Revista Espanola de Cirugia Ortopedica y Traumatologia最新文献

{"title":"[Translated article] Fixation of adult femoral neck fractures: Retrospective comparison between cannulated screws and femoral neck system (FNS)","authors":"E. Guillén Botaya,&nbsp;Á. Soler García,&nbsp;J.L. Aparicio Martínez,&nbsp;A. Tejeda Gómez,&nbsp;F. Segura Llopis,&nbsp;A. Silvestre Muñoz","doi":"10.1016/j.recot.2025.04.010","DOIUrl":"10.1016/j.recot.2025.04.010","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Method</h3><div>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 analysed. 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.</div></div><div><h3>Results</h3><div>No significant differences were found in age (<em>p</em>-value 0.32), fracture patterns (<em>p</em>-value 0.77), surgical delay (<em>p</em>-value 0.28), surgical time (<em>p</em>-value 0.226), length of hospital stay (<em>p</em>-value 0.921) and blood loss (<em>p</em>-value 0.086) between the two groups.</div><div>A significantly higher overall complication rate was observed in the group treated with cannulated screws (<em>p</em>-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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":"69 4","pages":"Pages T385-T391"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144549787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Translated article] Do octogenarian patients undergoing total knee replacement return to physical activity?","authors":"J. Teves,&nbsp;F. Holc,&nbsp;A. García-Mansilla,&nbsp;S. Vildoza,&nbsp;R. Brandariz,&nbsp;L. Carbó,&nbsp;J. Costantini","doi":"10.1016/j.recot.2025.04.003","DOIUrl":"10.1016/j.recot.2025.04.003","url":null,"abstract":"<div><h3>Background and objectives</h3><div>It has been shown that total knee replacement improves functional capacity and physical activity; however, the influence of age remains unclear. The objective is evaluate the pre and postoperative physical activity measured with the Knee Society Score (KSS) score and the Tegner score.</div></div><div><h3>Materials and methods</h3><div>A retrospective cohort analysis was conducted on patients who underwent total knee replacement (TKR) between January 2016 and December 2019 at our institution. Demographic variables (age, sex, and body mass index), activities of daily living, age-adjusted Charlson Comorbidity Index, American Society of Anesthesiologists score, the Knee Society Score (KSS) in its clinical (KSSc) and functional (KSSf) subscales, the Tegner functional scale, activity variables from the 2011 KSS version, and pain assessment using the visual analogue scale were collected. Differences in these variables were analysed between two age groups: group A (between 65 and 79 years old) and group B (80 years or older).</div></div><div><h3>Results</h3><div>A total of 450 patients were evaluated (group A<!--> <!-->=<!--> <!-->245, group B<!--> <!-->=<!--> <!-->167). Group A showed a Tegner improvement of 1.19 (95% CI: 1.06–1.31), whereas group B averaged 0.61 (95% CI: 0.43–0.80) (<em>p</em> <!-->&lt;<!--> <!-->.001). Age<!--> <!-->&gt;<!--> <!-->80 was an independent risk factor for less Tegner improvement. In KSSc, group A improved by 43 points (95% CI: 40.82–46.14), while group B showed a greater increase of 53 points (95% CI: 49.74–57.80). Adjusted for confounders, those &gt;80 showed significantly higher KSSc improvement (12.8 points). For KSSf, group A improved by 33.91 points (95% CI: 31.07–36.75), and group B by 15.57 points (95% CI: 11.78–19.35). Adjusted for confounders, patients &gt;80 had less improvement than those &lt;80 (19 points).</div></div><div><h3>Conclusions</h3><div>Patients who underwent TKR experienced improvements in physical and functional activity parameters. While these improvements were seen in the entire population, they were most notable in patients younger than 80 years.</div></div>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":"69 4","pages":"Pages T323-T329"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144549788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Artículo traducido] Técnica «sin túneles óseos» (Micheli-Kocher) en la reconstrucción del ligamento cruzado anterior en pacientes en edad de crecimiento. Técnica quirúrgica y nuestra experiencia con 19 casos","authors":"J.J. Lopez Martínez ,&nbsp;J.M. Rodríguez-Roiz ,&nbsp;C. Salcedo Cánovas ,&nbsp;J.P. García Paños ,&nbsp;S. Toledo García","doi":"10.1016/j.recot.2025.04.005","DOIUrl":"10.1016/j.recot.2025.04.005","url":null,"abstract":"<div><h3>Background</h3><div>Given the rise 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.</div></div><div><h3>Methods</h3><div>To show the surgical technique “without bone tunnels” by Micheli-Kocher in anterior cruciate ligament reconstruction in growing patients based on our results.