hospitalized for nonpathological FPF; group II consisted of 50 individuals older than 65 years (72.9 +/- 5.2 years) without FPF and group III consisted of 98 young normal Brazilian individuals aged 32.6 +/- 6.6 years (mean +/- SD). Analysis of VDR gene polymorphism by restriction fragment length polymorphism (RFLP) was performed by PCR amplification followed by BsmI digestion of DNA isolated from peripheral leukocytes. The genotype distribution in group I was 20.5% BB, 42.5% Bb and 37% bb and did not differ significantly from the values obtained for group II (16% BB, 36% Bb and 48% bb) or for group III (10.2% BB, 47.6% Bb and 41.8% bb). No differences in genotype distribution were observed between sexes or between the young and elderly groups. We conclude that determination of VDR polymorphism is of no practical use for the prediction of FPF. Other nongenetic factors probably start to affect bone mass, the risk to fall and consequently the occurrence of osteoporotic fractures with advancing age.

Análise pré e pós-operatória da capacidade funcional e qualidade de vida de pacientes portadores de osteoartrose de quadril submetidos à artroplastia total

OBJETIVO: avaliar a capacidade funcional da articulacao do quadril e a qualidade de vida de pacientes portadores de osteoartrose submetidos a artroplastia total. METODOS: foram avaliados 12 pacientes atraves do questionario Harris Hip Score (modificado/ escala de 0-95 pontos) e goniometria no pre e pos-operatorio de artroplastia total de quadril. RESULTADOS: a amplitude de movimento mostrou-se incompleta em todos os arcos de movimento no pre-operatorio. No pos-operatorio os valores aumentaram significativamente na flexao (p=0,007), extensao (p=0,02), abducao (p=0,001), rotacao medial (p=0,0002) e lateral (p=0,01), apenas o aumento do movimento de aducao de quadril nao foi significativo (p=0,08). A medida do escore obtido atraves do questionario no pre-operatorio foi 39,7 pontos e no pos-operatorio 74,1 pontos (P<0,000001). CONCLUSOES: a artroplastia total do quadril proporciona ao paciente alivio da dor, melhora na realizacao das atividades da vida diaria e aumento da amplitude do movimento articular do quadril. Os pacientes, porem, relatam medo e inseguranca na realizacao dessas atividades.

Osteossíntese da fratura do colo femoral: dois ou três parafusos?

OBJECTIVES: To evaluate the efficacy of osteosynthesis on femoral neck fractures using two instead of three screws. METHODS: Thirtynine fractures were retrospectively evaluated, divided into groups in which two screws were used in parallel (n = 28) or three screws (n =11) in an inverted triangle configuration (in accordance with the AO technique). The patients were then followed up until reaching the outcome of either consolidation or failure. RESULTS: In the group in which two screws were used, consolidation was observed in 23 of the 28 fractures (82%). In the group in which three screws were used, consolidation was observed in 6 of the 11 fractures (55%). There was no statistically significant difference between these percentages. CONCLUSION: There was no difference in the prognosis for these fractures when treated using two screws in parallel or three screws in an inverted triangle in accordance with the AO technique. Further studies are needed in order to establish a definitive conclusion.

Impacto isquiofemoral: uma etiologia de quadril doloroso: relato de caso

An association between hip pain and quadratus femoris muscle abnormality on magnetic resonance imaging (MRI) with concurrent narrowing of the ischiofemoral space has been reported in the recent literature. This raises the possibility that the muscle damage observed is due to ischiofemoral impingement. This diagnosis has been noted in middle-aged females either with or without a history of trauma or surgery, is a rarely described feature. We report here on a 31-year-old woman who presented with non-traumatic hip pain and evidence of narrowing of the ischiofemoral space and edema in the quadratus femoris. Nonsurgical treatment was administered, which relieved her hip pain. The diagnosis of ischiofemoral impingement should be considered in female patients complaining of hip pain without any other evident cause.

Gluteal pain in athletes: how should it be investigated and treated?

