Navegando por Palavras-chave "Orthopedics"

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    Anxiety and Depression in Brazilian Orthopaedics Inpatients: A Cross Sectional Study with a Clinical Sample Comparison
    (Springer, 2010-03-01) Moraes, Vinicius Ynoe de [UNIFESP]; Jorge, Miguel Roberto [UNIFESP]; Faloppa, Flavio [UNIFESP]; Belloti, Joao Carlos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    There are few studies on the development of anxiety and depression in orthopaedics and trauma (O&T) inpatients. We designed a cross-sectional study aimed at comparing the prevalence of depression and anxiety in 100 O&T inpatients and 100 clinical inpatients in the same hospital. O&T patients were divided into subgroups: trauma and non-trauma (arthroplasty, tumour, and infection sub grouping). We measured anxiety and depression by the Hospital Anxiety and Depression Scale and co-morbidities by the Charlson age-adjusted comorbidity index (CCI). for the trauma subgroup, AO/OTA fracture classification and Gustillo and Anderson grade of open fractures classification was applied. the prevalence of anxiety and depression was 35% and 28%, respectively for the clinical sample, and 44% and 33% for the O&T sample. Compared with the clinical sample, anxiety scores were higher in the O&T sample (p = .047), and in arthroplasty (p = .020) and trauma subgroups (p = .031). in the O&T sample, high CCI scores were associated with high anxiety scores (p = .033).
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    Auto cuidado no tratamento pelo método de Ilizarov: um estudo de caso
    (Associação Brasileira de Enfermagem, 1995-03-01) Tashiro, Marisa Toshiko Ono [UNIFESP]; Souza, Mariana Fernandes De [UNIFESP]; Oliveira, Sandra Denise De [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    The authors performed a case study using Dorothea Orem's self-care model as a franieworkin thetreatment by Ilizarov's method, administering care and specific orientationsfor recovery and prevention of further disorders. The operational system of the study consisted of procedures relatedto demands of universal andtherapeuticcare during hospitalization.Demands were detected in the pre-operative and care developed inthe postoperative phase, providing the patiente with the knowledge and achivement of the necessary proceduresto be followed at home.
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    Classificações e fluxogramas em cirurgia do joelho
    (Universidade Federal de São Paulo (UNIFESP), 2021) Pires, Diego Pontes De Carvalho [UNIFESP]; Cohen, Moises [UNIFESP]; Universidade Federal de São Paulo
    The knee joint is a complex structure and may be susceptible to the involvement of different types of injuries. Since most of these injuries require a costly, long and continuous treatment, diagnostic methods are essential for the correct identification and to justify the treatment. Thus, classification systems, flowcharts, and questionnaires for the assessment of the functional condition and the establishment of the degree of severity of the lesion are widely important in directing and monitoring the prognostic evolution. Objective: The main objective of this work is to develop an updated national technical reference, with the various classifications and flowcharts in knee surgery, which will serve as a source of information and consultation for orthopedists, specialists, and specialists in knee surgery. Materials and methods: The present work is a literature review and subsequent creation of a book with classifications and flowcharts in knee surgery. As reference bibliographies, the main books adopted for this approach and a wide systematic search in journals indexed in the databases were used. As criteria and inclusion, classifications and flowcharts were established in reference bibliographies and indexed scientific articles. And, by exclusion, tumor lesions involving the knee. Results: After applying the determined inclusion and exclusion criteria, a total of 117 classifications, 36 flowcharts, and 6 functional questionnaires were included in the book entitled “Classifications and Flowcharts in Knee Surgery”. To facilitate the organization and facilitate the consultation, the classifications were organized in specific chapters by sub-themes. They are: Meniscal Injuries; Chondral/patellofemoral lesions; Ligament Injuries; Fractures; Musculotendinous Injuries; Degenerative Lesions. The book was designed in such a way as to favor the reader's easy identification and interpretation. Discussion: The complexity of the knee joint and the numerous criteria to assess its function make it difficult to measure and quantify the diagnostic techniques and the possibilities of treatments used. Thus, classifications play a fundamental role in knee surgery and can help professionals through complete cataloging of treatment approaches, prognostic estimates, and standardization of nomenclatures, which are essential for the development of an effective protocol. Conclusion: The book “Classifications and Flowcharts in Knee Surgery” is a national reference work directed to knee surgery. The book covers and brings together the various classifications, flowcharts, and questionnaires in the area, helping in continuing education, in the preparation of specialists, and the updating of specialists.
