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Background: Evidence concerning the complex foot trauma, especially its definitive management, is scarce. Soft tissue envelope sequalae are the primary parameters that delay or make internal fixation implausible. Stability conferred by external fixators makes them a reasonable initial treatment choice. Although AO or circular fixators can be applied around the foot, this can involve a learning curve and substantial costs, especially for the circular fixator. There is little evidence as to how well external fixators work as a definite method of fixation in patients where progression to internal fixation cannot be made. Methods: We prospectively evaluated 10 adult patients with severe and complex foot trauma who were consecutively treated at our clinic. Initial reduction and stabilization were performed with an external fixator that was initially conceived for distal radius fractures, applied during the initial procedure and mantained throughout the treatment. Results: Fracture healing was obtained in all 10 cases, and both internal and external column length was restored. One of the patients developed chronic osteomyelitis. At the 1-year follow-up visit, these patients averaged 45.6 points in the physical and 44.8 points on the mental status sections of the 12-Item Short Form Health Survey (SF-12). The Foot Function Index findings for pain, disability, and daily activities limitations were 33.3, 39, and 41.5, respectively, which suggest moderate residual impairment. Conclusion: In this relatively small case series of complex foot trauma, we found that the use of simple external fixation as definitive treatment worked reasonably well. Level of Evidence: Level III, prospective cohort study.

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OBJECTIVE: To compare the outcomes of surgical stabilization of pediatric supracondylar humeral fractures with the use of crossed Kirschner wires versus divergent lateral pinning wires. METHODS: This is a systematic review with meta-analysis carried out by searching the MEDLINE/PubMed, Science Direct and Scielo databases. In these, the search for journals was carried out between January and August 2023, where 695 studies were found. To assess the quality of the studies, the Jadad and the MINORS scales were used.. The selection and reading of relevant articles were carried out by the researchers and 11 studies met the selection criteria. RESULTS: From the 11 selected studies, 963 patients who met the criteria for the surgical treatment of these fractures were grouped. After the statistical analysis, we found that the ulnar nerve injury had a higher incidence when the crossed-K wire technique was used; and the lateral fixation is safer for the ulnar nerve. CONCLUSION: Both fixation techniques determine good functional results. However, fixation with lateral Kirschner wires proves to be safer considering the risk of iatrogenic injury to the ulnar nerve. Crossed-K wire fixation is more effective in terms of stability and maintenance of fracture reduction. Level of Evidence II, Systematic Review of Level II or Level I Studies with discrepant results.

Objetivo: Comparar os desfechos da estabilização cirúrgica das fraturas supracondilianas do úmero pediátricas com o uso de fios de Kirschner cruzados versus fios laterais divergentes. Métodos: Trata-se de uma Revisão Sistemática com metanálise realizada pela pesquisa nas bases de dados MEDLINE/PubMed, Science Direct e Scielo. Nessas, a busca dos periódicos foi realizada entre janeiro e agosto de 2023, e foram encontrados 695 estudos. Para a avaliação da sua qualidade, foram utilizadas a escala de Jadad e a escala MINORS. A seleção e a leitura dos artigos pertinentes foram realizadas pelos pesquisadores e 11 estudos preencheram os critérios de escolha. Resultados: Dos estudos selecionados, agrupamos 963 pacientes que preenchiam os critérios para o tratamento cirúrgico das fraturas. Após a análise estatística, observamos que maior incidência de lesão do nervo ulnar quando foi utilizada a técnica de pinagem cruzada; e a fixação lateral demonstrou ser mais segura para tal. Conclusão: Ambas as técnicas de fixação determinam bons resultados funcionais. Entretanto, a fixação com fios de Kirschner laterais demonstra ser mais segura, considerando o risco de lesão iatrogênica do nervo ulnar. A fixação com fios cruzados é mais eficaz, levando em conta a estabilidade e a manutenção da redução das fraturas. Nível de evidência II, Revisão sistemática de Estudos de Nível II ou Nível I com resultados discrepantes.

