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Para avaliar a mortalidade precoce de idosos que apresentaram fraturas do quadril tratadas cirurgicamente neste hospital, no período de 11 de dezembro de 2020 a 30 de abril de 2021, foram realizados interrogatórios em busca de fatores que poderiam estar relacionados a esse desfecho, como sexo, idade, tipo de fratura, cirurgia realizada, comorbidades, tempo de internação até a cirurgia, tempo de internação total e complicações, incluindo óbito. Com uma amostra final de 74 (setenta e quatro) pacientes, 16 (dezesseis), 21,5%, evoluíram com morte nos primeiros 90 (noventa) dias. Este estudo demonstrou que elevados risco cirúrgico, tempo de internação hospitalar e tempo entre a data do trauma e o procedimento cirúrgico contribuíram para o aumento da morbimortalidade nesses pacientes. Além disso, a maioria desses pacientes eram mulheres e receberam transfusão sanguínea. Assim, é importante reduzir o tempo total de hospitalização e evitar transfusão sanguínea em pacientes sem sintomas de anemia ou com níveis de Hb ≥ de 8 g/dl.

Objective: To perform a systematic review and meta-analysis to compare clinical and surgical outcomes of posterior versus anterior approach to primary total hip arthroplasty (THA). Methods: This study followed the standard methodology established by the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two independent reviewers searched for randomized controlled trials comparing posterior an anterior approach to primary THA with at least one quantifiable functional outcome published in the PubMed, Cochrane, and Virtual Health Library databases. Results: The analysis included ten randomized controlled trials conducted with 774 patients. The posterior approach was associated with shorter operative time (mean of 15.98 minutes shorter, 95% CI 11.21 to 20.76, p < 0.00001) while the anterior approach was associated with shorter length of hospital stay (0.31 days or about eight hours shorter, 95% CI 0.12 to 0.51, p = 0.002) and greater earlier improvement in functional outcomes up to six months from the procedure (mean Harris Hip Score of 4.06 points greater, 95% CI 2.23 to 5.88, p < 0.0001). Conclusion: Whereas the posterior approach to primary THA is associated with a shorter operative time, the anterior approach has the potential to decrease the length of stay and provide greater short-term functional restoration. Level of evidence I, Systematic Review and Meta-Analysis. RESUMO Objetivo: Realizar uma revisão sistemática e metanálise para comparar os resultados clínicos e cirúrgicos entre a via posterior e via anterior para ATQ. Métodos: Este estudo seguiu as diretrizes Cochrane e PRISMA (Principais Itens para Relatar Revisões Sistemáticas e Meta-Análises). Dois investigadores independentes procuraram estudos randomizados controlados nas plataformas de busca PubMed, Cochrane e Biblioteca Virtual em Saúde. Estudos comparando a via posterior com a via anterior para ATQ primária com pelo menos um escore funcional de resultado clínico foram incluídos. Resultados: Dez estudos com 774 pacientes foram incluídos. A via posterior foi associada a um tempo operatório menor (média de 15.98 minutos menor, IC 95% 11.21 a 20.76, p < 0.00001), enquanto a via anterior foi associada a um tempo de internação hospitalar menor (0.31 dia ou cerca de oito horas a menos, IC 95% 0.12 a 0.51, p = 0.002) e melhora superior dos resultados funcionais em até seis meses após a cirurgia (Harris Hip Score médio de 4.06 pontos maior, IC 95% 2.23 a 5.88, p < 0.0001). Conclusão: A via posterior foi associada a um tempo operatório menor, enquanto a via anterior tem o potencial de diminuir o tempo de hospitalização e fornecer melhor recuperação funcional no curto prazo. Nível de Evidência I, Revisão Sistemática e Metanálise.

