Revista Espanola de Cirugia Ortopedica y Traumatologia最新文献

Introduction: The short stature characteristic of patients with achondroplasia can negatively affect health-related quality of life (HRQoL). Lower limb lengthening reusing telescopic intramedullary nails (TIMNs) offers an alternative to external fixators, with the potential to enhance functionality, self-esteem, and HRQoL, while reducing complication risks, which this study aims to evaluate.

Materials and methods: This retrospective study included nine patients with achondroplasia who underwent parallel transverse lengthening of femurs and/or tibias reusing a TIMN between 2015 and 2022. Functionality (Lower Extremity Functional Scale, LEFS), self-esteem (Rosenberg Self-Esteem Scale), and HRQoL (Short Form-12, SF-12, and EuroQol VAS) were assessed preoperatively and at least two years post-surgery. Complications (Clavien-Dindo-Sink classification) and patient satisfaction were also recorded.

Results: The median age was 13.5 years (IQR: 12.5-17.1), with a significant height increase of +19.9 cm +19.9 cm (p<0.05). Improvements were significant in functionality (LEFS, +4.6 points; p<0.05), self-esteem (Rosenberg, +3.7 points; p<0.05), and HRQoL (SF-12 physical, +8.9 points; p<0.05; EQ-VAS, +20 points; p<0.05). A total of 22 complications were reported in 32 treated bones, most classified as grade 2 or 3B, with no significant correlation to functionality, HRQoL, or self-esteem outcomes (p > 0.05).

Conclusions: Lower limb lengthening reusing TIMNs appears to improve functionality, HRQoL, and self-esteem in patients with achondroplasia compared to their preoperative status. High patient satisfaction and manageable complications were observed, with no negative impact on outcomes, laying the groundwork for future studies. LEVEL OF EVIDENCE Level IV, Retrospective case series.

Background: Selecting the right technique for lower limb soft tissue reconstruction is a therapeutic challenge. Despite having several reconstruction options, it's important to choose a technique that is effective and with the least possible donor site morbidity.

Objective: Demonstrate the therapeutic efficacy of the medial tab flap in soft tissue reconstruction on the leg, compared to conventional flaps.

Materials and methods: Cohort study matched by age. 64 patients with soft tissue defects were selected and according to the intervention divided in: group 1)medial tab flap, and group 2)conventional flaps (sural, soleus, gastrocnemius) followed up to one year postoperatively.

Outcome variables: surgical time in minutes, healing, healing time in days, complications.

Results: The patients who underwent surgery with medial tab flap and with conventional flaps healed completely. The healing time was 16.2±11.2 days in the tab flap and 16.1±11.2 days in conventional flaps, no statistically significant differences were found between the groups (P=.89). The surgical time for tab flaps was 225.2±117.8minutes, and 191.3±117.2minutes for the comparison flaps (P=.65), there were no statistically significant differences. There were no complications in the medial tab flaps.

Conclusion: The findings suggest that the medial tab flap technique is as effective as the conventional flap technique, with complete flap survival and healing, and without any major complications in this studied group.

Introduction: Reported prevalence for reamputation in diabetic foot is diverse, risk factors are not clear for minor amputations. This study aims to determine the prevalence for reamputation in diabetic foot from minor amputations and to evaluate associated factors for such outcome.

Methods: Cross sectional study developed in 2 hospitals. Patients hospitalized for diabetic foot ulcer requiring a minor amputation were included. A descriptive analysis of all variables is presented, as well as prevalence ratios (PR) and a multivariate logistic regression.

Results: The prevalence was of 48% for 15 years. Toes were the most frequent minor amputation that required reamputation and above the knee amputation was the most frequent reamputation level (45%). Variables whose PR was associated to reamputation risk were: smoking history (PR 1.32, CI 95%: 1.02-1.67, p=0.03), vascular occlusion in doppler (PR 1.47, CI 95%: 1.11-1.73, p=0.01), revascularization (PR 1.73, CI 95%: 1.31-2.14, p=0.00002), Wagner>3 (PR 1.75, CI 95%: 1.16-1.84, p=0.01) and leucocytosis>11,000 (PR 1.39, CI 95%: 1.07-1.68, p=0.01). Leucocytosis>11,000, Wagner>3, vascular occlusion in doppler and revascularization were the variables that best predicted the outcome. Furthermore, leucocytosis was the best variable for predicting reamputation (OR 2.4, CI 95%: 1.1-5.6, p=0.04).