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OBJECTIVES: To identify the characteristics of patients and femur fractures treated with a stainless steel intramedullary nail (ESIN) in children under 15 years of age. Know the results of using the ESIN of related steel in the service. METHODS: Retrospective study with review of hospital records and organization of data in spreadsheets. RESULT: 24 cases were identified, 17 male cases and 7 female cases. A minimum age of 4 years and a maximum of 11 years were observed (average of 7 years). The 3 most common trauma mechanisms were being run over (n:8, 33%) and falling from a height (n:8, 3%). The most common location of the fractures was in the mid-diaphyseal region (n: 20, 88%), only one case presented a bilateral femur fracture. The most common associated trauma was traumatic brain injury. The observation period observed several months between 2 and 5. With regard to complications, 3 cases were observed (12.5%) being bursitis, vicious construction and loss of reduction. CONCLUSION: Steel HIF shows similar good results. As the study includes the retrospective profile, the absence of a group and the small sample size. Level of Evidence IV, Case series.

OBJETIVOS: Identificar as características dos pacientes e das fraturas de fêmur tratadas com haste intramedular flexível (HIF) de aço inoxidável em menores de 15 anos. A partir disso, conhecer os resultados relacionados ao uso da HIF de aço inoxidável no serviço. Métodos: Estudo retrospectivo, com revisão de prontuários hospitalares e organização dos dados em planilhas. RESULTADO: Identificados 24 casos, sendo 17 do gênero masculino e sete do gênero feminino. Foram observadas idade mínima de 4 anos e máxima de 11 anos (média de 7 anos). Os mecanismos de trauma mais comuns foram atropelamento (n: 8, 33%) e queda de altura (n: 8, 33%). A localização mais comum das fraturas foi na região médio diafisária (n: 20, 88%), apenas um caso apresentou fratura de fêmur bilateral. O trauma associado mais comum foi traumatismo crânio-encefálico. O período de consolidação observado variou entre 2 e 5 meses. No que se refere a complicações, foram observados três casos (12,5%), sendo estes: bursite, consolidação viciosa e perda de redução. Conclusão: A HIF de aço apresenta bons resultados, semelhantes aos das hastes de titânio. As limitações do estudo incluem o perfil retrospectivo, a ausência de grupo controle e o número pequeno da amostra. Nível de evidência IV, Série de casos.

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Osteoporotic vertebral fractures frequently result in pain and decreased quality of life (QoL). The management of these fractures remains a topic of debate. Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we analyzed randomized controlled trials comparing percutaneous vertebroplasty (PV) with non-operative treatment (non-OT). The outcomes of interest included pain, QoL, cement leakage, and new osteoporotic vertebral fractures after 1 year. Compared to non-OT regarding pain relief, PV yielded significant improvement at 1-2 weeks, 1 month, 6 months (standard mean difference [SMD] = -0.67 (6/14; 95% confidence interval [CI]: -1.29 to -0.06; I2 = 92%, random effects) and 1 year (mean difference = -1.07 (4/14; 95% CI: -1.97 to -0.18; I2 = 97%, random effects). For QoL, notable improvements were observed at 1 week (standard mean difference = -2.10 (5/14; 95% CI: -3.77 to -0.42; I2 = 98%, random effects) and 3 months (mean difference = -1.58 (4/14; 95% CI: -3.07 to -0.09; I2 = 96%, random effects), with 1 month, 6 months and 1 year being inconclusive. A cement leakage rate of 42% (10/14; 95% CI: 25% to 59%; I2 = 99%, random effects) was found. Further, PV did not significantly heighten the risk of new fractures within a year (odds ratio = 1.26 (6/14; 95% CI: 0.63 to 2.53; I2 = 74%, random effects). PV emerges as a promising intervention for specific time intervals regarding pain relief, especially in the extended-term analysis, and QoL, especially in the short-term analysis, compared to non-OT. However, clinicians must consider cement leakage risks. Heterogeneity among studies underscores careful patient selection.

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Objective: To describe the accuracy of HealthVCF, a software product that uses artificial intelligence, in the detection of incidental moderate-to-severe vertebral compression fractures (VCFs) on chest and abdominal computed tomography scans. Materials and Methods: We included a consecutive sample of 899 chest and abdominal computed tomography scans of patients 51-99 years of age. Scans were retrospectively evaluated by the software and by two specialists in musculoskeletal imaging for the presence of VCFs with vertebral body height loss > 25%. We compared the software analysis with that of a general radiologist, using the evaluation of the two specialists as the reference. Results: The software showed a diagnostic accuracy of 89.6% (95% CI: 87.4-91.5%) for moderate-to-severe VCFs, with a sensitivity of 73.8%, a specificity of 92.7%, and a negative predictive value of 94.8%. Among the 145 positive scans detected by the software, the general radiologist failed to report the fractures in 62 (42.8%), and the algorithm detected additional fractures in 38 of those scans. Conclusion: The software has good accuracy for the detection of moderate-to-severe VCFs, with high specificity, and can increase the opportunistic detection rate of VCFs by radiologists who do not specialize in musculoskeletal imaging.

