Robinson E. Pires

• MD, PhD
• Professor at Federal University of Minas Gerais

Objective Evaluate radiographic outcomes of patients over 50 years old who underwent plate or nail fixation for proximal humeral fractures within 6 months of follow-up. Methods A retrospective observational study with 222 patients was conducted in a single tertiary hospital to evaluate radiographic outcomes of patients who underwent surgery for fra...

Purpose The evolution of survey methods in clinical research has been significantly shaped by technological advances and the global upheaval caused by the Coronavirus Disease 2019 (Covid-19) pandemic. The use of traditional face-to-face interviews has been augmented, and in some cases replaced, by a range of remote interviewing techniques. This shi...

Background The surgical management of complex proximal tibia shaft fractures that extend into the joint remains a difficult challenge. The existing body of literature outlines a variety of reduction and fixation strategies, ranging from traditional double-plate constructs, with or without the use of minifragment plates, to fragment-specific plates...

Purpose Although several techniques have been described for bent intramedullary nail removal, there is no universally accepted strategy. We hypothesized that a device based on the action principle of a three-point bend fixture could facilitate extraction of bent intramedullary nails; this paper describes its design and experimental testing. Method...

There is a great limitation in the availability of resources for the care of patients with pelvic fractures associated with haemorrhagic shock in Latin America. Therefore, treatment protocols that adapt to this reality must be standardized and education and training improved.

Purpose This study aims to refine management strategies for malunion and nonunion of Hoffa fractures, as these rare complications present significant clinical challenges. Methods We conducted a case series involving seven patients with Hoffa fracture complications, including four cases of malunion and three cases of nonunion. Each patient underwen...

To work efficiently in healthcare organizations and optimize resources, team members must have a high degree of emotional intelligence, so they can be able to critically agree with their leaders' decisions. Adopting a strategic leadership style has a positive effect on job satisfaction and company performance. In this chapter, we have gathered the...

Background The surgical management of complex proximal tibia shaft fractures that extend into the joint remains a difficult challenge. The existing body of literature outlines a variety of reduction and fixation strategies, ranging from traditional double plate constructs, with or without the use of minifragment plates, to fragment-specific plates...

Purpose The optimal duration of antibiotic therapy for fracture-related infection (FRI) has not been well defined. Our aim was to assess the recurrence rate of infection in patients who underwent six, 12, or 24 weeks of antibiotic therapy following surgical treatment for FRI one year after antibiotic discontinuation. Additionally, complications wer...

Objective Analyze the current evidence on the treatment and outcomes of hyperextension fractures of the tibial plateau and propose a treatment algorithm. Methods An electronic search at PubMed/MEDLINE, Cochrane Library, Embase, and Google Scholar database from December 24th, 2023 to June 26th, 2024 was carried out. The terms for the database searc...

With the dizzying growth in the number of reverse shoulder arthroplasties (RSA), a rare but emerging complication is gaining attention: the periprosthetic scapular spine or acromial fracture following RSA. In this chapter, we will present epidemiological aspects, the potential risk factors, and the current management of this challenging complicatio...

Scapular fractures are rare and generally involved in the scenario of a high-energy blunt chest trauma. Most scapula fractures can be safely and effectively managed with non-operative treatment, especially when there is no involvement of the glenoid fossa. In this chapter, we outline the patient selection, our non-operative treatment protocol, and...

The appropriate management of glenoid fractures is debatable and still is a common and ongoing topic of discussion within orthopaedic trauma and shoulder surgeons (Seidl AJ, Joyce CD, J Am Acad Orthop Surg 28:e978–e987, 2020). Glenoid fractures are associated with a direct lateral and high-energy injury mechanism to the shoulder or to a low-energy...

Treatment of coracoid process and acromion fractures remains controversial in the literature. Both fractures are rare, but frequently associated with acromioclavicular injuries. In this book chapter, we address diagnosis, classification, current evidence, and our treatment protocol for coracoid process and acromion fractures.

