➢ Argentine orthopaedics was shaped by the influence of Dr. Vittorio Putti (Rizzoli Institute, Bologna, Italy). Dr. Carlos E. Ottolenghi, one of Dr. Putti's most distinguished disciples, together with Dr. José Valls, founded the Instituto de Ortopedia y Traumatología at Hospital Italiano de Buenos Aires in 1926. Prof. Ottolenghi transformed the Orthopaedic Service into a leading academic center and pioneer of subspecialization, serving as a foundational driver of orthopaedic development in Argentina and Latin America, while establishing strong international academic connections and collaborations.➢ Major milestones include the establishment of one of the earliest institutional bone banks and the performance of one of the world's first reported massive bone allograft reconstructions (1948); the performance of the first Charnley total hip replacement in the Americas (1967) and the first total knee replacement in Argentina (1970); and the early adoption of intramedullary nailing (1972), knee arthroscopy (1976), and femoral bone impaction allografting (1987). These contributions helped to define modern orthopaedic practice across Latin America and influenced global reconstructive strategies.➢ Advances such as surgical navigation (2010) and augmented reality (2025) have strengthened its role as a regional and globally connected center of excellence, particularly in musculoskeletal oncology.➢ Over the past 25 years, 180 residents and 160 fellows have been trained in our institute, and more than 500 indexed publications have been produced in the last 10 years, with alumni holding leadership roles across major orthopaedic centers worldwide, amplifying our institute's global footprint.➢ A merit-based, highly selective system based on excellence determines who becomes a staff surgeon. Currently, 85% of the actual staff surgeons completed residency training in our department, fostering a unique sense of institutional identity and perceived belonging. This experience reinforces the concept that excellence in orthopaedics transcends geographic boundaries and can emerge as a global reference from any setting committed to innovation, mentorship, and academic rigor.
Radial tears of the lateral meniscus have limited healing potential and unfavorable biomechanics, and current suture constructs that use capsular rip-stop stitches may increase meniscal extrusion and constrain native motion. This technical note describes an all-inside, crossed, meniscus-based repair for complete or near-complete radial tears of the lateral midbody using a percutaneous needle. Key steps, indications, and rehabilitation are detailed. This construct aims to balance stability with preservation of meniscal mobility and vascularity; prospective clinical studies are required to confirm its long-term efficacy.
To evaluate the evolution of surgical outcomes in patients undergoing surgery for spinal metastases from solid tumors over more than two decades in a single tertiary referral center. The present retrospective comparative study included 2 cohorts of patients who underwent surgical treatment for spinal metastases: cohort 1 (2002-2015) and cohort 2 (2018-2024). Overall survival was estimated using the Kaplan-Meier method and compared with the log-rank test. Major postoperative complications (grades III-IV) were analyzed per patient and compared between cohorts. A total of 301 patients were included (175 in cohort 1 and 126 in cohort 2). The more recent cohort demonstrated significantly improved overall survival (log-rank p  < 0.001), with a hazard ratio for mortality of 0.61 (95%CI: 0.48-0.78) compared with the earlier cohort. Early survival at 30 and 90 days also improved in cohort 2. Overall complication rates were similar between groups; however, cohort 2 showed a significant reduction in local complications. Surgical outcomes for spinal metastases improved over time, particularly in early survival and the reduction of local complications. These findings suggest that refinement in patient selection, prognostic stratification, and multidisciplinary perioperative care may have contributed to this temporal improvement. Avaliar a evolução dos desfechos cirúrgicos em pacientes submetidos à cirurgia para metástases vertebrais de tumores sólidos ao longo de mais de duas décadas em um único serviço terciário. Estudo retrospectivo comparativo envolvendo 2 coortes de pacientes submetidos a tratamento cirúrgico para metástases vertebrais: coorte 1 (2002–2015) e coorte 2 (2018–2024). A sobrevida global foi estimada pelo método de Kaplan-Meier e comparada pelo teste log-rank. Complicações maiores pós-operatórias (graus III–IV) foram analisadas por paciente e comparadas entre as coortes. Foram incluídos 301 pacientes (175 na coorte 1 e 126 na coorte 2). A coorte mais recente apresentou aumento significativo da sobrevida global (log-rank p  < 0,001), com razão de risco para mortalidade de 0,61 (IC95%: 0,48–0,78) em relação à coorte anterior. Observou-se também melhora da sobrevida precoce nos marcos de 30 e 90 dias. A incidência global de complicações foi semelhante entre os grupos, porém houve redução significativa das complicações locais na coorte 2. Os desfechos cirúrgicos das metástases vertebrais demonstraram melhora ao longo do tempo, especialmente em relação à sobrevida precoce e à redução das complicações locais. Esses achados sugerem que o refinamento da seleção de pacientes, da estratificação prognóstica e do cuidado perioperatório multidisciplinar pode ter contribuído para essa evolução.
