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Introduction: About 20% of all fractures in the human skeleton involves the hand, affecting primarily the young and active population. A Bennett’s fracture (BF) is a fracture of the base of the first metacarpal and surgical management is generally needed, with the K-wire fixation being the most preferred option. Among the most common complications with K-wires, we find infection and soft-tissues damages like tendon ruptures. Case Report: Here, we report a case of iatrogenic rupture of the Little Finger’s Flexor Profundus Tendon after K-wire fixation of a BF that was diagnosed 4 weeks after the lesion. Different surgical strategies were proposed for managing chronic flexor tendon’s ruptures; however, no consensus exist around what option would be the best. Here, we describe a flexor transfer from the 5th to the 4th finger that resulted in a great improvement in patient’s DASH score and general quality of life. Conclusion: It is important to remember that percutaneous fixations with K wires in the hand can have disastrous complications, patients should be evaluated for possible tendon ruptures after the surgery, no matter how impossible they may seem, as even unexpected complications can have easier solutions in the acute setting. Keywords: Bennett’s Fracture, Complications, Tendon rupture, Tendon Repair, Tendon Transfer.

Objectives: Hip fractures in the elderly are common injuries that need timely surgical management. Since the beginning of the pandemic, patients with a proximal femoral fracture (PFF) experienced a delay in time to surgery. The primary aim of this study was to evaluate a possible variation in mortality in patients with PFF when comparing COVID-19 negative versus positive. Methods: This is a multicentric and retrospective study including 3232 patients with PFF who underwent surgical management. The variables taken into account were age, gender, the time elapsed between arrival at the emergency room and intervention, pre-operative American Society of Anesthesiology score, pre-operative cardiovascular and respiratory disease, and 10-day/1-month/6-month mortality. For 2020, we had an additional column, “COVID-19 swab positivity.” Results: COVID-19 infection represents an independent mortality risk factor in patients with PFFs. Despite the delay in time-to-surgery occurring in 2020, no statistically significant variation in terms of mortality was detected. Within our sample, a statistically significant difference was not detected in terms of mortality at 6 months, in patients operated within and beyond 48 h, as well as no difference between those operated within or after 12/24/72 h. The mortality rate among subjects with PFF who tested positive for COVID-19 was statistically significantly higher than in patients with PFF who tested. COVID-19 positivity resulted in an independent factor for mortality after PFF. Conclusion: Despite the most recent literature recommending operating PFF patients as soon as possible, no significant difference in mortality was found among patients operated before or after 48 h from diagnosis.

Proximal humerus fractures (PHFs) are frequent and associated with significant health care burden. National epidemiological data are limited. Our objective is to characterize the Portuguese population admitted with PHFs and analyze therapeutic management, the impact of associated lesions, and mortality rate.This was a retrospective, observational study of admissions from mainland public hospitals (2000-2015), with primary or secondary diagnosis of PHFs. Incomplete records, pathologic lesions, malunion/nonunion, and hardware removal were excluded. Age, gender, admission date, hospitalization period, associated injuries, treatment, and mortality were recorded.A total of 19,290 patients were included. Through the analyzed period, an increase in the absolute number and incidence of PHFs was observed. The mean age at diagnosis was 62.6 ± 21.0 years old (57% elderly; 63.5% female). The mean length of stay was 10.0 ± 14.1 days, higher in patients submitted to arthroplasty (There is a trend toward an increase in surgical management of PHFs. The relative proportion of open reduction and internal fixation and arthroplasty (particularly reverse arthroplasty) increased, probably reflecting biomechanical implant properties, fracture pattern, and demand for better functionality. Associated fractures are an important comorbidity, associated with increased mortality and length of stay.

Loss of reduction is the most common complication following acromioclavicular dislocations treatment, with literature showing greater postoperative coracoclavicular distances associated with worse clinical results. We present a surgical gesture that aims to help surgeons achieve and secure an anatomic acromioclavicular reduction during coracoclavicular fixation. This technique has the possibility to improve radiological and functional results of acromioclavicular dislocation treatment., Technique Video Video 1 A technique for a more accurate acromioclavicular joint reduction in arthroscopic coracoclavicular stabilization of acromioclavicular joint dislocation.

