Antonio Carlos da Costa

Objective: This study aimed to evaluate the outcomes of the Ishiguro technique in the treatment of flexion deformity of the interphalangeal distal (IFD) joint, known as bony mallet finger (BMF) Albertoni Type C2, addressing a common condition that may cause functional impairment if not adequately treated. Methods: All cases of patients with Albertoni Type C2 bony mallet finger (BMF) who underwent the Ishiguro method between March 2018 and February 2023 were included, with a minimum postoperative follow-up of five months; cases of patients who did not complete the minimum five-month postoperative follow-up were excluded. Epidemiological data (age, sex, dominance) and fracture-related information (affected finger, fragment size, time from trauma to surgery, follow-up duration) were analyzed. Outcomes included anatomic reduction, union, return to activities, pain, flexion deficit, passive extension of the affected finger, passive extension of the contralateral finger, and Crawford criteria. Results: None of the analyzed characteristics—such as age, affected finger, interval between trauma and surgery, fragment size, and union—significantly influenced anatomic reduction (p > 0.05). The Crawford scale, as well as anatomic reduction, showed no significant impact (p > 0.05). However, all patients with positive results on the Crawford scale demonstrated union (p = 0.063). Conclusion: In our series, more than half of the patients achieved good or excellent results, predominantly characterized by anatomic reduction. No significant associations were identified with variables such as age, affected finger, time from trauma to surgery, fragment size, bone union, or anatomic reduction. These findings suggest that the Ishiguro technique may be effective in the treatment of BMF Albertoni Type C2. Level of Evidence III; Retrospective Study.

Objective: This study aimed to evaluate the use of ultrasonography (USG) compared to radiography in identifying callus formation and fracture healing in hand bones (metacarpals and phalanges). Methods: A prospective observational study was conducted with patients who sustained metacarpal and phalangeal fractures and were followed in the hand and microsurgery clinic of a philanthropic hospital in São Paulo between July 2023 and April 2024. Fractures were treated either conservatively or surgically with Kirschner wire fixation. Callus formation was monitored using serial weekly USG and radiographic examinations. Follow-up ended when bone healing was confirmed by both methods. Results: There was a difference in the mean time of callus appearance between ultrasonographic and radiographic evaluations for all analyzed variables. Conclusion: Ultrasonographic callus formation preceded radiographic callus appearance by approximately 18.2 days across all variables studied, suggesting that USG is a useful and alternative tool for the early diagnosis of bone healing in phalangeal and metacarpal fractures. Level of Evidence II; Prospective Observational Study.

Objective: Evaluate the impact of COVID-19 on elective and emergency hand and wrist surgeries operated in a private orthopedic center.

Synovial cyst (SC) is the most common soft tissue tumor in the wrist and hand, accounting for almost 50–70% of the total. It is more frequent in women, between the second and fourth decades of life. Clinically, it presents as a nodular and superficial increase in volume, which is mostly located in the dorsal and central region of the wrist (up to 80%) and originates from the radiocarpal joint (RCJ). It can also be located in the volar and radial region, which is the second most common location, or originate from the mid-carpal joint (MCJ), mainly in the scaphotrapeziotrapezoid (STT) joint, when they are located more distally¹ 1 Nahra ME, Bucchieri JS. Ganglion cysts and other tumor related conditions of the hand and wrist. Hand Clin. 2004;20(3):249-60. https://doi.org/10.1016/j.hcl.2004.03.015 https://doi.org/10.1016/j.hcl.2004.03.01... .

Objective: To determine the epidemiological profile of patients treated at a philanthropic hospital specialized in Orthopedics and Traumatology, located in a significant urban center, and evaluate the efficacy of initial empirical antibiotic treatment. Methods: Patients diagnosed with hand infections from September 2020 to September 2022 were included, excluding cases related to open fractures or post-surgical infections and those with incomplete medical records. The chi-square test was performed using STATISTICA ® software to correlate various variables. Results: A total of 34 patients participated, including 24 men and 10 women, with an average age of 41.9 years. Most male patients had Diabetes Mellitus, HIV, and drug addiction, and they resided in urban areas. Half of the patients did not report any apparent trauma. The most common infectious agent was Staphylococcus aureus*. Nearly 62% of patients required a change in the initial antibiotic regimen, with Penicillin being the most frequently substituted medication. Beta-lactam antibiotics and Quinolones were the most effective. Conclusion: These results suggest the importance of carefully evaluating the epidemiological profile of patients with acute hand infections and improving initial empirical treatment to ensure appropriate and effective therapy. Level of Evidence IV, Cross-Sectional Observational Study.