Purpose To quantify the damage to the soft tissue stabilizers of the hip after a transverse interportal capsulotomy and subspine trimming in hip arthroscopy. Methods Eight human cadaveric hemipelvises underwent hip arthroscopy through a transverse interportal capsulotomy. Arthroscopic subspine trimming performed on all specimens was classified according to an anatomic index. The width of the proximal capsule was measured before and after subspine trimming. The extent of damage to the iliofemoral ligament (IFL) after dissection was recorded. Potential damage to pericapsular structures was assessed by measuring the distance between the capsulotomy and rectus femoris and iliocapsularis muscle with an electronic caliper. Results In all specimens, ≥50% of the width of the IFL was damaged. The subspine trimming was successfully performed in 7 of 8 specimens (87.5%) according to the proposed index. The sizes of the trimmed bone area measured in the anteroposterior and proximal-distal axis were 21.2 ± 7.5 and 13.1 ± 9 mm, respectively (mean ± standard deviation). The width of the proximal capsule at the anterior and posterior corner of the capsulotomy was 19.8 ± 5.2 and 11.8 ± 1.7 mm, respectively. After subspine trimming, the mean width of the anterior and posterior proximal capsular attachments was 6.4 ± 1.4 and 7.0 ± 1.6 mm, respectively. On average, 13.4 mm of anterior capsule was damaged after anterior inferior iliac spine trimming, versus 4.7 mm of the posterior capsule. The distances from the capsulotomy to the rectus femoris direct and reflected head were 6.8 ± 4.9 and 6.3 ± 7.7 mm, respectively, and to the iliocapsularis muscle, 11.5 ± 7.8 mm. Conclusion High rates of damage to the IFL were observed with the interportal capsulotomy. Increased tissue damage at the anterior capsule was observed after subspine trimming. The width of the proximal capsular attachment was ≥5 mm in all specimens. Clinical Relevance Surgeons should be aware of the potential damage to the native capsule and pericapsular structures when using a transverse interportal capsulotomy for the arthroscopic subspine decompression. Level of Evidence IV: cadaveric study, case series.

The purpose of this study was to report the proportion of venous thromboembolic events (VTE) in patients undergoing primary hip arthroscopy for femoroacetabular impingement (FAI) and present a critical overview of the literature to aid in better result interpretation. MedLine, Scopus and Web of Science databases were searched from January 2000 to March 2017. Four thousand-five-hundred and seventy-seven hip cases were included in the meta-analysis of 38 studies. The mean age of patients was 36 ± 1.8 years and the mean follow-up time was 20.6 months. The meta-analysed rate of deep vein thrombosis (DVT) in patients undergoing primary hip arthroscopy for FAI syndrome was 1.18%; 95%CI [0.8–1.74%]; The meta-analysed rate of pulmonary embolism (PE) in patients undergoing primary hip arthroscopy for FAI syndrome was 0.59%; 95%CI [0.38–0.92%]. Quality assessment was performed using the Methodological Index for Non-Randomized Studies (MINORS) criteria the Quality in Prognostic Studies (QUIPS) tool. Sensitivity analysis was conducted to assess for publication bias and its influence on the results. The corrected for publication bias proportion of DVT was 2.02%; 95%CI [1.36–2.99%]. The DVT rate was double following the correction of bias while additional types of bias were detected. Attention must be paid when considering the outcomes of observational studies to make clinical decisions. Insufficient evidence exists to support whether anti-VTE chemoprophylaxis should be administered to patients undergoing primary hip arthroscopy for FAI. Due to the life-threatening character of this complication, the results should serve as starting point to design clinical trials and establish guidelines. Until then, the application of preventive measures against VTE should be decided on a case-by-case basis.

The purpose of this study was to determine the diagnostic value of the flexion abduction external rotation (FABER) distance test (FDT) for the diagnosis of cam-type femoroacetabular impingement (FAI) as defined by alpha angle. For this study, 603 patients with symptomatic, unilateral femoroacetabular impingement were included. Patients with symptoms of hip instability, bilateral symptoms, bilateral surgery, or bilateral alpha angles over 55 were excluded from the analysis. A positive FDT was defined as a difference of 4 cm or more between hips. A pathological cam was defined as an alpha angle of 78° or greater. The average age was 36.4 ± 12 years, with 344 males and 259 females. Faber distance of the injured hip was correlated with age at surgery (rho = 0.148; p

