Revista Latinoamericana de Cirugía Ortopédica最新文献

Purposes

Objectives technique of preoperative planning in total knee arthroplasty is to set up accurate components, prosthetic under a proper alignment, according to the axial axis of the limb to intervene. To determine the efficacy of the predictive model that sets the size of the femoral and tibial components with patients who underwent primary knee arthroplasty.

Material and methodology

Retrospective, longitudinal study, observational, there were recruited patients submitted to total knee arthroplasty with the design Sigma PFC, realized between January, 2013 to December, 2014 in 80 women and 43 men registered with an age average of 67 years. The average in height, weight and CMI they were 1.65 cm, 76.6 kg and 28.4 Kg/m² respectively.

Results

The models predicted the size of the components exactly in 76% for the femur and 83% for the tibial. All the predictions were inside a size ± 1 number as regards the real components and that they were implanted at the moment of the surgery, with a prediction of 100%. For both models, the height was the most important predictor to determine the size of the components, continued by the genre and the age.

Conclusion

This model predictive has the aptitude to be high precise although he allows to predict a better size, we must have all the sizes available in the surgical room. The prediction model facilitates the preparation of the femur and the shinbone with the final size of the components.

Avascular necrosis of the metacarpal head is a rare condition known as Dietererich disease. There are few cases described in the literature. Due to its low incidence the evidence published in the medical community literature has not an optimal treatment for a graceful recovery.

We report the case of a patient who developed a Dieterich disease at the ring finger that was surgically treated and presents a satisfactory outcome with the longest follow up described in the literature.

The main concern in treating supracondylar fractures of the elbow in the child is to control the rotation of the distal fragment. When the doctor detects the rotation, to achieve the reduction the proximal fragment must be controlled, placing the shoulder in an anatomical position and performing the maneuver. Our objective is to show that in the supracondylar fractures of the humerus in the child, the fragment that rotates is the proximal and not the distal, as has been argued.

Material and method

We conducted a prospective study in 72 pediatric patients, out of 150 who came to the emergency room with supracondylar elbow fractures; Grades II-B and III of Gartland, which showed rotation on the radiograph. We performed AP and strict side radiographs and a 3D CAT of the shoulder and elbow. The diameters of the distal end of the proximal fragment and the proximal end of the distal fragment were measured and compared in each patient. The relationship between rotated fractures, fracture type and lateral or medial displacement was sought.

Objective

The objective of our study was to compare the functional and radiographic behavior of fractures treated with percutaneous threaded needles with those treated by open reduction, internal fixation with fixed angle volar plates for the same type of fracture according to AO classification.

Material and methods

A prospective, analytical, comparative study was performed in 68 patients with fractures of the distal radius, 34 with the technique of percutaneous intrafocal thread (Group A) and 34 with fixed angle (Group B). 59% (20) of the patients in Group A and 76% (26) of Group B were female. The average age of Group A was 49 years and that of Group B was 55 years. A descriptive and inferential analysis was performed using Fisher's test t, Fisher's exact test and mixed linear model.

Results

In the “Radio-Cubital” difference and “radial inclination” the value was lower for the percutaneous intrafocal thread method, at 3 and 6 months, as was the “Flexo-Extension”. The closure force was lower for the percutaneous intrafocal thread method, at 3 months, and there were no differences between the two methods at 6 months.

Conclusions

RAFI recovery is earlier with a better radiographic result, without finding functional differences at 6 months; The treatment is indicated according to the experience and familiarity of the surgeon since both techniques achieve good results.

Level of Evidence

II.

Aim

Synovitis is one of the most frequent complications of haemophilic disease produced by intra-articular deposits of hemosiderin.

Patients and methods

99 patients with haemophilia with 124 synovitis joints were treated with intra-articular rifampicin injection, between 1992 to 2001. The mean follow up was 5 years. Mean age was 15 years old. 12 patients had inhibitors to factor VIII. The joints affected were: 28 (22.6%) elbows, 19 (15.3%) ankles and 77 (62.1%) knees. The mean number or injections according each joint was: elbow: 4, ankle: 3 and knee: 7.

Results

101 (81,5%) joints showed excellent results, 17 (13.7%) good results and 6 (4.8%) poor results. Small joints (ankle and elbow) showed better results than big ones (knee) (p < 0,001). Patients with severe hemophilia had worse outcomes than patients with mild or moderate disease. Time of synovitis affected the outcome of the patients. Excellent results were seen in patients without recurrence.

Conclusion

Synoviorthesis with rifampicin seems to be an effective method for the treatment of synovitis, with excellent results specially in small joints with short period of evolution.

Objective

To know the results of a total knee arthroplasty series performed with surgical navigation in frontal angulation and final rotation of the knee at both 0° and 90° of flexion and to study the influence on these results of certain factors such as body mass index, minimal invasive surgery and computer navigation software.

Material and methods

A study was carried out on a personal series of 145 total knee arthroplasty operated with a wireless system of computer assisted surgery. The results have been graded taking into account the frontal angulation of the mechanical axis and the final rotation of the limb at 0° and at 90° of flexion. The data has been collected from the computer system database. A descriptive analysis of the series has been made, also studying the influence on the final results of certain factors.