Complex scapular fractures are conceptually defined by the presence of a glenoid fracture combined with a multifragmentary fracture of the whole scapular body (Pires et al., Patient Safety Surg 15(6):1–18, 2021). In this chapter, however, we will present the set-up strategies for challenging scapular fractures, but not only addressing this fracture...

Scapular fractures are extremely rare injuries in children and adolescents. These fractures can result from an enormous variety of mechanisms, including direct trauma and stress fractures. The diagnosis of scapular fractures can be challenging, especially in children and adolescents, due to the complex anatomy of the scapula and its proximity to ot...

The goals of a classification system are to stratify patients according to injury patterns, orientate treatment decision-making, and predict prognosis. In this book chapter, we aim to present the most used classification systems for scapular fractures, according to fracture location, and certain particularities of each scapular region.

Floating flail chest is the combination of ipsilateral floating shoulder and flail chest. In this chapter, we aim to highlight the importance of recognizing this challenging injury and the role of the restoration of the scapula-clavicular arch to improve respiratory function and pain control.

Scapular fractures generally occur in the context of a high-energy chest trauma scenario. Understanding the anatomy, biomechanics, and mechanism of injury, as well as epidemiologic aspects is essential for the correct management of the scapular fractures. In this chapter, we will present the essential basis for the correct interpretation and manage...

Scapular body and neck fractures commonly occur secondary to high energy mechanisms. While most can be treated non-operatively, for those with indicated deformity, there are several different approaches and fixation strategies that can be used to address the fractures. Approaches include the Judet, modified Judet, Brodsky, and minimally invasive ap...

The idea of this book stemmed from the collective expertise of three orthopaedic trauma surgeons deeply passionate about this subject. In recent decades, we have devoted a substantial portion of our professional careers to providing care for patients affected by this uncommon but challenging fracture. Fractures of the Scapula: Current Management Co...

Background and Objectives: Management of acetabular fractures is aimed at anatomically reducing and fixing all displaced or unstable fractures, as the accuracy of fracture reduction has been demonstrated to strongly correlate with clinical outcomes. However, there is a noticeable gap in the literature concerning the perioperative and postoperative...

Femoral shaft fractures are most often associated with high-energy trauma, occurring predominantly in the young and economically active population. Associated injuries occur in 5–15% of cases, increasing morbidity and mortality rates, and bringing a great socioeconomic burden. Radiographs are routinely sufficient to have the correct diagnosis, howe...

Diaphyseal and articular bone loss probably poses one of the greatest challenges in terms of limb reconstruction, and treatments that have historically ranged from amputation to reconstruction with different techniques. The key to the correct treatment requires adequate soft tissue coverage, controlled infection, and vital remaining bone. There is...

Objective To report on the experience and impressions of the Brazilian orthopedic trauma surgeons attending the Leadership Development Program (LDP) hosted by the Sociedade Brasileira do Trauma Ortopédico (SBTO) in Sao Paulo, Brazil on November 4, 2022. Methods Forty-eight orthopedic trauma surgeons from five different regions throughout Brazil we...

In orthopaedic surgery, as well as other areas in medicine, it is common for a surgical technique to carry the original authors’ name describing the procedure. The Judet family represents a unique history, since several orthopaedic procedures are known as “Judet’s technique”. The aim of this historic review is to outline the genealogy of the orthop...

The treatment of moderate to high-energy tibial pilon fractures continues to be associated with a high risk of complications. Anatomical reduction of the fracture, restoration of joint congruence, reconstruction of the medial, lateral, anterior, and posterior columns, and minimal soft tissue damage are highly recommended. Fixation failure can occur...

Fraturas e luxações são condições músculo-esqueléticas traumáticas que afetam sobremaneira e de modo imediato o bem-estar do indivíduo que as sofre. Em geral, apresentam sintomas comuns, que compreendem dor de moderada e grande intensidade, deformidade e aumento de volume no local da lesão, muitas vezes com redução ou perda completa da função do se...