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    Collaborative multicenter trials in Latin America: challenges and opportunities in orthopedic and trauma surgery
    (Associacao Paulista Medicina, 2013-01-01) Moraes, Vinicius Ynoe de [UNIFESP]; Belloti, Joao Carlos [UNIFESP]; Faloppa, Flavio [UNIFESP]; Bhandari, Mohit; Universidade Federal de São Paulo (UNIFESP); McMaster Univ
    CONTEXT and OBJECTIVE: Orthopedic research agendas should be considered from a worldwide perspective. Efforts should be planned as the means for obtaining evidence that is valid for health promotion with global outreach.DESIGN and SETTING: Exploratory study conducted at Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil, and McMaster University, Hamilton, Canada.METHODS: We identified and analyzed collaborative and multicenter research in Latin America, taking into account American and Canadian efforts as the reference points. We explored aspects of the data available from official sources and used data from traffic accidents as a model for discussing collaborative research in these countries.RESULTS: the evaluation showed that the proportion of collaborative and multicenter studies in our setting is small. A brief analysis showed that the death rate due to traffic accidents is very high. Thus, it seems clear to us that initiatives involving collaborative studies are important for defining and better understanding the patterns of injuries resulting from orthopedic trauma and the forms of treatment. Orthopedic research may be an important tool for bringing together orthopedic surgeons, researchers and medical societies for joint action.CONCLUSIONS: We have indicated some practical guidelines for initiatives in collaborative research and have proposed some solutions with a summarized plan of action for conducting evidence-based research involving orthopedic trauma.
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    Como o especialista em ortopedia e traumatologia avalia o atendimento ao trauma ortopédico no Brasil
    (Sociedade Brasileira de Ortopedia e Traumatologia, 2011-01-01) Silva, Jorge Santos; Kfuri Jr., Mauricio; Abagge, Marcelo; Guimarães, João Matheus; Barbosa, Paulo Roberto Lourenço; Balbachevsky, Daniel [UNIFESP]; Christian, Ralph; Kojima, Kodi; Universidade de São Paulo (USP); Universidade Federal do Paraná Hospital do Trabalhador; Instituto Nacional de Traumatologia e Ortopedia; Hospital Ipanema; Universidade Federal de São Paulo (UNIFESP); Santa Casa de São Paulo Serviço de Ortopedia
    OBJECTIVES: The aim of this article is to present the data collected by Datafolha institute, from September 23rd. through October 18th. 2010 about orthopedic trauma care in Brazil. METHOD: A quantitative analysis based on telephonic interviews has been performed. From Brazilian Orthopedic Society database containing more than 7000 records. A structured query has been applied and the interview lasted around 25 minutes. RESULTS: 97% of interviewees dedicate part of his/her time to orthopedic trauma. 87% of all interviewees dedicate his/her time to more than one sub-specialty. The majority of orthopedic trauma patients comes from government insurance system (43%), while 41% of patients come from private insurance. 61% of all interviewees think that the quality of public health system could be rated as unsatisfactory. Northeast of Brazil is the place where the majority of patients are from public health system and where we have highest rates of dissatisfaction (85%) related to available infrastructure for orthopedic trauma care. Half of all interviewed individuals have problems for getting private insurance authorization previously to a surgery. CONCLUSIONS: Orthopedic trauma is a specialty practiced by the vast majority of orthopedic surgeons in our country. Neither the infrastructure nor the salaries satisfy the majority or orthopedic surgeons dedicated to trauma care.
