Marcelo Hide Matsumoto

Treatment of Bankart Lesions in Traumatic Anterior Instability of the Shoulder: A Randomized Controlled Trial Comparing Arthroscopy and Open Techniques

PURPOSE The objective of this study was to compare the functional assessments of arthroscopy and open repair for treating Bankart lesion in traumatic anterior shoulder instability. METHODS Fifty adult patients, aged less than 40 years, with traumatic anterior shoulder instability and the presence of an isolated Bankart lesion confirmed by diagnostic arthroscopy were included in the study. They were randomly assigned to receive open or arthroscopic treatment of an isolated Bankart lesion. In all cases of both groups, the lesion was repaired with metallic suture anchors. The primary outcomes included the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. RESULTS After a mean follow-up period of 37.5 months, 42 patients were evaluated. On the DASH scale, there was a statistically significant difference favorable to the patients treated with the arthroscopic technique, but without clinical relevance. There was no difference in the assessments by University of California, Los Angeles and Rowe scales. There was no statistically significant difference regarding complications and failures, as well as range of motion, for the 2 techniques. CONCLUSIONS On the basis of this study, the open and arthroscopic techniques were effective in the treatment of traumatic anterior shoulder instability. The arthroscopic technique showed a lower index of functional limitation of the upper limb, as assessed by the DASH questionnaire; this, however, was not clinically relevant.

Medical assistance at the Brazilian juniors tennis circuit — a one-year prospective study

A prospective study was conducted during one year to evaluate injuries in Brazilian Junior tennis players during the national circuit, in 2001. Male and female athletes in the age categories under 12, under 14, under 16 and under 18 years, all members of The Brazilian Tennis Confederation, participated in the study. Two physiotherapists and/or one physician evaluated the athletes. A total of 280 medical examinations were performed in 151 tennis players who needed medical treatment during the tournaments. The 151 athletes had 1-6 medical treatments during the tournaments and the mean was 1.8 treatment per athlete. The overall incidence was 6.9 medical treatments for every 1,000 games played. Medical assistance tothe athletes was performed on court in 83 (29.6%) occasions, 185 (66.1%) at the medical department and in both in 12 (4.3%) occasions. Retirement of the match was reported in 9 (3.2%) lesions. The most frequent injuries were: muscle contractures (76 - 27.14%), muscle pain/fatigue (36-12.85%), muscle strain (35-12.52%), tendinopathies (20 - 7.14%), cramps (16 -5.71%), ankle sprain (12 -4.28%) and low back pain (10-3.57%). Muscle pathology was the major source of injuries causing the athlete to seek medical assistance. Preventative measures are important to reduce the number of injuries, which may include muscle stretching programs and adequate nutrition and hydration.

Are classifications of proximal radius fractures reproducible

BackgroundFractures of the proximal radius need to be classified in an appropriate and reproducible manner. The aim of this study was to assess the reliability of the three most widely used classification systems.MethodsElbow radiographs images of patients with proximal radius fractures were classified according to Mason, Morrey, and Arbeitsgemeinschaft für osteosynthesefragen/Association for the Study of Internal Fixation (AO/ASIF) classifications by four observers with different experience with this subject to assess their intra- and inter-observer agreement. Each observer analyzed the images on three different occasions on a computer with numerical sequence randomly altered.ResultsWe found that intra-observer agreement of Mason and Morrey classifications were satisfactory (κ = 0.582 and 0.554, respectively), while the AO/ASIF classification had poor intra-observer agreement (κ = 0.483). Inter-observer agreement was higher in the Mason (κ = 0.429-0.560) and Morrey (κ = 0.319-0.487) classifications than in the AO/ASIF classification (κ = 0.250-0.478), which showed poor reliability.ConclusionInter- and intra-observer agreement of the Mason and Morey classifications showed overall satisfactory reliability when compared to the AO/ASIF system. The Mason classification is the most reliable system.

