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Objective: This study evaluated sociodemographic and radiographic features of patients with distal radial fractures treated at a trauma hospital in southern Brazil, comparing those treated by hand surgery specialists (group 1) and non-specialists (group 2). Methods: This study consists of a retrospective cohort of 200 patients treated in 2020. After reviewing medical records and radiographs, the following parameters were analyzed: age, gender, trauma mechanism, laterality, associated comorbidities and fractures, fracture classification (AO), radial height, radial inclination, and volar inclination. Comparison of the two groups used the Student t-test, chi-square test, or Fisher exact test. Results: Most subjects were women (54%), sustained low-energy traumas (58%), and were left-handed (53%). Group 1 had a lower mean age (50.2 years); most of their subjects sustained high-energy trauma (54%) and had type C fractures (73%); type A fractures prevailed in group 2 (72%). Radiographs showed a significant difference regarding the mean radial inclination (21.5° in group 1 and 16.5° in group 2 [ p < 0.001] in women, and 21.3° in group 1 and 17° in group 2 [ p < 0.001] in men) and volar inclination (10.1° and 12.8° in groups 1 and 2, respectively [ p < 0.001]). In addition, the absolute number of cases with reestablished anatomical parameters per the three evaluated variables was also significantly different; all parameters were better in group 1. Conclusion: Hand surgeons treated the most severe fractures and had the best radiographic outcomes.

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Introducción: Las fracturas supracondíleas del húmero en el niño, por lo general, son tratadas de manera quirúrgica, durante esa intervención se pueden presentar situaciones específicas en este tipo de enfermos. Objetivo: Actualizar y brindar información sobre algunas de las situaciones transoperatorias en pacientes con fractura supracondílea del húmero. Métodos: La búsqueda y análisis de la información se realizó en un periodo de 61 días (primero de septiembre al 31 de octubre de 2022) y se emplearon palabras de búsqueda relacionadas con la investigación. A partir de la información obtenida, se realizó una revisión bibliográfica de un total de 245 artículos publicados en las bases de datos: PubMed, Hinari, SciELO y Medline, mediante el gestor de búsqueda y administrador de referencias EndNote, de ellos, se utilizaron 29 citas seleccionadas para realizar la revisión, 28 de los últimos cinco años. Resultados: Se hace referencia a cuatro de las situaciones transoperatorias más frecuentes en este tipo de fractura. Se mencionan la conminución de la pared medial, como identificar esta situación y su conducta. En relación a las lesiones asociadas, se recomienda primero estabilizar el antebrazo y luego la fractura supracondílea. Para las fracturas inestables en flexión se recomienda la técnica a emplear. Por su parte, la conversión de la reducción cerrada a abierta está justificada en ciertas circunstancias que de forma detallada se describen en el trabajo. Conclusiones: Las fracturas supracondíleas del húmero en el niño son tratadas en su mayoría mediante tratamiento quirúrgico. Durante el transoperatorio se pueden presentar situaciones para las cuales el médico tratante debe estar preparado.

Introduction: Supracondylar fractures of the humerus in children are generally treated surgically, during surgery intervention may occur specific situations in this type of patient. Objective: To update and provide information on some of the intraoperative situations in patients with supracondylar fracture of the humerus. Methods: The search and analysis of the information was carried out in a period of 61 days (September 1st to October 31st, 2022) and search words related to the investigation were used. Based on the information obtained, a bibliographic review of a total of 245 articles published in the PubMed, Hinari, SciELO and Medline databases was carried out using the EndNote search manager and reference administrator, of which 29 selected citations were used to carry out the review, 28 of the last five years. Results: Reference is made to four of the most frequent intraoperative situations in this type of fracture. Comminution of the medial wall, how to identify this situation and its behavior are mentioned. In relation to associated injuries, it is recommended to first stabilize the forearm and then the supracondylar fracture. For unstable fractures in flexion, the technique to be used is recommended. For its part, the conversion from closed to open reduction is justified in certain circumstances that are described in the article. Conclusions: Supracondylar fractures of the humerus in children are mostly treated by surgical treatment. During the trans-operative period situations may arise for which the treating physician must be prepared.

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Abstract Objective: This study evaluated sociodemographic and radiographic features of patients with distal radial fractures treated at a trauma hospital in southern Brazil, comparing those treated by hand surgery specialists (group 1) and non-specialists (group 2). Methods: This study consists of a retrospective cohort of 200 patients treated in 2020. After reviewing medical records and radiographs, the following parameters were analyzed: age, gender, trauma mechanism, laterality, associated comorbidities and fractures, fracture classification (AO), radial height, radial inclination, and volar inclination. Comparison of the two groups used the Student t-test, chi-square test, or Fisher exact test. Results: Most subjects were women (54%), sustained low-energy traumas (58%), and were left-handed (53%). Group 1 had a lower mean age (50.2 years); most of their subjects sustained high-energy trauma (54%) and had type C fractures (73%); type A fractures prevailed in group 2 (72%). Radiographs showed a significant difference regarding the mean radial inclination (21.5° in group 1 and 16.5° in group 2 [p < 0.001] in women, and 21.3° in group 1 and 17° in group 2 [p < 0.001] in men) and volar inclination (10.1° and 12.8° in groups 1 and 2, respectively [p < 0.001]). In addition, the absolute number of cases with reestablished anatomical parameters per the three evaluated variables was also significantly different; all parameters were better in group 1. Conclusion: Hand surgeons treated the most severe fractures and had the best radiographic outcomes.