</div></div><div><h3>Results</h3><div>Since 2017 we have performed the technique “without bone tunnels” by Micheli-Kocher in 30 patients, 19 of whom have been followed up for more than 2 years. In ourstudy, 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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":"69 4","pages":"Pages T347-T354"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144549834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Translated article] Madrid hosts the 45th SICOT Orthopaedic World Congress","authors":"A. Combalia ,&nbsp;P. Hernigou ,&nbsp;L. López-Duran Stern ,&nbsp;M. Scarlat","doi":"10.1016/j.recot.2025.04.013","DOIUrl":"10.1016/j.recot.2025.04.013","url":null,"abstract":"","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":"69 4","pages":"Pages T319-T322"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144550000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artrosis de rodilla asociada a deformidad extraarticular tratada mediante prótesis total de rodilla y osteotomía correctora de forma simultánea","authors":"L. Arbeloa-Gutierrez ,&nbsp;A. Arenas-Miquelez ,&nbsp;J. de Pablos","doi":"10.1016/j.recot.2024.09.006","DOIUrl":"10.1016/j.recot.2024.09.006","url":null,"abstract":"<div><h3>Background and objective</h3><div>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.</div></div><div><h3>Material and methods</h3><div>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).</div></div><div><h3>Results</h3><div>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 6.9<!--> <!-->cm to 0.45<!--> <!-->cm 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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":"69 4","pages":"Pages 355-364"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Translated article] Ramón y Cajal and the cartilaginous growth plate","authors":"M.J. Delgado-Martos ,&nbsp;B. Quintana-Villamandos ,&nbsp;E. Delgado-Baeza","doi":"10.1016/j.recot.2025.05.002","DOIUrl":"10.1016/j.recot.2025.05.002","url":null,"abstract":"<div><div>Santiago Ramón y Cajal (1852–1934), a distinguished histologist and Nobel Laureate in Physiology or Medicine in 1906, is considered the father of Neuroscience. However, his legacy also extended to the study of various tissues, including hyaline cartilage, an area in which he was a pioneer. Throughout his work <em>Elements of Normal Histology and Micrographic Technique</em>, Cajal developed fundamental concepts that, when reviewed in light of molecular biology, resonate with current ideas about cellular communication and macromolecular interactions. In particular, his observations on hyaline cartilage, such as stellate chondrocytes, were largely overlooked in the scientific literature until today. In this paper, four hypotheses based on his discoveries are proposed: the architecture of chondrocyte columns, the role of the perichondrium in endochondral ossification, cartilage nutrition, and the role of the Golgi apparatus in the resting zone. Nearly a century later, research on hyaline cartilage continues to confirm Cajal's pioneering ideas.</div></div>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":"69 4","pages":"Pages T402-T410"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144549847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Translated article] Knee osteoarthritis associated with extra-articular deformity treated by total knee arthroplasty plus simultaneous corrective osteotomy","authors":"L. Arbeloa-Gutierrez ,&nbsp;A. Arenas-Miquelez ,&nbsp;J. de Pablos","doi":"10.1016/j.recot.2025.04.006","DOIUrl":"10.1016/j.recot.2025.04.006","url":null,"abstract":"<div><h3>Background and objective</h3><div>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.</div></div><div><h3>Material and methods</h3><div>We retrospectively reviewed all cases of severe KOA associated with EAD treated surgically in our institution from 2010 to 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).</div></div><div><h3>Results</h3><div>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 6.9<!--> <!-->cm to 0.45<!--> <!-->cm and the joint line was rendered horizontal in all cases. In none of the cases did the bone resection affect the insertion of the collateral 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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":"69 4","pages":"Pages T355-T364"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144549835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Translated article] Isolated repair shows higher postoperative patellar height according to the Insall–Salvati index compared to biological augmentation in acute patellar tendon ruptures","authors":"R. Olivieri ,&nbsp;J.T. Muñoz ,&nbsp;J.I. Laso ,&nbsp;J. Ugarte ,&nbsp;N. Franulic ,&nbsp;P. Innocenti","doi":"10.1016/j.recot.2025.04.008","DOIUrl":"10.1016/j.recot.2025.04.008","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background and objective&lt;/h3&gt;&lt;div&gt;Patellar tendon ruptures (PTR) are rare but highly disabling injuries. Surgical treatment is the standard approach. Postoperative patellar height (PH) is used to determine the success of the intervention, with various indices described in the literature. The objective of the study was to determine if there are differences in PH according to the Insall–Salvati index in the immediate postoperative period and at 4 months, between two groups of patients operated on for acute PTR: The first group underwent isolated repair techniques (IR) and the second group had biological augmentation with autograft or allograft added to the repair (BAR). Our hypothesis was that the BAR group would have lower PH in the immediate postoperative period and at 4 months.