Fraturas expostas: estudo epidemiológico e prospectivo

OBJECTIVE: to delineate the epidemiological profile of patients attended by an emergency unit, diagnosed with open fractures. MATERIALS AND METHODS: This is an epidemiological, prospective, descriptive, observational study of open fractures attended at the institution, selected by convenience sampling, in the period September 1, 2005 to March 31, 2007. The data were collected from patients using a questionnaire with multiple variables. RESULTS: we obtained 342 patients with 346 open fractures. The majority of the patients were male (86.84%), with an average age of 30.41 years and average hospitalization time of 6.87 days. The main professions were students (21.92%), followed by motorcycle couriers (11.40%). The accidents occurred on public roads (57.30%), affecting mainly the leg bones (37.86%) and classified as level III (45.36%). Associated injuries occurred in 27.19%, with 11.11% complications. There was evidence of alcohol consumption (12.86%) and drug use (1.46%) in the six hours prior to the trauma. CONCLUSION: The patients were mainly young, male, with incomplete school education. The main cause of the traumas was road accidents, occurring at night (between 7 pm and midnight), with leg bone injuries classified as level III. The associated injuries and early complications were predominantly related to injuries of greater severity.

Treatment of the humeral shaft fractures - minimally invasive osteosynthesis with bridge plate versus conservative treatment with functional brace: study protocol for a randomised controlled trial

BackgroundHumeral shaft fractures account for 1 to 3% of all fractures in adults and for 20% of all humeral fractures. Non-operative treatment is still the standard treatment of isolated humeral shaft fractures, although this method can present unsatisfactory results. Surgical treatment is reserved for specific conditions. Modern concepts of internal fixation of long bone shaft fractures advocate relative stabilisation techniques with no harm to fracture zone. Recently described, minimally invasive bridge plate osteosynthesis has been shown to be a secure technique with good results for treating humeral shaft fractures. There is no good quality evidence advocating which method is more effective. This randomised controlled trial will be performed to investigate the effectiveness of surgical treatment of humeral shaft fractures with bridge plating in comparison with conservative treatment with functional brace.Methods/DesignThis randomised clinical trial aims to include 110 patients with humeral shaft fractures who will be allocated after randomisation to one of the two groups: bridge plate or functional brace. Surgical treatment will be performed according to technique described by Livani and Belangero using a narrow DCP plate. Non-operative management will consist of a functional brace for 6 weeks or until fracture consolidation. All patients will be included in the same rehabilitation program and will be followed up for 1 year after intervention. The primary outcome will be the DASH score after 6 months of intervention. As secondary outcomes, we will assess SF-36 questionnaire, treatment complications, Constant score, pain (Visual Analogue Scale) and radiographs.DiscussionAccording to current evidence shown in a recent systematic review, this study is one of the first randomised controlled trials designed to compare two methods to treat humeral shaft fractures (functional brace and bridge plate surgery).Trial registrationCurrent Controlled Trials: ISRCTN24835397

Open fractures and the incidence of infection in the surgical debridement 6 hours after trauma

Objectives: To determine whether a time delay greater than 6h from injury to surgical debridement influences the infection rate in open fractures. Methods: During a period of 18 months, from October 2010 to March 2012, 151 open fractures were available for study in 142 patients in our hospital. The data were collected prospectively and the patients were followed up for 6 weeks. The patients were divided into two groups regarding the time delay from injury to surgical debridement (more or less than 6 hours). Results: Surgical debridement was carried out in less than 6h from injury in 90 (59.6%) fractures and after 6 hours from injury in 61 (40.4%) fractures. Infection rates were 12.22% and 13.24%, respectively. The global infection rate was 13.24%. Conclusion: A significantly increased infection rate was not observed in patients whose surgical debridement occurred more than 6h after injury. However, in the fractures of high-energy trauma, a statistically significant increase of the rate of infection was observed in those operated 6 hours after trauma. Level of Evidence II, Study Type Comparative and Prospective.

Result from surgical treatment on the terrible triad of the elbow

Objective To evaluate the results from surgical treatment of the terrible triad of the elbow, with a minimum of six months of follow-up, taking elbow function into consideration. Methods The analyzed aspects of 20 patients, who underwent surgical treatment of the terrible triad of the elbow, were given as follows: Dash score (Disabilities of the Arm, Shoulder and Hand), Meps (Mayo Elbow Performance Score), pain according to VAS (visual analog scale), ROM (range of motion), patient satisfaction, degree of energy of the trauma, complications and radiographs. Results The mean length of follow-up among the patients was 38 months. There were statistically significant relationships between the following set of parameters: trauma mechanism and patient satisfaction; radiological outcome of “heterotopic ossification” and satisfaction; functional flexion–extension ROM and satisfaction; and between type of radial head fracture and presence of a radiological outcome. Conclusion The surgical treatment for the terrible triad of the elbow generally provided satisfactory results, when the functioning of this joint upon the return to activities was taken into consideration.