Resumo Objetivo: Avaliar as características sociodemográficas e radiográficas dos pacientes com fratura de rádio distal tratados em um hospital de trauma no sul do Brasil, comparando os casos tratados pelos especialistas em cirurgia da mão (grupo 1) com aqueles tratados por não especialistas (grupo 2). Métodos: Coorte retrospectiva realizada com 200 pacientes, no ano de 2020. Por meio da revisão de prontuários e radiografias, analisaram-se: idade, sexo, mecanismo de trauma, lateralidade, presença de comorbidades e fraturas associadas, classificação da fratura (AO), altura radial, inclinação radial e, inclinação volar. Comparou-se os dois grupos por meio do teste t de Student, qui-quadrado ou exato de Fisher. Resultados: A maioria era de pacientes do sexo feminino (54%), traumas de baixa energia (58%) e lateralidade esquerda (53%). O grupo 1 apresentou média de idade menor (50,2 anos), traumas de alta energia (54%), e fraturas tipo C (73%), enquanto no grupo 2 fraturas tipo A prevaleceram (72%). As radiografias apresentaram diferença significativa quanto à média de valores de inclinação radial (21,5° no grupo 1 e 16,5° no grupo 2 [p < 0,001] nas mulheres e, 21,3° no grupo 1 e 17° no grupo 2 [p < 0,001] nos homens) e inclinação volar (10,1° e 12,8° no grupo 1 e 2, respectivamente [p < 0,001]), bem como no número absoluto de casos que reestabeleceram os parâmetros anatômicos nas três variáveis avaliadas, sendo todos melhores no grupo 1. Conclusão: Os cirurgiões de mão trataram as fraturas mais graves e apresentaram os melhores resultados radiográficos.

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Objective The present study compares the analgesic efficacy of two techniques to perform non-surgical reduction: fracture hematoma block and radial nerve supracondylar block. Methods Forty patients with fractures of the distal third of the radius, who required reduction, were selected in a quasi-randomized clinical trial to receive one of the anesthetic techniques. All patients signed the informed consent form, except for those who did not wish to participate in the study, had neurological injury, had contraindication to the procedure in the emergency room, or with contraindication to the use of lidocaine. To measure analgesia, the numerical pain rate scale was used at four different moments: preblock, postblock, during reduction, and after reduction; then three differences were calculated: the first between before and after blocking; the second between during reduction and after blockade; and the third between before blocking and after reduction. Results The fracture hematoma and supracondylar block groups showed the following mean values, respectively: 3.90 (1-10) and 3.50 (-6-10) in difference 1; 4.35 (-5-10) and 5.00 (-3-10) in difference 2; and 4.65 (1-10) and 3.80 (-3-10) in difference 3. Conclusion Both techniques proved to be efficient for analgesia, with mild superiority of hematoma block, but without statistical significance.

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Abstract Objective The present study compares the analgesic efficacy of two techniques to perform non-surgical reduction: fracture hematoma block and radial nerve supracondylar block. Methods Forty patients with fractures of the distal third of the radius, who required reduction, were selected in a quasi-randomized clinical trial to receive one of the anesthetic techniques. All patients signed the informed consent form, except for those who did not wish to participate in the study, had neurological injury, had contraindication to the procedure in the emergency room, or with contraindication to the use of lidocaine. To measure analgesia, the numerical pain rate scale was used at four different moments: preblock, postblock, during reduction, and after reduction; then three differences were calculated: the first between before and after blocking; the second between during reduction and after blockade; and the third between before blocking and after reduction. Results The fracture hematoma and supracondylar block groups showed the following mean values, respectively: 3.90 (1-10) and 3.50 (-6-10) in difference 1; 4.35 (-5-10) and 5.00 (-3-10) in difference 2; and 4.65 (1-10) and 3.80 (-3-10) in difference 3. Conclusion Both techniques proved to be efficient for analgesia, with mild superiority of hematoma block, but without statistical significance.

Resumo Objetivo O estudo compara a eficácia analgésica de duas técnicas para realizar redução incruenta: o bloqueio de hematoma da fratura e o bloqueio supracondilar de nervo radial. Métodos Quarenta pacientes com fraturas do terço distal do rádio, que necessitassem redução, foram selecionados em um ensaio clínico quasi-randomizado, para receber uma das técnicas anestésicas. Todos os pacientes assinaram o termo de consentimento ou assentimento, com exceção daqueles que não desejassem participar do estudo, tivessem lesão neurológica, com contraindicação ao procedimento na sala de emergências, ou com contraindicação ao uso da lidocaína. Para aferir a analgesia foi utilizada a escala numérica da dor em quatro momentos distintos: pré-bloqueio, pós-bloqueio, durante a redução e após a redução; em seguida, foram calculadas três diferenças: a primeira entre antes e após o bloqueio; a segunda entre durante a redução e após o bloqueio; e a terceira entre antes do bloqueio e após a redução. Resultados Os grupos do bloqueio de hematoma de fratura e bloqueio supracondilar apresentaram respectivamente os seguintes valores médios: 3.90 (1-10) e 3.50 (-6-10) na diferença 1; 4.35 (-5-10) e 5.00 (-3-10) na diferença 2; e 4.65 (1-10) e 3.80 (-3-10) na diferença 3. Conclusão As duas técnicas se provaram eficientes para analgesia, com discreta superioridade do bloqueio de hematoma, mas sem significância estatística.

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Objectives: Investigate the effect of closed reduction and per- cutaneous pedicle screw fixation in treating thoracolumbar fractures. Methods: This retrospective study analyzed 12 cases of single-segment thoracolumbar spine fractures without spinal cord and nerve injury at our department from March 2016 to September 2017. Patients were treated with closed reduction, percutaneous reduction, and internal fixation with solid pedicle screws. The operation time, intraoperative blood loss, anterior vertebral body height ratio (AVHR), Cobb angle (CA) of sagittal kyphosis, and VAS of back pain were determined and statistically compared. Results: The average operation time was 147.2 ± 45.6 min, and the average intraoperative bleeding was 67.8 ± 34.2 mL. All fractured vertebrae were completely reduced, their height was restored, and kyphosis was corrected. The average follow-up period was 10.6 ± 2.7 months, with significant improvements seen in the AVHR, CA of sagittal kyphosis, and VAS score (P < 0.01). One case had a broken rod after three months, and another had a postoperative infection. All the patients achieved bony healing. Conclusion: The treatment of thoracolumbar fractures by closed reduction and internal fixation with a percutaneous solid pedicle screw is simple, effective, and economical. Level of Evidence VI; Therapeutic Study, Case Series .