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    Effectiveness of intra-articular lidocaine injection for reduction of anterior shoulder dislocation: randomized clinical trial
    (Associação Paulista de Medicina - APM, 2012-01-01) Tamaoki, Marcel Jun Sugawara [UNIFESP]; Faloppa, Flávio [UNIFESP]; Wajnsztejn, André [UNIFESP]; Archetti Netto, Nicola [UNIFESP]; Matsumoto, Marcelo Hide [UNIFESP]; Belloti, Joao Carlos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    CONTEXT AND OBJECTIVE: Shoulder dislocation is the most common dislocation among the large joints. The aim here was to compare the effectiveness of reduction of acute anterior shoulder dislocation with or without articular anesthesia. DESIGN AND SETTING: Prospective randomized trial conducted in Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP) (EPM-UNIFESP). METHODS: From March 2008 to December 2009, 42 patients with shoulder dislocation were recruited. Reductions using traction-countertraction for acute anterior shoulder dislocation with and without lidocaine articular anesthesia were compared. As the primary outcome, pain was assessed through application of a visual analogue scale before reduction, and one and five minutes after the reduction maneuver was performed. Complications were also assessed. RESULTS: Forty-two patients were included: 20 in the group without analgesia (control group) and 22 in the group that received intra-articular lidocaine injection. The group that received intra-articular lidocaine had a statistically greater decrease in pain over time than shown by the control group, both in the first minute (respectively: mean 2.1 (0 to 5.0), standard deviation, SD 1.3, versus mean 4.9 (2.0 to 7.0, SD 1.5; P < 0.001) and the fifth minute (respectively: mean 1.0; 0 to 3.0; SD = 1.0 versus mean 4.0; 1.0 to 6.0; SD = 1.4; P < 0.001). There was one failure in the control group. There were no other complications in either group. CONCLUSION: Reduction of anterior shoulder dislocation using intra-articular lidocaine injection is effective, since it is safe and diminishes the pain. CLINICAL TRIAL REGISTRATION: ISRCTN27127703.
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    Ensaios Clínicos Randomizados na ortopedia e traumatologia: avaliação sistemática da evidência nacional
    (Sociedade Brasileira de Ortopedia e Traumatologia, 2010-01-01) Moraes, Vinícius Ynoe de [UNIFESP]; Moreira, Cesar Domingues [UNIFESP]; Tamaoki, Marcel Jun Sugawara [UNIFESP]; Faloppa, Flávio [UNIFESP]; Belloti, Joao Carlos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: To assess whether there was an improvement in the quality and quantity of randomized controlled trials (RCTs) in nationally published journals through an application of standardized and validated scores. METHODS: We selected, electronically, for the period of 2000-2009, all RCTs published at the two indexed, orthopaedics-focused Brazilian journals: Acta Ortopédica Brasileira(AOB) and Revista Brasileira de Ortopedia (RBO). These RCTs were identified and scored by two independent researchers according to the JADAD scale and Cochrane Bone, Joint and Muscle Trauma Group score. The selected studies were grouped: 1) by publication period (2000-2004 and 2004-2009); 2) journal of publication (AOB and RBO). RESULTS: Twenty-two papers were selected, 10 from AOB and 12 from RBO. No statistically significant differences were found between the proportion (nRCT/nTotal of published papers) of RCTs published in the two journals (p=0.458), as well as for the JADAD score (p=0.722) and Cochrane score (p=0.630). CONCLUSION: The quality and quantity of randomized clinical trials in the period was similar in the journals analyzed. There is a trend of improvement of quality, yet there was no increase in the number of randomized clinical trials in both periods.