Objetivo: Descrever a acurácia do software HealthVCF na detecção incidental de fraturas compressivas de corpos vertebrais moderadas a graves em exames de tomografia computadorizada do tórax e abdome. Materiais e Métodos: Foram incluídos 899 exames consecutivos de pacientes com idades entre 51 e 99 anos. As imagens foram retrospectivamente avaliadas pelo software e por dois radiologistas especializados em musculoesquelético que investigaram fraturas compressivas de corpos vertebrais com perda da altura somática > 25%. A análise comparativa foi realizada entre o software e um radiologista geral, usando a avaliação do especialista como referência. Resultados: O software apresentou uma acurácia de 89,6% (IC 95%: 87,4­91,5%) para fraturas compressivas moderadas a graves, com sensibilidade de 73,8%, especificidade de 92,7% e valor preditivo negativo de 94,8%. Entre as 145 tomografias positivas detectadas pelo software, o radiologista geral deixou de relatar as fraturas em 62 (42,8%) e o algoritmo detectou fraturas adicionais em 38 dessas tomografias. Conclusão: O software possui boa acurácia na detecção de fraturas compressivas moderadas a graves, com alta especificidade, podendo aumentar a taxa de detecção oportunística dessas fraturas por radiologistas não especializados em musculoesquelético.

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INTRODUCTION: To evaluate the relationship between initial displacement in proximal humeral fractures and fatty degeneration of the rotator cuff measured by CT according to the Goutallier classification. MATERIAL AND METHODS: This cross-sectional observational study evaluated patients with proximal humeral fractures over a six-month period. The study included patients ≥ 18 years old with complete radiological views (anteroposterior, lateral, and Grashey) and a CT scan of the affected shoulder; previous fracture or ipsilateral shoulder surgery were excluded. Neer's classification system and Goutallier stages were used to evaluate the patients. Demographic data were collected and, two groups were analysed according to age (≤ 50 years and > 50 years). RESULTS: Sixty-two patients were included (m = 36, f = 26, ratio 1.3:1); seven patients were excluded. Male patients (36, 58.1%), patients older than 50 years (33, 53.2%) and a low-energy injury mechanism (36, 58.1%) were the most frequent cases. According to the Neer system, the most common proximal humerus fracture was fracture-dislocation in 17 (27.4%) cases. The most common stage in Goutallier's classification was I (some fatty streaks) in 22 (35.4%) cases. Younger patients (≤ 50 years) had more displaced fractures with low fatty degeneration (p = < 0.001) than older patients (> 50 years), who had minimally displaced fractures with greater fatty degeneration (p = 0.567). CONCLUSIONS: High-energy mechanisms are associated with younger patients and a more displaced fracture according to the Neer classification. Older patients had a more advanced Goutallier stage and lesser displaced fracture. We should consider a more aggressive approach in the treatment of non-displaced fractures in elderly patients, less conservative and more surgical management, to obtain a better clinical evolution after the treatment of these kinds of fractures. LEVEL OF EVIDENCE: IV.