Objetivo: Investigar o efeito da redução incruenta e da fixação com parafuso de pedículo percutâneo no tratamento das fraturas toraco- lombares. Métodos: Este estudo retrospectivo analisou 12 casos de fraturas toracolombares com segmento único sem lesão medular ou neural, encontrados no departamento dentro do período de março de 2016 a setembro de 2017. Os pacientes foram tratados com redução fechada e fixação interna com parafusos de pedículo percutâneo. O tempo de operação, a perda sanguínea intra-operatória, a relação da altura do corpo vertebral anterior (AVHR), o ângulo de Cobb (CA) da cifose sagital e a EVA relativa à dor nas costas foram determinados e comparados estatisticamente. Resultados: O tempo médio da operação foi de 147,2±45,6 min, com sangramento intraoperatório médio de 67,8±34,2 mL. Todas as vértebras fraturadas foram com- pletamente reduzidas, suas alturas foram restauradas e a cifose foi corrigida. O período médio de acompanhamento foi de 10,6±2,7 meses, apresentando melhorias significativas observadas no AVHR, CA da cifose sagital e pontuação VAS (P <0,01). Um caso teve uma haste quebrada após 3 meses, e outro paciente apresentou uma infecção pós-operatória. Todos os pacientes alcançaram a recuperação óssea. Conclusão: O tratamento das fraturas toracolombares por redução fechada com fixação interna pelo parafuso de pedículo percutâneo é simples, eficaz e econômico. Nível de Evidência IV; Estudos Terapêuticos, Série de Casos.

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In the current scenario of medical education, a trend of using models and simulators to train operational skills, especially in the practice of basic orthopedic techniques, is growing. This form of teaching allows academics to maximize learning opportunities and contributes to improving the quality of care for their future patients. However, the realistic simulation has high costs as a major limitation. Objective: To develop a low-cost orthopedic simulator for practicing pediatric forearm reduction skills in the preclinical setting. Methods: A model of an arm and forearm with a fracture in the middle third was developed. Orthopedists, residents, and medical students evaluated the simulator's ability to reproduce fracture reduction. Results: The simulator had a significantly lower cost than the others in the literature. The participants agreed that the model had a good performance, and that the manipulation was consistent with the reality of reducing closed pediatric forearm fracture. Conclusion: The results suggest that this model can be used to teach orthopedic residents and medical students the skill of closed reduction of fractures in the middle third of the forearm. Level of Evidence III, Case Control Study.

No cenário atual de ensino médico existe uma tendência crescente do uso de modelos e simuladores para o treino de habilidades operacionais, principalmente na prática de técnicas ortopédicas básicas, que permite aos acadêmicos maximizarem as oportunidades de aprendizado e contribui para melhorar a qualidade de atendimento dos futuros pacientes atendidos. A simulação realística, no entanto, tem como grande limitação os altos custos. Objetivo: Desenvolver um simulador ortopédico de baixo custo para a prática de habilidades de redução incruenta do antebraço pediátrico no cenário pré-clínico. Métodos: Desenvolveu-se um modelo de braço e antebraço com fratura no terço médio, que foi avaliado por médicos ortopedistas, residentes e acadêmicos de medicina quanto à capacidade do simulador de reproduzir a redução da fratura. Resultados: O simulador desenvolvido teve custo significativamente inferior aos existentes na literatura. Os participantes concordaram que o modelo teve um bom desempenho e que a manipulação foi condizente com a realidade de redução de fratura incruenta do antebraço pediátrico. Conclusão: Os resultados levam a crer que esse modelo pode ser usado para ensinar a redução incruenta de fratura no terço médio do antebraço para residentes de ortopedia e acadêmicos de medicina. Nível de Evidência III, Estudo de Caso-Controle.

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ABSTRACT In the current scenario of medical education, a trend of using models and simulators to train operational skills, especially in the practice of basic orthopedic techniques, is growing. This form of teaching allows academics to maximize learning opportunities and contributes to improving the quality of care for their future patients. However, the realistic simulation has high costs as a major limitation. Objective: To develop a low-cost orthopedic simulator for practicing pediatric forearm reduction skills in the preclinical setting. Methods: A model of an arm and forearm with a fracture in the middle third was developed. Orthopedists, residents, and medical students evaluated the simulator's ability to reproduce fracture reduction. Results: The simulator had a significantly lower cost than the others in the literature. The participants agreed that the model had a good performance, and that the manipulation was consistent with the reality of reducing closed pediatric forearm fracture. Conclusion: The results suggest that this model can be used to teach orthopedic residents and medical students the skill of closed reduction of fractures in the middle third of the forearm. Level of Evidence III, Case Control Study.

RESUMO No cenário atual de ensino médico existe uma tendência crescente do uso de modelos e simuladores para o treino de habilidades operacionais, principalmente na prática de técnicas ortopédicas básicas, que permite aos acadêmicos maximizarem as oportunidades de aprendizado e contribui para melhorar a qualidade de atendimento dos futuros pacientes atendidos. A simulação realística, no entanto, tem como grande limitação os altos custos. Objetivo: Desenvolver um simulador ortopédico de baixo custo para a prática de habilidades de redução incruenta do antebraço pediátrico no cenário pré-clínico. Métodos: Desenvolveu-se um modelo de braço e antebraço com fratura no terço médio, que foi avaliado por médicos ortopedistas, residentes e acadêmicos de medicina quanto à capacidade do simulador de reproduzir a redução da fratura. Resultados: O simulador desenvolvido teve custo significativamente inferior aos existentes na literatura. Os participantes concordaram que o modelo teve um bom desempenho e que a manipulação foi condizente com a realidade de redução de fratura incruenta do antebraço pediátrico. Conclusão: Os resultados levam a crer que esse modelo pode ser usado para ensinar a redução incruenta de fratura no terço médio do antebraço para residentes de ortopedia e acadêmicos de medicina. Nível de Evidência III, Estudo de Caso-Controle.

