Acta ortopedica mexicana最新文献

Navigation in total knee arthroplasties has been recommended in recent years to facilitate the technique and improve its results. An extensive literature has compared it with conventional surgery, but its superiority has not been able to be demonstrated. Given the abundant bibliography and disparity in their conclusions, a good number of meta-analyses have been published that have attempted to summarize and schematize the results. We have reviewed 41 published meta-analyses comparing both techniques. Most of them have focused on the placement of implants and the restoration of the axes of the extremity, demonstrating the superiority of navigation. On the contrary, no clinically valuable differences have been observed when analyzing the clinical and functional results. However, navigation allows a dynamic view of the knee, an objective evaluation of the soft tissues and ligaments, and is essential for functional alignment as an individualized technique.

Müller-Weiss is a disease characterized by deformation, fragmentation and necrosis of the navicular, which presents with midfoot varus and long-standing pain, mostly in females. It is related to delayed ossification due to physical or nutritional stress, associated with abnormal force distribution. There are still few studies on this condition and there is no consensus in the literature on its classification and treatment. At first, conservative treatment does not show positive results, only acute symptomatic improvement. Isolated talonavicular arthrodesis is the method most commonly adopted by specialists, showing good results and scores in the early stages, while triple and double arthrodesis is the choice in advanced stages. Knowledge of the radiology and findings is important for planning and individualizing the choice of treatment in each case. At the moment, there are several different techniques for approaching Müller-Weiss disease, however, studies evaluating long-term approaches as well as their complications need to be carried out. We present a systematic review on this disease.

Introduction: lumbar foraminal stenosis refers to the constriction of the lateral canal through which the nerve root exits the spinal canal in the lumbar spine. It occurs in 8-11% of patients aged over 40 years. Failure to detect and alleviate foraminal constriction can contribute to up to 60% of instances of unsuccessful lumbar surgery. This study aimed to develop an index to assess the extent of foraminal narrowing, thereby aiding decisions regarding direct or indirect foraminal decompression.

Material and methods: a cross-sectional study was conducted, involving 49 patients, wherein measurements of all five lumbar foramina were taken using X-rays and simple magnetic resonance imaging. These measurements primarily focused on the foraminal width and the lower endplate, which were then correlated to establish a foraminal width/lower endplate index.

Results: the foraminal width/lower endplate index < 10% yielded an odds ratio (OR) of 3.07 on lateral radiography, 3.59 on flexion radiography, and 4.01 on extension radiography. In MRI, an OR of 0.195 was found for the left foramina, while an OR of 3.07 was observed for the right foramina.

Conclusion: this study paves the way for further exploration of preoperative and postoperative clinical outcomes across various surgical decompression methods guided by the FW/LE index. To enhance decision making, it is recommended to conduct research comparing pre- and postoperative clinical findings in individual patients, considering their FW/LE index measurements.

Meniscal injuries represent one of the main causes of intra-articular knee pain, especially in young patients, athletes or those with a high demand for physical activity; representing a challenge for the arthroscopist surgeon due to the great complexity that some of these injuries can present. Currently, the advances that have been implemented in arthroscopy allow us to repair meniscal injuries that in the past were considered irreparable. Although our priority is to preserve as much of the meniscus as possible, there are cases in which the injury reaches such complexity that this is impossible, with partial or total meniscectomy being the only therapeutic option. In the United States, approximately 690,000 partial meniscectomies are performed each year. This situation makes us consider meniscal transplantation as a great therapeutic option for patients considered young enough for joint replacement. The ideal patient is a relatively young patient (between skeletal maturity and 50 years), who has a well-documented history of partial or total meniscectomy, pain well localized to the affected compartment, with failure to conservative treatment and without high-grade chondral defects. in a generalized way. We present the case of a 35-year-old male patient with a history of total meniscectomy of the right lateral meniscus seven years ago, who currently presents with a postmeniscectomy syndrome of the lateral compartment. Due to the clinical and demographic characteristics of our patient, as well as the findings in the imaging studies, meniscal transplantation with allograft represents an excellent alternative to alleviate the symptoms and slow down as much as possible the need for joint replacement as a definitive treatment.

Introduction: chondrosarcoma is a high-grade malignant tumor composed of mesenchymal cells with cartilage differentiation. It most frequently appears in the bones of the pelvis, the femur, and the humerus. The main management method is oncological resection with wide margins and function-preserving reconstruction. The prognosis depends on the histologic grade and location of the tumor.

Case presentation: we present the case of an adult patient with chondrosarcoma in the right humerus managed in our unit with wide resection and massive allograft reconstruction (limb salvage).

Conclusions: the option of reconstructive surgery could lead to considerable success and minimize the functional, emotional, and aesthetic impairment that an amputation would entail.