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    Epidural versus intravenous fentanyl for postoperative analgesia following orthopedic surgery: randomized controlled trial
    (Associação Paulista de Medicina - APM, 2010-01-01) Privado, Marcelo Soares [UNIFESP]; Issy, Adriana Machado [UNIFESP]; Lanchote, Vera Lucia; Garcia, João Batista Santos [UNIFESP]; Sakata, Rioko Kimiko [UNIFESP]; Universidade Federal do Maranhão Department of Anesthesia; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)
    CONTEXT AND OBJECTIVE: Controversy exists regarding the site of action of fentanyl after epidural injection. The objective of this investigation was to compare the efficacy of epidural and intravenous fentanyl for orthopedic surgery. DESIGN AND SETTING: A randomized double-blind study was performed in Hospital São Paulo. METHODS: During the postoperative period, in the presence of pain, 29 patients were divided into two groups: group 1 (n = 14) received 100 µg of fentanyl epidurally and 2 ml of saline intravenously; group 2 (n = 15) received 5 ml of saline epidurally and 100 µg of fentanyl intravenously. The analgesic supplementation consisted of 40 mg of tenoxicam intravenously and, if necessary, 5 ml of 0.25% bupivacaine epidurally. Pain intensity was evaluated on a numerical scale and plasma concentrations of fentanyl were measured simultaneously. RESULTS: The percentage of patients who required supplementary analgesia with tenoxicam was lower in group 1 (71.4%) than in group 2 (100%): 95% confidence interval (CI) = 0.001-0.4360 (P = 0.001, Fisher's exact test; relative risk, RR = 0.07). Epidural bupivacaine supplementation was also lower in group 1 (14.3%) than in group 2 (53.3%): 95% CI = 0.06-1.05 (P = 0.03, Fisher's exact test; RR = 0.26). There was no difference in pain intensity on the numerical scale. Mean fentanyl plasma concentrations were similar in the two groups. CONCLUSION: Intravenous and epidural fentanyl appear to have similar efficacy for reducing pain according to the numerical scale, but supplementary analgesia was needed less frequently when epidural fentanyl was used. CLINICAL TRIAL REGISTRATION NUMBER: NCT00635986
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    EVALUATION OF THE KNOWLEDGE ON COST OF ORTHOPEDIC IMPLANTS AMONG ORTHOPEDIC SURGEONS
    (Atha Comunicacao & Editora, 2016) Arliani, Gustavo Gonalves [UNIFESP]; Sabongi, Rodrigo Guerra [UNIFESP]; Batista, Alysson Ferreira [UNIFESP]; Astur, Diego Costa [UNIFESP]; Falotico, Guilherme Guadagnini [UNIFESP]; Cohen, Moises [UNIFESP]
    Objective: To determine the knowledge of Brazilian Orthopedic Surgeons on the costs of orthopedic surgical devices used in surgical implants. Methods: A questionnaire was applied to Brazilian Orthopedic Surgeons during the 46th Brazilian Congress on Orthopedics and Traumatology. Results: Two hundred and one Orthopedic Surgeons completely filled out the questionnaire. The difference between the average prices estimated by the surgeons and the average prices provided by the supplier companies was 47.1%. No differences were found between the orthopedic specialists and other subspecialties on the prices indicated for specific orthopedic implants. However, differences were found among orthopedic surgeons who received visits from representatives of implant companies and those who did not receive those visits on prices indicated for shaver and radiofrequency device. Correlation was found between length of orthopedic experience and prices indicated for shaver and interference screw, and higher the experience time the lower the price indicated by Surgeons for these materials. Conclusion: The knowledge of Brazilian Orthopedic Surgeons on the costs of orthopedic implants is precarious. Reduction of cost of orthopedics materials depends on a more effective communication and interaction between doctors, hospitals and supplier companies with solid orientation programs and awareness for physicians about their importance in this scenario.
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    Evidence hierarchies relating to hand surgery: current status and improvement. A bibliometric analysis study
    (Associacao Paulista Medicina, 2017) Barroso, Thais Silva [UNIFESP]; Cavalcante, Marcelo Cortes [UNIFESP]; Gomes dos Santos, Joao Baptista [UNIFESP]; Belloti, Joao Carlos [UNIFESP]; Faloppa, Flavio [UNIFESP]; de Moraes, Vinicius Ynoe [UNIFESP]
    BACKGROUND: Hierarchy of evidence is an important measurement for assessing quality of literature. Information regarding quality of evidence within the Brazilian hand surgery setting is sparse, especially regarding whether research has improved in either quality or quantity. This study aimed to identify and classify hand surgery studies published in the two most important Brazilian orthopedics journals based on hierarchy of evidence, with comparisons with previously published data. DESIGN AND SETTING: Bibliometric analysis study performed in a federal university. METHODS: Two independent researchers conducted an electronic database search for hand surgery studies published between 2010 and 2016 in Acta Ortopedica Brasileira and Revista Brasileira de Ortopedia. Eligible studies were subsequently classified according to methodological design, based on the Haynes pyramid model (HP) and the JBJS/AAOS levels of evidence and grades of recommendations (LOR). Qualitative and quantitative data were gathered regarding all studies. Previous data were considered to assess whether the proportion of high-quality studies had improved over time (2000-2009 versus 2010-2016). RESULTS: The final analysis included 123 studies, mostly originating from the southeastern region (78.8%) and private institutions (65%), with self-funding (91.8%). Methodological assessment showed that 15.4% were classified as level I/II using HP and 16.4% using LOR. No significant difference in proportions of high-quality studies was found between the two periods of time assessed (5% versus 12%; P = 0.13). CONCLUSION: Approximately 15% of hand surgery studies published in two major Brazilian journals were likely to be classified as high-quality through two different systems. Moreover, no trend towards quality-of-evidence improvement was found over the last 15 years.
