Pub Date : 2025-06-12DOI: 10.1016/j.recot.2025.06.007
V. Jiménez-Díaz , L. García-Lamas , I. Auñón-Martín , V. Rodríguez-Vega , D. Cecilia-López
Main
To describe our experience treating dorsal radiocarpal fracture dislocations, regarding long-term clinical and radiological outcomes.
Material and method
Retrospective chart review of 15 patients treated in our institution from 2007 to 2021. Inclusion criteria were patients over 16 years, treated at a third level hospital of Madrid and an average follow-up of 56 months. Epidemiological data were collected from digital records. VAS, QuickDASH and Patient-Rated Wrist Evaluation (PRWE) scales were employed for clinical results assessment. All radiological studies were reviewed for radiological results assessment. A descriptive statistical analysis of all variables was developed.
Results
Among 15 patients with a mean follow-up of 56 months: 12 males (80%) and 3 females (20%) with a mean age of 39.5 years. The left wrist was injured in most cases (66.7%). All patients were treated surgically; 4 of them (27%) were assisted by wrist arthroscopy. Mean VAS at final follow-up was 2.6 with activity. Mean PRWE was 32 and mean QuickDASH was 28, which means satisfactory results. Eighty percent of patients developed wrist stiffness with most affected flexo-extension followed by prono-supination. Sixty-seven percent of patients developed radiological signs of wrist osteoarthritis at the end of follow-up.
Conclusions
In spite of a large number of clinical and radiological complications during follow-up, long-term functional results are good in this kind of wrist injuries.
{"title":"[Translated article] Treatment of dorsal radiocarpal fracture dislocation: Clinical and radiological long-term outcomes","authors":"V. Jiménez-Díaz , L. García-Lamas , I. Auñón-Martín , V. Rodríguez-Vega , D. Cecilia-López","doi":"10.1016/j.recot.2025.06.007","DOIUrl":"10.1016/j.recot.2025.06.007","url":null,"abstract":"<div><h3>Main</h3><div>To describe our experience treating dorsal radiocarpal fracture dislocations, regarding long-term clinical and radiological outcomes.</div></div><div><h3>Material and method</h3><div>Retrospective chart review of 15 patients treated in our institution from 2007 to 2021. Inclusion criteria were patients over 16 years, treated at a third level hospital of Madrid and an average follow-up of 56 months. Epidemiological data were collected from digital records. VAS, QuickDASH and Patient-Rated Wrist Evaluation (PRWE) scales were employed for clinical results assessment. All radiological studies were reviewed for radiological results assessment. A descriptive statistical analysis of all variables was developed.</div></div><div><h3>Results</h3><div>Among 15 patients with a mean follow-up of 56 months: 12 males (80%) and 3 females (20%) with a mean age of 39.5 years. The left wrist was injured in most cases (66.7%). All patients were treated surgically; 4 of them (27%) were assisted by wrist arthroscopy. Mean VAS at final follow-up was 2.6 with activity. Mean PRWE was 32 and mean QuickDASH was 28, which means satisfactory results. Eighty percent of patients developed wrist stiffness with most affected flexo-extension followed by prono-supination. Sixty-seven percent of patients developed radiological signs of wrist osteoarthritis at the end of follow-up.</div></div><div><h3>Conclusions</h3><div>In spite of a large number of clinical and radiological complications during follow-up, long-term functional results are good in this kind of wrist injuries.</div></div>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":"69 5","pages":"Pages T429-T438"},"PeriodicalIF":0.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144891028","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}
Pub Date : 2025-06-12DOI: 10.1016/j.recot.2025.06.009
C.M. Posada , R. D’Amato , M. Galán-Olleros , C. Miranda-Gorozarri , Á. Palazón-Quevedo , J. Alonso-Hernández
Introduction
Telescopic intramedullary nails (TIMN) have represented a significant advancement in limb lengthening procedures. However, their elongation capacity is limited to 5 cm in the bones of patients with achondroplasia. Consequently, techniques involving TIMN reutilization have been developed. This reuse presents mechanical and safety challenges due to material fatigue and repetitive loading, which may compromise the structural integrity of the implant. This study evaluates the biomechanical performance and potential damage of a reused TIMN.
Methods
An experimental analysis was conducted on a femoral TIMN removed after two 5-cm lengthenings in a patient with achondroplasia. The nail was measured and examined following non-destructive deconstruction, material analysis, 3D reverse engineering modeling, and finite element analysis to assess its performance under various loading conditions.