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ABSTRACT Objectives: Investigate the effect of closed reduction and per- cutaneous pedicle screw fixation in treating thoracolumbar fractures. Methods: This retrospective study analyzed 12 cases of single-segment thoracolumbar spine fractures without spinal cord and nerve injury at our department from March 2016 to September 2017. Patients were treated with closed reduction, percutaneous reduction, and internal fixation with solid pedicle screws. The operation time, intraoperative blood loss, anterior vertebral body height ratio (AVHR), Cobb angle (CA) of sagittal kyphosis, and VAS of back pain were determined and statistically compared. Results: The average operation time was 147.2 ± 45.6 min, and the average intraoperative bleeding was 67.8 ± 34.2 mL. All fractured vertebrae were completely reduced, their height was restored, and kyphosis was corrected. The average follow-up period was 10.6 ± 2.7 months, with significant improvements seen in the AVHR, CA of sagittal kyphosis, and VAS score (P < 0.01). One case had a broken rod after three months, and another had a postoperative infection. All the patients achieved bony healing. Conclusion: The treatment of thoracolumbar fractures by closed reduction and internal fixation with a percutaneous solid pedicle screw is simple, effective, and economical. Level of Evidence VI; Therapeutic Study, Case Series.

RESUMO Objetivo: Investigar o efeito da redução incruenta e da fixação com parafuso de pedículo percutâneo no tratamento das fraturas toraco- lombares. Métodos: Este estudo retrospectivo analisou 12 casos de fraturas toracolombares com segmento único sem lesão medular ou neural, encontrados no departamento dentro do período de março de 2016 a setembro de 2017. Os pacientes foram tratados com redução fechada e fixação interna com parafusos de pedículo percutâneo. O tempo de operação, a perda sanguínea intra-operatória, a relação da altura do corpo vertebral anterior (AVHR), o ângulo de Cobb (CA) da cifose sagital e a EVA relativa à dor nas costas foram determinados e comparados estatisticamente. Resultados: O tempo médio da operação foi de 147,2±45,6 min, com sangramento intraoperatório médio de 67,8±34,2 mL. Todas as vértebras fraturadas foram com- pletamente reduzidas, suas alturas foram restauradas e a cifose foi corrigida. O período médio de acompanhamento foi de 10,6±2,7 meses, apresentando melhorias significativas observadas no AVHR, CA da cifose sagital e pontuação VAS (P <0,01). Um caso teve uma haste quebrada após 3 meses, e outro paciente apresentou uma infecção pós-operatória. Todos os pacientes alcançaram a recuperação óssea. Conclusão: O tratamento das fraturas toracolombares por redução fechada com fixação interna pelo parafuso de pedículo percutâneo é simples, eficaz e econômico. Nível de Evidência IV; Estudos Terapêuticos, Série de Casos

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Las Fracturas Acetabulares bilaterales tienen una incidencia extremadamente baja. El objetivo es evaluar los resultados funcionales, radiológicos y las complicaciones en el tratamiento quirúrgico de las fracturas acetabulares bilaterales. Este estudio se basa en datos de 722 Fracturas de Acetábulo tratadas por el autor principal durante 15 años desde enero de 2005 a septiembre de 2020. Se realizó un estudio descriptivo y retrospectivo. Se incluyeron 13 casos correspondientes al 1,8% del universo. El 72,7% de las fracturas se presentaron por accidentes de tránsito, el 69,3% corresponden a fracturas de patrón asociado en relación con el 30,7% de fracturas de patrón simple. En el 56,5% se realizó abordaje de Kocher Langenbeck. La reducción anatómica se logró en el 92,30%, en el 7,69% la reducción no fue satisfactoria. Para la evaluación funcional se utilizó el HHS, 88,46% reportaron buenos resultados y 11,53% insatisfactorios. Respecto a las complicaciones, 7,69% presentaron osteoartrosis Tönnis II y 7,69% neuroapraxia del nervio ciático izquierdo. Se encontró supervivencia del 100%. El tiempo ideal para la resolución quirúrgica es antes de las 3 semanas. Los resultados radiológicos y funcionales están directamente relacionados al tiempo de fijación, es importante tomar en cuenta que debido a la magnitud de la energía del impacto que se transmite por ambos acetábulos los patrones de fractura que coexisten entre ambas superficies articulares son diferentes, por lo que optimizar la planificación preoperatoria es fundamental(AU)

Bilateral Acetabular Fractures have an extremely low incidence. The objective is to evaluate the functional and radiological results and the complications in the surgical treatment of bilateral Acetabular Fractures. This study is based on a data of 722 acetabulum fractures cases treated by the lead author for over 15 years from january 2005 to september 2020. A descriptive, retrospective study was made. 13 cases corresponding to 1,8% of the universe were included. 72,7% of the fractures occurred due to traffic accidents, 69,3% correspond to associated pattern fractures in relation to 30,7% of simple pattern fractures. In 56,5% the Kocher Langenbeck approach was performed. The anatomical reduction was achieved in 92,30%, in 7,69% the reduction was not satisfactory. The functional result was evaluated according to the HHS, obtaining good results in 88,46% of the cases and unsatisfactory results in 11,53%. Regarding complications, we found 7,69% with Tönnis II osteoarthrosis, 7,69% with neuropraxia of the left sciatic nerve. Successful results with 100% survival were found. The ideal time for surgical resolution is before 3 weeks. The radiological and functional results are directly related to the fixation time. It is important to take into account that due to the magnitude of the impact energy that is transmitted by both acetabulums, the fracture patterns that coexist between both articular surfaces are different, so optimizing preoperative planning is essential(AU)

