Acta ortopedica mexicana最新文献

Sternoclavicular joint dislocation is an uncommon injury and is usually consequential to high-energy trauma. These can be classified as anterior or retro-sternal (posterior) dislocation. Sometimes they can be accompanied by injury to large vessels due to their anatomical proximity mainly retrosternal. Conceptually closed reduction is indicated as the first line of treatment in acute injuries and open reduction tends to be for failing the previous one. We present a case of anterior clavicular sternal dislocation, with recurrence after closed reduction under anesthesia and surgically operated with reconstruction and allograft use with favorable evolution six years after its surgical procedure.

Introduction: Scoliosis is a complex deformity that affects all three planes of the axis of the spine. The association between neuromuscular pathology and vertebral alignment was initially described in 1960. Neuromuscular pathology is progressive and results in postural abnormalities. Surgical goals in patients with neuromuscular deformity include anatomical correction for sedation and ambulation, as well as functional improvement. The gold standard of treatment is by posterior approach with transpedicular screws. The "hands-free" technique saves surgical time, decreases radiation by reducing the use of fluoroscopy. The advent of 3D printing technology allows precise study of the anatomical area and detail of the deformity in its three planes. This model can be sterilized for transoperative guidance. A 13-year-old female patient who develops thoracolumbar neuromuscular scoliosis secondary to spastic cerebral palsy (CP), with previous instrumentation T11-L3 of which he develops severe proximal curve. After the segmentation of the three-dimensional model, pedicle violation greater than 2 mm towards bilateral medullary canal was detected in the pedicles of L1 and L2 of previous instrumentation, pedicle dysplasia and the morphological characteristics of the pedicles were observed. Three-dimensional planning and the use of surgical guides represent a tool for surgical planning, especially in severe cases and with pedicle dysplasia. It helps as a surgical guide for the placement of hands-free transpedicular screws with possible reduction of radiation and anesthetic time.

No Abstract available.

Introduction: The deforming condition of the navicular bone known as Müller-Weiss disease (MWD) is a rare disease. Patients present with chronic pain in the talonavicular joint and a paradoxical flat foot with a varo hindfoot.

Objective: To analyze the clinical results of a lateral osteotomy of calcaneus applied to patients with MWD.

Material and methods: Retrospective observational study carried out in two hospitals. The series consists of nine cases in eight patients, all of them with symptomatic Müller-Weiss disease, treated by lateral osteotomy of the calcaneus between 2012 and 2017, obtaining an average follow-up of 4 years (2-6). The mean age was 62 years (50-75). In all patients, Costa-Bartani angles (CB), Kite angle and Calcaneal Inclination (CI) were measured. In addition, the Manchester Oxford Scale (MO) to measure the post-surgical satisfaction of patients.

Results: All patients report having improved their pain by obtaining a postoperative score on the mean Manchester Oxford scale of 32.54 points (15.62-53.75). In 66% of patients the CB angle improves, the Kite angle in 89% and the CI in 33%.

Conclusion: The improvement in the pain of the patients in our series is not accompanied by radiological changes in the same proportion, it is a simple and uncomplicated technique in our follow-up.

Introduction: Eighty percent of the Proximal humerus fractures are not displaced or minimally displaced and stable. The international treatment recommendation is conservative. Immobilization of the limb carries risk of stiffness, pain and decreased function. Currently being used rehabilitation programs with early mobilization of the injured shoulder within the first week post-fracture, with evidence of early functional and labor recovery and with no risk for displacement of fragments. However, in our country, these patients start rehabilitation late, which leads to a delay in the recovery of functionality and delay in returning to work, translating into increased costs. At the moment there is no national benchmark for the cost of this late-onset rehabilitation.

Material and methods: From a non-probabilistic sample for convenience, were analyzed records of 52 patients, treated in the period from January to December 2019. Inclusion criteria were workers diagnosed with a proximal humeral fracture, conservative management; exclusion criteria were peripheral nerve injury, aggregate fracture or surgically treated.

Results: The mean direct medical cost was $19,090.69 Mexican pesos, directly proportional to the days of stay in the unit and disability.

Conclusion: Late rehabilitation leads to more days of disability than recommended by the based guidelinesin the workload, therefore, higher cost.

Introduction: Major orthopedic surgery such as total hip arthroplasty (THA) is associated with an increased risk of postoperative complications. Candidates for THA are often older adults, with comorbidities that increase the risk of major bleeding, the IMPROVE scale has independent actors on the risk of bleeding according to the characteristics of the patients at hospital admission. It foresees the possibility of hemorrhage and the need for blood transfusion, being support in decision-making in the planning of a safe THA with the provision of the necessary resources.

Objective: To evaluate the sensitivity, validity and reliability of the modified IMPROVE scale in patients undergoing primary total hip arthroplasty.

Material and methods: Study of processes with a sample of 131 patients undergoing primary THA, in the period from January 01, 2018 to July 01, 2018.

Results: The scale presents good reliability, as for the performance of the scale, a good sensitivity was obtained, classifying 96.9% of the patients correctly; which is suitable for the type of scale.