Results
Mechanical and chemical damage compromising the integrity of the nail was identified. The aged Ti6Al4V alloy was validated for its resistance to complex loads. The 3D model showed that the gear mechanism effectively transformed rotational into translational motion. Finite element analysis revealed that the safety factor reached its critical threshold at 2.44̊ and 2.25̊, indicating the nail was near its mechanical limit. The rod and guide were identified as critical components.
Conclusions
TIMN reuse should be approached with caution due to potential material fatigue. This study provides a foundation for redesigning these implants to improve their ability to withstand prolonged loading cycles.
{"title":"[Translated article] Biomechanical evaluation and analysis of a reused telescopic intramedullary femoral nail in a child with achondroplasia","authors":"C.M. Posada , R. D’Amato , M. Galán-Olleros , C. Miranda-Gorozarri , Á. Palazón-Quevedo , J. Alonso-Hernández","doi":"10.1016/j.recot.2025.06.009","DOIUrl":"10.1016/j.recot.2025.06.009","url":null,"abstract":"<div><h3>Introduction</h3><div>Telescopic intramedullary nails (TIMN) have represented a significant advancement in limb lengthening procedures. However, their elongation capacity is limited to 5<!--> <!-->cm in the bones of patients with achondroplasia. Consequently, techniques involving TIMN reutilization have been developed. This reuse presents mechanical and safety challenges due to material fatigue and repetitive loading, which may compromise the structural integrity of the implant. This study evaluates the biomechanical performance and potential damage of a reused TIMN.</div></div><div><h3>Methods</h3><div>An experimental analysis was conducted on a femoral TIMN removed after two 5-cm lengthenings in a patient with achondroplasia. The nail was measured and examined following non-destructive deconstruction, material analysis, 3D reverse engineering modeling, and finite element analysis to assess its performance under various loading conditions.</div></div><div><h3>Results</h3><div>Mechanical and chemical damage compromising the integrity of the nail was identified. The aged Ti6Al4V alloy was validated for its resistance to complex loads. The 3D model showed that the gear mechanism effectively transformed rotational into translational motion. Finite element analysis revealed that the safety factor reached its critical threshold at 2.44̊ and 2.25̊, indicating the nail was near its mechanical limit. The rod and guide were identified as critical components.</div></div><div><h3>Conclusions</h3><div>TIMN reuse should be approached with caution due to potential material fatigue. This study provides a foundation for redesigning these implants to improve their ability to withstand prolonged loading cycles.</div></div>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":"69 5","pages":"Pages T523-T531"},"PeriodicalIF":0.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144890965","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}
Pub Date : 2025-06-12DOI: 10.1016/j.recot.2025.06.011
S.M. Miguela Alvarez, A. Bartra, M. Novellas, M. Surroca, F. Anglès
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.
{"title":"[Translated article] Evolution of the rapid recovery program to outpatient surgery in total hip arthroplasty","authors":"S.M. Miguela Alvarez, A. Bartra, M. Novellas, M. Surroca, F. Anglès","doi":"10.1016/j.recot.2025.06.011","DOIUrl":"10.1016/j.recot.2025.06.011","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Material and method</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":"69 5","pages":"Pages T504-T511"},"PeriodicalIF":0.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144890997","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}
Pub Date : 2025-06-09DOI: 10.1016/j.recot.2025.06.002
J.F. Garrido Ferrer, J. Diranzo García, X. Bertó Martí, L. Marco Díaz, L. Hernández Ferrando
Introduction
The aim of this study was to describe and analyze the musculoskeletal injuries treated at a tertiary hospital, resulting from the sudden flooding and landslides that occurred on October 29, 2024, in the province of Valencia, Spain.
Materials and methods
A retrospective, single-center study design was employed, documenting all patients who required hospital treatment from October 29, 2024, to November 30, 2024, inclusive. Data collected included the date of treatment, delay time until rescue and evacuation, demographic information, injury location and severity, records of surgeries performed and required hospitalization time.
Results
A total of 410 hospital admissions were recorded, all of which were through the emergency department. A slight male predominance was observed (55.5%), with an average age of 48 years (range 1–97). The mean time to treatment was 1.4 days from the trauma (range 1–12), although 47% of cases exceeded 48 h. 60.1% of contusions presented with at least one associated fracture. A total of 84 wounds (20.5% of the sample) and musculoskeletal and ligament injuries (14.4%) were treated, along with joint dislocations (2.4%). The most common injury sites were the lower limbs (48.6%), followed by the upper limbs (36.7%). The majority of cases (90.5%) were managed with conservative treatment, with 9.5% requiring surgical revision. During this period, 53 hospital admissions (1.76 admissions/day) and 38 urgent surgeries were performed.