Recalcitrant lateral elbow pain is often associated with minor lateral elbow instability, involving laxity of the radial band of the lateral collateral ligament and the annular ligament. To date, the role of coronoid morphology in this pathology has never been studied. This study aims to investigate the potential relationship between lateral elbow pain and specific morphometric measurements of the coronoid process using flexion computed tomography arthrography. All elbow flexion computed tomography arthrography from the hospital server was retrospectively analyzed. A total of 133 patients were enrolled and divided into 2 groups: 108 with lateral elbow pain and 25 controls. Coronoid flange and width were measured and compared to the radioulnar articular width in both groups. No significant morphometric differences in the coronoid process were found between patients with chronic lateral elbow pain and controls. Other factors, such as capsuloligamentous structures, may have a greater impact on recalcitrant lateral elbow pain compared to the bony morphology of the medial structure of the elbow.
BackgroundDigital speech analysis affords robust markers of Parkinson's disease (PD). However, most studies target late-onset PD (LOPD), neglecting early-onset PD (EOPD) -an increasingly prevalent subtype. This proof-of-concept study tackles such gap.MethodsWe used machine learning to discriminate persons with EOPD (with symptom onset before age 50) and LOPD (with symptom onset after age 50) from healthy controls (HCs) through prosodic and articulatory features from natural speech.ResultsMaximal classification between patients and HCs was afforded by combined prosodic and articulation features in LOPD (AUC = 0.90) and by articulation alone in EOPD (AUC = 0.79), with chance-level discrimination between patient groups (AUC = 0.55). Motor severity (MDS-UPDRS-III) scores predicted by these features correlated with actual motor severity scores in both LOPD (r = 0.52, p < 0.001) and EOPD (r = 0.27, p < 0.001).ConclusionsDigital speech markers offer markers of PD irrespective of age of onset. Voice recordings capture motor symptoms in Parkinson's disease irrespective of age of onsetPlain language summaryOne of the earliest symptoms in Parkinson's disease is abnormal speech. Most people living with this disorder present a softer voice, unclear pronunciation, or reduced variation in pitch. These changes can impact communication, confidence, and everyday life. New digital tools now allow researchers to measure speech automatically and objectively, offering a simple and affordable way to monitor these problems. However, most studies have focused on people whose Parkinson's symptoms begin after age 50 (late-onset Parkinson's disease). Little is known about speech changes in people whose symptoms begin earlier in life, before age 50 (early-onset Parkinson's disease).In this study, we recorded natural speech samples from adults with early-onset Parkinson's, late-onset Parkinson's, and healthy adults. Participants were asked to describe what they had done since waking up—an easy, conversational task similar to everyday speaking. We then used computer-based methods to measure two aspects of speech: prosody (pitch, loudness, timing) and articulation (how clearly sounds are produced). Using machine-learning techniques, we tested whether these speech features could help distinguish people with Parkinson's from healthy adults and whether they could estimate the severity of movement symptoms.Our results showed that speech could reliably identify people with Parkinson's in both groups. For the late-onset group, disease detection was maximal when combining prosodic and articulatory features. For the early-onset group, articulation alone worked best, though accuracy was somewhat lower. Importantly, speech features also related to the severity of patients' motor symptoms in both groups.This study suggests that simple speech recordings can provide valuable insights into Parkinson's disease regardless of the age at which symptoms begin. With further research, digital speech analysis could support earlier detection, personalized care, and improved tracking of symptoms over time.
