Revista Brasileira de Ortopedia最新文献

{"title":"[Horizontal Tension-Band Plating: A New Strategy for Displaced and Multifragmentary Anterior Tibial Tuberosity Fractures Associated with Complex Metaphyseal Fractures].","authors":"Robinson Esteves Pires, Gustavo Waldolato Silva, Rafael Chagas Silva, Erick Veiga Franco da Rosa","doi":"10.1055/s-0046-1822833","DOIUrl":"10.1055/s-0046-1822833","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":21536,"journal":{"name":"Revista Brasileira de Ortopedia","volume":"61 3","pages":"s00461822833"},"PeriodicalIF":0.5,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13368383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148449094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Horizontal Tension-Band Plating: A New Strategy for Displaced and Multifragmentary Anterior Tibial Tuberosity Fractures Associated with Complex Metaphyseal Fractures.","authors":"Robinson Esteves Pires, Gustavo Waldolato Silva, Rafael Chagas Silva, Erick Veiga Franco da Rosa","doi":"10.1055/s-0046-1822832","DOIUrl":"10.1055/s-0046-1822832","url":null,"abstract":"<p><p>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 the ATT.</p>","PeriodicalId":21536,"journal":{"name":"Revista Brasileira de Ortopedia","volume":"61 3","pages":"s00461822832"},"PeriodicalIF":0.5,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13368382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148449097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rotator Cuff Surgery and Artificial Intelligence: A Comparative Analysis of Quality and Readability Between ChatGPT and Gemini.","authors":"Vinicius Borges Alencar, Matheus Mariano Teles, Diogo Fonseca da Cunha, Pedro Henrique Nunes Piropo, Paulo Sergio Milan Robazzi, Thiago Batista Faleiro","doi":"10.1055/s-0046-1820460","DOIUrl":"10.1055/s-0046-1820460","url":null,"abstract":"<p><strong>Objective: </strong>Artificial intelligence (AI) tools based on natural language, such as ChatGPT 4.1 mini (OpenAI Group PBC) and Gemini 2.5 Flash (Alphabet Inc.), are used by patients as sources of medical information. The current study aimed to evaluate and compare the quality and readability of responses provided by these AIs, in Brazilian Portuguese, regarding rotator cuff surgery.</p><p><strong>Methods: </strong>The present cross-sectional, descriptive, and comparative study followed qualitative and quantitative approaches. A total of 24 frequently-asked patient questions were used, classified according to Rothwell. Each question was entered individually into both platforms, and only the first response was considered. The quality assessment used the DISCERN instrument, developed by the University of Oxford and the British Library, and the Journal of the American Medical Association (JAMA) benchmark criteria. Readability was estimated using Análise de Legibilidade Textual (ALT, \"Text Readibility Anallysis\", in Portuguese) software, validated for Brazilian Portuguese. The statistical analyses included the Wilcoxon and Friedman tests, repeated-measures analysis of variance (ANOVA), and the Conover post-hoc test with Bonferroni correction.</p><p><strong>Results: </strong>ChatGPT achieved a mean DISCERN score of 58.7 ± 4.0, and Gemini, 56.3 ± 3.5, with no significant difference ( <i>p</i>  = 0.174), but with a maximum effect size (rank-biserial correlation [rrb] = 1.0). Both models showed a mean readability corresponding to 13.3 years of schooling ( <i>p</i>  = 1.000). No response met the JAMA benchmark criteria. Value-based questions achieved the highest quality scores, whereas policy-related questions were the most complex in terms of readability. The correlation between quality and readability was moderate (ρ = 0.73; <i>p</i>  = 0.099).</p><p><strong>Conclusion: </strong>ChatGPT 4.1 mini and Gemini 2.5 Flash do not yet provide adequate medical information in Brazilian Portuguese regarding editorial reliability, quality, and textual accessibility for the general public.</p>","PeriodicalId":21536,"journal":{"name":"Revista Brasileira de Ortopedia","volume":"61 2","pages":"s00461820460"},"PeriodicalIF":0.5,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13271820/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148272799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Treatment of Pubic Symphysis Instability Using Semitendinosus Tendon Grafts: A Two-Case Report with Surgical Technique Description.","authors":"Henrique Antônio Berwanger de Amorim Cabrita, Tatiana Ciocler Trahtenberg Guttmann, Adriano Rodrigues da Silva","doi":"10.1055/s-0046-1820487","DOIUrl":"10.1055/s-0046-1820487","url":null,"abstract":"<p><p>The pubic symphysis is a key joint for the stability of the pelvic ring. Pubic symphysis instability may lead to chronic pain and significant functional limitation, particularly in athletes and young subjects. Although conservative management is the first-line approach, refractory cases may require surgical intervention. The present study aimed to describe