Acta ortopedica mexicana最新文献

Introduction: Metastatic Bone Cancer (MBC) is the most common malignancy affecting the skeletal system. The cancers that most frequently metastasize to bone include breast, prostate, lung, kidney, and thyroid cancers (comprising 70% of cases). Metastatic patterns are classified as lytic, blastic, or mixed lesions, often affecting the axial skeleton.

Materials and methods: this retrospective cohort study included patients with MBC treated between January 1, 2012, and December 31, 2022. Patients over 17 years of age with a diagnosis of solid neoplasia and evidence of metastatic bone disease confirmed by plain radiographs, computed tomography, magnetic resonance imaging, or PET-CT were included. Patients who died from causes unrelated to cancer and those who discontinued follow-up were excluded. Statistical analysis: we performed a descriptive analysis of demographic variables and used a Cox regression model, incorporating variables adapted to the model. Overall Survival (OS) was evaluated using the Kaplan-Meier method.

Results: we analyzed data from 902 patients with a median age of 61 years. The majority were male (54.4%). Multiple lesions (three or more) were found in 49% of cases, primarily in the axial skeleton. Prostate cancer was the most common primary cancer (32%), while lytic lesions were most often associated with lung cancer (38%). Additionally, 153 patients (17%) had pathological fractures, 77% experienced pain secondary to Hypercalcemia of Malignancy (HCM), and 59% had metastases in organs other than bone. The median OS was 15 months.

Conclusions: bone metastases are a poor prognostic factor in cancer patients and negatively impact quality of life. Identifying and understanding metastatic patterns is essential for developing effective therapeutic strategies and innovative treatments.

Introduction: the forearm is considered a joint in itself where the ulna and radius interact. It is composed of the proximal radioulnar joint (PRUJ), the interosseous membrane (IOM), with the central band as the main component, and the distal radioulnar joint (DRUJ), which includes the triangular fibrocartilage complex (TFCC). Essex-Lopresti lesion (ELL) is a complex injury caused by axial forearm loading, leading to longitudinal radioulnar dissociation and stability loss due to IOM rupture, PRUJ injury with radial head involvement, and DRUJ injury with TFCC involvement. Early diagnosis is crucial as treating chronic injuries poses a significant challenge.

Objective: to describe chronic ELL, review the literature, and share treatment experience.

Case presentation: we describe the case of a 30-year-old male patient with a history of a motorcycle accident in 2019, initially diagnosed as a comminuted radial head fracture and treated with its resection at another center. He presented to our center in June 2023, complaining of wrist pain and a reducible but unstable dorsal ulnar protrusion. He had no elbow or forearm pain and had a full range of motion. Complementary tests (X-rays, CT scans, and MRI) showed a positive ulnar variance, a dorsal ulnar subluxation at the wrist and a TFCC lesion, without evidence of acute rupture of the IOM. An examination under anesthesia and fluoroscopic evaluation was performed to examine the stability and range of motion of the elbow and ARCD, as well as longitudinal stability of the forearm by traction, with no longitudinal instability observed. After considering the longitudinal stability of the forearm A 10 mm ulnar shortening osteotomy was performed and fixed with a plate and screws (FreeFix® SKDynamics). Arthroscopically, the TFCC was disinserted and reinserted using a modification of the Mantovani technique. It was immobilized with a Münster splint. At six-month follow-up, he has a VAS of 0 at the elbow and wrist, and a dorsal flexion/ volar flexion of 80o/80o, and a supination/pronation deficit of 10o/10o.

Conclusion: ELL is a rare but challenging pathology for orthopaedic surgeons. Therapeutic options include various surgical interventions, with ulnar shortening with TFCC repair being a viable option in chronic cases without longitudinal instability.

Introduction: the impact of preoperative screening and the effectiveness of targeted decolonization in carriers of Staphylococcus aureus (SA) on the prevalence of acute periprosthetic infections (PJI) in patients undergoing hip and knee arthroplasty was evaluated.