Conclusions: Reamputation prevalence was 48%. The toes were the minor amputation more frequently requiring reamputation and above the knee was the most frequent reamputation level. Risk for reamputation was associated with variables related to vascular compromise and infection.

Introduction: Although conservative treatment of calcific tendinopathy has a high success rate, arthroscopic excision of the calcific deposit is occasionally necessary. Controversy exists as to whether the remaining rotator cuff defect can be left in situ or should be repaired to achieve better functional outcomes. This study aimed to compare the results of debridement versus debridement combined with suturing in arthroscopic surgery for calcific tendinopathy.

Methodology: MEDLINE, EMBASE, Cochrane Library, and Web of Science were searched from inception to February 2023 for articles on arthroscopic treatment of calcific tendinopathy. Functional outcomes (VAS, ASES, UCLA, and Constant) and the number of complications were analyzed. The effect size was calculated using Cohen's d-index.

Results: Twenty-one studies were included, including a total of 1172 patients aged between 44.7 and 55 years. The mean follow-up time was 24.7 months. The combined ES estimates for the total score of the VAS, ASES, UCLA, and Constant scales were very strong (>1.0) for both debridement and combined debridement with suture. The ES estimates for the number of total complications were 1.75 (95% CI: 0.08-3.43, I²=0%) for debridement and 9.07 (95% CI: -0.03 to 18.17, I²=50.4%) for combined debridement with suture.

Conclusions: Both arthroscopic procedures improve the total score significantly on the EVA, ASES, UCLA, and Constant scales. However, a higher proportion of complications was observed in the group that performed suturing. In this regard, we must consider whether it is really necessary to repair all partial tears after the calcified deposits removal.

Background and objective: The objective is to develop a model that predicts vital status six months after fracture as accurately as possible. For this purpose we will use five different data sources obtained through the National Hip Fracture Registry, the Health Management Unit and the Economic Management Department.

Material and methods: The study population is a cohort of patients over 74 years of age who suffered a hip fracture between May 2020 and December 2022. A warehouse is created from five different data sources with the necessary variables. An analysis of missing values and outliers as well as unbalanced classes of the target variable («vital status») is performed. Fourteen different algorithmic models are trained with the training. The model with the best performance is selected and a fine tuning is performed. Finally, the performance of the selected model is analyzed with test data.

Results: A data warehouse is created with 502 patients and 144 variables. The best performing model is Linear Regression. Sixteen of the 24 cases of deceased patients are classified as live, and 14 live patients are classified as deceased. A sensitivity of 31%, an accuracy of 34% and an area under the curve of 0.65 is achieved.

Conclusions: We have not been able to generate a model for the prediction of six-month survival in the current cohort. However, we believe that the method used for the generation of algorithms based on machine learning can serve as a reference for future works.

Background: Selecting the right technique for lower limb soft tissue reconstruction is a therapeutic challenge. Despite having several reconstruction options, it's important to choose a technique that is effective and with the least possible donor site morbidity.

Objective: Demonstrate the therapeutic efficacy of the medial tab flap in soft tissue reconstruction on the leg, compared to conventional flaps.

Materials and methods: Cohort study matched by age. 64 patients with soft tissue defects were selected and according to the intervention divided in: group (1) medial tab flap, and group (2) conventional flaps (sural, soleus, gastrocnemius) followed up to one year postoperatively.

Outcome variables: surgical time in minutes, healing, healing time in days, complications.

Results: The patients who underwent surgery with medial tab flap and with conventional flaps healed completely. The healing time was 16.2±11.2 days in the tab flap and 16.1±11.2 days in conventional flaps, no statistically significant differences were found between the groups (p=.89). The surgical time for tab flaps was 225.2±117.8min, and 191.3±117.2min for the comparison flaps (p=.65), there were no statistically significant differences. There were no complications in the medial tab flaps.

Conclusion: The findings suggest that the medial tab flap technique is as effective as the conventional flap technique, with complete flap survival and healing, and without any major complications in this studied group.