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As luxações dorsais da articulação metacarpofalangeana dos dedos são lesões raras, vistas com mais frequência em pacientes jovens, secundárias a trauma por hiperextensão forçada do dedo na mão que estende. São classificadas como simples, quando a redução fechada é possível; ou complexas, quando a redução por métodos fechados não é possível devido à interposição de estruturas periarticulares. É importante distinguir entre uma luxação simples e uma complexa porque sua abordagem e tratamento são diferentes. O objetivo deste estudo é atualizar a abordagem clínica e as diferentes técnicas cirúrgicas utilizadas no tratamento das luxações complexas. Foi realizada uma revisão bibliográfica sobre a luxação dorsal metacarpofalangeana dos dedos longos, excluindo os do polegar, incluindo o Medline (interface PubMed), SciELO e bancos de dados acadêmicos do Google. Todos os artigos revisados concluem que as tentativas de redução incruenta nesses tipos de lesões costumam ser malsucedidas e levar a complicações adicionais. A redução cirúrgica aberta é o método de escolha, permitindo a recuperação anatômica articular com o menor risco de complicações. A imobilização pós-operatória com uma tala de travamento dorsal é recomendada por duas semanas, seguida por reabilitação por terapia ocupacional, esperando-se uma amplitude de movimento normal em seis semanas. A baixa frequência somada ao desconhecimento do médico emergencista ao realizar a manobra de redução pode, muitas vezes, levar à transformação de um simples deslocamento em complexo, tornando-o irredutível e lesionando estruturas adjacentes, por isso, acreditamos ser fundamental conhecer o manejo desta lesão.

Dorsal dislocations of the metacarpophalangeal joint of the fingers are rare injuries that are seen more frequently in young patients secondary to trauma due to forced hyperextension of the finger on the extending hand. They are classified as simple when closed reduction is possible, or complex when reduction by closed methods is not possible given the interposition of peri-articular structures. It is important to distinguish between a simple and complex dislocation because their approach and treatment differ. The objective of this study is to update the clinical approach and the different surgical techniques used in the treatment of complex dislocations. We conducted a bibliographic review on metacarpophalangeal dorsal dislocation of the long fingers, excluding those of the thumb, including the Medline (PubMed interface), SciELO and academic google databases. All the articles reviewed conclude that attempts at closed reduction in these types of injuries are often unsuccessful and often lead to additional complications. Open surgical reduction is the method of choice, allowing joint anatomical recovery with the lowest risk of complications. Postoperative immobilization using a dorsal locking splint is recommended for two weeks followed by rehabilitation by occupational therapy, expecting a normal range of motion at six weeks. The low frequency added to the ignorance of the emergency physician when performing the reduction maneuver can often lead to transform a simple dislocation into a complex one, making it irreducible and injuring adjacent structures, which is why we believe it is essential to know the management of this injury.

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As fraturas nasais são de grande incidência dentre as fraturas faciais, podendo envolver também outras estruturas da face. O diagnóstico é baseado no exame físico, o qual muitas vezes é dificultado devido ao edema formado na região. A palpação dos contornos ósseos, verificação de presença de crepitação nasal, alterações de permeabilidade e assimetrias locais são algumas das alterações sugestivas de fraturas nasais. Além disso, a inserção do ligamento cantal medial pode ser perdida devido ao trauma ou devido ao deslocamento ósseo em que ele se encontra inserido. Exames de imagem, como radiografias e Tomografias Computadorizadas, são utilizados para a visualização das fraturas ósseas e planejamento cirúrgico. A redução aberta dos ossos nasais é indicada para fraturas de maior complexidade e cominuição, tendo em vista o adequado reposicionamento dos ossos, cartilagens e ligamentos deslocados. Assim, o objetivo deste estudo é relatar a redução aberta de uma fratura dos ossos nasais com perda de inserção do ligamento cantal medial direito, sob anestesia geral... (AU)

Nasal fractures are of great incidence among facial fractures, and may also involve other facial structures. The diagnosis is based on physical examination, which is often hampered due to the edema formed in the region. Palpation of bone contours, checking for the presence of nasal crackling, changes in permeability and local asymmetries are some of the changes suggestive of nasal fractures. In addition, the insertion of the medial canthal ligament may be lost due to trauma or due to the bone displacement in which it is inserted. Imaging exams, such as radiographs and CT scans, are used for visualizing bone fractures and surgical planning. The open reduction of the nasal bones is indicated for fractures of greater complexity and comminution, in view of the appropriate repositioning of the bones, cartilage and dislocated ligaments. Thus, the aim of this study is to report the open reduction of a fracture of the nasal bones with loss of insertion of the right medial canthal ligament, under general anestesia... (AU)

Las fracturas nasales son de gran incidencia entre las fracturas faciales, y también pueden involucrar otras estructuras faciales. El diagnóstico se basa en el examen físico, que a menudo se ve obstaculizado por la inflamación que se forma en la región. La palpación de los contornos óseos, confirmación de la presencia de crepitantes nasales, alteraciones de la permeabilidad y asimetrías locales son algunas de las alteraciones sugestivas de fracturas nasales. Además, la inserción del ligamento cantal medial puede perderse debido a un traumatismo o al desplazamiento del hueso en el que se inserta. Las pruebas de imagen, como las radiografías y las tomografías computadorizadas, se utilizan para visualizar las fracturas óseas y planificar la cirugía. La reducción abierta de los huesos nasales está indicada para las fracturas de mayor complejidad y conminución, en vista del reposicionamiento adecuado de los huesos, cartílagos y ligamentos dislocados. Así, el objetivo de este estudio es relatar la reducción abierta de una fractura de los huesos nasales con pérdida de inserción del ligamento cantal medial derecho, bajo anestesia general... (AU)

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Shell fractures are one of the most traumatic and recurrent injuries observed in chelonians during clinical practice. The most common causes of fractures are falling, being run over by automobiles, being burned, and wild animal bites. Epoxy, acrylic resin, polyester, fiber-grass blanket, and screw fixation are among the current techniques used to treat fractures. Regarding the difficulty of fracture repair in the carapace, this case report aimed to report a procedure that is effective, less time-consuming, accessible, affordable, and safe for shell fractures in C. carbonarius. During the physical examination, the animal showed two fractures, in the dorsal region of the carapace and right lateral side of the bridge, with subcutaneous tissue exposure and loss of a small piece of dorsocranial carapace. To treat these injuries, the animal was submitted to a resin application. The procedure consists of using ethyl-cyanoacrylate associated with sodium bicarbonate, which produces a more resistant resin that is bactericidal, non-toxic, and easy to apply in a low surgery time compared to the common methods used to fix shell fractures. The resin application was successfully done, and the animal was under care for a month after the fracture reduction. It was observed that the treatment was effective, presenting reduction of the fracture. A month after the procedure, the animal showed no intercurrence. Three years after the procedure, the animal still presents part of the material still fixed to the shell, normal growth, without interference in locomotor capacity. This resin proved to be an innovative and promising alternative way to treat fractures, suggesting the development of new non-invasive approaches for several tissues and different animal species.