Gluteal pain is a frequent symptom in athletes, and defining it etiologically is a challenge for orthopedists. In the present study, using an anatomical approach to the posterior region of the pelvis and the proximal femur, divided into four quadrants, systematized investigation is proposed with the aim of optimizing the treatment and accelerating athletes’ return to their sport, through correct diagnosis.

Ischiofemoral impingement: an etiology of hip pain: case report

An association between hip pain and quadratus femoris muscle abnormality on magnetic resonance imaging (MRI) with concurrent narrowing of the ischiofemoral space has been reported in the recent literature. This raises the possibility that the muscle damage observed is due to ischiofemoral impingement. This diagnosis has been noted in middle-aged females either with or without a history of trauma or surgery, is a rarely described feature. We report here on a 31-year-old woman who presented with non-traumatic hip pain and evidence of narrowing of the ischiofemoral space and edema in the quadratus femoris. Nonsurgical treatment was administered, which relieved her hip pain. The diagnosis of ischiofemoral impingement should be considered in female patients complaining of hip pain without any other evident cause.

Advantages and limitations of national arthroplasty registries. The need for multicenter registries: the Rempro-SBQ

While the value of national arthroplasty registries (NAR) for quality improvement in total hip arthroplasty (THA) has already been widely reported, some methodological limitations associated with observational epidemiological studies that may interfere with the assessment of safety and efficacy of prosthetic implants have recently been described in the literature. Among the main limitations of NAR, the need for at least 80% compliance of all health institutions covered by the registry is emphasized; completeness equal or greater than 90% of all THA performed; restricted data collection; use of revision surgery as the sole criterion for outcome; and the inability of establishing a definite causal link with prosthetic dysfunction. The present article evaluates the advantages and limitations of NAR, in the light of current knowledge, which point to the need for a broader data collection and the use of more structured criteria for defining outcomes. In this scenario, the authors describe of idealization, conceptual and operational structure, and the project of implantation and implementation of a multicenter registry model, called Rempro-SBQ, which includes healthcare institutions already linked to the Brazilian Hip Society (Sociedade Brasileira de Quadril [SBQ]). This partnership enables the collection of more reliable and comprehensive data at a higher hierarchical level, with a significant reduction in maintenance and financing costs. The quality improvement actions supported by SBQ may enhance its effectiveness and stimulate greater adherence for collecting, storing, interpreting, and disseminating information (feedback).

Regulatory CD4+ T lymphocytes after allogeneic transfusion in orthopaedic surgical patients

