Acta ortopedica mexicana最新文献

Introduction: shoulder hemiarthroplasty is being relegated as a treatment for non-osteosynthetic proximal humerus fractures. Our objective is to analyze the functional results of patients treated with hemiarthroplasty for this reason in our hospital.

Material and methods: cross-sectional descriptive study that includes patients operated between February 2016 and November 2021; 24 patients, with an average follow-up of 44.6 months. Active joint balance, the Constant-Murley test, the DASH questionnaire and current pain (VAS) were collected. The radiographic parameters analyzed were the number of fracture fragments and the consolidation of the tuberosities.

Results: a mean of 71.65 ± 13.75 was obtained in the Constant-Murley and 18.14% ± 13.92 in the DASH. For shoulder flexion, the mean was 108.75° ± 41.26; 104.5° ± 43.68 for abduction and 33° ± 14.73 for external rotation. About internal rotation, 60% of the patients reached the scapular plane. Average VAS was 1.25 ± 1.74. Consolidated tuberosities in 90.5%. There were no significant differences comparing the Constant-Murley test, DASH or rotations between both, over and under 65 years old group of patients. Those over 65 years of age obtained a mean flexion of 125.91° ± 26.82 whereas those under 87.78° ± 26.82 (p = 0.038). The mean abduction in those over 65 was 125.45 ± 28.94 vs 78.89 ± 46.29 in the young group (p = 0.012).

Conclusion: hemiarthroplasty provides quality of life with acceptable functionality and good pain control, therefore it should continue to be an alternative to consider in selected patients.

Introduction: when faced with a chronic digital injury, the differential diagnosis between osteomyelitis or primary tumor is raised. Coexistence between osteomyelitis and epidermoid bone cyst is not uncommon.

Material and methods: in this article, we describe two cases of epidermoid cysts in distal phalanx of the hand associated with osteomyelitis and a review of the literature is presented.

Results: both osteomyelitis and epidermoid bone cyst have been related to the presence of previous trauma at the site of the lesion, nail alterations and chronic phlogotic signs, so it is important to reach a diagnosis of certainty through an anatomopathological study and to perform a good surgical debridement to ensure the healing of both entities.

Conclusions: surgical debridement associated with curettage and filling of the bone defect with bone substitute with antibiotic is a good therapeutic option in the treatment of these lesions.

Introduction: surgical wound dehiscence with exposure of internal fixation material is a serious problem in orthopedic surgery and an important factor for infection.

Objective: presentation of an unusual case of an adult patient with surgical wound dehiscence and complete exposure of 20 cm of the ulnar plate after six years of surgery, without infection signs, with bone healing and skin behind the plate.

Case presentation: 39-year-old man with an open Gustilo II Monteggia fracture-dislocation multifracture. The patient had a history of drug dependence. He had an open reduction and internal fixation with an ulnar reconstruction plate. The patient did not have any follow-up. After six years of the surgery, there was a complete exposure of the plate (20 cm) without infection and healing of the fracture with misalignment. After removing the plate, we observed spontaneous epithelialization attached to the bone bed. Skin coverage was complete at two months.

Conclusion: although unusual, bone consolidation without infection is possible in an open fracture with long-standing exposure to a forearm plate in the adult.

Cross-sectional-retrospective study with 120 anteroposterior pelvic radiographs. Eight measurements were taken by three raters in two times to calculate the morphological-cortical (MCI), cortico-metaphyseal (CMI), and cortico-diaphysaire (CDI) indices. Intra/interobserver reproducibility was evaluated with the Bland-Altman method, and hip fracture occurrence was predicted by comparing cut-off points between raters maximizing sensitivity/specificity. The proportion of measurements outside ± 2 SD was similar for diameters/corticals (~5%), but exceeded 1 mm in some corticals, representing 10-20% of distances < 1 cm. Cut-off points fluctuated between 2.45 and 2.53 for MCI (3% difference), between 0.37 and 0.41 for CMI (12% difference), and between 0.23 and 0.33 for CDI (44% difference).

Introduction: alkaptonuria is a very rare metabolic disease with autosomal recessive inheritance due to HGA oxidase deficiency. Classically described and diagnosed in the third to fourth decade of life, affecting both men and women; Its diagnostic impression is clinical based on the blue/black coloration of the conjunctivae, however it is confirmed by the specific analysis of the enzyme in the urine, to date there is no cure and its treatment is palliative and symptomatic.

