RESUMO Objetivo: Avaliar a funcionalidade e fatores associados em crianças e adolescentes com osteogênese imperfeita (OI). Métodos: Estudo transversal com 30 crianças e adolescentes com OI. Foram avaliados prontuários médicos, uso de bisfosfonatos, características socioeconômicas, dinamometria de preensão palmar, equilíbrio, hipermobilidade articular, nível de deambulação e escores do Pediatric Evaluation of Disability Inventory - Computer Adaptative Test (PEDI-CAT). Os dados foram apresentados em média e desvio padrão e comparados por teste t por Mann-Whitney, enquanto os categóricos foram apresentados em frequência e comparados pelo teste exato de Fisher. Análises intragrupos foram realizadas por análise de covariância (ANCOVA) ou Teste de Wilcoxon para postos sinalizados. O teste Tau-b de Kendall foi usado para correlações. Resultados: A idade variou de 6 a 18 anos. A amostra foi dividida em dois grupos de acordo com a gravidade da doença. Casos moderados/graves (n=10) apresentaram menor estatura e força muscular comparadas às dos leves (n=20). Fraqueza muscular foi observada em todos os casos de OI quando comparados à população normal. Não houve diferença nos domínios do PEDI-CAT com exceção do domínio mobilidade. Houve correlação entre o número de fraturas, tipo de OI, peso e equilíbrio e o domínio mobilidade; e entre os domínios Atividades Diárias e Mobilidade e Responsabilidade e Social/cognitivo do PEDI-CAT. Conclusões: Nossos achados sugerem que crianças com OI moderada/severa podem atingir o mesmo nível de funcionalidade que crianças com a forma leve. Fraturas podem ter grande influência no nível de funcionalidade e o tratamento deve enfocar a prevenção e a reabilitação desses eventos. Objetivo . (OI) Métodos 3 médicos bisfosfonatos socioeconômicas palmar articular PEDICAT. PEDICAT PEDI CAT (PEDI-CAT) MannWhitney, MannWhitney Mann Whitney, Whitney Mann-Whitney Fisher ANCOVA (ANCOVA sinalizados Taub Tau b correlações Resultados 1 anos doença moderadosgraves moderados graves n=10 n10 n 10 (n=10 n=20. n20 n=20 20 (n=20) normal mobilidade fraturas Socialcognitivo Social cognitivo CAT. Conclusões moderadasevera moderada severa leve eventos (OI (PEDI-CAT n=1 n1 (n=1 n2 n=2 2 (n=20 n= (n= (n=2 (n

ABSTRACT Objective: The aim of this study was to evaluate the functioning and associated factors in children and adolescents with osteogenesis imperfecta (OI). Methods: This is a cross-sectional study conducted on 30 children and adolescents with OI. Medical records, use of bisphosphonates, socioeconomic status, handgrip strength, balance, joint hypermobility, ambulatory level, and the Pediatric Evaluation of Disability Inventory—Computer Adaptative Test (PEDI-CAT) scores were assessed. Data is presented as mean and standard deviation and Student’s t-test or Mann–Whitney U test. Categorical data is presented as frequency and analyzed using Fisher’s exact test. Within-group analyses were conducted using ANCOVA or Wilcoxon signed-rank test. Correlations used Kendall’s Tau-b test. Results: The participants involved in this study were 6–18 years old. The sample was separated into two groups according to disease severity. The moderate/severe OI group (n=10) presented a lower height and muscular strength than the mild group (n=20). Muscle weakness was observed in all participants with OI when compared with the normal population. No differences were observed between the groups in the PEDI-CAT scores except for the mobility domain. There were correlations between the PEDI-CAT mobility domain and the number of fractures, OI type, weight, and balance; there was also a correlation between the PEDI-CAT daily activities, mobility, responsibility, and social/cognitive domains. Conclusions: The findings suggest that children with moderate/severe forms of OI can achieve the same function levels as children with mild OI. Fractures can have a major influence on the functional level, and treatment should focus on the prevention and rehabilitation of these events when they occur. Objective . (OI) Methods crosssectional cross sectional 3 records bisphosphonates status balance hypermobility level InventoryComputer Inventory Computer PEDICAT PEDI CAT (PEDI-CAT assessed Students Student s ttest t test MannWhitney Mann Whitney Fishers Fisher Withingroup Within signedrank signed rank Kendalls Kendall Taub Tau b Results 618 6 18 6–1 old severity moderatesevere moderate severe n=10 n10 n 10 (n=10 n=20. n20 n=20 20 (n=20) population fractures type weight activities responsibility socialcognitive social cognitive domains Conclusions occur (OI 61 1 6– n=1 n1 (n=1 n2 n=2 2 (n=20 n= (n= (n=2 (n