Conclusion
The flooding caused by the Valencia flood in October 2024 is considered one of the most severe environmental disasters in the history of Spain. Natural disasters affecting multiple victims demand effective and coordinated medical attention across all healthcare levels. Continuous learning for trauma specialists will provide the necessary tools for appropriate knowledge and management of such potentially severe injuries.
Level of evidence: IV. Retrospective descriptive and analytical study. Case series.
{"title":"[Translated article] Musculoskeletal injuries treated following the flood in October 2024 in Valencia, Spain","authors":"J.F. Garrido Ferrer, J. Diranzo García, X. Bertó Martí, L. Marco Díaz, L. Hernández Ferrando","doi":"10.1016/j.recot.2025.06.002","DOIUrl":"10.1016/j.recot.2025.06.002","url":null,"abstract":"<div><h3>Introduction</h3><div>The aim of this study was to describe and analyze the musculoskeletal injuries treated at a tertiary hospital, resulting from the sudden flooding and landslides that occurred on October 29, 2024, in the province of Valencia, Spain.</div></div><div><h3>Materials and methods</h3><div>A retrospective, single-center study design was employed, documenting all patients who required hospital treatment from October 29, 2024, to November 30, 2024, inclusive. Data collected included the date of treatment, delay time until rescue and evacuation, demographic information, injury location and severity, records of surgeries performed and required hospitalization time.</div></div><div><h3>Results</h3><div>A total of 410 hospital admissions were recorded, all of which were through the emergency department. A slight male predominance was observed (55.5%), with an average age of 48 years (range 1–97). The mean time to treatment was 1.4 days from the trauma (range 1–12), although 47% of cases exceeded 48<!--> <!-->h. 60.1% of contusions presented with at least one associated fracture. A total of 84 wounds (20.5% of the sample) and musculoskeletal and ligament injuries (14.4%) were treated, along with joint dislocations (2.4%). The most common injury sites were the lower limbs (48.6%), followed by the upper limbs (36.7%). The majority of cases (90.5%) were managed with conservative treatment, with 9.5% requiring surgical revision. During this period, 53 hospital admissions (1.76 admissions/day) and 38 urgent surgeries were performed.</div></div><div><h3>Conclusion</h3><div>The flooding caused by the Valencia flood in October 2024 is considered one of the most severe environmental disasters in the history of Spain. Natural disasters affecting multiple victims demand effective and coordinated medical attention across all healthcare levels. Continuous learning for trauma specialists will provide the necessary tools for appropriate knowledge and management of such potentially severe injuries.</div><div><em>Level of evidence</em>: IV. Retrospective descriptive and analytical study. Case series.</div></div>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":"69 5","pages":"Pages T421-T428"},"PeriodicalIF":0.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144889541","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}
Pub Date : 2025-06-09DOI: 10.1016/j.recot.2025.06.003
O. Pujol , P. Hinarejos , A. Pons , E. Famada , A. Zumel , J. Erquicia , J. Leal-Blanquet
Introduction
The CPAK classification aims to categorize knee phenotypes. The original study was based on Australian and Belgian population, but significant variation in CPAK distribution exists between different geographic areas. The primary objective is to evaluate knee phenotypes of osteoarthritic Spanish population based on the CPAK system. The secondary objective is to compare the Spanish CPAK distribution with that observed in the original study to analyse if proposing modifications is necessary when applying the classification to our population. Finally, we aim to critically analyse the utility of this classification to plan individualized TKA.
Methods
It is a cross-sectional observational study analysing radiological datasets from 121 patients with knee osteoarthritis treated with a Mako assisted TKA in three Spanish institutions. The preoperative lower limb CT-scan was used to measure the MPTA and LDFA of each patient. Then, the aHKA (MPTA − LDFA) and JLO (MPTA + LDFA) were calculated to categorize patients into the nine CPAK phenotypes.
Results
The commonest knee phenotypes of osteoarthritic Spanish population were the distal apex JLO CPAK types (74%: II [28%], I [23%] and III [23%]). No patient presented a proximal apex type (VII, VIII and IX). The 30% of the patients had a varus alignment and 26% a valgus. No relevant differences were found between the Spanish CPAK distribution and that observed in the original study.
Conclusions
No modifications to the CPAK classification should be necessary for the Spanish population. The CPAK classification can be useful to describe and categorize osteoarthritic patients. However, relevant limitations have been found to the classification, questioning its utility to plan and guide individualized TKA surgery.