Introduction: Necrotizing soft tissue infections (NSTI) are increasing, posing a significant risk of morbidity and mortality. Due to nonspecific symptoms, a high index of suspicion is crucial. Treatment involves a multidisciplinary approach, with broad-spectrum antibiotics, early surgical debridement, and life support. This study analyzes the characteristics, demographics, complications, and treatment of NSTI in a hospital in Madrid, Spain.

Methods: A retrospective observational study was conducted, including all surgically treated NSTI patients at our center from January 2016 to December 2022, examining epidemiological and clinical data. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) was prospectively calculated for all patients.

Results: Twenty-two patients (16 men, 6 women, mean age 54.8) were included. Median time from symptom onset to emergency room visit was 3.5 days. All reported severe treatment-resistant pain; sixteen had fever exceeding 37.8°C (72.7%). Skin lesions occurred in twelve (54.5%), and thirteen had hypotension and tachycardia (59.1%). Treatment involved resuscitative support, antibiotherapy, and radical debridement. Median time to surgery was 8.25h. Intraoperative cultures were positive in twenty patients: twelve Streptococcus pyogenes, four Staphylococcus aureus, one Escherichia coli, and four polymicrobial infection. In-hospital mortality rate was 22.73%.

Conclusions: We examined the correlation between our results, amputation rates and mortality with LRINEC score and time to surgery. However, we found no significant relationship unlike some other studies. Nevertheless, a multidisciplinary approach with radical debridement and antibiotic therapy remains the treatment cornerstone. Our hospital stays, outcomes and mortality rates align with our literature review, confirming high morbimortality despite early and appropriate intervention.

Introduction: Although conservative treatment of calcific tendinopathy has a high success rate, arthroscopic excision of the calcific deposit is occasionally necessary. Controversy exists as to whether the remaining rotator cuff defect can be left in situ or should be repaired to achieve better functional outcomes. This study aimed to compare the results of debridement versus debridement combined with suturing in arthroscopic surgery for calcific tendinopathy.

Methodology: MEDLINE, EMBASE, Cochrane Library, and Web of Science were searched from inception to February 2023 for articles on arthroscopic treatment of calcific tendinopathy. Functional outcomes (VAS, ASES, UCLA, and Constant) and the number of complications were analyzed. The effect size was calculated using Cohen's d-index.

Results: Twenty-one studies were included, including a total of 1172 patients aged between 44.7 and 55 years. The mean follow-up time was 24.7 months. The combined ES estimates for the total score of the VAS, ASES, UCLA, and Constant scales were very strong (>1.0) for both debridement and combined debridement with suture. The ES estimates for the number of total complications were 1.75 (95% CI: 0.08-3.43, I² = 0%) for debridement and 9.07 (95% CI: -0.03-18.17, I² = 50.4%) for combined debridement with suture.

Conclusions: Both arthroscopic procedures improve the total score significantly on the EVA, ASES, UCLA, and Constant scales. However, a higher proportion of complications was observed in the group that performed suturing. In this regard, we must consider whether it is really necessary to repair all partial tears after the calcified deposits removal.

Introduction: Generative Artificial Intelligence is a technology that provides greater connectivity with people through conversational bots («chatbots»). These bots can engage in dialogue using natural language indistinguishable from humans and are a potential source of information for patients.The aim of this study is to examine the performance of these bots in solving specific issues related to orthopedic surgery and traumatology using questions from the Spanish MIR exam between 2008 and 2023.

Material and methods: Three «chatbot» models (ChatGPT, Bard and Perplexity) were analyzed by answering 114 questions from the MIR. Their accuracy was compared, the readability of their responses was evaluated, and their dependence on logical reasoning and internal and external information was examined. The type of error was also evaluated in the failures.

Results: ChatGPT obtained 72.81% correct answers, followed by Perplexity (67.54%) and Bard (60.53%).Bard provides the most readable and comprehensive responses. The responses demonstrated logical reasoning and the use of internal information from the question prompts. In 16 questions (14%), all 3 applications failed simultaneously. Errors were identified, including logical and information failures.

Conclusions: While conversational bots can be useful in resolving medical questions, caution is advised due to the possibility of errors. Currently, they should be considered as a developing tool, and human opinion should prevail over Generative Artificial Intelligence.