Scielo RSS <![CDATA[Acta Ortop├ędica Brasileira]]> vol. 23 num. 2 lang. en <![CDATA[SciELO Logo]]> <![CDATA[Comparison between methods of assessing lumbosacral curve obtained by radiographic image]]> OBJECTIVE: To investigate the correlation between different radiographic methods in the evaluation of the lumbosacral concavity. METHODS: The sample consisted of 52 individuals with ages ranging from 18 to 28 years old. The procedures related to radiographic image collection were carried out in collaboration with a diagnostic imaging center of a hospital in Curitiba, PR, Brazil. The angles of the lumbosacral concavity were evaluated by the following methods: Centroid, Cobb1L1-S1, Cobb2L1-L5, Cobb3L2-S1 Cobb4T12-S1, Posterior Tangent and Trall. RESULTS: High correlation coefficients (r ranging from 0.77 to 0.89) were found among variations of the Cobb method. Additionally, we propose a categorical classification of angle values obtained by each method. We also analyzed the influence of the level of the inflection point between the lumbar lordosis and thoracic kyphosis in determining the evaluation method to be used. The inflection point had a higher incidence in the region between the twelfth thoracic vertebra and the first lumbar vertebra (63.5%). CONCLUSION: The correlation and agreement between methods vary considerably. Moreover, the thoracolumbar inflection point should be considered when choosing the method of assessing patients. Level of Evidence I, Diagnostic Study. <![CDATA[Gantzer muscle. An anatomical study]]> OBJECTIVE: The relationship of Gantzer muscle to the median and anterior interosseous nerve is debated. METHODS: Ìn an anatomical study with 80 limbs from 40 cadavers the incidence, origin, insertion, nerve supply and relations of Gantzer muscle have been documented. RESULTS: The muscle was found in 54 forearms (68% of limbs) and was supplied by the anterior interosseous nerve. It arose from the deep surface of the flexor digitorum superficialis muscle, (42 limbs), coronoid process (eight limbs) and medial epicondyle (seven limbs). Its insertion was to the ulnar part of flexor pollicis longus muscle. The Gantzer muscle always lay posterior to both the median and anterior interosseous nerve. CONCLUSION: The Gantzer muscle may contribute to the median nerve and anterior interosseous nerve compression. The muscle was found in 68% of limbs and should be considered a normal anatomical pattern rather than an anatomical variation. Level of Evidence IV, Case Series . <![CDATA[Corticoid injection as a predictive factor of results of carpal tunnel release]]> OBJECTIVE: To evaluate whether the symptoms relief after local corticoid injection correlate with better results of surgical treatment in carpal tunnel syndrome. METHODS: Between February 2011 and June 2013, 100 wrists of 88 patients were included in the study. All patients were subjected to corticoid injections in the carpal tunnel and evaluated before and after infiltration and surgery. The following parameters were evaluated: visual analog scale (VAS) for pain, Boston questionnaire, sensitivity and strength. RESULTS: Only 28 out of 100 wrists subjected to injection were symptom-free after six months follow up. Sixty out of the 72 patients who did not present relief or relapse symptoms were treated surgically. Surgical results were better regarding VAS, Boston questionnaire and sensitivity in a specific group of patients, which had a longer relief of symptoms after the corticoid injection, with statistical significance. CONCLUSION: Longer relief of symptoms after corticoid injection correlated with better results of surgical treatment. Level of Evidence II, Prognostic Study. <![CDATA[Correlation between functional disability and quality of life in patients with adhesive capsulitis]]> OBJECTIVE: To determine the correlation between functional disability and quality of life of patients with adhesive capsulitis. METHODS: Two instruments (WHOQOL-BREF and DASH) were applied to evaluate the quality of life and functional capacity of patients with adhesive capsulitis. Inclusion criteria were age between 35 and 75 years old and achievement of shoulder imaging. Each domain of the WHOQOL-BREF was correlated with DASH. Pearson's correlation coefficient was used for parametric variables and Spearman's correlation coefficient was used when at least one variable had a non-normal distribution. The level of significance was p &lt;0.05. RESULTS: Forty three patients with mean age of 54.7 years old were evaluated. The mean values found in the physical, psychological, social and environmental domains of the WHOQOL-BREF and DASH were 45.3, 63.9, 68.2, 60.2 and 61.6, respectively. A moderate negative correlation was found between DASH and the physical domain of WHOQOL-BREF (r= - 0.583, p&lt;0.001). CONCLUSION: The only domain where WHOQOL-BREF correlates with DASH is the physical domain, suggesting that measures to promote the improvement of functional capacity may lead to better quality of life of patients with adhesive capsulitis. Level of Evidence IV, Prospective Study. <![CDATA[Arthroscopic treatment of adhesive capsulitis of the shoulder with minimum follow up of six years]]> OBJECTIVE: To evaluate the results of the arthroscopic treatment of adhesive capsulitis of the shoulder with six to nine years of follow up. METHODS: From August 2002 to December 2004, ten patients underwent arthroscopic capsular release for adhesive capsulitis refractory to conservative treatment. An interscalene catheter was used for postoperative analgesia, before the procedure. All were in stage II, with a minimum follow up of six years. The mean age was of 52.9 years old (range, 39 to 66), with female predominance (90%) and six left shoulders. The time between the onset of symptoms and surgery varied from six to 20 months. There were four patients in the primary form (40%) and six in the secondary (60%). RESULTS: In the preoperative evaluation, the mean active anterior elevation was 92°, 10.5° of external rotation, and internal rotation level L5. Postoperatively, the mean active elevation was 149°, 40° of external rotation and internal level T12, respectively. Thus, the average gains were 57° in forward active elevation, 29.5° in external rotation and six spinous processes, these values being statistically significant (p &lt;0.001). According to the Constant functional score (arc of movements), the