RESUMO Objetivos: Descrever a utilização clínica da escala de triagem de Manchester adaptada ao pronto-socorro ortopédico e avaliar sua validade para detectar pacientes com necessidade de cuidados hospitalares e sua confiabilidade quando reproduzida por diferentes profissionais. Métodos: Cinco fluxogramas de triagem foram desenvolvidos com base na escala de Manchester: lesões traumáticas, dor articular, dor vertebral, transtorno pós-operatório e infecção musculoesquelética. Uma série de pacientes triados por dois ortopedistas foi analisada para avaliação da concordância entre os avaliadores (confiabilidade) e sua validade como preditivo de gravidade. Resultados: A avaliação da confiabilidade incluiu 231 pacientes, com concordância inter-observadores de 84% (Kappa = 0,77; p <0,001). A análise da validade incluiu 138 pacientes. A classificação de risco apresentou forte associação com a necessidade de cuidados hospitalares em pacientes com trauma (OR = 6,57; p = 0,001), não sendo significativa nos transtornos não-traumáticos (OR = 2,42; p = 0,208). A sensibilidade geral foi de 64% e a especificidade de 76%. Conclusão: O sistema avaliado apresentou alta confiabilidade. Sua validade foi adequada, com boa sensibilidade para detectar pacientes com necessidade de procedimentos hospitalares em lesões traumáticas, enquanto a sensibilidade foi baixa em pacientes com lesões não-traumáticas. Nível de Evidência III, Estudo Retrospectivo.

ABSTRACT Objectives: To describe the clinical utility of the Manchester triage scale adapted for orthopedic emergency departments and to evaluate its validity in identifying patients with the need for hospital care and its reliability when reproduced by different professionals. Methods: Five triage flowcharts were developed based on the Manchester scale for the following orthopedic disorders: traumatic injuries, joint pain, vertebral pain, postoperative disorders, and musculoskeletal infections. A series of patients triaged by two orthopedists was analyzed to assess the concordance between the evaluators (reliability) and the validity of the Manchester scale as predictive of severity. Results: The reliability analysis included 231 patients, with an inter-observer agreement of 84% (Kappa = 0.77, p <0.001). The validity analysis included 138 patients. The risk category had a strong association with the need for hospital care in patients with trauma (OR = 6.57, p = 0.001) and was not significant for non-traumatic disorders (OR = 2.42; p = 0.208). The overall sensitivity and specificity were 64% and 76%, respectively. Conclusion: The evaluated system presented high reliability. Its validity was adequate, with good sensitivity for identifying patients requiring hospital care among those with traumatic lesions. However, the sensitivity was low for patients with non-traumatic lesions. Level of Evidence III, Retrospective Study.

ABSTRACTOBJECTIVE: To verify the frequency of late radiological com-plications in spinal fixation surgeries performed without fu-sion in oncological patientsMETHODS: This is a retrospective analysis analysing failure in cases of non-fused vertebral fixation in an oncology reference hospital between 2009 and 2014. Failure was defined as implant loosening or bre-akage, as well as new angular or translation deformitiesRESULTS: One hundred and five cases were analyzed. The most common site of primary tumor was the breast and the most common place of metastasis was the thoracic spine. The average follow-up was 22.7 months. Nine cases (8%) of failure were reported, with an average time until failure of 9.5 months. The most common failure was implant loosening. No case required further surgeryCONCLUSION: The occurrence of failure was not different than that reported for fused cases. The time interval until failure was higher than the median of survival of the majority (88%) of cases. Level of Evidence IV, Therapeutic Study.