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Objective: This study aimed to investigate whether isokinetic strength decrease significantly after using volar plating for distal radius fractures and evaluate the pronator quadratus muscle regarding atrophy. Methods: This study took place between 2011 and 2015 and included 18 distal radius fracture patients (group 1) who were treated via volar plating at least one year prior and 14 healthy controls (group 2). All participants were tested isokinetically. Grip strength, radiological evaluation, wrist range of motion, disabilities of the arm, shoulder, and hand and visual analog scale scores were assessed for clinical and functional outcomes. Ultrasonography evaluated the pronator quadratus muscle thicknesses. Results: The peak supination torque (PT) and supination work per repetition (WPT) strength values significantly decreased (p:0.039, p:0.025, respectively). Although we determined an 11% pronation PT deficit and a 19% pronation WPT deficit, neither were significant. In group 1, the pronator quadratus muscle thickness decreased 5.9% ± 13.3 in the radial area and 9.7% ± 10.5 in the interosseous area according with ultrasonography; these results were not statistically significant compared to group 2. All clinical and functional outcomes were not statistically significant between the groups. Conclusion: The use of volar plating after distal radius fractures is a safe method regarding isokinetic strength and pronator quadratus muscle atrophy. Level of evidence III; Retrospective case-control study .

Objetivo: Este estudo teve como objetivo investigar se as forças isocinéticas diminuem significativamente após o uso de placa volar para tratamento de fraturas do rádio distal e avaliar o músculo pronador quadrado quanto à atrofia. Métodos: Este estudo realizado entre 2011 e 2015 incluiu 18 pacientes com fratura do rádio distal (grupo 1) que tenham sido tratadas com placa volar pelo menos um ano antes e 14 pessoas saudáveis como controle (grupo 2). Todos os participantes foram testados isocineticamente. Força de preensão, avaliação radiológica, amplitude de movimento do punho, deficiências do braço, ombro e mão e escores da escala visual analógica foram avaliados clinica e funcionalmente. A ultrassonografia avaliou a espessura do músculo pronador quadrado. Resultados: A força máxima do torque de supinação (TM) e do trabalho por repetição (ER) de supinação diminuíram significativamente (p: 0,039, p: 0,025, respectivamente). Embora tenhamos determinado um déficit de TM de pronação de 11% e um déficit de ER de pronação de 19%, nenhum dos dois foi significativo. No grupo 1, a espessura do músculo pronador quadrado diminuiu 5,9% ± 13,3 na área radial e 9,7% ± 10,5 na área interóssea, segundo ultrassonografia; estes resultados não foram estatisticamente significativos em comparação com o grupo 2. Nenhum resultados clínico ou funcional foi estatisticamente significativo entre os grupos. Conclusão: O uso de placa volar após fraturas do rádio distal é um método seguro em relação à força isocinética e atrofia do músculo pronador quadrado. Nível de evidência III; estudo retrospectivo de caso-controle .

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Introducción: Las lesiones traumáticas del codo son muy frecuentes, sobre todo en niños y adolescentes. Algunas de ellas son de difícil tratamiento y se asocian a complicaciones. De ellas, las fracturas supracondíleas del húmero son una de las más frecuentes. Objetivo: Describir las características epidemiológicas de un grupo de pacientes con esta enfermedad traumática. Métodos: Se realizó un estudio observacional descriptivo en 56 pacientes menores de 18 años atendidos en el Hospital Pediátrico Provincial Dr. Eduardo Agramonte Piña de la provincia Camagüey desde el primero de enero de 2018 al 31 de diciembre de 2021 con un total de 48 meses. Resultados: La razón sexo masculino-femenino de los 56 pacientes fue de 3,3 a 1, codo izquierdo-derecho de 1,9 a 1 y zona rural urbana de 2,2 a 1. El promedio de edades en general fue de 7,5 años. La estadía hospitalaria promedio fue de 4,8 días. El mecanismo de extensión fue el hallazgo más frecuente, así como las fracturas grado III. Los meses de enero y julio en conjunto con los días del jueves, viernes y domingo son los que presentan la mayor cantidad de pacientes. La reducción cerrada y fijación percutánea con alambres de Kirschner fue el método más empleado en esta enfermedad traumática. Conclusiones: Las fracturas supracondíleas del humero en el niño son más frecuentes en el sexo masculino y el codo izquierdo. El promedio de edades en el sexo masculino es mayor que en el femenino. Las zonas rurales aportan la mayor cantidad de pacientes. El tratamiento más empleado es el quirúrgico y las complicaciones inmediatas son infrecuentes.

Introduction: Traumatic injuries of the elbow are very frequent, some of them are difficult to treat and are associated with complications, of which supracondylar fractures of the humerus are one of the most frequent. Objetive: To describe the epidemiological behavior of a group of patients with this traumatic disease. Methods: A descriptive observational study was carried out in patients treated at the Dr. Eduardo Agramonte Piña Provincial Pediatric Hospital in the city of Camagüey from January 1st, 2018 to December 31st, 2021 with a total of 48 months. Results: the male-female sex ratio of the 56 patients was 3.3 to 1, the left-right elbow was 1.9 to 1, and the urban rural area was 2.2 to 1. The average age in general was 7.5 years. The average hospital stay was 4.8 days. The extension mechanism was the most frequent finding, as well as grade III fractures. The months of January and July together with the days of Thursday, Friday and Sunday are the ones with the largest number of patients. Closed reduction and percutaneous fixation with Kirschner wires was the most used method in this traumatic entity. Conclusions: Supracondylar fractures of the humerus in children are more frequent in males and in the left elbow. The average age of males is higher than that of females. Rural areas provide the largest number of patients. The most used treatment is surgery and immediate complications are infrequent.

