Revista Colombiana de Ortopedia y Traumatología最新文献

Introduction

The tranexamic acid is currently one of the most effective pharmacological methods for blood lose in articular replacements. The study aimed to evaluate the effects of TXA administration in periarticular infiltration combined with intraarticular administration compared to topical TXA in blood lose in total knee arthoplasty.

Methods

Retrospective observational study. Patients undergoing total primary knee arthoplasty were included. Hematocrit and pre-surgical and post-surgical hemoglobin values ??were collected in patients operated between March 2016 and March 2018. The first group underwent peripheral joint infiltration with bupivacaine mixture with epinephrine 150 mg, ketorolac 30 mg, morphine 0.1 mg / kg and 2 g. of intraarticular TXA; the second group administered the same previous protocol plus 1 g. of TXA in the infiltrated mixture.

Outcomes

174 patients [Group 1: 174 (65.9%) and Group 2: 90 (34.1%)]. From group 1, the percentage of transfusion was 0.57% (1 patient). The average decrease in hematocrit was 7.03% (-1.4 to 18.3) and the decrease in hemoglobin from 2.51 (-0.5 to -5.7) g / dl. In group 2 there were no transfusions. The average decrease in hematocrit was 7.05 (-0.3 to 15.1) and the decrease in hemoglobin of 2.56 (0.0-5.2) g / dl.

Discussion

The results of our study are similar to reports from previous studies. The use of TXA in the mixture of periarticular infiltration in addition to its topical use does not generate benefit in the control of blood loss in the total knee arthroplasty.

Evidence: III

Atypical and complex congenital clubfoot have particular characteristics in their pathophysiology, clinical presentation, and management. The omission in its diagnosis prevents from opting for the modified Ponseti method described for these conditions, which results in poor results due to skin complications, deterioration of some deformities and even instability in the Lisfranc joint.

Regarding the modification of the Ponseti method, the way in which the forefoot is manipulated stands out: all metatarsal heads are extended simultaneously with both thumbs while avoiding excessive abduction, not only during manipulation and casting, but also with the position of the foot in the postoperative splint.

The characteristics of these feet make manipulations and plastering a demanding task, so it is recommended for this treatment to be carried out by personnel properly trained in the Ponseti method and its modifications for complex feet. Characteristics and treatment of these varieties of clubfoot are described in detail in this review.

After correction, strict and prolonged follow-up is necessary, since the probability of recurrence and the need for reoperations is greater than that described for typical idiopathic clubfoot. The good results obtained with the Ponseti method in various clinical situations apply to cases of recurrence of atypical and complex feet which means, the modified Ponseti method allows the deformities to be corrected without extensive surgeries.

Evidence Level

IV

In the last decades, Ponseti's Method (PM) has become the gold standard for the treatment of clubfoot. Although in the new born patients is indisputable, the implementation of this method in older patients has been slower due to the small amount of protocols that supports it and the difficulty of follow ups, which limits a timely treatment, creating in addition to the deformity and the limitation in the gait, extensive areas of pressure that makes their treatment more difficult. Therefore, in this revision the intention is to display the importance of this method for the non treated clubfoot in patients of walking age, as it's definitive treatment, or alternatively, as part of it's treatment, and in the future of PM making it accessible to all new borns, avoiding the need to perform such technique for the treatment of this pathology in older patients.

Evidence Level: IV.

Background

Scoliosis is a three-dimensional deformity of the spine. The main objective of treatment is to avoid progression, achieve maximum correction and arthrodesis of the least number of segments, with good coronal and sagittal balance that allows a painless fusion. The aim of the study is to evaluate the results of patients who underwent to surgical fusion for adolescent idiopathic scoliosis.

Material and Methods

A case series study was conducted by analyzing medical records of patients who underwent to surgical fusion for adolescent idiopathic scoliosis. between 2011 through 2017.An analysis of demographic data, the type of curve, the density of screws used, the percentage of reduction achieved after one year, and complications was performed.

Results

Data of 27 patients was included. Lenke 1B curves were predominant. The mean preoperative Cobb angle was 66.5o with a postoperative 24.4o. Screw density presented an average of 1.4. Complications were presented in 25.6% of the patients, the most frequent being infection. Good results were obtained in the SRS-22 questionnaire.

Discussion

A density of 0.8-1.69 screws per fused vertebra has been reported with a correction percentage of 64-70%. In our results, the density of screws per fused vertebra was 1.4, achieving a reduction of 64.1%. Increasing the number of screws did not increase the degree of correction of the curves. In accordance with the literature, the most frequent complication was infection, with a low incidence of neurological injury. We conclude that the arthrodesis technique used in our center, with third-generation pedicle screws, obtains good reduction results, with a percentage of complications similar to those previously reported.

Background

Fractures of the shaft of the humerus are frequent, with bimodal distribution in the population. Non-surgical management with immobilization and a functional brace is considered the gold standard with some specific complications that can occur early or late during treatment. The entrapment of the radial nerve by the bone callus with neurological involvement is a rare event reported in literature.

Methods

Two cases of late radial nerve neuropraxia are described in patients who suffered simple line fractures who met criteria for nonsurgical treatment. A narrative review of the literature in known databases was carried out looking for similar cases to optimize medical management.