a surgical technique used in two soccer players who underwent pubic symphysis reconstruction through a Pfannenstiel approach with an autologous semitendinosus tendon graft passed through bone tunnels in the pubic bones in a figure- eight configuration and fixed with non-absorbable sutures. This technique's goal is to preserve the physiological mobility of the pubic symphysis. At 6 months, both patients showed an improvement of more than 30 points in the modified Harris Hip Score. Moreover, they achieved satisfactory functional recovery, returning to sports at 6 and 8 months, respectively. Radiographic evaluation demonstrated improved pelvic stability over a 5-year follow-up period. The technique proved to be safe, with low morbidity, and good clinical outcomes, allowing pelvic mobility preservation and return to sports. Despite the small number of cases, this surgical approach appears to be reproducible, with biomechanical advantages over pubic symphysis arthrodesis and a low complication rate.</p>","PeriodicalId":21536,"journal":{"name":"Revista Brasileira de Ortopedia","volume":"61 2","pages":"s00461820487"},"PeriodicalIF":0.5,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13271821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148272843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Association between Sacral Fractures and Pelvic Ring Injuries: A Correlative Study of Fracture Morphologies].","authors":"João Victor Jordão Sousa, João Pedro Lemos Soares, Antenor Aguiar Almeida Junior, Tomas Costa Arslanian, Eriko Gonçalves Filgueira","doi":"10.1055/s-0046-1820459","DOIUrl":"10.1055/s-0046-1820459","url":null,"abstract":"<p><strong>Objective: </strong>To investigate, in a retrospective cohort, the association between sacral fractures and pelvic ring injuries (PRIs) by correlating their respective classification subtypes.</p><p><strong>Methods: </strong>We selected 45 patients admitted to a tertiary trauma center between March 2023 and May 2025. Imaging studies were evaluated for the presence of PRIs and sacral fractures, followed by their classification according to the Tile and Denis systems. Then, a statistical analysis was performed using the McNemar-Bowker test and the Cramér's V coefficient to assess the strength of the association.</p><p><strong>Results: </strong>Among the PRIs classified according to the Tile system, type B was predominant (62.22%), followed by type C (35.56%), and type A (2.22%). Among the sacral fractures classified according to the Denis system, type I was the most prevalent (50%), followed by type II (28.57%), and type III (21.43%). When the classifications were correlated, Tile type-B PRIs showed an 85.7% incidence of associated sacral fractures, 66.6% of which were Denis type I. For Tile type-C PRIs, the incidence of associated sacral fractures was of 100%, with 50% classified as Denis type II. There was a significant association between the Tile and Denis classifications ( <i>p</i>  < 0.001), with a moderate correlation (Cramér's V = 0.27-0.35).</p><p><strong>Conclusion: </strong>The study suggests correlations between PRIs and sacral fracture subtypes, with Tile B-Denis I and Tile C-Denis II representing the most frequent associations. This relationship may facilitate diagnostic investigation and improve patient outcomes.</p>","PeriodicalId":21536,"journal":{"name":"Revista Brasileira de Ortopedia","volume":"61 2","pages":"s00461820459"},"PeriodicalIF":0.5,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13271823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148272696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between Sacral Fractures and Pelvic Ring Injuries: A Correlative Study of Fracture Morphologies.","authors":"João Victor Jordão Sousa, João Pedro Lemos Soares, Antenor Aguiar Almeida Junior, Tomas Costa Arslanian, Eriko Gonçalves Filgueira","doi":"10.1055/s-0046-1820458","DOIUrl":"10.1055/s-0046-1820458","url":null,"abstract":"<p><strong>Objective: </strong>To investigate, in a retrospective cohort, the association between sacral fractures and pelvic ring injuries (PRIs) by correlating their respective classification subtypes.</p><p><strong>Methods: </strong>We selected 45 patients admitted to a tertiary trauma center between March 2023 and May 2025. Imaging studies were evaluated for the presence of PRIs and sacral fractures, followed by their classification according to the Tile and Denis systems. Then, a statistical analysis was performed using the McNemar-Bowker test and the Cramér's V coefficient to assess the strength of the association.</p><p><strong>Results: </strong>Among the PRIs classified according to the Tile system, type B was predominant (62.22%), followed by type C (35.56%), and type A (2.22%). Among the sacral fractures classified according to the Denis system, type I was the most prevalent (50%), followed by type II (28.57%), and type III (21.43%). When the classifications were correlated, Tile type-B PRIs showed an 85.7% incidence of associated sacral fractures, 66.6% of which were Denis type I. For Tile type-C PRIs, the incidence of associated sacral fractures was of 100%, with 50% classified as Denis type II. There was a significant association between the Tile and Denis classifications ( <i>p</i>  < 0.001), with a moderate correlation (Cramér's V = 0.27-0.35).