ABSTRACT Introduction/framework/objectives Salt production, especially using artisanal methods, does not exist in all countries, given the climatic and logistical requirements. Portugal has some tradition in this sector, but even so, most professionals working in Occupational Health and Safety have no experience in the area. The aim of this review was to summarize the most relevant and recent publications, to improve their performance capacity and enhance the productivity, satisfaction and well-being of the workers involved. Methodology This is a Bibliographic Review, initiated through a search carried out in April 2023 in the databases “CINALH plus with full text, Medline with full text, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Nursing and Allied Health Collection: comprehensive, MedicLatina and RCAAP”. Content Salt pans can be inland (far from the sea, using groundwater with a high salt content) or coastal. The former are scarcer in Portugal and only exist between Lisbon and Coimbra. Over time, in our country, evaporation was carried out by fire and sun. The latter is believed to have been developed by the Romans who created the first version of salt flats. At national level there is evidence of salt production since the end of the Neolithic, but here more frequently with the use of fire. Throughout Europe there has been a decline in artisanal versus industrial salt production, even in sea salt pans (especially on the northwest coast of France and, in Portugal, on the western coasts). Artisanal production in our country is more prevalent in the Figueira da Foz area. The product obtained via artisanal production has better quality, particularly in terms of flavor and nutritionally (via industrial production the taste is more metallic). Portugal is a large producer and consumer of traditional salt. The climatic characteristics suit production, due to summers with frequent high temperatures and strong, hot winds. National salt was and is consumed in other European countries; for presenting superior quality, even though it is more expensive. Production depends on the climate, namely insolation (number of hours in the sun), precipitation, temperature, cloudiness and winds (which affect evaporation). In other words, this is more intense and faster if the air temperature is higher, such as with more dry winds (which are generally more frequent in summer); low precipitation is also favorable. Salt production has been increasing, due to growing industrial needs. To be used in this last situation, it must be at 100% purity. Discussion and Conclusions No bibliography was found that referred the dimension of occupational health and safety in this professional sector. Based on the authors' theoretical and practical experience, the most relevant risk factors and risks in the sector are described: ultraviolet radiation and possible skin cancer, cataracts and other associated injuries; thermal discomfort and eventual higher accident rates associated with motor incoordination, worse cardiovascular adjustment, as well as disorientation and ability to make decisions; forced/maintained loads and/or postures and possible musculoskeletal injuries, emergence/worsening of hernia pathology and falling objects at the same level and possible bruises, skin lacerations and/or fractures. It would be interesting to learn more about the national panorama of this sector, through studies that hierarchically stratify the risk, also accurately describing occupational illnesses and associated accidents, as well as more effective measures to mitigate these issues.

RESUMO Introdução/enquadramento/objetivos A produção de sal, sobretudo com métodos artesanais, não existe em todos os países, dadas as exigências climáticas e logísticas. Portugal apresenta alguma tradição nesse setor mas, ainda assim, a maioria dos profissionais a exercer na Saúde e Segurança Ocupacionais não tem experiência na área. Pretendeu-se com esta revisão resumir o que mais relevante e recente se publicou, de forma a melhorar a capacidade de atuação destes e a potenciar a produtividade, satisfação e bem-estar dos trabalhadores afetos. Metodologia Trata-se de uma Revisão Bibliográfica, iniciada através de uma pesquisa realizada em abril de 2023 nas bases de dados “CINALH plus with full text, Medline with full text, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Nursing and Allied Health Collection: comprehensive, MedicLatina e RCAAP”. Conteúdo As salinas podem ser interiores (afastadas do mar, usando água subterrânea com elevado conteúdo em sal) ou litorais. As primeiras são mais escassas em Portugal e apenas existem entre Lisboa e Coimbra. Ao longo do tempo, no nosso país, a evaporação era realizada pelo fogo e sol. Esta última acredita-se que foi desenvolvida pelos romanos que, de certa forma, criaram a primeira versão das salinas. A nível nacional há evidência de produção de sal desde o final do Neolítico, mas aqui mais frequente com a utilização do fogo. Por toda a Europa tem existido um declínio da produção artesanal de sal, versus industrial, mesmo em salinas marítimas (sobretudo na costa noroeste de França e, em Portugal, na costa ocidental). A produção artesanal no nosso país é mais prevalente na zona da Figueira da Foz. O produto obtido via artesanal tem mais qualidade, nomeadamente a nível de sabor e nutricionalmente (via industrial o paladar é um pouco mais metálico). Portugal é um grande produtor e consumidor de sal tradicional. As caraterísticas climáticas adequam-se à produção, devido aos verões com temperaturas elevadas frequentes e ventos fortes e quentes. O sal nacional era e é consumido noutros países europeus, por apresentar qualidade superior, mesmo tendo um preço mais elevado. A produção depende do clima, nomeadamente a insolação (número de horas ao sol), precipitação, temperatura, nebulosidade e ventos (que condicionam a evaporação). Ou seja, esta é mais intensa e rápida se a temperatura do ar for mais elevada, tal como com mais ventos secos (que geralmente são mais frequentes no Verão); a baixa precipitação também é favorável. A produção de sal tem vindo a aumentar, até pelas crescentes necessidades industriais. Para ser usado nesta última situação, deverá estar no patamar de 100% de pureza. Discussão e Conclusões Não se encontrou bibliografia que fizesse referência à dimensão da saúde e segurança ocupacionais neste setor profissional. Em função de experiência teórica e prática dos autores, descrevem-se os fatores de riscos e riscos mais relevantes do setor: radiação ultravioleta e eventual cancro de pele, cataratas e outras lesões associadas; desconforto térmico e eventual maior sinistralidade associada a descoordenação motora, pior ajuste cardiovascular, bem como desorientação e capacidade de tomar decisões; cargas e/ou posturas forçadas/mantidas e eventuais lesões músculo-esqueléticas, surgimento/agravamento de patologia herniária e queda de objetos e ao mesmo nível e eventuais equimoses, lacerações cutâneas e/ou fraturas. Seria interessante conhecer melhor o panorama nacional deste setor, através de estudos que estratificassem hierarquicamente o risco, descrevendo ainda com rigor as doenças profissionais e acidentes associados, bem como medidas mais eficazes para atenuar essas questões.

