Revista Colombiana de Ortopedia y Traumatología最新文献

Background

SPECT bone scan with is an important diagnostic tool in patients with neck and back pain. It is a functional test that anticipates structural changes in some spinal pathologies. Aim of study is to define the epidemiological profile of patients with chronic and/or subacute axial spine pain.

Methods

A retrospective descriptive study whose general objective is to present the clinical and sociodemographic characteristics, as well as the results of the SPECT scans of the patients who visited the Hospital in a period of time with a diagnosis of neck or back pain and were requested such an examination.

Results

Seventy-seven patients met the inclusion criteria. The median age was 48 years, 57.1% were men and 42.9% were women. Fifty-seven patients had a single location of pain (74%) and 20 patients had multiple location (26%), the affected segments were 57 lumbar (74%), cervical 15 (19.5%) and sacrum 1 (1.3%). The most common pre-examination diagnostic impression was facet disease in 25 cases for 32.5%. Regarding the SPECT results, the radiopharmaceutical captured on 48 occasions (62.3%) and the sites where it captured the radiopharmaceutical were distributed as follows: facets 13 (16.9%), vertebral body 28 (36.4%), pars interarticularis 3 (3.8%).), intervertebral disc 1 (1.3%), 3 (3.8%) captured in sites other than the spine. The diagnostic concordance index after SPECT occurred in 33 cases (42.85%).

Discussion

Most of the uptake scans were in the vertebral bodies, beneath the context of our hospital, as a trauma center, and that many of the patients had pain secondary to traffic accidents or work behavior accidents, they are correlated with micro-fractures or bone contusions. SPECT scintigraphy continues to be a functional test that can help us in the diagnosis, prognosis and therapeutic approach of patients with axial spinal pain in its different stages.

Evidence Level

III

Background

Patellofemoral pain syndrome (PFPS) is a possible cause of anterior knee pain that predominantly affects young women. To date, there is no consensus regarding the aetiology, but the evidence suggests that patellofemoral misalignment probably plays a role in the pathogenesis of pain and particularly in chondromalacia. Osteotomies classically used and described in the literature report variable functional results. As the good results described in the literature are in a range between 50%-80%, this indicates some difficulty with the reproducibility of the technique, or its effectiveness, we wish to evaluate the results of a different technique.

Materials and Methods

Prospective case series study of patients with patellofemoral pain syndrome treated with a new osteotomy technique of the anterior tibial tuberosity, anterior-medialized, in V.

Results

A total of 19 knees were evaluated. The mean pain intensity was 9 in the preoperative period, and 4 and 3 in the follow-up at three and six months, respectively. A mean of 33 points on the Kujala scale was obtained in the pre-operative period, and 75 at 3 months and 87 at six months follow-up.

Discussion

A percentage of 94.7% was considered good or excellent results, and 5% of considered as bad. The technique described and used in our study presents a rate of good results similar to those described in the literature with other surgical techniques and with different functional scales.

Level of evidence: IV.

Background

The movement of the fingers is given by a complex mechanism that combines both extension and flexion. The alteration of the extensor mechanism at distal interphalangeal joint of the finger is known as mallet finger. Mallet finger can be managed either surgically or not surgically with external splints.

Materials and methods

A retrospective cross-sectional descriptive observational study was performed including patients diagnosed with mallet finger injury between June 2017 and January 2018 surgically treated with percutaneous internal fixation surgical technique using a transosseous pin.

Results

A total of 48 patients were included, 81.25% of the cases were men, between 31 and 55 years old, the vast majority right-handed, with a higher frequency of injury to the right hand. 41.67% of cases involved the second finger, followed by the third finger (39.58%), secondary to a blunt trauma. Additionally, complications were reported in 2 patients (4.16%).

Discussion

Mallet finger is an injury mostly secondary to a blunt trauma, predominantly in men and of the dominant hand, which can receive conservative management from the use of a stack-type or surgical splint. The results reported in the present study follow the data described in the international literature, additionally finding the presentation of multiple comorbidities and the incidence of injury in young populations being rare. The population treated presents demographic and injury-related characteristics similar to those reported in the international literature.

Evidence level: III.

Background

Hip fractures are a pathology with an increasing incidence, represent a challenge for public health due to the high socioeconomic cost and high morbidity and mortality. It is important to document the complications in our population, as well as the reasons for readmission to be able to propose strategies that contribute to reducing them.