O manejo de pacientes politraumatizados passou por uma revolução nos últimos 80 anos. Em seu início na década de 1940, o tratamento ortopédico de pacientes politraumatizados envolvia predominantemente o uso de tração, gesso e talas. As décadas seguintes trouxeram mudanças fundamentais no cenário da abordagem inicial do paciente politraumatizado com...

Surgical treatment of Bush-Hoffa fractures is still controversial, since a treatment protocol has not been defined. The objective of this study is to evaluate, through finite element analysis, the biomechanical behavior of two surgical solutions that use screws with a posterior-to-anterior and anterior-to-posterior approach, commonly used in the li...

Background Accomplish a thorough review on the existing biomechanical and clinical studies about coronal plane fractures of the distal femur. Methods We performed an electronic search of PubMed/MEDLINE database from April to June, 2023. The terms for the database search included “Hoffa fractures,” OR “Busch-Hoffa fractures” OR “coronal plane fract...

Introduction: We investigated the biomechanical behaviour of different fixations of the tibial posterior malleolus (TPM), simulating distinct situations of involvement of the tibiotalar articular surface (TTAS) through a finite element model (FEM). Material and methods: A 3D computer-aided design model of the left ankle was obtained. The materials...

Introduction: Ankle fractures are one of the most frequent injuries managed by any trauma surgeon. Literature has shown that adequate reduction is of utmost importance to achieve satisfactory functional outcomes. However, malreduction rates remain high worldwide. The objective of the present study is to evaluate the quality of ankle fracture reduct...

Background: Dysesthesia, electrical and burning sensations, in addition to allodynia are frequent symptoms of neuropathic pain. Despite the high frequency, scientific data on the development of neuropathic pain after surgery for fracture fixation are scarce. The goal of the present study was to determine the prevalence, risk factors, and evaluate p...

Femoral neck fractures (FNFs) affect the young adult population and are intimately related to high-energy trauma. Despite innovations in osteosynthesis materials, the rate of complications remains at 10%-59% in Pauwels type III (PIII) fractures. The authors thus propose a fixation model with a novel self-compression screw, comparing it to a sliding...

Postoperative bone infection is a severe complication in the treatment of fractures. The management of this pathology is challenging, but recent advances have been made to achieve standardization that can help diagnosis and decision-making. However, we are unaware of studies validating these models in Latin America. Therefore, this study aims to co...

Determining the true availability of resources and understanding the level of training of surgeons involved in the treatment of patients with pelvic fractures and haemorrhagic shock is critical. In the herein study, the availability of technical, technological, and human resources for the care of this injury in Latin America region was analysed, an...

Transverse fractures of the acetabulum Posterior column fractures of the acetabulum Antegrade lag screw fixation for acetabular fractures a b s t r a c t Antegrade fixation of posterior column fractures of the acetabulum is challenging due to the narrow corridor and risk of screw misplacement. Although both antegrade and retrograde lag screws have...

Objective: The aim of this study was to evaluate the Latin American orthopaedic trauma surgeons preference regarding knee positioning and entry portals for IM nailing and identify the reasons of these preferences. Methods: Using the AO Trauma database, 22.285 surveys were distributed by email to Latin American ortho-paedic surgeons. Demographic dat...

We investigated the biomechanical behaviour of different fixations of the tibial posterior malleolus (TPM), simulating distinct situations of involvement of the tibiotalar articular surface (TTAS) through a finite element model (FEM). A 3D computer-aided design model of the left ankle was obtained. The materials used were divided according to their...

Resumo Objetivo Verificar se implantes metálicos de uso rotineiro (aço inoxidável, liga de alumínio, cobalto-cromo-molibdênio e feitos de titânio) serão detectados em um aeroporto internacional do Brasil e gerar informações úteis para evitar transtornos ao paciente e apoiar os órgãos reguladores de segurança. Métodos Estudo experimental, não random...

Background In cases of proximal humeral fractures, fracture severity and the patient’s osteoporotic condition should be assessed to achieve the best possible treatment outcomes. The Tingart measurement is commonly used to assess bone quality, but it can be problematic if the measurement area is affected by the fracture. Recently, the deltoid tubero...