RESUMEN Introducción: Las fracturas de tibia son lesiones frecuentes. En los niños existe una mayor capacidad de curación debido al mayor grosor y mejor vascularización que presenta su periostio. Como resultado, la mayoría pueden tratarse de manera exitosa de forma no quirúrgica. Está descrito el tratamiento funcional para estas fracturas, siguiendo los principios desarrollados por Sarmiento. Dada la falta de evidencia actual acerca del tratamiento funcional en este grupo etario, realizamos el análisis del mismo mediante una serie de casos tratados siguiendo este método. Materiales y métodos: Se incluyeron pacientes que cumplieron con los criterios de inclusión y exclusión, tratados mediante tratamiento funcional siguiendo los principios desarrollados por Sarmiento. Se evaluaron clínica y radiográficamente. Se evaluó la técnica registrando tiempos para cada período en este grupo etario, así como la satisfacción con el tratamiento de los pacientes y padres y/o tutores. Todas las complicaciones relacionadas fueron documentadas. Resultados: Evaluamos un total de 15 pacientes, con al menos 6 meses de seguimiento. La edad promedio fue de 11.7 años. Todas las fracturas consolidaron, el tiempo promedio hasta la consolidación fue de 7.6 semanas. El período agudo de 3.4 semanas y el período funcional de 4.2 semanas promedio respectivamente. Todas las fracturas consolidaron con una reducción aceptable. Existió un 100% de satisfacción tanto de los pacientes como de los padres ó tutores con el tratamiento implementado. Dos pacientes presentaron complicaciones menores. Conclusión: El tratamiento funcional para las fracturas de pierna en niños entre 10 y 15 años es una técnica segura, reproducible, con buenos resultados funcionales, que le permite tanto a los pacientes y a sus cuidadores gran independencia durante el período de curación.

ABSTRACT Introduction: Tibial fractures are frequent injuries. In children there is a greater healing capacity due to the greater thickness and better vascularization of their periosteum. As a result, most of them can be successfully treated non-surgically. Functional treatment for these fractures is described, following the principles developed by Sarmiento. Given the lack of current evidence on functional treatment in this age group, we analyzed a series of cases treated following this method. Materials and methods: We included patients who met the inclusion and exclusion criteria, treated by functional treatment following the principles developed by Sarmiento. They were evaluated clinically and radiographically. The technique was evaluated by recording times for each period in this age group, as well as the satisfaction with the treatment of the patients and parents and/or guardians. All related complications were documented. Results: We evaluated a total of 15 patients, with at least 6 months of follow-up. The average age was 11.7 years. All fractures consolidated, the average time to consolidation was 7.6 weeks. The acute period of 3.4 weeks and the functional period of 4.2 weeks average respectively. All fractures healed with acceptable reduction. There was 100% satisfaction of both patients and parents or guardians with the treatment implemented. Two patients presented minor complications. Conclusion: Functional treatment for leg fractures in children between 10 and 15 years of age is a safe, reproducible technique, with good functional results, which allows both patients and their caregivers great independence during the healing period.

RESUMO Introdução: As fracturas da tíbia são lesões comuns. Nas crianças existe uma maior capacidade de cicatrização devido à maior espessura e melhor vascularização do periósteo. Como resultado, a maioria pode ser tratada com sucesso de forma não cirúrgica. É descrito o tratamento funcional destas fracturas, seguindo os princípios desenvolvidos por Sarmiento. Dada a falta de evidência atual sobre o tratamento funcional neste grupo etário, procedeu-se à análise de uma série de casos tratados por este método. Material e métodos: Foram incluídos pacientes que preencheram os critérios de inclusão e exclusão, tratados por tratamento funcional seguindo os princípios desenvolvidos por Sarmiento. Foram avaliados clínica e radiograficamente. A técnica foi avaliada através do registro dos tempos para cada período nessa faixa etária, bem como a satisfação com o tratamento por parte dos pacientes e dos pais e/ou responsáveis. Todas as complicações relacionadas foram documentadas. Resultados: Avaliámos um total de 15 doentes, com pelo menos 6 meses de seguimento. A idade média foi de 11,7 anos. Todas as fracturas cicatrizaram, sendo o tempo médio de cicatrização de 7,6 semanas. O período agudo foi de 3,4 semanas e o período funcional de 4,2 semanas, em média, respetivamente. Todas as fracturas foram curadas com uma redução aceitável. Os doentes e os pais/encarregados de educação ficaram 100% satisfeitos com o tratamento efectuado. Dois doentes tiveram complicações ligeiras. Conclusão: O tratamento funcional das fracturas da perna em crianças com idades compreendidas entre os 10 e os 15 anos é uma técnica segura, reprodutível e com bons resultados funcionais, que permite aos doentes e aos seus cuidadores uma grande independência durante o período de cura.

RESUMEN Introducción: Las luxaciones traumáticas de codo posteromediales asociadas a fracturas de cóndilo externo constituyen una lesión poco común dentro de la patología ortopédica. Pueden pasar desapercibidas si no se tiene la sospecha clínica, y la falla en el diagnóstico y tratamiento pueden derivar en un mal pronóstico funcional para el miembro lesionado. Metodología: Entre el año 2020 y 2022 identificamos 3 pacientes pediátricos con luxación posteromedial de codo asociado a fractura del cóndilo externo. Los tres pacientes presentaron fractura de cóndilo externo tipo 2 de la clasificación de Milch. Todos los pacientes fueron tratados de manera quirúrgica. Tuvieron un seguimiento de 2 años, salvo en uno de ellos, el cual fue de 18 meses. Se realizó un seguimiento clínico y radiológico para la evaluación de la lesión, al tiempo que se aplicó el cuestionario DASH a los 3 pacientes. Resultados: Se obtuvieron excelentes resultados en 2 de los pacientes y buen resultado en uno de ellos dado por una pérdida de la extensión de 15 grados. Aunque todos tuvieron un buen resultado en el cuestionario funcional DASH adaptado. Conclusión: La luxación de codo asociado a la fractura de cóndilo externo es una lesión poco común. Es necesario realizar un diagnóstico precoz a través de un correcto estudio de la lesión, ya sea con radiografías, artrografía, tomografía o resonancia magnética. Se pueden lograr buenos resultados siempre que se realice un correcto tratamiento de la misma con un exhaustivo control evolutivo.