Although a two-stage exchange revision is reported to have a high success rate, this strategy may fail as a treatment for prosthetic joint infection (PJI). When it does, resection arthroplasty, arthrodesis, amputation, and chronic antibiotic suppression may play a role. The purpose of this review is to determine which are the main risk factors for a two-stage exchange failure and to analyze the indications and results of resection arthroplasty, arthrodesis, amputation, and antibiotic chronic suppression for PJI. Recent literature demonstrates that the main risk factors for a two-stage exchange failure are as follows: hemodialysis, obesity, multiple previous procedures, diabetes mellitus, corticosteroid therapy, hypoalbuminemia, immunosuppression, rheumatological conditions, coagulation disorders, and infection due to multidrug-resistant (MDR) bacteria or fungal species. Regarding microorganisms, besides Staphylococcus aureus, Streptococcus spp., Enterobacteriaceae species such as Klebsiella pneumoniae and Enterobacter sp., Pseudomonas aeruginosa, or Acinetobacter baumannii, and fungus including Candida sp. are also considered risk factors for a two-stage exchange failure. Resection arthroplasty, arthrodesis, and amputation have a limited role. Chronic suppression is an option for high-risk patients or unfeasible reconstruction. In summary, we report the main risk factors for a two-stage exchange failure and alternative procedures when it occurs. Future research on patient-specific risk factors for a two-stage exchange may aid surgical decision-making and optimization of outcomes.

Resumo Objetivo Investigar o uso de drenos em uma populacao controlada de pacientes com osteoartrose do quadril submetidos a artroplastia total de quadril primaria. Metodos Este estudo prospectivo controlado avaliou 93 pacientes randomizados em dois grupos: um grupo no qual se usaram drenos e um grupo no qual nao se usaram drenos. Os pacientes randomizados para o grupo com drenos usaram dreno de 3,2 mm, colocado sob a fascia e mantido por 24 horas. As avaliacoes pos‐operatorias foram feitas apos 24 horas e tres, seis e 12 semanas apos a artroplastia total de quadril. O desfecho primario foi perda sanguinea perioperatoria em ambos os grupos 24 horas apos a artroplastia total de quadril. Os demais parâmetros avaliados foram circunferencia do meio da coxa, taxa de transfusao de sangue, hematocrito, niveis sericos inflamatorios e Harris Hip Score. Resultados Os dados clinicos e laboratoriais nao indicaram diferencas entre os grupos de estudo quanto a perda de sangue e necessidade de transfusao de sangue, tempo de internacao hospitalar, taxa de reoperacao, complicacoes, marcadores sericos inflamatorios e Harris Hip Score. Os pacientes que nao usaram drenos de succao fechada relataram maiores niveis de dor apos 24 horas (EVA 1 vs. 2, p Conclusao Encontramos resultados clinicos e laboratoriais semelhantes em ambas as coortes.

Background: The capsular ligaments and the labral suction seal cooperatively manage distractive stability of the hip. Capsular reconstruction using an iliotibial band (ITB) allograft aims to address capsular insufficiency and iatrogenic instability. However, the extent to which this procedure may restore hip distractive stability after a capsular defect is unknown. Purpose: To evaluate the biomechanical effects of capsular reconstruction on distractive stability of the hip joint. Study Design: Controlled laboratory study. Methods: Eight fresh-frozen cadaveric hip specimens were dissected to the level of the capsule and axially distracted in 3 testing states: intact capsule, partial capsular defect, and capsular reconstruction with an ITB allograft. Each femur was compressed with 500 N of force and then distracted 6 mm relative to the neutral position at 0.5 mm/s. Distractive force was continuously recorded, and the first peak delineating 2 phases of hip distractive stability in the force-displacement curve was analyzed. Results: The median force at maximum distraction in the capsular reconstruction state (156 N) was significantly greater than that in the capsular defect state (89 N; P = .036) but not significantly different from that in the intact state (218 N; P = .054). Median values for distractive force at first peak (60 N, 72 N, and 61 N, respectively; P = .607), distraction at first peak (2.3 mm, 2.3 mm, and 2.5 mm, respectively; P = .846), and percentage decrease in distractive force (35%, 78%, and 63%, respectively; P = .072) after the first peak were not significantly different between the intact, defect, and reconstruction states. Conclusion: Capsular reconstruction with an ITB allograft significantly increased the force required to distract the hip compared with a capsular defect in a cadaveric model. To our knowledge, this is the first study to report an initial peak distractive force and to propose 2 distinct phases of hip distractive stability. Clinical Relevance: The consequences of a capsular defect on distractive stability of the hip may be underappreciated among the orthopaedic community; with that said, capsular reconstruction using an ITB allograft provided significantly increased distractive stability and should be considered an effective treatment option for patients with symptomatic capsular deficiency.

