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Objective: To evaluate and compare the proportions of complications and radiographic findings of osteosynthesis of 2- and 3-part proximal humerus fractures with two methods of treatment: third-generation antegrade nailing and locking plate. Methods: 46 patients with a mean age of 58.9 ± 16.6 years between January 2020 and January 2021 were evaluated. In sixteen cases (34.8%), antegrade nailing was used, and in thirty cases (65, 2%), a locking proximal humerus plate. The method used included the rate of complications with a minimum follow-up of 6 months after surgery and radiographic evaluation. Results: There was no difference between the groups regarding the proportion of complications (nail group 18.8%, plate group 13.3%; p = 0.681). The nail group had less residual varus loss (cervicodiaphyseal angle nail group with 132.1º ± 2.3º, plate group 123.8º ± 10.1º; p < 0.001). In the plate group, women had the lowest value (1.43 ± 0.22) of the deltoid tuberosity index (DTI) compared to men (1.58 ± 0.11) (p = 0.022). Conclusion: Osteosynthesis, with a locking plate and antegrade nailing, did not show differences in the proportion of complications. The nail group had less change in the postoperative cervicodiaphyseal angle, however, there were two serious complications with screw cut-out and varus deviation, requiring surgical reapproach. Level of Evidence II, Retrospective Observational Study.
Objetivo: Avaliar retrospectivamente e comparar proporções de complicações e achados radiográficos da osteossíntese da fratura do úmero proximal em duas e três partes com dois métodos de tratamento: haste intramedular bloqueada de terceira geração e placa bloqueada. Métodos: Foram avaliados 46 pacientes com idade média de 58,9 ± 16,6 entre janeiro de 2020 a janeiro de 2021. Em 16 casos (34,8%), utilizou-se a haste intramedular e, em 30 casos (65,2%), a placa bloqueada de úmero proximal. A avaliação incluiu a taxa de complicações com seguimento mínimo de seis meses de pós-operatório e avaliação radiográfica. Resultados: Não houve diferença significativa entre os grupos quanto à proporção de complicações (grupo haste: 18,8%; grupo placa: 13,3%; p = 0,681). O grupo haste apresentou menor perda residual em varo (ângulo cervicodiafisário: grupo haste com 132,1º ± 2,3º; grupo placa com 123,8º ± 10,1º; p < 0,001). No grupo placa, as mulheres apresentaram menor índice de tuberosidade-deltoide (DTI) (1,43 ± 0,22) em relação aos homens (1,58 ± 0,11) (p = 0,022). Conclusão: No seguimento de curto prazo, a osteossíntese, com placa bloqueada ou haste intramedular, não apresentou diferenças nas proporções de complicações. O grupo haste apresentou menor alteração do ângulo cervicodiafisário no pós-operatório; entretanto, ocorreram duas complicações graves com cut out e desvio em varo com necessidade de reabordagem cirúrgica no grupo haste. Nível de Evidência II, Estudo Retrospectivo Observacional.
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ABSTRACT Objective: To evaluate and compare the proportions of complications and radiographic findings of osteosynthesis of 2- and 3-part proximal humerus fractures with two methods of treatment: third-generation antegrade nailing and locking plate. Methods: 46 patients with a mean age of 58.9 ± 16.6 years between January 2020 and January 2021 were evaluated. In sixteen cases (34.8%), antegrade nailing was used, and in thirty cases (65, 2%), a locking proximal humerus plate. The method used included the rate of complications with a minimum follow-up of 6 months after surgery and radiographic evaluation. Results: There was no difference between the groups regarding the proportion of complications (nail group 18.8%, plate group 13.3%; p = 0.681). The nail group had less residual varus loss (cervicodiaphyseal angle nail group with 132.1º ± 2.3º, plate group 123.8º ± 10.1º; p < 0.001). In the plate group, women had the lowest value (1.43 ± 0.22) of the deltoid tuberosity index (DTI) compared to men (1.58 ± 0.11) (p = 0.022). Conclusion: Osteosynthesis, with a locking plate and antegrade nailing, did not show differences in the proportion of complications. The nail group had less change in the postoperative cervicodiaphyseal angle, however, there were two serious complications with screw cut-out and varus deviation, requiring surgical reapproach. Level of Evidence II, Retrospective Observational Study.