{"title":"[Artículo traducido] ¿Es útil la clasificación CPAK (Coronal Plane Alignment of the Knee) para planificar la cirugía individualizada de artroplastia total de rodilla en la población española? Un análisis crítico de la clasificación CPAK","authors":"O. Pujol , P. Hinarejos , A. Pons , E. Famada , A. Zumel , J. Erquicia , J. Leal-Blanquet","doi":"10.1016/j.recot.2025.06.003","DOIUrl":"10.1016/j.recot.2025.06.003","url":null,"abstract":"<div><h3>Introduction</h3><div>The CPAK classification aims to categorize knee phenotypes. The original study was based on Australian and Belgian population, but significant variation in CPAK distribution exists between different geographic areas. The primary objective is to evaluate knee phenotypes of osteoarthritic Spanish population based on the CPAK system. The secondary objective is to compare the Spanish CPAK distribution with that observed in the original study to analyse if proposing modifications is necessary when applying the classification to our population. Finally, we aim to critically analyse the utility of this classification to plan individualized TKA.</div></div><div><h3>Methods</h3><div>It is a cross-sectional observational study analysing radiological datasets from 121 patients with knee osteoarthritis treated with a Mako assisted TKA in three Spanish institutions. The preoperative lower limb CT-scan was used to measure the MPTA and LDFA of each patient. Then, the aHKA (MPTA<!--> <!-->−<!--> <!-->LDFA) and JLO (MPTA<!--> <!-->+<!--> <!-->LDFA) were calculated to categorize patients into the nine CPAK phenotypes.</div></div><div><h3>Results</h3><div>The commonest knee phenotypes of osteoarthritic Spanish population were the distal apex JLO CPAK types (74%: II [28%], I [23%] and III [23%]). No patient presented a proximal apex type (VII, VIII and IX). The 30% of the patients had a varus alignment and 26% a valgus. No relevant differences were found between the Spanish CPAK distribution and that observed in the original study.</div></div><div><h3>Conclusions</h3><div>No modifications to the CPAK classification should be necessary for the Spanish population. The CPAK classification can be useful to describe and categorize osteoarthritic patients. However, relevant limitations have been found to the classification, questioning its utility to plan and guide individualized TKA surgery.</div></div>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":"69 5","pages":"Pages T477-T483"},"PeriodicalIF":0.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144890985","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}
Pub Date : 2025-06-09DOI: 10.1016/j.recot.2025.06.004
Y. Hernanz-González , J.C. Martínez-Ávila , E. Sánchez-Morata , A. Gómez-Sánchez , J.D. Serrano-Alonso , J. Vilá-Rico
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.
Materials 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.
{"title":"[Artículo traducido] Parámetros radiológicos preoperatorios correlacionados con la recidiva del hallux valgus después de una osteotomía en chevron distal","authors":"Y. Hernanz-González , J.C. Martínez-Ávila , E. Sánchez-Morata , A. Gómez-Sánchez , J.D. Serrano-Alonso , J. Vilá-Rico","doi":"10.1016/j.recot.2025.06.004","DOIUrl":"10.1016/j.recot.2025.06.004","url":null,"abstract":"<div><h3>Background and study aims</h3><div>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.</div></div><div><h3>Materials and methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>Greater age at time of surgical treatment and preoperative noncongruent<!--> <!-->I metatarsophalangeal joint were identified as predictors for HV recurrence.</div></div>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":"69 5","pages":"Pages T461-T468"},"PeriodicalIF":0.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144889539","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}
Pub Date : 2025-06-09DOI: 10.1016/j.recot.2025.06.005
F. Moller-Macherone , M. Lobos-Urbina , I. Cañete-Campos , C. Vidal-Olate , F. Hodgson-Ovalle , P. Murati-Carrasco , M.A. Ibañez-León , M.J. Figueroa-Gatica
Purpose
Complications from cast removal are infrequent but can cause permanent skin sequelae. Formal training in cast removal is limited during residency. This study aimed to develop a plaster cast removal simulation model for resident training.
Methods
Quasiexperimental study. A pediatric forearm phantom with temperature sensors was designed to simulate forearm cast removal. Six first-year orthopedic residents with no prior cast removal experience and two experts were evaluated. The residents underwent an initial evaluation, followed by an instruction session, and a final evaluation. Performance was assessed using a specific ratings scale (SRS), the Objective Structured Assessment of Technical Skills (OSATS) guideline, procedure time, and temperature measurement. Median scores with ranges were reported, and pre- and posttraining performances were compared using the Wilcoxon test. Experts scores were compared with resident scores using the Mann-Whitney test. The statistical significance was set at P < .05.