Emanuel, R.M., Dueck, A.C., Geyer, H.L., Kiladjian, J.J., Slot, S., Zweegman, S., te Boekhorst, P.A., Commandeur, S., Schouten, H.C., Sackmann, F., Kerguelen Fuentes, A., Hern andezMaraver, D., Pahl, H.L., Griesshammer, M., Stegelmann, F., Doehner, K., Lehmann, T., Bonatz, K., Reiter, A., Boyer, F., Etienne, G., Ianotto, J.C., Ranta, D., Roy, L., Cahn, J.Y., Harrison, C.N., Radia, D., Muxi, P., Maldonado, N., Besses, C., Cervantes, F., Johansson, P.L., Barbui, T., Barosi, G., Vannucchi, A.M., Passamonti, F., Andreasson, B., Ferrari, M.L., Rambaldi, A., Samuelsson, J., Birgegard, G., Tefferi, A. & Mesa, R.A. (2012) Myeloproliferative neoplasm (MPN) symptom assessment form total symptom score: prospective international assessment of an abbreviated symptom burden scoring system among patients with MPNs. Journal of Clinical Oncology, 30, 4098–4103. Harrison, C., Kiladjian, J.J., Al-Ali, H.K., Gisslinger, H., Waltzman, R., Stalbovskaya, V., McQuitty, M., Hunter, D.S., Levy, R., Knoops, L., Cervantes, F., Vannucchi, A.M., Barbui, T. & Barosi, G. (2012) JAK inhibition with ruxolitinib versus best available therapy for myelofibrosis. New England Journal of Medicine, 366, 787–798. Katsanos, G.S., Anogeianaki, A., Orso, C., Tet e, S., Salini, V., Antinolfi, P.L. & Sabatino, G. (2008) Mast cells and chemokines. Journal of Biological Regulators and Homeostatic Agents, 22, 145–151. Lasho, T., Tefferi, A. & Pardanani, A. (2010) Inhibition of JAK-STAT signaling by TG101348: a novel mechanism for inhibition of KITD816Vdependent growth in mast cell leukemia cells. Leukemia, 24, 1378–8. Lim, K.H., Tefferi, A., Lasho, T.L., Finke, C., Patnaik, M., Butterfield, J.H., McClure, R.F., Li, C.Y. & Pardanani, A. (2009) Systemic mastocytosis in 342 consecutive adults: survival studies and prognostic factors. Blood, 113, 5727–5736. Mayado, A., Teodosio, C., Garcia-Montero, A.C., Matito, A., Rodriguez-Caballero, A., Morgado, J.M., McClure, R.F., Li, C.Y. & Pardanani, A. (2015) Increased IL6 plasma levels in indolent systemic mastocytosis patients are associated with high risk of disease progression. Leukemia, doi:10.1038/leu.2015.176 [Epub ahead of print] Quint as-Cardama, A., Vaddi, K., Liu, P., Manshouri, T., Li, J., Scherle, P.A., Caulder, E., Wen, X., Li, Y., Waeltz, P., Rupar, M., Burn, T., Lo, Y., Kelley, J., Covington, M., Shepard, S., Rodgers, J.D., Haley, P., Kantarjian, H., Fridman, J.S. & Verstovsek, S. (2010) Preclinical characterization of the selective JAK1/2 inhibitor INCB018424: therapeutic implications for the treatment of myeloproliferative neoplasms. Blood, 115, 3109–3117. Shelburne, C.P., McCoy, M.E., Piekorz, R., Sexl, V.V., Gillespie, S.R., Bailey, D.P., Gharse, A., Mirmonsef, P., Mann, M.N., Kashyap, M., Wright, H.V., Chong, H.J., Bouton, L.A., Ramirez, C.D., Lantz, C.S. & Ryan, J.J. (2002) Stat5: an essential regulator of mast cell biology. Molecular Immunology, 38, 1187–1191. Tefferi, A., Vaidya, R., Caramazza, D., Finke, C., Lasho, T. & Pardanani, A. (2011) Circulating interleukin (IL)-8, IL-2R, IL-12, and IL-15 levels are independently prognostic in primary myelofibrosis: a comprehensive cytokine profiling study. Journal of Clinical Oncology, 29, 1356–1363. Verstovsek, S., Kantarjian, H., Mesa, R.A., Pardanani, A.D., Cortes-Franco, J., Thomas, D.A., Estrov, Z., Fridman, J.S., Bradley, E.C., Erickson-Viitanen, S., Vaddi, K., Levy, R. & Tefferi, A. (2012) Safety and efficacy of INCB018424, a JAK1 and JAK2 inhibitor, in myelofibrosis. New England Journal of Medicine, 363, 1117–1127.

Osteosynthesis of femoral neck fractures: two or three screws?

Objectives: To evaluate the efficacy of osteosynthesis on femoral neck fractures using two instead of three screws. Methods: Thirty-nine fractures were retrospectively evaluated, divided into groups in which two screws were used in parallel (n = 28) or three screws (n =11) in an inverted triangle configuration (in accordance with the AO technique). The patients were then followed up until reaching the outcome of either consolidation or failure. Results: In the group in which two screws were used, consolidation was observed in 23 of the 28 fractures (82%). In the group in which three screws were used, consolidation was observed in 6 of the 11 fractures (55%). There was no statistically significant difference between these percentages. Conclusion: There was no difference in the prognosis for these fractures when treated using two screws in parallel or three screws in an inverted triangle in accordance with the AO technique. Further studies are needed in order to establish a definitive conclusion.