RESUMO Objetivo: Avaliar retrospectivamente e comparar proporções de complicações e achados radiográficos da osteossíntese da fratura do úmero proximal em duas e três partes com dois métodos de tratamento: haste intramedular bloqueada de terceira geração e placa bloqueada. Métodos: Foram avaliados 46 pacientes com idade média de 58,9 ± 16,6 entre janeiro de 2020 a janeiro de 2021. Em 16 casos (34,8%), utilizou-se a haste intramedular e, em 30 casos (65,2%), a placa bloqueada de úmero proximal. A avaliação incluiu a taxa de complicações com seguimento mínimo de seis meses de pós-operatório e avaliação radiográfica. Resultados: Não houve diferença significativa entre os grupos quanto à proporção de complicações (grupo haste: 18,8%; grupo placa: 13,3%; p = 0,681). O grupo haste apresentou menor perda residual em varo (ângulo cervicodiafisário: grupo haste com 132,1º ± 2,3º; grupo placa com 123,8º ± 10,1º; p < 0,001). No grupo placa, as mulheres apresentaram menor índice de tuberosidade-deltoide (DTI) (1,43 ± 0,22) em relação aos homens (1,58 ± 0,11) (p = 0,022). Conclusão: No seguimento de curto prazo, a osteossíntese, com placa bloqueada ou haste intramedular, não apresentou diferenças nas proporções de complicações. O grupo haste apresentou menor alteração do ângulo cervicodiafisário no pós-operatório; entretanto, ocorreram duas complicações graves com cut out e desvio em varo com necessidade de reabordagem cirúrgica no grupo haste. Nível de Evidência II, Estudo Retrospectivo Observacional.
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INTRODUCTION: Little is known about the development of specific acromioclavicular joint osteoarthritis. Its histologic alterations are controversial, and radiologic alterations are seen in asymptomatic people. The objective of this study was to evaluate histologically the distal clavicle subchondral bone and to analyze magnetic resonance images in patients with painful and nonpainful acromioclavicular joint osteoarthritis. METHODS: An observational, analytical, and cross-sectional study with a control group was conducted. Between August 2018 and June 2019, we analyzed a total of 41 patients. Group 1 consisted of patients with pain in the acromioclavicular joint (symptomatic osteoarthritis), and group 2 consisted of patients without pain in the acromioclavicular joint (asymptomatic osteoarthritis). RESULTS: Twelve of the 15 patients with acromioclavicular joint pain (group 1) were female, 13 presented distal clavicle edema on magnetic resonance imaging, and 9 had subchondral bone edema on histologic examination. Patients with acromioclavicular joint pain had longer shoulder pain duration than patients without pain. Women were more likely to have acromioclavicular joint pain compared with men. Patients with edema on magnetic resonance imaging showed a greater chance of presenting pain in the acromioclavicular joint in comparison with patients without edema. CONCLUSION: Women had a higher chance of presenting with acromioclavicular joint pain than men. Patients with edema on magnetic resonance imaging were more likely to present with pain than patients without edema. Patients with acromioclavicular joint pain had longer shoulder pain duration than patients without pain, and subchondral bone edema on histologic examination was more frequent in patients with pain.
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OBJECTIVE: To evaluate and to compare the Spaso and Kocher reduction maneuvers in terms of efficiency, time of reduction, facileness, pain, discomfort to the patient, complications and risks, besides promoting the comparison between the two maneuvers, aiming to ground the emergency conduct. METHODS: A prospective study with 105 patients with acute shoulder dislocations were enrolled in the study between February 2011 and September 2012. The patients were randomized into two groups and they were submitted to the reduction of dislocation using the Spaso maneuver (group A) or the Kocher technique (group B) by first, second or third-year orthopedic surgery residents from our service. The results were evaluated and compared. RESULTS: There was no statistically significant difference between the two groups in terms of age, gender, timing of reduction, number of precedent episodes and complications after reduction. However, reduction was achieved in more cases using the Spaso method than it was among the Kocher group, as well as the mean duration of the reduction maneuver and discomfort were shorter in the group A patients. CONCLUSIONS: Both methods presented good results in terms of dislocation reduction and low complications rates. Nevertheless, the Spaso maneuver was more efficient, fast and easily applicable in comparison with Kocher's method. Level of Evidence I, Therapeutic.
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OBJECTIVE: To evaluate and to compare the Spaso and Kocher reduction maneuvers in terms of efficiency, time of reduction, facileness, pain, discomfort to the patient, complications and risks, besides promoting the comparison between the two maneuvers, aiming to ground the emergency conduct. METHODS: A prospective study with 105 patients with acute shoulder dislocations were enrolled in the study between February 2011 and September 2012. The patients were randomized into two groups and they were submitted to the reduction of dislocation using the Spaso maneuver (group A) or the Kocher technique (group B) by first, second or third-year orthopedic surgery residents from our service. The results were evaluated and compared. RESULTS: There was no statistically significant difference between the two groups in terms of age, gender, timing of reduction, number of precedent episodes and complications after reduction. However, reduction was achieved in more cases using the Spaso method than it was among the Kocher group, as well as the mean duration of the reduction maneuver and discomfort were shorter in the group A patients. CONCLUSIONS: Both methods presented good results in terms of dislocation reduction and low complications rates. Nevertheless, the Spaso maneuver was more efficient, fast and easily applicable in comparison with Kocher's method. Level of Evidence I, Therapeutic.