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Introduction: Similar to chronic pain conditions, individuals with endometriosis can be affected by central sensitization syndrome (CSS), which is characterized by a loss of analgesia and central amplification of pain. Transcranial direct current stimulation (tDCS) has shown potential as an effective intervention to improve pain generated by other chronic pain conditions impacted by CSS, such as fibromyalgia and chronic pelvic issues. This study aims to evaluate the effectiveness of tDCS on pain, fatigue, and quality of life among patients affected by endometriosis., Methods: This is a single-center, parallel, double-blinded, randomized, controlled clinical trial protocol study. We aim to recruit 40 participants affected by endometriosis (active group, n = 20; sham group, n = 20). Anodal tDCS will be delivered at an intensity of 2mA, applied over the primary motor cortex for 20 minutes per day for 10 consecutive days. There will be four assessment times: 1 week before beginning the intervention; on the 10th day following the last tDCS session; and 1 and 2 months after the last tDCS session. Pain evaluated by the algometry will be the primary outcome. Pain intensity, quality of life, fatigue, and global perception of change will be the secondary outcomes. We will calculate the effects of the active versus sham stimulation on primary and secondary outcomes by using generalized estimated equations or mixed model analysis. The effect size calculation will represent the effect measure. We expect that only the active group show reductions in pain, fatigue, and quality of life. The results of this trial will produce an important first step in providing evidence on the effectiveness of neuromodulation for the management of pain and will provide data to support new studies on tDCS., Registration: Brazilian Clinical Trials Registry (RBR-4q69573)., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Camila de Lima Alves da Silva et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: The biggest challenge in the treatment of acute ankle sprain is the uncertainty of the prognosis. The traditional classifications have several interpretations and little correlation with prognosis. In this study we propose a new classification for acute ankle sprain only based on clinical criteria., Material and Methods: We prospectively evaluated all patients with an ankle sprain, aged between 18 and 45 years, admitted to a hospital during a 24 month period. The minimum follow-up period was 12 months. The sprains were classified, in the first few days (CASCaIS-Initial), according to autonomous gait capacity, inspection and palpation. After a few weeks (CASCaIS-Deferred), it was complemented with the mechanical evaluation of ligaments through the ankle pivot test., Results: Among the 49 patients who completed the follow-up, none of those who had a pivot-negative test progressed to chronic ankle instability (CAI). Nine of the 33 patients (27%) with a positive pivot progressed to CAI (p = 0.022). The evaluation of CASCaIS-Deferred demonstrated an association with CAI (p = 0.018)., Conclusion: This classification proved to be a simple, inexpensive, and reliable tool that clinicians can use to determine the prognosis of the sprain.

Isolated pisiform dislocation is a rare lesion with few cases described in the literature. This type of lesion is typically observed in young males and can be easily overlooked at first assessment. Isolated proximal dislocation is more common due to the action of the flexor carpi ulnaris (FCU) muscle. We present the case of a 19-year-old male patient with isolated distal pisiform dislocation after wrist trauma. He underwent open reduction and internal fixation with Kirschner wires with excellent functional outcomes. Although there is no consensual therapeutic method, closed reduction is a first-line treatment for acute presentations. Pisiform open reduction or excision may be performed alternatively or after a failed closed reduction., Competing Interests: Conflito de Interesses Os autores declaram não haver conflito de interesses. O estudo foi realizado em conformidade com a Declaração da Associação Médica Mundial de Helsinque sobre Princípios Éticos para Pesquisa Médica Envolvendo Seres Humanos., (Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Introduction: Ankle fractures are among the most common injuries treated by orthopaedic surgeons. Malunion is one of the possible complications, and corrective surgery is often used to avoid long-term disability. However, few studies address medial malleolus malunion and the best revision surgery technique is controversial. We describe a new surgical technique, the "box resection"., Material and Methods: We present two cases of medial malleolus malunion with secondary talus lateral translation and syndesmotic incongruence. In order to restore a congruent tibiotalar joint, we performed the described technique., Results: We record significant improvement of AOFAS Score and range of motion in both cases, with resolution of pain symptoms. Postoperative radiographs show a congruent mortise with syndesmosis reduction., Conclusion: The box resection allowed immediate talus medial translation to its original position. It is a simple and effective solution, with a good functional outcome.