ABSTRACT Introduction: Traumatic posteromedial elbow dislocations associated with external condyle fractures constitute a rare injury in orthopedic pathology. They can go unnoticed if there is no clinical suspicion, and failure in diagnosis and treatment can lead to a poor functional prognosis for the injured limb. Methods: Between 2020 and 2022, we identified 3 pediatric patients with posteromedial elbow dislocation associated with an external condyle fracture. The three patients presented type 2 external condyle fracture of the Milch classification. All patients were treated surgically. A 2-year follow-up was carried out, except in one of them. A clinical and radiological follow-up was performed to evaluate the injury. The DASH questionnaire was administered to the 3 patients. Results: Excellent results were obtained in 2 of the patients and a good result in one of them due to a loss of extension of 15 degrees. Although everyone had a good DASH functional questionnaire. Conclusion: Elbow dislocation associated with lateral condyle fracture is a rare injury. It is necessary to make an early diagnosis through a correct study of the injury, whether with x-rays, arthrography, tomography or magnetic resonance imaging. Good results can be achieved as long as correct treatment is carried out with exhaustive evolutionary control.

RESUMO Introdução: As luxações póstero-mediais traumáticas do cotovelo associadas a fraturas do côndilo externo constituem uma lesão rara na patologia ortopédica. Podem passar despercebidos se não houver suspeita clínica, e a falha no diagnóstico e tratamento pode levar a um mau prognóstico funcional para o membro lesado. Metodologia: Entre 2020 e 2022 identificamos 3 pacientes pediátricos com luxação posteromedial do cotovelo associada a fratura do côndilo externo. Os três pacientes apresentavam fratura de côndilo externo tipo 2 da classificação de Milch. Todos os pacientes foram tratados cirurgicamente. Tiveram seguimento de 2 anos, exceto em um deles, que foi de 18 meses. Foi realizado acompanhamento clínico e radiológico para avaliação da lesão e aplicado o questionário DASH nos três pacientes. Resultados: Excelentes resultados foram obtidos em 2 dos pacientes e bom resultado em um deles devido à perda de extensão de 15 graus. Embora todos tenham obtido bom resultado no questionário funcional DASH adaptado. Conclusão: A luxação do cotovelo associada à fratura do côndilo externo é uma lesão rara. É necessário fazer um diagnóstico precoce através de um estudo correto da lesão, seja com radiografias, artrografia, tomografia ou ressonância magnética. Bons resultados podem ser alcançados desde que realizado um tratamento correto e com exaustivo controle evolutivo.

Resumen Las fracturas mandibulares poseen una alta prevalencia en el territorio maxilofacial, requiriendo, en su mayoría, resolución quirúrgica. El Gold Standard corresponde a la reducción abierta con osteosíntesis con placas de titanio. Nuevos materiales biocompatibles han sido aplicados con el fin de subsanar las complicaciones y desventajas de las placas de titanio, surgiendo las placas de osteosíntesis reabsorbibles. Conocer la efectividad de las placas de titanio y placas de osteosíntesis reabsorbibles en el tratamiento de fracturas mandibulares permite determinar la necesidad de invertir en nuevas técnicas con resultados predecibles. Describir la efectividad del uso de placas de titanio y placas de osteosíntesis reabsorbibles en el tratamiento de fracturas mandibulares. Durante agosto del año 2023, se realizó una revisión sistemática exploratoria de la literatura disponible desde 2018 sobre el uso de placas de osteosíntesis reabsorbibles en fracturas mandibulares, empleándose los buscadores PubMed, Scopus y WOS incluyendo estudios en inglés o español. Se obtuvieron 227 artículos. Después de la revisión de título y resumen, 29 fueron incluidos para lectura de texto completo, se descartaron 9 duplicados, 10 fueron descartados por criterios de exclusión, quedando en total 10 artículos en este estudio. Autores relatan menor desplazamiento de la superficie de contacto de las placas de titanio en los segmentos fracturados, por una mayor área de presión superficial, rigidez y fuerza de carga. Las placas de osteosíntesis reabsorbibles son más flexibles y están sujetas a mayor deformación ante fuerzas masticatorias de gran magnitud, pudiendo generar apertura de la fractura, desplazamiento de segmentos óseos. Se analizaron las complicaciones post operatorias y no presentan diferencias estadísticamente significativas. Los dispositivos de titanio y reabsorbibles no difirieron en términos de comportamiento biomecánico y complicaciones postquirúrgicas en el tratamiento de fracturas mandibulares. Faltan nuevos estudios que comparen ambas placas en fracturas mandibulares.

