Revista Colombiana de Ortopedia y Traumatología最新文献

Intraosseous xanthomas are expandable lytic lesions composed of lipid-laden histiocytes. They are usually secondary to endocrine or metabolic diseases or as an incidental finding in a pathological fracture not associated with systemic diseases. In the latter case it is called primary intraosseous xanthoma.

We describe the case of a 32-year-old woman with a 4-month history of pain in the right hip, with images and biopsy of the right intertrochanteric area, compatible with a residual simple bone cyst. Intralesional treatment was performed with demineralized bone matrix filling, segmental fibular allograft and osteosynthesis with surgical pathology that reported bone xanthogranuloma in a patient with normal cholesterol levels with adequate disease control, consolidation, and functional recovery. We present this report given the low incidence of this pathology and the differential diagnoses are discussed.

Introduction

Percutaneous osteosynthesis of the sacroiliac joint guided by fluoroscopy in posterior pelvic ring lesions, described by Matta in the 1990s, remains the gold standard technique. However, the development of novel techniques such as 2D/3D navigation-assisted or CT-assisted surgery brings improvements in terms of ease and safety.

Objective

To present the 2D navigation-assisted percutaneous sacro-iliac fixation technique, as well as the clinical and radiological results of the patients operated.

Materials and methods

Twenty-three patients with a diagnosis of posterior pelvic ring disruption (sacroiliac dislocation and/or fracture) operated by 2D navigation-assisted percutaneous fixation (Medtronic Synergy System) in our hospital from 2017 to present were reviewed. Demographic, classification, therapeutic variables and derived complications were collected. The modified POS (Multicenter Study Group Pelvis Outcome Scale) rating scale was used to assess clinical, radiological and social outcome.

Results

Eight patients had sacro-iliac dislocation and 15 had fracture through the sacrum. A total of 40 iliaosacral screws were implanted. The mean operative time was 20 min for each screw. An average of eight fluoroscopy pulses were required per procedure. There were three malpositioned screws (7.5%). Fifteen patients had good or excellent results on the POS form.

Conclusions

Navigation-assisted percutaneous iliaosacral fixation is an alternative to the classic method guided by radioscopy, with good results. It facilitates the surgeon the correct placement of the screws, shortening the surgical time and with less exposure to ionizing radiation. It is useful for all types of ring lesions and when reduction maneuvers are necessary.

Introduction

Through this study, the clinical and demographic characterization of patients with chronic low back pain operated on with transforaminal epidural steroid injection will be carried out in a fourth level hospital.

Materials and methods

A retrospective analytical study of longitudinal temporality was carried out, which included 85 adult patients with chronic low back pain operated on with transforaminal injection from January 1, 2020 to March 31, 2021.

Results

Fifty-three adults (62.4%) were women and 32 (37.6) were men. On average, the age of these individuals was 54 ± 14 years. In 37 cases (43.5%) it was performed bilaterally, and 42 individuals (49.4%) required this type of injection at three lumbar levels. The mean of related symptoms was 24.37 ± 23.5 months. As triggering etiology, 33 individuals (38.8%) had degenerative disc disease, 25 (29.4%) due to spondyloarthrosis, 16 (18.8%) due to spondylolisthesis. In relation to subjective low back pain, a decrease of −4.1 ± 3.4 (CV = 82.1%) (p = 0.00) was recorded.

Discussion

Transforaminal epidural steroid injection in patients with chronic low back pain is a safe and minimally invasive procedure, which during the period of time studied did not present complications or subsequent hospitalization. The majority of the intervened population corresponds to women between 35 and 55 years of age. A decrease in subjective low back pain was observed after one month of performing this procedure.

Level of evidence

Retrospective analytical study of longitudinal temporality. Level III.

Introduction

Developmental dysplasia of the hip is a pathology that causes functional sequelae if it is missed or misdiagnosed. AP radiography of the pelvis is the method most used for screening; however, multiple variables alter the result; positioning, environment, patient, etc. The objective was to determine the incidence of developmental dysplasia of the hip using the anti-rotational device, evaluating the agreement between observers with quantitative and qualitative parameters in the radiograph for diagnosis.

Materials and methods

Retrospective observational study of historical cohort including patients between 4 and 9 months of age with AP radiography of the pelvis using the anti-rotational device evaluating only simple dysplasia. For the measurement, the CareStream program and the concordance analysis with the Stata 15 program were used.

Results

One hundred eighty-one radiographs of patients were included, with an incidence of developmental dysplasia of the hip of 9.4% (95% CI: 5.5–14.6), where 29.4% were bilateral, 35.3% of the right hip and 35.3% of the left hip, taking into account 3 or more qualitative parameters, such as the lateral acetabular sclerosis, flat acetabular configuration, line in the external metaphysis, and an irregular rim. A good degree of agreement (kappa greater than 0.6) was found in acetabular sclerosis, left acetabular line and in the final diagnosis (kappa 0.8).

Discussion

The standardization of radiography taking with the use of an anti-rotational device «Orthohip» and qualitative parameters additional to the acetabular index facilitates an adequate diagnosis avoiding the taking of multiple radiographs.