The Third International StemNet Meeting, held on March 12-13, 2026, served as a landmark event uniting Italy's four major stem cell research associations: FIRST, GISM, IPLASS, and SCRI. By integrating the unique expertise of these organizations, the meeting aimed to enhance the quality and clinical impact of regenerative medicine through proactive synergy and knowledge exchange. The scientific program, organized into six comprehensive sessions, highlighted recent advances in basic and translational research, specifically focusing on the evolution of advanced therapies such as Extracellular Vesicles and Advanced Therapy Medicinal Products (ATMPs). Beyond scientific findings, the proceedings also addressed biomedical communication and research translation, ensuring that scientific discoveries translate effectively into social and economic benefits. A significant highlight was the "Next Generation Session", organized by early-career scientists to foster the development of the field's future leaders. With a faculty of renowned national and international experts, the meeting facilitated rigorous debate and established a collaborative roadmap for addressing the current challenges in stem cell science and its therapeutic applications.
This technical note describes a knotless trans-tendon proximal-pulley repair with distal suture-bridge fixation and bioinductive collagen patch augmentation for high-grade partial gluteus medius and minimus tears. The technique preserves intact tendon fibers, restores broad footprint compression, and supports biologic healing through a resorbable collagen scaffold. Detailed steps emphasize anatomic anchor placement, controlled tensioning, and efficient suture management to improve construct reliability. This combined mechanical and biologic augmentation offers a promising option for enhancing tendon healing and optimizing outcomes in patients with degenerative high-grade partial-thickness abductor tears.
In revision anterior cruciate ligament reconstruction (R-ACLR), adding a lateral extra-articular procedure (LEAP) reduces graft failure and postoperative laxity. Iliotibial band (ITB)-based techniques may avoid patellar tendon harvesting morbidity, but evidence in adults, particularly in revision cases, remains limited. We compared clinical outcomes at ≥2 years after R-ACLR using a modified ITB-allograft (ITB-AG) technique versus bone-patellar tendon-bone with lateral extra-articular tenodesis (BPTB-LET). It was hypothesized that no difference in retear rates between techniques would be found. A retrospective analysis of prospectively collected data was performed on consecutive adult patients (≥18 years) undergoing R-ACLR between 2018 and 2023. Patients were included if they received ITB-AG or BPTB-LET R-ACLR, if surgery occurred within 24 months of graft failure and follow-up was ≥2 years. Exclusions were multiligament injury, concomitant osteotomy or refusal to participate. Primary outcome was graft retear, and secondary outcomes were International Knee Documentation Committee (IKDC) subjective score, Lysholm score, complications, side-to-side anterior laxity and pivot-shift grade. Comparisons between groups were performed using Student's t test or Mann-Whitney U test for continuous variables and chi-square or Fisher exact test for categorical variables, with statistical significance set at p < 0.05. One hundred ninety-five patients were analysed (BPTB-LET, n = 105; ITB-AG, n = 90). Groups were similar at baseline; follow-up was 38 ± 9 months for BPTB-LET and 34 ± 7 months for ITB-AG (p = 0.0005). Meniscal tears and repairs were more frequent with ITB-AG; graft diameter was slightly smaller with ITB-AG (8.8 ± 0.7 mm for ITB-AG vs. 9.3 ± 0.5 mm for BPTB-LET; p = 0.0001). Retear rates were not different (5.7% BPTB-LET vs. 4.4% ITB-AG; p = 0.7551). IKDC was higher with ITB-AG (90.7 ± 10.8 vs. 88.3 ± 10.1; p = 0.0026); 97% (BPTB-LET) and 93% (ITB-AG) achieved the IKDC Patient Acceptable Symptom State (p = 0.3073). Lysholm was higher with ITB-AG (94.6 ± 10.8 vs. 90.8 ± 9.0; p < 0.00001). A negative pivot-shift was found in 98.9% (ITB-AG) versus 66.7% (BPTB-LET) (p < 0.00001), while KT-1000 anterior laxity did not differ significantly (p = 0.1164). Complication rates were similar (4.7% vs. 5.5%; p = 1). At midterm follow-up, a modified ITB-AG technique provided comparable graft survival to BPTB-LET, with similarly low complication rates. Patient-reported outcome measures were statistically higher and a greater proportion of patients demonstrated a negative pivot-shift test in the ITB-AG group, although the clinical relevance of these differences remains uncertain. Level III.
