Acta ortopedica mexicana最新文献

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Introduction: degenerative shoulder diseases have an estimated prevalence between 16 and 25% in the population over 65 years of age. Mexico lacks a system to document and analyze shoulder arthroplasty procedures. This study aimed to identify the clinical profile of patients undergoing shoulder arthroplasty in Mexico.

Material and methods: observational, descriptive, and multicenter study conducted between 2014 and 2024. Clinical and demographic characteristics were collected, including comorbidities, surgical indication, Constant functional score, type of arthroplasty performed, type of prosthesis used, and average cost.

Results: a total of 516 patients were included; 353 (68.41%) were female. The mean age was 70.09 ± 9.5 years. The right shoulder was affected in 321 (62.2%) cases, and right-hand dominance was present in 485 (93.9%) patients. The most common comorbidity was arterial hypertension (266 patients, 39.45%). The most frequent indication was rotator cuff tear arthropathy (208 patients, 40.31%). The Constant score improved by 46.54 points. The most commonly used arthroplasty was reverse in-lay (339 cases, 65.69%). The average cost per prosthesis was $170,000.00 MXN.

Conclusion: in our country, the typical candidate for shoulder arthroplasty is a female patient between 60 and 80 years of age, with a diagnosis of rotator cuff tear arthropathy or osteoarthritis causing significant functional limitation of the affected limb.

Polytrauma refers to significant injuries to three or more points in two or more different AIS anatomical regions along with physiological variables. Polytrauma presents a clinical and therapeutic challenge on its own; however, the combined fracture of the spine and pelvis entails its own set of challenges. In a combined spine and pelvis fracture, we may encounter a spino-pelvic dissociation, which is anatomically characterized by the inability to transmit loads through the spine to the pelvis and consequently to the lower limbs. This interferes with the transmission of axial loads and stability. In this scenario, it has been demonstrated that conventional plates and screws are not sufficient. Faced with this problem, it has been observed that a long posterior fixation can be a good alternative, as it has been shown to provide greater stability and earlier rehabilitation.

Introduction: carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment disorder. Electrodiagnostic studies are useful for confirming the diagnosis, as they reveal focal demyelinating involvement predominantly affecting sensation. However, their correlation with symptoms is not always adequate, and there are cases of discrepancy between the study results and the patient's clinical presentation. The objective was to analyze the correlation between the findings in median nerve conduction studies and the severity of symptoms on the Boston scale.

Material and methods: an observational, cross-sectional study was conducted with prospective recruitment of patients with carpal tunnel syndrome. A correlation analysis was performed between the Boston scale in general and each of the symptom severity items with different sensory and motor nerve conduction parameters.

Results: correlations with the total Boston scale score were low and insignificant, the highest being r = 0.22 with motor conduction velocity in the wrist. The symptom of weakness in grasping small objects obtained the highest correlations, the highest being with sensory latency r = 0.64 p < 0.05.

Conclusion: there is little correlation between sensory symptoms and neuroconduction studies. Motor symptoms have a higher degree of correlation. There is a difference between the patient's perception (carpal tunnel syndrome) and the electrodiagnostic study (median nerve neuropathy). The studies are useful for demonstrating focal damage to the median nerve.

Introduction: subtalar dislocations, typical of high-energy trauma, are classified as medial, lateral, anterior or posterior depending on the deviation of the foot in relation to the talus. Lateral dislocation accounts for 17% of the total and has a worse prognosis. Immediate reduction is required to reduce the risk of sequelae, the incidence of which is around 90%.

Objective: a case of lateral subtalar dislocation is presented; a review of the literature on its diagnosis, treatment and prognosis is carried out.

Clinical case: a 46-year-old woman fell from a height of 3 meters, with severe deformity in the hindfoot. There was good distal vascular coloration, but no pulse or posterior tibial sensitivity could be identified. In addition, she had a medial sulcocutaneous fold under the head of the talus. Plain radiograph and CT revealed lateral subtalar dislocation, with fracture of the sustentaculum tali, and a "fleck sign" in the posterior region of the distal fibula. Suspecting soft tissue incarceration, a medial approach was performed, observing interposition of the posterior tibial neurovascular bundle. After joint reduction, the sustentaculum tali and the "fleck sign" were osteosynthesized. In addition, a complete section of the long lateral peroneal tendon was identified, which was tenodesed to the short peroneal tendon. Finally, an external fixator was placed. After eight weeks, the fixator was removed and weight bearing was authorized; after six months, mobility was complete and hypoesthesia persisted only in the plantar pad.

Conclusions: lateral subtalar dislocation is an uncommon entity with a poor prognosis. Adequate interpretation through a thorough examination and pre-reduction CT of the bone and soft tissue lesions minimizes future sequelae.

