ABSTRACT Monteggia fracture-dislocations are rare injuries, affecting about 2-5% of the population. Jesse Jupiter subdivided Bado’s Type II fractures into four types, all of which presented an associated radial head fracture. Associated chondral and ligament injuries can evolve with postoperative complications. Objective: To evaluate the incidence of complications and risk factors that may influence the postoperative outcomes of Jupiter lesions. Methods: This retrospective study was conducted with surgically treated patients. The characteristics related to fractures and surgical approaches were evaluated and these variables were correlated with radiographic and functional postoperative complications. Results: A total of 15 patients were evaluated, mostly men and with a higher prevalence of Types IIA and IID. The most frequent complications were heterotopic ossification and osteolysis around the radial head prosthesis. Postoperative instability occurred only in the lateral collateral ligament. According to MEPS functional score, 53% of the patients evolved with unfavorable outcomes. Conclusion: The studied cases evolved with high rates of postoperative complications, mainly in Jupiter’s Type IID fractures and associated coronoid fractures. Level of Evidence III, Therapeutic Study.

RESUMO A fratura-luxação de Monteggia é uma lesão rara que acomete cerca de 2-5% da população. Jesse Jupiter subdividiu as fraturas tipo II de Bado em quatro tipos, todos eles associados à fratura da cabeça do rádio. As lesões condral e ligamentares associadas podem evoluir com complicações pós-operatórias. Objetivo: Avaliar a incidência das complicações e os fatores de risco que podem influenciar os resultados pós-operatórios nas fraturas de Monteggia tipo II de Jupiter. Métodos: Estudo retrospectivo com pacientes tratados cirurgicamente. Avaliaram-se as características relacionadas às fraturas e as técnicas cirúrgicas utilizadas e, em seguida, tais variáveis foram correlacionadas com complicações pós-operatórias radiográficas e funcionais. Resultados: Foram avaliados 15 pacientes, havendo predomínio do sexo masculino e maior prevalência das fraturas tipo IIA e IID. As complicações mais frequentes foram a ossificação heterotópica e a osteólise ao redor da prótese da cabeça do rádio. A instabilidade pós-operatória ocorreu somente no complexo ligamentar lateral. Funcionalmente, segundo o Mayo Elbow Performance Score, 53% dos pacientes evoluíram com resultados desfavoráveis. Conclusão: Observou-se alta taxa de complicação pós-operatória, principalmente nas fraturas tipo II-D de Jupiter e naquelas com fratura do coronoide associada. Nível de Evidência III, Estudo Terapêutico.

Abstract Objectives: The aim of this study was to evaluate the effect of STS resection in the thigh on MS and the HRQoL. Methods: Fourteen adults patients with STS in the thigh who underwent wide resection and limb preservation were evaluated. The patients were submitted to the Mini-Mental State Examination (MMSE). A hand-held dynamometer was used to measure the MS the flexors, adductors, abductors, and extensors muscles of the operated and non-operated thighs and between the dominant and non-dominant operated sides. The Musculoskeletal Tumor Society (MSTS) and Short Form Health Survey-36 (SF-36) questionnaires were applied to quantify the psychometric properties of the HRQoL. The data were submitted to statistical analysis using the Wilcoxon test (MS), and Mann-Whitney and Spearman correlation (MSTS and SF-36) (α = 0.05). Results: There was no significant difference in MS between the operated side and the non-operated side, and between the dominant and non-dominant operated side (ρ > 0.05). The MSTS presented a significant difference in the emotional acceptance for patients submitted to radiotherapy (ρ = 0.029). The SF-36 showed significant differences in the emotional aspect for patients submitted to chemotherapy (ρ = 0.027) and in the social aspect between the dominant and non-dominant operated side (ρ = 0.024). Conclusions: The HRQoL of adult patients is hampered after the treatment of STS even when MS is maintained.

RESUMO Objetivo: Avaliar dados normativos da força isocinética do ombro de judocas profissionais, saudáveis. Métodos: Estudo transversal com 20 atletas profissionais de ambos os sexos (dez mulheres) avaliados com dinamômetro isocinético. A avaliação da força foi realizada em rotação externa e interna, flexão, extensão, adução e abdução. Todos os dados coletados do torque muscular foram normalizados com o índice de massa corporal. Resultados: Os atletas demonstraram maior pico de torque e trabalho articular em adução, abdução, flexão e extensão do ombro para o membro dominante, comparado ao contralateral (p < 0,05), com a maioria desses défices abaixo de 10%. As razões de rotação interna/externa do ombro para atletas de ambos os sexos não apresentaram diferenças significativas entre o lados dominante e não dominante, demonstrando valores a 60°/s de 49,4 ± 7,2 no lado dominante dos homens e 49,1 ± 4,9 no das mulheres. Conclusão: Os dados normativos são descritos para auxiliar durante o tratamento, o retorno ao esporte e a prevenção de lesões. Nível de evidência IV, estudo transversal.