value increased from 13.8 (preoperative mean) to 32 points (postoperative mean). CONCLUSION: Arthroscopic treatment of adhesive capsulitis of the shoulder refractory to conservative treatment allows effective gain of range of motion of this joint. Level of Evidence IV, Retrospective Study (Case Series). <![CDATA[Effect of hyaluronic acid on chondrocyte apoptosis]]> OBJECTIVE: To determine the percentage of apoptotic cells in a contusion model of osteoarthritis (OA) and to assess whether intra-articular injection of high doses of hyaluronic acid (HA) immediately after trauma reduces chondrocyte apoptosis. METHODS: Forty knees from adult rabbits were impacted thrice with a 1 kg block released through a 1 meter tall cylinder (29.4 Joules). Subsequently, 2 mL of HA was injected in one knee and 2 mL saline in the contra-lateral knee. Medication were administered twice a week for 30 days, when animals were sacrificed. Specimens were prepared for optical microscopy exam and terminal deoxynucleotidyl transferase end labeling assay (TUNEL). RESULTS: The apoptosis rate in the contusion model was 68.01% (± 19.73%), a higher rate than previously described. HA significantly reduced the rate of apoptosis to 53.52% (± 18.09) (p &lt;0.001). CONCLUSION: Intra-articular HA administration started immediately after trauma reduces impact-induced chondrocyte apoptosis rates in rabbits. Level of Evidence I, Experimental Study. <![CDATA[Evaluation of the thickness of the proximal femoral canal in patients living at altitude]]> OBJECTIVE: Our goal is to confirm the hypothesis that people who were born and raised on cities at altitude have a smaller proximal femoral canal. METHODS: Prospective study with 169 participants, divided into two groups. Group A: 99 patients who were born and raised at altitude and group B: 70 patients who were born and raised at low altitude. All patients underwent panoramic radiographs of the pelvis, where we marked three measure and checked the thickness of the cortical and the lateral and medial cortical, as well as the thickness of the femoral canal. RESULTS: We noticed that the first measure showed no significant difference in both groups, but the second measure, the lateral cortex, is thicker in group A, and the femoral canal is smaller in comparison to group B. CONCLUSION: We concluded that patients who were born and raised at altitude have a smaller femoral canal. This may help in proper planning of future surgical procedures, especially in total hip arthroplasty cases. Level of Evidence II, Development of Diagnostic Criteria in Consecutive Patients (with universally applied reference "gold" standard). <![CDATA[Histomorphometric analysis of the femoral neck in patients with and without femoral neck fracture]]> OBJECTIVE: To determine, through bone histomorphometry in femoral neck, whether there are differences in the cancellous bone of the proximal femur from female patients over 60 years old who had femoral neck fracture and similar patients who did not have such fracture. METHODS: We analyzed the trabecular part of the femur of 13 female patients, aged over 60 years old, by the bone histomorphometry method. Seven of these patients had femoral neck fracture. All of them were subjected to hip arthroplasty. RESULTS: Bone densitometry showed no significant difference. There was no significant difference on the average thickness of the trabecular bone (124.38µm versus 147.09µm). The number of bone trabeculae was lower (1.52, versus 1.88) and the separation between them was larger (541,19µm versus 391,14µm) in the fracture group. CONCLUSION: A difference in histomorphometric parameters of cancellous bone of the femur neck was observed among patients who had fractures as compared to patients who had not. Level of Evidence II, Diagnostic Studies. <![CDATA[Histomorphometric bone assessment in patients with fracture of the proximal end of the femur]]> OBJECTIVE: To determine whether there is a difference on the bone architecture in patients with femoral neck fracture compared to patients with intertrochanteric fractures and assess the importance of aging on bone microarchitecture in patients with proximal femoral fracture. METHODS: Biopsy of the iliac crest was made in seventeen patients between 55 and 90 years old who were admitted to the emergency room with fractures of the proximal end of the femur. After a small fragment was removed, we made a histomorphometric analysis of it. RESULTS: There was no significant difference between patients with femoral neck fracture and trochanteric fracture in structural parameters, formation and resorption. Comparing age groups we also did not find any significant change between the groups in the parameters volume and trabecular separation. CONCLUSION: There are no difference in the morphometric parameters analyzed between the different types of fracture and age is not a significant factor in the alteration of these parameters. Level of Evidence II, Diagnostic Studies. <![CDATA[Anxiety, depression and quality of life in individuals with phantom limb pain]]> OBJECTIVE: This study aims to evaluate emotional factors such as anxiety and depression, and the Quality of Life of individuals with chronic persistent pain after amputation in order to identify the interindividual variation in response to pain. METHODS: This was a descriptive, exploratory and cross-sectional study with quantitative approach. Twenty seven patients were interviewed. The instruments have rated the sociodemographic, clinical and economic profile (semistructured interview) and the Quality of Life (generic Quality of Life questionnaire SF-12) and emotional factors (HAD scale) of the interviewed patients. RESULTS: It was identified that the most frequent amputations occur in males aged 18-38 years and are related to occupational accidents. The Quality of Life was compromised in both components of physical and mental health. Furthermore, anxiety levels were more prevalent in the range from aged 18 to 38 years old, while the levels of depression were most prevalent among the elderly (60 to 80 years old). CONCLUSION: The impairment of Quality of Life and change in the perception of body image has a major impact on adherence to the rehabilitation program and the functional prognosis. Therapeutic orientation is, therefore, critical after this type of surgery. Level of Evidence II, Descriptive and Exploratory Study.