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The SPAH study is a population-based prospective cohort of Brazilian community-dwelling elderlies with higher fracture risk than observed in the studies used to construct the Brazilian FRAX model. In this study, the FRAX tool was a good fracture predictor within this high-risk elderly cohort, especially when calculated without bone density. PURPOSE: To determine the performances of FRAX and age-dependent intervention thresholds according to National Osteoporosis Guideline Group (NOGG) guidelines with and without bone mineral density (BMD) regarding fracture prediction in community-dwelling elderly Brazilians. METHODS: Seven hundred and five older adults (447 women; 258 men) were followed for 4.3 ± 0.8 years. FRAX risk for hip and major osteoporotic fractures with and without BMD was calculated at baseline. The bivariate analysis investigated the associations between the absolute probability of fracture (FRAX), as well as the age-dependent intervention thresholds (NOGG), and the incidence of vertebral fracture (VF), non-vertebral fracture (NVF), and major osteoporotic fractures (MOF), segregated by sex. Age-adjusted Poisson's multiple regression and ROC curves were constructed to determine FRAX and NOGG's accuracies as fracture predictors. RESULTS: Fractures occurred in 22% of women and 15% of men. FRAX with and without BMD was higher in women with all types of fractures (p < 0.001). Only NOGG risk classification without BMD was associated with NVF (p = 0.047) and MOF (p = 0.024). FRAX was associated with NVF in the multiple regression, regardless of BMD. ROC curves of FRAX with and without BMD had AUCs of 0.74, 0.64, and 0.61 for NVF, VF, and MOF, respectively. The most accurate risk cutoffs for FRAX were 8% for MOF and 3% for hip fractures. No statistically significant associations were found in men. CONCLUSION: FRAX predicted NVF more accurately than VF or MOF in elderlies, regardless of BMD. These results reiterate that FRAX may be used without BMD, even considering that Brazilian elderlies have known higher fracture risk.

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INTRODUCTION: Although a well-established component of bone metabolism, the efficacy and safety of vitamin D supplementation for the prevention of fractures in elderly healthy individuals is still unclear. PURPOSE: To perform a meta-analysis comparing vitamin D supplementation with placebo and its contributions on fracture incidence. METHODS: This meta-analysis was registered in the International Prospective Register of Systematic Reviews (PROSPERO), under protocol CRD42023484979. We systematically searched PubMed, Embase, and Cochrane Central databases from inception to November 2023 for randomized controlled trials (RCTs) comparing vitamin D supplementation versus placebo in individuals with 60 years of age or more and without bone related medical conditions such as cancer and osteoporosis. RESULTS: Seven RCTs with 71,899 patients were included, of whom 36,822 (51.2%) were women. There was no significant difference in total fracture incidence (RR 1.03; 95% CI 0.93-1.14; p = 0.56; I2 = 58%) between groups or subgroups. However, women had an increased risk for hip fractures (164 vs. 121 events; RR 1.34; 95% CI 1.06-1.70; p = 0.01; I2 = 0%). There was no significant difference in non-vertebral fractures, osteoporotic fractures development, or falls (RR 1.02; 95% CI 0.94-1.12; p = 0.6; I2 = 47%; RR 0.97; 95% CI 0.87-1.08; p = 0.63; I2 = 0%; RR 1.01; 95% CI 0.97-1.04; p = 0.66; I2 = 55%, respectively). CONCLUSION: Vitamin D supplementation does not reduce the total fracture development rate in the elderly healthy population, and it may increase the incidence of hip fractures among elderly healthy women. This finding suggests refraining from prescribing high intermittent doses of vitamin D, without calcium, to individuals aged 60 or older with unknown vitamin D serum concentration or osteoporosis status and inadequate calcium intake.

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Purpose: This study examined the influence of a metal artifact reduction (MAR) tool, sharpening filters, and their combination on the diagnosis of vertical root fracture (VRF) in teeth with metallic posts using cone-beam computed tomography (CBCT). Materials and Methods: Twenty single-rooted human premolars - 9 with VRF and 11 without - were individually placed in a human mandible. A metallic post composed of a cobalt-chromium alloy was inserted into the root canal of each tooth. CBCT scans were then acquired under the following parameters: 8 mA, a 5×5 cm field of view, a voxel size of 0.085 mm, 90 kVp, and with MAR either enabled or disabled. Five oral and maxillofacial radiologists independently evaluated the CBCT exams under each MAR mode and across 3 sharpening filter conditions: no filter, Sharpen 1×, and Sharpen 2×. The diagnostic performance was quantified by the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity. These metrics were compared using 2-way analysis of variance with a significance level of α=5%. Intra- and inter-examiner agreement were assessed using the weighted kappa test. Results: Neither MAR nor the application of sharpening filters significantly impacted AUC or specificity (P>0.05). However, sensitivity increased when MAR was combined with Sharpen 1× and Sharpen 2× (P=0.015). The intra-examiner agreement ranged from fair to substantial (0.34-0.66), while the inter-examiner agreement ranged from fair to moderate (0.27-0.41). Conclusion: MAR in conjunction with sharpening filters improved VRF detection; therefore, their combined use is recommended in cases of suspected VRF.