Instituto Nacional de Traumatologia e Ortopedia

Avenida Brasil 500
Rio de Janeiro 20940-070
Brazil
+55 21 21345000
www.into.saude.gov.br

Chief Director of Orthopaedic Department
Geraldo da Rocha Motta, MD

CEO/President
João Matheus Guimarães, MD, PhD


Hospital’s
Mission

To promote actions as a reference institute in health care, research, prevention and coordination of public policies in orthopedics, traumatology and rehabilitation.

Year Founded
1994

Hospital Type
Federal funding

University Affiliations
• Universidade Federal do Rio de Janeiro – UFRJ (Federal University of Rio de Janeiro): partnership with the Graduate Program of Morphological Sciences through the development and supervision of doctoral thesis and dissertations; scientific collaboration with the Laboratory of Cellular Morphogenesis
• Universidade Federal do Rio de Janeiro – UFRJ (Federal University of Rio de Janeiro): partnership through the development of a clinical trial in severe osteoporosis in collaboration with the Endocrinology Department (Public Notice Call MCT / FINEP / MS / SCTIE / DECIT – Clinical Research – 02 /2008)
• Universidade Federal do Rio de Janeiro – UFRJ (Federal University of Rio de Janeiro): partnership with the coordination office of the post graduate programs in engineering (COPPE) through the development and supervision of doctoral thesis and dissertations in collaboration with the Nuclear Instrumentation Laboratory (LIN)
• Universidade Federal do Rio de Janeiro – UFRJ (Federal University of Rio de Janeiro): partnership with the Laboratory of Brain Mapping and Sensorimotor Integration from the Institute of Psychiatry
• Instituto Nacional do Câncer – INCA (National Institute of Cancer): partnership with the Division of Pathology and Tumor Registry
• Universidade Federal Fluminense – UFF (Fluminense Federal University): partnership with the Graduate Program of Medical Sciences through the development and supervision of doctoral thesis and dissertations
• Comitê Olímpico Brasileiro – COB (Brazilian Olympic Committee): Partnership with the Brazilian Volleyball Confederation for the development of studies and research aiming to reduce the impact of injuries in high-performance athletes
• Universidade de São Paulo – USP (University of São Paulo): partnership with the College of Veterinary Medicine Animal Science (Department of Surgery) and the Graduate Program Anatomy of Domestic and Wild Animals for the development of preclinical models of orthopedic diseases in large animals
• Universidade Federal de São Paulo – UNIFESP (Federal University of São Paulo): partnership with the Graduate Program of Translational Surgery for the development and supervision of doctoral thesis
• National Institute of Health, Bethesda, MD, USA: Dr. Pamela Gehron Robey (Chief Craniofacial and Skeletal Disease Branch, Co-Coordinator NIH Bone Marrow Stromal Cell Transplantation Center; Skeletal Biology Section Chief, Section Chief Matrix Metalloproteinase; Acting Scientific Director NIH Stem Cell Unit)
• University of California, CA, USA: Dr. Samuel S. Murray and Elsa Brochmann Murray (Department of Medicine, Geriatric and Gerontology and Discipline Engineering and Biomedical Engineering; Chief Bone Metabolism Laboratory) and Dr. Michael Daubs, from the Department of Orthopedic Surgery
• University of Leeds, UK: Dr. Peter V. Giannoudis from the Department of Trauma and Orthopedics , Leeds Teaching Hospital
• University of Pittsburgh, PA, USA: Dr. Alexandre R. Vieira from the Department of Oral Biology
• Center for Craniofacial and Dental Genetics and Department of Pediatric Dentistry, School of Dental Medicine, and Clinical and Translational Science, PA , USA
• Technishe Universität Chemnitz, German Institute of Sports Science, Department of Human Locomotion, Prof. Dr. Thomas Milani and Dr. Günther Schlee.

Accreditations
• Certification on International Accreditation by the Joint Commission International – JCI (2006, 2009 and 2012)

Hospital Awards/Recognitions
1st Certification on International Accreditation – JCI (2006); 1st Participation in PQRio Award – silver category (2007); 2nd Participation in PQRio Award – gold category (2008); 3rd Participation in PQRio Award – gold category (2009), 4th Participation in PQRio Award – Trophy and gold medal (2010); 2nd Certification on International Accreditation – JCI (2009); Trophy “Rio Voluntário” (2007, 2008 and 2009); “INOVAMOS Award” (2010); “Safe Surgery” Award (2011), and 3rd Certification on International Accreditation – JCI (2012).*

• PQRio (QUALITY PROGRAM RIO) Award is an award given by the state of Rio de Janeiro to outstanding institutions in the national and international scenario, regarding quality, safety, productivity and excellence in health care management. There are three categories of awards: bronze, silver and gold. The gold medal and trophy are given to highly differentiated organizations.
• “INOVAMOS” (INNOVATING) Award is an award given by the Ministry of Health to innovative initiatives within the public administration. INTO has been awarded due to the use of palmtops for surgical checklists and due to the innovation in its home care protocol.
• RIO VOLUNTÁRIO (RIO VOLUNTEER) trophy is an award given by the State Government to institutions that encourage engagement and participation of the civil society in favor of collective causes.