Abstract Mandibular fractures have a high prevalence in the maxillofacial region, often requiring surgical intervention. The gold standard for treatment involves open reduction with osteosynthesis using titanium plates. New biocompatible materials have been applied to address the complications and disadvantages of titanium plates, leading to the emergence of absorbable osteosynthesis plates. Understanding the effectiveness of titanium plates and absorbable osteosynthesis plates in the treatment of mandibular fractures helps determine the need to invest in new techniques with predictable outcomes. To describe the effectiveness of using titanium plates and absorbable osteosynthesis plates in the treatment of mandibular fractures. In August 2023, an exploratory systematic review of the available literature since 2018 on the use of absorbable osteosynthesis plates in mandibular fractures was conducted. PubMed, Scopus, and WOS were searched, including studies in English or Spanish. A total of 227 articles were obtained. After reviewing titles and abstracts, 29 articles were included for full-text reading. Nine duplicates were discarded, and 10 were excluded based on predefined criteria, resulting in a total of 10 articles for this study. Authors report that titanium plates exhibit less displacement of the contact surface in fractured segments due to a larger surface area, rigidity, and load-bearing capacity. Absorbable osteosynthesis plates are more flexible but are susceptible to greater deformation under significant masticatory forces, potentially leading to fracture opening and displacement of bone segments. Postoperative complications were analyzed, and no statistically significant differences were found. Titanium and absorbable devices did not differ in terms of biomechanical behavior and postoperative complications in the treatment of mandibular fractures. Further studies comparing both types of plates in mandibular fractures are needed.

Boring of tunnels and shafts in hard rock under high stress conditions is becoming more common as mines and tunnels are developed at greater depths. Under the high stress conditions, fracturing of the often-brittle rock occurs in the walls, backs, and ahead of advancing faces of excavations. Fracturing can have a significant impact on boring activities: sidewall spalling, which affects machine gripper capacity, and fractures can also develop in the rock ahead of the face, leading to blocky rock conditions, which may have a significant effect on machine excavation. Fracturing may develop dynamically, leading to rock bursts manifesting in the form of strain bursts, which can be hazardous and destructive. In brittle rock, fracturing is commonly extensional in nature. The focus of this paper is on fracturing in the face of the excavation. Examples of such fracturing behaviour are described briefly in the paper. Numerical analyses were carried out to predict the initiation of extension fractures and their orientations ahead of excavation surfaces, and the resulting formation of rock slabs/plates, and the stability of these plates. The results should be beneficial for the evaluation of the conditions prior to, and during boring operations.

BACKGROUND. Golf club-related traumatic brain injuries are an uncommon occurrence in adults, and the use of golf clubs as a weapon of interpersonal assault resulting in compound skull fractures is rare. OBJECTIVE. To present a case series of golf club-related compound skull fractures in adults secondary to assault, representing the largest study of this entity to date. METHODS. A retrospective analysis was performed of a prospectively maintained database for patients admitted to Tygerberg Academic Hospital in Cape Town, South Africa, with golf club-related compound skull fractures between 1 January 2018 and 31 December 2021. Data on demographic details, computed tomography brain image findings, presenting Glasgow Coma Scale, surgical operative notes, septic complications and outcomes at discharge were collected. RESULTS. A total of 21 patients were included. The majority were male (95.2%) and the mean age was 32.6 years. Fractures were most commonly seen in the frontal bone (n=9), followed by parietal (n=8), temporal (n=3) and occipital (n=1) bones. Depressed skull fractures were the most common type of injury, and local pneumocephalus was present in the majority of patients. The mean presenting Glasgow Coma Scale was 14, and most patients had no focal neurological deficits. Surgical debridement was required in the majority of patients, with a high rate of septic complications (33.3%). However, most patients had good neurological outcomes at discharge, and the mean length of stay was 11.9 days. CONCLUSION. This study highlights the potential dangers of golf clubs as a weapon of interpersonal assault, and the need for prompt and appropriate management of compound skull fractures to reduce the risk of complications.

Abstract Introduction: Osteoporosis (OP) is the most frequent metabolic bone disease, associated with fragility fractures and increased morbimortality. Despite population aging, there has been a downward trend in the implementation of anti-osteoporotic therapy. Objectives: To determine the therapeutic inertia in OP in postmenopausal women in primary health care. Verify whether age, T-score, the FRAX value, and anti-osteoporotic therapeutic inertia are associated. Methods: Cross-sectional observational study. Inclusion criteria: women aged between 55 and 85 coded with OP (ICPC-2 - L95) or fractures (ICPC-2 - L72-76) in the list of problems. A simple random sample was selected. Therapeutic inertia was defined based on the Portuguese Society of Rheumatology recommendations. Results: A sample of 217 patients was obtained. Therapeutic inertia was found in 17.5% of women, which increased to 48.6% in those who suffered fractures (p<0.001). There was a statistically significant difference between the ages of patients with and without therapeutic inertia (77.5 vs 73.0, p<0.010). The median FRAX for major osteoporotic fracture (16.5 vs 9.65, p<0.001) and hip fracture (7.6 vs 3.3, p<0.001) was higher in the group with therapeutic inertia. The difference between T-score values for the lumbar spine (2.45 vs 2.71) and the femoral neck (2.07 vs 2.02) did not reach statistical significance (p=0.299). Conclusion: This study highlights the application of the most recent national guidelines regarding osteoporosis treatment in the studied health care unit, but underlines the need for broader intervention in osteoporosis-related fractures and at older ages.

