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BACKGROUND: Clavicle fractures represent 2.5-4% of all fractures observed in emergency services. 80% occurs in the middle third. Treatment by plating requires a higher level of evidence. OBJECTIVE: To compare the functional outcomes of mid-shaft clavicle fractures managed with superior plating compared to anteroinferior plating. TRIAL DESIGN: A randomized, double-blind, parallel, superiority clinical trial. PATIENTS AND METHODS: Patients with fractures of the clavicles AO15B1 and AO15B2 were studied. Patients were randomized to be treated with either 3.5 mm superior or anteroinferior plating. A rehabilitation program was designed for both groups. The primary outcome measure was the Disability of Arm, Shoulder, and Hand (DASH) score; secondary outcomes included pain, union rate, and complication rates. RESULTS: Twenty-eight patients were studied and were eligible for analysis. Significant differences were found in the function assessed with the DASH score at 30 days for the superior plating compared with anteroinferior (43.74 vs. 29.26, respectively, p = 0.027), 60 days (23.97 vs. 11.18, p = 0.021), and 90 days (9.52 vs. 3.5, p = 0.016). One loosening with superficial infection was found with superior plating. CONCLUSIONS: Using an anteroinferior reconstruction plate in diaphyseal fractures offers better functional results than the upper plate in patients with fractures of the middle third of the clavicle.

ANTECEDENTES: Las fracturas de clavícula comprenden el 2.5-4% de todas las fracturas observadas en los servicios de emergencia. El 80% se presentan en el tercio medio. La posición de la placa como tratamiento requiere mayor nivel de evidencia. OBJETIVO: Comparar los resultados funcionales de las fracturas diafisarias de clavícula manejadas con placa superior versus placa anteroinferior. MÉTODO: Ensayo clínico aleatorizado, doble ciego, paralelo, de superioridad. Se estudiaron pacientes con fractura diafisaria de clavícula AO15B1 y AO15B2. Se manejaron con placa de reconstrucción de 3.5 mm colocada en forma superior o anteroinferior. Se diseñó un programa de rehabilitación para ambos grupos. El resultado primario fue medido con el cuestionario DASH y los resultados secundarios incluyeron dolor, presencia de consolidación y complicaciones. RESULTADOS: Fueron elegibles para análisis 28 pacientes. Se encontraron diferencias significativas de la escala DASH a los 30 días para la maniobra superior comparada con la inferior (43.74 vs. 29.26, respectivamente; p = 0.027), a los 60 días (23.97 vs. 11.18; p = 0.021) y a los 90 días (9.52 vs. 3.5; p = 0.016). CONCLUSIONES: El uso de placa de reconstrucción anteroinferior en las fracturas diafisarias ofrece mejores resultados funcionales en comparación con la placa superior en pacientes con fracturas de tercio medio de clavícula.

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AIM: to assess the small-scale 3D printing feasibility and cost estimation of a device for controlled dynamization. MATERIALS AND METHOD: The two-part device previously developed by our research group was printed with a carbon fiber-reinforced nylon filament (Gen3 CarbonX™ PA6+CF, 3DXTECH Additive Manufacturing) by a professional 3D printer (FUNMAT HT, Intamsys). Electricity, material, and labor costs for production in a Brazilian city in the Santa Catarina state were calculated. RESULTS: The devices for controlled dynamization were successfully printed in accordance with the planned design and dimensions. Six out of 38 printed devices presented defects in the bolt hole and were discarded. The average printing time per device was 1.9 h. The average electricity, material, and labor costs per printed device were respectively US$0.71, US$13.55, and US$3.04. The total production cost per device reaches approximately US$20 by adding the average cost of defective devices (15 %). CONCLUSION: 3D printing of the controlled dynamization device is feasible and its cost seems affordable to most healthcare services, which could optimize the consolidation of diaphyseal fractures and reduce treatment time for patients.

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CONTEXT: Controversial results have emerged regarding whether polycystic ovary syndrome (PCOS) is protective or increases the risk of bone frailty. OBJECTIVE: This study investigated whether the PCOS condition affects bone parameters of premenopausal women. This is an update for a previous meta-analysis published in 2019. DATA SOURCES: We searched MEDLINE and Embase. STUDY SELECTION: Studies were considered eligible for the update if published in English between October 1, 2018, and December 31, 2023. The diagnosis of PCOS should be based on National Institutes of Health criteria, the Rotterdam Consensus, Androgen Excess & PCOS Society criteria, or International Classification of Diseases codes in women over 18 years old. Only records with the Newcastle-Ottawa Scale ≥ 6 were selected for data extraction. DATA EXTRACTION: Data were extracted by 2 independent reviewers. DATA SYNTHESIS: We identified 31 studies that met the inclusion criteria for qualitative analysis from 3322 studies in the whole period (1990-2023). Overall, cross-sectional studies included 1822 individuals with PCOS and 1374 controls, while cohort studies incorporated 30 305 women with PCOS and 10,1907 controls. Contrasting profiles emerged after stratification using a body mass index (BMI) cutoff of 27 kg/m2. Individuals with PCOS and a BMI <27 kg/m2 exhibited lower vertebral and nonvertebral bone density, reduced bone turnover marker (osteocalcin), and increased bone resorption marker (C-terminal type I collagen) levels. Conversely, individuals with PCOS and a BMI ≥27 kg/m2 exhibited increased vertebral and nonvertebral bone mineral density, with no significant changes in bone formation and resorption markers (except osteocalcin). CONCLUSION: The findings of this study alert for a low bone mass, low bone formation, and increased bone resorption PCOS with a BMI <27 kg/m2.