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and methods&lt;/h3&gt;&lt;div&gt;All patients with acute PTR treated at our centre between 2016 and 2022 were reviewed retrospectively. Patients with re-rupture of the operated tendon and those with non-biological augmentation were excluded. PH according to the Insall–Salvati index was measured in radiographs taken the day after surgery and at 4 months postoperatively by three orthopaedic surgeons with a subspecialty in knee surgery, independently. A fourth blind evaluator analysed the measurement results, determining the average PH and the intraclass correlation coefficient for absolute agreement among the three evaluators. The primary outcome was the difference in PH between both groups the day after surgery and at 4 months. The secondary outcome was the difference in PH between the immediate postoperative measurement and at 4 months in both groups.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;This was a retrospective observational study. Thirty-one operated knees were included. IR was performed on 15 knees (48.38%), and biological augmentation was added in 16. The intraclass correlation coefficient between observer 1 and 2 was 0.88; between 2 and 3 it was 0.89; and between observers 1 and 3 it was 0.92, showing at least substantial agreement among observers. The average Insall–Salvati index the day after surgery and at 4 months was 1.15 and 1.21 for the IR group, and 0.97 and 1.07 for the BAR group, respectively. A statistically significant difference in the Insall–Salvati index was found between the two groups, both in the measurement taken the day after surgery (&lt;em&gt;p&lt;/em&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;0.0001) and at 4 months (&lt;em&gt;p&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.0002). Additionally, significant differences were observed indicating an increase in average PH when comparing the immediate postoperative measurement and at 4 months in each study group (for IR &lt;em&gt;p&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.0016 and for BAR &lt;em&gt;p&lt;/em&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;0.0001).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;The Insall–Salvati index was significantly lower in BAR cases both the day after surgery and at 4 months postoperatively. Additionally, a significant increase in PH was observed at 4 month","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":"69 4","pages":"Pages T372-T379"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144549837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Artículo traducido] ¿Es la descompresión endoscópica del neuroma de Morton una técnica segura?","authors":"L. López-Capdevila ,&nbsp;M. Ballester ,&nbsp;G. Lucar ,&nbsp;T. Mota-Gomes ,&nbsp;M. Fa-Binefa ,&nbsp;S. López-Hervás","doi":"10.1016/j.recot.2025.04.009","DOIUrl":"10.1016/j.recot.2025.04.009","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Materials and methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>Endoscopic dorsal decompression of Morton's neuroma presents as an accessible minimally invasive surgical option with low risk of collateral associated injuries.</div></div>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":"69 4","pages":"Pages T380-T384"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144549786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Artículo traducido] El índice de comorbilidad de Charlson ajustado por la edad en las fracturas acetabulares de los pacientes ancianos","authors":"J.M. Bogallo ,&nbsp;C. Castillejo ,&nbsp;A. Ramirez ,&nbsp;J.R. Cano ,&nbsp;F. Rivas-Ruiz ,&nbsp;E. Guerado","doi":"10.1016/j.recot.2025.04.011","DOIUrl":"10.1016/j.recot.2025.04.011","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>Design retrospective cohort study.</div></div><div><h3>Setting</h3><div>Single Level 2 Trauma Center.</div></div><div><h3>Patient selection criteria</h3><div>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.</div></div><div><h3>Outcome measures and comparisons</h3><div>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.</div></div><div><h3>Results</h3><div>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; <em>P</em>=.015) and mortality (OR: 1.32; 95% CI: 1.04-1.67; <em>P</em>=.025) and between CFS and complications (OR: 2.01; 95% CI: 1.30.3.11; <em>P</em>=.001) and mortality (OR: 1.59; 95% CI: 1.08.2.35; <em>P</em>=.019). No statistical correlation was established between ASA and complications or mortality.</div></div><div><h3>Conclusion</h3><div>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 &gt;4 (mild frailty) and mortality and complications at one year.</div></div>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":"69 4","pages":"Pages T392-T401"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144549930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}