Conclusions: The modified IMPROVE scale is a discretely adequate and useful tool for the prognosis of bleeding risk in patients who undergo THA, compared with other assessment scales developed in other geographical areas. It is recommended to continue with the study of risk factors for major bleeding in this specific population.

Introduction: Tranexamic acid is an antifibrinolytic drug which has been used in many disciplines of Medicine, as well as in Orthopaedics and Traumatology, with the objective of diminishing and preventing blood loss and the necessity of allogenic blood transfusion. This study has the objective to demonstrate the uses, indications and contraindications of tranexamic acid in the different subspecialties of Orthopaedics and Traumatology.

Material and methods: A through search was performed looking at the most recent evidence regarding the use of tranexamic acid in the different subspecialties of Orthopaedics and Traumatology, as well as its indications, contraindications and adverse effects.

Results: Tranexamic acid has a great amount of applications in Orthopaedics and Traumatology, especially in primary and revision knee and hip arthroplasties, spine surgery and trauma. It has been observed that tranexamic acid is effective in diminishing perioperative bleeding, less necessity of blood transfusion, among other benefits. Tranexamic acid is a safe drug, which does not increase the risk of developing thrombotic events in healthy patients. There are a number of administration routes of tranexamic acid as well as many dosage regimens, all being efficient. Therefore, no standardization regarding the best administration route and most effective dose has been established.

Conclusions: Tranexamic acid is a safe and effective drug for diminishing perioperative bleeding and to avoid the necessity of blood transfusion, with many applications in Orthopaedics and Traumatology.

SCIWORA (Spinal Cord Injury without Radiologic Abnormality) is a rare condition that mainly affects pediatric patients; We present the case of a teenage male patient diagnosed with SCIWORA/Brown Séquard Syndrome. In admission, he has multiple bruises on his neck and right hemibody and immediately he refers paraesthesia in all four limbs and spastic hemiparesis with right predominance, as well as inability to stand up and urinary continence. Treatment based on NASCIS III study is initiated and after the imaging tests, a diagnosis has already been made. We present the most current definitions of SCIWORA and the recommendations to make its diagnosis, as well as its relationship and coexistence with spinal syndromes.

Introduction: Glenohumeral instability occurs in active-age patients with high recurrence rates in previously described treatments. The objective of the study was to analyze the functional and radiographic results of the patients that underwent a modified Eden-Hybinette technique.

Material and methods: From January 2017 to December 2019, 14 patients with post-traumatic anterior glenohumeral instability with glenoid bone loss higher or equal to 15% with or without Hill-Sachs lesion were included, qe used the modified Eden-Hybinette technique and outcomes were evaluated with WOSI and ROWE scales pre and post-procedure at 6, 12, and 24 months follow-up, a CT scan was performed at 6 weeks to evaluate the integration of the graft.

Results: Five women (35%) and nine men (65%) with a mean age of 39.1 (± 14) years were included. Ten involved the right shoulder (71.4%) and four the left one (28.5%). The results of WOSI and ROWE scales were statistically significant (p 0.05) in postsurgical evaluations as in all periods analyzed in contrast to a pre-surgical standing point; components of the WOSI test were also viewed separately (Sports, Lifestyle, Emotion, and Physical Symptoms) to assess if any of those separately could've altered or significantly influenced the total score obtained, but we found statistical significance (p 0.05) in all parameters. There was no recurrence or complications until the last follow-up.

Conclusions: The modified Eden-Hybinette technique offers good short-term functional results. It is a safe technique. Further studies are necessary to determine the effectiveness and possible long-term results and complications.

Introduction: Iron deficiency anaemia in orthopaedic surgery is common and there is increased risk of blood transfusion and associated adverse reactions. The management involves administration of iron (oral or intravenous) and erythropoietin stimulating agents.

Material and methods: We searched for PubMed, Embase, Google Scholar and Cochrane database to identify the studies from inception to April 2021. Randomized controlled trials with adult patients undergoing orthopedic surgery were included. The metanalysis compared patients who were administered combination of erythropoietin stimulating agents and iron in one group and iron alone. The primary outcome was the rate of blood transfusion and the secondary outcome studied were postoperative hemoglobin concentration, after treatment hemoglobin levels, and complications like mortality, stroke, myocardial infarction, deep vein thrombosis, pulmonary embolism and renal dysfunction.

Results: Eleven studies were included. The combination of ESA and iron decreased number of patients who required blood transfusion in comparison to patients treated with iron therapy alone (RR, 0.73; 95% CI, 0.59 to 0.91, I.

Conclusion: 2 = 65%; p = 0.005). In subgroup analysis with oral and intravenous iron, the difference was not statistically significant (p = 0.24). Administration of erythropoietin either in high ( 80,000 IU) or low dose ( 80,000 IU) resulted in lower blood transfusion rates (p = 0.0007) with no significant difference between groups. The risk of mortality, myocardial infarction, stroke, deep vein thrombosis or pulmonary embolism did not significantly increase. Combined administration of ESA and iron versus iron only reduces the number of red blood cell transfusions in the postoperative period in orthopedic procedures with minimal risk of complications.