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Objective To describe suspected/confirmed cases of child maltreatment related to fractures in a pediatric hospital in southern Brazil. Method Study of the Information System of Notifiable Diseases notifications and the victims' medical records between January/2016 and December/2020. Variables related to the victim, the perpetrator, the type of abuse, the presence of fractures, and their anatomical location and death were evaluated. Logistic regression was performed to identify fracture-related variables, adjusted for sex and age. The results were expressed in odds ratios and their respective 95% confidence intervals. It was considered significant p < 0.05. Results There were 276 cases, 73 infants (26.4%), male predominance (151, 54.7%), with authorship of the mistreatment by relatives (245, 96,0%), 85 (31,5%), they presented fractures, with five deaths (1.9%). Factors related to the presence of fracture: age of the victim (less than two years old; n = 82; or 2.48; 95% CI: 1.45 - 4.25), having more than two aggressors involved ( n = 144; or 2.09; 95% CI: 1.16-3.75), the medium being traffic/automobile accident, ( n = 52; or 2.65; 95% CI: 1.04-6.75), consult an orthopedist ( n = 91; or 6.77 / 95% CI: 3.66-12.51), and the need for surgical intervention ( n = 15; OR 36.72; 95% CI: 8.22-164.03). Conclusions The importance of suspicion, early identification of aggression, and the correct completion of notifications for activating the system of guaranteeing rights and removal of the aggressor was emphasized.

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The aim of this study was to evaluate the effectiveness of photobiomodulation with a 780 nm laser as an adjunct to surgical treatment in the regeneration of bone fractures. Twenty patients diagnosed with open fractures in the lower limbs were selected and randomly divided into two groups: control and LLLT. LLLT parameter: 780 nm, 0.04 cm2 of light beam diameter, 40 mW of power, 10 s per point, 0.4 J of energy, fluence of 10 J/cm2 and irradiance of 1 W/cm2. The evaluated data were: pain, using McGill scale, use of analgesics and anti-inflammatories, levels of cytokines TNF-α, IFN-γ, IL-1ß, IL-10, and IL-17, and bone level regeneration. Data were analyzed using Wilcoxon and Mann-Whitney tests (5%). We can conclude that LLLT was effective as an adjuvant in the bone fracture regeneration process, altered IL-1ß levels, reduced the use of analgesics and anti-inflammatories, reducing the pain pattern throughout the sessions.

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The postoperative period for limbs fractures is characterized by different levels of pain intensity. Shiatsu is a therapy applied with the hands on meridians and tsubos (points similar to acupuncture) related to pain. Objective: To evaluate the effect of shiatsu on postoperative pain in men with arm and leg fractures. Method: Non-randomized and uncontrolled clinical trial, with assessment of pain levels using the Visual Numerical Scale (VNS) (0­10) and measurement of salivary cortisol. The R software and the Wilcoxon test and Fisher's exact test were used. Results: 41 people participated in the research; the initial mean value of salivary cortisol concentration was 0.39 µg/dl and, after shiatsu intervention, it decreased to 0.32 µg/dl (p<0.0001). The Mean pain value was 4.93 (VNS) before the intervention and 3.90 (p<0.0001) after. Conclusion: The application of shiatsu contributed to reducing pain and cortisol levels in people undergoing orthopedic surgery. (AU)

O pós-operatório de fraturas dos membros superiores e inferiores é caracterizado por diversos níveis de intensidade dolorosa. O shiatsu é uma terapia aplicada com as mãos nos meridianos e tsubos (pontos similares aos da acupuntura) relacionados à dor. Objetivo: Avaliar o efeito do shiatsu sobre a dor no pós-operatório de homens com fraturas dos braços e pernas. Método: Ensaio clínico não randomizado e não controlado, com avaliação dos níveis de dor por meio da Escala Numérica Visual (ENV) (0­10) e de mensuração do cortisol salivar. Foi utilizado o software R e o teste de Wilcoxon e o teste exato de Fisher. Resultados: 41 pessoas participaram da pesquisa; o valor médio inicial da concentração salivar de cortisol foi de 0,39 µg/dl e, depois da intervenção com shiatsu, diminuiu para 0,32 µg/dl (p<0,0001). O valor médio da dor foi 4,93 (ENV) antes da intervenção e 3,90 (p<0,0001) depois. Conclusão: A aplicação do shiatsu contribuiu para reduzir os níveis de dor e cortisol em pessoas submetidas a cirurgias ortopédicas. (AU)

El postoperatorio de fracturas de miembros superiores e inferiores se caracteriza por diferentes niveles de intensidad del dolor. El Shiatsu es una terapia que se aplica con las manos sobre meridianos y tsubos (puntos similares a la acupuntura) relacionados con el dolor. Objetivo: Evaluar el efecto del Shiatsu sobre el dolor postoperatorio en hombres con fracturas de brazo y pierna. Método: ensayo clínico no aleatorizado y no controlado, con evaluación de los niveles de dolor mediante la Escala Numérica Visual (ENV) (0­10) y medición de cortisol salival. Se utilizó el software R, la prueba de Wilcoxon y la prueba exacta de Fisher. Resultados: Participaron de la investigación 41 personas y el valor medio inicial de la concentración de corti-sol salival fue de 0,39 µg/dl y después de la intervención de Shiatsu disminuyó a 0,32 µg/dl (p<0,0001). El valor promedio del dolor fue de 4,93 (ENV) antes de la intervención y de 3,90 (p<0,0001) después de la intervención. Conclusión: La aplicación de Shiatsu contribuyó a reducir el dolor y los niveles de cortisol en personas sometidas a cirugía ortopédica. (AU)

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Abstract Objective To describe suspected/confirmed cases of child maltreatment related to fractures in a pediatric hospital in southern Brazil. Method Study of the Information System of Notifiable Diseases notifications and the victims' medical records between January/2016 and December/2020. Variables related to the victim, the perpetrator, the type of abuse, the presence of fractures, and their anatomical location and death were evaluated. Logistic regression was performed to identify fracture-related variables, adjusted for sex and age. The results were expressed in odds ratios and their respective 95% confidence intervals. It was considered significant p < 0.05. Results There were 276 cases, 73 infants (26.4%), male predominance (151, 54.7%), with authorship of the mistreatment by relatives (245, 96,0%), 85 (31,5%), they presented fractures, with five deaths (1.9%). Factors related to the presence of fracture: age of the victim (less than two years old; n = 82; or 2.48; 95% CI: 1.45 - 4.25), having more than two aggressors involved (n = 144; or 2.09; 95% CI: 1.16-3.75), the medium being traffic/automobile accident, (n = 52; or 2.65; 95% CI: 1.04-6.75), consult an orthopedist (n = 91; or 6.77 / 95% CI: 3.66-12.51), and the need for surgical intervention (n = 15; OR 36.72; 95% CI: 8.22-164.03). Conclusions The importance of suspicion, early identification of aggression, and the correct completion of notifications for activating the system of guaranteeing rights and removal of the aggressor was emphasized.