Introduction: surface sarcomas are a rare entity that need correct diagnosis to differentiate parosteal (cPOS), periosteal and the high grade surface osteosarcomas (HGSO). HGSO has malignant behavior similarities with osteosarcomas and wide resection is the key to a successful treatment.1 The Capanna and Hemi-Capanna reconstruction techniques have being developed in order to avoid amputation after an oncological resection, allowing structural support from an allograft and biological advantages from a vascularised autograft.

Case presentation: 46 years old male presenting with knee pain and 4 × 3 cm soft tissue tumor on the right tibial surface diagnosed of High Grade Surface Osteosarcoma (HGSO). Was treated by oncological resection followed by reconstruction with allograft and ipsilateral fibula autograft following the "Hemi-Capanna" technique and pedicled medial gastrocnemius flap.

Conclusion: sufficient evidence supports the use of the Capanna technique in major musculoskeletal reconstructions. The new "Hemi-Capanna" technique has less evidence but proves to be an easier surgical technique with good functional results and little complications.

Introduction: evaluation of predictors of periprosthetic fracture in loosened femoral stems.

Material and methods: retrospective case-control study comparing aseptic loosened stems in two groups: cases: patients who experienced periprosthetic femoral fracture before replacement could be performed (n = 9). Controls: experienced prosthetic replacement without fracture (n = 19).

Results: pain intensity (VAS) was the most important aspect (p = 0.01), predominating in the controls. The simple radiological parameters did not show statistically significant findings predictive of peri-prosthetic fracture (number of Gruen zones, sum of them in mm, stress shielding, pedestal, polyethylene wear, stem subsidence). The role of complementary tests (CT and scintigraphy) for the definitive diagnosis of loosening was relevant, but not significant. The type of implant showed no differences. Overall implant survival was higher in cases than in controls (p = 0.016). This difference continues when comparing each loosened stem until fracture or replacement (p = 0.024).

Conclusion: the main factor protecting against fracture is the replacement of a stem with clinical and radiological diagnosis of loosening. Adequate follow-up of the patient plays a determining role in this, especially when considering the greater intensity of pain in the controls, which used to guide surgeons to perform replacements before the fracture occurred. This is reinforced if we take into account that up to one third of the cases did not have regular check-ups, and therefore did not have the opportunity for replacement prior to the fracture. The role of complementary tests (CT and scintigraphy) is also very important, taking into account the low diagnostic yield obtained from simple X-rays.

Introduction: fixation of unstable intertrochanteric fractures presents a significant challenge, especially in the context of osteoporosis. Intramedullary implants have been established as superior to plate constructs. Our aim is to compare the complications and clinical outcomes of the Proximal Femur Nail (PFN) and Proximal Femur Nail Antirotation-2 (PFNA2) in managing unstable intertrochanteric fractures.

Material and methods: a total of 212 patients meeting inclusion and exclusion criteria underwent fixation of trochanteric fractures using either a standard PFN (n = 110) or PFNA2 (n = 102). Their intraoperative and postoperative clinical and radiographic data were evaluated along with the quality of fixation. Data analysis was performed using the student's t-test, 2 test, and Mann-Whitney U test.

Results: PFNA2 demonstrated more favorable outcomes compared to PFN in terms of a better intraoperative profile, functional outcomes (PFNA2: PFN = 82:75), and fewer implant-related complications. Significant issues in the PFN group included screw back-out, guidewire breakage, and proximal protrusion of the nail tip. In contrast, locking mechanism failure and lateral screw prominence were significant problems in the PFNA2 group.

Conclusion: PFNA2 is the preferred implant for managing osteoporotic unstable intertrochanteric fractures, given the bone's weak inherent tendency to secure the implant.

The evolution and challenges of unicompartmental knee prostheses (UNIS) are addressed, highlighting their use since the 1970s as an alternative to osteotomies. Over the years, these prostheses have gained popularity, although they initially faced criticism due to higher revision rates compared to total knee arthroplasties (TKA). Multicenter studies, such as that of Heck et al., revealed an increase in failures associated with body mass index and female sex. Despite this, recent reviews, such as that of Vasso et al., have shown a positive evolution in the results of UNIS, although with a higher percentage of revisions than TKA. The importance of adequate patient selection, meticulous surgical technique, and avoidance of overcorrection for surgical success is also emphasized. It is mentioned that external UNIS, although representing a small percentage of total prosthetic knees, have shown favorable results in terms of long-term survival. In addition, technical aspects such as minimal bone resection and polyethylene wear, which are crucial for the performance of prostheses, are discussed. In conclusion, the need for further research and improvement of techniques to optimize the results of unicompartmental arthroplasties is highlighted.