The triceps brachii muscle (TBM) is the main muscle of the posterior aspect of the arm, occupying most of the extensor compartment. Proximally, it is composed of three heads: long, lateral, and medial, and presents a single tendon. Its insertion in the olecranon region remains controversial. Magnetic resonance imaging (MRI) assessment and detailed knowledge of this insertion may assist in orthopedic surgical reconstructions. To evaluate the anatomical aspect of the insertion of the triceps brachii tendon (TBT) into the olecranon regarding tendon insertion. In vivo MRI studies of patients were retrospectively evaluated. Two radiologists assessed 44 MRI scans from patients aged 20 to 50 years, with no previous triceps brachii tendon injuries or other TBT tendon pathologies. There was agreement between the observers in the MRI scans evaluated, and the TBT insertion was found to be single. The triceps brachii tendon presented a single insertion into the olecranon. Level of Evidence III; Retrospective Comparative Study. O músculo tríceps braquial (MTB) é o principal músculo da porção posterior do braço, preenchendo a maior parte do compartimento extensor. Na porção proximal, é composto por três cabeças: longa, curta e medial, apresentando um único tendão. Sua inserção na região do olécrano ainda é controversa. O estudo por ressonância magnética (RM) e o conhecimento pormenorizado dessa inserção auxiliam nas reconstruções cirúrgicas ortopédicas. Avaliar o aspecto anatômico da inserção do tendão do tríceps braquial (TTB) no olécrano em relação à inserção tendínea. Estudos de RM de pacientes in vivo, avaliados de forma retrospectiva. Dois radiologistas avaliaram 44 exames de RM de pacientes com idade entre 20 e 50 anos, sem lesões prévias do tendão do tríceps braquial ou outras patologias tendíneas do TTB. Houve uma concordância entre os observadores nas RM avaliadas e a inserção do TTB apresentou-se ser único. O tendão do tríceps braquial apresentou uma única inserção no olécrano. Nível de Evidência III; estudo Retrospectivo Comparativo.
Lateral condyle fractures of the humerus are the second most common elbow fracture in children. Both Kirschner wires (K-wires) and cannulated screws are widely used for fixation, but the optimal technique remains debated. This study aimed to compare these methods in terms of functional outcomes and complications. A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Thirteen comparative studies involving 1,230 pediatric patients were included. Outcomes were analyzed using random-effects models, with risk ratios (RRs) and 95% confidence intervals (CIs). Meta-regression and prediction intervals (PIs) were applied to explore heterogeneity. Screw fixation significantly reduced the risk of postoperative infection (RR = 0.27; 95% CI: 0.12-0.60) and was associated with better functional outcomes (RR = 1.09; 95% CI: 1.01-1.18). No significant differences were observed in overall complications (RR = 0.89; 95% CI: 0.66-1.20), lateral overgrowth, range of motion limitation, or nonunion. Meta-regression did not identify age or fracture severity as effect modifiers. Cannulated screw fixation may be preferable for reducing infection and improving outcomes, but individualized clinical decisions and further high-quality research remain essential. Level of Evidence III; Systematic Review. A fratura do côndilo lateral do úmero é a segunda mais comum do cotovelo da criança. Os fios de Kirschner e os parafusos canulados são amplamente utilizados para sua fixação, mas o dispositivo ideal ainda é discutível. Este estudo teve como objetivo comparar esses métodos considerando os resultados funcionais e as complicações. Foi realizada uma revisão sistemática e uma metanálise, seguindo as diretrizes PRISMA. Treze estudos comparativos envolvendo 1.230 pacientes pediátricos foram incluídos. Os resultados foram analisados usando modelos de efeitos aleatórios, com razões de risco (RRs) e intervalos de confiança (ICs) de 95%. Meta-regressão e intervalos de predição (PIs) foram aplicados para explorar a heterogeneidade. A fixação com parafuso reduziu significativamente o risco de infecção pós-operatória (RR = 0,27; IC 95%: 0,12–0,60) e foi associada a melhores resultados funcionais (RR = 1,09; IC 95%: 1,01–1,18). Nenhuma diferença significativa foi observada considerando: complicações gerais (RR = 0,89; IC 95%: 0,66–1,20), supercrescimento lateral, limitação da amplitude de movimento ou não-união. A meta-regressão não identificou idade ou gravidade da fratura como modificadores de efeito. A fixação com parafuso canulado é preferencial para reduzir infecções e melhorar os resultados, mas decisões clínicas individualizadas e pesquisas futuras de alta qualidade continuam sendo essenciais. Nível de Evidência III; Revisão Sistemática.