Resumo Objetivo Descrever os casos suspeitos/confirmados de maus-tratos infantis relacionados a fraturas, atendidos em um hospital pediátrico no Sul do Brasil. Método Estudo das notificações do Sistema de Informação de Agravos de Notificação e dos prontuários das vítimas, entre janeiro/2016 e dezembro/2020. Avaliadas variáveis relacionadas à vítima, ao autor, à tipologia de maus-tratos, à presença de fraturas e sua localização anatômica e óbito. Regressão logística foi realizada para identificar as variáveis relacionadas à fratura, ajustada para sexo e idade, expressa em razão de chance e seus respectivos intervalos de confiança de 95%. Foi considerado significativo p < 0.05. Resultados Houve 276 casos, 73 lactentes (26,4%), predomínio do sexo masculino (151, 54,7%), com autoria dos maus-tratos por parentes (245, 96,0%), 85 (31,5%), apresentaram fraturas, sendo cinco óbitos (1,9%). Fatores relacionados à presença de fratura: idade da vítima (menor de dois anos; n = 82; RC 2,48; IC 95%: 1,45 - 4,25), ter mais de dois agressores envolvidos (n = 144; RC 2,09; IC 95%: 1,16 - 3,75), o meio ser trânsito/acidente automobilístico, (n = 52; RC 2,65; IC 95%: 1,04-6,75), consultar com ortopedista (n = 91; RC 6,77 / IC 95%: 3,66-12,51), e necessidade de intervenção cirúrgica (n = 15; RC 36,72; IC 95%: 8,22-164,03). Conclusões Ressaltada a importância da suspeição e identificação precoce da agressão, o preenchimento correto das notificações, para o acionamento do sistema de garantia de direitos e afastamento do agressor.

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RESUMO: Objetivo: conhecer as principais complicações pós-operatórias e o desfecho clínico de idosos após cirurgia corretiva de fratura. Método: estudo descritivo e transversal realizado em um hospital público em Minas Gerais - Brasil, entre agosto e outubro de 2021. Os dados foram obtidos por meio de entrevista e do prontuário e analisados através dos testes de Qui-Quadrado e Exato de Fisher. Resultados: as principais complicações pós-operatórias foram dor, sangramento e confusão mental. As variáveis correlacionadas à quantidade de complicações foram o desfecho (p=0,016), a classificação ASA (p=0,047) e tempo de pós-operatório (p=0,002). Quanto ao tipo de fratura, foram o setor de destino (p=0,002) e o tempo de internação (p>0,0001). Conclusão: esse estudo permite um maior conhecimento à equipe acerca do perfil de idosos, a fim de melhorar o planejamento cirúrgico e reduzir os fatores correlacionados à presença de complicações pós-operatórias.

ABSTRACT Objective: To find out about the main postoperative complications and the clinical outcome of elderly people after corrective fracture surgery. Method: a descriptive, cross-sectional study carried out in a public hospital in Minas Gerais, Brazil, between August and October 2021. Data was obtained through interviews and medical records and analyzed using the Chi-square and Fisher's exact tests. Results: The main postoperative complications were pain, bleeding, and mental confusion. The variables correlated with the number of complications were outcome (p=0.016), ASA classification (p=0.047) and postoperative time (p=0.002). As for the type of fracture, it was the destination sector (p=0.002) and length of stay (p>0.0001). Conclusion: This study provides the team with greater knowledge about the profile of the elderly, to improve surgical planning and reduce the factors correlated with the presence of postoperative complications.

RESUMEN: Objetivo: conocer las principales complicaciones postoperatorias y el resultado clínico de los ancianos tras la cirugía correctora de fracturas. Método: estudio descriptivo, transversal, realizado en un hospital público de Minas Gerais - Brasil, entre agosto y octubre de 2021. Los datos se obtuvieron a través de entrevistas e historias clínicas y se analizaron mediante las pruebas de chi cuadrado y exacta de Fisher. Resultados: las principales complicaciones postoperatorias fueron dolor, hemorragia y confusión mental. Las variables correlacionadas con el número de complicaciones fueron el resultado (p=0,016), la clasificación ASA (p=0,047) y el tiempo postoperatorio (p=0,002). En cuanto al tipo de fractura, fueron el sector de destino (p=0,002) y la duración de la hospitalización (p>0,0001). Conclusión: Este estudio proporciona al equipo un mayor conocimiento sobre el perfil del anciano, con el fin de mejorar la planificación quirúrgica y reducir los factores correlacionados con la presencia de complicaciones postoperatorias.

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Bisphosphonates are widely used in the treatment of osteoporosis but predispose the patient to the appearance of atypical fractures. The femoral subtrochanteric region is usually affected, but other bones can be as well. Atypical tibia fractures in patients with severe gonarthrosis is a therapeutic challenge. The present work reports the case of an elderly patient with advanced gonarthrosis who presented atypical tibial fracture. The patient made prolonged use of bisphosphonates for osteoporosis, presenting with pain and functional limitation resulting from gonarthrosis, which progressed to sudden pain in the right tibial metaphysis, preventing ambulation. The radiographs showed bilateral severe arthrosis; marked varism; tibial and femoral medial erosion; and fracture in the proximal third of the right tibial diaphysis. The fracture and arthrosis on the right side were treated by osteosynthesis with blocked plaque and total knee arthroplasty with posterior stabilization and fixed base. After physical rehabilitation, significant improvement of pain and function was reported, independent gait was reacquired and a range of motion of 0 to 100° was reached. After one year, the radiographs showed fracture consolidation and satisfactory alignment of the lower limbs' axes. The coexistence of severe arthrosis and atypical fracture made treatment difficult. However, the result was satisfactory and the approach with simultaneous osteosynthesis and arthroplasty proved to be adequate.