ABSTRACT Objective: To evaluate normative data of shoulder isokinetic strength in healthy professional judo athletes. Methods: Cross-sectional study with 20 professional male and female athletes (10 female), evaluated with an isokinetic dynamometer. The strength assessment was carried out in external and internal rotation, flexion, extension, adduction and abduction. All data collected on muscle torque were normalized with body mass index. Results: Athletes demonstrated higher peak torque and joint work in shoulder adduction, abduction, flexion, and extension for the dominant limb compared to the non-dominant limb (p <0.05), with most of these deficits below 10%. Shoulder internal/external rotation ratios for male and female athletes had no significant differences between dominant and non-dominant sides, demonstrating values at 60°/s of 49.4 ± 7.2 on the dominant side of males and 49.1 ± 4.9 for females. Conclusion: The normative data are described to assist during treatment, return to sport and injury prevention. Level of evidence IV, cross-sectional study.

RESUMO Objetivo: Avaliar a via de acesso de escolha entre os ortopedistas brasileiros e se a formação de especialista em cirurgia do ombro e/ou tempo de experiência influenciam nessa decisão. Métodos: Realizou-se questionário entre ortopedistas, com e sem especialização em ombro, sobre qual a via de acesso preferida e as complicações observadas. Aplicou-se o teste do qui-quadrado ou o teste exato de Fisher. Resultados: Foram entrevistados 114 ortopedistas, 49 (43,0 %) traumatologistas, 36 (31,5 %) cirurgiões especialistas e 29 (25 %) residentes de especialização em cirurgia do ombro. Nas fraturas sem luxação a formação especializada e o tempo de experiência não influenciaram na escolha (maioria deltopeitoral). Na fratura/luxação, 97,2% dos especialistas optaram pela deltopeitoral, comparado com 82,1% dos traumatologistas (p=0,034). Nas fraturas/luxação, cirurgiões com experiência superior a 5 anos optaram pela deltopeitoral (92,5%) e aqueles com menos de 5 anos optaram pela via deltopeitoral (78,7%) (p=0,032). A diminuição do arco de movimento (ADM) foi a complicação mais relatada. Conclusão: A especialização em cirurgia do ombro não influenciou na escolha nas fraturas sem luxação. Na fratura/luxação, a especialização e o tempo de experiência associaram-se à escolha da via deltopeitoral. A complicação mais frequente foi a diminuição do ADM, principalmente entre os cirurgiões do Ombro. Nível de Evidência V, Opinião de especialistas.

ABSTRACT Objective: To evaluate the choice of surgical approach among Brazilian orthopedists and whether shoulder surgery specialty training or duration of experience influences the decision-making. Methods: A questionnaire on the preferred approach and complications was administered to orthopedic surgeons with and without shoulder specialization training. The chi-square test or Fisher's exact test was applied. Results: We interviewed 114 orthopedists, 49 (43.0%) traumatologists, 36 (31.5%) specialist surgeons, and 29 (25%) shoulder surgery specialist residents. In cases of fracture without dislocation, specialized training and duration of experience did not influence the approach used (primarily deltopectoral). In cases of fracture/dislocation, 97.2% of the specialists versus 82.1% of the traumatologists opted for the deltopectoral approach (p = 0.034). In cases of fractures/dislocation, 92.5% of surgeons with more than 5 years of experience and 78.7% with less than 5 years of experience opted for the deltopectoral approach (p = 0.032). Conclusion: Specialization in shoulder surgery did not influence surgeons' approaches to manage fractures without dislocation. In cases of fracture/dislocation, shoulder surgery specialization training and duration of experience were associated with selection of the deltopectoral approach. Level of Evidence V, Expert opinion.

RESUMO INTRODUÇÃO: O carcinoma de mama é um tumor maligno comum no mundo desenvolvido. O diagnóstico tardio da doença está associada com metástases ósseas. O fêmur é comumente afetado. Fatores prognósticos de mortalidade em pacientes com metástases ósseas provenientes de cânceres em geral têm sido relatados. No entanto, não há nenhum relatório específico de fatores prognósticos em relação à metástase do câncer de mama no fêmur tratados cirurgicamente. A determinação de fatores prognósticos em pacientes com metástases ósseas pode auxiliar a tomada de decisões terapêuticas. OBJETIVO: Determinar os fatores clínicos e ortopédicos relacionados com a mortalidade em pacientes com câncer de mama e metástases ao fêmur tratados cirurgicamente. MÉTODO: Foi realizado um estudo retrospectivo que incluiu 41 pacientes submetidos ao tratamento cirúrgico de metástases femorais. Foram analisadas as seguintes variáveis: (i) número e a localização das metástases ósseas, (ii) metástases viscerais, (iii) presença de fratura patológica, (iv) método de fixação e (v) testes de laboratório. Esses fatores foram correlacionados com a mortalidade por meio de regressão logística multivariada Cox e curvas Kaplan-Meier. RESULTADOS: Houve uma alta prevalência de metástases múltiplas associadas com fraturas patológicas, no momento da cirurgia. A mortalidade foi alta e precoce. Localização subtrocantéricas, a presença de fraturas, anemia e alterações na função renal foram associados a maior mortalidade. O método de fixação, o número de metástases ósseas, e a presença de metástases em outros órgãos não alterou a mortalidade. CONCLUSÕES: O câncer de mama com metástase para o fêmur é uma doença avançada, com mortalidade precoce. Factores clínicos e ortopédicas deve ser considerado. A cirurgia é recomendada quando ocorrem lesões, independente do tipo de implante utilizado.