AI is increasingly used for medical education and assessment, yet effectiveness on specialized exams remains underexplored. We aim to compare multiple AI models with national human averages on SBCOC entrance exams (2021-2023), evaluate answer accuracy and citation reliability, and contrast models. Five models-ChatGPT-4 (standard and literature-trained), ChatGPT-o1-pro, Gemini, and Meta Llama 3.1-answered official SBCOC exams (50 items/year) individually using a unified prompt and identical images. Each response included one choice (A-D) and a cited source. Outcomes were accuracy and source reliability (peer-reviewed articles/textbooks versus websites). Statistics used chi-square tests and one-way ANOVA with Tukey post-hoc (p<0.05). Across 150 questions, ChatGPT-o1-pro led (66%, 62%, 68%) and exceeded human national averages each year (p<0.05). Gemini (40%, 28%, 38%) and Meta Llama 3.1 (32%, 44%, 50%) underperformed relative to humans, while both ChatGPT-4 versions hovered near the ≥50% pass threshold without significant differences. Regarding sources, ChatGPT-o1-pro and Llama predominantly cited articles or books, ChatGPT-4 alternated between literature and websites, and Gemini did not specify references. ChatGPT-o1-pro outperformed the national human average and mostly used credible sources; ChatGPT-4 matched humans, while Gemini and Meta Llama 3.1 lagged. Level of evidence IV; Case series. A IA é cada vez mais usada na educação e avaliação médicas, mas sua efetividade em exames especializados permanece pouco explorada. O objetivo foi comparar modelos de IA às médias humanas nos exames de ingresso da SBCOC (2021–2023), avaliar acurácia e confiabilidade das citações e contrastar modelos. Cinco modelos—ChatGPT-4 (padrão e treinado com literatura), ChatGPT-o1-pro, Gemini e Meta Llama 3.1—responderam às provas da SBCOC (50 itens/ano) individualmente, com prompt unificado e imagens idênticas. Cada resposta continha uma alternativa (A–D) e uma fonte. acurácia e confiabilidade das fontes (artigos/livros vs. sites). Estatística: qui-quadrado e ANOVA de uma via com pós-teste de Tukey (p<0,05). Em 150 questões, o ChatGPT-o1-pro liderou (66%, 62%, 68%) e superou médias humanas em todos os anos (p<0,05). Gemini (40%, 28%, 38%) e Meta Llama 3.1 (32%, 44%, 50%) abaixo dos humanos; ambas as versões do ChatGPT-4 próximas ao limiar de aprovação ≥50%, sem diferenças significativas. Quanto às fontes, ChatGPT-o1-pro e Llama citaram predominantemente artigos/livros; o ChatGPT-4 alternou entre literatura e sites; Gemini não especificou referências. O ChatGPT-o1-pro superou a média humana e usou majoritariamente fontes confiáveis; o ChatGPT-4 igualou os humanos; Gemini e Meta Llama 3.1 ficaram aquém. Nível de evidência IV; série de casos.