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Introduction: Osteoporosis is a chronic disease characterized by a decrease in the density of bone mass, making bone more porous, less resistant and of lower quality than normal bone. This leads to the deterioration of its microstructure, making the bone more fragile and therefore increasing the risk of fracture. It has been found that high concentrations of Lactobacillus and Bifidobacterium promote the absorption of minerals such as calcium, magnesium, and phosphorus and thus increase mineral density. Due to the great social and economic impacts of osteoporosis, it is necessary to develop interventions that can be easily adopted at the population level, improving the quality of life of individuals without significantly affecting the health system. Objective: Assessing the impact of increased dairy consumption on the Colombian population diagnosed with osteoporosis between 2015 and 2020 through the simulation of the potential impact fraction (PIF). Methods: Using data from the Integrated Social Protection Information System (SISPRO) and National Nutritional Situation Survey (ENSIN), the incidence, the frequency of milk consumption, the potential impact fraction (PIF), and disability-adjusted life years (DALYs) were estimated. Results: A total of 63,640 cases of osteoporosis were identified. The highest incidence was observed in 2019. Seventeen food groups were identified in the ENSIN, and the most frequent products consumed by respondents over 50 years of age were milk, cheese, and yogurt. The PIF was then analysed, with a calcium intake of 600 mg/ day, and a significant difference in the decrease in the number of cases was observed. In 2019, a higher estimated DALY loss of 9.9 was observed. In women, years of life lost due to fractures were the highest in the 65-69 age group. In men, they were highest in the 75-79 age group. Discussion: We observed that the departments with the highest consumption of dairy products were the capital of the country and regions where dairy products factories are located. It was not possible to establish an association between socioeconomic strata and low dairy intake. Nevertheless, some authors have proposed that westernization of diets and low income reduce access to fresh fruits and milk derivates. Conclusion: Years lost due to disability increased in the population over 60 years of age. In the PIF analysis, a decrease in cases was observed when the population increased consumption of dairy products.

Introducción: La osteoporosis es una enfermedad crónica caracterizada por una disminución de la densidad de la masa ósea que hace que el hueso sea más poroso, menos resistente y de menor calidad que el hueso normal. Esto conduce al deterioro de su microestructura, por lo que el hueso se hace más frágil y, por lo tanto, aumenta el riesgo de fractura. Se ha encontrado que las altas concentraciones de Lactobacillus y Bifidobacterium promueven la absorción de minerales como calcio, magnesio y fósforo y, por lo tanto, aumentan la densidad mineral. Debido a los grandes impactos sociales y económicos de la osteoporosis, es necesario desarrollar intervenciones que puedan ser fácilmente adoptadas a nivel poblacional con el fin de mejorar la calidad de vida de los individuos sin afectar significativamente el sistema de salud. Objetivo: Evaluar el impacto del aumento del consumo de lácteos en la población colombiana con diagnóstico de osteoporosis entre 2015 y 2020 mediante la simulación de la fracción de impacto potencial (PIF). Materiales y métodos: Estudio ecológico realizado en adultos mayores de 50 años con diagnóstico de osteoporosis. A partir de los registros del Sistema Integrado de Información de Protección Social (SISPRO) y la Encuesta Nacional de Situación Nutricional (ENSIN), se estimó la incidencia, la frecuencia de consumo de leche, el PIF y los años de vida ajustados por discapacidad (AVAD). Resultados: Se identificaron un total de 63 640 casos de osteoporosis en SISPRO, la mayor incidencia se observó en 2019. Se establecieron 17 grupos de alimentos en la ENSIN, los productos más frecuentes consumidos en población mayor de 50 años fueron leche, queso y yogur. En el cálculo del PIF se encuentra que con una ingesta de calcio de 600 mg/día se reduciría significativamente el número de casos. En 2019 se observó una mayor pérdida estimada de AVAD de 9,9. En las mujeres, los años de vida perdidos debido a fracturas fueron más altos en el grupo de edad de 65 a 69 años. En los hombres, fue más alta en el grupo de edad de 75-79 años. Discusión: Observamos que los departamentos con mayor consumo de productos lácteos fueron la capital y las regiones donde se encuentran las fábricas de productos lácteos. No fue posible establecer una asociación entre los estratos socioeconómicos y la baja ingesta de lácteos. Sin embargo, algunos autores han propuesto que la occidentalización de las dietas y los bajos ingresos reducen el acceso a frutas frescas y derivados de la leche. Conclusión: Los años perdidos por discapacidad aumentaron en la población mayor de 60 años. En el análisis PIF, se observó una disminución en los casos (reducción de 2329 casos/ año) cuando la población aumentó el consumo de productos lácteos.

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Contexto: Las fracturas óseas en pacientes en hemodiálisis son frecuentes y agregan una grave incapacidad y morbimortalidad; se han relacionado a alteraciones óseo-minerales, aunque su asociación con las alteraciones de la hormona paratiroidea es controversial. Objetivo: determinar la relación entre hormona paratiroidea intacta (PTH) alterada y fracturas óseas en pacientes en hemodiálisis. Metodología: se realizó un estudio transversal y analítico en 250 pacientes en hemodiálisis atendidos en el Hospital Víctor Lazarte Echegaray (La Libertad, Perú) entre el 2015 y el 2020. Los pacientes se clasificaron de acuerdo con su valor de PTH (alterada si PTH 300 pg/ml) y la presentación de fracturas óseas. La asociación entre PTH alterada y la presencia de fracturas óseas se determinó al usar un análisis bivariado y multivariado; los resultados se presentan como odds ratio (OR) considerando un valor p significativo si < 0,05. Resultados: se evaluaron 250 pacientes, 69 tuvieron PTH alterada (27,6 %) y 181 tuvieron PTH normal (72,4 %); asimismo, 42 tenían fracturas óseas (16,8 %) y 208 no tenían fracturas óseas (83,2 %). De los 42 pacientes con fracturas óseas, 22 presentaron PTH alterada (52,4 %) y 20 PTH normal (47,6 %); de los 208 pacientes sin fracturas óseas, 47 presentaron PTH alterada (22,6 %) y 161 PTH normal (p = 0,001) (77,4 %). Así, tener PTH alterada se asoció a la presencia de fracturas óseas con un OR de 3,77 (IC 95 %: 1,90-7,49) en el análisis bivariado y un OR de 2,85 (IC 95 %: 1,19-6,82) en el análisis multivariado. Las covariables que se asociaron a presencia de fracturas óseas fueron: tener más de 60 años (OR: 2,74, IC 95 %: 1,12-6,69) y tener más de cinco años en hemodiálisis (OR: 6,72, IC 95 %: 2,98-15,13). Conclusiones: la hormona paratiroidea alterada se relaciona con fracturas óseas en pacientes en hemodiálisis.