The purpose of this study was to compare the midterm outcomes and conversion to total hip arthroplasty (THA) rate in patients who had repair of the capsulotomy versus nonrepair following arthroscopic hip labral repair and correction of femoroacetabular impingement (FAI).All patients undergoing primary arthroscopic hip labral repair and correction of FAI between 2005 and 2012 were eligible for this study. Exclusion criteria were age18 years, lateral center-edge angle25°, previous hip procedures, femoral avascular necrosis, radiographic joint space ≤ 2 mm, or microfracture at arthroscopy. Patients who did not have the capsulotomy repaired were matched 1:2 with patients who had the capsulotomy repaired. Patients were matched by age, gender, and intraoperative procedures. The primary outcome score was the Hip Outcome Score Daily Living (HOS-ADL).Forty-two patients (18 female patients, 24 male patients) without repair of the capsulotomy were matched with 84 patients with repaired capsulotomy. The average age for both groups was 38 ± 15 years. Patients in the nonrepair group were 6.8 (95% confidence interval, 1.2-52) times more likely to undergo THA compared with the repair group. There was no difference in revision rate between the 2 groups. The mean follow-up time was 7.3 ± 2.7 years and 6.4 ± 2.3 years for the nonrepair and repair group, respectively (P = .107). Patients in the repair group had significantly higher HOS-ADL (P = .01) and modified Harris hip score (mHHS; P = .007). The percentage of patients who reached minimum clinically important difference was significantly higher in the repair group for HOS-ADL (P = .002) and HOS-Sport (P = .036) compared with the nonrepair group. However, there was no difference in the percentage of patients who reached minimal important change for the mHHS (P = .060). Following hip arthroscopy, the average alpha angle was 41.6° ± 6° in the nonrepair group and 40.8° ± 3° in the repair group.Patients who undergo arthroscopic FAI correction and hip labral repair with repair of the capsulotomy had higher HOS-ADL and mHHS scores at midterm follow-up compared with patients with nonrepair, and the percentage of patients who reached the minimum clinically important difference was significantly higher in the repair group for HOS-ADL and HOS-Sport compared with the nonrepair group. In addition, a lower rate of conversion to THA was seen in the repair group.Level III, retrospective comparative study.

Objective: To determine the reliability of two classification methods for wound hematoma after total hip replacement. Methods: This prospective cohort study was conducted on patients who underwent total hip replacement for hip osteoarthritis between May 2014 and April 2015. Epidemiological, surgical, and functional data were assessed. Two experienced hip surgeons evaluated 75 pictures of wounds taken 24 hours after surgery. Both evaluators performed the analysis twice, with a 6-week interval between the two analyses. The subjective classification was divided into four different categories describing the hematoma: absent, mild, moderate, and severe. The objective classification was derived from mathematical calculation of the area of the hematoma using a grid superimposed on a picture of the wound. Results: The subjective classification demonstrated an intra-rater agreement of more than 70%, while kappa values showed poor to moderate inter-rater reliability. The objective classification based on mathematical measurements of the hematoma area was more reliable, with good to excellent intra- and inter-rater reliability. Conclusion: The objective classification demonstrated higher intra- and inter-rater reliability. The classification methods used in this study could serve as a useful instrument for orthopedic surgeons, researchers, and health care providers when assessing wound hematomas after total hip replacement. Level of Evidence II; Development of diagnostic criteria on consecutive patients (with universally applied reference ‘‘gold’’ standard). RESUMO Objetivo: Determinar a confiabilidade de dois métodos de classificação dos hematomas de ferida cirúrgica após artroplastia total do quadril. Métodos: Este estudo prospectivo de coorte foi conduzido em pacientes com osteoartrose do quadril submetidos à artroplastia total do quadril entre maio de 2014 e abril de 2015. Foram analisados dados epidemiológicos, cirúrgicos e funcionais. Dois experientes cirurgiões de quadril avaliaram 75 fotografias de feridas obtidas 24 horas após a cirurgia. Ambos os avaliadores analisaram as fotografias duas vezes, em intervalo de seis semanas. A classificação subjetiva consistiu em quatro categorias descrevendo o hematoma: ausente, leve, moderado e grave. A classificação objetiva foi obtida pelo cálculo matemático da área do hematoma, sobrepondo-se uma retícula a cada fotografia de ferida. Resultados: A classificação subjetiva mostrou concordância intra-avaliador de mais de 70%, enquanto que os valores de kappa mostraram concordância inter-avaliador baixa a moderada. A classificação objetiva baseada em cálculo matemático da área do hematoma foi mais confiável, com excelente concordância intra e inter- avaliador. Conclusão: A classificação objetiva demonstrou melhor concordância intra e inter-avaliador. Os métodos de classificação usados neste estudo podem ser um instrumento útil para cirurgiões ortopedistas, pesquisadores e profissionais de saúde para avaliar hematomas de feridas cirúrgicas após artroplastia total de quadril. Nível de Evidência II; Desenvolvimento de critérios diagnósticos em pacientes consecutivos (com padrão de referência "ouro" aplicado).