IntroductionFixation of distal femur fractures with a lateral pre-contoured locking plate provides stable fixation and is the standard treatment in most cases, allowing early range of motion with a high rate of union. However, in situations, the stability achieved with the lateral plate alone may be insufficient, predisposing to fixation failure. T...

The incidence of femoral neck fractures has increased in young adults. Although new implants and surgical techniques have been developed over the past decade, the rate of nonunion and osteonecrosis, which may be related to poor osteosynthesis stability, remains concerning. To address this issue, we propose a new implant model that has been anatomic...

Purpose To systematically review the currently available existing evidence related to the presentation and management of simultaneous floating hip and knee injuries to identify injury characteristics, treatment strategies, and complications. Methods Data sources: Relevant articles were identified by searching Medline, PubMed, and Google Scholar da...

Background: Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods: This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published i...

The most common periprosthetic fractures occur around the hip. The most widely used classification is the Vancouver classification, and management requires careful planning and skill in both arthroplasty and fracture surgery. This article presents an overview of the diagnosis, classification, and management of periprosthetic fractures of the proxim...

Historically, proximal ulna fractures have been simplistically diagnosed and treated as simple olecranon fractures, leading to an unacceptable number of complications. Our hypothesis was that the recognition of lateral, intermediate, and medial stabilizers of the proximal ulna and ulnohumeral and proximal radioulnar joints would facilitate decision...

In recent years, especially driven by concerns generated by the COVID-19 pandemic, there has been a growing interest in online activities for the training of orthopaedic surgeons of all ages and levels of expertise. In this context, continuing education also focuses on improving research knowledge with several online courses promoted by different m...

Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index...

Over the last year, with the social isolation imposed by the coronavirus disease pandemic, there has been a significant increase in complaints associated with physical violence against women. In the present study, an exploratory literature review was carried out on the role of the on-call orthopedic surgeon when faced with a suspicion of domestic v...

Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index...

Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index...

Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index...

Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index...

Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index...

Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index...

Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index...

Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index...

Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index...

Background and Objectives: Proximal humerus fractures are the second most frequent site of avascular necrosis (AVN), occurring in up to 16% of cases. The Hertel criteria have been used as a reference for the prediction of humerus head ischemia. However, these are based solely on the use of radiographs, which can make interpretation extremely diffic...

Resumo Objetivo Avaliar a capacidade biomecânica de duas formas de fixação de fraturas tipo II de Pipkin descrevendo o desvio da fratura no sentido vertical, as tensões máxima e mínima principais, e a tensão equivalente de Von Mises nas sínteses utilizadas. Materiais e Métodos Dois fixadores internos foram desenvolvidos para tratar a fratura tipo I...

Purpose Non-prosthetic peri-implant fractures are challenging injuries. Multiple factors must be carefully evaluated for an adequate therapeutic strategy, such as the state of bone healing, the type of implant, the time and personnel of previous surgery, and the stability of fixation. The aim of this study is to propose a rationale for the treatmen...

Resumo: Fraturas da escápula são raras e, geralmente, estão associadas a traumas de alta energia no contexto de trauma torácico. A literatura é controversa em relação às indicações do tratamento cirúrgico e o manejo não operatório proporciona resultados satisfatórios à maioria dos pacientes. A anatomia desfavorável da escápula, combinada com a comp...

Introduction The standard treatment of anterior glenaoid fractures carrying > 20% of the glenoid fossa is open reduction and internal fixation (ORIF). In the herein study, we report our outcomes in a retrospective cohort of anterior and anteroinferior glenoid rim fractures using an accelerated postoperative rehabilitation protocol. A secondary aim...

Femoral neck fractures in young adults are uncommon, resulting from high-energy trauma. Despite their infrequency in this population, there is higher rate of complications, especially in the more vertical fracture line, classified by Pauwels as a type-3 femoral neck fracture. The implant type is of paramount importance for maintaining anatomical re...

