Acta ortopedica mexicana最新文献

Introduction: the ankle is a modified hinge-shaped synovial joint. Multiple studies have been performed where no significant difference has been observed, as well as similar functional evaluation between patients with open reduction and internal fixation of the ankle with and without transsyndesmotic fixation of Weber B ankle fractures.

Objective: to determine a comparison by means of functional evaluation based on the AOFAS scale in patients with and without transsyndesmal fixation.

Material and methods: cross-sectional and retrospective study. Clinical-radiographic records of patients with a diagnosis of Weber B type ankle fractures who have undergone surgical procedures and are in the follow-up period in the Traumatology and Orthopedics Unit from January 1, 2022 to January 1, 2024 were included.

Results: mean age was 40.1 ± 13.3 years. 47.9% (n = 46) of the files were female, and 52.1% (n = 50) were male. 47.9% (n = 46) of the patients underwent transindorsal fixation, while 52.1% (n = 50) did not undergo transindorsal fixation. The primary mechanism of injury was pronation with abduction 43.8% (n = 42) and supination with external rotation with 40.6% (n = 39). The AOFAS score was reported with 83.3% (n = 80) was excellent and the remaining 16.7% was good.

Conclusion: patients with transsyndesmotic fixation in patients with Weber B ankle fractures have a better functional assessment by AOFAS scale compared to those without transsyndesmotic fixation.

Type III acromioclavicular dislocation is characterized by the complete rupture of the acromioclavicular and coracoclavicular ligaments. The approach to acute type III acromioclavicular dislocation is still dichotomous in the literature, since both the non-surgical and surgical approaches have similar clinical results. This study is a systematic review applying the PRISMA guidelines. The data sources used were PubMed/MEDLINE, Embase, Cochrane and Scopus. The search was carried out using the descriptors "acromioclavicular dislocation", "type III", "treatment" and "conservative". The methodological evaluation was carried out using the Newcastle-Ottawa scale. The scales used to assess pain were the Constant Score and the Visual Analog Scale (VAS). After analysis, 7 studies were reviewed, from which 299 patients were included, 148 undergoing conservative treatment and 151 undergoing surgical treatment. The average age of the patients was 41, with a predominance of males. The average follow-up time was 5.3 years for conservative treatment and 3.7 years for surgical treatment. With regard to the functional scales, the Constant Score (CS) was higher in the surgical approach and the visual analog scale was lower. The scores for the surgical modality were CS 90.2 and VAS 0.83, while the conservative modality was CS 87.9 and VAS 1.66. There seems to be no significant difference in the persistence of pain between conservative and surgical treatment. The choice of treatment still depends on the surgeon, and risk factors and complications should help in the decision.

Introduction: distal radius fractures are an important cause of disability in adults. Fracture displacement and malunion are known and common complications of treatment. Open reduction and fracture fixation with volar plates and screws restore the normal alignment of the radius, but there are few reports in the literature regarding secondary displacement of the fracture fragments.

Objective: detect secondary displacement in patient receiving distal radius open reduction and internal fixation with volar plates in the last five years at a private third level hospital.

Material and methods: a total of 54 patients satisfied our inclusion criteria. Radiographic measurements were taken on standard anteroposterior (AP) and lateral films, preoperative, immediate postoperative and six weeks postoperative. We considered significant displacement as follows: More than 5° of volar tilt or radial inclination change, and more than 1 mm displacement in ulnar variance or radial height.

Results: all patients presented some degree of postoperative displacement, only seven patients were affected with displacement above our defined threshold. One patient displaced over acceptable reduction parameters. Statistical analysis with ² test determined that female sex was the only significant risk factor for displacement in this study. Binary logistic regression analysis didn't find any significant risk factors.

Conclusions: in these series, female sex was the only risk factor for postoperative displacement. This displacement probable is not clinically significant. Long term follow-up and increasing the number of patients can give more power to our evidence.

Introduction: we describe the case of a 24-year-old male with an initial diagnosis of arthritis of the first metatarsophalangeal joint (MTP). In the magnetic resonance imaging (MRI) the abnormal findings were a bipartite medial sesamoid versus fracture of the medial sesamoid. During follow-up, the patient developed a fistula in the first MTP with a positive culture for methicillin-sensitive Staphylococcus aureus (MSSA), leading to the diagnosis of septic arthritis (SA) of the first MTP. Treatment involved surgical debridement and targeted antibiotic therapy, resulting in good outcomes and satisfactory progress.