Purpose: The proximal tibiofibular joint (PTFJ) is a rather unknown articulation. There is little understanding of its anatomy, physiology, and functional role. The objectives of this research are to describe the normal kinematics of the PTFJ and its relation to the ankle and knee movements., Methods: Fourteen knees of seven adult fresh frozen whole body cadavers were studied. The proximal tibiofibular joint and ligaments were identified, after which we sequentially sectioned the anterior proximal tibiofibular ligament (APTFL), the posterior proximal tibiofibular ligament (PPTFL), and the interosseous syndesmotic membrane. Models with intact and sectioned ligaments were compared, while the unloaded lower limb was manually mobilized in a pre-defined sequence of combined movements of knee, ankle, and proximal tibiofibular joints. The PTFJ spatial displacement was measured by analyzing the length of a distance vector between two 3D coordinate systems settled over the tibia and fibula., Results: On the unaltered PTFJ, direct grasping of the head of the fibula with the hip in 45° of flexion and the knee in 90° of flexion was found to produce an average displacement of 7 mm. Knee movements caused the greatest spatial displacements, almost ten times the ones produced by ankle flexion/extension. Flexion/extension of the knee caused 1.8 times more displacement than single rotations with the knee flexed to 90°. It was found that the APTFL was an important stabilizer of the PTFJ when this joint is tensioned accommodating the movements of ankle extension and foot eversion. The APTFL was not a significant stabilizer of the PTFJ during direct manipulation of the fibular head when imprinting a manual force with posterior direction. The PPTFL was an important accommodator of ankle flexion, foot inversion and knee flexion. The interosseous syndesmotic membrane also proved to be a significant PTFJ stabilizer in rotational movements of the ankle and knee., Conclusions: This is the first cadaver study to illustrate the PTFJ normal spatial displacement, thereby contributing to a deeper insight of this joint. The contribution of each ligament for PTFJ stability was described and, based on these findings; a new mechanism of injury was suggested. Surgeons can translate the results of this study into the clinical practice.

Purpose: Dislocation of the proximal tibiofibular joint is a complex injury that is often overlooked or misdiagnosed. Surgical treatment is recommended for severe acute or for chronic symptomatic instability but there is still no evidence on the optimal reconstruction technique. The purpose of this study is to analyze the motion of the proximal tibiofibular joint after repair with a bicortical suspension device as compared to its normal kinematics., Methods: Kinematic analysis of the proximal tibiofibular joint was performed during continuous passive motion of the knee and ankle in 7 whole body cadavers in a controlled laboratory study. The 14 knees were measured in four conditions: (1) intact; (2) repair with transarticular bicortical suspension device tensioned to 40 N; (3) the same repair tensioned to 50 N; and (4) the repair tensioned to 50 N after interosseous syndesmotic membrane sectioning., Results: Proximal tibiofibular joint can be successfully repaired by a bicortical suspension device restoring its normal 3D spatial motion. The fixation of the PTFJ with the device tested tensioned to 40 or 50 N could restore the intact joint kinematics for every movement tested except knee internal and external rotation. The fixation to 40 N attained closer values to the intact joint in the movements that evolve the anterior PTFJ ligament. The 50 N fixation is overall more rigid than the intact joint but statistically closer to the normal PTFJ kinematics for the movements more dependent on the posterior PTFJ ligament. Sectioning of the interosseous syndesmotic membrane determined an important loss of stability of the PTFJ during the movements of ankle extension and ankle flexion. Such loss illustrates the relevance of this associated injury when planning PTFJ ligament reconstruction., Conclusions: This study indicates that the repair of the proximal tibiofibular joint with a transarticular bicortical suspension device tensioned to 40 and 50 N can restore the normal kinematics of this joint. Based on these findings, Surgeons may consider this option as a reliable solution when planning successful treatment for proximal tibiofemoral joint instability.

Objective: To evaluate how Swedish massage affects the level of anxiety and vital signs of Intensive Care Unit (ICU) patients., Methods: Quasi-experimental study., Inclusion Criteria: ICU patients, 18-50 years old, cooperative, respiratory and hemodynamic stable, not under invasive mechanical ventilation., Exclusion Criteria: allergic to massage oil, vascular or orthopedic post-operative, skin lesions, thrombosis, fractures. A 30-min Swedish massage was applied once., Variables: arterial pressure, heart rate, respiratory rate, S-STAI questionnaire. Timing of evaluation: pre-massage, immediately post-massage, 30 min post-massage. Comparison: T-test, corrected by Bonferroni method, level of significance of 5%, confidence interval of 95%., Results: 48 patients included, 30 (62.5%) female, mean age 55.46 (15.70) years old. Mean S-STAI pre-massage: 42.51 (9.48); immediately post-massage: 29.34 (6.37); 30 min post-massage: 32.62 (8.56), p < 0.001 for all comparison. Mean vital signs achieved statistical significance between pre-massage and immediately post-massage., Conclusion: Swedish massage reduced anxiety of ICU patients immediately and 30 min post-massage. Vital signs were reduced immediately post-massage., (Copyright © 2016 Elsevier Ltd. All rights reserved.)