Objective: This study aimed to investigate drain use in a controlled population of patients with hip osteoarthritis undergoing primary total hip arthroplasty. Methods: This prospective controlled trial evaluated 93 patients randomized into two groups: a group that received drains and a group that did not. The patients who were randomized to the drain group used a 3.2 mm drain placed under the fascia that was kept in place for 24 h. Postoperative evaluations were performed after 24 h and then three, six, and 12 weeks after total hip arthroplasty. The primary outcome was perioperative blood loss in both groups 24 h after total hip arthroplasty. The other parameters that were evaluated included mid-thigh circumference, the rate of blood transfusion, hematocrit, inflammatory serum levels, and the Harris Hip Score. Results: The clinical and laboratory data revealed no differences between the study groups with respect to blood loss and need for blood transfusion, duration of hospital stay, reoperation rate, complications, inflammatory serum markers, and the Harris Hip Score. Patients without closed suction drainage reported higher pain levels after 24 h (VAS score 1 vs. 2, p < 0.01). Conclusion: Similar clinical and laboratory outcomes were found in both cohorts. RESUMO Objetivo: Investigar o uso de drenos em uma população controlada de pacientes com osteoartrose do quadril submetidos a artroplastia total de quadril primária. Métodos: Este estudo prospectivo controlado avaliou 93 pacientes randomizados em dois grupos: um grupo no qual se usaram drenos e um grupo no qual não se usaram drenos. Os pacientes randomizados para o grupo com drenos usaram dreno de 3,2 mm, colocado sob a fáscia e mantido por 24 horas. As avaliações pós-operatórias foram feitas após 24 horas e três, seis e 12 semanas após a artroplastia total de quadril. O desfecho primário foi perda sanguínea perioperatória em ambos os grupos 24 horas após a artroplastia total de quadril. Os demais parâmetros avaliados foram circunferência do meio da coxa, taxa de transfusão de sangue, hematócrito, níveis séricos inflamatórios e Harris Hip Score. Resultados: Os dados clínicos e laboratoriais não indicaram diferenças entre os grupos de estudo quanto à perda de sangue e necessidade de transfusão de sangue, tempo de internação hospitalar, taxa de reoperação, complicações, marcadores séricos inflamatórios e Harris Hip Score. Os pacientes que não usaram drenos de sucção fechada relataram maiores níveis de dor após 24 horas (EVA 1 vs. 2, p < 0,01). Conclusão: Encontramos resultados clínicos e laboratoriais semelhantes em ambas as coortes.

Objective: The incidence of hip arthroscopy procedures has recently increased, current trends demonstrating a wide geographical variation and relatively similar functional outcomes among a wide age range. We aimed to evaluate spatio-temporal trends in state variation of hip arthroscopy procedures as well as the rate and determinants of 90-day hospital revisits.Methods: This was a secondary spatiotemporal analysis of data on hip arthroscopy procedures from the Healthcare Cost and Utilization Project databases, including the State Inpatient Database (SID), the State Ambulatory Surgery Database and the State Emergency Department Database (SEDD) for Florida, Kentucky, and Maryland, spanning a total of six years (2009 - 2014). Revisit risk was only evaluated through Florida data.Results: Out of 4,085 patients, the mean age was 40.7 years, 60.5% were female, 81.4% white, 77.7% had private insurance, and 96.5% were located in metropolitan areas. The average Charlson co-morbidity score was 0.11 (± 0.39), the Van Walraven score was 0.17 (± 1.51). Revisit rates progressively decreased during the study period, from 13.3% in 2009 to 6.2% in 2014 (p for trend 42 [OR: 2.13 (1.7, 2.69)] and a Charlson comorbidity score >0 [OR: 2.35 (1.73, 3.16)] were risk factors for a revisit. Paying mechanisms other than Medicare were protective. Most revisits (93.19%) occurred in the first 25 days after the procedure and the 90-day revisit rates for the State of Florida were centered on the major metropolitan areas such as West Palm Beach, Sarasota, Tampa, and Orlando. The incidence of hip arthroscopies increased in most parts of Florida, Kentucky, and Maryland over the study period.Conclusion: Revisit rates may reflect the quality of care and highlight the need for improvement. Future registries should include patient factors like pre-operative function and social determinants of health that might influence outcomes and revisit rates.

