Acta ortopedica mexicana最新文献

Introduction: the recurrent dislocation of the patella is a condition in which the congruence of the surface of the patella is not maintained in its displacement on the intercondyleal groove of the femur in the flexo-extension movements of the knee. The objectives of the study are: to show the distribution of patients with recurrent dislocation of patella according to different socio-demographic variables and to evaluate the results with the use of campbell's technique.

Material and methods: An observational study was conducted in patients with recurrent patella dislocation in the period from December 2017 December 2019. Data collection was carried out with the review of medical records. The sample was 19 patients, the evaluation of the surgical technique was used the system proposed by the authors. Information processing included the calculation of summary measures for qualitative variables, absolute frequencies and percentages.

Results: The female sex and the age group of 15 to 30 years were the most frequent, healing was poor in two patients, good results were obtained in 84.3% of the operated patients.

Conclusions: Predominance of the female sex and the group of 15 to 30 years, the healing was bad in two patients, good results were obtained in the operated patients. Although most authors recommend medial patello-femoral ligament repair as a technique of choice or the Insall technique, Campbell's technique yields good results when applied to recurrent patella dislocation that need proximal realignment of the extensor mechanism.

Introduction: Complex acetabulum fractures are a challenge for orthopedic surgeons. An evaluation of the radiographic reduction and functional result of the patients with complex fracture of the acetabulum who underwent the combined Kocher-Langenbeck and Stoppa approach was carried out.

Material and methods: Cross-sectional, descriptive, ambispective design. Patients with complex acetabulum fracture who underwent the combined Kocher-Langenbeck approach plus Stoppa between 2016 and 2020 were included. The clinical records were reviewed, and the quality of the radiographic reduction was evaluated according to Matta criteria. In addition, a functional evaluation was performed with the Merle d'Aubigne and Postel scale at least 12 months after the injury.

Results: Of the 31 patients, the average time between the date of fractures and the surgical intervention was 13.7 days (3-38 days). In the radiographic evaluation according to Matta criteria, 21 anatomical patients (67.7%), 7 almost anatomical (22.5%), 3 imperfect (9.6%). Functional results according to the Merle d'Aubigne and Postel scale resulted in 8 (25.8%) with excellent results, 16 (51.6%) with good results, 5 (22.5%) moderate and 2 (16.1%) poor patients. There was a statistical correlation between the age of the patient and the functional result (p = 0.029), also between the body mass index and blood loss (p = 0.027).

Conclusion: The combined Kocher-Langenbeck plus Stoppa approaches are a valid alternative in these lesions, mostly with anatomical and almost anatomical radiographic results according to the Matta radiographic scale, and with excellent and good functional results according to the Merle d'Aubigne and Postel scale.

Introduction: Rotator cuff (MR) ruptures occur in more than 50% of patients over the age of 60, and can cause changes in normal shoulder biomechanics that can trigger rotator cuff tear arthropathy. There is currently no consensus on treatment for massive rotator cuff tears.

Objective: To evaluate the clinical and radiographic outcomes of subacromial balloon placement in these lesions.

Material and methods: Analytical, longitudinal and retrospective study of 10 consecutive patients treated with the use of the subacromial balloon. Constant (CS) and ASES scales were used preoperatively and at 6, 12 months of post-surgical follow-up. Radiographic results were assessed using the Acromio-humeral Interval (AHI) on a true AP shoulder X-ray.

Results: The average improvement in CS was 41.7 ± 8.93 at 12 months of follow-up, the ASES scale showed an average improvement of 64.6 ± 4.9 at 12 months of follow-up. The presurgical AHI was 6.1 ± 1.10 and the mean at 12 months of follow-up was 7.1 ± 0.9. Clinical and radiographic improvement was observed at all scales, however no statistically significant results were found.

Conclusion: The subacromial balloon prevents the ascent of the humeral head in the first 12 months of placement; we assume that it could restore normal glenohumeral kinematics by improving mobility and decreasing pain.