Spinopelvic fixation (SPF), alone or combined with iliosacral or transiliac-transsacral fixation, is often used for highly unstable posterior pelvic ring injuries and some fragility fracture patterns in older adults. However, the evidence specifically describing complications after SPF in older patients with U-type sacral fractures is limited. This systematic review was conducted according to the Cochrane Handbook and PRISMA recommendations. PubMed, Embase, and grey-literature sources were searched from January 1, 2000 to July 31, 2025. Eligible studies included adults aged 60 years or older with U-type sacral fractures or closely related spinopelvic dissociation/FFP IVb patterns treated with SPF, and reporting at least one complication. Because of the small number of eligible studies, probable cohort overlap, heterogeneity in fracture definitions, treatment indications, fixation constructs, and outcome reporting, findings were synthesized narratively rather than pooled quantitatively. Three studies met the eligibility criteria, comprising 157 patients overall; however, only a subset underwent SPF, and two studies were produced by the same group with probable cohort overlap. The available cohorts mixed bilateral sacral fragility fractures, FFP IVb patterns, and comparative SPF-versus-trans-sacral constructs. Reported adverse events included wound or infectious complications, urinary tract infection and other medical complications, reoperation, and mortality. Construct-specific complication rates for true SPF-treated U-type fractures in older adults could not be estimated reliably. The available literature on SPF for U-type sacral fractures in older adults is extremely limited, clinically heterogeneous, and partly overlapping. Current evidence permits only a cautious narrative description of reported complications; it does not allow reliable estimation of complication rates, meaningful comparison with alternative fixation strategies, or definitive conclusions regarding indications for routine SPF use in this population.
Injuries to the posterolateral corner (PLC) of the knee represent a complex clinical entity that is frequently underdiagnosed and undertreated, often leading to persistent instability and failure of concomitant ligament reconstructions. Although open surgical approaches to the PLC have been extensively described, the role of arthroscopy in the diagnosis and management of these injuries remains less clearly defined despite increasingly encouraging clinical and biomechanical results. The aim of this narrative review was to analyze the role of knee arthroscopy in the diagnosis, evaluation, and treatment of PLC injuries. A comprehensive literature review was performed focusing on studies investigating arthroscopic findings, diagnostic signs, and arthroscopic or arthroscopy-assisted techniques for PLC management. Relevant clinical, anatomical, biomechanical, and surgical studies were analyzed to provide an integrated arthroscopy-oriented perspective. Arthroscopy enables direct visualization of key posterolateral structures and identification of characteristic diagnostic findings, such as the lateral drive-through sign, potentially improving detection of subtle or combined PLC injuries. In addition, arthroscopic assessment facilitates evaluation of associated intra-articular lesions and may contribute to more accurate characterization of injury patterns. Emerging arthroscopic and arthroscopy-assisted reconstruction techniques may offer advantages in selected cases by supporting tailored surgical strategies, accurate graft positioning, and reduced surgical morbidity. Knee arthroscopy is assuming an increasingly important role in the comprehensive management of PLC injuries, extending beyond the treatment of associated intra-articular pathology alone. Integration of arthroscopy into the diagnostic and therapeutic algorithm of PLC injuries may improve surgical decision-making and patient-specific management. Nevertheless, further high-quality clinical studies are required to establish standardized arthroscopic criteria and validate the long-term clinical advantages of arthroscopy-guided approaches.
Pheochromocytomasand paragangliomas (PPGLs) are rare catecholamine-secreting tumors that can affect systemic physiology, including bone metabolism. Although they are typically associated with genetic syndromes such as MEN2 and von Hippel-Lindau disease, PPGLs are not commonly linked to primary bone tumors. However, recent findings suggest a novel cancer syndrome involving both PPGLs and giant cell tumor of bone (GCTB) through H3F3A mutations. We report a rare case of a 53-year-old woman with multicentric GCTB, initially diagnosed at age 24, who subsequently developed bilateral pheochromocytomas. Following multiple recurrences of skeletal tumors and eventual leg amputation, imaging and biochemical evaluation revealed bilateral adrenal tumors with markedly elevated catecholamine levels. Genetic analysis identified mosaicism for a pathogenic H3F3A (G35W) variant in both adrenal and bone tumors. Surgical resection of both adrenal glands normalized catecholamine levels and resolved hypertension. The patient has remained tumor-free and normotensive for five years following adrenalectomy. This case supports the existence of a shared pathogenic mechanism linking PPGLs and GCTBs, likely mediated by postzygotic H3F3A mutations. Recognition of this association is crucial for early diagnosis, genetic counseling, and management of similar cases.
