Luiz Eugênio Garcez Leme

Study of the proximal femoral fractures mortatlity in elderly patients

Foi feito um estudo de revisao sobre a mortalidade na fratura do femur proximal em idosos com base nas publicacoes mais relevantes do periodo de 1998 a 2002. Foram incluidos 25 artigos relacionados ao assunto, selecionados com base nos bancos de dados Medline e Cochrane, totalizando 24.062 pacientes com mais de 60 anos de idade, que tiveram fratura do femur proximal. Quatorze estudos foram prospectivos, oito retrospectivos e tres revisoes sistematicas. As taxas medias de mortalidade foram de 5,5% durante a internacao hospitalar, 4,7% ao fim de um mes de seguimento, 11,9% com tres meses, 10,8% com seis meses, 19,2% com um ano e 24,9% com dois anos. Foram identificados quatro fatores intimamente relacionados com uma maior mortalidade nestes pacientes: idade avancada, grande numero de doencas associadas, sexo masculino e presenca de deficiencias cognitivas. Outros fatores mostraram uma fraca correlacao com a mortalidade como capacidade deambulatoria previa, indice de risco anestesico da Sociedade Americana de Anestesia (ASA), anemia, hipoalbuminemia, linfopenia e existencia de AVC previo. Os fatores como tempo previo a cirurgia, tipo de anestesia utilizada e tipo de osteossintese empregada nao mostraram ter interferencia.

Isokinetic assessment of knee flexor/extensor muscular strength in elderly women

OBJECTIVE To assess knee flexor-extensor muscular strength in elderly women with no previous history of musculoskeletal disorders on the lower limbs using an isokinetic dynamometer, in order to obtain data that could be used as a comparative parameter in the evaluation of elderly women with knee disorders, thus facilitating a better rehabilitation of these patients. METHODS Twenty-six volunteers aged 75 to 83 years were studied using a Cybex 6000 isokinetic dynamometer. The chosen angular velocity was 60 degrees /s, and concentric exercise was used for either flexion or extension. The studied parameters were: peak torque, angle of peak torque, and flexor-extensor torque rate. RESULTS There were no differences between dominant (D) and nondominant (ND) knee peak torque values. This was true for both flexor (D = 42.46 +/- 9.09 Nm / ND = 40.65 +/- 9.38 Nm) and extensor (D = 76.92 +/- 13.97 Nm / ND = 77.65 +/- 15.21 Nm) movements. The descriptive statistical analysis of the values obtained for the flexor-extensor peak torque rate and for the angle of occurrence of peak torque was the same for the dominant and nondominant sides. CONCLUSIONS The values of peak torque for the contralateral side can be used as a reference during rehabilitation of elderly women with acute disease of the knee, and the angular velocity of 60 degrees /s is proper and safe for isokinetic assessment of elderly people.

Isokinetic dynamometry in elderly women undergoing total knee arthroplasty: a comparative study

OBJECTIVE The present study assessed the reliability and validity of isokinetic dynamometry in the qualitative determination of the evolution of total knee arthroplasty. CASES 20 patients whose mean age was 71.35 years, undergoing knee arthroplasty, and 25 controls whose mean age was 71.36 years. METHOD Computerized isokinetic assessment of flexor and extensor muscles using a CYBEX 6000 dynamometer. RESULTS The total flexor/extensor effort ratio for the treated side of patients vs the nondominant side of controls was not significantly different. The flexion/extension ratio concerning maximum torque for the treated side of patients vs the nondominant side of controls was significantly different. CONCLUSION By detecting deficiencies in the balance of flexor and extensor muscles (a balance that is required for uniform gait), it will be possible to select specific rehabilitation exercises according to the individual needs of each patient undergoing surgery.

INTERDISCIPLINARY CARE IN ORTHOGERIATRICS: A GOOD COST‐BENEFIT MODEL OF CARE

Even more eye catching is the assertion that, “at the very least, the data in this trial demonstrate that cognition and overall dementia severity are maintained for 6 months.” At 6 months, the cognitive measure, the main outcome measure, and the ADL measure were not significantly different from placebo. There is no evidence of stabilization. The drug makers supported four of the seven authors in this study and have paid them consulting fees and honoraria. The other three authors are full-time employees of the drug company. This article represents a failure of peer review.