Introduction: Total hip arthroplasty is popular for its success in treating coxarthrosis, its associated with substantial blood loss. Significant bleeding causes complications such as increase in hospitalization days, higher costs, exposing the patient to complications associated with blood transfusion. The aim of the study is to investigate the association between preoperative plasma fibrinogen concentration and trans-surgical bleeding and determine fibrinogen level cut-off to present greater trans-surgical bleeding.

Material and methods: Retrospective, observational, analytical study, from June to December 2020, including 227 patients with Kellgren and Lawrence scale IV coxarthrosis undergoing primary total hip arthroplasty, beneficiaries, older than 18 years, without liver or hematological diseases, and history of significant surgical bleeding.

Results: Mean preoperative hemoglobin value was 14.6 ± 1.3 g/dl, after surgery (48 hours) 10.5 ± 1.4 g/dl; decrease of 4.1 ± 1.2 g/dl (p 0.0001). Mean preoperative hematocrit value 43% [41-45], after the procedure; 32% [29-35]; decrease of 11% [8-14] (p 0.0001). 98 patients had intraoperative bleeding 300 ml, 129 had 300 ml; 61.2% of patients with bleeding greater than 300 ml had fibrinogen values below the cut-off point (388 mg/dl).

Conclusion: In postoperative patients, preoperative fibrinogen levels 388 mg/dl and age 58 years were associated with an increased risk of OR = 0.18 (95% CI 0.10-0.32) of presenting trans-surgical bleeding 300 ml, with a decrease in Hb of 4.1 ± 1.2 g/dl (p = 0.0001) and Hto of 11% [8-14] (p = 0.0001) between the pre and postoperative period in 48 hours.

No Abstract available.

Introduction: The aneurysmal bone cyst is a rare benign but aggressive osteolytic tumor for which there is still no ideal treatment, the reports on treatment by sclerotherapy in the pediatric population are scarce and in our region even less. The objective is to communicate the experience of the treatment of aneurysmal bone cyst with polydocanol 3%.

Material y methods: Retrospective, descriptive and cross-sectional study. Period: June/2017 to June/2021. Inclusion: patients with histological diagnosis of aneurysmal bone cyst; Under general anesthesia and fluoroscopic guidance, intralesional puncture with 16G needle was performed through which 3% polydocanol was slowly administered. Data: medical history. Quantitative variables shall be expressed in measures of central tendency and dispersion; qualitative variables shall be expressed as frequencies or percentages.

Results: Nine consecutive patients were included, all of whom had pain and tumor in one of the extremities. Gender: 3 female and 6 male. Age: median 10.5 years (range: 2-15.1). Weight: median 32.8 kg (range: 11-44.5). Total procedures: 44; procedures per patient: mean 4.9 (SD: ± 2.0). Procedure time: mean 33.9 minutes (SD: ± 18.3); radiation: mean 1.34 mGy (SD: ± 1.55). Hospitalization: one day, except one patient. Complications: skin damage in one case, no recurrences follow-up: 12 to 50 months.

Conclusion: In this pediatric series, polydocanol 3% was useful and effective for the treatment of aneurysmal bone cyst, with few complications. One disadvantage is that it requires several sessions and in addition, no significant difference has been demonstrated between other forms of treatment in terms of the recurrence rate.

Introduction: Proximal tibiofibular joint dislocations (PTFJD) are uncommon and underdiagnosed injuries. Urgent reduction is mandatory to avoid chronic disfunction. The scarcely available literature does not present a unified management guideline. An acute PTFJD case report with spontaneous reduction and a review of the literature is presented, aiming to assist the diagnosis and management of this pathology.

Case report: A 22-years old male presented to the emergency department with high intensity right knee pain after falling in a four-wheel motorcycle. The physical exam revealed a prominent painful mass on the lateral aspect of his knee and proximal leg. His range of motion and knee stability were unremarkable. X-rays were informed negative for musculoskeletal injuries. According to a sustained suspicion of PTFJD, the study was continued with a magnetic resonance imaging (MRI), which suggested PTFJD. During the following 24 hours, the patient referred he was entirely asymptomatic after feeling a loud "clank". He has been followed for three months with MRI, and remains asymptomatic with full functions.

