RESUMO Objetivo: Avaliar retrospectivamente e comparar proporções de complicações e achados radiográficos da osteossíntese da fratura do úmero proximal em duas e três partes com dois métodos de tratamento: haste intramedular bloqueada de terceira geração e placa bloqueada. Métodos: Foram avaliados 46 pacientes com idade média de 58,9 ± 16,6 entre janeiro de 2020 a janeiro de 2021. Em 16 casos (34,8%), utilizou-se a haste intramedular e, em 30 casos (65,2%), a placa bloqueada de úmero proximal. A avaliação incluiu a taxa de complicações com seguimento mínimo de seis meses de pós-operatório e avaliação radiográfica. Resultados: Não houve diferença significativa entre os grupos quanto à proporção de complicações (grupo haste: 18,8%; grupo placa: 13,3%; p = 0,681). O grupo haste apresentou menor perda residual em varo (ângulo cervicodiafisário: grupo haste com 132,1º ± 2,3º; grupo placa com 123,8º ± 10,1º; p < 0,001). No grupo placa, as mulheres apresentaram menor índice de tuberosidade-deltoide (DTI) (1,43 ± 0,22) em relação aos homens (1,58 ± 0,11) (p = 0,022). Conclusão: No seguimento de curto prazo, a osteossíntese, com placa bloqueada ou haste intramedular, não apresentou diferenças nas proporções de complicações. O grupo haste apresentou menor alteração do ângulo cervicodiafisário no pós-operatório; entretanto, ocorreram duas complicações graves com cut out e desvio em varo com necessidade de reabordagem cirúrgica no grupo haste. Nível de Evidência II, Estudo Retrospectivo Observacional.

ABSTRACT Objective: To evaluate and compare the proportions of complications and radiographic findings of osteosynthesis of 2- and 3-part proximal humerus fractures with two methods of treatment: third-generation antegrade nailing and locking plate. Methods: 46 patients with a mean age of 58.9 ± 16.6 years between January 2020 and January 2021 were evaluated. In sixteen cases (34.8%), antegrade nailing was used, and in thirty cases (65, 2%), a locking proximal humerus plate. The method used included the rate of complications with a minimum follow-up of 6 months after surgery and radiographic evaluation. Results: There was no difference between the groups regarding the proportion of complications (nail group 18.8%, plate group 13.3%; p = 0.681). The nail group had less residual varus loss (cervicodiaphyseal angle nail group with 132.1º ± 2.3º, plate group 123.8º ± 10.1º; p < 0.001). In the plate group, women had the lowest value (1.43 ± 0.22) of the deltoid tuberosity index (DTI) compared to men (1.58 ± 0.11) (p = 0.022). Conclusion: Osteosynthesis, with a locking plate and antegrade nailing, did not show differences in the proportion of complications. The nail group had less change in the postoperative cervicodiaphyseal angle, however, there were two serious complications with screw cut-out and varus deviation, requiring surgical reapproach. Level of Evidence II, Retrospective Observational Study.

OBJECTIVE: To evaluate and to compare the Spaso and Kocher reduction maneuvers in terms of efficiency, time of reduction, facileness, pain, discomfort to the patient, complications and risks, besides promoting the comparison between the two maneuvers, aiming to ground the emergency conduct. METHODS: A prospective study with 105 patients with acute shoulder dislocations were enrolled in the study between February 2011 and September 2012. The patients were randomized into two groups and they were submitted to the reduction of dislocation using the Spaso maneuver (group A) or the Kocher technique (group B) by first, second or third-year orthopedic surgery residents from our service. The results were evaluated and compared. RESULTS: There was no statistically significant difference between the two groups in terms of age, gender, timing of reduction, number of precedent episodes and complications after reduction. However, reduction was achieved in more cases using the Spaso method than it was among the Kocher group, as well as the mean duration of the reduction maneuver and discomfort were shorter in the group A patients. CONCLUSIONS: Both methods presented good results in terms of dislocation reduction and low complications rates. Nevertheless, the Spaso maneuver was more efficient, fast and easily applicable in comparison with Kocher's method. Level of Evidence I, Therapeutic.

INTRODUÇÃO: A ingesta de corpos estranhos é um acontecimento frequente, principalmente entre crianças. A maioria destes passa de forma inócua pelo trato gastrointestinal, sem causar sintomas ou deixar sequelas. Apendicite aguda é a patologia cirúrgica emergencial de maior prevalência. CONTUDO: a impactação de um corpo estranho no lúmen apendicular como agente etiológico de apendicite é um evento muito raro. RELATO DE CASO: Descrevemos o caso de um paciente masculino de 21 anos com quadro de dor abdominal baixa há aproximadamente 6 dias, associando-se a vômitos, febre e distensão abdominal. Após exames de imagem, identificou-se corpo estranho radiopaco em topografia pélvica, distensão e níveis hidroaéreos em alças intestinais. Foi submetido a apendicectomia laparotômica, evidenciando-se apendicite aguda perfurada e presença de dois corpos estranhos em seu lúmen. Evoluiu de forma satisfatória no pós-operatório, tendo-se feito uso de antibióticos de largo espectro. DISCUSSÃO: Corpos estranhos impactados no trato gastrointestinal são usualmente retirados por técnicas endoscópicas. Quando provocam quadros infecciosos, deve-se proceder a uma resolução cirúrgica, preferencialmente por videolaparoscopia, a qual servirá tanto para fins diagnósticos quanto terapêuticos.

INTRODUCTION: The ingestion of foreign bodies is a frequent occurrence, especially among children. The majority of these objects travel safely through the gastrointestinal tract, without causing symptoms or leaving sequelae. Acute appendicitis is the emergency surgical pathology of greater prevalence. However, the impaction of a foreign body into the appendicular lumen as an etiologic agent of appendicitis is a very rare event. CASE REPORT: We describe the case of a 21-year-old male patient with lower abdominal pain over approximately six days, in association with vomiting, fever and abdominal distension. After imaging studies, a radiopaque foreign body was identified in a pelvic topography, with distention and air-fluid levels in intestinal loops. Our patient was submitted to an open appendectomy, evidencing acute perforated appendicitis and the presence of two foreign bodies in its lumen. The patient progressed satisfactorily in the post-operative period, with use of broad-spectrum antibiotics. DISCUSSION: Foreign bodies impacted in the gastrointestinal tract are usually removed by endoscopic techniques. When these bodies cause infections, there should be a resolution, preferably by surgical laparoscopy, which will serve both for diagnostic as therapeutic purposes.