Acta ortopedica mexicana最新文献

Avulsion fractures of the medial head of the gastrocnemius muscle are extremely uncommon, with only a few cases documented in medical literature. We present a case involving a 12-year-old female gymnast who experienced acute pain in the back of her knee after a training incident. Initial radiographs did not reveal any abnormalities, prompting further imaging for accurate diagnosis. Advanced imaging identified an avulsion fracture at the posteromedial aspect of the femur, originating from the medial gastrocnemius tendon. The patient underwent conservative treatment. At the three-month follow-up, she had returned to gymnastics without any symptoms. At the two-year follow-up, she remained asymptomatic and had fully resumed her pre-injury level of athletic performance.

Introduction: osteogenesis imperfecta (OI) is a rare inherited bone disorder resulting from defects in type I collagen synthesis or structure. It is characterized by increased bone fragility, recurrent fractures, and early-onset hearing loss. Management requires a multidisciplinary approach aimed at reducing fracture incidence, enhancing mobility, and promoting functional independence. Since 1998, bisphosphonates (BPs) have been used as compassionate therapy in OI.

Objective: to characterize children with osteogenesis imperfecta (OI) and report the incidence of atypical femoral fractures (AFFs) in relation to the duration of zoledronic acid treatment.

Material and methods: a single group ambispective cohort study of pediatric patients diagnosed with osteogenesis imperfecta according to the Sillence criteria and treated with zoledronic acid (0.1 mg/kg/year); the retrospective period spanned from January 2008 to July 2017, while the prospective period extended from October 2017 to March 2024.

Results: a total of 68 patients were included, with 24 fractures identified in 21 patients (31%). Fractures were more frequent in males (67%), adolescents (76%) and those receiving continuous treatment (76%). The duration of treatment before developing an AFF was also shorter in males (69 months) compared to females (77 months). Cox regression analysis showed that male patients with OI had a hazard ratio (HR) 3.13 (95% CI 1.18-8.26, p = 0.021) indicating a significantly higher risk of developing an AFF compared to female patients.

Conclusion: there may be an association between prolonged use of zoledronic acid and the occurrence of AFFs. Male and adolescents exhibited a higher risk of AFFs (HR 3.13, 95% CI 1.18-8.26) These fractures may not be limited to the femur, as other long bones could also be affected. Larger cohorts and longer follow-up periods, including control groups not exposed to zoledronic acid, are needed to establish causation.

Introduction: fractures and dislocations of the cuneiform bones represent a diagnostic and therapeutic challenge due to their low incidence and anatomical complexity. The objective of this work focuses on the clinical relevance of the Roman arch of the midfoot and its susceptibility to injuries from direct and indirect trauma.

Materials and methods: a review of the literature was carried out by consulting the PUBMED, EMBASE, COCHRANE, in English, Spanish, and French databases, using the MeSH terms: "cuneiform", "fracture", "dislocation", "treatment", "surgery", "rehabilitation", "fixation", "biomechanics", "trauma", and "Lisfranc", a total of 69 articles were obtained, of which 10 were excluded because they were duplicates and one because the full text could not be obtained. for a total of 58 eligible items. Similarly, the search was extended to classic textbooks from June 1990 to June 2024, with no restrictions on the type of study.

Results: a narrative review of the literature over the last 34 years is carried out, trying to synthesize the most important aspects in relation to anatomy, epidemiology, trauma mechanism, diagnostic images classification, treatment, and rehabilitation in the approach to cuneiform lesions.

Conclusion: this narrative review allows us to conclude that early identification and anatomical reduction are critical to improve functional outcomes and prevent long-term complications, such as osteoarthritis and pseudoarthrosis. The weakness of our work lies in the lack of systematic review studies, cases and controls or large case series, available in the literature that allow us to establish management guidelines for this type of injury.

Introduction: the "Inside-out" technique is one of the options for medial epicondyle fracture fixation of the humerus. It involves preparing the fixation from the internal portion of the fracture to the external portion. Then, the fracture is fixed with a cannulated screw from the external to the internal portion. This study aims to describe our experience with this technique, its outcomes, and its complications.

Material and methods: this is a retrospective observational study describing a series of cases treated with the "Inside-out" technique for medial epicondyle fracture fixation from 2020 to 2024. We evaluated demographic data, follow-up duration, intraoperative events, postoperative complications, and functional outcomes.

Results: we analyzed 21 patients, 61.9% of whom were male, with a mean age of 13 years and a mean follow-up period of 19 months. Among these, 71.4% had fractures in the right upper limb, with the most prevalent trauma mechanism being a ground-level fall. No open fractures were observed. A total of 38% had dislocated elbows with an incarcerated medial epicondyle, and one patient had an associated fracture. There were no intraoperative complications. One patient had a 5-degree extension limitation, all fractures achieved consolidation, and no postoperative neurological injuries or valgus instability were observed after fixation. Four patients reported discomfort at the site of the screw head insertion, and one patient complained of a hypertrophic scar. The functional assessment using the QuickDASH score yielded an average of 1.1.