Material and methods: analytical, observational, case-control, ambispective and consecutive study. 256 patients were included for hip and knee prosthetic surgery between January 2020 and December 2022. Those who underwent surgery in the period prior to the pre-surgical search for S. Aureus were called pre-intervention group (G1) between January 2020 and June of 2021, and those intervened in the search and decolonization called intervention group (G2) between July 2021 to December 2022. In G2, SA carriage and the effectiveness of bacterial decolonization were evaluated. The prevalence of periprosthetic infection due to this germ in both groups was also compared.

Results: the prevalence of nasal and inguinal colonization for MSSA was 25.8% and that of MRSA was 2.3%. Preoperative decolonization therapy in SA carriers was associated with a reduction in the rate of periprosthetic infections.

Conclusions: the incidence Staphylococcus aureus carriers in patients scheduled for hip and knee arthroplasty was high. Preoperative detection of S. aureus with targeted decolonization therapy was associated with a reduction in periprosthetic infections mediated.

Introduction: peritrochanteric syndrome, also known as greater trochanteric pain syndrome, affects 10-25% of the population, resulting in pain and functional impairment in the lateral hip region. This condition is often associated with significant long-term disabilities.

Objective: this study aims to introduce a novel surgical approach for treating peritrochanteric syndrome that minimizes invasiveness and enhances patient outcomes.

Material and methods: we describe a technique that utilizes customized portals through the iliotibial band (ITB) along with the release of the proximal insertion of the gluteus maximus (GM). Patients are positioned supine, with access to the peritrochanteric space achieved through a 70° arthroscope. Radiofrequency release of approximately 3-4 cm of the distal GM insertion is performed to alleviate pressure and reduce friction in the peritrochanteric space.

Conclusion: the proposed surgical method offers a promising alternative to traditional approaches for treating peritrochanteric syndrome by minimizing the tissue trauma and enhancing recovery. Further research is necessary to evaluate the long-term efficacy and safety of this innovative intervention in a larger patient population.

Introduction: the objective of our work is to assess the timeline of return to work (RTW) and sports, following arthroscopic partial meniscectomy. We hypothesized that patients in greater-intensity occupations would demonstrate greater duration of absence from work and sports, and also that most patients return to unrestricted activity within 7 weeks after knee arthroscopy.

Material and methods: we obtained from 100 cases preop Tegner, Lysholm, VAS and type of work based on physical demand (REFA classification). We reevaluate all cases at three months and at two years postop.

Results: all the patients returned to work, and 90% returned to sports. The median RTW time was 4.8 months. 79% RTW by six months. Of the 21 patients with no subjective improvement by six months, seven required revision knee arthroscopy, 14 had biomechanical examinations that showed submaximal effort and they returned to work. We evaluated type of meniscal tear, gender, age, Lysholm score, Tegner, VAS, satisfaction with knee results postop and rehabilitation sessions, and we did not find any statistically significant correlation with RTW time.

Conclusion: we thought RTW after meniscal surgery strongly depends on the physical work strain, but we didn't find that in our study. So, we taught much more variables influences on work return, and worker compensation has an important value.

Introduction: myxoinflammatory fibroblastic sarcoma is a rare type of sarcoma characterized by the abnormal growth of mesenchymal tissue. It is known for its locally aggressive behavior, high recurrence rate, and potential for metastasis. Clinically, it typically presents as a superficial, painless subcutaneous mass, although it may sometimes cause pain and restricted movement. Histologically, comprises spindle cells with myxoid stroma and large atypical cells with marked nuclear pleomorphism, similar to Reed-Sternberg cells.

Case presentation: an 83-year-old woman presented with a lesion on the anterior region of her left leg. A comprehensive study protocol for a musculoskeletal tumor was initiated, followed by an incisional biopsy for histological and immunohistochemical analysis, which led to the diagnosis of myxoinflammatory fibroblastic sarcoma. The tumor was surgically resected, and the intraoperative and final report indicated negative surgical margins.

Results: the patient experienced a favorable recovery and regained full mobility. Despite initial treatment and recovery, signs of local persistence were observed during follow-up four months later. The patient opted not to pursue the recommended treatment, choosing instead to continue monitoring the lesion.