Resumo Introdução: A osteoporose (OP) é a doença óssea metabólica mais frequente, associando-se a fraturas de fragilidade e aumento de morbimortalidade. Apesar do envelhecimento populacional tem-se verificado uma tendência decrescente na implementação de terapêutica antiosteoporótica. Objetivos: Determinar a inércia terapêutica na OP em mulheres pós-menopáusicas ao nível dos cuidados de saúde primários. Verificar se existe associação entre a idade dos utentes, o T-score e o valor de FRAX e a inércia terapêutica antiosteoporótica. Métodos: Estudo observacional transversal. Critérios de inclusão: mulheres com idades entre os 55 e os 85 anos codificadas com OP (ICPC-2 - L95) ou fraturas (ICPC-2 - L72-76) na lista de problemas. Foi selecionada uma amostra aleatória simples. A inércia terapêutica foi definida com base nas recomendações da Sociedade Portuguesa de Reumatologia. Resultados: Obteve-se uma amostra de 217 utentes. Apurou-se inércia terapêutica em 17,5% das mulheres, valor que aumenta para 48,6% nas que sofreram fraturas (p<0,001). As idades diferem de forma estatisticamente significativa entre os utentes com e sem inércia terapêutica (77,5 vs 73,0, p<0,010). A mediana do FRAX para fratura osteoporótica major (16,5 vs 9,65, p<0,001) e fratura da anca (7,6 vs 3,3, p<0,001) foi superior no grupo com inércia terapêutica. Os valores de T-score da coluna lombar (2,45 vs 2,71) e do colo do fémur (2,07 vs 2,02) não diferiram de forma estatisticamente significativa (p=0,299). Conclusão: Este estudo realça a aplicação da evidência mais atual ao nível do tratamento da OP na unidade estudada, mas salienta a necessidade de maior intervenção na OP fraturária e em idades mais avançadas.

SUMMARY OBJECTIVE: February 2023 saw major earthquakes in Pazarcık and Elbistan, causing significant devastation in Turkey. Patients were transferred to hospitals in neighboring provinces, with multiple traumas—especially fractures and organ injuries—forming the main reasons for hospital admissions. This study aimed to examine earthquake-related injuries in pediatric and adult populations to understand differences. METHODS: This study analyzed 1,220 adults and 590 pediatric patients with radiological imaging out of 8,704 earthquake trauma cases. Radiological images were assessed independently by two radiologists. Statistical analysis using SPSS examined relationships between variables such as age group and injury type. RESULTS: Results showed 40% of adults and 64% of children had normal radiological findings. Cerebral and extremity traumas were most common in pediatrics, while adults showed more extremity, thoracic, and spinal traumas. Significant differences between adult and pediatric groups were observed in cranial fractures, thoracic and lumbar vertebral fractures, hemopneumothorax, lung contusions, rib fractures, femur and talocalcaneal fractures, and compartment syndrome (p<0.001). CONCLUSION: Earthquake-related injuries may vary between children and adults. Due to children's more flexible anatomical structure, it is believed that earthquake-related injuries occur less frequently in children. In this study, head traumas were more common in children compared to adults. The rate of cranial fractures was significantly higher in children, with a higher incidence of epidural hematoma compared to adults. Spinal traumas were more frequent in adults than in children, attributed to children's greater flexibility reducing the risk of entrapment under rubble. Pediatric thoracic compliance being significantly higher than in adults often resulted in milder chest traumas. However, compartment syndrome was more common in children, with a lower rate of accompanying bone fractures compared to adults. No significant difference was observed between children and adults in maxillofacial, abdominal, and pelvic traumas. These findings provide insights for future disaster healthcare planning and management. OBJECTIVE 202 Elbistan Turkey provinces traumasespecially especially injuriesforming forming admissions earthquakerelated related METHODS 1220 1 220 1,22 59 8704 8 704 8,70 cases radiologists type RESULTS 40 64 pediatrics hemopneumothorax contusions p<0.001. p0001 p p<0.001 . 0 001 (p<0.001) CONCLUSION Earthquakerelated Earthquake childrens s structure rubble However maxillofacial abdominal management 20 122 22 1,2 5 870 70 8,7 4 6 p000 p<0.00 00 (p<0.001 2 12 1, 87 7 8, p00 p<0.0 (p<0.00 p0 p<0. (p<0.0 p<0 (p<0. p< (p<0 (p< (p

Abstract Shoulder trauma is one of the most common pathologies in traumatology; it can range from soft-tissue trauma to fractures. Dislocations are common and generate damage to internal structures that predispose to new dislocation events and chronic pain. In this paper, an image review will be performed of the different pathologies that can occur in traumatic and non-traumatic dislocations. Glenohumeral instability has many forms of presentation and the radiologist plays an important role in the diagnosis.

Resumen El trauma del hombro es una de las patologías más comunes en traumatología, se pueden presentar desde trauma de tejidos blandos hasta fracturas. Las luxaciones son comunes y generan daños de estructuras internas que predisponen a nuevos eventos de luxación y dolor crónico. En este trabajo se realizará una revisión por imagen de las diferentes patologías que pueden ocurrir en las luxaciones traumáticas y no traumáticas. La inestabilidad glenohumeral tiene muchas formas de presentación y el radiólogo juega un papel importante en el diagnóstico.