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    Functional outcomes of traumatic and non-traumatic rotator cuff tears after arthroscopic repair
    (Baishideng Publishing Group Inc, 2017) Kitagaki Abechain, Jose Jorge [UNIFESP]; Godinho, Glaydson Gomes; Matsunaga, Fabio Teruo [UNIFESP]; Netto, Nicola Archetti [UNIFESP]; Daou, Julia Pozzetti [UNIFESP]; Sugawara Tamaoki, Marcel Jun [UNIFESP]
    AIM To compare the functional outcomes of traumatic and non-traumatic rotator cuff tears after arthroscopic repair. METHODS Eighty-seven patients with rotator cuff tears following arthroscopic treatment were divided into traumatic and non-traumatic tear groups. Postoperative muscle strength and outcomes using the modified University of California, Los Angeles score were evaluated. Sex, age, affected limb and dominant limb were correlated between groups. Muscle strength of the repaired and unaffected shoulders was compared. Rotator cuff injury size was measured. RESULTS Of the 87 patients who underwent rotator cuff repairs, 35 had traumatic tears and 52 had non-traumatic tears. In patients with non-traumatic tears, the average age was 59 years, 74.5% were female, 96.1% were righthand dominant and 92.3% had their dominant shoulder affected. Patients with traumatic tears were 59.5 years hand dominant and 88.5% had their dominant shoulder affected. No difference existed in the mean modified University of California, Los Angeles score between patients with traumatic tears (33.7) compared with those with non-traumatic tears (32.8). No strength differences were observed between groups: The strength difference between the non-affected and affected sides was 1.21 kg in the non-traumatic group and 1.39 kg in the traumatic group (P = 0.576), while the strength ratio between the non-affected/affected sides was 0.805 in the nontraumatic group and 0.729 in the traumatic group (P = 0.224). CONCLUSION The functional results of traumatic rotator cuff repairs are similar to non-traumatic tears. Both outcomes are satisfactory.
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    Hierarchy of evidence relating to hand surgery in Brazilian orthopedic journals
    (Associação Paulista de Medicina - APM, 2011-03-01) Moraes, Vinícius Ynoe de [UNIFESP]; Belloti, Joao Carlos [UNIFESP]; Moraes, Fábio Ynoe de; Galbiatti, José Antonio; Palácio, Evandro Pereira; Santos, João Baptista Gomes dos [UNIFESP]; Faloppa, Flávio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Faculdade Estadual de Medicina de Marília; Faculdade Estadual de Medicina de Marília Department of Orthopedics and Traumatology
    CONTEXT AND OBJECTIVE: There is no systematic assessment of the quality of scientific production in the specialty of hand surgery in our setting. This study aimed to systematically assess the status of evidence generation relating to hand surgery and to evaluate the reproducibility of the classification method based on an evidence pyramid. DESIGN AND SETTING: Secondary study conducted at Universidade Federal de São Paulo (UNIFESP) and Faculdade Estadual de Medicina de Marília (Famema). METHODS: Two researchers independently conducted an electronic database search for hand surgery studies published between 2000 and 2009 in the two main Brazilian orthopedic journals (Acta Ortopédica Brasileira and Revista Brasileira de Ortopedia). The studies identified were subsequently classified according to methodological design (systematic review of the literature, randomized clinical trial, cohort study, case-control study, case series and other studies) and evidence level (I to V). RESULTS: A total of 1,150 articles were evaluated, and 83 (7.2%) were included in the final analysis. Studies with evidence level IV (case series) accounted for 41 (49%) of the published papers. Studies with evidence level V (other studies) accounted for 12 (14.5%) of the papers. Only two studies (2.4%) were ranked as level I or II. The inter-rater reproducibility was excellent (k = 0.94). CONCLUSIONS: Hand surgery articles corresponded to less than one tenth of Brazilian orthopedic production. Studies with evidence level IV were the commonest type. The reproducibility of the classification stratified by evidence level was almost perfect.