Results
Significant improvements in OSATS [(pre 22 points (range: 20-24); posttraining 25 (range: 25-28) (P = .03)] and SRS [pre 8.5 points (range: 7-9); post 10 points (range: 8-10) (P = .02)] were observed. No differences were found in temperature (P = .50) and procedure time (P = .09). When comparing residents’ post-training scores with those of experts, no significant differences were found in OSATS (P = .16), SRS (P = .11), temperature measurement (P = .50), or procedure time (P = .09).
Conclusions
The plaster cast removal simulation model proved to be an effective training tool for residents, enabling them to achieve expert-level competency. Significant improvements were observed in OSATS and SRS scores post-training, highlighting the positive impact of the intervention on this skill.
{"title":"[Artículo traducido] Modelo de simulación de retirada de yesos para el entrenamiento de residentes","authors":"F. Moller-Macherone , M. Lobos-Urbina , I. Cañete-Campos , C. Vidal-Olate , F. Hodgson-Ovalle , P. Murati-Carrasco , M.A. Ibañez-León , M.J. Figueroa-Gatica","doi":"10.1016/j.recot.2025.06.005","DOIUrl":"10.1016/j.recot.2025.06.005","url":null,"abstract":"<div><h3>Purpose</h3><div>Complications from cast removal are infrequent but can cause permanent skin sequelae. Formal training in cast removal is limited during residency. This study aimed to develop a plaster cast removal simulation model for resident training.</div></div><div><h3>Methods</h3><div>Quasiexperimental study. A pediatric forearm phantom with temperature sensors was designed to simulate forearm cast removal. Six first-year orthopedic residents with no prior cast removal experience and two experts were evaluated. The residents underwent an initial evaluation, followed by an instruction session, and a final evaluation. Performance was assessed using a specific ratings scale (SRS), the Objective Structured Assessment of Technical Skills (OSATS) guideline, procedure time, and temperature measurement. Median scores with ranges were reported, and pre- and posttraining performances were compared using the Wilcoxon test. Experts scores were compared with resident scores using the Mann-Whitney test. The statistical significance was set at <em>P</em> <!--><<!--> <!-->.05.</div></div><div><h3>Results</h3><div>Significant improvements in OSATS [(pre 22 points (range: 20-24); posttraining 25 (range: 25-28) (<em>P</em> <!-->=<!--> <!-->.03)] and SRS [pre 8.5 points (range: 7-9); post 10 points (range: 8-10) (<em>P</em> <!-->=<!--> <!-->.02)] were observed. No differences were found in temperature (<em>P</em> <!-->=<!--> <!-->.50) and procedure time (<em>P</em> <!-->=<!--> <!-->.09). When comparing residents’ post-training scores with those of experts, no significant differences were found in OSATS (<em>P</em> <!-->=<!--> <!-->.16), SRS (<em>P</em> <!-->=<!--> <!-->.11), temperature measurement (<em>P</em> <!-->=<!--> <!-->.50), or procedure time (<em>P</em> <!-->=<!--> <!-->.09).</div></div><div><h3>Conclusions</h3><div>The plaster cast removal simulation model proved to be an effective training tool for residents, enabling them to achieve expert-level competency. Significant improvements were observed in OSATS and SRS scores post-training, highlighting the positive impact of the intervention on this skill.</div></div>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":"69 5","pages":"Pages T439-T445"},"PeriodicalIF":0.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144891029","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}
Pub Date : 2025-05-07DOI: 10.1016/j.recot.2025.04.017
R. Gonzalez-Pola , R.O. Tafoya-Olivos , L.A. Culebras-Almeida , G. Zermeño-Garcia , A. Herrera-Lozano
Objectives
To evaluate perioperative strategies for minimizing bleeding and transfusion needs in single-stage bilateral hip and knee arthroplasty. This systematic review identifies effective interventions and provides evidence-based recommendations and highlight areas for future research in optimizing bleeding management.
Methods
A systematic review of literature from January 2010 to October 2024 was conducted, focusing on randomized controlled trials (RCTs), meta-analyses, and guidelines. Databases searched included PubMed/MEDLINE, Embase, Cochrane Library, and Web of Science. Interventions assessed included tranexamic acid (TXA), surgical techniques, regional anesthesia, controlled hypotension, preoperative anemia correction, tourniquet use, bone wax, and restrictive transfusion strategies. Study selection, data extraction, and quality assessment followed PRISMA and Newcastle-Ottawa Scale guidelines.