Background: Bone fractures in patients on dialysis are frequent and impose a high burden of disability and multimorbidity. They have been linked to mineral-bone disorders but its association with parathyroid hormone remains controversial. Purpose: To determine the relationship between altered parathyroid hormone (PTH) and bone fractures in hemodialysis patients. Metthodology: A cross-sectional, analytical study was conducted in 250 hemodialysis patients attending Hospital Víctor Lazarte Echegaray from 2015 to 2020. Patients were classified according to whether their PTH was altered (PTH 300 pg/ml) and whether bone fractures were present. The association between altered PTH and the presence of bone fractures was determined using bivariate and multivariate analysis; the results are presented as odds ratio (OR) considering a significant p-value if <0.05. Results: 250 patients were evaluated in which 69 (27.6%) had altered PTH, 181 (72.4%) had normal PTH; likewise, 42 (16.8%) had bone fractures and 208 (83.2%) had no bone fractures. Of the 42 patients with bone fractures, 22 (52.4%) had altered PTH and 20 (47.6%) had normal PTH; of the 208 patients without bone fractures, 47 (22.6%) had altered PTH and 161 (77.4%) had normal PTH (p=0.001). Altered PTH was associated with the presence of bone fractures with OR: 3.77 (95% CI: 1.90-7.49) in the bivariate analysis and with OR: 2.85 (95% CI: 1.19-6.82) in the multivariate analysis. The covariates that were associated with the presence of bone fractures were being over 60 years (OR: 2.74, 95% CI: 1.12-6.69) and having been on hemodialysis for more than 5 years (OR: 6.72, 95% CI: 2.98-15.13). Conclusions: Altered parathyroid hormone is related with bone fractures in hemodialysis patients.

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RESUMEN Introducción: Los tratamientos para fracturas de órbita se basan en la corrección del defecto de las lesiones orbitarias de tipo blow in y blow out (o de estallido), mediante diversas placas y mallas biocompatibles con el organismo, dándose una cicatrización de primera generación evitando un callo óseo y una fijación más rígida. Para el diagnóstico de este tipo de lesiones tenemos inflamación periorbitaria, enoftalmos, diplopía, equimosis, hemorragia subconjuntival. Existen diversos materiales reconstructivos siendo estos compuestos por distintas materias primas, como son los aloplásticos y autógenos; donde encontramos varios tipos como placas de titanio y las placas reabsorbibles siendo estas las más comunes y usadas actualmente, por su bajo estímulo a reabsorciones óseas y evitando efectos secundarios a largo plazo. Estas placas presentan diversos grados de ductilidad y resistencia. Se informó sobre varias complicaciones según el tipo de placas como es la cicatrización, las cirugías postquirúrgicas en caso de placas de titanio, etc. El objetivo de esta revisión es la evaluación de la eficacia las placas reabsorbibles versus placas de titanio en fracturas de órbita. Materiales y métodos: La investigación es de carácter documental, descriptivo y no experimental. En el cual se emplea una metodología de identificación e inclusión de artículos científicos tipo prisma. Resultados y conclusiones: Se verificaron las ventajas y desventajas tanto de las placas reabsorbibles como las de titanio siendo estas similares en la biocompatibilidad con el organismo humano, así como también varias diferencias como el soporte, fuerzas, resistencia de estas, concluyendo que es debatible el material ideal para tratar fracturas de órbita. Se seleccionaron artículos tomando en cuenta el título y objetivos; considerando estudios comparativos, revisiones sistemáticas, revisiones de literatura, los cuales comprendían criterios con respecto a fracturas de órbita y tratamientos quirúrgicos. La búsqueda arrojó 55 artículos en PubMed, 65 en Google, 4 en Scielo y 29 en Science direct, de los cuales se excluyeron libros, monografías, estudios experimentales, dando como resultado 21 artículos para el desarrollo de esta revisión bibliográfica. Y que fueron leídos y analizados en su totalidad, estudiando los objetivos, metodología y conclusión de cada uno de ellos para la posterior comparación.

ABSTRACT Introduction: Treatments for orbit fractures are based on the correction of the defect of blow in and blow out orbital injuries, by means of various plates and meshes biocompatible with the organism, giving a first-generation healing avoiding a bony callus and a more rigid fixation. For the diagnosis of this type of lesions we have periorbital inflammation, enophthalmos, diplopia, ecchymosis, subconjunctival hemorrhage. There are several reconstructive materials being these composed of different raw materials, such as alloplastic and autogenous, where we find several types such as titanium plates and resorbable plates being these the most common and currently used, for its low stimulus to bone resorption and avoiding long-term side effects. These plates have different degrees of ductility and resistance. Several complications have been reported depending on the type of plates, such as scarring, post-surgical surgeries in the case of titanium plates, etc. The objective of this review is to evaluate the efficacy of resorbable versus titanium plates in orbital fractures. Materials and methods: This research are a documentary, descriptive and non-experimental nature. A prism-type methodology of identification and inclusion of scientific articles was used. Results and conclusions: The advantages and disadvantages of both resorbable and titanium plates were verified, being these similar in biocompatibility with the human organism, as well as several differences such as support, forces, resistance of the same, concluding that it is debatable. The ideal material to treat orbital fractures. Articles were selected considering the title and objectives; considering comparative studies, systematic reviews, literature reviews, which included criteria regarding orbital fractures and surgical treatments. The search yielded 55 articles in PubMed, 65 in Google, 4 in Scielo and 29 in Science direct, from which books, monographs, experimental studies were excluded, resulting in 21 articles for the development of this bibliographic review. The 21 articles were read and analyzed in their entirety, studying the objectives, methodology and conclusion of each one of them for subsequent comparison.