ResumoRelatar o caso de um paciente adulto jovem que evoluiu com tumoração na coxa esquerda após 14 anos de uma cirurgia de revisão de artroplastia do quadril. Davies em 2005 descreveu esta afecção em pacientes submetidos a atroplastia de quadril com par tribológico metal‐metal, mas na última década é possível achar relatos de pseudotumores em superfície metal‐polietileno. O paciente iniciou queixa de aumento de volume da coxa esquerda após oito anos da cirurgia de revisão da artroplastia do quadril. Dois anos antes do aparecimento da tumoração da coxa, a investigação para descartar um processo neoplásico maligno de um nódulo em região inguinal foi inconclusiva. Suas principais queixas pré‐operatórias eram dor, limitação funcional e marcada redução da amplitude de movimento do quadril esquerdo. As radiografias do membro acometido evidenciavam soltura dos componentes acetabular e femoral, e uma grande massa entre os planos musculares se revelou à ressonância magnética da coxa esquerda. A abordagem cirúrgica consistiu de ressecção intralesional da coxa esquerda, seguida da retirada dos componentes pela via lateral direta. No âmbito da cirurgia de artroplastia de quadril, os pseudotumores são neoplasias benignas cujo par tribológico consiste em metal ‐metal, mas podem também ocorrer em diferentes pares tribológicos, como neste caso.AbstractThe aim here was to report a case of a young adult patient who evolved with tumor formation in the left thigh, 14 years after revision surgery on hip arthroplasty. Davies in 2005 made the first description of this disease in patients undergoing metal‐on‐metal hip arthroplasty. Over the last decade, however, pseudotumors around metal‐on‐polyethylene surfaces have become more prevalent. Our patient presented with increased volume of the left thigh eight years after hip arthroplasty revision surgery. Two years before the arising of the tumor in the thigh, a nodule in the inguinal region was investigated to rule out a malignant neoplastic process, but the results were inconclusive. The main preoperative complaints were pain, functional limitation and marked reduction in the range of motion of the left hip. Plain radiographs showed loosening of acetabular and femoral, and a large mass between the muscle planes was revealed through magnetic resonance imaging of the left thigh. The surgical procedure consisted of resection of the lesion and removal of the components through lateral approach. In respect of total hip arthroplasty, pseudotumors are benign neoplasms in which the bearing surface consists of metal‐on‐metal, but they can also occur in different tribological pairs, as presented in this case.

Hip arthroscopy is a technically demanding procedure that is currently characterized by a "steep" learning curve. Therefore, achieving an advanced technical level is often challenging, especially for the amateur hip arthroscopist. Hand laterality when training in hip arthroscopy is an aspect that has been omitted. In addition, the technical differences regarding the handling of the surgical instruments when performing hip arthroscopy on the left versus right hip can influence the technical excellence. This Technical Note summarizes our preferred hip arthroscopy technique by comparing the surgeon's hand position when operating on the left versus right hip. We also emphasize how the surgeon's hand laterality affects the instrument manipulation during the procedure and potentially the clinical outcomes.

