Revista Espanola de Cirugia Ortopedica y Traumatologia最新文献

Introduction: Ankle fractures are increasingly common in frail patients, with hospitalization being the principal cost driver, particularly for the elderly who often need referral to nursing facilities. This study aims to identify factors affecting resource utilization per admission (hospital and nursing) in the fixation of low-energy ankle fractures.

Materials and methods: This retrospective cohort study examined patients undergoing fixation for low-energy ankle fractures. The primary outcome was the length of hospitalization. Secondary outcomes included delays in fixation and the need for referral to a nursing institution. Multiple linear and logistic regression models were used to determine predictors related to patient demographics, injury characteristics, and treatment.

Results: We analyzed 651 patients with a median age of 58 years. The median hospitalization duration was 9 days, primarily before surgery. Extended hospitalization was associated with antithrombotic treatment (b=4.08), fracture-dislocation (2.26), skin compromise (7.56), complications (9.90), and discharge to a nursing center (5.56). Referral to a nursing facility occurred in 17.2%, associated with older age (OR=1.10) and an ASA score ≥III (6.96).

Conclusions: Prolonged hospitalization was mainly due to surgical delays and was related to fracture-dislocations, skin compromise, and complications. Older and comorbid patients were more likely to need nursing facilities, and delays in these facilities' availability contributed to extended hospital stays.

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: The implementation of enhanced recovery programs has transformed total hip arthroplasty (THA) surgery. Outpatient prosthetic surgery is a safe and beneficial technique. Few centers in our country perform outpatient total hip arthroplasty (OTHA). We present the preliminary results of our experience.

Material and method: This is a prospective observational study conducted in 2023 with a sample of 30 patients proposed for THA following an outpatient surgery protocol by the orthopedic surgery and traumatology service.

Results: In 2023, we performed 132 THAs in our center. Thirty patients, 27 men and 3 women with an average age of 55.7 years were included for an outpatient surgery circuit. Three patients did not meet the inclusion criteria identified by the Anesthesiology Department. Of the 27 patients included in the program, 25 were discharged on the same day. Two patients were admitted: one due to an intraoperative fracture and the other due to poor pain control and dizziness. No secondary complications related to the program were observed after discharge. All patients except one would recommend the outpatient protocol.

Conclusions: OTHA programs should evolve from rapid recovery programs. Their implementation depends on an experienced multidisciplinary team. In this study, inclusion criteria were defined, achieving high satisfaction without increased complications. Outpatient surgery is a good option, and the implementation of this circuit is a safe, effective, and a satisfactory practice for selected patients.

Objective: This study aimed to analyze factors of comorbidity in older patients with acetabular fracture to know the role of disease in the treatment of this population.

Methods: Design: retrospective cohort study.

Setting: Single Level 2 Trauma Center.

Patient selection criteria: A prospective database of acetabular fractures in patients over 55 years between January 2011 and January 2021 was studied. The exclusion criteria were age, pathological fracture, associated pelvic or hip fracture, follow-up of less than one year, and not having a computed tomography.

Outcome measures and comparisons: Patients were categorised as low (0-2), intermediate (3-4) or high (≥5) risk according to the age-adjusted Charlson comorbidity index (ACCI). The primary outcomes were risk of complications, number of complications and mortality at one year according to the ACCI scale. The difference between the pre-fracture Clinical Frailty Scale (CFS) and the one-year follow-up was also analysed. Descriptive and multivariable regression analyses were performed and ROC curves were constructed.

Results: A total of 119 patients with acetabular fracture were collected. Ninety-eight out of those met inclusion criteria for our study. In regard to ACCI groups, 22% were low-risk, 26% were intermediate-risk, and 52% were high-risk. Statistically significant differences were found according to age, sex, mechanism of injury, treatment type, surgical treatment type, Clinical Frailty Scale (CFS) score, readmissions, complications, and mortality. ROC curves showed an association between ACCI and CFS in terms of complications and mortality, with the exception of unadjusted Charlson comorbidity index. On the multivariable regression analysis, associations were found between ACCI and presence of complications (OR 1.37, 95% CI 1.06-1.77, p=0.015) and mortality (OR 1.32, 95% CI 1.04-1.67, p=0.025) and between CFS and complications (OR 2.01, 95% CI 1.30-3.11, p=0.001) and mortality (OR 1.59, 95% CI 1.08-2.35, p=0.019). No statistical correlation was established between ASA and complications or mortality.

Conclusion: Presurgical ACCI and CFS scales may serve as a risk assessment method in treatment decision-making for patients with acetabular fracture. An association is observed between patients with a pre-fracture ACCI score ≥5 (high-risk) and a pre-fracture CFS score >4 (mild frailty) and mortality and complications at one year.

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 64.7hours, with a mean percentage of patients operated on within 24hours at 18%, and within 48hours 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 48hours, 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.

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.

Objective: The FNS System DePuy Synthes® (EEUU, 2018) represents a recent alternative treatment for the fixation of femoral neck fractures, providing biomechanical advantages with respect to cannulated screws (3 CS). The objective of this study is to compare the clinical results of both fixation methods.

Method: A retrospective collection of the 36 subcapital fractures treated with the FNS system was carried out compared with a retrospective search of the last 35 patients treated with 3 CS. Age, sex, fracture pattern, delay until the intervention, length of intervention, hospital length stay, and haemoglobin loss were analyzed. In addition, the rate of avascular necrosis, nonunion, symptomatic femoral neck shortening, and material protrusion with or without its removal were recorded during a minimum follow-up of 6 months.

Results: No significant differences were found in age (p-value 0.32), fracture patterns (p-value 0.77), surgical delay (p-value 0.28), surgical time (p-value 0.226), length of hospital stay (p-value 0.921) and blood loss (p-value 0.086) between the two groups. A significantly higher overall complication rate was observed in the group treated with cannulated screws (p-value 0.004). Analysed separately, a higher rate of avascular necrosis, symptomatic shortening of the femoral neck, protrusion of the osteosynthesis material with or without removal was observed in the group treated with cannulated screws.

Conclusions: The FNS system represents a safe and reproductible alternative for the fixation of femoral neck fractures, showing non-inferior outcomes to treatment with cannulated screws.

Introduction: Morton's neuroma is predominantly attributed to chronic nerve entrapment within third space adjacent metatarsals, the deep transverse metatarsal ligament (DTML), and the plantar skin. While conservative treatments are of election, failures require alternative interventions such as ultrasound-guided injections and various surgical procedures, including minimally invasive neurectomy and DTML release. This study aimed to anatomically assess the risks associated with the endoscopic dorsal surgical decompression of Morton's neuroma.

Materials and methods: Twenty feet from ten fresh-frozen cadaveric specimens underwent a dorsal percutaneous approach for endoscopic access. Surgical procedures were monitored by three foot and ankle surgeons. Post-surgical anatomical dissections were conducted to evaluate potential risks to surrounding structures.

Results: The endoscopic technique successfully sectioned the DMTL in all specimens (100%) without iatrogenic injury of tendons, nerves, or arteries, while lumbricals may be at risk.

Conclusion: Endoscopic dorsal decompression of Morton's neuroma presents as an accessible minimally invasive surgical option with low risk of collateral associated injuries.

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.