Method

A descriptive, cross-sectional, retrospective study was conducted in the period between January 2015 and December 2017. All patients with hip fractures older than 65 years were included. Those with pathological fractures and patients with a history of fracture in that hip were excluded. The variables of age, sex, pathological antecedents, use of anticoagulants, type of fracture, intra-surgical and postoperative complications and total time from fracture to surgical management were collected.

Results

155 hip fractures were properly documented, mean age 81.6 years, 74.8% were women. The most frequent fracture was the intertrochanteric (46.5%). 93.6% of the cases received surgical management, being hip arthroplasty the most performed procedure. Surgical management was performed in 85.16% of patients before 48 h and 40% before 24 h from the time of fracture. The readmission rate was 20% and the main cause was new fractures 5.8%

Discussion

We consider the approach of patients from a multidisciplinary standpoint that treat the comorbidities, bone fragility, muscle weakness and alterations in the mental sphere, because that may possibly affect the outcome of patients in a positive way.

Evidence level: III

Background

The purpose of this study was to determine if there is a difference between the critical shoulder angle measured by MRI in patients with rotator cuff tear and healthy patients, also to evaluate the intraobserver reliability in this measure. Other variables were included as well, lateral acromial extension, acromial height, glenoid version, glenoid inclination and lateral acromial angle.

Materials and methods

Two groups were evaluated, the control group consisted in a total of 16 patients and the group with rotator cuff tear consisted of 15 patients. The critical shoulder angle, glenoid inclination, glenoid version, acromial height, lateral acromial extension and lateral acromial angle were measured on MRI. A student T test was used for comparison of means between both groups, Pearson correlation coefficient was used for evaluating the association between variables. The intraobserver reliability was evaluated using the intraclass correlation coefficient.

Results

A result of 0.961 was obtained for the intraobserver reliability using the intraclass correlation coefficient for the critical shoulder angle. For the comparison of means of the critical shoulder angle in the control group and the rotator cuff tear group a result of 32.3° (3.6) vs. 35.01° (2.4) was obtained with a statistically significant difference of p = 0.02. Likewise, statistically significant differences were obtained in the glenoid inclination and glenoid version in both groups (81.56° SD 4.04 vs 77.11° SD 3.84; p = 0.004) and (−4.47° SD 4.56 vs −1.58° SD 3.94; p = 0.04).

Discussion

Critical shoulder angle measured by MRI is statistically significant different in control group and in rotator cuff tear group.

Evidence Level: III.

Shoulder instability is a frequent condition in people involved in sport activities of high-physical demand. Due to their anatomical features, adolescents are at greater risk of recurrence after a first episode of shoulder dislocation. Male gender, age and participation in high-impact sport activities are the main risk factors for recurrence. We report the case of a cheerleader teenager with anterior shoulder instability with favorable evolution after open stabilization complemented by a review of the state of the art of the therapeutic approaches of recurrent shoulder instability in adolescents.

Background

Limbs soft tissue sarcomas have an incidence of 4.7 cases per 100,000 inhabitants and their surgical management has a high rate of morbidity and mortality due to bleeding. Use of ultrasonic vessel sealing is a novel technique often required. The aim of the study is to determine whether the intraoperative and postoperative results can be improve with the use of ultrasonic vessel sealing systems when surgeons are performing resection surgery of soft tissue sarcomas.

Methods

A longitudinal cohort was conducted between May 2017 and December 2018, including all patients undergoing resection of soft tissue sarcomas using ultrasonic vessel sealing technology that presented intraoperative and postoperative complications. The variables of age, sex, municipality, neighborhood, occupation, preoperative hemoglobin, intraoperative bleeding, hemovac drainage, postsurgical hemoglobin, seroma, hematoma, need for blood transfusion, and major complications were recorded. Data were analyzed using Shapiro Wilk or Kolmogorov Smirnov for descriptive statistics. Hypothesis tests to compare the occurrence of certain characteristics by stage or severity of the tumor pathology were performed using the Chi2 test or Fisher's test in qualitative variables, while the quantitative ones with t Student or Mann Whitney, a value of p < 0.05 it was considered statistically significant.

Results

32 patients were included in the study: 13 women and 19 men; the main types of sarcomas found were spindle cell sarcoma in 11 cases and liposarcoma in 5 cases. A median hemoglobin difference of −1.85 g/dL was found. The use of the ultrasonic bipolar vessel sealing system showed a 71% success rate for surgeries; complications occurred in 12% of patients.

Discussion

Ultrasonic vessel sealing system is a valid alternative that benefits limbs soft tissue sarcomas resection patient surgery by reducing surgery time and improving safer hemostasis. Further randomized controlled studies should be preformed.

