Acta ortopedica mexicana最新文献

Introduction: Reconstruction of the anterior cruciate ligament attempts to reproduce the native ligament; make independent tunnels optimize the entry points and effectiveness the anatomy. Perform radiographic measurements of the knee, identify position of femoral and tibial tunnels in patients operated for reconstruction of anterior cruciate ligament with anatomical technique.

Material and methods: Patients were identified in the period January 2018 to December 2019. 98 patients were retrospectively evaluated. Radiographic measurements in the femur, the inclination angle of the tunnel, the insertion site with respect to the Blumensaat line and the transosseous distance were determined. In tibia, the location in percentage of the tibial plateau location in anteroposterior and lateral view, tibial tunnel angle.

Results: Postoperative patients were 98. (75.5%) male, female (24.5%). Postoperative in 2018 (57.15%) and 2019 (42.85%) Age range: affected group was 21-25 years, right side affected in 57.15%; Radiographic measurements in femur, the angle of inclination of the tunnel was 45o, percentage in the Blumensaat line was 20%, and the transosseous distance was 3.43 cm. In tibia the percentage distance in anteroposterior projection was 44%, and lateral 28%, The angle in tibial tunnel anteroposterior projection of 73 degrees, and lateral 114.

Conclusion: The anatomical technique is a good option to perform tunnels with an optimal anatomical position. By making independent tunnels it allows to improve coverage of normal antomic footprint. Increases degrees and inclination of tunnels, causes added injuries.

Introduction: Osteoarthritis in Mexico is one of the ten most frequent causes of disability. Early diagnosis and detection of risk factors are determinant for treatment. The institutional organization establishes therapeutic guidelines according to each level of care, but effective management is not achieved.

Material and methods: A prospective, pilot, interventional, clinical study was conducted, which included patients diagnosed with different degrees of knee osteoarthritis in the first, second and third level of care, with an integrative model that includes a group of professionals for the intervention of nutritional, physiotherapeutic, social and psychological evaluation from the first level.

Results: The intervention of a multidisciplinary care group allows a correct evaluation and assignment of the level of care, optimizing human and material resources. The participation of different disciplines in nutrition, psychology, social work, physiotherapy and rehabilitation modifies the global lifestyle by involving the patients themselves in their treatment. The intervention group had improvements in the visual analog pain scale, mobility arcs, low body mass index and improvement in the psychological aspect.

Conclusions: The proposed model of care demonstrates that implementation in the institution and in each clinical care unit should be considered to improve outcomes.

Introduction: The Single Assessment Numeric Evaluation (SANE) score is a brief method of evaluating patients' perception of the shoulder joint and has proven high correlation with other outcome measures that are more lengthy and time-consuming in daily practice. The SANE score to date has not been validated in Spanish.

Objective: To translate, adapt, and validate the SANE score in Spanish.

Material and methods: An initial translation and counter-translation was conducted by two bilingual evaluators and an official translator. Content validity was evaluated by a group of experts in shoulder surgery. The criteria validity was determined by determining correlation with the previously translated and validated ASES score. Reliability of the test was determined.

Results: 113 patients were evaluated, with an average age of 53.6 being 56% female. The most frequent diagnosis was rotator cuff syndrome in 78.6% followed by frozen shoulder, glenohumeral and acromioclavicular osteoarthritis and shoulder instability and acromioclavicular dislocation. Correlation between the SANE and ASES results was 0.699. The test was highly reliable with an intraclass correlation coefficient of 0.86.

Conclusion: The SANE score is a valid and reliable patient centered outcome measure that has a good correlation with other previously validated scores in Spanish that are less practical. We present a translated valid version of the SANE score in Spanish that can be used as a patient reported outcome measure for shoulder pathologies.

Introduction: Carpal dislocations and fracture-dislocations are uncommon injuries and represent approximately 5-7% of all wrist injuries, or about 10% of all carpal injuries. Multiple treatments are proposed to treat these injuries. The aim of our paper is to review the evidence about the treatment of lesser arc perilunate dislocations and to assess the results of the different therapeutic methods.

Material and methods: A systematic review was carried out through the electronic search engines PubMed, Bireme and Timbó. The search reached a total of 898 articles, according to the inclusion and exclusion criteria, 16 works were selected to carry out our systematic bibliographic review.

Results: The majority of the studies analyzed are retrospective case series studies, level of evidence IV. Our results are based on the extraction of data only from minor arc lesions of said works. Five subgroups were performed according to the type of treatment to analyze the results.

Discussion: The different therapeutic methods were analyzed and clinical, functional and radiographic parameters were compared during follow-up.

Conclusion: There are no significant differences, in terms of the scores used, between closed reduction and percutaneous fixation or open reduction and ligament repair.

Bone metastases from a primary cancer of any part of the body are the most common form of malignant bone tumor constituting approximately 70% of them. The proximal femur being the most common extra-vertebral location for its location; 10% of patients have some pathological fracture, which is a serious complication. Currently the objectives of the treatment of a pathological fracture are: resection with adequate oncological margins, that the patient survives the surgical intervention, maintain the functionality, that the placed implant has a longer life time than the patient. The use of non-conventional hip prostheses is an excellent treatment option fulfilling the 4 established objectives, therefore this case is presented in which a right bipolar hip hemiarthroplasty is performed with a non-conventional prosthesis where it was treated with a described complication and the surgery of resolution.

The objective of this study was to investigate the prevalence and epidemiology of knee cartilage lesions in the work environment, and to assess whether they increase the patient's work leave and thus also cost. We also analyzed the prevalence of concomitant pathology and how it affected recovery and final outcome.