Results

The final alignment obtained in the whole series is close to the ideal situation regarding the angulation of the limb in frontal position (0° ± 3°), although a slight residual deviation in varus is appreciable (less than 1°). No differences were found in the final results in relation to the different software systems used, neither with the body mass index nor with the type of surgery (minimal invasive surgery vs standard surgery).

Conclusions

Results regarding the front mechanical axis of the knee replacements performed with surgical navigation are not changed depending on the factors studied.

Introduction

Total hip arthroplasty revision surgery it's a big challenge due to the increase of severe acetabular bone defects and the poor quality of the remaining bone.

Objective

Assess clinical and radiological outcomes, complications and survival of the trabecular metal system implants in the treatment of severe acetabular bone defects (AAOS II, III y IV) with a mean follow up of 56 months.

Material y method

We retrospectively reviewed the data of 58 patients who underwent acetabular revision surgery with a trabecular metal system implant between January of 2008 and December of 2014. Demographics, clinical outcomes through Harris Hip Score, satisfaction, radiographic characteristic, percentage and type of complication and survival after 56 months of follow up were registered.

Results

All patients improved their score on the Harris Hip Score scale after surgery (P = 0.0001). Thirteen patients showed intraoperative complications (8 periprosthetic fractures and 5 nerve injuries), another 13 patients showed postoperative complications (6 dislocations y 7 wound infections). A second revision surgery was needed in 5 patients. The 7,5 years survivorship was 91,2%.

Conclusion

Trabecular metal system implants have shown good functional and survival outcomes after 56 months follow up, probably higher than other acetabular reconstruction systems.

Introduction

Ankle arthrodesis constitutes the gold standard for the treatment of postraumatic ankle osteoarthritis. Total ankle replacement has been developed as an alternative surgical option with motion preserving advantage. However, relative benefits of ankle replacement remain unclear. The objective of this study was to compare clinical, radiological results and complication rates in patients with postraumatic ankle osteoarthritis treated with arthrodesis and ankle replacement.

Material and methods

A retrospective study was made between 2007-2013 with postraumatic ankle osteoarthritis treated with ankle replacement (group 1) and ankle arthrodesis (group 2). Patients between 18-75 years with a minimum follow-up of 2 years were included. Neurological conditions, infections, rheumatic disease and previous ankle and mid-foot surgery were excluded. Varus-valgus correction, adjacent degenerative disease, reoperation rate and clinical evaluation (AOFAS and visual analoge scale) were evaluated.

Results

A total of 63 patients with (average age of 50) with 66 months follow-up were involved. There was no difference in terms of reoperation rate (P=.44) neither adjacent osteoarthritis (P=.62).

Varus-valgus preoperative and postoperative was 5.92 and 2.51 respectively (P=.0053) in group 1, 13.59 and 5.39 (P=.0002) in group 2. AOFAS score was 88 in group 1 and 92 in group 2. The visual analoge scale score was 4 in group 1 and 2.5 in group 2.

Conclusion

Ankle replacement resulted in similar varus-valgus correction, adjacent degenerative disease, complication rate and functional results compared with arthrodesis in our study. Ankle replacement could be a suitable surgical option for the treatment of postraumatic ankle osteoarthritis.

The cervical whiplash syndrome is a disorder that affects a many people following road traffic accidents and which has a high economic cost. The disorders associated with whiplash syndrome are numerous, and include neck pain and muscle stiffness, headache, and dizziness. In approximately 50% of people who suffer from whiplash, the initial pain develops and is maintained into the chronic phase. Mechanisms of central sensitization to pain has been recognized as an important pathophysiological mechanism which may mediate various types of pain and which may be responsible for its chronification in these patients, as they show signs of hypersensitivity to pain, including decreased pain pressure thresholds and altered temporal summation to noxious stimuli. With regards to treatment, although there is a wide range of physical therapies available to treat whiplash disorders, currently there is no consensus on which therapy is most effective. Understanding the mechanisms by which pain becomes chronic following whiplash will help to develop an effective therapy that could directly treat the disorders associated with this pathology in many people with chronic pain symptomatology based on the evidence-based diagnosis of pathophysiological mechanisms.

Osteoarthritis (OA) is a disease of the whole joint that presents obvious signs at advanced stages preceded by a long asymptomatic period difficult to identify. Conventional X-ray is still the most common utilized method for diagnosis, however, it remains silent during most of the degenerative process and it presents late indirect signs of degeneration, such as joint space narrowing and osteophytes. Despite its cost, MR has demonstrated to be a really effective method to evaluate initial degenerative changes in OA. Quantitative MRI has been shown to be able to detect some of the initial changes at early stages of OA, however, this technique requires highly specialized technicians and an elevated cost. In addition, compositional MR is one of the most promising techniques for the visualization and quantification of pre-morphologic cartilage changes by analyzing the biomechanical properties that take place at the early onset of the disease. Likewise, synovial fluid analysis and the presence of certain biomarkers constitute an additional method for the evaluation of early degenerative changes in OA.