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ABSTRACT Objective: This study aimed to investigate whether isokinetic strength decrease significantly after using volar plating for distal radius fractures and evaluate the pronator quadratus muscle regarding atrophy. Methods: This study took place between 2011 and 2015 and included 18 distal radius fracture patients (group 1) who were treated via volar plating at least one year prior and 14 healthy controls (group 2). All participants were tested isokinetically. Grip strength, radiological evaluation, wrist range of motion, disabilities of the arm, shoulder, and hand and visual analog scale scores were assessed for clinical and functional outcomes. Ultrasonography evaluated the pronator quadratus muscle thicknesses. Results: The peak supination torque (PT) and supination work per repetition (WPT) strength values significantly decreased (p:0.039, p:0.025, respectively). Although we determined an 11% pronation PT deficit and a 19% pronation WPT deficit, neither were significant. In group 1, the pronator quadratus muscle thickness decreased 5.9% ± 13.3 in the radial area and 9.7% ± 10.5 in the interosseous area according with ultrasonography; these results were not statistically significant compared to group 2. All clinical and functional outcomes were not statistically significant between the groups. Conclusion: The use of volar plating after distal radius fractures is a safe method regarding isokinetic strength and pronator quadratus muscle atrophy. Level of evidence III; Retrospective case-control study .

RESUMO Objetivo: Este estudo teve como objetivo investigar se as forças isocinéticas diminuem significativamente após o uso de placa volar para tratamento de fraturas do rádio distal e avaliar o músculo pronador quadrado quanto à atrofia. Métodos: Este estudo realizado entre 2011 e 2015 incluiu 18 pacientes com fratura do rádio distal (grupo 1) que tenham sido tratadas com placa volar pelo menos um ano antes e 14 pessoas saudáveis como controle (grupo 2). Todos os participantes foram testados isocineticamente. Força de preensão, avaliação radiológica, amplitude de movimento do punho, deficiências do braço, ombro e mão e escores da escala visual analógica foram avaliados clinica e funcionalmente. A ultrassonografia avaliou a espessura do músculo pronador quadrado. Resultados: A força máxima do torque de supinação (TM) e do trabalho por repetição (ER) de supinação diminuíram significativamente (p: 0,039, p: 0,025, respectivamente). Embora tenhamos determinado um déficit de TM de pronação de 11% e um déficit de ER de pronação de 19%, nenhum dos dois foi significativo. No grupo 1, a espessura do músculo pronador quadrado diminuiu 5,9% ± 13,3 na área radial e 9,7% ± 10,5 na área interóssea, segundo ultrassonografia; estes resultados não foram estatisticamente significativos em comparação com o grupo 2. Nenhum resultados clínico ou funcional foi estatisticamente significativo entre os grupos. Conclusão: O uso de placa volar após fraturas do rádio distal é um método seguro em relação à força isocinética e atrofia do músculo pronador quadrado. Nível de evidência III; estudo retrospectivo de caso-controle .

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Background Despite the high prevalence of unstable distal radius fractures (DRFs), there is no consensus regarding the optimal method and treatment timing, especially for elderly patients with multiple associated injuries. Purpose This study aimed to compare the grip strength achieved with two different methods for definitive dynamic external fixation of DRFs in elderly patients with polytrauma operated on within the first 24 hours. Methods In this prospective randomized trial, 35 patients were assigned to undergo definitive external dynamic fixation of DRFs using the nonbridging (group A) or bridging (group B) method. The grip strength, range of motion (ROM), Disabilities of the Arm, Shoulder and Hand (QuickDASH) outcome measure, visual analog scale (VAS) score for pain, and radiographic characteristics were evaluated at 6 and 12 months. Results At 12 months, no significant between-group difference was observed with respect to grip strength. All patients showed results in the third or fourth quartiles. The mean ROMs were 96.94 and 96.38% and the mean QuickDASH scores were 3.53 and 3.85 in groups A and B, respectively. The VAS scores were 1.60 and 1.85 in groups A and B, respectively. The overall complication rates were 13.3 and 15% in groups A and B, respectively. Initial fracture reduction was maintained in 86.67 and 95% of the patients in groups A and B, respectively. Conclusions Both bridging and nonbridging external definitive dynamic fixation proved safe and reliable for the treatment of unstable DRFs in elderly patients with polytrauma. The grip strength results in both groups predicted the restoration of ability in elderly patients to perform activities of daily living independently.

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Resumen Introducción: Es importante conocer las características demográficas y clínicas de las fracturas en niños para mejorar las estrategias de prevención y tratamiento en estos pacientes. Objetivos: Describir las fracturas en niños y sus características epidemiológicas. Metodología: Estudio tipo corte transversal desde enero 2014 hasta diciembre 2017. Pacientes menores de 18 años que consultaron por fracturas a una clínica en Colombia fueron incluidos. Se incluyeron datos demográficos, lugar donde ocurrió el trauma, huesos fracturados y tipo de tratamiento. Se evaluó la distribución por género y grupo etario. La fuente de información fue la historia clínica. Se utilizaron medidas de tendencia central y dispersión para agrupar los datos. Se calculó la incidencia de fracturas por cada 1000 niños/ año. Este estudio recibió aval del comité de ética de la institución. Resultados: Hubo 2436 niños fracturados, 65.6% (n=1597) ocurrieron en hombres. La mayoría fueron entre 6-11 años (40.7%, n=991), luego entre 12-17 años (36.4%, n=887) y finalmente, menores de 6 años (22.9%, n=558). La localización de la fractura más frecuente entre 0-5 años fue el húmero (30.6%, n=171), seguido por el radio (29%, n=162) y la clavícula (15.9%, n=89); entre 6-11 años fue el radio (45.2%, n=448), seguido por el húmero (18%, n=178) y el cúbito (16.6%, n=165); y entre 12-17 años fue el radio (34.6%, n=307), seguido por los huesos de la mano (22.7%, n=201) y los huesos del pie (10.8%, n=96). Requirieron manejo quirúrgico 30.9% de los niños fracturados (n=752). La incidencia de fracturas fue de 29.7/1000 niños por año. Conclusión: Las fracturas en niños se presentan con mayor frecuencia en el género masculino. Los huesos fracturados varían dependiendo del grupo etario, con un porcentaje importante del radio en todos los grupos. La mayoría se manejan de forma conservadora.