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To evaluate the association between sagittal femoral morphology and coronal alignment phenotypes. It was hypothesised that sagittal femoral morphology is not associated with coronal phenotype classifications. This retrospective study analysed a prospectively maintained institutional database including patients who underwent primary total knee arthroplasty (TKA) between January 2021 and November 2022. Preoperative radiographic assessment included standardised lateral and full-length weight-bearing radiographs. Coronal alignment parameters included mechanical hip-knee-ankle angle (mHKA), arithmetic hip-knee-ankle angle (aHKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA) and joint line obliquity (JLO). Sagittal femoral morphology was assessed using anterior femoral offset (AFO), posterior femoral offset (PFO) and anteroposterior femoral size (AP size). Patients were classified according to the coronal plane alignment of the knee (CPAK) classification and functional knee phenotypes (FKPs). A total of 212 patients were included. No significant associations were observed between sagittal femoral morphology and coronal phenotypes. AFO, PFO and AP size did not differ across CPAK types (p = 0.779, p = 0.127 and p = 0.124, respectively) or FKP groups (p = 0.622, p = 0.409 and p = 0.196, respectively). No significant differences were found when stratifying patients according to aHKA or JLO categories. Interaction analyses showed no significant effects between coronal phenotypes and sagittal morphology (all p > 0.05), with low explanatory power (R 2 ≤ 0.14). Sagittal femoral morphology is not associated with coronal alignment phenotypes, indicating that sagittal and coronal knee characteristics represent independent anatomical domains. Coronal phenotype classifications alone may therefore be insufficient to characterise patient-specific femoral morphology during preoperative TKA planning. Level III.
To translate and culturally adapt the Unité Rhumatologique des Affections de la Main (URAM) scale, a specific instrument for functional assessment in Dupuytren's disease (DD), into Brazilian Portuguese. Following the methodology of Beaton (2000), the scale underwent five stages: translation, synthesis, back-translation, expert committee, and pre-testing. After adaptation, the Brazilian version of the scale (URAM-BR) was administered to 40 patients with Dupuytren's contracture. Internal consistency was tested using Cronbach's alpha, reproducibility was analyzed using the intraclass correlation coefficient (ICC), and construct validity was analyzed by correlation with the Brazilian version of QuickDASH. The URAM-BR showed excellent internal consistency (α = 0.930-0.938), significant reproducibility (ICC > 0.89), and moderate-to-strong construct validity (r = 0.69, p < 0.001). The adapted version proved to be clear, reliable, and appropriate to the Brazilian cultural context. The URAM-BR is a valid, reliable, and reproducible instrument for functional assessment of patients with DD in Brazil. Level of evidence IV; Observational cross-sectional instrument validation study. Traduzir e adaptar culturalmente para o português do Brasil a escala Unité Rhumatologique des Affections de la Main (URAM), instrumento específico para avaliação funcional na Doença de Dupuytren (DD). Seguindo a metodologia de Beaton (2000), a escala passou por cinco etapas: tradução, síntese, retrotradução, comitê de especialistas e pré-teste. Após a adaptação, a versão brasileira da escala (URAM-BR) foi aplicada em 40 pacientes com contratura de Dupuytren. A consistência interna foi testada pelo alfa de Cronbach, a reprodutibilidade foi analisada pelo Coeficiente de Correlação Intraclasse (ICC), e a validade de construto pela correlação com a versão brasileira da QuickDASH. O URAM-BR apresentou excelente consistência interna (α = 0,930–0,938), reprodutibilidade significativa (ICC > 0,89) e validade de construto moderada-forte (r = 0,69, p < 0,001). A versão adaptada demonstrou ser clara, confiável e adequada ao contexto cultural brasileiro. O URAM-BR é um instrumento válido, confiável e reprodutível para avaliação funcional de pacientes com DD no Brasil. Nível de evidência IV; estudo observacional transversal de validação de instrumento.
