Eduardo da Frota Carrera

Validity and reliability of the Western Ontario Rotator Cuff Index (WORC) for use in Brazil.

Objective:To evaluate the validity and reliability of the Brazilian Portuguese version of the Western Ontario Rotator Cuff Index (WORC). Design and Setting:A cross-sectional survey at the Physiotherapy Unit and Outpatient Orthopedic and Traumatology Clinic, Universidade Federal de São Paulo. Methods:To test validity, 100 patients with rotator cuff disorders were evaluated using the WORC, clinically relevant outcomes for patients with shoulder disorders (pain, range of motion, and strength), and the Disabilities of Arm, Shoulder, and Hand (DASH), University of California Los Angeles Shoulder Rating Scale (UCLA), and Short Form-36 (SF-36) self-report measures. The WORC was repeated on 50 patients on the same day (more than 1 hour later) and after a mean interval of 7 days to evaluate the test-retest reliability. Concurrent validity was tested by correlating the WORC to the other outcome measures using Pearsons correlation coefficient. Test-retest reliability and internal consistency were determined by the intraclass correlation coefficient and Cronbachs alpha coefficient, respectively. The scores were used to assess the standard error measurement (SEM) and minimal detectable change (MDC). Results:Analysis between the WORC and clinically relevant outcomes for patients with shoulder disorders revealed weak to strong correlations; the weakest for active internal rotation (r = -0.22) and the strongest for pain during movement (r = -0.75). Strong correlations were found among the WORC and the DASH and UCLA (r = -0.86 and r = 0.80, respectively). There were moderate correlations between the WORC and SF-36 domains (0.37 to 0.69); the best correlations related to the physical domains. Reliability analysis revealed excellent results, with the intraclass correlation coefficient ranging from 0.95 to 0.99 and Cronbachs alpha ranging from 0.88 to 0.97. The SEM was 5.2 and 3.0 for time 0 and after a mean interval of 7 days, respectively. The MDC was 7.1 over this mean time interval (90% confidence interval). Conclusions:The Brazilian version of the WORC proved to be a valid and reliable measurement tool for assessing health-related quality of life in patients with rotator cuff diseases.

Tradução e adaptação cultural do Modified-University of California at Los Angeles Shoulder Rating Scale para a língua portuguesa

OBJECTIVES: the aims of this study were to translate into Brazilian-Portuguese the Modified - University of California at Los Angeles Shoulder Rating Scale and to cross-culturally adapt it to the Brazilian environment. METHODS: the scale was translated to Portuguese and back translated into English according to internationally recommended process described by Guillemin et al(28). The translated and revised version was administered to two groups (patients between 45 and 75 years old and health professionals) to evaluate the comprehension level of the items. If 15% or more of health professionals or patients reported difficulty in understanding, that item was reformulated and reapplied. RESULTS: we did three applications. Each group had 20 consecutive people, totalizing 120 people. To obtain the final Brazilian version, we modified five items in the pain parameter and four in the function parameter. Beyond these alterations, we identified problems about the structure suggesting that we need to continue the validity and possible modifications of this scale.

A mechanical comparison between conventional and modified angular plates for proximal humeral fractures

The objective of this study is to present a modified angular blade plate for fixing 2-part and even 3-part fractures of the proximal humerus, as well as the results of the comparative mechanical test between the conventional angular blade plate and this new modified plate. The plates were tested in flexion and rotational trials in a wooden model that simulated a 2-part humeral fracture of the proximal extremity. The results (mean +/- SD) of bending strength and stiffness obtained after testing showed findings of 601 +/- 349 N and 0.5 +/- 0.2 N/mm, respectively, for the conventional plate and 4005 +/- 164 N and 3.9 +/- 0.7 N/mm, respectively, for the modified plate. The torsional stiffness test showed findings of 1.26 +/- 0.09 KN.mm degrees for the conventional plate and 1.74 +/- 0.21 KN.mm degrees for the modified plate. The test of torsional moment showed findings of 57.0 +/- 7.6 KN.mm for the conventional plate and 115.2 +/- 9.3 KN.mm for the modified plate. The test of angular displacement at the torsional moment showed findings of 50.8 degrees +/- 7.2 degrees for the conventional plate and 70.2 degrees +/- 2.6 degrees for the modified plate. The results of the mechanical trials of flexion and rotation were superior for the modified angular blade plate compared with the conventional angular blade plate.

Avascular necrosis of the sternal end of the clavicle: A case report

Avascular necrosis of the sternal end of the clavicle was described by Friedrich in 1924 and is known as Friedrich disease. Since then, few cases have been reported in the literature. Most patients have been women and without histologic confirmation of the disease. The disease is rare, and the etiology is unknown. In general, it presents with pain in the sternoclavicular joint (SCJ) and an increase in the volume of the sternal end of the clavicle that progresses to an insidious functional limitation of the shoulder joint. Conservative treatment results in remission of the symptoms in most patients, and resection of the sternal end of the clavicle is reserved for resistant cases. We report a man with Friedrich disease confirmed by histologic examination who underwent resection of the sternal end of the clavicle.

Preferências dos cirurgiões ortopédicos para o tratamento da fratura do terço médio da clavícula em adultos

RESUMO Objetivo Determinar a pratica clinica atual na America Latina para o tratamento das fraturas do terco medio da clavicula, incluindo abordagens cirurgicas e nao cirurgicas. Metodos Estudo transversal com aplicacao de questionario descritivo. Cirurgioes de ombro e cotovelo da Sociedade Brasileira de Cirurgia do Ombro e Cotovelo e da Sociedade Latino-Americana de Ombro e Cotovelo foram contatados e convidados a completar um breve questionario (SurveyMonkey®) sobre o manejo das fraturas do terco medio da clavicula. Foram excluidas as respostas [...]ABSTRACT Objective To determine the current clinical practice in Latin America for treating midshaft clavicle fractures, including surgical and non-surgical approaches. Methods A cross-sectional study using a descriptive questionnaire. Shoulder and elbow surgeons from the Brazilian Society of Shoulder and Elbow Surgery and from the Latin American Society of Shoulder and Elbow were contacted and asked to complete a short questionnaire (SurveyMonkey®) on the management of midshaft fractures of the clavicle. Incomplete or inconsistent answers were excluded. Results The type of radiographic classification preferably used was related to description of fracture morphology, according to 41% of participants. Allman classification ranked second and was used by 24.1% of participants. As to indications for surgical treatment, only the indications with shortening and imminence of skin exposure were statistically significant. Conservative treatment was chosen in cortical contact. Regarding immobilization method, the simple sling was preferred, and treatment lasted from 4 to 6 weeks. Although the result was not statistically significant, the blocked plate was the preferred option in surgical cases. Conclusion The treatment of midshaft clavicle fractures in Latin America is in accordance with the current literature.