Leadership Appointments
• João Matheus Guimarães, MD, PhD – President of the Brazilian Society of Orthopedic Trauma (SBTO) 2013 and Chairman of the Brazilian Society of Orthopedics and Traumatology (SBOT) Committee in Education and Training 2013.
• Geraldo da Rocha Motta, MD – President of the Brazilian Society of Orthopedics and Traumatology (SBOT) 2012 and President of the Brazilian Society for Surgery of the Shoulder and Elbow (SBCOC) 2014.
• Anderson Monteiro, MD – President of the Brazilian Society for Surgery of the Hand (SBCM) 2013.
• Hugo Cobra, MD – President of the Brazilian Society for Surgery of the Knee (SBCJ) 2014.
• Walter Meohas, MD – President of the Brazilian Society of Orthopedic Oncology 2012.

Number of Orthopaedic Residents
44 (40 residents with full-time training on general orthopedics and four hand surgery residents)

Length of Residency
Orthopedics and Traumatology = three years; Hand Surgery = two years (previous three years in Orthopedics)

Number of Orthopaedic Fellows
35

Length of fellowship
Craniomaxillofacial Surgery, Spine Surgery and Orthopedic Oncology = two years; Knee, Shoulder and Elbow, Foot and Ankle, Hip Surgery, Microsurgery, Trauma and Pediatric Orthopedic Surgery = one year; and Reconstruction and Limb Lengthening = six months

Fellowship categories
Craniomaxillofacial Surgery, Spine Surgery, Shoulder and Elbow Surgery, Hip Surgery, Knee Surgery, Foot and Ankle Surgery, Trauma Surgery, Microsurgery, Pediatric Orthopedic Surgery, Orthopedic Oncology and Reconstruction and Limb Lengthening.

Is CME required in your country?
No

Does your hospital/center conduct CME programs?
No

Average number of peer reviewed articles published annually
60

Number of beds
321 (273 orthopedic beds and 48 Intensive Care Unit beds)

Total number of active medical staff (MDs)
Orthopaedic Surgeons – 161
Rheumatologists – 6
Physiatrists – 8
Rehabilitation – 133 (102 physiotherapists, 7 speech therapists and 24 occupational therapists)
Anesthetists: 147
G.P.s: 40
Pediatricians: 20
Intensivists: 100

Number of scientists = 20
Orthopaedic Appointments – 35, Other – 55

Type of research
1. Prophylactic, diagnostic and therapeutic methods applied to the musculoskeletal system:

• Surgical treatment of stable transtrochanteric fracture.
• Perception of self-efficacy: its influence on rehabilitation of patients with spinal cord lesion.
• The importance of MRI evaluation and staging of the classical radiological giant cell bone tumors.
• The clinical, epidemiological features and bad prognosis factors of infections associated with primary total hip arthroplasty in an orthopaedic hospital in Rio de Janeiro, Brazil.
• Comparison of the radiological space in loading area of the hip joint in radiographs in a supine position under the influence of local loading.
• Response to treatment with tranexamic acid in primary total non-cemented hip arthroplasty.
• Analysis of the role of a condroprotective hyaluronic acid with high molecular weight associated with dexamethasone in patients with knee osteoarthrosis.
• The impact of accidental fall in hospital bed turnover: analysis of notices of falls in patients admitted to an Orthopedic Institute in Rio de Janeiro, Brazil, between 2011 and 2012.
• Effective communication of critical laboratory tests in an intensive care unit at an Orthopedic Institute in Rio de Janeiro, Brazil.
• Influence of fibrin glue in reducing bleeding after primary total knee arthroplasty.
• Arthroplasty registry at the National Institute of Traumatology and Orthopaedics (INTO).
• Effect of autologous bone marrow concentrate in the healing of femoral nonunion stabilized with intramedullary nailing.
• Comparison of the efficacy of four anti-osteoporotic drugs in patients with severe osteoporosis.
• The ratio of protein and cytolysins in septic loosening of hip prosthesis.
• Epidemiologic analysis of osteosarcoma in the Brazilian population.

2. Stress and performance of the musculoskeletal system:

• Validation of equipment for measurement of proprioception in patients undergoing total elbow arthroplasty.
• Comparative study of muscular strength and evaluation of movement arch between three accesses in surgical patients undergoing total knee arthroplasty.
• Validation of the “HEALTH CIRCUIT” to improve employees´cardiorespiratory and musculoskeletal capacity in the National Institute of Traumatology and Orthopedics / INTO-RJ, Brazil.

