Acta ortopedica mexicana最新文献

Introduction: median nerve neuropathy accompanying a distal radius fracture is common. Differential diagnosis includes nerve contusion, acute carpal tunnel syndrome, forearm compartment syndrome or exacerbation of an idiopathic carpal tunnel syndrome.

Case report: a 44-year-old male presented with a right distal radius fracture after a motorcycle accident. He presented a 1.3 cm blunt wound situated proximal to the radiocarpal flexion crease and complained of well-defined numbness in the median nerve territory. The fracture was reduced and fixed using a volar plate and the median nerve was explored finding a complete section with a 2.0 cm defect. The carpal tunnel was released and a sural nerve fascicular graft was interposed presenting good results at final follow-up.

Conclusion: a median nerve transection after a radius fracture is an exceedingly rare injury. This case report emphasizes the importance of an accurate physical examination including the initial neurological assessment.

Introduction: the most associated cause of compartment syndrome is fracture; however, it is not the only one. Direct trauma without bone involvement, indirect soft tissue injuries, or iatrogenic injuries can also evolve devastatingly. Often, diagnosis is delayed due to low clinical suspicion. In pediatric patients, correlating clinical findings to establish a diagnostic suspicion becomes even more challenging, as the patient does not directly communicate symptoms.

Material and methods: descriptive observational study of case series. Patients under 16 years of age who were hospitalized with a diagnosis of compartment syndrome following a snakebite were included. Patients with compartment syndrome related to trauma or fracture were excluded.

Results: three cases of compartment syndrome were presented: two males and one female. A multidisciplinary approach was evaluated, and the clinical evolution of the patients was documented.

Conclusion: this work aims to draw attention to this injury to encourage future research and the creation of protocols that allow for timely identification and appropriate management in this population, as well as its dissemination among all professionals involved in these procedures.

The trapezium is the most radial and mobile bone in the distal row of the carpus, establishing a proximal joint with the scaphoid and a distal one with the first metacarpal. Isolated trapezium fractures are uncommon, accounting for only 1 to 5% of all carpal fractures. Fractures are often associated with other injuries, including the rare hamate body fracture. At initial presentation, diagnosing those fractures can be challenging as clinical findings are often minimal, without obvious deformities. Crushing injuries are frequently associated with trapezium tuberosity fractures while hamate body fractures are commonly caused by direct impacts. We report the case of a 19-year-old man presenting significant pain in his left hand following a motorcycle accident 30 minutes ago. Physical examination shows swelling, local hematoma and inability to move the hand. Radiography shows no detectable fracture lines. CT scan reveals a hamate bone fracture without apparent misalignment and a type I trapezium tuberosity base fracture. He made a conservative treatment with analgesic medication and immobilization with a forearm-palmar immobilization for one month followed by two months of physiotherapy. At the end of the two-month treatment, the patient exhibits normal mobility and pain-free, returning to usual activities.

Introduction: low-energy acetabular fractures in older adults have significantly increased, with an incidence up to 2.4 times higher over the last three decades. While osteosynthesis is the standard treatment in young patients, its suitability for older adults is debated due to higher risks of complications and reinterventions. These risks are exacerbated by osteoporosis, comminution, and articular surface damage, such as femoral head impaction and preexisting conditions like coxarthrosis. The literature suggests that total hip arthroplasty (THA) may be more appropriate in cases of severe displacement, articular comminution, acetabular impaction in the load zone, and other complex scenarios.

Material and methods: this retrospective study analyzed patients over 65 years with acetabular fractures treated with THA between 2008 and 2018, with a minimum follow-up of one year. Parameters evaluated included fracture type, mechanism of injury, associated injuries, use of traction, time to surgery, type of implant, and complications. Clinical evaluations utilized the Merle d'Aubigné-Postel (MAP) scale, and statistical analysis was conducted using SPSS 18.0.

Results: seven patients were included, with a mean age of 76.4 years. The most common fracture was anterior column with associated posterior hemi-transverse. The most used implant was the uncemented tantalum revision acetabulum. The mean follow-up period was 7.8 years, with an average MAP score of 16.6 at one year. No intraoperative complications occurred, and radiographic consolidation was observed in all cases at three months.

Conclusions: THA showed good clinical outcomes in older adults with acetabular fractures, without increasing the risk of complications, and demonstrated high long-term survival.

Osteoarthritis of the first metatarsophalangeal joint (MTP) is a common disease of the foot and is associated with decreased range of motion, especially dorsal flexion. It is the second most common pathological condition of the foot, generating pain and stiffness. Treatment for this type of osteoarthritis is still a challenge. Autologous matrix-induced chondrogenesis (AMIC) has emerged as an alternative for treating osteoarthritis while maintaining joint mobility, which has already shown good results in other regions. AMIC has good results in chondral degeneration stages I/II, but it is impossible to assign precise indication criteria for its use. Studies are needed to evaluate advanced stages of degeneration. Good functional and clinical stability have been observed in up to five years of follow-up evaluations. Associations such as cheilectomy and/or osteotomy enhance the results. Currently, there are several different techniques for approaching MTP osteoarthritis and AMIC could be an alternative, however, there is a need for studies evaluating long-term approaches, as well as their complications.