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    INTRA- AND INTER-OBSERVER AGREEMENT IN THE AO AND GARNAVOS SYSTEMS FOR DIAPHYSEAL HUMERUS FRACTURE
    (Atha Comunicacao & Editora, 2017) Neto, Roberto Meriqui [UNIFESP]; Masuda, Rodrigo Yuzo [UNIFESP]; Utino, Artur Yudi [UNIFESP]; Pierami, Rafael [UNIFESP]; Matsunaga, Fabio Teruo [UNIFESP]; Sugawara Tamaoki, Marcel Jun [UNIFESP]
    Objective: The objective of this study was to compare inter- and intra-observer agreement using the Garnavos and AO/ASIF systems for classifying humeral diaphysis fractures. Methods: Eighty X-ray images taken of humeral diaphysis fractures in adult patients (age >= 18 years) between January 2013 and September 2015 in the Radiology Department of Hospital Sao Paulo were selected for subsequent classification by five orthopedic surgeons with differing levels of experience. The images were examined at two different times and reproducibility analysis was evaluated using Fleiss' kappa to verify intra- and inter-observer agreement. Results: High-level agreement was observed for both classification systems, but particularly for the AO/ASIF classification. Inter-observer evaluation yielded excellent levels of agreement for both classifications, but principally for the Garnavos classification. Conclusions: Good or excellent inter-and intra-observer agreement was seen for both the AO/ASIF and Garnavos classification systems. However, intra-observer agreement was higher for the AO/ASIF system and inter-observer agreement was higher for the Garnavos classification.
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    Outcomes in orthopedics and traumatology: translating research into practice
    (Sociedade Brasileira de Ortopedia e Traumatologia, 2014-12-01) Moraes, Vinícius Ynoe de [UNIFESP]; Ferrari, Paula Martins de Oliveira; Gracitelli, Guilherme Conforto; Faloppa, Flávio [UNIFESP]; Belloti, Joao Carlos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Clinical research is focused in generating evidence that is feasible to be applicable to practitioners. However, translating research-focused evidence into practice may be challenging and often misleading. This article aims is to pinpoint these challenges and suggest some methodological safeguards, taking platelet-rich plasma therapies and knee osteochondral injuries as examples. Studies and systematic reviews involving the following concepts will be investigated: clinically relevant outcomes, systematic errors on sample calculation, internal and external validity. Relevant studies on platelet-rich plasma for muscle-tendon lesions and updates on osteochondral lesions treatment were included in this analysis. Authors and clinicians should consider these concepts for the implementation and application of dissemination of the best evidence. Research results should be challenged by a weighted analysis of its methodological soundness and applicability. Level of Evidence V, Therapeutic Studies - Investigating the Results of Treatment.
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    Perfil do cirurgião de coluna brasileiro
    (Sociedade Brasileira de Coluna, 2013-01-01) Alves, Pedro Luz [UNIFESP]; Ueta, Fernando Tadashi Salvioni [UNIFESP]; Ueta, Renato Hiroshi Salvioni [UNIFESP]; Del Curto, David [UNIFESP]; Martins, Délio Eulálio [UNIFESP]; Wajchenberg, Marcelo [UNIFESP]; Puertas, Eduardo Barros [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: To conduct cross-sectional study identifying the profile of the Brazilian spinal surgeon. METHODS: Data were collected through a questionnaire with multiple alternatives during two major events for spine surgery at national level in 2011, the Congresso da Sociedade Brasileira de Coluna (Congress of the Brazilian Spine Society) and Simpósio Internacional de Coluna (International Spine Symposium, SINCOL). The data were submitted to statistical analysis comparing and stratifying the information obtained according to the profile. RESULTS: We obtained 182 questionnaires answered by orthopedists and neurosurgeons with peculiarities and similarities on their medical management. CONCLUSIONS: The data obtained in this study may be important for the development of health policies in the spine surgery in Brazil.