Few studies have compared conventional and self-assisted shoulder reduction maneuvers. The goal of this study was to evaluate the results of self-assisted Davos vs. traction/countertraction (T/Ct) techniques in the treatment of acute anterior shoulder dislocations.This was a single-center, prospective study carried out at a tertiary hospital emergency department. Patients aged 18-69 years old, with radiographic confirmation of anterior glenohumeral dislocations, were consecutively allocated to treatment groups. Recorded data included pain at admission (visual analog scale [VAS] score at admission), analgesia before reduction, maximum pain during reduction (maximum VAS score), demographic characteristics, lesion mechanism, laterality, prior dislocation, and immediate complications. The primary outcomes were reduction success rate and pain.Eighty individuals were included (40/group). Regarding the success rate, no statistically significant differences were found between Davos or T/Ct (87.5% vs. 85%;Davos was as effective as T/Ct for reduction of acute anterior shoulder dislocations (highest reported success rate: 87.5%) and conditioned a less traumatic experience, with significantly lower pain during reduction (the maximum VAS score was more than 2 points lower in the Davos group;The Davos is a patient-controlled, atraumatic, and safe technique, allowing successful, gentle, and less painful glenohumeral reduction. These findings favor Davos as an easy-to-teach and effective first-line treatment for first-time and recurrent shoulder dislocations.

Case A 41-year-old right-handed male patient presented to our institution with a chronic distal biceps rupture after failed primary surgery 6 months previously. We performed a reconstruction with semitendinosus autograft fixed proximally with a Pulvertaft weave and distally with a cortical button plus interference screw. The patient showed complete pain resolution and excellent functional results. Conclusion This is the first case described with the use of a cortical button plus interference screw distally for distal biceps reconstruction after chronic distal biceps rupture. The option of doing the Pulvertaft proximally first also allowed us to fine-tune the final graft tension.

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Introduction: Increasing interest has been seen in understanding the anatomy and biomechanics involved in the Deep Gluteal Syndrome, therefore the main objective of our paper was to define the anatomy of the deep gluteal space concerning the important osseous, muscular and neurological structures. Methods: 12 cadaveric models (24 hemipelvises) were used. We proceeded with classical anatomic dissection and evaluated numerous osseous, musculotendinous and neurologic structures and their relationships. We also determined the femoral anteversion and neck-shaft angles. Results: We found that 15.4% of lower limbs examined presented variations in the sciatic nerve (SN) emergence, and this was significantly longer in men. The distance from the SN to the trochanteric region was also significantly lower in males. The average ischiofemoral distance (IFD) was 2.5 ± 1.3 cm, at the same time that the structures comprised in that space showed superior areas, such as the quadratus femoris (QF) with 5.0 ± 1.1 cm and the SN with 1.4 ± 0.3 cm widths. Besides that, we also evaluated the distance from the SN to the lesser trochanter (LT) and the ischial tuberosity (IT), in the ischiofemoral space, reaching average values of 1.1 ± 0.7 cm and 1.5 ± 0.6 cm respectively. Regarding the relationship between the proximal hamstring insertion, we verified that the LT was at an average distance of 1.6 ± 1.1 cm, that the SN was only 0.2 ± 0.3 cm lateral to it, and the PN is just 2.6 ± 1.2 cm proximal to it. Conclusions: Our study confirmed the extreme variation in the SN origin that can contribute to the Piriformis syndrome. The IFD obtained in our study showed that this distance was small for the structures contained in this space. The proximal hamstring insertion showed a significantly more extended footprint in males, which puts the pudendal nerve (PN) at higher risk of iatrogenic injury.

