Revista Espanola de Cirugia Ortopedica y Traumatologia最新文献

Objective: The objective of this study is to compare the outcomes of using the Femoral Neck System (FNS) (DePuy Synthes®) versus the use of cannulated screws (CS) in the surgical treatment of non-displaced subcapital hip fractures.

Materials and methods: A retrospective cohort study was conducted on non-displaced subcapital hip fractures treated with CS or FNS between 2020 and 2023, with a minimum follow-up of one year. A total of 28 patients were included, 14 treated with CS and 14 with FNS. Demographic, radiological, clinical, and functional variables were analyzed.

Results: In the CS group, 64% were male, with a mean age of 66.5 years (SD 14.9) and an average follow-up of 22 months (range, 12-36 months). In the FNS group, 57% were male, with a median age of 60.8 years (SD 13.78) and an average follow-up of 16 months (range, 12-24 months). Regarding functional outcomes, no significant differences were found between FNS and CS in the Harris scale: 94.21±11.55 for FNS and 96.50±6.9 for CS (p=0.618). The total postoperative complications (FNS/CS) were 7.1% versus 43%, and implant failure with conversion to total hip replacement was 0% versus 43%, both significantly higher in the CS group (p=0.047; p=0.016, respectively). The FNS also presented a lower rate of avascular necrosis (0% versus 11.1%, p=0.391) and nonunion (0% versus 20%, p=0.163), although these differences did not reach statistical significance.

Conclusions: Although both treatment methods, cannulated screws and the FNS, showed similar short-term functional outcomes in the management of undisplaced subcapital femoral fractures, the FNS demonstrated a significantly lower rate of complications and reoperations. These results suggest that the FNS could be considered a safer and more effective option compared to cannulated screws.

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 CCN 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.

Background and objective: Correct mechanical limb alignment is crucial in Total Knee Arthroplasty (TKA) and is particularly difficult to achieve when the knee osteoarthritis (KOA) is associated with an Extra-Articular Deformity (EAD). Our objective is to present a surgical option in cases of severe knee arthritis associated with an EAD (indications, mechanical planning and surgical technique), pros and cons and discuss the results with this one-stage technique.

Material and methods: We retrospectively reviewed all cases of severe KOA associated with EAD treated surgically in our institution from 2010-2016. In our study, we only included cases treated via simultaneous TKA and corrective osteotomy (CO) and with a minimum follow-up period of three years. In terms of imaging, we determined the apex and angulation of the EAD as well as the modification of the mechanical parameters post-treatment. The pre- and postoperative clinical assessment was performed using the Knee Society Score (KSS).

Results: Ten patients (10 knees) underwent combined surgery (simultaneous TKA and CO). The mean age was 67.7 years and the mean follow-up period was 49.2 months. The mechanical parameters were consistently corrected in the post-operative period. The mechanical axis deviation (MAD) shifted from a mean value of 6.9cm to 0.45cm and the joint line was rendered horizontal in all cases. In none of the cases did the bone resection affect the insertion of the colateral ligaments. The mean KSS value improved from 32.3 points preoperatively to 79.4 postoperatively. There were no major complications, but there were two planning errors that did not impact upon the end result.

Conclusions: In severe associated KOA and EAD, the combined surgical treatment proposed achieves in one stage an effective anatomical and mechanical correction which is crucial to optimise clinical results and implant durability. The surgery is complex and requires careful planning.

The lateral antebrachial cutaneous nerve (LACN) is the sensory branch of the musculocutaneous nerve and usually innervates the lateral aspect of the forearm. Isolated lesions are rare, of varied etiology and generally underdiagnosed. We present a retrospective descriptive study of electromyography performed at the General University Hospital of Castellón in the last 20 years with isolated NCAL lesion. We identified 11 cases (8 men and 3 women), average age 44 years (15-73 years). 73% were referred from traumatology. Only one patient was correctly guided in the application. 63.6% of cases noted hypoesthesia extending to the wrist and 18.2% to the thumb. The electromyographic study showed severe axonal involvement in 3 patients and moderate in 8. The symptoms were observed associated with surgery in 4 patients, manipulation of the elbow flexure in 4 cases and bicipital tendonitis in the rest. Four patients had a poor clinical outcome (3 with severe axonal involvement and 1 with moderate involvement). Isolated involvement of the NCAL is a rare and underdiagnosed alteration. It is important to suspect it in patients with hypoesthesia in the forearm, including the radial edge of the wrist or thumb, especially if it is associated with manipulations around the elbow flexure or bicipital tendonitis. Electromyography is useful in confirming the diagnosis, ruling out other differential diagnoses, and predicting prognosis. Knowing the location of this nerve during manipulations on the arm and placing patients in an appropriate posture during surgeries can help minimize cases.

Background: Given the boom in sports in school age, its intensity and the increase in sports in females, we are experiencing a boom in sports injuries characteristic of "adults" in growing patients, the anterior cruciate ligament being an injury with possible serious consequences.

Methods: To show the surgical technique "without bone tunnels" by Micheli-Kocher in anterior cruciate ligament reconstruction in growing patients based on our results in 20 patients.

Results: Since 2017 we have performed the technique "without bone tunnels" by Micheli-Kocher in 30 patients, 20 of whom have been followed up for more than 2 years. In our study, we have observed a return to previous sports activity in more than 90% of the patients, with only one patient undergoing reoperation due to a new rupture of the plasty. The results on the IKDC scales show an improvement in mean score from 42 points preoperatively to 84 postoperatively and on the Lysholm scale from 48 preoperatively to 94 postoperatively.

Conclusions: The technique "without bone tunnels" by Micheli-Kocher is a technique indicated in patients under 12 years of age and Tanner stage 2 or less. It is a technique of moderate complexity with excellent results in recovery from previous sports activity and knee stability.

Objective: To determine if subchondral bone damage can influence the clinical results of intraarticular platelet-rich-plasma (PRP) treatment in knee osteoarthritic patients.

Material and methods: A retrospective review of patients treated with intraarticular PRP injections for knee osteoarthritis who previously underwent a Magnetic Resonance (MR) of the knee was performed. Visual Analogic Score (VAS) was assesed for pain, whereas WORMS MR score was adapted to assess the damage to the subchondral bone (WORMSsc score).

Results: Sixty-one patients were treated with 3 weekly injections of PRP. Mean VAS reduction was 27.67±13.13 points (P<.005). WORMS sc mean score was 32±18.5 points. NO correlation between WORMSsc and VAS was found. A moderate correlation between WORMSsc score and Preoperative VAS was found (r=.43; P<.005).

Conclusion: There is no correlation between the damage to the subchondral bone assesed by MR and pain relief at 12 weeks in patients treated with intraarticular platelet-rich plasma in patients with knee osteoarthritis. A greater damage to the subchondral bone could be associated with more pain.