Conclusion: sesamoid bone pathology is rare, with fractures and sesamoiditis being the most common conditions. Acute or chronic infection osteomyelitis of sesamoids is extremely unusual, and aggressive treatment is required. Sample collection should be performed to initiate targeted antibiotic therapy for the causative pathogens, with Staphylococcus aureus and Pseudomonas aeruginosa being the most frequent. Subsequently, extensive surgical debridement should be performed, aiming to avoid complete sesamoidectomy due to its significant comorbidity.

Osteomyelitis caused by Bacillus Calmette-Guerin (BCG) is a rare complication of Mycobacterium bovis vaccination. Lesions are usually localized in the metaphysis or epiphysis of long bones, but rarely affect the foot. This report describes two cases of BCG osteomyelitis involving the talus in infants of 13 months and eight months old. BCG-osteomyelitis should be suspected in children under two years of age with insidious osteomyelitis, accompanied with characteristic imaging findings.

Introduction: the indication for total vertebrectomy in single vertebral metastases is increasingly questioned, especially in metastases with unknown primary tumour.

Material and methods: in this article we describe a case of vertebral metastasis of unknown primary tumour treated by total vertebrectomy, and a review of the literature.

Results: in those patients with a good general condition, single vertebral metastases and no involvement of internal organs, as in our case, curative surgical treatment can be considered with total vertebrectomy being the treatment of choice in lesions that only affect the body of the vertebra.

Conclusions: total vertebrectomy may be a therapeutic alternative in patients with primary tumours or single vertebral metastases, but the high rate of associated complications should not be underestimated.

Introduction: total knee arthroplasty (TKA) is a surgical procedure with a growing number of indications worldwide. The trend in recent years has been to reduce hospital stay without compromising safety and quality of care. The aim of this study was to determine whether early discharge (less than 24 hours) is associated with a higher rate of complications, readmissions and unscheduled visits in patients undergoing primary knee arthroplasty.

Material and methods: we performed a sample calculation and proposed a statistical test of non-inferiority. We retrospectively studied 229 patients undergoing TKA between 2020 and 2022. Patients with primary osteoarthritis undergoing primary total knee arthroplasty with 90 days of postoperative follow-up were included. Those with revision surgeries, simultaneous bilateral surgeries, complications intraoperatively or during hospitalisation, and those unable to follow the usual postoperative protocol for medical reasons were excluded. These were divided into two groups: early discharge (less than 24 hours) and standard discharge (more than 24 hours). The occurrence of the target variables was recorded for 90 days.

Results: the analysis showed no statistically significant differences when comparing readmissions 4.1 vs 2.2% (p = 0.407), complications 11.4 vs 12% (p = 0.895) and unscheduled consultations 15.6 vs 16.5% (p = 0.853) between both groups of patients.

Conclusions: the findings suggest that the early discharge protocol in primary total knee arthroplasty is not significantly inferior to the standard and could be considered as a viable alternative in clinical practice.

Introduction: anterior cruciate ligament rupture has evolved to be one of the most common sports injuries with a remarkable increase in its incidence in the last two decades, with Return-To-Sport being a crucial approach in the choice of autologous graft for its surgical repair, the most commonly used being hamstring and quadriceps tendon graft.

Material and methods: a prospective randomized study was performed with 32 patients divided into two groups, one for each type of graft, with 13 patients in each. They were evaluated before surgery, at 30, 180 and 360 days after the procedure using scales such as Lysholm, mCKRS and ACL-RSI, and their previous activity level was considered using the Tegner score.

Results: it was observed that, at 30 and 180 days after surgery, there were significant differences in pain assessment using the VAS scale between the groups, while at 360 days no significant differences were observed. No significant differences were found in Lysholm and mCKRS scale scores in either group at days 30, 180, and 360, but significant differences were found in ACL-RSI scale scores at 30 and 180 days between the two groups, which did not hold at 360 days.

Conclusion: despite the difference in postoperative pain, Return-To-Sport times and overall recovery showed no significant differences between the two types of grafts in this study.