Acta ortopedica mexicana最新文献

Fractures about the knee are common in children and adolescents. Characteristics of the growing skeleton make children susceptible to specific fractures that do not occur in adults. Understanding the relevant anatomy, pathophysiology, diagnosis, and treatment options are important to decrease the risk of complications. The aim of this article is to discuss the current trends in diagnosis and treatment of tibial eminence, tibial tuberosity sleeve, and osteochondral fractures in children and adolescents.

Introduction: femoral lengthening using an intramedullary nail is one of the surgical options in the treatment of severe lower limb dysmetria in routine clinical practice.

Material and methods: a retrospective descriptive study was carried out on a series of five patients with a mean age of 15.4 years, who underwent femoral lengthening surgery using a Precice® intramedullary nail. The etiology in all cases was idiopathic. Preoperative and definitive postoperative theoretical lengthening or dysmetry was measured, as well as lengthening accuracy, distraction rate and index (mm/day and days/cm, respectively) and consolidation index (days/cm). Intraoperative and postoperative complications were identified in all cases.

Results: mean follow-up was 21 months (12-42), with no loss to follow-up. The mean duration of the surgical procedure was 126 minutes (105-160). The preoperative theoretical dysmetry was 38 ± 2.7 mm. The final mean lengthening was 41 ± 7.5 mm. The mean accuracy was 108% (91-125) and the distraction rate was 0.9 ± 0.4 mm/day. The distraction rate was 13.9 ± 5.1 days/cm and the consolidation rate was 26.6 ± 9.1 days/cm. Bone consolidation was observed in all patients with a mean of 113 ± 58 days. Regarding complications, a total of four minor muscular complications were found.

Conclusion: the Precice® intramedullary nail is a good treatment option for cases of severe femoral shortening, providing good clinical and radiological results with a low rate of complications and implant failure.

Introduction: there are numerous classifications for herniated discs, such classifications guide professionals about the severity of the lesion, the possible clinical picture of the patient, the most appropriate treatment and are undoubtedly a predictive tool to project the possible results of the therapies used. The main purpose of this work is to validate the inter- and intra-observer reliability of the Michigan State University (MSU) classification among the spine surgeons of our service and also to know the risk factors associated with the patients who underwent lumbar discectomy, the most affected disc level, the clinical presentation and the previous treatments performed in the patients treated by our team.

Material and methods: 50 nuclear magnetic resonance (MR) images in axial T2 section corresponding to the "maximum disc herniation" level were selected from patients diagnosed and submitted to meningo-radicular release surgery and single level lumbar discectomy retrospectively in the last two years from our database; these images were distributed among three spine surgeons of our institution. The three spine surgeons gave a specific classification for each MR image based on the MSU classification, then at an interval of seven days one of the three surgeons reclassified the images. The degree of agreement between surgeons was analyzed by calculating interobserver and intraobserver reliability using kappa statistical analysis.

Results: the analysis of the kappa coefficient indicated that most of the comparisons by observer gave a "good" concordance strength, the kappa index was higher than 0.64 in all the possible comparisons of the observations. In relation to the number of coincidences, in 60% of the patients there was a total coincidence between the three surgeons, with two coincidences in 24%, and in 16% there was no coincidence at all. For the intraobserver analysis the kappa index was 0.953 with a very good concordance strength, the observed agreement was 96%.

Conclusion: our research shows a good reliability in the MSU classification among spine surgeons of our institution, as well as very good when reclassifying the intraobserver; we believe that having a sagittal MRI slice to classify them would be very useful, more research is needed to give a prognostic value to the location and size of the hernia and its relation with the surgical indication.

Introduction: dislocation of the acromioclavicular (AC) joint is a common injury seen in young adults. The objective is to describe a surgical technique that can restore the horizontal and vertical stability of the AC joint.

Material and methods: we describe a surgical technique that can restore horizontal and vertical stability using an allograft for the anatomical reconstruction of the CC and AC ligaments, for AC grade III-V dislocations according to the Rockwood classification.