Level of evidence: IV

Background

The Lysholm scale was developed in 1982 and modified in 1985 in order to assess the functionality of patients with knee ligament injuries; since then it has been widely used to subjectively evaluate patients in relation to their functional capacity. The purpose of the study was to carry out its translation and cross-cultural adaptation to Colombian Spanish and to develop psychometric validation through the evaluation of internal consistency and test-retest reliability.

Methods

After identifying the original scale of interest, translation (English-Spanish), cultural adaptation and re-translation (Spanish-English) were carried out by native linguist experts, who assessed the similarity of the content of both products (original and retranslated). Likewise, this latest version was evaluated by 40 patients with knee disease (meniscal injury, anterior cruciate ligament rupture, chondromalacia and gonarthrosis), who confirmed that they understood the text. Subsequently, the internal consistency was evaluated using Cronbach's alpha test for all items, and the intraclass correlation coefficient – ??total score of the sub-construct through a random sample (n = 93), which validated the factorial structure of the scale.

Results

Cronbach's alpha was 0.737 and the interclass correlation coefficient was 0.844, associated with a high inter-observer agreement (Gamma = 0.752). The Bland-Altman plot did not show systematic differences between the measurements

Discussion

This Spanish (Colombian) version of the Lysholm scale is a valid tool to measure functionality in patients with meniscal lesions of the anterior cruciate ligament, patellofemoral chondromalacia and gonarthrosis in Spanish-speaking countries (preferably in Colombia).

Evidence Level

I

Background

The Masquelet technique is used in the treatment of bone defects in long bones with high success rete reports. It has been described for the treatment of bone loss in the 1st metatarsal and midfoot. The aim of the report is to describe the experience with the technique in a patient with a bone defect of the fourth and fifth metatarsals associated with a transfixing skin defect.

Case report

In a 42-year-old patient who presented a gunshot wound to the lateral column of the right foot with subsequent transfixing coverage defect and bone defect due to comminuted fracture of the fourth and fifth metatarsals. Surgical treatment was performed in 3 stages, the first stabilization and surgical lavage, 2nd stage coverage with a reverse flow sural flap, fixation with a plate and a cement spacer. For a third stage, the bone cement was removed and an autologous cortico-cancellous bone graft was placed. Clinical and radiological follow-up was carried out for 18 months.

Results

The patient did not present complications including infection, presented anesthesia area in the sural nerve territory, complete viability of the flaps. Normal gait without metatarsalgia was evidenced and in the radiological evaluation it presents graft integration of 90% at described follow up term. Adequate space over the metatarsal cuboid interposition arthroplasty was observed, with a VAS of 1/10 and an AOFAS mid foot score OF 85.

Discussion

There are 7 reports in the literature about the Masquelet technique in the foot, with favorable results, mostly with functional restoration in complex cases in the medial column and no reports on the lateral column. In our case, the technique proves to be a viable alternative, achieving functional and structural restitution of the foot.

Evidence level

IV.

Background

Shoulder arthoplasty is an effective procedure to improve pain and function in chronic shoulder pathologies. Considering the risks and costs associated with hospital stay, performing joint replacements on an outpatient setting emerges as an option to optimize this therapeutic strategy.

Methods

A prospective analysis was performed in 10 patients undergoing same-day discharge total shoulder arthroplasty with anatomic and reverse prostheses. Pain was managed with a continuous peripheral interscalene block using an elastomeric infusion pump. ASES and SANE scores, pain, patient satisfaction, complications, and readmissions after 90 days were recorded.

Results

10 patients (average age 59.6 (±3.9) years) underwent outpatient shoulder arthroplasty (50% reverse shoulder arthroplasty, 40% total shoulder arthroplasty and 10% hemiarthroplasty). On post-operative day 4, mean visual analogue scale (VAS) for pain assessment was 1.3 (±0.62) and day 10, 2.7 (±1.1). Pre-operative SANE score was 31 (±9.7), and 90 days after the procedure was 76.1 (±6.8). All patients were satisfied with the procedure. One patient had a mild bronchospasm on day 3 that resolved with bronchodilators on an outpatient basis. One patient had a superficial surgical site infection that resolved completely with oral antibiotics administration. There were no re-admissions or major complications.

Discussion

We present short- to medium-term outcomes of the first case series in our setting of shoulder replacement performed with same-day discharge. This procedure can be performed safely, following a standardized protocol and making a judicious selection of patients.