3. Translational research applied to the musculoskeletal system:

• Evaluation of BMP4 and FGFR1 gene expression in long bone atrophic non-union.
• Analysis of genetic markers in tendinopathy of the posterior tibial tendon.
• Development of clinical grade human BMSCs for bone graft cellularization.
• Prognostic factors of osteosarcoma: a clinical and in vivo study.
• Impact of obesity in response to vitamin D supplementation in patients with osteoporosis.
• Comparative study of biological tissue composition at the focus of nonunion before and after reaming for the placement of intramedullary locking nail (HIM).
• In vitro and in vivo characterization of the potential of mesenchymal stem cells to differentiate into osteoprogenitors patients with osteogenesis imperfecta (OI).
• Identification of the correlation between genetic polymorphism and tendinopathy in elite Brazilian volleyball athletes.
• Evaluation of correlation between genetic polymorphisms in genes of musculoskeletal metabolism and rotator cuff injury in Brazilian patients.
• Investigation of the late-adherence behavior of human stromal cells form bone marrow stroma and reconstitute the hematopoietic microenvironment in vivo.
• Development of a genetic susceptibility test for tendinopathy in volleyball athletes.
• The role of chondrocytes in the maintenance of synovial cell activity: in vitro model for the study of human osteoarthrosis.
• Isolation and characterization of tumor stem cells as a prognostic tool for osteosarcoma.
• Role of BMP-2 and spp24 on the evolution of osteosarcoma: an In Vivo and In Vitro Study.
• Role of membrane transporters MDR in osteosarcoma´s resistance to chemotherapy.
• Membrane transporters MDR expression in bone tumors.
• The influence of genetic polymorphism in the development of temporomandibular disorder.
• Idiopathic temporomandibular joint ankylosis in children: correlation of genetic polymorphism and expression of microRNAs.
• Evaluation of gene expression of microRNA in musculoskeletal diseases.
• Evaluation of the expression of the transcription factor Nrf2 in patients with osteomyelitis.
• Evaluation of transcription factor Nrf2 expression in high-performance Brazilian volleyball athletes.

Amount of grant funding received annually
USD 600,000.00 from Financiadora de Estudos e Pesquisas – FINEP (Funding Authority for Studies and Projects) and USD 12,000.00 from Fundação de Amparo a Pesquisa do Estado do Rio de Janeiro – FAPERJ (Rio de Janeiro State Agency for Funding Research)

Number of full time employees
2,261

Number of operating rooms
21

Number of orthopaedic surgeries
Inpatient: 9,659 (in 2013)

Number of outpatient visits to orthopaedists, rheumatologists, and other medical services
208,217 (in 2013)

Other pertinent institutional information
The National Institute of Traumatology and Orthopedics – INTO is a public hospital in Rio de Janeiro, Brazil, specialized in high complexity surgical care in both traumatology and orthopedics that exclusively cares for patients from the public health system. The rate of high complexity surgeries is 34.2%. It does not provide first-aid services. The Institute receives patients from public health units from all over the country.

INTO is a branch of the Ministry of Health direct administration, linked to the Department of Health Care (SAS/MS) and has as its main missions:

• To assist the Ministry of Health in formulating national policies on prevention, diagnosis and treatment of orthopedic diseases and lesions of the musculoskeletal system secondary to trauma
• To plan, coordinate and establish guidelines for the prevention, diagnosis and treatment of orthopaedic diseases and rehabilitation nationwide
• To develop and guide the execution of educational and training activities, improving human resources at all levels in the areas of orthopaedics, traumatology and rehabilitation
• To coordinate programs and to conduct clinical, epidemiological and experimental studies in orthopaedics and traumatology
• To establish rules, standards and technical assessment of services and results, and
• To coordinate and to guide the provision of medical care to patients with trauma and orthopaedic diseases nationwide.

INTO is certified as a teaching hospital, offers residency programs in orthopedics and traumatology, nursing and pharmacy. It also supports the promotion of technical qualification in highly complex orthopedic surgical procedures for professionals throughout the country. The Institute provides on a regular basis intensive (“immersion”) weeks in orthopedic surgery as well as hosts scientific conferences. Through an integrated network of Telemedicine it is possible to discuss highly complex cases and to promote the teaching of surgical techniques in real time. This tool will be used extensively during the 2016 Olympic Games as the Institute was designated by the Olympic Committee as the reference hospital for orthopedic care of injured athletes.

INTO also provides a professional Masters degree in Sciences applied to the Musculoskeletal System, which is aligned with its strategy to become a reference Institute, not only in health care and medical assistance, but also in teaching and research. The Institute has a Tissue Bank that captures, processes, stores and freely distributes bones and musculoskeletal tissues collected from corpses to the National System of Transplants.