Mini Nutritional Assessment predicts gait status and mortality 6 months after hip fracture.

The aim of the present study was to evaluate the Mini Nutritional Assessment (MNA), the Nutritional Risk Screening (NRS) 2002 and the American Society of Anesthesiologists Physical Status Score (ASA) as predictors of gait status and mortality 6 months after hip fracture. A total of eighty-eight consecutive patients over the age of 65 years with hip fracture admitted to an orthopaedic unit were prospectively evaluated. Within the first 72 h of admission, each patient's characteristics were recorded, and the MNA, the NRS 2002 and the ASA were performed. Gait status and mortality were evaluated 6 months after hip fracture. Of the total patients, two were excluded because of pathological fractures. The remaining eighty-six patients (aged 80·2 (sd 7·3) years) were studied. Among these patients 76·7 % were female, 69·8 % walked with or without support and 12·8 % died 6 months after the fracture. In a multivariate analysis, only the MNA was associated with gait status 6 months after hip fracture (OR 0·773, 95 % CI 0·663, 0·901; P= 0·001). In the Cox regression model, only the MNA was associated with mortality 6 months after hip fracture (hazard ratio 0·869, 95 % CI 0·757, 0·998; P= 0·04). In conclusion, the MNA best predicts gait status and mortality 6 months after hip fracture. These results suggest that the MNA should be included in the clinical stratification of patients with hip fracture to identify and treat malnutrition in order to improve the outcomes.

Incomplete mandibular fracture after lateralization of the inferior alveolar nerve for implant placement

PURPOSE: The present case describes an inferior alveolar nerve lateralization for implant placement that caused mandible fracture a few days after surgery. CLINICAL REPORT: In this case, a 56-year-old female patient who had a severely atrophied jaw and showing bone height less than 7 mm from the bone crest and the mandibular canal was submitted to surgery lateralization of the inferior alveolar conducted with piezzo. Even with all postoperative care, the patient suffered an incomplete fracture of the mandible a few days after lateralization of the inferior alveolar nerve for implant placement. The patient was treated with soft diet and medications for pain and antibiotics, besides removing the implant associated with the fracture. CONCLUSION: It is suggested that this procedure may be conducted in 2 operative periods: firstly, the lateralization of the inferior alveolar; and secondly, after a period of 3 months, the implant placement in a situation of more bone stability. Copyright © 2013 by Mutaz B. Habal, MD.

Failure of miniplate osteosynthesis for the management of atrophic mandibular fracture

Fractures of the severely atrophic (<10 mm) edentulous mandible are not common, and these fractures with a vertical height of 10 mm or less have long been recognized as being particularly problematic. Although there are advances in the treatment of the atrophic mandibular fracture, the treatment remains controversial. There are some options for treatment planning because of using small miniplates to large reconstruction plates. However, when the fixation method fails, it causes malunion, nonunion, and/or infection, and sometimes it has been associated with large bone defects. The authors describe a clinical report of a failed miniplate fixation for atrophic mandibular fracture management. The authors used a load-bearing reconstruction plate combined with autogenous bone graft from iliac crest for this retreatment. The authors show a follow-up of 6 months, with union of the fracture line and no complication postoperatively. © 2013 by Mutaz B. Habal, MD.

Management of pure medial orbital wall fracture with autogenous bone graft

The orbit is an irregular conical cavity formed from 7 bones including the frontal, sphenoid, zygomatic, maxillary, ethmoid, lacrimal, and palatine bones. Fractures of the internal orbit can cause a number of problems, including diplopia, ocular muscle entrapment, and enophthalmos. Although muscle entrapment is relatively rare, diplopia and enophthalmos are relatively common sequelae of internal orbital fractures. Medial orbital wall fracture is relatively uncommon and represents a challenge for its anatomical reconstruction. In this context, autogenous bone graft has been the criterion standard to provide framework for facial skeleton and orbital walls. Therefore, it is possible to harvest grafts of varying size and contour, and the operation is performed through the bicoronal incision, which is the usual approach to major orbital reconstruction. Thus, this article aimed to describe a patient with a pure medial orbital wall fracture, and it was causing diplopia and enophthalmos. The orbital fracture was treated using autogenous bone graft from calvarial bone. The authors show a follow-up of 12 months, with facial symmetry and without diplopia and enophthalmos. In addition, a computed tomography scan shows excellent bone healing at the anterior and posterior parts of the medial orbital wall reconstruction. Copyright © 2013 by Mutaz B. Habal, MD.

Using the bottom-up and outside-in sequence for panfacial fracture management: Does it provide a clinical significance?