PurposeThe primary aim was to analyse the lateral malleolus morphology with a focus on the shape of the distal fibula for IM fixation of the fibula in infra- and transsyndesmotic fracture patterns. The secondary aim was to propose a treatment algorithm according to the lateral malleolar anatomy.Methods77 healthy, skeletally mature volunteers underw...

» COVID-19 is a disease that is challenging science, health-care systems, and humanity. An astonishingly wide spectrum of manifestations of multi-organ damage, including musculoskeletal, can be associated with SARS-CoV-2. » In the acute phase of COVID-19, fatigue, myalgia, and arthralgia are the most common musculoskeletal symptoms. » Post-COVID-19...

Objective: The goal of this study is to verify how commercially available pre-contoured superior plates fit on clavicle midshaft fractures. Methods: 100 cadaveric clavicles were evaluated by three distinct observers applying the clavicle congruence score and comparing four different 6 to 8-hole pre-contoured anatomic locking-plate systems. Results:...

Objective The goal of this study is to verify how commercially available pre-contoured superior plates fit on clavicle midshaft fractures. Methods 100 cadaveric clavicles were evaluated by three distinct observers applying the clavicle congruence score and comparing four different 6 to 8-hole pre-contoured anatomic locking-plate systems. Results...

Several surgical approaches and treatment methods are currently described for coronal plane fractures of the distal femur. This chapter aims to outline these treatment methods and the author’s preference according to the fracture pattern.

This chapter addresses the management of complex distal femur fractures (native bone or periprosthetic) by the combined use of a retrograde femoral nail and lateral locking plate, as well as the double-plating technique. Both surgical procedures are rapidly gaining favor because they provide stable and balanced fixation, allowing early knee mobiliz...

Purpose This study examined soft-tissue coverage techniques of open tibia fractures, described soft-tissue treatment patterns across income groups, and determined resource accessibility and availability in Latin America. Methods A 36-question survey was distributed to orthopaedic surgeons in Latin America through two networks: national orthopaedic...

Background The Reamer–Irrigator–Aspirator system was initially developed to reduce fat embolism and thermic necrosis during reamed intramedullary nail fixation of femoral shaft fractures. Currently, this system is used in extended applications including accessing large volume of autologous bone graft, as alternative for iliac crest harvesting. Ante...

Fraturas e luxações são urgências músculo-esqueléticas traumáticas que afetam o bem-estar do indivíduo que as sofre. Apresentam sintomas comuns, que compreendem dor de moderada e grande intensidade, deformidade e aumento de volume no local da lesão, muitas vezes com redução ou perda completa da função do segmento. Neste artigo, os autores abordam e...

Objective the management of septic metaphyseal nonunions is challenging, with inconsistent outcomes. Antibiotic cement-coated implants have been demonstrated good outcome for diaphyseal infected nonunions, however there is no data in metaphyseal infected nonunions. Methods fifteen adult patients with septic metaphyseal nonunions of the femur or ti...

Objective the management of septic metaphyseal nonunions is challenging, with inconsistent outcomes. Antibiotic cement-coated implants have been demonstrated good outcome for diaphyseal infected nonunions, however there is no data in metaphyseal infected nonunions. Methods fifteen adult patients with septic metaphyseal nonunions of the femur or ti...

PurposeDespite the fact that open reduction and internal fixation with a plate, either non-locked or locked, is the standard of care for managing lateral malleolus fractures, intramedullary (IM) fixation of the fibula has been recently introduced as an alternative, mainly for some potential complicated situations. We hypothesized that almost all pa...

The widespread adoption of smartphones and other mobile devices amongst healthcare providers opened new possibilities arising from the use of non-medical apps, social media, meeting platforms, and non-medical devices with intended medical purposes, thus expanding the communication and imaging chat systems between these professionals and their patie...

OBJECTIVES: This study aimed to correlate a higher Pelvic–Trochanteric Index (PTI) with an increased varus of the femoral neck with greater trochanteric pain syndrome (GTPS). The secondary objective was to check whether the pelvic width changes with age. METHODS: A prospective study was conducted to compare female patients diagnosed with GTPS (case...