Results: this is a surgical technique with anatomical and biological reconstruction of the CC and AC ligaments, using an allograft. Two bone tunnels are made in the clavicle, passing the lateral end of the graft below the acromion; then the two ends are fixed with two bioabsorbable screws, restoring vertical and horizontal stability.

Conclusion: this procedure allows to restore the vertical and horizontal stability of the AC joint. Follow up studies are required to report functional and radiological results, in order to ensure advantages compared to existing techniques.

Introduction: the tibial slope has been identified as one of the factors associated with graft failure after anterior cruciate ligament (ACL) reconstruction; however, its relationship with functional results has been little studied. The main purpose of this study is to determine the effect of the tibial slope on functional recovery in patients undergoing reconstruction of the anterior cruciate ligament.

Material and methods: we included patients with a diagnosis of anterior cruciate ligament injury undergoing primary reconstruction, from May 2018 to May 2019, who had a complete radiographic and clinical record; also, the scores from questionnaires of the International Knee Documentation Committee (IKDC) and Lysholm scores were collected pre surgical procedures and throughout the one-year follow-up. The measurement of the tibial slope was performed in lateral knee X-rays from the electronic clinical record. A descriptive analysis of first intention was done, and to achieve the objectives, we compared 25 patients who had normal tibial slope that were selected randomly with 25 patients who had increased tibial slope.

Results: a total of 98 patients were included, 73 had a normal tibial slope (equal to or less than 12 degrees) and 25 with an increased tibial slope (greater than 12 degrees), the average age in both groups was 28.43 years for the group with normal tibial slope and 28.26 for patients with increased tibial slope. Regarding the functional assessment, the IKDC and Lysholm scores at the end of the follow-up were better for patients with normal tibial slope. Graft failure was only identified in the group with increased tibial slope. On the other hand, the comparative analysis with the control group randomly selected who had normal tibial slope, showed a better functional result assessed by IKDC score at the end of the follow-up for the group with normal tibial slope.

Conclusion: patients undergoing ACL reconstruction and increased Tibial Slope have an inferior functional result at one year of follow-up assessed by IKDC, when compared with patients with normal tibial slope.

Introduction: Developmental hip dysplasia (DHD) is the most common disorder affecting pediatric hip; screening all neonates clinically, and using ultrasonography selectively for those babies who are at high risk is a widespread recommendation. our goal is to evaluate the impact that USG diagnosis and early treatment of DHD has had on the child population of our unit.

Material and methods: Retrospective, descriptive and cross-sectional study. Records of those children from one to six months of age, with a diagnosis of DHD, without distinction of sex, subjected to ultrasonographic tracking in the period from January 2018 to December 2019 were reviewed. A follow-up of six months was carried out in all patients, from the moment of diagnosis and the start of treatment with harness, weekly visits for relocation, as well as ultrasonographic revision every four weeks to monitor the treatment.

Results: 19 cases were reported from the left side (47.5%), 10 cases from the right side (25%) and 11 bilateral cases (27.5%). The main associated risk factors were: product of the first pregnancy, family history of DHD, pelvic presentation, female sex. The results were favorable with a continuous use of harness of 23 hours observing a satisfactory evolution in 99.2% of the patients.

Conclusion: With the results obtained we can analyze the considerable success rate of the hip clinic of our hospital with the realization of the ultrasound, we find a lower incidence of patients with pain, limitation of function, as well as satisfactory gait patterns.

Introduction: Growing evidence suggests that shoulder injuries involving the rotator cuff cause severe pain and deterioration of quality of life and sleep.

Objective: To present the results of a systematic review on the association of rotator cuff injuries with nighttime pain and sleep quality before and after treatment.

Material and methods: We searched PubMed limited to humans, with no language, age and time period limit with the following terms: [rotator cuff tear and (nocturnal pain OR sleep)]. We used the PRISMA criteria for systematic reviews. Information was extracted on the frequency of nighttime pain and sleep quality in patients with rotator cuff injuries.