Panfacial fractures usually refer to simultaneous facial fractures, which affect the upper, middle, and lower thirds of the face. The management of panfacial fracture is complex because of the lack of reliable landmarks. Literature has shown many approaches for management of panfacial fractures. Every segment of bone has a precise function in the repair. Therefore, the bottom-up and outside-in sequence is the most widely used approach in the management of panfacial fractures. These facial fractures present remarkable challenges for both experienced and inexperienced surgeons. This article aimed to report a case of a panfacial fracture (mandibular condylar and symphysis fractures associated with an atypical Le Fort III fracture) in a 48-year-old man. The patient was successfully treated using bottom-up and outside-in sequence by accessing all facial injuries. Postoperatively, radiograph examination revealed good reduction and fixation of titanium plates, and physical examination revealed good functional and esthetic outcomes. Copyright © 2013 by Mutaz B. Habal, MD.

Um modelo constitutivo de dano composto para simular o comportamento de materiais quase-frágeis

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Impact of muscle fatigue on mechanics and motor control of walking

Pós-graduação em Ciências da Motricidade - IBRC

Caracterização petrográfica, química e tecnológica dos quartzitos do centro produtor de São Thomé das Letras no sudoeste do Estado de Minas Gerais

Pós-graduação em Geologia Regional - IGCE

Assessment of the mechanics of a tissue-engineered rat trachea in an image-processing environment

OBJECTIVES: Despite the recent success regarding the transplantation of tissue-engineered airways, the mechanical properties of these grafts are not well understood. Mechanical assessment of a tissue-engineered airway graft before implantation may be used in the future as a predictor of function. The aim of this preliminary work was to develop a noninvasive image-processing environment for the assessment of airway mechanics.METHOD: Decellularized, recellularized and normal tracheas (groups DECEL, RECEL, and CONTROL, respectively) immersed in Krebs-Henseleit solution were ventilated by a small-animal ventilator connected to a Fleisch pneumotachograph and two pressure transducers (differential and gauge). A camera connected to a stereomicroscope captured images of the pulsation of the trachea before instillation of saline solution and after instillation of Krebs-Henseleit solution, followed by instillation with Krebs-Henseleit with methacholine 0.1 M (protocols A, K and KMCh, respectively). The data were post-processed with computer software and statistical comparisons between groups and protocols were performed.RESULTS: There were statistically significant variations in the image measurements of the medial region of the trachea between the groups (two-way analysis of variance [ANOVA], p<0.01) and of the proximal region between the groups and protocols (two-way ANOVA, p<0.01).CONCLUSIONS: The technique developed in this study is an innovative method for performing a mechanical assessment of engineered tracheal grafts that will enable evaluation of the viscoelastic properties of neo-tracheas prior to transplantation.

Cardiovascular risk and mortality in end-stage renal disease patients undergoing dialysis: sleep study, pulmonary function, respiratory mechanics, upper airway collapsibility, autonomic nervous activity, depression, anxiety, stress and quality of life: a prospective, double blind, randomized controlled clinical trial

Background: Chronic kidney disease (CKD) is one of the most serious public health problems. The increasing prevalence of CKD in developed and developing countries has led to a global epidemic. The hypothesis proposed is that patients undergoing dialysis would experience a marked negative influence on physiological variables of sleep and autonomic nervous system activity, compromising quality of life.Methods/Design: A prospective, consecutive, double blind, randomized controlled clinical trial is proposed to address the effect of dialysis on sleep, pulmonary function, respiratory mechanics, upper airway collapsibility, autonomic nervous activity, depression, anxiety, stress and quality of life in patients with CKD. The measurement protocol will include body weight (kg); height (cm); body mass index calculated as weight/height(2); circumferences (cm) of the neck, waist, and hip; heart and respiratory rates; blood pressures; Mallampati index; tonsil index; heart rate variability; maximum ventilatory pressures; negative expiratory pressure test, and polysomnography (sleep study), as well as the administration of specific questionnaires addressing sleep apnea, excessive daytime sleepiness, depression, anxiety, stress, and quality of life.Discussion: CKD is a major public health problem worldwide, and its incidence has increased in part by the increased life expectancy and increasing number of cases of diabetes mellitus and hypertension. Sleep disorders are common in patients with renal insufficiency. Our hypothesis is that the weather weight gain due to volume overload observed during interdialytic period will influence the degree of collapsibility of the upper airway due to narrowing and predispose to upper airway occlusion during sleep, and to investigate the negative influences of haemodialysis in the physiological variables of sleep, and autonomic nervous system, and respiratory mechanics and thereby compromise the quality of life of patients.

Unerupted Lower Third Molar Extractions and Their Risks for Mandibular Fracture

As every surgical procedure extraction of third molars can result in several complications, among them the mandibular angle fracture. Predisposing factors for fracture should be analyzed during and after the surgery. This paper aims to discuss the predisposing factors to the occurrence of mandibular angle fractures during and after the procedure for third molars extraction, as well as surgical principles to avoid this complication.

Effect of triceps surae and quadriceps muscle fatigue on the mechanics of landing in stepping down in ongoing gait

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)