Material and methods: Monocentric retrospective cohort of patients with occupational injuries who underwent knee arthroscopy during 2018. Demographic data, diagnosis, concomitant chondral pathology, treatment, symptoms and signs at discharge, work leave and total cost were collected.

Results: 123 patients were analyzed, with a mean age of 47 years. No differences were found between sexes or with respect to obesity. Asymptomatic chondral lesions were found in 35.25% of the patients, primarily the older ones (48-53 years). The presence of cartilaginous pathology did not increase days of work leave or total cost (p > 0.05). In patients with meniscopathy in whom meniscectomy is performed, the chondral lesion increased the number of days of work leave (p = 0.03). There were no differences in the number of days of work leave nor total cost for different treatments of chondral pathology.

Conclusion: The management of a concomitant chondral knee lesion is still controversial. These lesions might convey poorer functional prognosis in patients with meniscopathy. Current therapies have not shown a clear benefit in work injuries.

Introduction: The rupture of the Achilles tendon is one of the most frequent of the lower limb, the increase in its incidence invites to evaluate its associated characteristics that act as triggers or as risk factors.

Methods: Descriptive, retrospective, cross-sectional study, based on clinical history data, using mean, standard deviation and percentages.

Results: We evaluated 49 patients: males 83.7%, administrative profession 46.9%, sport injury 61.2% (soccer 38.8%). 75.5% were acute injuries, affecting the left tendon (57.1%). The most referred symptom is sudden pain (95.9%) and the most common sign is Thompson's (89.8%). Ultrasonography was used in 42.9%. 95.5% received treatment by open surgery and spinal anesthesia 85.1%. Intraoperatively they reported complete rupture 95.7%, at 2-5 cm insertion 66%, 98% of them had no associated injuries. The repair was simple tenorrhaphy with Kessler's point (51%) and Vycril as suture material (95.7%). Immobilization was performed with warm-pedium plaster (98%) for a period of 6-8 weeks (91.9%). Surgical waiting was 3.6 days and hospital stay 4.9 days.

Conclusions: Achilles tendon rupture occurred more frequently in sedentary males between 29-48 years, acute presentation in sports activity, affecting the left tendon. Most were complete ruptures located between 2-5 cm from its insertion, performing simple tenorrhaphy.

Introduction: Aneurysms and pseudoaneurysms of the arteries of the foot and ankle are rare clinical entities. In most cases occur within months or years of the initial trauma, complications in the aforementioned situations are very uncommon, however, they should be ruled out at medical check-ups. We will present a clinical case in which pseudoaneurysm of the Distal Peroneal Artery occurred as a result of a fracture- dislocation of the ankle.

Clinical case: Patient of 60 years of age with trauma in right ankle, his radiographic study of the right ankle evidencing fracture- dislocation of the same. Surgical treatment is decided four days after the injury. In the postoperative course with edema, circulatory changes of abnormal form that merited imaging complement and arteriography was performed which indicates the presence of pseudoaneurysm of approximately 28 × 30 mm in distal peroneal artery meriting specific treatment with adequate control of symptoms.

Conclusion: We believe that it is of the utmost importance the correct assessment and physical examination of patients undergoing ankle surgery in successive post-surgical controls to detect these types of complications early and treat them in time.

Introduction: According to the NRF (National Resource Fund) there has been an increase in the number of TKA (total knee arthroplasty) in our country. There are no studies evaluating their results. The objective of the study was to analyze survival, evaluate results and analyze the population of ATR replacements.

Material and methods: A retrospective observational and descriptive cohort study of 156 cases of ATR turnover registered in the NRF was conducted between 2004 and 2014. The analysis of the cumulative percentage of survival was performed with the Kaplan-Meier method, using re-revision as an event of interest. The WOMAC, KOOS and SANE score were used to assess functional outcomes.

Results: The cumulative percentage of survival was 85% at 10 years. The average scores were: KOOS 61.5, WOMAC 29.8 and SANE 65. Complications were recorded in 25% of cases (infection 14.10%). The average age was 71 years and 60.9% of the cases were in women. 62.82% of the replacements were of aseptic cause and in the vast majority (89.1%) constricted prostheses were used.

Conclusion: The cumulative percentage of survival of revision TKA was 86% at 10 years according to the Kaplan-Meier method. Only 51% of revisions were functional at 10 years. We must be cautious when interpreting the results obtained with this method. Acceptable functional outcomes were recorded compared to other registries, although patient satisfaction was low in more than one third of cases and there was a high percentage of complications. A trend towards an increase in the turnover rate was observed between 2004 (1.4%) and 2014 (2%).

Intraoperative acetabular fractures (IAF) is a rare complication with an incidence 2% - 5%. We present the review of a series of 13 cases, discussing diagnosis, treatment and results.

Material and methods: Between 2006 and 2018, we performed 4800 primary hip arthroplasties (THA) In our hospital, we identified 13 cases with FIA with a follow-up of 38.3 months.

Results: Two cases were stable with conservative management; 11 unstable cases: seven cases we placed trabecular metal, one case we increased acetabular diameter, one case acetabular replacement, one case revision with Ganz type ring and one case do not accept treatment. The use of trabecular metal is an implant that helps effectively and with good results in FIA.

Conclusion: These fractures are rare, knowing the implant to use is mandatory because if the implants are oversized, with greater rigidity or hemispheric, patients have increased risk of suffering from this complication.