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    Perguntas e respostas em cirurgia do ombro
    (Universidade Federal de São Paulo (UNIFESP), 2021) Cardozo Filho, Nivaldo Souza [UNIFESP]; Ejnisman, Benno [UNIFESP]; Universidade Federal de São Paulo
    Introduction: Medical knowledge has progressively advanced throughout history to the current point of subspecialties, procedures dedicated to the detailed care of diseases and medicine has acquired the status of science based on the natural interpretation of the disease. However, this is not the end of the line, the practice and models of medical care will continue to change and technological advances will require constant learning of new skills by the doctor. As old as medicine, orthopedics has accompanied humans since ancient times. Fossil findings dated from primitive men, point to bone alignment procedures and rudimentary immobilizations. Shoulder surgery over time has evolved significantly. From the first rotator cuff injury described by Smith in 1834 to current minimally invasive surgeries, progress in techniques and material is visible. Taking these advances into account, it is necessary to rethink the process of training new orthopedists, the way of building this knowledge, in view of the speed and density of themes that modern orthopedics carries in its scope. Objective: The main objective of this work is to produce updated literary work, which will serve as a source of information and consultation for health professionals, residents and orthopedists in the Portuguese language of Brazil. Materials and methods: This work is a review of the literature, carried out between the years 2019 and 2020 and subsequent production of a book with multiple choice questions. The main current reference on this theme is the book The Shoulder. three hundred and three multiple choice questions were elaborated, each with four possible answer alternatives. This project was designed according to the terms established by Resolution 466/2012 and was submitted to the Research Ethics Committee of the Federal University of São Paulo and approved under number - 2512131119 and the publication and printing of the copies was financed by Clínica UORT in the amount of R $ 27,800. Results: The questions were organized in specific chapters by subthemes. The first edition of the book “Questions and answers on shoulder surgery” (Figure 1) was launched in September 2020 containing 103 pages and 303. Discussion: The ways of learning have evolved with the recent technological advance of humanity in the last decades and, gradually , academics at the most varied levels of education seek access to information more efficiently. Taking into account the problem-based knowledge acquisition process, in this work we seek to associate the concepts of shoulder surgery supported by Evidence-Based Medicine; Although digital technology has the advantage of updating more frequently, with different tools for accessing information and databases, traditional books have not lost their status. Conclusion: The book "Questions and xv Answers in Shoulder Surgery" was published to fill a gap in the Brazilian market, lacking works produced in the Portuguese language and adapted to the reality of the population of Brazil.
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    Transplante osteocondral autólogo no tratamento de lesões condrais na patela
    (Sociedade Brasileira de Ortopedia e Traumatologia, 2012-01-01) Cohen, Moises [UNIFESP]; Amaro, Joicemar Tarouco; Fernandes, Ricardo De Souza Campos; Arliani, Gustavo Gonçalves [UNIFESP]; Astur, Diego Da Costa [UNIFESP]; Kaleka, Camila Cohen; Skaf, Abdalla; Universidade Federal de São Paulo (UNIFESP); Instituto Cohen de Ortopedia, Reabilitação e Medicina do Esporte; Santa Casa de São Paulo Faculdade de Ciências Médicas Grupo do Joelho; Hospital do Coração Clínica de Diagnóstico por Imagem
    OBJECTIVE: The primary aim of this study was to assess the clinical and functional evolution of patients with total-thickness symptomatic cartilaginous injury of the patellar joint surface, treated by means of osteochondral autologous transplantation. METHODS: This prospective study was conducted from June 2008 to March 2011 and involved 17 patients. The specific questionnaires of Lysholm, Kujala and Fulkerson were completed preoperatively and one year postoperatively in order to assess the affected knee, and SF-36 was used to assess these patients' general quality of life. The nonparametric paired Wilcoxon test was used for statistical analysis on the pre and postoperative questionnaires. The data were analyzed using the SPSS for Windows software, version 16.0, and a significance level of 5% was used. RESULTS: The Lysholm preoperative and postoperative average scores were 54.59 and 75.76 points (p < 0.05). The Fulkerson pre and postoperative average scores were 52.53 and 78.41 points (p < 0.05). CONCLUSIONS: We believe that autologous osteochondral transplantation is a good treatment method for total-thickness symptomatic chondral lesions of the joint surface of the patella.
