Revista Espanola de Cirugia Ortopedica y Traumatologia最新文献

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.

Objective: To evaluate the range of motion (ROM) of the knee in patients with severe post-traumatic knee arthrofibrosis after being treated with arthroscopic fibroarthrolysis (AFA) and manipulation under anesthesia (MUA).

Methods: Case series of patients with severe post-traumatic knee arthrofibrosis who underwent AFL + MUA in a national referral center. The primary outcome to be assessed was ROM before and after surgery and then at 3-month intervals until a minimum follow-up of one year was completed.

Results: 51 patients were included. The main injuries preceding the stiffness were tibial plateau fracture (37.3%), distal femur fracture (27.5%), and femoral shaft fracture (15.7%). Forty-five patients had severe flexion deficits with a median preoperative flexion of 70°. Intraoperative flexion significantly improved to 110°. Significant loss of flexion was observed at 3 and 6 months, however, patients regained ROM in the 9 and 12-month follow-ups. At discharge, 80% of the patients achieved flexion of 90° or more. There were 4 intraoperative complications and 3 reinterventions were performed.

Conclusion: AFA + MUA can help patients with severe post-traumatic knee arthrofibrosis to recover ROM in most cases. However, this procedure is not without risks and complications, therefore, careful consideration should be given to its indication and execution.

Background and study aims: Most foot surgeons recognize the difficulties to define each patient's hallux valgus (HV) deformity and to select the most appropriate surgical treatment to achieve the best long term outcome. The goal of this study was to analyze radiologic outcomes after distal chevron metatarsal osteotomy and to identify specific preoperative radiological parameters correlating with radiological recurrence. Methods and methods: One hundred twenty patients (134 feet) in patients with symptomatic moderate or severe HV deformity who underwent distal chevron metatarsal osteotomy at our hospital between 2014 and 2019 were included in the present study. Each patient was evaluated preoperatively, postoperatively and at final follow-up by means of radiographs lateral and dorsoplantar views. We examined fourteen radiographic measurements. Data were collected retrospectively.

Results: The mean follow-up time was 23.65 months (range 6-69.4 months). The recurrence rate was 76.1%. Radiologic HV recurrence was defined by a final hallux valgus angle (HVA) equal or greater than 20 degrees.

Conclusions: Greater age at time of surgical treatment and preoperative noncongruent I metatarsophalangeal joint were identified as predictors for HV recurrence.

Level of evidence: Level IV.

Introduction: The increase in life expectancy and the aging population have led to a higher incidence of hip fractures, especially in women over 60 years old. This study analyzes the influence of a multidisciplinary team with the collaboration of a specialist in internal medicine (IM) with the trauma department on mortality, perioperative complications and hospital stay in patients with hip fractures.

Material y methods: An analytical observational study of historical cohorts was conducted in patients over 65 years admitted for hip fracture and treated with arthroplasty or intramedullary nailing. Two cohorts were established: one before and one after the IM assignment. Patients with metabolic bone diseases different from osteoporosis and those who were operated in other centers were excluded. The minimum follow-up was 12 months.

Results: A total of 190 patients (50 men, 140 women) were included, with a mean age of 82.0 years and a BMI of 27.5. Mortality, which was the main objective of our study, during the first 12 months was higher in the non-IM (27.1 vs. 13.5%; P=.035). In addition, we included systemic complications and hospital stay as secondary objectives. Systemic complications were also higher in the non-IM cohort (43.2 vs. 27.1%; P=.031). Overall hospital stay was shorter in the IM cohort (7.3 vs. 9.9 days; P=.001). "Preoperative stays shorter than 72 hours" were more frequent in the IM group (53.0 vs. 33.2%; P=.009).

Conclusions: Multidisciplinary collaboration with a specialist in internal medicine significantly reduces first-year mortality, systemic complications, and hospital stay in hip fracture patients, allowing earlier interventions and hospital discharge.

Background and objectives: Total hip arthroplasty (THA) is an effective surgery for treating hip osteoarthritis, but access is limited in Sub-Saharan Africa due to multiple challenges. This article describes the implementation of a THA program at Monkole Hospital in the Democratic Republic of Congo, focusing on the technical challenges and surgical complications. The objective is to share our experience to assist other professionals and organizations in similar settings.

Materials and methods: Eight THA surgery campaigns were conducted between July 2019 and February 2023. Most patients presented with femoral head necrosis secondary to sickle cell anemia. Demographic and surgical data, technical difficulties, and complications were prospectively collected, and follow-up was conducted by a local orthopedic surgeon.

Results: Seventy-three surgeries were performed on 63 patients with a mean age of 34 years and an average follow-up of 24 months. Seventeen intraoperative technical incidents (23.2%) were observed. The postoperative complication rate was 9.5%, and three patients required revision surgery due to complications.

Conclusions: The THA program at Monkole Hospital demonstrates that it is feasible to perform complex surgeries in developing countries and that it is a cost-effective procedure that improves patients' quality of life, provided there are adequate hospital infrastructures, team training, availability of implants, and ensured proper care and follow-up. Training local surgeons and investing in resources are key to the sustainability of the program and the improvement of surgical care.

Introduction and objective: Hip arthroplasty represents a significant advancement in the treatment of refractory chronic joint pain, improving quality of life and functionality. The objective of this study is to identify the risk factors associated with local and systemic complications in patients treated with total hip arthroplasty.

Methods: Observational, analytical, retrospective cohort study, which included 304 participants treated with total hip replacement. Comparison of variables between two groups was performed; 38 participants in the group with complications and 266 participants in the group without complications.

Results: The mean age in the complication group was 66 years (SD 18.7) and in the uncomplicated group it was 67,1 years (SD 15.1) (p 0,686). Female sex was observed in 73.3% of the group with complications and 65% in the group without complications. (p 0.292). Risk factors were: hip fracture as an indication for arthroplasty RR 1.33 [95% CI 1.004;1.775 p 0.047], coronary heart disease RR 1.31 [95% CI 1.067;1.616 p 0.010] and surgical bleeding equal to or greater than 400 cc RR 1.11 [95% CI 1.012;1.218 p 0.028].

Conclusions: The risk factors for complications in total hip arthroplasty were: hip fracture as the indication for arthroplasty, coronary artery disease, and surgical bleeding equal to or greater than 400 cc.