Resumo Objetivo Avaliar a reprodutibilidade intra- e interobservador das classificações de Lauge-Hansen, Danis-Weber e Arbeitsgemeinschaft für Osteosynthesefragen (AO) para as fraturas de tornozelo, e a influência do estágio de formação dos participantes na avaliação. Métodos Foram selecionadas radiografias de 30 pacientes com fratura de tornozelo nas incidências anteroposterior (AP), perfil e AP verdadeiro. Todas as imagens foram avaliadas por 11 participantes em diferentes estágios de formação profissional (cinco residentes e seis cirurgiões ortopédicos), em dois momentos distintos. Analisou-se a concordância inter- e intraobservador por meio do coeficiente Kappa ponderado. O teste t de Student para amostras pareadas foi aplicado para verificar se havia diferença significativa no grau de concordância interobservador entre os instrumentos. Resultado Observou-se que existe concordância significativa em todas as classificações quando da análise intraobservador isolada. Existe concordância interobservador altamente significativa de grau moderado a ótimo na classificação de Danis-Weber (p ≤ 0,0001). A classificação de Danis-Weber apresentou, em média, grau de concordância significativamente maior que as outras classificações (p ≤ 0,0001). Conclusão A classificação de Danis-Weber se mostrou a mais reprodutiva entre os instrumentos avaliados, e a pouca experiência do avaliador não influencia negativamente a reprodutibilidade das classificações das fraturas do tornozelo. Nível de Evidência II, Estudos Diagnósticos - Investigação de um Exame para Diagnóstico.

No abstract

Increasing age appears to influence several morphologic changes in major tendons. However, the effects of aging on the cross‐sectional area (CSA) of different ankle tendons are much less understood. Furthermore, potential differences in specific tendon regions along the length of the tendons have not been investigated in detail. Sixty healthy adult participants categorized by age as young (n = 20; mean ± SD age = 22.5 ± 4.5 years), middle‐age (n = 20; age = 40.6 ± 8. 0 years), or old (n = 20; age = 69.9 ± 9.1 years), from both sexes, were included. The tendon CSA of tibialis anterior (TA), tibialis posterior (TP), fibularis (FT), and Achilles (AT) was measured from T1‐weighted 1.5 T MR images in incremental intervals of 10% along its length (from proximal insertion) and compared between different age groups and sexes. The mean CSA of the AT was greater in the middle‐age group than both young and old participants (p < 0.01) and large effect sizes were observed for these differences (Cohen's d > 1). Furthermore, there was a significant difference in CSA in all three groups along the length of the different tendons. Region‐specific differences between groups were observed in the distal portion (90% and 100% of the length), in which the FT presented greater CSA comparing middle‐age to young and old (p < 0.05). In conclusion, (1) great magnitude of morpho‐structural differences was discovered in the AT; (2) there are region‐specific differences in the CSA of ankle tendons within the three groups and between them; and (3) there were no differences in tendon CSA between sexes.

Background Subtalar pain following intra-articular calcaneus fractures may be associated with disability, pain, and a negative impact on the quality of life. Salvage procedures as subtalar fusion are associated with further consequences as stiffness, altered ankle biomechanics, and adjacent articular overloading with degenerative changes. The objective of the present study is to evaluate the short-term effects of viscosupplementation with intra-articular hyaluronic acid (HA) on function and pain, in patients with painful subtalar joint after calcaneus fracture. Methods We searched for patients who underwent osteosynthesis of intra-articular calcaneus fracture between January 2011 and July 2015 and were diagnosed during the follow-up with pain and subtalar osteoarthritis. Between January and December of 2018, 13 patients (50 ± 10 years) accepted to participate in this study and received intra-articular HA injections. Three consecutive doses of 20 mg of HA were administered within a week interval, through anterolateral injections into the subtalar joint. We prospectively evaluated the function using the ankle/hindfoot American Orthopaedic Foot & Ankle Society score (AOFAS) and level of pain using the visual analog scale (VAS) before the intervention and 4, 12, and 24 weeks after the first injection. Results Hindfoot function improved with an increase of AOFAS from 55 ± 19 before the intervention to 88 ± 20 at the 24th week ( P = .001). Similarly, we observed relief of pain during the 24 weeks following intra-articular hyaluronic acid injection, with a decrease in VAS from 8.3 ± 1.3 before treatment to 2.2 ± 3.0 at the 24th week ( P = .001). Conclusion For patients experiencing pain and dysfunction with subtalar osteoarthritis after intra-articular calcaneus fracture, viscosupplementation with intra-articular HA may be associated with improvement in function and pain in the short term. Furthermore, patients with higher grades of osteoarthritis may have limited benefit in pain relief and function improvement. Level of evidence: IV, Case series

Introduction: The handheld dynamometer has been validated to measure muscle strength in different muscle groups. However, to date, it has not been tested in individuals who experience pain induced by hip osteoarthritis. The current study aimed to evaluate the intra- and inter-rater reliability, agreement, and minimal detectable change of the Lafayette handheld dynamometer, model 1165, to assess the peak force (Pk) and average peak force (Af) of hip muscles in individuals with symptomatic hip osteoarthritis. Methods: Twenty participants with hip osteoarthritis (mean ± SD age: 58.7±15.3 years; body mass index: 28.8±4.2 kg/m2) and a pain intensity on the Visual Analogue Scale ≥ 4 (8.05±1.2) were recruited to participate in this study. Pk and Af of hip flexors (seated position), abductors and adductors (supine position), and extensors (prone position) were collected in a single day by two independent raters, each one obtaining test and retest in randomly ordered separate sessions. Results The intra-rater intraclass correlation coefficient (ICC) was classified as good (>0.75) or excellent (≥0.90) for all muscle groups, and all inter-rater ICCs were classified as excellent. Rater A had a lower standard error of measurement compared to rater B, ranging from 0.15 to 0.58 kilogram-force (Kgf) compared with 0.34 to 1.25 kg, respectively. However, the inter-rater comparison showed a minimal detectable change < 10% for all Pk and Af measures (except Af for the abductor muscle group). Finally, the inter-rater Bland-Altman analysis demonstrated good agreement for abductors, adductors, and extensors. Conclusion: Despite pain and dysfunction related to hip osteoarthritis, the handheld dynamometer was shown to be a reliable tool to assess hip muscle strength, with good to excellent intra- and inter-rater ICCs, satisfactory agreement, and small values for minimal detectable change.