Health-related quality of life assessment is increasingly important as it can help both clinical research and care for patients, particularly among oncological patients. Quality of Life Questionnaire - OES18 (esophageal module) and Quality of Life Questionnaire - OG25 (esophagogastric module) are the European Organization for Research and Treatment of Cancer modules for the evaluation of quality of life in patients with esophageal and esophagogastric cancers, respectively. The aim of our study was to translate, to culturally adapt and to perform a pilot testing to create the Portuguese version of both questionnaires.The European Organization for Research and Treatment of Cancer guidelines were followed for translation, cultural adaptation and pilot testing of Quality of Life Questionnaire - OES18 (esophageal module) and Quality of Life Questionnaire - OG25 (esophagogastric module). The Quality of Life Questionnaire - OG25 (esophagogastric module) went through a process of forward (English → Portuguese) and backward (Portuguese → English) translation, by independent native speaker translators. After review, a preliminary version was created to be pilot tested among Portuguese patients. As a Brazilian version was already available for Quality of Life Questionnaire - OES18 (esophageal module), the questionnaire was simply culturally adapted and pilot tested. Both cancer and non-cancer patients were included.Overall, 30 patients completed the Portuguese version of each questionnaire. Afterwards, a structured interview was conducted to find and report any problematic items. Troublesome items and wording were changed according to the pilot testing results. The final versions were sent to the European Organisation for Research and Treatment of Cancer Quality of Life Group and approved.The Portuguese versions of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - OES18 (esophageal module) and OG25 (esophagogastric module) questionnaires are useful, reliable and valid tools for measuring health-related quality of life in patients with esophageal and esophagogastric cancers, respectively. They can now be used in clinical setting and for scientific purposes.Introdução: A avaliação da qualidade de vida relacionada com a saúde é cada vez mais importante, já que pode beneficiar a investigação clínica e os cuidados prestados aos doentes, particularmente entre doentes oncológicos. O Quality of Life Questionnaire – OES18 (esophageal module) e o Quality of Life Questionnaire – OG25 (esophagogastric module) são módulos da Organização Europeia para a Investigação e Tratamento do Cancro para avaliação da qualidade de vida em doentes com neoplasia esofágica e/ou esofagogástrica, respetivamente. O objetivo do nosso estudo foi traduzir, adaptar culturalmente e realizar um ensaio-piloto para criar a versão portuguesa de ambos os questionários. Material e Métodos: Foram seguidas as orientações da Organização Europeia para a Investigação e Tratamento do Cancro para tradução, adaptação cultural e ensaio-piloto do Quality of Life Questionnaire – OES18 (esophageal module) e Quality of Life Questionnaire – OG25 (esophagogastric module). O Quality of Life Questionnaire – OG25 (esophagogastric module) passou por um processo de tradução (inglês → português) e tradução-reversa (português → inglês), por tradutores independentes falantes nativos. Após revisão, uma versão preliminar for criada para ensaio-piloto entre doentes portugueses. Uma vez que já estava disponível uma versão brasileira do Quality of Life Questionnaire – OES18 (esophageal module), o questionário foi apenas adaptado culturalmente e alvo de ensaio-piloto. Foram incluídos doentes com e sem neoplasia. Resultados: No total, 30 doentes preencheram a versão portuguesa de cada questionário. No final, foi conduzida uma entrevista estruturada para detetar e documentar quaisquer tópicos problemáticos. Tópicos e enunciados problemáticos foram alterados, conforme os resultados do ensaio-piloto. As versões finais foram enviadas para o grupo de Qualidade de Vida da Organização Europeia para a Investigação e Tratamento do Cancro e foram aprovados. Conclusões: As versões portuguesas dos questionários da Organização Europeia para a Investigação e Tratamento do Cancro Quality of Life Questionnaire – OES18 (esophageal module) e OG25 (esophagogastric module) são instrumentos úteis, fidedignos e válidos para aferição da qualidade de vida relacionada com a saúde em doentes com neoplasia esofágica e/ou esofagogástrica, respetivamente. Podem agora ser utilizados em contexto clínico e para fins científicos.

The pathophysiology of subscapularis (SS) lesions is still relatively unknown despite recent interest in predictive factors for SS tears. Our goal was to determine the influence of the coracoid morphology and humeral version on SS tears.This was a retrospective, controlled, single-blinded study. We analyzed 232 shoulders with SS lesions confirmed by magnetic resonance imaging. The coracoid proximal length, coracoid distal length (CLD), and coracoid total length were measured. The coracoid length ratio, coracoid angle (CA), and humeral version were also evaluated.We found that greater humeral retroversion was progressively related to more serious SS injuries, with values of -28.6° ± 19.5° and -51.0° ± 11.1° in the normal SS group and tear group, respectively (P.001). The same tendency was shown for the CA, with values of 123.8° ± 11.1° in the control group vs. 97.4° ± 10.1° in the tear group (P.001). Greater CLD, coracoid total length, and coracoid length ratio were also associated with an increased risk of SS tears (P.001). The CA and CLD represented the best predictors of SS tears, presenting areas under the receiver operating characteristic curve of 90.0% and 89.0%, respectively.This article is the first to study the influence of different parameters of the coracoid process morphology and humeral version on SS tears. We proved that humeral version and coracoid morphology were important risk factors for SS pathology and could accurately predict these lesions. Finally, our study was the first to create a classification system to divide coracoids according to their morphology and relative risk of associated SS tears.

Case We present a case of azole and partial caspofungin-resistant Candida albicans spondylodiscitis, after bariatric surgery with bowel perforation. Treatment included debridement and several months of anidulafungin, complemented with antibacterial therapy because of relapse for bacterial superinfection. After treatment, the infection did not recur clinically or radiologically during one and half years follow-up. Conclusion Although C. albicans spondylodiscitis is rare, fungi should be suspected as a causative agent. Adequate history, imaging and laboratory testing, and medical and surgical treatment should be performed to successfully eradicate the infection and resolve potential neurological deficits.