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Acute ankle injury is one of the main reasons for observation of patients in the emergency department. Only 15% present with clinically significant fractures, but they are almost always referred for radiography. The Ottawa ankle rules have provided specific directions for carrying out radiography in these situations, allowing a reduction in hospital costs and reducing exposure to ionizing radiation. The aim of the study is to verify that the protocol of the Ottawa rules for evaluating ankle trauma can adapt to a sample of the Portuguese population.This prospective study was done in the Emergency Department of Orthopedics, for a period of 9 months, integrating all patients who presented with complaints in the ankle with less than 48 hours development. All patients underwent radiography of the injured area. Radiographic images were evaluated by the orthopaedic doctor in the emergency department. Patients were reassessed in about 10-15 days after injury by the same observer.We evaluated 123 patients. The average age was 35.2 (range, 7 to 88) years. Sixty had positive criteria for radiological assessment, of which 43 had fracture; none of the patients with negative criteria had fratures. Sensitivity of Ottawa ankle rules for detecting fractures was 100%.The implementation of the Ottawa ankle rules appears to have potential to reduce the number of radiographs for the assessment of these patients by about 51%. The results of this study demonstrate no false negatives and are consistent with the results of other similar studies which sensitizes us to implement these criteria in our emergency services.

As deformidades axiais dos membros inferiores constituem um dos principais motivos de consulta na área de Ortopedia Infantil. Esta situação deve-se, por um lado, ao facto de haver uma grande percentagem de crianças (cerca de 20%) que apresentam uma deformidade fisiológica durante o desenvolvimento e, por outro, à «tradição» existente, segundo a qual estes desvios necessitam de um tratamento, usualmente por calçado ortopédico. Torna-se, por isso, imperioso destrinçar o fisiológico do patológico, diferenciar as diferentes etiologias e corrigi-las precocemente medicamente e, ainda, determinar quando uma deformidade é passível de correcção espontânea ou quando exige uma terapêutica cirúrgica.

Os conceitos que ditam o diagnóstico e o tratamento das lesões de etiologia traumática na criança (e no adulto) são, frequentemente, «diluídos» na enorme massa de informação fornecida durante a formação universitária e pós-graduada dos médicos. Para poder ultrapassar estas limitações apresenta-se, de forma genérica, a fisiopatologia, a epidemiologia e a semiologia a valorizar num quadro de traumatologia infantil; também são apresentados alguns princípios terapêuticos para solucionar uma parte significativa destas situações.

ABSTRACT Objective: This study aims to compare the use of halo-gravity traction (HGT) with and without previous anterior release, in terms of curve reduction, for the treatment of pediatric severe spinal deformity. Methods: From 2010 to 2016, all patients treated with HGT prior to instrumentation for scoliosis and kyphoscoliosis were reviewed. They were assessed by deformity etiology, previous anterior release, instrumentation procedure used, traction protocol, major Cobb angle before traction, after the protocol, and after the instrumentation procedure. Twelve patients met these criteria and constituted the sample groups: Group I (n=7) with anterior release and Group II (n=5) without anterior release. Results: The average pre-traction major curve Cobb angles were 114.9o and 108.4º for Group I and II, respectively (P>0.05). After HGT, both groups achieved a significant reduction in curve angle (P0.05). No major HGT related complications were reported. Conclusions: Anterior release prior to HGT did not increase major curve correction after posterior surgery for severe pediatric idiopathic and syndromic scoliosis. HGT is an effective and safe technique, though it frequently presents minor and transitory complications. Level of Evidence III; Retrospective Comparative Study.

This study attempts to analyze the relationship between two key psychological variables associated with performance in sports – Self-Determined Motivation and Competitive Anxiety – through Bayesian Networks (BN) analysis. We analyzed 674 university students that are athletes from 44 universities that competed at the University Games in Mexico, with an average age of 21 years (SD = 2.07) and with a mean of 8.61 years’ (SD = 5.15) experience in sports. Methods: Regarding the data analysis, firstly, classification using the CHAID algorithm was carried out to determine the dependence links between variables; Secondly, a BN was developed to reduce the uncertainty in the relationships between the two key psychological variables. The validation of the BN revealed AUC values ranging from 0.5 to 0.92. Subsequently, various instantiations were performed with hypothetical values applied to the “bottom” variables. Results showed two probability trees that have extrinsic motivation and amotivation at the top, while the anxiety/activation due to worries about performance was at the bottom of the probabilities. The instantiations carried out support the existence of these probabilistic relationships, demonstrating their scarce influence on anxiety about competition generated by the intrinsic motivation, and the complex probabilistic effect of introjected and identified regulation regarding the appearance of anxiety due to worry about performance.