Level of evidence: Level III.

Introduction

Knee arthroscopy is considered a safe procedure with low rate of complications. The aim of the study was to calculate the incidence of symptomatic thromboembolic events: deep vein thrombosis and pulmonary embolism, associated with knee arthroscopy and evaluate possible related risk factors.

Materials and Methods

Retrospective cohort study. Patients who underwent knee arthroscopy between January 2011 and December 2015 at a University Hospital were included. Follow-up was performed during the first 30 postoperative days. Demographic characteristics, symptomatic thromboembolic events, type of arthroscopic procedure and possible risk factors were recorded.

Results

1,097 arthroscopic knee surgeries were performed in the 5 years of the study. 100% had 10-day postoperative follow-up and 90.5% of patients completed the 30-day follow-up. The mean follow-up time was 15.1 months. The rate of symptomatic thromboembolic events during follow-up was 1.4% (n = 14). There were two risk factors statistically associated with the outcome of the study: previous thromboembolic events (p = 0.013) and the current use of anticoagulants (p = 0.001). The mean age of the group with thromboembolic events was significantly higher (58 years) than that of the control group (46 years) (p = 0.009).

Discussion

The incidence of symptomatic thromboembolic events associated with knee arthroscopy was low. The routine use of thromboembolic prophylaxis is not recommended in patients undergoing this surgery. We recommend using it in patients with risk factors such as history of previous thromboembolic events and actual use of anticoagulants. Likewise, its use in patients over 50 years should be considered.

Level of evidence

III, Retrospective Cohort Study.

Introduction

The discoid meniscus is a meniscal malformation that can generate symptoms in children and adolescents. Arthroscopic techniques have been developed achieving improved functionality in the vast majority of patients with discoid meniscus and associated lesions. The objective is to show the clinical and functional results of patients operated by arthroscopy in a reference center in pediatric orthopedics during a period of 3 years.

Materials and methods

The results of a retrospective cohort of patients under 18 years of age treated surgically for symptomatic discoid meniscus over a 3-year period were analyzed by reviewing medical records and evaluating clinical outcomes using the Tegner–Lysholm scale.

Results

Twenty-five knees were operated on in 21 patients with an average age of 8.9 years. The average follow-up time was 8.3 months, 60% of the knees had peripheral rim instability. Ninety-two percent of the patients had an excellent score (>90) on the Tegner–Lysholm scale and the remaining 8% had a good score. Eighty-eight percent of the cases had no postoperative pain and 12% had mild pain. Return to sport occurred within the first 4 months in 19 patients.

Conclusion

Arthroscopic treatment of symptomatic discoid meniscus with meniscal remodeling and stabilization of the peripheral rim has good functional results in the short and medium term, allowing patients to return to their activities in a short period of time.

Introduction

Giant cell tumor is a benign but locally invasive neoplasia; presentation at the distal end of the ulna is very rare. In Campanacci grade 3 lesions of the distal ulna, en bloc resection of the tumor is recommended, with or without reconstruction or stabilization of the ulnar stump.

Case report

A 29-year-old woman with a Campanacci grade 3 giant cell tumor of the distal ulna; she was treated with en bloc resection of the tumor, including the extensor carpi ulnaris (ECU) due to being well adhered to the tumor; tendon defect was replaced with a palmaris longus (PL) autograft, to later stabilize the ulnar stump with the reconstructed tendon. Follow-up after 2 years 5 months showed no evidence of tumor recurrence with an excellent functional result and stable ulnar stump.

Discussion

Currently there is insufficient evidence to support the use of a stabilization technique or not, however, it is expected that the treatment carried out will be interesting and avoid possible stability problems of the ulnar stump in the face of wide resections that compromise the extensor carpi ulnaris (ECU).

Level of evidence: IV.

Introduction

Knowledge of anatomy of the median nerve in its course through the elbow allows understanding the origin of several pathologies; in addition, identifying the distribution and anatomical variants of the nerve branches is useful for defining surgical approaches for this nerve.

Materials and methods

Dissection of cadaveric specimens, convenience sample, with prior approval of the ethics committee and following a dissection protocol identifying the median nerve and its ramifications in the elbow and its relationship with vascular and myotendinous structures.

Results

Twenty elbows with an average age of 60.8 years were dissected, exploring the median nerve, its ramifications and adjacent anatomical structures in the antecubital fossa. No Struthers ligament was found, the distance to the pronator teres (PT) arcade from the interepichondyle line was 51.3 mm and 74.1 mm to the flexor digitorum superficialis (FDS) arch. The most frequent pattern was a trunk for PT, a proximal transverse branch with divisions for FDS, flexor carpi radialis (FCR) and palmaris longus (PL). The innervation of the FCR originated mostly from the trunk of the PT.

Discussion

Great variability of origin and distribution of the branches originated from the median nerve in the elbow was observed, the distances and morphological characteristics in the known compression sites were quantified. The FCR branch is put at risk in the exploration of the tendon arches of the PT and the FDS.