BACKGROUND: Breast carcinoma is a common malignancy in the developed world. Late diagnosis of the disease is associated with bone metastasis. The femur is commonly affected. Prognostic factors of mortality in patients with bone metastases originating from cancers in general have been reported. However, there is no specific report of prognostic factors in relation to breast cancer metastasis in the surgically treated femur. The determination of prognostic factors in patients with bone metastasis can assist in therapeutic decisions. OBJECTIVE: To determine clinical and orthopedic factors related to mortality in patients with breast cancer and metastases to the femur treated surgically. METHOD: This was a retrospective study and included 41 patients undergoing surgical treatment of femoral metastases. We analyzed the following variables: (i) number and location of bone metastases, (ii) visceral metastases, (iii) presence of pathological fracture, (iv) fixation method, and (v) laboratory tests. These factors were correlated with mortality using Cox Multivariate Logistic regression and Kaplan-Meier curves. RESULTS: There was a high prevalence of multiple metastases associated with pathological fractures at the time of surgery. Mortality was high and early. Subtrochanteric location, the presence of fractures, anemia, and alterations in renal function were associated with higher mortality. The fixation method, the number of bone metastases, and the presence of metastasis in other organs did not affect mortality. CONCLUSIONS: Breast cancer with metastasis to the femur is an advanced disease with early mortality. Clinical and orthopedic factors should be considered. Surgery is recommended when lesions occur, regardless of the type of implant used.

OBJECTIVE: Unplanned excision of soft tissue sarcomas is common because benign soft tissue lesions are very frequent. This study evaluated the impact of unplanned resections on overall survival, local recurrence and distant metastasis in patients with soft tissue sarcomas of the extremities. METHODS: In total, 52 patients who were diagnosed with soft tissue sarcomas between May 2001 and March 2011 were analyzed in a retrospective study. Of these patients, 29 (55.8%) had not undergone previous treatment and the remaining 23 (44.2%) patients had undergone prior resection of the tumor without oncological planning. All subsequent surgical procedures were performed at the same cancer referral center. The follow-up ranged from 6 to 122 months, with a mean of 39.89 months. Age, lesion size and depth, histological grade, surgical margins, overall survival, local and distant recurrence and adjuvant therapies were compared. RESULTS: Residual disease was observed in 91.3% of the re-resected specimens in the unplanned excision group, which exhibited greater numbers of superficial lesions, low histological grades and contaminated surgical margins compared with the re-resected specimens in the planned excision group. No differences were observed in local recurrence and 5-year overall survival between the groups, but distant metastases were significantly associated with planned excision after adjustment for the variables. CONCLUSIONS: There was no difference between patients undergoing unplanned excision and planned excision regarding local recurrence and overall survival. The planned excision group had a higher risk of distant metastasis, whereas there was a high rate of residual cancer in the unplanned excision group.

OBJECTIVES: To study the role of angiogenesis and cyclooxygenase-2 expression in cartilaginous tumors and correlate these factors with prognosis. INTRODUCTION: For chondrosarcoma, the histological grade is the current standard for predicting tumor outcome. However, a low-grade chondrosarcoma can follow an aggressive course-as monitored by sequential imaging techniques-even when it is histologically indistinguishable from an enchondroma. Therefore, additional tools are needed to help identify the biological potential of these tumors. The degree of angiogenesis that is induced by the tumor could assist in this task. Angiogenesis can be quantified by measuring the expression of vascular endothelial growth factor and CD34, and cyclooxygenase-2 can induce angiogenesis by stimulating the production of proangiogenic factors. METHODS: In total, 21 enchondromas and 58 conventional chondrosarcomas were studied by examining the clinical and histopathological findings in conjunction with the immunostaining markers of angiogenesis and cyclooxygenase- 2 expression. RESULTS: The significant variables that were associated with poor outcome were 1) higher-grade chondrosarcomas, 2) tumors that developed in flat bones, and 3) over-expression of CD34 (with a median count that was higher than 5.9 vessels in 5 high power fields). Moreover, CD34 expression (measured using the Chalkley method) revealed significantly higher microvessel density in flat bone chondrosarcomas. DISCUSSION: Previous studies have shown a positive correlation between Chalkley microvessel density and histological grade; however, in our sample, we found that the former is predictive of the outcome. Chondrosarcomas in flat bones have been shown to correlate with a poor prognosis. We also found that CD34 microvessel density values were significantly higher in flat-bone chondrosarcomas. This could explain-at least in part-the more aggressive biological course that is taken by these tumors. CONCLUSIONS: These results provide evidence that CD34 microvessel density in chondrosarcomas can be helpful in predicting patient outcome and may add to our understanding of chondrosarcoma pathogenesis.