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Background: Patients with thoracolumbar fractures with TLICS 4 classification are at the limit of surgical fixation with regards to conservative treatment; however, results in our environment are not known, which is why this study has innovative characteristics. Objective: To determine the quality of life in patients with TLICS 4 thoracolumbar fractures using traditional fixation with regards to no fixation in a third level hospital. Material and methods: A cohort prospective study was carried out in patients with TLICS 4 classification thoracolumbar fractures using traditional fixation with regards to no fixation in beneficiaries from the Mexican Institute for Social Security. The SF-12 instrument, which assessed quality of life, was administered; age, sex, days of hospitalization, time of spinal cord injury were searched in the patients' medical history. It was used descriptive and inferential statistics using Student's t or Mann-Whitney U. Results: 20 patients participated and 9 had traditional fixation (45%). All patients had type E spinal cord injuries according to the International Standards for Neurological Classification of Spinal Cord Injury. Mean age of non-fixation was 42.2 ± 12.9 and of fixation 44.9 ± 10.2; in non-fixation 6 (67%) were male. The quality of life score was 29.1 ± 0.9 in the conservative treatment and 28.7 ± 1.3 in the surgical treatment, p < 0.462. Conclusions: No differences in quality of life were observed in patients with TLICS 4 thoracolumbar fractures using traditional fixation with regards to no fixation.

Introducción: los pacientes con fracturas toracolumbares con clasificación TLICS 4 se encuentran en el límite de la fijación quirúrgica con respecto al tratamiento conservador; sin embargo, resultados en nuestro medio no son conocidos, por lo que este estudio tiene características innovadoras. Objetivo: determinar la calidad de vida en pacientes con fracturas toracolumbares clasificación TLICS 4, mediante fijación tradicional con respecto a no fijación en un hospital de tercer nivel. Material y métodos: estudio de cohorte prospectiva en pacientes con fracturas toracolumbares clasificación TLICS 4 mediante fijación tradicional con respecto a no fijación en población derechohabiente del Instituto Mexicano del Seguro Social (IMSS). Se aplicó el instrumento SF-12, que evaluó la calidad de vida; se buscó en los expedientes de los pacientes edad, sexo, días de hospitalización, tiempo de lesión medular. Se usó estadística descriptiva e inferencial mediante t de Student o U de Mann Whitney. Resultados: participaron 20 pacientes y 9 (45%) tuvieron fijación tradicional. Todos los pacientes pertenecían a la clase E según las Normas Internacionales para la Clasificación Neurológica de lesiones de la médula espinal. Edad media de no fijación con 42.2 ± 12.9 y de fijación 44.9 ± 10.2; en no fijación, 6 (67%) eran varones. La puntuación de calidad de vida fue en el tratamiento conservador con 29.1 ± 0.9 y quirúrgico 28.7 ± 1.3, p < 0.462. Conclusiones: no se observaron diferencias en la calidad de vida en pacientes con fracturas toracolumbares clasificación TLICS 4 mediante fijación tradicional y no fijación.

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Background: Patients with thoracolumbar fractures with TLICS 4 classification are at the limit of surgical fixation with regards to conservative treatment; however, results in our environment are not known, which is why this study has innovative characteristics. Objective: To determine the quality of life in patients with TLICS 4 thoracolumbar fractures using traditional fixation with regards to no fixation in a third level hospital. Material and methods: A cohort prospective study was carried out in patients with TLICS 4 classification thoracolumbar fractures using traditional fixation with regards to no fixation in beneficiaries from the Mexican Institute for Social Security. The SF-12 instrument, which assessed quality of life, was administered; age, sex, days of hospitalization, time of spinal cord injury were searched in the patients' medical history. It was used descriptive and inferential statistics using Student's t or Mann-Whitney U. Results: 20 patients participated and 9 had traditional fixation (45%). All patients had type E spinal cord injuries according to the International Standards for Neurological Classification of Spinal Cord Injury. Mean age of non-fixation was 42.2 ± 12.9 and of fixation 44.9 ± 10.2; in non-fixation 6 (67%) were male. The quality of life score was 29.1 ± 0.9 in the conservative treatment and 28.7 ± 1.3 in the surgical treatment, p < 0.462. Conclusions: No differences in quality of life were observed in patients with TLICS 4 thoracolumbar fractures using traditional fixation with regards to no fixation.

Introducción: los pacientes con fracturas toracolumbares con clasificación TLICS 4 se encuentran en el límite de la fijación quirúrgica con respecto al tratamiento conservador; sin embargo, resultados en nuestro medio no son conocidos, por lo que este estudio tiene características innovadoras. Objetivo: determinar la calidad de vida en pacientes con fracturas toracolumbares clasificación TLICS 4, mediante fijación tradicional con respecto a no fijación en un hospital de tercer nivel. Material y métodos: estudio de cohorte prospectiva en pacientes con fracturas toracolumbares clasificación TLICS 4 mediante fijación tradicional con respecto a no fijación en población derechohabiente del Instituto Mexicano del Seguro Social (IMSS). Se aplicó el instrumento SF-12, que evaluó la calidad de vida; se buscó en los expedientes de los pacientes edad, sexo, días de hospitalización, tiempo de lesión medular. Se usó estadística descriptiva e inferencial mediante t de Student o U de Mann Whitney. Resultados: participaron 20 pacientes y 9 (45%) tuvieron fijación tradicional. Todos los pacientes pertenecían a la clase E según las Normas Internacionales para la Clasificación Neurológica de lesiones de la médula espinal. Edad media de no fijación con 42.2 ± 12.9 y de fijación 44.9 ± 10.2; en no fijación, 6 (67%) eran varones. La puntuación de calidad de vida fue en el tratamiento conservador con 29.1 ± 0.9 y quirúrgico 28.7 ± 1.3, p < 0.462. Conclusiones: no se observaron diferencias en la calidad de vida en pacientes con fracturas toracolumbares clasificación TLICS 4 mediante fijación tradicional y no fijación.