OBJECTIVE: to evaluate the results from surgical treatment of the terrible triad of the elbow (fracture of the radial head, fracture of the coronoid process and elbow dislocation) and its complications.METHODS: between August 2002 and August 2010, 15 patients (15 elbows) with the terrible triad were treated by the Shoulder and Elbow Group of the Department of Orthopedics and Traumatology, School of Medical Sciences, Santa Casa de São Paulo. Nine (60%) were male and six (40%) were female; their ages ranged from 21 to 66 years, with a mean of 41 years. With the exception of one case that underwent arthroscopic surgery, all the patients underwent open surgery. The fracture of the coronoid process was fixed in 10 patients (66.7%). The fracture of the radial head was treated by means of internal osteosynthesis in 11 cases (73.3%); in three cases (20%), the radial head was resected; and in one case, only the fragment of the fracture was resected. The collateral ligaments, except for one case, were repaired whenever they were found to be injured; ten cases (66.7%) of medial collateral injury and 15 (100%) of lateral collateral injury were found. The mean length of the postoperative follow-up was 62 months, with a minimum of 12 months. The postoperative evaluation was done by means of the Bruce score.RESULTS: more than 80% of the patients recovered their functional ranges of motion but, according to the Bruce score, only 26% of the patients achieved results that were considered satisfactory.CONCLUSION: despite the unsatisfactory results, the functional ranges of motion and elbow function could be restored. OBJETIVO: avaliar o resultado do tratamento cirúrgico da tríade terrível do cotovelo (fratura da cabeça do rádio e do processo coronoide e luxação do cotovelo) e suas complicações.MÉTODOS: entre agosto de 2002 e agosto de 2010 foram tratados 15 cotovelos (15 pacientes) com tríade terrível pelo Grupo de Ombro e Cotovelo do Departamento de Ortopedia e Traumatologia da Faculdade de Ciências Médicas da Santa Casa de São Paulo. Nove (60%) eram do sexo masculino e seis (40%) do feminino; a idade variou de 21 a 66, com média de 41. Com a exceção de um caso, que foi submetido a cirurgia artroscópica, todos foram submetidos a cirurgia aberta. A fratura do processo coronoide foi fixada em 10 pacientes (66,7%). A fratura da cabeça do rádio foi submetida a osteossíntese interna em 11 casos (73,3%); em três (20%), a cabeça do rádio foi ressecada; em um caso, somente o fragmento da fratura foi ressecado. Os ligamentos colaterais, com exceção de um caso, foram reparados sempre que se encontrassem lesados; foram encontradas 10 (66,7%) lesões do colateral medial e 15 (100%) do lateral. O seguimento no período pós-operatório foi, em média, de 62 meses, com mínimo de 12. A avaliação pós-operatória foi feita por meio do escore de Bruce.RESULTADOS: mais de 80% dos pacientes recuperaram os arcos de movimentos funcionais e, de acordo com o escore de Bruce, apenas 26% obtiveram resultados considerados satisfatórios.CONCLUSÃO: apesar dos resultados insatisfatórios, os arcos funcionais de movimento e a função do cotovelo podem ser restaurados.

Background and Aim: The role of vitamin D plus calcium to protect against hip fracture in postmenopausal women remains controversial. Two major studies on this subject presented diverse outcomes; they implemented different doses of Vitamin D and Calcium, and they studied different populations. One study found evidence that Calcium plus Vitamin D do protect against fractures; the second study failed to demonstrate such protection. The aim of the present study is to test the hypothesis that a higher dose of vitamin D plus calcium is effective in reducing hip fractures in non-osteoporotic elderly women when compared to placebo. Methods: This will be a randomized, double-blinded superiority, multicenter trial involving three centers in Sao Paulo, Lima and Mexico City. After a three-month run-in period, 7176 participants will receive Calcium + Vitamin D or Placebo. The primary outcome is the occurrence of hip fractures assessed by the pelvic radiographic image; secondary outcomes include other fractures, the variation of Bone Mass Density, and the adverse effects rate. Conclusion: There is an increase in morbidity, mortality, and costs resulting from hip fractures since it is an important risk fact following accidents. A possible lack of benefit inside the active group drives more attention to an eventual over-prescription of those substances. Therefore, further studies including a phase II trial with different exclusion criteria could be desirable to confirm these findings and help to reduce the incidence of hip fractures.. Key-Words: Hip Fractures, Bone Loss, Postmenopausal, Vitamin D Deficiency, Bone Density, Calcium, Dietary, Osteopenia, Postmenopausal Osteoporosis, Design, Research Protocol, Clinical Research.

The anterior approach (AA) with a specialized table has been gaining popularity since it was taught at the first technique course in 2003. It has evolved since that time thanks to the contributions of many. Developments that are of note include new femoral stem designs to facilitate the angle of the exposure, modifications to the specialized table, increasing use of computer navigation and lastly, now it can be performed with the assistance of a mechanical mallet.

Case Arthroscopic labral repair has resulted in excellent functional outcomes. However, extensive labral damage or diminutive size of the labrum may preclude a repair. In these cases, labral augmentation serves as an operative treatment option. We report the case of a labral augmentation with 7.5 years of follow-up, including intraoperative reexamination, which highlights the ability of an iliotibial band autograft to incorporate with the native labrum. Conclusion When indicated in an appropriate patient, labral augmentation with an iliotibial band autograft is an established technique that can result in an excellent outcome.