Material and methods: descriptive, observational, case series study, the primary objective of which is to describe the progression of the disease and its involvement in the musculoskeletal system.

Results: two clinical cases are presented in women and men in which the broad clinic is illustrated, its progressive advance and the different alterations that it can generate in the musculoskeletal system.

Conclusions: alkaptonuria is a rare disease which leads to a severe secondary arthropathy, currently without a specific management which is based on treating the symptoms, in its final stages joint replacements are a management option with satisfactory results for the relief of pain.

Introduction: the gold standard for tibial diaphyseal fracture treatment is represented by the intramedullary nail (IMN). This study aimed to assess the relevance of nail diameter in bone healing of tibial diaphyseal fractures.

Material and methods: a retrospective study was conducted analyzing patients with closed 42 OTA/AO tibial fractures, treated with a reamed and locked IMN between January 2014 and December 2020. The variables assessed were gender, age, comorbidities, number of bolts used, canal/nail index (difference between the diameter of the medullary canal and nail), nail/canal ratio (ratio between nail diameter and medullary canal), related to consolidation and failure rates (delay and non-union).

Results: 96 patients were included. The consolidation rate was 91.7% (n = 88). Patients with consolidation had a significantly larger nail diameter than those who failed (p = 0.0014), increasing the chance of consolidation 5.30 (p = 0.04) times for each millimeter that the nail increased its diameter. Using a nail > 10 mm increased the chance of consolidation 13.56 times (p = 0.018). A nail/canal ratio 0.80 increased the chance of consolidation 23.33 times (p = 0.005).

Conclusion: our findings suggested that reamed and locked IMN in tibial diaphyseal fractures should be implanted with the largest possible diameter (> 10 mm and with a nail-to-canal ratio 0.80) to promote bone healing.

Osteochondral lesions of the talus (OLTs) are defined as damage to the talar cartilage, with pathological changes in the underlying bone. They include a group of injuries that involve juvenile osteochondritis dissecans (JOCD) and osteochondral fractures of the talus. The etiology of OLT remains not fully clarified but is more common in young and active patients. Treatment strategies for OLTs in skeletally immature populations depend on the magnitude of symptoms, lesion morphology (stability and overlying cartilage integrity), size, nature of the lesion (traumatic versus JOCD), ankle stability, lower extremity alignment, and previous treatment. The aim of this review is to provide an overview of the current evidence for the diagnosis and treatment of OLTs in skeletally immature patients.

Introduction: although pediatric orthopedic surgeons worldwide perform scoliosis surgery, the training received is variable and poorly understood. By surveying the European Pediatric Orthopedic Society (EPOS) and the Sociedad Latinoamericana de Ortopedia (SLAOTI), we aim to characterize this variability.

Material and methods: in 2021, we distributed an anonymous online questionnaire to EPOS and SLAOTI.

Results: 43% EPOS and 22% SLAOTI perform scoliosis procedures (p < 0.05). 18% EPOS and 2% SLAOTI performed > 35 procedures annually (p < 0.05). 70% EPOS and 27% SLAOTI received formal training in spinal deformity surgery (p < 0.005).

Conclusions: results show significant differences in training and performance of scoliosis procedures between societies.

Introduction: acetabular fractures constitute between 0.3 and 0.6% of all observed fractures, being these injuries relatively infrequent.

Objective: to evaluate clinical and radiological outcomes of surgical treatment of patients with acetabular fracture treated in our hospital with a minimal follow-up of 11.5 years. The secondary objective is to determine the rate of failure in the hip joint of these patients and establish risk factors that are involved.

Material and methods: 23 patients with acetabular fractures that were treated by open reduction and internal fixation (ORIF) were retrospectively analysed. They were follow-up during an average of 14 years (range 11.5-17.5). Fractures were classified by Judet y Letournel as simple or complex. Clinical and radiological outcomes were analysed by Harris scale.

Results: We obtained an average of 81.90/100 on the Harris scale, aiming at better outcomes on simple fractures compare to those that were complex (p = 0.027). Higher scores were also achieved on those patients with an anatomical reduction (p = 0.033). Three patients required revision and placement of a total arthoplasty (13%). However, patients with body mass index (BMI) > 30 tend to achieve poor clinical results (p = 0.151).

Conclusions: ORIF may be suggested for acetabular fractures since good clinical and radiological outcomes were recorded on a long-term follow-up. Complex fractures, non-anatomical reduction and BMI > 30 were identified as risk factors to coxarthrosis progression.

No Abstract available.