Revista Espanola de Cirugia Ortopedica y Traumatologia最新文献

The Latarjet technique is a procedure used to treat anterior glenohumeral instability with glenoid bone loss. Various fixation systems for the coracoid have been described in the literature. This study aims to compare the results in quality of life and complications between patients treated with plate and screws (GP) for coracoid fixation and those treated with screws (GSP) only. Material and methods A retrospective study including patients with anterior glenohumeral instability and glenoid bone loss treated with Latarjet at the same centre between October 2009 and February 2021. A total of 85 shoulders were analysed, of which 64 completed at least one year of follow-up. Patients with previous surgical history in the same shoulder, bone loss <10%, ligamentous hyperlaxity (Beighton score >6), and previous infections were excluded. Complications were recorded, and the WOSI and Rowe tests were used to assess quality of life and return to sports activity. Results Of the 64 patients, 35 were treated with a plate (GP) and 29 with screws (GSP). The mean age was 30 ± 8.78 years. Both groups were statistically comparable. No significant differences were found in the WOSI test (P = .140), the Rowe test (P = .380) or in complications (P = .692). A higher percentage of the GP group returned to sports activity (77.1% GP vs. 51.7% GSP, P = .039). Conclusions No statistically differences were observed in quality of life, complications, or re-dislocations. However, the use of a plate showed a greater predisposition to return to sports activity (P = .039) in patients with anterior glenohumeral instability.

Background Tarsal coalitions are aberrant unions of two or more tarsal bones which may condition variable foot and ankle conditions. Their incidence is also variable but most frequently diagnosed coalitions are talocalcaneal and calcaneonavicular. This article aims to evaluate clinical and epidemiological characteristics of patients diagnosed with tarsal coalitions. Materials and methods Cross-sectional descriptive study of patients with tarsal coalitions from August 2007 to January 2020 in a private University Hospital in Madrid, Spain. Data on age, sex, type of coalition according to anatomical location and tissue type, laterality and hindfoot condition and symptoms were obtained and analyzed. Results Of the 57 patients identified (80 feet), there were 31 males (54.4%) and 26 females (45.6%). Average age was 36.9 years. The total number of coalitions was 85. There were 48 bilateral coalitions (56,5%). Fifty-two talocalcaneal coalitions (TCC) (61.2%), 32 calcaneonavicular coalitions (CNC) (37.6%) and 1 calcaneocuboid coalition (1.2%) were registered. Our series showed 36 osseous coalitions (42.4%) and 49 fibrocartilaginous coalitions (57.6%). When evaluated separately, 35 of the TCC were osseous (67.3%) and 17 were fibrocartilaginous (32.7%); 1 of the CNC was osseous (3.1%) and 31 were fibrocartilaginous (96.9%). Discussion In our review, TCC was the most frequent subtype, with the majority being the bony in nature. In the distribution according to sex, a higher incidence of males is found within the CNC group (Fisher's Exact test, P=.032). Some of the results obtained are different from what was previously reported in the literature, which gives rise to new studies that explain this difference in our population.

Introduction The incidence of hip fracture in the elderly is on the rise, occasionally accompanied by concurrent upper limb fractures. Our investigation aims to determine whether these patients experience poorer functional outcomes, prolonged hospitalisation, or higher mortality rates when compared to those with isolated hip fracture. Material and methods We retrospectively reviewed 1,088 elderly patients admitted to our centre with hip fracture between January 2017 and March 2020. We recorded the presence of concomitant fractures and their treatment. We analysed the duration of hospital stay, in-hospital mortality and function. Results We identified 63 patients with concomitant upper limb fracture (5.6%). Among them, 93.7% were women and the average age was 86.4 years. 80.9% of the upper limb fractures were of the distal radius or proximal humerus. Patients with concomitant fracture had increased length of stay (mean, 19.6 vs, 12.8, p = 0.002), decreased proportion of patients returning to their own home at discharge (23.6% vs, 26.3%, p = 0.042) and increased in-hospital mortality rate (9.5% vs, 5.9%, p = 0.003). Conclusions Patients with concomitant upper limb fracture require a longer length of stay and exhibit an elevated in-hospital mortality rate. Furthermore, this condition is associated with a reduced short-term functional recovery, thereby decreasing the chances of the patient returning home upon hospital discharge.