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In post-menopausal women, aged individuals, and patients with diabetes mellitus or chronic renal disease, bone mineral density (BMD) decreases while the vasculature accumulates arterial calcifications (ACs). AC can be found in the tunica intima and/or in the tunica media. Prospective studies have shown that patients with initially low BMD and/or the presence of fragility fractures have at follow-up a significantly increased risk for coronary and cerebrovascular events and for overall cardiovascular mortality. Similarly, patients presenting with abdominal aorta calcifications (an easily quantifiable marker of vascular pathology) show a significant decrease in the BMD (and an increase in the fragility) of bones irrigated by branches of the abdominal aorta, such as the hip and lumbar spine. AC induction is an ectopic tissue biomineralization process promoted by osteogenic transdifferentiation of vascular smooth muscle cells as well as by local and systemic secreted factors. In many cases, the same regulatory molecules modulate bone metabolism but in reverse. Investigation of animal and in vitro models has identified several potential mechanisms for this reciprocal bone-vascular regulation, such as vitamin K and D sufficiency, advanced glycation end-products-RAGE interaction, osteoprotegerin/RANKL/RANK, Fetuin A, oestrogen deficiency and phytooestrogen supplementation, microbiota and its relation to diet, among others. Complete elucidation of these potential mechanisms, as well as their clinical validation via controlled studies, will provide a basis for pharmacological intervention that could simultaneously promote bone and vascular health.

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A osteotomia sagital bilateral de mandíbula (OSBM) foi publicada por Trauner e Obwegeser em 1957, desde então sofreu várias modificações a fim de diminuir as complicações e tornar o procedimento mais simples e previsível. Sendo assim objetivo do presente trabalho foi avaliar e comparar a fragilidade causada na mandíbula por 3 tipos de OSBM. Para isso, foram realizadas as osteotomias propostas por Trauner e Obwegeser modificada por Hunsuck e Epker (I), a de Sant'Ana (II) e de Wolford (III), em 24 hemimandibulas de poliuretano e foi realizado o ensaio mecânico para gerar a fratura sagital. Os dados foram coletados e tabulados, e obteve como resultado que, a maior quantidade de força máxima aplicada foi observada no grupo III, e a menor quantidade no grupo II; com relação à deflexão, apresentou significância estatística entre o grupo II e grupo III; com relação à rigidez, a maior média, foi encontrada no grupo I. Sendo assim, foi possível concluir que dentro deste modelo de estudo a osteotomia II foi capaz de gerar maior fragilidade à hemimandibula de poliuretano com menor quantidade de força. As OBMD dos grupos I e a III também apresentaram ótimos resultados, entretanto necessitaram mais força para alcançar a fratura... (AU)

The bilateral sagittal split osteotomy of the mandible (BSSO) was published by Trauner and Obwegeser in 1957, since then it has undergone several modifications in order to reduce complications and make the procedure simpler and more predictable. Therefore, the objective of this study was to evaluate and compare the fragility caused in the mandible by 3 types of BSSO. For this, the osteotomies proposed by Trauner and Obwegeser modified by Hunsuck and Epker (I), Sant'Ana (II) and Wolford (III) were performed on 24 polyuretha ne hemimandibles, a mechanical test to generate the sagittal fracture. Data were collected and tabulated, and the result was that, the highest amount of maximum force applied was observed in group III, and the lowest amount in group II; with regard to deflection, it was statistically significant between group II and group III; with regard to stiffness, the highest average was found in group I. Therefore, it was possible to conclude that within this study model, osteotomy II was able to generate greater fragility to the polyurethane hemimandible with less force. The BSSO of the groups I and III also showed excelent results, however they required more force to reach the fracture... (AU)

La osteotomía sagital bilateral de la mandíbula (OSBM) fue publicada por Trauner y Obwegeser en 1957, desde entonces ha sufrido varias modificaciones con el fin de reducir las complicaciones y hacer el procedimiento más simple y predecible. Por lo tanto, el objetivo de este estudio fue evaluar y comparar la fragilidad causada en la mandíbula por 3 tipos de OSBM. Para eso, se realizaron las osteotomías propuestas por Trauner y Obwegeser modificadas por Hunsuck y Epker (I), Sant'Ana (II) y Wolford (III) en 24 hemimandíbulas de poliuretano y se realizó un ensayo mecánico para generar la fractura sagital. Los datos fueron recolectados y tabulados, obteniendo como resultado que, la mayor cantidad de fuerza máxima aplicada se observó en el grupo III, y la menor cantidad en el grupo II; en cuanto a la deflexión, fue estadísticamente significativa entre el grupo II y el grupo III; en cuanto a la rigidez, la media más alta se encontró en el grupo I. Por lo tanto, se pudo concluir que, dentro de este modelo de estudio, la osteotomía II logró generar mayor fragilidad a la hemimandíbula de poliuretano con menor fuerza. El OSBM de los grupos I y III también mostró excelentes resultados, pero requirieron mayor fuerza para llegar a la fractura... (AU)

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Las fracturas de meseta tibial compleja se asocian a traumatismo de alta energía, principalmente en accidentes de motocicleta, siendo un desafío para el cirujano ortopedista. En la década de 1970, Schatzker propuso una clasificación radiológica para las fracturas de la meseta tibial, que destacaba la morfología de los seis tipos principales. Las imágenes de tomografía computarizada y tridimensional, han cambiado la comprensión y el tratamiento de las fracturas de la meseta tibial. Recientemente, esa clasificación original se complementó con una más amplia; puesto que, se introdujo el fragmento en cuña dividida y la continuidad de la columna posterior como determinantes de la estabilidad articular y el papel fundamental que desempeña en el tratamiento de las fracturas de la meseta tibial, con ellos también la importancia de abordajes quirúrgicos que permitan la visualización posterior para una adecuada reducción. El estudio documenta las técnicas de fijación interna y abordajes posteriores realizadas en el IAHULA, valorando los resultados clínicos en cuanto a dolor y satisfacción del paciente, como consolidación, pseudoartrosis o falla en la técnica de osteosíntesis realizada. El resultado a partir de las escalas de evaluación de la AO y KOOS, arrojaron que, con un efecto excelentes se agrupa un 28,6% y bueno a un 42,9%, indicando la importancia de la fijación de la columna posterior, para prevenir artrosis postraumática temprana e inestabilidad articular(AU)

