Nuno Alegrete

Sagittal standing posture, back pain, and quality of life among adults from the general population: a sex-specific association.

Study Design. A prospective radiographical study of sagittal standing posture among adults consecutively recruited from the general population. Objective. To analyze the relation of suboptimal sagittal standing posture with back pain and health-related quality of life in general adult males and females. Summary of Background Data. Clinical studies have shown the association of sagittal standing posture with pain and reduced quality of life, but this relation has not been assessed in the general adult population. Methods. As part of the EPIPorto population-based study of adults, 178 males and 311 females were evaluated. Age, education, and body mass index were recorded. Radiographical data collection consisted of 36-in. standing sagittal radiographs. Creation of 3 groups for individual spinopelvic parameters was performed (low, intermediate, or high), and 1 of 4 sagittal types of postural patterns attributed to each participant (Roussouly classification). Back pain prevalence and severity were assessed on the basis of self-reported data and health-related quality of life using 2 main components of the 36-Item Short Form Health Survey. Results. In males, differences in back pain severity were observed only among pelvic tilt/pelvic incidence ratio groups. Females presenting high pelvic incidence and sacral slope exhibited higher odds of severe back pain than those with intermediate values (adjusted odds ratios = 2.21 and 2.15; 95% confidence interval, 1.24–3.97 and 1.21–3.86; respectively). Sagittal vertical axis showed the largest differences in physical quality of life of females: high group had 8.8 lower score than the low group (P < 0.001), but this result lost statistical significance after adjustment for age, education, and body mass index. Conclusion. Sagittal standing posture was not consistently associated with quality of life measures in males. Increased pelvic incidence and sacral slope may be involved in causing severe back pain among females. Monitoring sagittal postural parameters has limited usefulness as a screening tool for causes of unspecific musculoskeletal symptoms in the general adult population. Level of Evidence: 3

Defining Patterns of Sagittal Standing Posture in School-Aged Girls and Boys

Background Sagittal postural patterns are associated with back pain in adolescents and adults. However, it is unknown if postural patterns are already observable during childhood. This would confirm childhood as a key period for posture differentiation and thus for chronic pain etiology. Objective We aimed to identify and describe postural patterns in school-aged girls and boys. Design This was a cross-sectional study. Methods Eligible children were evaluated at age 7 in the population-based birth cohort Generation XXI, Portugal. Posture was assessed through right-side photographs during habitual standing with retro-reflective markers placed on body landmarks. We defined postural patterns from trunk, lumbar and sway angles using model-based clusters and associations with anthropometric measures were assessed by multinomial logistic regression. Results Posture was evaluated in 1147 girls and 1266 boys. Three postural patterns were identified: “Sway” (26.9%), “Flat” (20.9%) and “Neutral to Hyperlordotic” (52.1%) in girls; “Sway to Neutral” (58.8%), “Flat” (36.3%) and “Hyperlordotic” (4.9%) in boys. In girls, higher body mass index was associated with a Sway pattern (vs. Flat, OR=1.21; 95% CI: 1.12-1.29), while in boys, body mass index was higher in the Hyperlordotic pattern (vs. Flat, OR=1.30; 95% CI: 1.17-1.44). Limitations Photogrammetry as a non-invasive method for posture assessment may have introduced some postural misclassification. Conclusions Postural patterns in seven-year-old children were consistent with those previously found in adults, suggesting childhood as a sensitive period for posture differentiation. Sagittal morphology differed between genders, emphasizing gender-specific biomechanical loads during habitual upright position even in prepubertal ages.

Medial epiphyseal fracture-detachment of the sternoclavicular joint with posterior displacement in a judo athlete - equivalent of posterior sternoclavicular dislocation

Posterior sternoclavicular dislocation is a rare traumatic injury that presents a potential risk of injury to mediastinal structures. The diagnosis is fundamentally clinical and treatment is done on an emergency basis. The authors report the clinical case of a young judo athlete with post-traumatic medial epiphyseal fracture-detachment, with posterior displacement (lesion equivalent to posterior sternoclavicular dislocation at pediatric ages). He underwent open reduction and ligament repair by means of a mini-anchor. The radiological and clinical outcome was excellent, and the athlete returned to his sports activity without limitations. We discuss the particular features of this pathological condition, along with the different therapeutic approaches and their complications.

The role of pharmacotherapy in modifying the neurological status of patients with spinal and spinal cord injuries

The aim here was to conduct a review of the literature on pharmacological therapies for modifying the neurological status of patients with spinal cord injuries. The PubMed database was searched for articles with the terms “spinal cord injury AND methylprednisolone/GM1/apoptosis inhibitor/calpain inhibitor/naloxone/tempol/tirilazad”, in Portuguese or in English, published over the last five years. Older studies were included because of their historical importance. The pharmacological groups were divided according to their capacity to interfere with the physiopathological mechanisms of secondary injuries. Use of methylprednisolone needs to be carefully weighed up: other anti-inflammatory agents have shown benefits in humans or in animals. GM1 does not seem to have greater efficacy than methylprednisolone, but longer-term studies are needed. Many inhibitors of apoptosis have shown benefits in in vitro studies or in animals. Naloxone has not shown benefits. Tempol inhibits the main consequences of oxidation at the level of the spinal cord and other antioxidant drugs seem to have an effect superior to that of methylprednisolone. There is an urgent need to find new treatments that improve the neurological status of patients with spinal cord injuries. The benefits from treatment with methylprednisolone have been questioned, with concerns regarding its safety. Other drugs have been studied, and some of these may provide promising alternatives. Additional studies are needed in order to reach conclusions regarding the benefits of these agents in clinical practice.

Two consecutive limb lengthenings with the same PRECICE nail: a technical note

PurposeThe most significant advance in our time about limb lengthening is the magnetic lengthening nail, as the first reports appeared to show good results with accurate lengthening rates and good regenerate bone formation. The described complication rate is generally low. They avoid external fixation elements, and are activated transcutaneously, so the patient’s pain and discomfort are reduced and the rehabilitation is faster and more effective. The aim of authors is to describe a special technical issue of the PRECICE system: the nail can be extended inside the patient limb (after the osteotomy), but it also can be retracted inside the limb after achieving the bone union.MethodsThe authors present a case in which the limb lengthening has been performed in consecutive lengthening periods using the same nail. The nail was extended and retracted by altering the settings on the external remote control as well as accurately setting the rate of distraction.ResultsAfter two consecutive femoral lengthening with the same PRECICE nail, the patient no longer has a significant lower limb length discrepancy and patient satisfaction was high. During this clinical case, we were not confronted with any type of complications.ConclusionThis technique utilizes the principles and advantages of lengthening over an magnetic lengthening nail, avoids the necessity of nail removal and minimizes the complication rates and the overall time for complete recovery.Level of evidenceLevel IV.

Congenital dislocation of the patella - clinical case

Congenital patellar dislocation is a rare condition in which the patella is permanently dislocated and cannot be reduced manually. The patella develops normally as a sesamoid bone of the femur. This congenital dislocation results from failure of the internal rotation of the myotome that forms the femur, quadriceps muscle and extensor apparatus. It usually manifests immediately after birth, although in some rare cases, the diagnosis may be delayed until adolescence or adulthood. Early diagnosis is important, thereby allowing surgical correction and avoiding late sequelae, including early degenerative changes in the knee. A case of permanent dislocation of the patella is presented here, in a female child aged seven years.