Introduction Stiffness is increased in vertebrae after kyphoplasty with bone cement is performed, which causes an increase in subsequent fractures in adjacent levels. This has led to increased interest in alternative filling materials such as bioactive calcium phosphate ceramics or silicon-based polymers. This study's objective is to compare the results between kyphoplasty with bone cement and with the VK100 silicone. Materials and methods This is a comparative, prospective study involving 64 patients, 23 treated using VK100 and 41 with PMMA. Clinical, radiological and functional results (Oswestry) and quality of life and (EQ-5D) were analysed and compared between both groups, focusing on differences in subsequent fractures in adjacent levels. Results There are no differences between the two treatments in terms of epidemiological factors (age and sex) or hospital management. A significant difference is observed in the gain of vertebral body height, with greater improvement in those treated with PMMA. There is also a higher fracture rate in the PMMA group, the difference is not significant. Finally, both treatments show similar outcomes in pain relief and quality of life. Conclusion Both VK100 Elastoplasty and PMMA Kyphoplasty are effective treatments for vertebral fractures. VK100 has a lower rate of complications and adjacent fractures. However, long-term results in terms of pain relief and quality of life are similar, making both treatments equally valid.

Objective Spain is expected to be the country with the highest life expectancy in the coming years. In this context, it is important to improve the care of hip fractures. The objective of this work was to describe the results of the registries published on hip fractures in Spain. Material and methods Systematic review and meta-analysis of the records published on hip fractures in Spain, the last 10 years. The characteristics of the study, characteristics of the patients, of the fractures, the type of surgery, as well as morbidity and mortality were analyzed. Results A total of 55,680 patients with a mean age of 84.6 years were analyzed, of whom 75% were women. Extracapsular fractures were the most frequent (58%). It was found that conservative treatment was applied in an average of 3% of cases. The average surgical delay was 64.7 hours, with a mean percentage of patients operated on within 24hours at 18%, and within 48 hours at 40%. A mean hospitalization time of 10.7 days was found. Delirium was found to be the most frequent postoperative complication (42%). The mean transfusion rate was 36%. Mean in-hospital mortality at one month and one year was 4%, 5% and 18%, respectively. Conclusions Less than half of patients with a hip fracture undergo surgery within 48 hours, despite being recommended by the majority of clinical practice guidelines. Delirium is the most frequently reported postoperative complication, and one in every 5 patients will die within a year after a hip fracture. Standardizing the management of hip fractures at the state level could improve healthcare quality and facilitate the establishment of common criteria for good clinical practice.

Objective: We aim to conduct a systematic review of the literature to evaluate the effectiveness of artificial intelligence prediction models in predicting complications in adult patients undergoing surgery for degenerative thoracolumbar pathology compared with other commonly used prediction techniques.

Methods: A systematic literature review was conducted in Medline/Pubmed, Cochrane Library, and Lilacs/Portal de la BVS to identify machine learning models in predicting complications in patients undergoing surgery for degenerative thoracolumbar spine pathology between January 1, 2000, and May 1, 2023. The risk of bias was assessed using the PROBAST tool. Study characteristics and outcomes focusing on general or specific complications were recorded.

Results: A total of 2,341 titles were identified (763 were duplicates). Screening was performed on 1,578 titles, and 22 were selected for full-text reading, with 18 exclusions and 4 publications selected for the subsequent review. Additionally, 8 publications were included from other sources (Argentine Association of Orthopedics and Traumatology Library; manual citation search). In 5 (41.6%) articles, the effectiveness of artificial intelligence predictive models was compared with conventional techniques. All were globally classified as having a very high risk of bias. Due to heterogeneity in samples, outcomes of interest, and algorithm evaluation metrics, a meta-analysis was not performed.

Conclusion: Although the available evidence is limited and carries a high risk of bias, the studies analysed suggest that these models may achieve promising performance in predicting complications, with area under the curve values mostly ranging from acceptable to excellent.