</p><p><strong>Conclusion: </strong>The study suggests correlations between PRIs and sacral fracture subtypes, with Tile B-Denis I and Tile C-Denis II representing the most frequent associations. This relationship may facilitate diagnostic investigation and improve patient outcomes.</p>","PeriodicalId":21536,"journal":{"name":"Revista Brasileira de Ortopedia","volume":"61 2","pages":"s00461820458"},"PeriodicalIF":0.5,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13271822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148272709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Rotator Cuff Surgery and Artificial Intelligence: A Comparative Analysis of Quality and Readability Between ChatGPT and Gemini].","authors":"Vinicius Borges Alencar, Matheus Mariano Teles, Diogo Fonseca da Cunha, Pedro Henrique Nunes Piropo, Paulo Sergio Milan Robazzi, Thiago Batista Faleiro","doi":"10.1055/s-0046-1820461","DOIUrl":"10.1055/s-0046-1820461","url":null,"abstract":"<p><strong>Objective: </strong>Artificial intelligence (AI) tools based on natural language, such as ChatGPT 4.1 mini (OpenAI Group PBC) and Gemini 2.5 Flash (Alphabet Inc.), are used by patients as sources of medical information. The current study aimed to evaluate and compare the quality and readability of responses provided by these AIs, in Brazilian Portuguese, regarding rotator cuff surgery.</p><p><strong>Methods: </strong>The present cross-sectional, descriptive, and comparative study followed qualitative and quantitative approaches. A total of 24 frequently-asked patient questions were used, classified according to Rothwell. Each question was entered individually into both platforms, and only the first response was considered. The quality assessment used the DISCERN instrument, developed by the University of Oxford and the British Library, and the Journal of the American Medical Association (JAMA) benchmark criteria. Readability was estimated using Análise de Legibilidade Textual (ALT, \"Text Readibility Anallysis\", in Portuguese) software, validated for Brazilian Portuguese. The statistical analyses included the Wilcoxon and Friedman tests, repeated-measures analysis of variance (ANOVA), and the Conover post-hoc test with Bonferroni correction.</p><p><strong>Results: </strong>ChatGPT achieved a mean DISCERN score of 58.7 ± 4.0, and Gemini, 56.3 ± 3.5, with no significant difference ( <i>p</i>  = 0.174), but with a maximum effect size (rank-biserial correlation [rrb] = 1.0). Both models showed a mean readability corresponding to 13.3 years of schooling ( <i>p</i>  = 1.000). No response met the JAMA benchmark criteria. Value-based questions achieved the highest quality scores, whereas policy-related questions were the most complex in terms of readability. The correlation between quality and readability was moderate (ρ = 0.73; <i>p</i>  = 0.099).</p><p><strong>Conclusion: </strong>ChatGPT 4.1 mini and Gemini 2.5 Flash do not yet provide adequate medical information in Brazilian Portuguese regarding editorial reliability, quality, and textual accessibility for the general public.</p>","PeriodicalId":21536,"journal":{"name":"Revista Brasileira de Ortopedia","volume":"61 2","pages":"s00461820461"},"PeriodicalIF":0.5,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13271825/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148272742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Surgical Treatment of Pubic Symphysis Instability Using Semitendinosus Tendon Grafts: A Two-Case Report with Surgical Technique Description].","authors":"Henrique Antônio Berwanger de Amorim Cabrita, Tatiana Ciocler Trahtenberg Guttmann, Adriano Rodrigues da Silva","doi":"10.1055/s-0046-1820488","DOIUrl":"10.1055/s-0046-1820488","url":null,"abstract":"<p><p>The pubic symphysis is a key joint for the stability of the pelvic ring. Pubic symphysis instability may lead to chronic pain and significant functional limitation, particularly in athletes and young subjects. Although conservative management is the first-line approach, refractory cases may require surgical intervention. The present study aimed to describe a surgical technique used in two soccer players who underwent pubic symphysis reconstruction through a Pfannenstiel approach with an autologous semitendinosus tendon graft passed through bone tunnels in the pubic bones in a figure- eight configuration and fixed with non-absorbable sutures. This technique's goal is to preserve the physiological mobility of the pubic symphysis. At 6 months, both patients showed an improvement of more than 30 points in the modified Harris Hip Score. Moreover, they achieved satisfactory functional recovery, returning to sports at 6 and 8 months, respectively. Radiographic evaluation demonstrated improved pelvic stability over a 5-year follow-up period. The technique proved to be safe, with low morbidity, and good clinical outcomes, allowing pelvic mobility preservation and return to sports. Despite the small number of cases, this surgical approach appears to be reproducible, with biomechanical advantages over pubic symphysis arthrodesis and a low complication rate.