A complex fracture of the posterior tibial plateau are related to high energy traumatisms, mainly during motorcycle accidents, becoming a challenge to the ortopedic surgen. During the seventies, Stchatzker proposed a radiologic classification for the tibial plateau fractures that pointed the morphology of six main types. The computarized and tridimensional tomographic images have changed the comprehension and treatment of these fractures. Recently, the original classification was complemented with a more broaded approach due to the introduction of the fragment in divided crib and the continuity of the posterior column as factors determining the articular stability and the fundamental roll played in the treatment of fractures of the tibial plateau, as well as the important roll of surgical approaches that allow the posterior visualization for a correct reduction. This research documents the technics of internal fixation and posterior approach developed in the IAHULA, evaluating the clinic results about patients' pain level and comfort, as well as the radiologic findings of consolidation, pseudoarthrosis, or fail in the technic of osteosynthesis developed. The results from a point of view of the evaluation scales of the AO and KOOS, show 28.6% with excellent outcomes, and 42.9% with good outcomes, indicating the importance of the fixation of the posterior column to prevent early start of posttraumatic arthrosis and articular instability(AU)

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Abstract Bisphosphonates are widely used in the treatment of osteoporosis but predispose the patient to the appearance of atypical fractures. The femoral subtrochanteric region is usually affected, but other bones can be as well. Atypical tibia fractures in patients with severe gonarthrosis is a therapeutic challenge. The present work reports the case of an elderly patient with advanced gonarthrosis who presented atypical tibial fracture. The patient made prolonged use of bisphosphonates for osteoporosis, presenting with pain and functional limitation resulting from gonarthrosis, which progressed to sudden pain in the right tibial metaphysis, preventing ambulation. The radiographs showed bilateral severe arthrosis; marked varism; tibial and femoral medial erosion; and fracture in the proximal third of the right tibial diaphysis. The fracture and arthrosis on the right side were treated by osteosynthesis with blocked plaque and total knee arthroplasty with posterior stabilization and fixed base. After physical rehabilitation, significant improvement of pain and function was reported, independent gait was reacquired and a range of motion of 0 to 100º was reached. After one year, the radiographs showed fracture consolidation and satisfactory alignment of the lower limbs' axes. The coexistence of severe arthrosis and atypical fracture made treatment difficult. However, the result was satisfactory and the approach with simultaneous osteosynthesis and arthroplasty proved to be adequate.

Resumo Bifosfonatos são amplamente usados no tratamento da osteoporose; porém, predispõem ao surgimento de fraturas atípicas. A região subtrocantérica femoral é usualmente acometida, mas outros ossos também são afetados. Fraturas atípicas da tíbia em pacientes portadores de gonartrose grave são um desafio terapêutico. O presente trabalho relata o caso de uma paciente idosa com gonartrose avançada que apresentou fratura atípica tibial. A paciente fazia uso prolongado de bifosfonatos para osteoporose, com quadro de dor e limitação funcional decorrentes da gonartrose, que progrediu para dor súbita na metáfise tibial à direita, impedindo a deambulação. Radiografias evidenciaram artrose grave bilateral; varismo acentuado; erosão medial tibial e femoral; e fratura no terço proximal da diáfise tibial direita. Trataram-se a fratura e a artrose à direita por osteossíntese com placa bloqueada e artroplastia total do joelho com estabilização posterior e base fixa. Após reabilitação física, relatou-se melhora significativa da dor e da função, readquiriu-se a marcha independente e alcançou-se arco de movimento de 0 a 100º. Após um ano, as radiografias mostraram consolidação da fratura e alinhamento satisfatório dos eixos dos membros inferiores. A coexistência de artrose grave e fratura atípica dificultou o tratamento. Contudo, o resultado foi satisfatório e a abordagem com osteossíntese e artroplastia simultâneas mostrou-se adequada.

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Traumatic injuries are a significant cause of death for birds worldwide, as they are at an increased risk of collisions and other injuries due to man-made environments. This study examined the frequency and morphological characteristics of fatal traumatic injuries in endemic and migratory Passeriformes and Psittaciformes from the Cerrado Biome, a biodiverse but threatened area in Brazil. Results showed that fatal traumatic injuries were found in 21.8% of birds (285/1305), mainly in spring and summer, during the birds' reproductive period. The yellow-chevroned parakeet (Brotogeris chiriri) and Passeriformes from the Thraupidae family were the most affected. Nearly 70% of the fatal injuries observed were to the thoracic, pelvic limbs, and skull, and types of fractures and affected bones were thoroughly evaluated. Blunt traumas were one of the most frequent causes of injuries. Injuries affecting the appendicular skeleton and head represented significant causes of traumatic death for Passeriformes and Psittaciformes. The frequency of these fatal injuries has been increasing in recent years, which may be related to the remarkable environmental changes in the Cerrado Biome and jeopardize the survival of many bird species.

As lesões traumáticas são uma causa significativa de morte nas aves em todo o mundo, pois apresentam um risco maior de colisões e outras lesões devido aos ambientes degradados e criados pelo homem. Este estudo examinou a frequência e as características morfológicas das lesões traumáticas fatais em Passeriformes e Psittaciformes endêmicos e migratórios do Bioma Cerrado, uma área com rica biodiversidade, mas ameaçada no Brasil. Os resultados demostraram que as lesões traumáticas fatais foram observadas em 21,8% das aves (285/1305), principalmente na primavera e verão, durante a época reprodutiva das aves. O periquito-do-encontro-amarelo (Brotogeris chiriri) e Passeriformes da família Thraupidae foram as aves mais frequentemente acometidas. Por volta de 70% das lesões fatais observadas foram nos membros torácicos e pélvicos, e crânio, e os tipos de fraturas e ossos afetados foram minuciosamente avaliados. Os traumas contudentes foram as principais causas das lesões. As injúrias que afetaram o esqueleto apendicular e a cabeça representaram as mais importantes causas de morte traumática para Passeriformes e Psittaciformes. A frequência dessas lesões fatais vem aumentando nos últimos anos, o que pode estar relacionado às mudanças ambientais marcantes no Bioma Cerrado e colocar em risco a sobrevivência de muitas espécies de aves.

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