Abstract Introduction: It is important to know the demographic and clinical characteristics of fractures in children to improve prevention and treatment strategies in these patients. Objectives: To describe fractures in children and their epidemiological characteristics. Methodology: Cross-sectional study performed between January 2014 and December 2017. Patients under 18 years old with fractures who consulted to a hospital in Colombia were included. Demographic data, the location where the trauma occurred, fractured bones and type of treatment were included. Age and gender distribution were analyzed. Medical records were the source of information. Central tendency and dispersion measures were used to group the data. Incidence of fractures per 1000 children / year was calculated. This study received approval from the institution's ethics committee. Results: There were 2436 children with fractures, 65.6% (n=1597) occurred in males. Most fractures were in children between 6-11 years old (40.7%, n=991), followed by 12-17 years old (36.4%, n=887) and finally by children under 6 years old (22.9%, n=558). For the group under 6 years, most fractures occurred in humerus (30.6%, n=171), followed by radius (29%, n=162) and clavicle (15.9%, n=89); between 6-11 years old it was in radius (45.2%, n=448), followed by humerus (18%, n=178) and ulna (16.6%, n=165); and between 12-17 years it was in radio (34.6%, n=307), followed by bones of the hand (22.7%, n=201) and bones of the foot (10.8%, n=96). Surgical treatment was required in 30.9% (n=752) of the patients. The incidence of fractures was 29.7/1000 children per year. Conclusions: Fractures in children occur more frequently in males. The fractured bones differ depending on the age group; however, radius fractures represent an important proportion in all groups. Most fractures in children are treated in a conservative manner.

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Introducción: el trauma facial es una de las urgencias más frecuentes del servicio de otorrinolaringología y cirugía maxilofacial. El tratamiento debe ser dirigido a identificar la causa y el tipo de fractura e implica que puede ser conservador o quirúrgico. Objetivo: describir la experiencia clínica y diagnóstica de las fracturas mandibulares en el servicio de otorrinolaringología y cirugía maxilofacial del Hospital San José de Bogotá entre 2014 y 2018. Diseño: estudio observacional descriptivo. Metodología: Se reclutó una cohorte de pacientes con diagnóstico de fractura mandibular en el Hospital de San José entre 2014 a 2018. Se describieron las principales características clínicas y demográficas, hallazgos imagenológicos, tipo de fractura, tratamiento, complicaciones y recidivas. Resultados: se incluyeron 25 casos de pacientes con fractura mandibular durante el período descrito. El 72 % de los pacientes fueron del sexo masculino, con edad promedio de 32 (DS 11,23) años. Con etiología por: caídas, la más frecuente (40 %), accidente de tránsito (32 %) y riña callejera (16 %). Las regiones anatómicas comprometidas con mayor frecuencia fueron el cóndilo (20 %), ángulo (12 %) y el área parasinfisiaria (12 %). El manejo quirúrgico estuvo presente en el 56 % de los pacientes, en los que se utilizó el abordaje oral en el 100 % de los casos. Conclusión: las fracturas mandibulares son frecuentes en hombres y comprometen con mayor frecuencia al cóndilo de la mandíbula. Según el tipo de fractura y el grado de compromiso, el manejo puede ser conservador o quirúrgico. Con baja frecuencia en complicaciones y recidiva.

Introduction: facial trauma is one of the most frequent emergencies of the otolaryngology and maxillofacial surgery service..Treatment should be aimed at identifying the cause and type of fracture and imply that it can be conservative and surgical to provide adequate knowledge and management for this type of pathology. Objective: to describe the experience in the conservative and surgical management of fractures. mandibular in the otolaryngology and maxillofacial surgery department of the San José Hospital in Bogotá between 2014 and 2018. Design: descriptive study. Methods: a cohort of patients with a diagnosis of mandibular fracture was enrolled at the Hospital de San José between 2014 and 2018. The main clinical and demographic characteristics, imaging findings, type of fracture, treatment, complications and recurrences were describe. Results: 25 cases of patients with mandibular fracture were included during the period described.72 % of the patients were men, with an average age of 32.32 years (DS11.23). With etiology due to falls, the most frequent cases (40 %), followed by traffic accidents (32 %) and street disputes (16 %) The anatomical regions frequently compromised are: the condyle (20 %), angle (12 %), parasinfisiary (12 %). Surgical treatment was present in 56 % of these patients, 100 % oral approach was used. Conclusion: mandibular fractures are common in men, and most often compromise the jaw condyle. Depending on the type of fracture and the degree of commitment, the treatment can be conservative or surgical. With low frequency in complications and recurrence.

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INTRODUCTION: The use of mini plates as a reduction tool is an elegant technique for temporary stabilization of multifragmentary fractures. For some complex periarticular fractures with severe comminution close to the articular surface, mini plates seem to be a better option than K-wires for provisional as well as definitive fixation, because of the presence of small fragments and proximity to the joint increases the risk of additional fragmentation and articular penetration, respectively. CASE REPORT: Five cases of complex periarticular fractures of the upper limb are presented. We used 2.3 mm mini plates as reduction plates for different situations, including one scapula fracture, one clavicle fracture, one distal humerus fracture, one proximal ulna fracture, and one distal radius fracture. In all cases, an excellent clinical outcome with a full return to pain-free activity was achieved after a minimum follow-up of 12 months. CONCLUSION: We feel that these mini extra-articular implants are particularly helpful as temporary reduction tools before the application of the definitive implant to a reduced and stabilized the fracture. Because they have longer screws allowing better cortical purchase and low-profile allowing plate overlap, the procedure seems to be faster and easier when compared to the use of temporary K-wires and clamps.