O objetivo do presente trabalho foi avaliar mutações e polimorfismos no Complexo V do DNA Mitocondrial e sua relação com o surgimento e progressão de tumores Gliais do Sistema Nervoso Central em pacientes atendidos em Hospital de Referência no Tratamento Oncológico em Belém, Estado do Pará, Brasil. Foram utilizadas 22 amostras tumorais do sistema nervoso humano, classificadas como astrocitomas de diferentes graus, onde apenas duas amostras apresentaram alterações nucleotídicas, sendo que a maioria dos pacientes acima de 50 anos estão relacionados com os tumores de alto grau e os abaixo de 50 anos estão relacionados com os tumores de baixo grau, fortalecendo a ideia que a maior parte dos astrocitomas de baixo grau são de origem hereditária e a maior parte do surgimento dos de alto grau, estão relacionados com a longa exposição a agentes carcinogênicos. As alterações parecem não interferir diretamente na função do gene. Apesar do mtDNA ser mais susceptível à mutações que o nDNA, os resultados deste estudo sugerem que o complexo V se mantém íntegro mesmo em ambiente reativo, sugerindo um mecanismo de proteção, garantindo a produção de energia na célula tumoral.

Objetivo Avaliar a flexão do cotovelo em crianças portadoras de paralisia obstétrica do plexo braquial submetidas à transferência de Oberlin. Métodos Estudo retrospectivo com 11 pacientes acometidos por paralisia decorrente do trabalho de parto e que não apresentaram recuperação espontânea da flexão do cotovelo até os 12 meses de vida, operados entre 2010 e 2018. Resultados As crianças foram operadas entre os 5 e 12 meses de vida, com média de 7,9 meses e o tempo médio de seguimento foi de 133,2 meses, variando de 37 a 238 meses. Seis pacientes (54,5%) apresentaram grau de força muscular ≥ 3, medido pela escala de força do Medical Research Council (MRC), e, pela escala de movimentação ativa (Active Momement Scale [AMS]), 5 pacientes obtiveram pontuação ≥ 5. Foi identificada correlação negativa entre a AMS e a classificação de Narakas (r = -0,509), bem como entre a MRC e a classificação de Narakas (r = -0,495). Já entre a AMS e a MRC, foi observada forte correlação positiva (r = 0,935), demonstrando que quanto maior a pontuação na escala de movimento, maior será a pontuação na escala de força muscular. Conclusão A cirurgia de Oberlin apresenta-se como uma opção possível para a recuperação da flexão do cotovelo em crianças com plexopatia neonatal; no entanto, demonstra resultados bastante heterogêneos, mesmo no seguimento a longo prazo. Não houve suporte financeiro de fontes públicas, comerciais, ou sem fins lucrativos. ^* Trabalho desenvolvido na Santa Casa da Misericórdia de São Paulo, Faculdade de Ciências Médicas, São Paulo, Brasil. Received: 26 April 2020 Accepted: 11 February 2021 Article published online: 21 January 2022 © 2022. 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/) Thieme Revinter Publicações Ltda. Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

Objective: To evaluate the volar cortical angle (VCA), the variation in lateral and intermediate columns, the shape and pattern of the watershed line (WL) of the distal radius and its correlation with locking volar plates available. Methods: 27 human cadaveric radial bones of the Department of Morphology and nine locking volar plates of six different companies were analyzed. VCA were measured from lateral and intermediate columns and their corresponding values on plates, as well as comparing the relief of radius and plates. In the WL analysis, we compared the standard format found on the radius and its equivalent on plates and divided into four types: biconvex, convex, ulnar convex and plan. Results: VCA varied between columns of the distal radius extremity. The mean in the lateral column was 153.40 degrees and 146.06 degrees in the intermediate. Four of nine plates showed no variation in volar angulation. From 27 distal radius, 13 showed convex pattern and 12 had biconvex, whereas most plates (seven of the nine analyzed) were biconvex drawing. Conclusion: Radial bone anatomy was variable. The intermediate column was, on average, steeper than lateral column. Synthes®-2 plate presented the closest design to the anatomy of the distal end of the radial bone, followed by Newclip®-2 plate. Level of Evidence II, Anatomic and Descriptive Study.