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    What is the impact of local control in Ewing sarcoma: analysis of the first Brazilian collaborative study group-EWING1
    (Biomed Central Ltd, 2017) Becker, Ricardo G.; Gregianin, Lauro J.; Galia, Carlos R.; Jesus-Garcia Filho, Reynaldo [UNIFESP]; Toller, Eduardo A.; Badell, Gerardo; Nakagawa, Suely A.; David, Alexandre; Baptista, Andre M.; Yonamime, Eduardo S.; Serafini, Osvaldo A.; Penna, Valter; Santos, Julie Francine C.; Brunetto, Algemir L.
    Background: Relapse in localized Ewing sarcoma patients has been a matter of concern regarding poor prognosis. Therefore, we investigated the impact of local control modality (surgery, surgery plus radiotherapy, and radiotherapy) on clinical outcomes such as survival and recurrence in patients with non-metastatic Ewing sarcoma treated on the first Brazilian Collaborative Group Trial of the Ewing Family of Tumors (EWING1). Methods: Seventy-three patients with localized Ewing sarcoma of bone aged < 30 years were included. The treating physicians defined the modality of local control based on the recommendations of the coordinating center and the patient and tumor characteristics. Possible associations of local control modality with local failure (LF), disease-free survival (DFS), event-free survival (EFS), overall survival (OS), and clinical characteristics were analyzed. Results: Mean patient age was 12.8 years (range, 2 to 25 years) and median follow-up time was 4.5 years (range, 2. 3 to 6.7 years). Forty-seven patients underwent surgery, 13 received radiotherapy, and 13 received both. The 5-year EFS, OS, and DFS for all patients was 62.1%, 63.3%, and 73.1%, respectively. The 5-year cumulative incidence (CI) of LF was 7.6% for surgery, 11.1% for radiotherapy, and 0% for postoperative radiotherapy (PORT) (p = 0.61). The 5-year EFS was 71.7% for surgery, 30.8% for radiotherapy, and 64.1% for PORT (p = 0.009). Conclusions: There was a significant effect of local control modality on EFS and OS in the study. Surgery and PORT modalities yielded very close results. The group treated with radiotherapy alone had considerably worse outcomes. This may be confounded by greater risk factors in these patients. There was no significant effect of local control modality on the CI of LF and DFS.
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    Why do patients undergoing anterior cruciate ligament reconstruction in Brazil stay in hospital for longer periods than in other countries? Prospective evaluation of 30 patients and presentation of possible discharge criteria
    (Sociedade Brasileira de Ortopedia e Traumatologia, 2013-08-01) Astur, Diego Costa; Navarro, Pedro Gabriel Riboli; Fonseca, Lucas Furtado; Arliani, Gustavo Goncalves; Aleluia, Vinicius; Veronese, Ciro; Kaleka, Camila Cohen; Cohen, Moises [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Instituto Cohen; Santa Casa de Misericordia de São Paulo School of Medical Sciences
    OBJECTIVE:Evaluate a better moment by the medical team and patient to be discharged and relate to possible medical discharge criteria.METHODS:31 anterior cruciate ligament reconstructed patients under similar conditions prospectively evaluated about the possibility of discharge with 24 and 48 hours after surgery and possibles discharges criteria such as pain, range of motion and capacity quadriceps contraction, besides the use of a validated scale to measure the patient's functional independence.RESULTS:50% and 6.4% of patients prefer remain hospitalized after 24 and 48 hours of surgery, respectively. The average of the visual analogue scale of pain was 2.63 and 1.76 points, and the range of motion of 79º and 86,7º after 24 and 48 hours, respectively. 100% of patients were able to quadriceps contraction in every evaluated moments.CONCLUSION:In Brazil, possible discharged criteria as pain, range of motion, quad contraction and motor independence motor function scale show that anterior cruciate reconstruction reconstructed patients could be discharged after 24 hours of surgery. However, 50% of patients still prefer to remain hospitalized for longer periods.