Introduction Shoulder calcific tendinopathy is a frequent cause of shoulder pain. Diagnosis is usually based on ultrasound (US) and/or X-ray. US is considered an inherently operator-dependent imaging modality and, interobserver variability has previously been described by experts in the musculoskeletal US. The main objective of this study is to assess the interobserver agreement for shoulder calcific tendinopathy attending to the size, type, and location of calcium analysed in plain film and ultrasound among trained musculoskeletal radiologists. Material and methods From June 2018 to May 2019, we conducted a prospective study. Patients diagnosed with shoulder pain related to calcific tendinopathy were included. Two different experienced musculoskeletal radiologists evaluated independently the plain film and the US. Results Forty patients, with a mean age of 54.6 years, were included. Cohen's kappa coefficient of 0.721 and 0.761 was obtained for the type of calcium encountered in plain film and the US, respectively. The location of calcification obtained a coefficient of 0.927 and 0.760 in plain film and US, respectively. The size of the calcification presented an intraclass correlation coefficient (ICC) of 0.891 and 0.86 in plain film and US respectively. No statistically significant differences were found in either measurement. Conclusion This study shows very good interobserver reliability of type and size measurement (plain film and US) of shoulder calcifying tendinopathy in experienced musculoskeletal radiologists.

Background: Prosthetic Joint Infections (PJI) are associated with significant morbidity and mortality, underscoring the importance of identifying the related risk factors. The objective of the present study was to evaluate whether environmental factors were correlated with an increase in PJI.

Material and method: Retrospective cohort study of 1847 consecutive hip and knee prosthesis surgeries performed at a single center over a 10-year period. All patients who underwent surgery during this period were included, with a minimum follow-up of 2 years. The association between infection cases and environmental temperature and humidity was analyzed for both the day of surgical intervention and the week following the procedure.

Results: Sixty-three cases of infection (3.4%) were identified. No statistically significant differences were observed in the infection rate according to the month (p = 0.13) or season (p = 0.42) in which the surgery was performed. Furthermore, no significant association was found between the incidence of PJI and the average temperature or humidity on the day or week following the prosthesis implantation.

Conclusions: Environmental temperature and humidity do not influence the incidence of PJI in regions with an oceanic climate. The increase in PJI according to environmental conditions is primarily observed in large-scale studies based on national registries.

Introduction: Intrapelvic suprapectineal plates play an important role in acetabular fracture fixation. However, the shape of these implants may interfere with the quality of reduction evaluations using plain X-rays. We sought to evaluate this artifact and its relationship with CT findings.

Materials and methods: In a retrospective, single-center series of 22 acetabular fractures, postoperative AP, alar and obturator X-ray views and CT images were evaluated by three independent observers. Cohen's kappa was used to examine interrater reliability.

Results: Suprapectineal plates interfered with the evaluation of the weight-bearing surface in 75.3%, and with all three oblique views in 43.9% of cases. The central segment was most consistently interfered with, corresponding to the area where the greatest malreduction was in 46.9% coronal and 42.4% of sagittal CT views.

Conclusions: Since the quality of reduction has prognostic value and is a necessary guide for the surgical team, that CT may be considered for the postoperative examination of the most challenging acetabular fracture cases.

Background This study aims to compare clinical and functional results after distal biceps tendon repair in manual workers vs. non-manual workers. Methods This is a retrospective comparative study which refers to 57 cases with distal biceps tendon rupture, divided in manual workers (24 elbows) and non-manual workers (33), that were treated by a single incision with cortical button and interference screw fixation. Included cases have a minimum of 3 months follow-up, post-operative X-ray and signed informed consent for the investigation. Results Supination and flexion strength was higher in manual workers vs. non-manual workers (p-value = 0.192 and 0.878, respectively). Nine patients showed loss of range of motion, concerning supination and pronation, and this was correlated to worse functional scores. Functional scores tend to be superior in non-manual workers. Ten patients had heterotopic ossification and 20 patients reported lateral antebrachial cutaneous nerve neuropraxia; one had both. Most of them had a full recovery. Conclusion According to clinical evaluation and post-operative scores, the performed surgical procedure provides good to excellent mid-term functional results. Nevertheless, there were not any differences between manual or non-manual workers.