Identification and treatment of osteoporosis among elderly patients with hip fractures

OBJECTIVE: To evaluate the profile of osteoporosis treatment among patients hospitalized due to hip fractures at a tertiary-level university hospital. To compare the impact of hospitalization on approaches toward treating bone mass losses. METHOD: The medical records of 123 hip fracture patients aged 60 years and over at the Institute of Orthopedics, Hospital das Clínicas, University of São Paulo School of Medicine, between 2004 and 2006 were reviewed and analyzed with respect to approaches towards investigating osteoporosis and treatments before and after fracture. RESULTS: The patients’ mean age was 78 ± 8.3 years, and the majority were women (71.54%). The patients had a mean of 2.72 comorbidities and used 3.26 medications on average. Among these patients, 12.3% reported a previous diagnosis of osteoporosis, and 5.83% were on medication for this. The mean waiting time for surgery was 6.3 ± 7.54 days, and seven patients (5.7%) died during the hospitalization. There were no investigations using bone densitometry, no changes in osteoporosis therapy between admission and discharge (p = 0.375), and no reports of referrals for the patient to have access to treatment. CONCLUSIONS: Investigations and treatments of osteoporosis and strategies for preventing new fractures were not implemented during the hospitalization of these elderly patients with hip fractures, even though this is the most feared complication of osteoporosis. These data need to be disseminated so that professionals dealing with elderly patients are attentive to the need for primary and secondary prevention of osteoporosis because of the impact of fractures on these patients’ quality of life, independence, morbidities, and mortality.

Analysis of static and dynamic balance in healthy elderly practitioners of Tai Chi Chuan versus ballroom dancing

OBJECTIVE: To determine whether Tai Chi Chuan or ballroom dancing promotes better performance with respect to postural balance, gait, and postural transfer among elderly people. METHODS: We evaluated 76 elderly individuals who were divided into two groups: the Tai Chi Chuan Group and the Dance Group. The subjects were tested using the NeuroCom Balance Master® force platform system with the following protocols: static balance tests (the Modified Clinical Tests of Sensory Interaction on Balance and Unilateral Stance) and dynamic balance tests (the Walk Across Test and Sit-to-stand Transfer Test). RESULTS: In the Modified Clinical Test of Sensory Interaction on Balance, the Tai Chi Chuan Group presented a lower sway velocity on a firm surface with open and closed eyes, as well as on a foam surface with closed eyes. In the Modified Clinical Test of Sensory Interaction on Unilateral Stance, the Tai Chi Chuan Group presented a lower sway velocity with open eyes, whereas the Dance Group presented a lower sway velocity with closed eyes. In the Walk Across Test, the Tai Chi Chuan Group presented faster walking speeds than those of the Dance Group. In the Sit-to-stand Transfer Test, the Tai Chi Chuan Group presented shorter transfer times from the sitting to the standing position, with less sway in the final standing position. CONCLUSION: The elderly individuals who practiced Tai Chi Chuan had better bilateral balance with eyes open on both types of surfaces compared with the Dance Group. The Dance Group had better unilateral postural balance with eyes closed. The Tai Chi Chuan Group had faster walking speeds, shorter transfer times, and better postural balance in the final standing position during the Sit-to-stand Test.

Linguagem metodológica: parte 1

The position of our country within international scenario has been increasing and Brazilian medicine follows this development. For this, it is our responsibility as human sciences professionals the adoption of modern principles ruling the preparation and publication of scientific papers and, among those principles, quality methodological criteria must be complied with. With this purpose, this inter-department and inter-disciplinary group of the Medical College of the University of S<o Paulo presents to Acta Ortopedica Brasileira a glossary of the terms that are frequently used in scientific methodology and related areas, such as epidemiology, statistics, and library sciences, added by some names and abbreviations of entities referred to on research programs. This combination of words, titles and abbreviations shall be of a great help to those who, by knowing them, shall be closer to the scientific community, enabled by the coliving, participation, discussion and engagement, which shall lead to a better understanding and shall target the improvement of their projects and publications.

Profilaxia do tromboembolismo venoso em cirurgia ortopédica

The relevance of prophylaxis of venous thromboembolism and its complications in orthopedic surgery is increasingly significant. This review discusses the pathophysiology of thrombus formation in general and orthopedic surgery, its incidence, predisposing factors and complications. It also presents an updated presen tation and critique of prophylaxis currently available in our environment.

Prophylaxis of venous thromboembolism in orthopaedic surgery

The relevance of prophylaxis of venous thromboembolism and its complications in orthopedic surgery is increasingly significant. This review discusses the pathophysiology of thrombus formation in general and orthopedic surgery, its incidence, predisposing factors and complications. It also presents an updated presentation and critique of prophylaxis currently available in our environment.

Revisão de artigos de ortopedia e medicina esportiva publicados em periódicos brasileiros

The purpose of this review is to present the most relevant articles on Orthopaedics and Sports Medicine published in Brazilian non-orthopedic medical journals indexed by ISI. These papers represent the most important contributions to this area of knowledge over the last two years. A total of thirty-eight papers were located for this period, published in different Brazilian journals and with different research designs. It is clear that better divulgation of papers on Orthopedics and Sports Medicine in general journals is needed, to give specialists a better source of reference and research.