Ergonomics is the science that studies how to adapt the relationship between the human being with its environment. Performing musculoskeletal ultrasound applying appropriate ergonomic techniques both in the patient and by the sonographer, can reduce bodily injuries that are usually generated in repetitive work like this, causing a detriment to the quality of life. The objective of this pictorial is to depict some of the ergonomic characteristics necessary in this work environment by reviewing the literature related to the objective of this work. We conclude that carrying out ergonomic measures during the performance of a musculoskeletal ultrasound study reduces the risk of presenting fatigue and injuries to both the sonographer and the patient.

Introduction: revision surgery in total hip arthroplasty associated with wear and loosening of its components has become a routine procedure. Revision arthroplasty is widely exposed in the literature. However, cases presenting with loosening and intrapelvic migration of the acetabular component are less frequent.

Clinical case: female, 82 years old, with no clinical history of importance, except for a total right hip arthroplasty cemented one month ago. The patient does not tolerate standing or sitting, and does not ambulate. MID: hip: presence of a healed wound of approximately 12 cm. Limited ranges of mobility not assessable due to pain. HHS 16 points and VAS 8/10, showing imaging studies showing intrapelvic medial migration of the acetabular component without lesion of the great vessels. Revision surgery was performed with removal of the acetabular and femoral components. Infection was ruled out using alpha-defensin. Subsequently, a bone allograft is placed in the acetabular defect, then metallic mesh over the allograft, and a tantalum wedge is placed to finally place an acetabular cup. Finally, a diaphyseal anchorage femoral stem was placed, a 28 mm femoral head with a double mobility system and reduction of prosthetic components with adequate stability with recovery of hip biomechanics.

Conclusions: the different options exposed for treatment and the combination of techniques present advantages and disadvantages. Highly porous metal cups and augmentations showed satisfactory results to correct severe defects, as is the case described, with an improvement in HHS of 64 points and VAS of 8 points one year after surgery.

Introduction: musculoskeletal involvement of the extremities is common in pediatric patients with acute lymphoblastic leukemia. The insidious and oligosymptomatic presentation of several musculoskeletal conditions in these patients often leads to different diagnostic suspicions, which may delay appropriate management of the pathology. Non-albicans Candida osteoarticular infections are a rare entity that may affect immunodeficient patients. We describe a case of osteoarticular infection caused by an opportunistic fungus in a pediatric patient with acute lymphoblastic leukemia during the second week of rest post-consolidation block.

Case presentation: we present a case of a 4-year-old girl diagnosed with B-cell acute lymphoblastic leukemia that developed an elbow infection by Candida tropicalis. Two surgical debridements of the elbow, combined with the administration of antifungals, were required to control the infection. She fully recovered at six months postoperatively and remains without osteoarticular sequelae at three years of follow up.

Conclusion: C. tropicalis infection should be included in the differential diagnosis of osteoarticular complications in immunocompromised patients with acute lymphoblastic leukemia (ALL). Prompt diagnosis and treatment are essential to avoid osteoarticular sequelae.

Introduction: traumatic diastasis of the pubic symphysis (PSD) is an uncommon but disabling injury, associated with implications on morbidity and mortality. Depending on the severity, the treatment can be conservative or surgical, this latter method can be single plate (SP) or double plate (DP) osteosynthesis, with sparse information and without consensus on which of these fixation techniques to use.

Objective: to determine the functional outcome and post-surgical complications of SP and DP in the treatment of PSD.

Material and methods: retrospective comparative observational study of a cohort of 40 patients with PSD, divided into two groups of 20 patients each, post-operated with SP (group 1) and DP (group 2) according to the Tile classification. For the functional outcome, we used the Majeed scale.

Results: the median age is 38 years-old, with a predominance of males in 67.5%. According to each comorbidity, type of fracture, hospital stay, distance of pubic diastasis, operating vacuum and surgical time, there are no significant differences, p > 0.05. Traumatic brain injury (TBI) was present in 60 and 25% of patients with SP and DP, respectively, p < 0.05. There were no differences in functional outcome or post-surgical complications between the two groups, p > 0.05.

Conclusions: fixation with SP and DP are equally effective, both in functional outcome and post-surgical complications in the treatment of PSD.

Introduction: knee arthroplasty can generate complications, but a benefit in quality of life. The objective of this research was to determine the functional results in patients with total knee arthroplasty with denervation of prosthetic patella compared to no denervation.

Material and methods: a prospective and longitudinal study was performed in patients who underwent total knee arthroplasty during March 2021 to September 2021, applying questionnaires with knee functional scales, such as KSS which evaluates knee functional outcomes. Data were analyzed using descriptive and inferential statistics with Mann Whitney U test.

Results: a total of 119 postoperative total knee arthroplasty patients were stratified: group 1 (with prosthetic patella denervation with 57 members (48% of the total)) and group 2 (without patella denervation with 62 members (52% of the total)). Pain assessment with KSS scale was 41.6 points for group 1 and 41 points for group 2. The evaluation of range of motion with KSS scale was 19.7 ± 3.2 points for group 1, and 18.9 ± 3 points for group 2; use of stairs in group 1 with 35.5 ± 5.6 points and without group 2 with 35 ± 5 points, help in walking 5.8 points in group 1 and 5.7 for group 2.

Conclusion: no significant differences were observed in the functional results in post-surgical total knee arthroplasty patients with denervation of the prosthetic patella compared to no denervation.