Results
From 325 included studies, TXA consistently demonstrated the most significant impact, reducing transfusion rates by 40–60%. Anterior THA was associated with reduced blood loss. Regional anesthesia and controlled hypotension further minimized intraoperative bleeding. Preoperative anemia correction and restrictive transfusion thresholds also showed benefits. Tourniquet evidence was inconclusive. Limited evidence supported bone wax. GRADE assessment suggested high evidence quality for TXA and regional anesthesia, moderate for minimally invasive surgery, anemia correction, and restrictive transfusion, and low for bone wax.
Conclusions
Multimodal approach integrating TXA, regional anesthesia, minimally invasive surgery, anemia correction, and restrictive transfusion protocols effectively reduces bleeding and transfusion needs in bilateral arthroplasty. Incorporation into Enhance recovery after surgery (ERAS) protocols is recommended. Future research should refine TXA dosing, clarify tourniquet use, and assess cost-effectiveness.
目的探讨单期双侧髋关节和膝关节置换术中减少出血和输血需求的围手术期策略。本系统综述确定了有效的干预措施，提供了基于证据的建议，并强调了优化出血管理的未来研究领域。方法对2010年1月至2024年10月的文献进行系统回顾，主要包括随机对照试验（rct）、meta分析和指南。检索的数据库包括PubMed/MEDLINE、Embase、Cochrane Library和Web of Science。评估的干预措施包括氨甲环酸（TXA）、手术技术、区域麻醉、控制低血压、术前贫血矫正、止血带使用、骨蜡和限制性输血策略。研究选择、数据提取和质量评估遵循PRISMA和纽卡斯尔-渥太华量表指南。结果在325项纳入的研究中，TXA始终显示出最显著的影响，可将输血率降低40-60%。前路THA与出血量减少有关。区域麻醉和控制低血压进一步减少术中出血。术前贫血矫正和限制性输血阈值也显示出益处。止血带证据尚无定论。有限的证据支持骨蜡。GRADE评价表明，TXA和区域麻醉的证据质量高，微创手术、贫血矫正和限制性输血的证据质量中等，骨蜡的证据质量低。结论结合TXA、区域麻醉、微创手术、贫血矫正和限制性输血方案的多模式入路可有效减少双侧关节置换术的出血和输血需求。建议纳入增强术后恢复（ERAS）方案。未来的研究应完善TXA剂量，澄清止血带的使用，并评估成本效益。
{"title":"Minimizing bleeding and transfusion in single-stage bilateral hip and knee arthroplasty: A systematic review of current interventions","authors":"R. Gonzalez-Pola , R.O. Tafoya-Olivos , L.A. Culebras-Almeida , G. Zermeño-Garcia , A. Herrera-Lozano","doi":"10.1016/j.recot.2025.04.017","DOIUrl":"10.1016/j.recot.2025.04.017","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate perioperative strategies for minimizing bleeding and transfusion needs in single-stage bilateral hip and knee arthroplasty. This systematic review identifies effective interventions and provides evidence-based recommendations and highlight areas for future research in optimizing bleeding management.</div></div><div><h3>Methods</h3><div>A systematic review of literature from January 2010 to October 2024 was conducted, focusing on randomized controlled trials (RCTs), meta-analyses, and guidelines. Databases searched included PubMed/MEDLINE, Embase, Cochrane Library, and Web of Science. Interventions assessed included tranexamic acid (TXA), surgical techniques, regional anesthesia, controlled hypotension, preoperative anemia correction, tourniquet use, bone wax, and restrictive transfusion strategies. Study selection, data extraction, and quality assessment followed PRISMA and Newcastle-Ottawa Scale guidelines.</div></div><div><h3>Results</h3><div>From 325 included studies, TXA consistently demonstrated the most significant impact, reducing transfusion rates by 40–60%. Anterior THA was associated with reduced blood loss. Regional anesthesia and controlled hypotension further minimized intraoperative bleeding. Preoperative anemia correction and restrictive transfusion thresholds also showed benefits. Tourniquet evidence was inconclusive. Limited evidence supported bone wax. GRADE assessment suggested high evidence quality for TXA and regional anesthesia, moderate for minimally invasive surgery, anemia correction, and restrictive transfusion, and low for bone wax.</div></div><div><h3>Conclusions</h3><div>Multimodal approach integrating TXA, regional anesthesia, minimally invasive surgery, anemia correction, and restrictive transfusion protocols effectively reduces bleeding and transfusion needs in bilateral arthroplasty. Incorporation into Enhance recovery after surgery (ERAS) protocols is recommended. Future research should refine TXA dosing, clarify tourniquet use, and assess cost-effectiveness.</div></div>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":"69 5","pages":"Pages 532-543"},"PeriodicalIF":0.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144890966","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}
Pub Date : 2025-05-06DOI: 10.1016/j.recot.2025.03.004
F.J. Quiñonez, M.R. Latorre, P. Dardanelli, C. Halliburton, R. Maenza, M. Puigdevall, S.T. Bosio
Introduction
Scoliosis in pediatric patients encompasses a highly heterogeneous group and is one of the most common reasons for consultation, with a prevalence ranging between 1.5% and 3% of the pediatric population. The most common categories of pediatric scoliosis include idiopathic, neuromuscular, and congenital forms. Surgical correction of spinal deformities is a complex procedure, and although major complications are rare, it remains a crucial intervention. The main goal of surgical treatment is to prevent deformity progression while minimizing morbidity, maximizing postoperative function, and improving the patient's quality of life. This study aims to evaluate complication rates associated with surgical treatment of pediatric scoliosis and analyze the variables linked to increased complication rates over a 30-year period.