Results

The clinical outcomes of the two cases that underwent surgery by the same surgeon and that shared the same diagnoses of radial nerve entrapment due to bone callus during initial non-surgical treatment are presented. The results of the narrative review of the literature are reported.

Discussion

Neuropraxia of the radial nerve due to entrapment in bone callus in the first days of a non-surgical treatment for fractures of simple lines in the diaphysis of the humerus is a rare but possible complication that confirms the need for strict monitoring of the patient.

Evidence Level: IV.

Background

Osteoporosis is recognized as a multifactorial systemic skeletal disorder, characterized by low bone mass and loss of bone tissue microarchitecture, which compromises its resistance, with the consequent increase in bone fragility and increased susceptibility to fractures. The aim of the study is to determine the prevalence of osteoporosis and associated risk factors in women in climacteric.

Materials and methods

Observational, descriptive cross-sectional study. Of a population of 705 women, belonging to the menopause and climacteric program, 618 (87.65%) were enrolled. Women of 40 years or more were included, in climacteric, and with risk factors for bone loss or fractures, residents in Quindío (Colombia); attended between May 2015 and August 2017 in a private institution of high complexity in Armenia (Quindío). Oophorectomized women, with cancer, were receiving radiotherapy or chemotherapy. Sampling was done for convenience. Socio-demographic and clinical variables were measured. Measures of central tendency and dispersion or average were described. A bivariate analysis was performed between the presence of osteoporosis and the associated factors, the Odds ratio (OR) was calculated with its respective 95% confidence interval (95% CI).

Results

The average age was 57.46 ± 7.38 years. The prevalence of osteoporosis in the general population was 34.46% (n = 213); being superior in those over 60 years (63.38%, n = 135) with respect to minors (36.61%, n = 78). In those over 70 it was 65.92%. The prevalence of vertebral fracture in those over 60 years was 17.96%. The incidence of hip fracture was 9.22%. The incidence of wrist fracture was 12.13%. Bone mineral density was normal in 20.38% (n = 126). Osteopenia was found in 45.14% (n = 279). The risk factors significantly related to osteoporosis were: age over 60 years, vitamin D deficiency, postmenopausal time greater than 10 years and not receiving hormone replacement therapy.

Discussion

The presence of osteoporosis is a common problem in women in climacteric. The prevalence increases as the age of women increases. When taking into account each of the factors involved, you should try to know that relationship, in order to be able to treat them together.

Evidence Level: II

Background

85% of amputations in diabetic patients are preceded by the appearance of an ulcer. Reamputation rates of up to 60.7% at 5 years has been described, as well as mortality of up to 69.7% at one year for major amputations. Aim of the study is to characterize a population of diabetic patients, amputees due to infections associated with diabetic foot in a university hospital.

Material and methods

Inclusion and exclusion criteria and a sociodemographic, clinical and microbiological data collection format were applied to all amputations related to infections associated with diabetic foot between 2014 and 2016. Means and standard deviations and / or medians and percentiles were used.

Results

The average age was 61.6 years. Male sex and poor glycemic control and a high number of comorbidities such as hypertension and chronic kidney disease predominated. 24.4% of previous ulcers and 18.1% previous amputations. Major amputations were 39%. Stump infection was 23.6% and reamputations 24.5%. Mortality was 4.54%

Discussion

Poor metabolic control was identified, as well as a high percentage of comorbidities and complications. Insufficient nutritional follow-up and staging of vascular status with underreporting of relevant data such as neuropathy, deformities and status of the contralateral foot. The number of ulcers and previous amputations was high. There was good clinical / laboratory correlation. Initial major amputations were more frequent in women. There is a high percentage of surgical site infections and reamputations.

Evidence Level: III

Septic polyarthritis in an immunocompetent patient is highly rare, even more when it coexists with necrotizing fasciitis caused by Streptococcus Pyogenes (SP). A 54 year old, immunocompetent male patient is presented herein. The patient had no relevant previous illness, before the installation of a septic arthritis of both knees and he's left ankle. He receives treatment with sequential surgical debridement, then develops necrotizing fasciitis of the posterior aspect of the left leg requiring adequate treatment for such condition (including Vacuum Assisted Closure), as well as antibiotic therapy for the specific infecting microorganism (Penicillin + Vancomycin). Nonetheless, after a month of surgical management between Plastic Surgery, Dermatology, Orthopaedics as well as surveillance in the Intensive Care Unit, the patient dies after multi organic failure. Infection caused by SP might entail high morbidity for a patient and even end with death of the aforementioned caused by a hard to manage systemic organic failure. The adequate diagnosis, as well as aggressive medical and surgical management could not be enough for controlling the infection, even in patients without previous immunological compromise. At the same time, a multidisciplinary approach must be the standard of treatment, aiming to control predisposing infectious conditions. This is the first case reported in national literature related to these two fatal conditions. Finally, one of the purposes of this report is to highlight that despite reports of this microorganism infecting infants and immunocompromised patients, it must not be obviated in healthy patients, especially in cases of rapidly spreading infection and scarce response to adequate management.

Evidence Level: IV