</p>","PeriodicalId":21536,"journal":{"name":"Revista Brasileira de Ortopedia","volume":"61 2","pages":"s00461820488"},"PeriodicalIF":0.5,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13271824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148272722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuropathic Pain in Patients Undergoing Primary Total Knee Arthroplasty: Preval ence and Risk Factors.","authors":"Gustavo Waldolato Silva, Rafael Silva E Castro, Gabriela Vieira Brito, Geovanna Reis","doi":"10.1055/s-0046-1820456","DOIUrl":"10.1055/s-0046-1820456","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the prevalence and risk factors of neuropathic pain (NP) in patients undergoing primary total knee arthroplasty (TKA).</p><p><strong>Methods: </strong>The present prospective observational study included patients aged 18 years or older who were candidates for TKA, conducted between October 2023 and October 2024 at a university hospital. Data were collected from medical records and through the application of a questionnaire assessing socioeconomic variables, comorbidities, prior treatments, and the interview version of the Douleur Neuropathique in 4 questions (DN4i) questionnaire, a validated screening instrument for NP. Paired samples were analyzed using the Wilcoxon, Chi-squared of independence, and Fisher's exact tests, with a significance level set at <i>p</i>  < 0.05.</p><p><strong>Results: </strong>Of the 68 participants, 20 (29%) tested positive for NP. Among these, most were female (80%, <i>p</i>  = 0.015). Pain intensity was significantly higher in this group, with 90% reporting VAS scores between 8 and 10. There were no significant associations with obesity, diabetes, or the use of pain modulators. Quality of life was more adversely affected in patients with NP, who reported poorer general health status and greater limitations in physical and social activities.</p><p><strong>Conclusion: </strong>There is a high prevalence of NP among patients undergoing TKA, particularly in females, and is associated with worse quality of life and greater pain intensity. Systematic screening using the DN4i questionnaire may improve diagnosis and support the development of individualized therapeutic strategies.</p>","PeriodicalId":21536,"journal":{"name":"Revista Brasileira de Ortopedia","volume":"61 2","pages":"s00461820456"},"PeriodicalIF":0.5,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13246236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Current Concepts in the Treatment of Distal Femur Fractures in Adults].","authors":"Fabricio Fogagnolo, Ricardo Antônio Tavares","doi":"10.1055/s-0046-1822640","DOIUrl":"10.1055/s-0046-1822640","url":null,"abstract":"<p><p>Distal femur fractures account for approximately 1% of all fractures and 3 to 7% of femoral fractures, representing complex injuries that frequently affect articular surfaces. Computed tomography is essential to evaluate articular involvement, the presence of coronal fracture lines, and metaphyseal comminution. Surgical treatment aims to restore mechanical alignment and articular congruity while providing sufficient stability to allow early mobilization.The epidemiology shows a bimodal pattern: in younger patients, high-energy trauma predominates, whereas in older patients, low-energy falls are more common, with higher mortality related to osteoporosis and comorbidities. Conservative treatment has limited indications and is often reserved for patients with high surgical risk or for nondisplaced fractures.Surgical management includes locking plates, retrograde intramedullary nails, and combined fixation techniques. Dual fixation has gained increasing attention in osteoporotic bone, cases with loss of medial support, and periprosthetic fractures. In selected cases, particularly in older patients with severely compromised bone quality, knee arthroplasty may be an alternative for early mobilization. The present article presents an updated review of the main epidemiological, diagnostic, and therapeutic aspects of distal femur fractures, including special situations such as open fractures, Hoffa fractures, and periprosthetic fractures.Complications such as infection, nonunion, stiffness, and posttraumatic osteoarthritis remain frequent.</p>","PeriodicalId":21536,"journal":{"name":"Revista Brasileira de Ortopedia","volume":"61 2","pages":"s00461822640"},"PeriodicalIF":0.5,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13246245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}