Abstract Introduction. Rectal perforation due to blunt trauma is rare and associated with pelvic fractures. Signs of necrotizing fasciitis in lower limbs have been reported in non-traumatic rectal perforations, in most cases associated with high mortality. Case report. A 36-year-old man presents blunt abdomino-pelvic trauma and perforation of the lower rectum. Surgical management by intestinal diversion and pelvic fixation is performed. 4 days after admission, evolves with over-infected scrotal hematoma, hemodynamic instability, signs of necrotizing fasciitis and septic shock. Results. A sample for culture was taken from a scrotal hematoma that reported E. coli. Pathology of scrotal debridement reported coagulation necrosis in the entire specimen. Discussion. Digital rectal examination should always be performed in the presence of subcutaneous emphysema on physical examination or CT scan for early and multidisciplinary diagnosis and surgical management as appropriate. Conclusion. The presence of subcutaneous emphysema should raise the suspicion of rectal perforation. There are few reports of rectal perforation due to blunt trauma and fasciitis, so the associated mortality is not precisely known.

Resumen Introducción. La perforación del recto por trauma cerrado es poco frecuente y se asocia a fracturas pélvicas. En pacientes con perforaciones de recto no traumáticas se ha reportado fascitis necrosante en miembros inferiores, en la mayoría de los casos asociada a alta mortalidad. Caso clínico. Hombre de 36 años con trauma cerrado abdomino-pélvico y perforación de recto inferior, quien recibió manejo quirúrgico mediante derivación intestinal y fijación pélvica. Evolucionó con hematoma escrotal sobreinfectado, inestabilidad hemodinámica, signos de fascitis necrosante y choque séptico 4 días posterior a su ingreso. Resultados. Se tomó muestra para cultivo del hematoma escrotal que reportó E. coli. La patología del desbridamiento escrotal informó necrosis de coagulación en toda la muestra. Conclusión. El tacto rectal debe realizarse siempre ante la presencia de enfisema subcutáneo al examen físico o en la tomografía, para un diagnóstico temprano y manejo quirúrgico multidisciplinario oportuno, según el caso. La presencia de enfisema subcutáneo debe aumentar la sospecha de perforación de recto. Hay pocos reportes de fascitis secundaria a perforación de recto por trauma cerrado, por lo que no se conoce con precisión la mortalidad asociada.

Resumo Este artigo propõe uma leitura d'O Rei de Havana (1999), romance de Pedro Juan Gutiérrez, considerando a imbricação entre o texto, o projeto político do Homem Novo, implantado pelo Governo Socialista de Fidel Castro, e a crise econômica vivida em Cuba, na década de 1990, durante o Período Especial em Tempos de Paz. Além das fraturas do projeto econômico e social cubano, a narrativa explora processos de produção de corpos e a instabilidade das categorias sexo, gênero e desejo, de forma a contestar a matriz da heterossexualidade compulsória (Butler, 2003). dO d O 1999, 1999 , (1999) Gutiérrez texto Novo Castro Cuba 1990 Paz cubano sexo desejo Butler, Butler (Butler 2003. 2003 . 2003) 199 (1999 200 19 (199 20 1 (19 2 (1 (

Abstract This article proposes a reading of The King of Havana (1999), a novel by Pedro Juan Gutiérrez, keeping in mind the connection between the text, the political project of the New Man, implemented by the Socialist Government of Fidel Castro, and the economic crisis in Cuba, in the 1990s, during the Special Period in Times of Peace. In addition to the fractures of the Cuban economic and social project, the narrative explores processes of production of bodies and the instability of the categories sex, gender and desire in order to contest the hegemonic heterosexual matrix (Butler, 2003). 1999, 1999 , (1999) Gutiérrez text Man Castro Cuba 1990s s Peace sex Butler, Butler (Butler 2003. 2003 . 2003) 199 (1999 200 19 (199 20 1 (19 2 (1 (

RESUMEN: El objetivo de este estudio fue comparar y analizar la eficacia clínica de diferentes abordajes de clavo intramedular con tornillos de bloqueo para las fracturas de tibia proximal. Se incluyeron en el estudio 100 casos de fracturas de tibia proximal tratados en el departamento de ortopedia desde abril de 2021 hasta septiembre de 2023 y se dividieron en grupos de control y de tratamiento mediante una tabla de números aleatorios. Un grupo control (n=50) tratado con clavo intramedular infrapatelar con tornillos de bloqueo, y un grupo tratamiento (n=50) tratado con clavo intramedular suprapatelar con tornillos de bloqueo. Observamos excelentes y buenas tasas en ambos grupos, comparamos varios indicadores perioperatorios, cambios en el rango de movimiento articular (ROM), puntuaciones de dolor en la escala visual analógica (EVA), puntuaciones de función Lysholm de la articulación de la rodilla , cambios en factores inflamatorios y varios marcadores óseos, antes y después del tratamiento, y se analizaron las complicaciones postoperatorias. No hubo diferencias significativas en los datos iniciales como edad, sexo, índice de masa corporal, sitio de fractura, fracturas de fíbula concomitantes, tiempo desde la fractura hasta la cirugía, mecanismo de lesión y clasificación de fractura AO/OTA entre los dos grupos (P>0,05). La tasa de excelente y buena en el grupo con tratamiento después del tratamiento fue del 90,00 % (45/50), significativamente mayor que el 72,00 % (36/50) en el grupo control (P<0,05). No hubo diferencias significativas en la pérdida de sangre intraoperatoria y el tiempo de curación de las fracturas entre los dos grupos (P>0,05). Sin embargo, el grupo con tratamiento tuvo tiempos quirúrgicos más cortos y menos tiempos de fluoroscopía que el grupo control (P <0,05). Después del tratamiento, ambos grupos mostraron un aumento de las puntuaciones de ROM y Lysholm, así como una disminución de las puntuaciones de VAS. Además, en comparación con el grupo control, el grupo con tratamiento tuvo puntuaciones ROM y Lysholm más altas y puntuaciones EVA más bajas (P <0,05). Los factores inflamatorios que incluyen interleucina-1β (IL-1β), proteína C reactiva (CRP), factor de necrosis tumoral-α (TNF-α), osteocalcina (BGP) y calcitonina (CT) aumentaron en ambos grupos después del tratamiento, mientras que el total disminuyó el propéptido n-terminal del procolágeno tipo I (Total-PINP) y el telopéptido β-C-terminal del colágeno tipo I (β-CTX). En comparación con el grupo control, el grupo con tratamiento mostró mayores aumentos en los factores inflamatorios y niveles más bajos de Total-PINP y β-CTX, pero niveles más altos de BGP y CT (P <0,05). La incidencia de complicaciones postoperatorias fue del 8 % (4/50) en el grupo de tratamiento y del 24 % (12/50) en el grupo control, con diferencias estadísticamente significativas (P=4,762, X2=0,029). En el tratamiento de las fracturas de tibia proximal, el clavo intramedular con tornillos de bloqueo mediante el abordaje suprapatelar logra una eficacia clínica significativa. Reduce el tiempo quirúrgico, minimiza la exposición a la radiación de los trabajadores de la salud y los pacientes, mejora el rango de movimiento y la función de la articulación de la rodilla, disminuye el dolor postoperatorio y las tasas de complicaciones, suprime las reacciones inflamatorias y promueve la mejora de los marcadores óseos relacionados con la curación de las fracturas.