Arthrogryposis multiplex congenita (AMC) is a group of rare congenital conditions, characterized by multiple joint contractures but may involve any body system including central nervous system. AMC is etiologically heterogeneous, with over 400 genetic and many non-genetic causes implicated in its prenatal development. AMC requires lifelong, multidisciplinary management, a challenge compounded by their rarity and phenotypic heterogeneity. Our understanding of AMC is hampered by diagnostic delays, scarce trained specialists, and variable clinician expertise. Research networks are paramount to harmonize efforts, increase awareness, and accelerate progress toward understanding of rare conditions. Therefore, we established a consortium for AMC (IC4AMC) in 2020, a multi-national network dedicated to improving AMC care, research, and knowledge across North America, Europe, and West Asia. IC4AMC engages a diverse group of stakeholders including clinicians, researchers, individuals with AMC, families, and support groups to better understand and address the most pressing needs in AMC care and research. In this paper, we introduced the missions and aims of the IC4AMC around four pillars of early detection, clinical care, research, and education, all embedded in two cross-cutting principles of knowledge mobilization and community engagement. This effort will inform the development of targeted initiatives aimed at improving outcomes for rare diseases.
There is no standardized treatment for multifragmentary fractures of the anterior tibial tuberosity (ATT) in adult patients, with or without concomitant metaphyseal fractures of the proximal tibia. This technical note aims to demonstrate the results of using a minifragment plate positioned horizontally according to the tension band principle in two patients with multifragmentary fractures of ATT. Não existe padronização de tratamento para as fraturas multifragmentares da tuberosidade anterior da tíbia (TAT) nos pacientes adultos, com ou sem associação com fraturas metafisárias da tíbia proximal. O objetivo desta nota técnica é demonstrar os resultados da utilização da placa de minifragmentos colocada segundo o princípio da banda de tensão, de forma horizontal, em dois pacientes portadores de fratura multifragmentar da TAT.
Developmental Dysplasia of the Hip (DDH) is the most common human congenital malformation. When diagnosed and treated before five months of age, it has a high cure rate. If not, surgical management is required with high economic costs, a great impact on morbidity and sequelae that can generate permanent disability. To design and validate an instrument to timely detect DDH. An instrument developed from a literature review on the timely diagnosis of DDC, using the PRISMA methodology. To validate it, an expert panel was formed comprising specialists from different healthcare institutions. All participants in the expert panel agreed that DDH is a public health problem. They consider that there are many patients with late diagnosis and sequelae due to a lack of timely treatment. There was consensus on the feasibility of implementing the proposal. The expressed need to update the current regulations regarding diagnostic means was identified. It is necessary to promote epidemiology, risk factors, correct physical examination, ideal imaging methods according to the patient's age, and timely referral pathways for patients. Add our DDH instrument to the section to the healthy child card. This should include risk factors: pelvic presentation, female sex, and family history of DDH. As well as the marking of a normal vs abnormal physical examination. la displasia del desarrollo de la cadera (DDC) es la malformación congénita más común en humanos. Si se diagnostica y trata antes de los cinco meses de edad presenta una alta tasa de curación; si no, requiere tratamiento quirúrgico con altos costos económicos, gran impacto en la morbilidad y secuelas que pueden generar discapacidad permanente. diseñar y validar un instrumento para detectar tempranamente la DDC. instrumento elaborado a partir de una revisión de la literatura sobre el diagnóstico oportuno de DDC, utilizando la metodología PRISMA. Para validarlo se conformó un panel de expertos con especialistas de diferentes instituciones de salud. todos los participantes del panel de expertos coincidieron en que la DDC es un problema de salud pública. Consideran que existen muchos pacientes con diagnóstico tardío y secuelas debido a la falta de tratamiento oportuno. Hubo consenso sobre la viabilidad de implementar la propuesta. Se identificó la necesidad de actualizar la normativa vigente en materia de medios de diagnóstico. es necesario promover la exploración física correcta, los métodos de imagen ideales según la edad del paciente y las vías de derivación oportunas. Incluir nuestro instrumento de DDC en la sección de la tarjeta del niño sano. Se deben incluir factores de riesgo: presentación pélvica, sexo femenino y antecedentes familiares de DDC. Además, se debe marcar una exploración física normal frente a anormal.