Methods
This study involved a retrospective review of prospectively collected data from a single institution's registry of patients who underwent surgical treatment for pediatric scoliosis over a 30-year period.
Results
Between 1991 and 2021, 779 patients underwent surgery. A total of 63 complications (8.08%) were recorded. Neuromuscular scoliosis had the highest complication rate, with 34 complications in 186 patients (18.28%), followed by congenital scoliosis with 6 complications in 57 patients (10.53%), and 23 complications in 536 patients with adolescent idiopathic scoliosis (4.29%). Infections were the most frequent complications at 4.49%. Neuromuscular scoliosis had the highest infection rate at 10.75%, followed by congenital scoliosis at 5.26%, and idiopathic scoliosis at 2.24%. Neurological deficit rates varied significantly according to the etiology of scoliosis (P<.001), with the highest rate in neuromuscular cases (2.69%), followed by congenital cases (1.75%), and idiopathic scoliosis (0.93%). Neuromuscular and congenital scoliosis had the highest rates of clinical complications, at 3.76% and 1.75%, respectively, followed by idiopathic scoliosis (1.12%).
Conclusión
An overall complication rate of 8.09% was observed in our series following surgery for pediatric scoliosis. Although neuromuscular scoliosis presented the highest morbidity, relatively high complication rates were observed across all groups. This information can be valuable for preoperative counseling and surgical decision-making in the treatment of pediatric scoliosis.
{"title":"Complicaciones en el tratamiento quirúrgico de escoliosis en pacientes pediátricos","authors":"F.J. Quiñonez, M.R. Latorre, P. Dardanelli, C. Halliburton, R. Maenza, M. Puigdevall, S.T. Bosio","doi":"10.1016/j.recot.2025.03.004","DOIUrl":"10.1016/j.recot.2025.03.004","url":null,"abstract":"<div><h3>Introduction</h3><div>Scoliosis in pediatric patients encompasses a highly heterogeneous group and is one of the most common reasons for consultation, with a prevalence ranging between 1.5% and 3% of the pediatric population. The most common categories of pediatric scoliosis include idiopathic, neuromuscular, and congenital forms. Surgical correction of spinal deformities is a complex procedure, and although major complications are rare, it remains a crucial intervention. The main goal of surgical treatment is to prevent deformity progression while minimizing morbidity, maximizing postoperative function, and improving the patient's quality of life. This study aims to evaluate complication rates associated with surgical treatment of pediatric scoliosis and analyze the variables linked to increased complication rates over a 30-year period.</div></div><div><h3>Methods</h3><div>This study involved a retrospective review of prospectively collected data from a single institution's registry of patients who underwent surgical treatment for pediatric scoliosis over a 30-year period.</div></div><div><h3>Results</h3><div>Between 1991 and 2021, 779 patients underwent surgery. A total of 63 complications (8.08%) were recorded. Neuromuscular scoliosis had the highest complication rate, with 34 complications in 186 patients (18.28%), followed by congenital scoliosis with 6 complications in 57 patients (10.53%), and 23 complications in 536 patients with adolescent idiopathic scoliosis (4.29%). Infections were the most frequent complications at 4.49%. Neuromuscular scoliosis had the highest infection rate at 10.75%, followed by congenital scoliosis at 5.26%, and idiopathic scoliosis at 2.24%. Neurological deficit rates varied significantly according to the etiology of scoliosis <em>(P</em><.001), with the highest rate in neuromuscular cases (2.69%), followed by congenital cases (1.75%), and idiopathic scoliosis (0.93%). Neuromuscular and congenital scoliosis had the highest rates of clinical complications, at 3.76% and 1.75%, respectively, followed by idiopathic scoliosis (1.12%).</div></div><div><h3>Conclusión</h3><div>An overall complication rate of 8.09% was observed in our series following surgery for pediatric scoliosis. Although neuromuscular scoliosis presented the highest morbidity, relatively high complication rates were observed across all groups. This information can be valuable for preoperative counseling and surgical decision-making in the treatment of pediatric scoliosis.</div></div>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":"69 6","pages":"Pages 652-658"},"PeriodicalIF":0.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145374458","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}
Pub Date : 2025-05-03DOI: 10.1016/j.recot.2025.04.014
J.F. Garrido Ferrer, J. Diranzo García, X. Bertó Martí, L. Marco Díaz, L. Hernández Ferrando
Introduction
The aim of this study was to describe and analyze the musculoskeletal injuries treated at a tertiary hospital, resulting from the sudden flooding and landslides that occurred on October 29, 2024, in the province of Valencia, Spain.