Tratamento da síndrome do túnel ulnar pela técnica da epicondilectomia parcial medial do cotovelo

OBJECTIVE: The authors made a retrospective analysis of the results of 21 cases of cubital syndrome that were surgically treated with the partial medial epicondylectomy. METHODS: From February 2001 to October 2006, 21 patients with cubital tunnel syndrome were treated with the technique of elbow partial medial epicondylectomy associated to neurolysis of the ulnar nerve. Of these patients, 12 (57.1%) were male. The right side was involved in 15 (71.4%). Mean age of the patients was 51.6 years. According to McGowan classification, six (28.6%) patients were grade I, 11 (52.3%), grade II, and four (19.1%), grade III in the preoperative period. RESULTS: The mean post-operative follow-up time was 25.7 months. In the post-operative period, patients were evaluated according to the Bishop score scale, and nine of them (42.8%) showed excellent results, seven (33.3%) had good results, three (14.2%), regular, and two patients (9.5%) had poor results. The authors did not find in this series any complications represented by residual valgus instability, permanent lesion of the ulnar nerve, recurrent compression, or subluxation of the ulnar nerve. Complications found were the loss of the movement arch in one case (4.7%), superficial infection in one case (4.7%), and residual pain in one case (4.7%). CONCLUSION: The results allow for the conclusion that partial medial epicondylectomy of the elbow associated to neurolysis of the ulnar nerve is effective and safe to treat cubital tunnel syndrome.

Minimally Invasive Osteosynthesis with a Bridge Plate Versus a Functional Brace for Humeral Shaft Fractures: A Randomized Controlled Trial

Background: Nonoperative treatment has historically been considered the standard for fractures of the shaft of the humerus. Minimally invasive bridge-plate osteosynthesis for isolated humeral shaft fractures has been proven to be a safe technique, with good and reproducible results. This study was designed to compare clinical and radiographic outcomes between patients who had been treated with bridge plate osteosynthesis and those who had been managed nonoperatively with a functional brace. Methods: A prospective randomized trial was designed and included 110 patients allocated to 1 of 2 groups: surgery with a bridge plate or nonoperative treatment with a functional brace. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) score at 6 months. The score on the Short Form-36 (SF-36) life-quality questionnaire, complications of treatment, Constant-Murley score for the shoulder, pain level, and radiographic results were assessed as secondary outcomes. Participants were assessed at 2 weeks; 1, 2, and 6 months; and 1 year after the interventions. Results: The mean DASH score of the bridge plate group was statistically superior to that of the functional brace group (mean scores, 10.9 and 16.9, respectively; p = 0.046) only at 6 months. The bridge plate group also had a significantly more favorable nonunion rate (0% versus 15%) and less mean residual angular displacement seen on the anteroposterior radiograph (2.0° versus 10.5°) (both p < 0.05). No difference between the groups was detected with regard to the SF-36 score, pain level, Constant-Murley score, or angular displacement seen on the lateral radiograph. Conclusions: This trial demonstrates that, compared with functional bracing, surgical treatment with a bridge plate has a statistically significant advantage, of uncertain clinical benefit, with respect to self-reported outcome (DASH score) at 6 months, nonunion rate, and residual deformity in the coronal plane as seen on radiographs. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Do computed tomography and its 3D reconstruction increase the reproducibility of classifications of fractures of the proximal extremity of the humerus

Objective to determine whether 3D reconstruction images from computed tomography (CT) increase the inter and intraobserver agreement of the Neer and Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification systems. Methods radiographic images and tomographic images with 3D reconstruction were obtained in three shoulder positions and were analyzed on two occasions by four independent observers. Results the radiographic evaluation demonstrated that using CT improved the inter and intraobserver agreement of the Neer classification. This was not seen with the AO classification, in which CT was only shown to increase the interobserver agreement. Conclusion use of 3D CT allows better evaluation of fractures with regard to their component parts and their displacements, but nevertheless the intraobserver agreement presented is less than ideal.