Conclusions: this case underscores the importance of including myxoinflammatory fibroblastic sarcoma in the differential diagnosis of musculoskeletal lesions and highlights the need for multidisciplinary collaboration for accurate diagnosis and effective treatment.

No Abstract available.

Introduction: Total Knee Arthroplasty (TKA) is one of the most frequently performed orthopedic interventions worldwide, with more than 700,000 primary procedures conducted in 2013. This study aims to demonstrate that TKA with cemented components and mobile bearings is a solid treatment option with low complication rates, good clinical outcomes, and adequate long-term survival.

Materials and methods: this retrospective study included 890 cases in 810 patients diagnosed with grade IV gonarthrosis, with a mean age of 67.80 years and a mean follow-up period of 12.5 years. Joint replacement was performed using the Langenbeck approach. Evaluation was both radiological and functional, using the American Knee Society Score (AKSS) and Oxford Knee Score (OKS) scales to demonstrate long-term results.

Results: the preoperative clinical AKSS was 58.7, and 94.4 points at 14 years; the preoperative functional AKSS was 56.73, and 72.5 points at 14 years; and the preoperative OKS was 26.77, and 44.2 points at 14 years, with a cumulative survival rate of 98.0% at 14 years, using revision for any reason as the primary endpoint.

Conclusion: TKA with mobile bearings for the treatment of grade IV gonarthrosis shows favorable functional outcomes, high long-term survival rates, and low complication rates.

Introduction: tenosynovial giant cell tumor (TGCT) is a rare benign neoplastic condition affecting joint synovia, bursae, and tendon sheaths. It is classified as localized or diffuse based on clinical and biological behavior. Localized forms often affect small joints like fingers (85%), while diffuse forms primarily involve large joints, particularly the knee. Diffuse forms are more aggressive and can exceptionally exhibit malignancy.

Case report: a 27-year-old male presented with a 2-year history of intermittent knee locking and reduced mobility, worsening after a sports-related trauma. MRI showed hyperintense nodular lesions in the posterior capsule of the knee. Arthroscopy confirmed a mass adherent to the posterior capsule, which was excised and pathologically diagnosed as localized TGCT. The patient was discharged home without complications 24 hours' post-surgery, and a 6-month follow-up MRI showed no significant findings. Currently, the patient has full range of motion and no limitations in physical activity.

Conclusions: TGCT diagnosis can be challenging due to variable presentation and nonspecific symptoms, often mimicking meniscal tears. MRI is crucial for diagnosis and surgical planning. Localized forms are managed with arthroscopic excision, yielding low recurrence rates (0-10%) and excellent outcomes. Diffuse forms may require adjuvant radiotherapy or pharmacological treatments in refractory cases.

Introduction: the decision to amputate a severely injured limb is a dilemma for any orthopedic surgeon. There are multiple factors for this decision, being controversial for decision making.

Objective: to know the type of prescription pattern for decision-making in early amputation of a severely injured limb in a reference trauma hospital.

Material and methods: analytical, cross-sectional and prospective observational study. Orthopedic surgeons and resident physicians in the orthopedic specialty were evaluated, who evaluated five clinical cases of severely injured limbs, and through MESS, decided whether to amputate the limb. The statistic used was 2 to assess the coincidence of the decisions with the experts' responses, and Odds Ratio to estimate risks. The value that was taken as statistically significant was p < 0.005.

Results: sample 81 participants, 64.2% OB and 35.8% MR. The agreement of responses with the group of experts, OB was 85.4% and MR was 70%. In the OB, work experience had a higher percentage of coincidences, but they were not statistically significant (> 20 years, p = 0.034; 10-19 years, p = 0.011; < 9 years, p = 0.011) on the other hand, presenting a current certification (p = 0.002) and have a postgraduate degree after the specialty (p = 0.006) if they had one when compared with the responses of the group of experts.

Conclusions: in all the physician surveyed, the correct application of MESS, they had a great agreement in the correct decision to save or amputate a severely damaged limb.