Results: Of 123 records found, 10 studies were included for meeting criteria, including 1,516 patients. Nighttime pain affected 91-93% of patients; its average intensity was 5.5 points of the EVA. 100% of the studies reported alterations in sleep quality associated with rotator cuff injury. After repair, a decrease in pain to inferior scores of 2 and improvement in sleep quality were reported.

Conclusion: Rotator cuff injuries produce nighttime pain and sleep quality disturbances that improve with treatment. Alterations in sleep quality are due not only to pain but to alterations in shoulder functionality.

Introduction: Expansive intra-spinal processes usually have an insidious course that makes their early diagnosis difficult. Intra-spinal tumors are classified according to their location in the spinal canal: extradural and intradural, and these are classified as extramedullary and intramedullary. At the beginning, they can cause non-specific pain conditions and, sometimes, root-type pain. The patient may have symptoms such as: loss of strength, loss of balance, loss of sensation, sphincter disorders. Intra-spinal neoplasms, when diagnosed, have an indication for surgical treatment.

Material and methods: The clinical case of a 14-year-old male adolescent is described, pain in the lumbar region for four years, of insidious onset, intermittent, progressive, exacerbated six months ago, with radiation to the lower extremities, which is accompanied by progressive paresthesia and paresis predominantly in the lower right limb.

Results: Bilateral L4 and L5 laminotomy is performed, exploration and resection of the tumor and release of nerve roots. Tumor with characteristics similar to adipose tissue is obtained, where a wide vascular network is observed inside, with an approximate size of 14 × 10 × 4 mm, ovoid in shape, flattened with a smooth and shiny surface.

Conclusion: Spinal tumors are relatively rare tumors, however, of these tumors, the extradural intraspinal location accounts for half of the cases. In our patient, the diagnosis of lipoma of the filum terminale was integrated, which corresponds to less than 1% of all tumors of the spine.

Introduction: 15-20% of patients undergoing total knee arthroplasty were not satisfied and the most common causes were residual pain and limited function. Epidural analgesia or peripheral nerve blocks have traditionally been used as analgesia.

Objective: To evaluate the efficacy of infiltration with epinephrine, ketorolac, morphine and ropivacaine solution in postoperative total knee replacement patients.

Material and methods: Observational, cross-sectional, retrospective and analytical cohort study. We included patients with gonarthrosis aged 18 to 100 years scheduled for total knee replacement surgery from May 2018 to August 2021; with documentation of their clinical, demographic, baseline, pre-surgical and postoperative pain data at 24 hours. Infiltrated patients were compared with those receiving intravenous analgesia.

Results: A total of 66 patients with a mean age of 69.1 were included;65.2% were women. Forty-three point nine percent had left-sided involvement, 50% had a classification of Kellgren-Lawrence III and 31.8% had a grade IV. Thirty-six patients (54.5%) formed the control group, while 30 (45.5%)received the intervention with the analgesic cocktail. With regard to pain,a lower median pain was found by visual analog scale in patients with the intervention (2 vs 8 points, p < 0.001); most with the cocktail they found no pain (66.7%) or mild pain (23.3%) and no patient in the control group reached it (p < 0.001). All patients of the control group required rescue analgesia, while only 30% of the intervention group used it (p < 0.001).

Conclusion: The use of trans-surgical local infiltration decreases postoperative pain and the requirement of analgesics and rescue analgesia during the first 24 hours.

Three-dimensional (3D) printing includes a group of technologies by means of which it is possible to generate three-dimensional objects from binary information. Orthopedics and traumatology are fields of medicine in which 3D planning has had the greatest impact, especially in trauma and oncological orthopedics. Applications of this technique include diagnosis, surgical planning, intraoperative guide creation, custom implants, surgical training, orthotic and prosthetic impression, and bioprinting. Advantages have been demonstrated in its use, such as greater technical precision, shorter surgical times, decreased blood loss and less exposure to X-rays. Although the process is increasingly optimized and accessible due to advances in software and automation, it is a technique that requires adequate training. The objective of this review is to offer an approach to this technology and its basic principles.