Materials and methods
A retrospective, single-center study design was employed, documenting all patients who required hospital treatment from October 29, 2024, to November 30, 2024, inclusive. Data collected included the date of treatment, delay time until rescue and evacuation, demographic information, injury location and severity, records of surgeries performed and required hospitalization time.
Results
A total of 410 hospital admissions were recorded, all of which were through the emergency department. A slight male predominance was observed (55.5%), with an average age of 48 years (range 1-97). The mean time to treatment was 1.4 days from the trauma (range 1-12), although 47% of cases exceeded 48 hours. 60.1% of contusions presented with at least one associated fracture. A total of 84 wounds (20.5% of the sample) and musculoskeletal and ligament injuries (14.4%) were treated, along with joint dislocations (2.4%). The most common injury sites were the lower limbs (48.6%), followed by the upper limbs (36.7%). The majority of cases (90.5%) were managed with conservative treatment, with 9.5% requiring surgical revision. During this period, 53 hospital admissions (1.76 admissions/day) and 38 urgent surgeries were performed.
Conclusion
The flooding caused by the Valencia flood in October 2024 is considered one of the most severe environmental disasters in the history of Spain. Natural disasters affecting multiple victims demand effective and coordinated medical attention across all healthcare levels. Continuous learning for trauma specialists will provide the necessary tools for appropriate knowledge and management of such potentially severe injuries.
Level of Evidence: IV. Retrospective descriptive and analytical study. Case Series.
{"title":"Lesiones musculoesqueléticas atendidas tras la inundación ocurrida en octubre del 2024 en Valencia, España","authors":"J.F. Garrido Ferrer, J. Diranzo García, X. Bertó Martí, L. Marco Díaz, L. Hernández Ferrando","doi":"10.1016/j.recot.2025.04.014","DOIUrl":"10.1016/j.recot.2025.04.014","url":null,"abstract":"<div><h3>Introduction</h3><div>The aim of this study was to describe and analyze the musculoskeletal injuries treated at a tertiary hospital, resulting from the sudden flooding and landslides that occurred on October 29, 2024, in the province of Valencia, Spain.</div></div><div><h3>Materials and methods</h3><div>A retrospective, single-center study design was employed, documenting all patients who required hospital treatment from October 29, 2024, to November 30, 2024, inclusive. Data collected included the date of treatment, delay time until rescue and evacuation, demographic information, injury location and severity, records of surgeries performed and required hospitalization time.</div></div><div><h3>Results</h3><div>A total of 410 hospital admissions were recorded, all of which were through the emergency department. A slight male predominance was observed (55.5%), with an average age of 48 years (range 1-97). The mean time to treatment was 1.4 days from the trauma (range 1-12), although 47% of cases exceeded 48<!--> <!-->hours. 60.1% of contusions presented with at least one associated fracture. A total of 84 wounds (20.5% of the sample) and musculoskeletal and ligament injuries (14.4%) were treated, along with joint dislocations (2.4%). The most common injury sites were the lower limbs (48.6%), followed by the upper limbs (36.7%). The majority of cases (90.5%) were managed with conservative treatment, with 9.5% requiring surgical revision. During this period, 53 hospital admissions (1.76 admissions/day) and 38 urgent surgeries were performed.</div></div><div><h3>Conclusion</h3><div>The flooding caused by the Valencia flood in October 2024 is considered one of the most severe environmental disasters in the history of Spain. Natural disasters affecting multiple victims demand effective and coordinated medical attention across all healthcare levels. Continuous learning for trauma specialists will provide the necessary tools for appropriate knowledge and management of such potentially severe injuries.</div><div>Level of Evidence: IV. Retrospective descriptive and analytical study. Case Series.</div></div>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":"69 5","pages":"Pages 421-428"},"PeriodicalIF":0.0,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144889540","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号