Objective. To examine the use of medications and nutritional supplements among top-level male futsal players during international tournaments.Materials and Methods. This retrospective survey of the four consecutive 2000 to 2012 FIFA (Fédération Internationale de Football Association) Futsal World Cup tournaments analyzes data about the use of medications and nutritional supplements by each player prior to every match. A total of 5264 reports on 1064 futsal players were collected from the 188 matches played.Results. A total of 4237 medications and 8494 nutritional supplements (0.8 and 1.6 per player per match, resp.) were prescribed, and 64% of the players used at least one type of medication over the four tournaments. The most frequently prescribed medication was nonsteroidal anti-inflammatory drugs (NSAIDs) (41.1%), whereby 45.7% of all players consumed at least one NSAID during the tournament and 27.4% did so prior to every match.Conclusions. The intake of medications, particularly of NSAIDs, is frequently high among top-level futsal players and follows a similar pattern to that found in FIFA Football World Cups. Campaigns should be instituted to understand this prescription practice by team physicians involving professional football players, with the aim to decrease its use and to prevent athletes from potential short- and long-term risks.

ResumoObjetivoavaliar o resultado do tratamento cirúrgico da tríade terrível do cotovelo (fratura da cabeça do rádio e do processo coronoide e luxação do cotovelo) e suas complicações.Métodosentre agosto de 2002 e agosto de 2010 foram tratados 15 cotovelos (15 pacientes) com tríade terrível pelo Grupo de Ombro e Cotovelo do Departamento de Ortopedia e Traumatologia da Faculdade de Ciências Médicas da Santa Casa de São Paulo. Nove (60%) eram do sexo masculino e seis (40%) do feminino; a idade variou de 21 a 66, com média de 41. Com a exceção de um caso, que foi submetido a cirurgia artroscópica, todos foram submetidos a cirurgia aberta. A fratura do processo coronoide foi fixada em 10 pacientes (66,7%). A fratura da cabeça do rádio foi submetida a osteossíntese interna em 11 casos (73,3%); em três (20%), a cabeça do rádio foi ressecada; em um caso, somente o fragmento da fratura foi ressecado. Os ligamentos colaterais, com exceção de um caso, foram reparados sempre que se encontrassem lesados; foram encontradas 10 (66,7%) lesões do colateral medial e 15 (100%) do lateral. O seguimento no período pós‐operatório foi, em média, de 62 meses, com mínimo de 12. A avaliação pós‐operatória foi feita por meio do escore de Bruce.Resultadosmais de 80% dos pacientes recuperaram os arcos de movimentos funcionais e, de acordo com o escore de Bruce, apenas 26% obtiveram resultados considerados satisfatórios.Conclusãoapesar dos resultados insatisfatórios, os arcos funcionais de movimento e a função do cotovelo podem ser restaurados.AbstractObjectiveto evaluate the results from surgical treatment of the terrible triad of the elbow (fracture of the radial head, fracture of the coronoid process and elbow dislocation) and its complications.Methodsbetween August 2002 and August 2010, 15 patients (15 elbows) with the terrible triad were treated by the Shoulder and Elbow Group of the Department of Orthopedics and Traumatology, School of Medical Sciences, Santa Casa de São Paulo. Nine (60%) were male and six (40%) were female; their ages ranged from 21 to 66 years, with a mean of 41 years. With the exception of one case that underwent arthroscopic surgery, all the patients underwent open surgery. The fracture of the coronoid process was fixed in 10 patients (66.7%). The fracture of the radial head was treated by means of internal osteosynthesis in 11 cases (73.3%); in three cases (20%), the radial head was resected; and in one case, only the fragment of the fracture was resected. The collateral ligaments, except for one case, were repaired whenever they were found to be injured; ten cases (66.7%) of medial collateral injury and 15 (100%) of lateral collateral injury were found. The mean length of the postoperative follow‐up was 62 months, with a minimum of 12 months. The postoperative evaluation was done by means of the Bruce score.Resultsmore than 80% of the patients recovered their functional ranges of motion but, according to the Bruce score, only 26% of the patients achieved results that were considered satisfactory.Conclusiondespite the unsatisfactory results, the functional ranges of motion and elbow function could be restored.