Conclusion: the "Inside-out" technique provided secure fixation of the medial epicondyle, preventing its fragmentation, ensuring fracture consolidation, allowing early mobility, and resulting in minimal complications.

Total knee arthroplasty infection (TKAI) is an important surgical outcome and quality indicator. We present a statistical method to analyze the rate of occurrence of TKAIs based upon the binomial distribution. The rationale, process and interpretation are presented to obtaining the exact and cumulative probability of having k infections after n procedures with a predetermined health quality indicator goal. In other words, to find out in a scientific manner whether there are too many infections or not.

No Abstract available.

Introduction: femorotibial laxity plays a crucial role in knee stability, as increased laxity can raise the risk of injuries not only to the anterior cruciate ligament (ACL) but also to other key structures such as the posterior cruciate ligament (PCL) and the posteromedial and posterolateral corners. This study analyzed the factors associated with laxity in young individuals, as identifying the elements that influence this condition is essential for its prevention. The objective was to evaluate knee joint laxity in young people, considering factors such as sex, bone structure, body composition, and physical activity.

Material and methods: a total of 114 patients over 18 years old without any history of knee ligament injuries were included. Body composition was evaluated with the OMRON HBF-514c body composition monitor and scale. The ACL laxity was measured using the KNEELAX 3® arthrometer, while internal and external rotation was measured with PhidgetSpatial Precision inertial sensors. Physical activity was classified with Tegner scale while Lachman and Pivot Shift tests were performed as well as indicators of the ACL stability.

Results: the mean age was 21.04 ± 2.2 years. Greater knee laxity (6.9 mm at 88N and 8.9 mm at 132N with p values of 0.047 and 0.001 respectively) and increased internal (28.7°) and external rotation (27.76°) were observed in women. ACL laxity was higher in individuals with smaller bone frame size (8.67 mm at 132N) and higher body fat percentage. In addition, participants with higher physical activity levels showed lower ACL laxity.

Conclusion: knee joint laxity was found to be greater in women, individuals with smaller bone frame size, and those with higher body fat percentage, which may increase the risk of injuries. Simultaneously, knee joint laxity was found to be lower in individuals with higher activity levels. It was concluded then that strengthening the musculature and making physical activity are essential for ligamentary injury prevention.

Introduction: hip fracture is one of the most common conditions in the professional practice of an orthopedic surgeon. The early mortality of primary total hip arthroplasty (THA) for osteoarthritis is 0.35% with an incidence of complications of 3.9%. This increases considerably (3.1%) when THA is performed as the treatment of a hip fracture. The main objective of this study is to determine if the surgical approach has an effect on the mortality of patients who are treated with THA in the context of a fracture.

Material and methods: we carried out a retrospective and observational study that included patients with intracapsular hip fractures who had been treated with THA, performed through an anterior or lateral approach, by the same team in a single center between 2007 and 2021.

Results: the anterior approach is independently associated with a lower risk of bleeding with an OR = 0.15 (95% CI = 0.051-0.48, p = 0.001) versus the lateral approach. Overall mortality in the anterior approach was 6.7 versus 15.2% in the lateral approach (p = 0.25).

Conclusions: this study demonstrates in a statistically significant way that patients who undergo arthroplasty through a lateral approach have a higher risk of bleeding. The anterior approach in the hands of a trained surgical team is a safe option for performing THA in patients with hip fractures and has the potential to reduce some of the risks associated with the procedure.

This paper presents two cases of bilateral atypical femoral fractures in postmenopausal women who underwent prolonged bisphosphonate therapy for osteoporosis. Both patients, aged 83 and 76, experienced fractures after long-term bisphosphonate treatment, highlighting concerns about suppressed bone turnover. Each case was treated with intramedullary nailing, and bisphosphonates were discontinued in favor of alternative therapies. These cases underscore the risks of atypical femoral fractures linked to extended bisphosphonate use, emphasizing the need for careful patient monitoring and further research to optimize osteoporosis treatment strategies and prevent such complications.

Avascular necrosis (AVN) of the femoral head is a type of aseptic osteonecrosis caused by the interruption of blood flow to the femoral head, resulting in the cellular death of osteocytes. This pathological process can lead to the degeneration and collapse of the femoral head, causing significant pain and functional disability. Acetabular joint changes or defects begin to be observed in the advanced stages of the disease, following its natural course with advanced joint degenerative changes. In the context of a case of AVN of the femoral head that has progressed to condition an acetabular defect, the placement of a bone graft followed by the placement of a titanium mesh is considered a valid and good therapeutic option, providing both biology and mechanics to the prosthetic construct. We present the case of a 54-year-old male patient with a history of AVN of the femoral head previously treated with total hip replacement of the left hip, who presented to us in an advanced stage of the disease with manifest arthritic changes that have conditioned a predominantly posterior acetabular defect in the right hip. Since we are in an advanced stage of the disease, it was decided to perform a total hip replacement of the right hip, adding the biological component to the acetabular defect by applying both allograft and autograft bone grafts, as well as the placement of a titanium alloy mesh prior to the placement of the acetabular prosthetic component. The entire replacement technique was carried out using uncemented implants.