SUMMARY: The objective of this study was to compare and analyze the clinical efficacy of different approaches of intramedullary nailing with blocking screws for proximal tibial fractures. One hundred cases of proximal tibial fractures treated in the orthopedic department from April 2021 to September 2023 were included in the study and divided into control and treatment groups using a random number table. A control group (n=50) treated with infrapatellar intramedullary nailing with blocking screws, and a treatment group (n=50) treated with suprapatellar intramedullary nailing with blocking screws. We observed the excellent and good rates in both groups, compared various perioperative indicators, changes in joint range of motion (ROM), Visual Analog Scale (VAS) pain scores, Lysholm knee joint function scores, changes in inflammatory factors, and various bone markers before and after treatment, and analyzed postoperative complications. There were no significant differences in baseline data such as age, sex, body mass index, fracture site, concomitant fibular fractures, time from fracture to surgery, injury mechanism, and AO/OTA fracture classification between the two groups (P>0.05). The excellent and good rate in the treatment group after treatment was 90.00 % (45/50), significantly higher than 72.00 % (36/50) in the control group (P<0.05). There were no significant differences in intraoperative blood loss and fracture healing time between the two groups (P>0.05). However, the treatment group had shorter surgical times and fewer fluoroscopy times than the control group (P<0.05). After treatment, both groups showed increased ROM and Lysholm scores, as well as decreased VAS scores. Moreover, compared to the control group, the treatment group had higher ROM and Lysholm scores and lower VAS scores (P<0.05). Inflammatory factors including interleukin-1β (IL-1β), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), osteocalcin (BGP), and calcitonin (CT) increased in both groups after treatment, while total n- terminal propeptide of type I procollagen (Total-PINP) and b-C-terminal telopeptide of type I collagen (β-CTX) decreased. Compared to the control group, the treatment group exhibited greater increases in inflammatory factors and lower levels of Total-PINP and β-CTX, but higher BGP and CT levels (P<0.05). The incidence of postoperative complications was 8.00 % (4/50) in the treatment group and 24.00 % (12/50) in the control group, with statistically significant differences (P=4.762, X2=0.029). In the treatment of proximal tibial fractures, intramedullary nailing with blocking screws using the suprapatellar approach achieves significant clinical efficacy. It reduces surgical time, minimizes radiation exposure to healthcare workers and patients, improves knee joint range of motion and function, decreases postoperative pain and complication rates, suppresses inflammatory reactions, and promotes the improvement of bone markers related to fracture healing.

Abstract Housing leaves a sample of different contexts in which the city is lived; its size, shape and location, according to its typology, are the initial referents of the costs in the market and therefore of those who acquire them. The main objective of this work is to expose a cartography of housing in the city. Where the urban form configured from the new house for sale and the social inequality that is marked through its acquisition is shown, taking into account only its economic dimension, which is affected according to its dimensions, location and the means to its financing. For this, 28 subdivisions that where identified had new homes for sale are analyzed, between May 2020 and April 2021, in Pachuca, Hidalgo, Mexico. This shows cuts in the city, which occur between spatial fractures and social disparity, which are evident from the type of housing and its costs in the real estate market.

Resumen La vivienda deja muestra de contextos diferenciados en los que se vive la ciudad; su tamaño, forma y ubicación, según su tipología, son los referentes iniciales de los costos en el mercado y, por ende, del poder económico de quienes las adquieren. Este trabajo tiene como objetivo principal dejar a la vista una cartografía de la vivienda en la ciudad, donde se muestre la forma urbana configurada a partir de la vivienda nueva a la venta y la desigualdad social que se marca a través de su adquisición. Se considera únicamente su dimensión económica, viéndose afectada según sus dimensiones, ubicación y los medios para su financiamiento. Para ello, fueron analizados 28 fraccionamientos identificados por contar con vivienda nueva a la venta, entre mayo del 2020 y abril del 2021, en Pachuca, Hidalgo, México. Lo anterior deja muestra de recortes en la ciudad, dados entre las fracturas espaciales y la disparidad social, y evidenciados a partir de la tipología de la vivienda y sus costos en el mercado inmobiliario.