Conclusion: PTFJD diagnosis requires appropriate images. Urgent close reduction is mandatory; if unsuccessful, open reduction, primary repair and internal fixation are indicated. The prognosis of spontaneous reduction remains uncertain and requires a serial clinical evaluation. In the case of recurrence, the appropriate surgical management is indicated according to the elapsed time from the injury.

Marfan syndrome ([MS], OMIM 154700) is a connective tissue disorder that exhibits an autosomal dominant pattern of inheritance, whose clinical characteristics can affect multiple systems or organs in a variable way. It is caused by mutations in the FBN1 gene (OMIM 134797) located at 15q21.1. Neonatal MS is an uncommon variety of the entity associated with missense mutation between exons 23-33 and truncating mutations, exhibits a more severe phenotype and high percentage of mortality in the first years of life. The case of male adolescent with neonatal MS and missense mutation (c.3037G> A; p.Gly225Arg) in exon 24 of the FBN1 gene is presented. Given these findings, interfamilial phenotype variation, the early interdisciplinary medical evaluation necessary for the management of possible complications, as well as the appropriate family genetic counseling were studied.

Introduction: The anterior cruciate ligament is an anatomical structure that tends to cause problems for specialists when formulating an accurate diagnosis. There are measurement tools that support the diagnosis such as the KT1000; however, it still has some limitations, since it only manages to measure a single axis of movement, while the "pivot-shift" maneuver manages to capture more information about the state of the ligament, as it allows to evaluate the three axes of movement of the joint. The "pivot-shift" maneuver lacks a standard execution, therefore it can produce disagreement between evaluators; this creates the need for a tool capable of standardizing the maneuver, while providing an interpretable measurement.

Material and methods: Pivot-shift meter application, a mobile software capable of capturing information on the movements made when executing a pivot maneuver. Intraclass correlation coefficient to measure the intra- and inter-observer correlation of the information captured by the application. The data was obtained from 66 random participants, using the mobile phone's built-in gyroscopes.

Results: With the 66 tests carried out, it was observed that the evaluators tend to achieve high reproducibility when executing the maneuvers within the time period established by the application, which reached an intraclass correlation coefficient above 90%.

Conclusion: The intra- and inter-observer correlation is high enough to be able to perform a quantitative analysis of the pivot-shift maneuver, through a mobile phone.

Introduction: Transtrochanteric fractures represent 50% of proximal femur fractures, with a higher incidence in patients older than 65 years. The objective of the study is to evaluate the association of orthopedic factors with the presence of mediate complications in post-operative geriatric patients for transtrochanteric fractures with the 135o dynamic hip screw (DHS) system.

Material and methods: Retrospective, analytical study. We evaluated patients older than 65 years with transtrochanteric fractures treated with 135o DHS. We analyzed pre-surgical, post-surgical, and 3 and 6-month radiographs. We performed a descriptive analysis of the population characteristics, comparison analysis of means (Mann-Whitney U) and proportions (chi square), correlation analysis, and a logistic regression model to determine the degree of association of the factors with mediate complications.

Results: We evaluated 92 patients with a mean age of 83 ± 6.7 years. We evidenced mediate orthopedic complications in 8.7%; considering as the most frequent the cut-out (5.4%). In the correlation analysis, the peak apex index > 25 has a weak correlation (r = 0.372), the peak apex index modified to calcar > 27 moderate correlation (r = 0.528). The lateral cervico-diaphyseal angle > 20° has a high correlation (r = 0.7). In the regression analysis, the latter was associated with the presence of mediate orthopedic complications (OR 4.93, CI 1.2-15.81, p = 0.000).

Conclusions: A correlation was observed between factors such as tip apex index > 25, tip apex index modified to calcar > 27 and cervical-lateral diaphyseal angle > 20o with the presence of complications, highlighting the latter as the factor that presents association with statistically significant differences.