Introduction: the progressive increase in the volume of primary knee arthroplasty surgery is leading in parallel to an increase in revision surgeries, and this trend is expected to continue in the coming decades.

Material and methods: a retrospective observational study with 203 interventions in 201 patients with knee arthroplasty revision surgery at our center between 2018-2022, including the variables age, sex, body mass index, primary implant, time until revision surgery, mechanical alignment of the primary implant, cause of revision, revision implant, and need for secondary revision.

Results: the average age of the patients was 73.8 years (70% were women). The average time from primary surgery to revision was 58.7 months. The main cause of revision was aseptic loosening (37.9%). Eighty-three (34.9%) patients required an early revision (on average, in 12.7 months), with instability being the main cause in this subgroup (36.1%). Twenty-four (11.8%) patients required an additional revision, also mainly due to instability (33.3%), with a younger average age (66.9 years). The most common surgical approach was complete replacement (70%).

Conclusions: knee arthroplasty revision surgery in our environment is determined by different patterns depending on the chronology. Joint stability is the main determinant of revision in the first two years, while aseptic loosening seems to predominate in the long term, with infection in the background. Revision of primary knee arthroplasty remains to be a surgical challenge, as 11.8% of patients required an additional revision surgery, especially in younger patients.

Introduction: medial patellofemoral ligament (MPFL) reconstruction using an autologous quadriceps tendon graft to treat patellofemoral dislocation in the pediatric population is a surgical alternative that may offer advantages compared to other types of grafts. We assessed clinical and functional outcomes, rate of return to sport, and complications in a cohort of pediatric patients.

Material and methods: retrospective and descriptive cohort study. Pediatric patients with recurrent patellofemoral dislocation treated with MPFL reconstruction using an autologous quadriceps tendon graft, with or without an additional procedure, were included. A minimum follow-up of two years was required. Patients with congenital patellofemoral dislocation, previous surgeries, connective tissue disorders, and medial patellar dislocation were excluded. We measured the Kujala functional score, its minimally clinically important difference (MCID), and the Tegner activity scale. The difference between preoperative and postoperative Kujala and Tegner scores was analyzed using the Wilcoxon signed-rank test.

Results: we selected nine patients (12 knees) with a mean age of 16.5 years. The median preoperative Kujala score was 56 with an interquartile range (IQR) of 51-65, and 99 (IQR 95100) postoperatively. A MCID and a statistically significant difference were achieved (p < 0.01). The median preoperative Tegner score was 6 (IQR 68.5) and 5.5 (IQR 47) postoperatively, with this difference being statistically significant (p = 0.02). The average time to return to sports was 6.5 months. Four complications were found.

Conclusions: MPFL reconstruction using autologous quadriceps tendon graft in pediatric patients is a reliable option with good clinical and functional outcomes.

The rupture of the teres major muscle is a well-known condition in sports activities like baseball, hockey, and tennis. There is no real consensus in the literature regarding treatment, with approaches varying between functional and surgical methods. While functional treatment appears to be a viable option, there is a lack of evidence indicating significant improvement in medial rotation strength after aforementioned treatment. We report a 30-year-old male with pain below the right armpit for the past 10 days, attributed to jiu-jitsu training which revealed a complete tear of the musculotendinous junction of the teres major and a partial insertional tear (approximately 75% of thickness) of the supraspinatus and infraspinatus tendons, along with atrophy in the musculotendinous transition of the pectoralis major. The patient was treated with analgesic medication, accompanied by physiotherapeutic treatment included electrothermophototherapy, laser/LED therapy, manual therapy, and a structured exercise regimen over 14 weeks, gradually reintroducing sport-specific training.

Articular tuberculosis is a rare condition, with extrapulmonary presentations most commonly appearing in joints such as the hip or knee. It is usually associated with conditions like immunosuppression or a history of pulmonary tuberculosis. Diagnosis involves imaging or pathology, and treatment typically involves surgical intervention along with medication. Here is the case of a 25-year-old male from Barranquilla, Colombia. He lacks classical risk factors for pulmonary tuberculosis but has a history of open reduction of a traumatic fracture in his right distal radius four years ago. He presented with persistent pain, joint swelling, and limited movement, leading to removal of the osteosynthesis material. Despite this, the pain persisted, prompting further investigation with X-ray and MRI of the wrist. These imaging studies revealed findings compatible with tuberculosis. Based on these results, the medical team opted for a surgical procedure. An oncological resection of the synovium was performed, and the material that was removed was used for histological studies to confirm suspicions of extrapulmonary tuberculosis. Following these procedures, the patient underwent physical therapy and began tuberculosis medication, resulting in significant improvement of his symptoms.