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OBJECTIVE: To value the complications and sequels for patients with Lisfrancs fracture-luxation (FLL). MATERIAL AND METHODS: A transverse ambispective study of cohorts was realized of 83 patients by diagnosis of Lisfrancs fracture-luxation. There was in use a protocol of withdrawal of information with variables related to the injury, clinical, therapeutic parameters, complications and scales of clinical valuation. RESULTS: 66 patients (79.5%) presented complications grouping early and late. Analyzing the early complications, we observe 9 cases of postoperatory edema with inflammation and swelling, 3 cases of superficial infection, 2 cases of necrosis cutaneous that precise graft should free of skin (ILPH), 1 case of vascular complication, 1 case of pulmonary embolis (TEP), 1 case of loss of reduction in the precocious postoperatory, 1 case of bad reduction that was necessary new intervention. The late complications presented the following distribution: 41 patients (49.40%) presented radiological signs of degenerative osteoarthritis in the tarsometatarsal joint, 5 cases of Sudecks disease that needed treatment, 8 cases of decalcification for disuse, 12 cases of edema and residual inflammation, 1 case of loss of reduction in late phase, 1 case of hypertrophic scar with retractable bridle, 1 case of chronic osteomyelitis, 1 case of seudodegenerative osteoarthritis, 3 cases of late intolerance/infection to the osteosynthesis material, reintervention of 7 patients in phase of sequels where they were realized artrodesis. No break of material was observed of osteosynthesis. Almost the half of the patients (49.4%) they received some type of economic indemnification after the accident. CONCLUSIONS: The treatment of the FLL must be realized as soon as possible, providing that the general condition of the patient and of the soft parts allows it, since the stabilization in the brief space of time can help to improve the results. The anatomical reduction cannot grant a good result. An important number of patients had residual pain.

OBJETIVO: Valorar las complicaciones y secuelas del tratamiento de la fractura-luxación de Lisfranc (FLL). MATERIAL Y MÉTODOS: Se realizó un estudio de cohortes ambispectivo trasversal de 83 pacientes con diagnóstico de fractura-luxación de Lisfranc. Se utilizó un protocolo de recopilación de datos con variables relacionadas con la lesión, parámetros clínicos, terapéuticos, complicaciones y escalas de valoración clínica. RESULTADOS: 66 pacientes (79.5%) presentaron complicaciones tanto precoces como tardías. Las complicaciones precoces sumaron nueve casos de edema postoperatorio, tres de infección superficial, dos de necrosis cutánea que precisó injerto libre de piel (ILPH), uno de lesión vascular, uno de tromboembolismo pulmonar (TEP), uno de pérdida de reducción en el postoperatorio precoz, uno de mala reducción que precisó de nueva intervención. Entre las complicaciones tardías, 41 pacientes (49.40%) presentaron signos radiológicos de artrosis en la articulación tarsometatarsiana, cinco con enfermedad de Sudeck que precisó tratamiento, ocho con descalcificación por desuso, 12 con edema residual, uno con pérdida de reducción en fase tardía, uno con cicatriz hipertrófica y brida retráctil, uno con osteomielitis crónica, uno con seudoartrosis, tres con intolerancia/infección tardía al material de osteosíntesis; también hubo reintervención de siete pacientes en fase de secuelas donde se les realizó artrodesis. No se observó ninguna rotura de material de osteosíntesis. Casi la mitad de los pacientes (49.4%) recibieron algún tipo de indemnización económica tras el accidente. CONCLUSIONES: El tratamiento de las FLL debe realizarse lo antes posible, ya que la estabilización en un breve plazo de tiempo puede ayudar a mejorar los resultados. La reducción anatómica no predice los buenos resultados. Un número importante de pacientes refirió dolor residual.

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Sequelae of forefoot surgery range between 30 and 40%; the most frequent ones are transfer metatarsalgia and deformity relapse. Forefoot surgery complications disrupt biomechanics. Anterointernal weight bearing alteration is most frequent, due to involvement of the metatarsal, the phalanx or both. Metatarsophalangeal arthrodesis normalizes the length of the first ray and pressure transmission. The use of this technique has made it possible to confirm pain relief, as well as improved function and a better cosmetic result, which allows the patient to wear ormal footwear.

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We conducted an ambispective cohort study of 83 patients with a diagnosis of Lisfranc fracture dislocation from 1993 to 2008. The lesions were classified into two groups: pure dislocations and fracture dislocations of the Lisfranc joint using the Hardcastle-Reschamer classification. The results included the following data: sociodemographic and epidemiologic variables, lesion-related variables, clinical parameters, and the following clinical and functional assessment scales: Baltimore Painful Foot Score, Creighton-Nebraska Health Foundation, American Orthopaedic Foot and Ankle Society (AOFAS), and Hannover Scoring System. Sixty-three patients were treated surgically. Closed reduction and minimally invasive fixation with Kirschner nails were performed in 53 patients (63.9%), and open reduction with a dorsal approach and fixation with Kirschner nails in 10 cases (15.2%). In 46 cases de medial column was fixed, in 61 cases the intermediate column, and in 42 the lateral column. Sixty-six (79.5%) of the patients had complications including both acute and late ones. Regardless of the technique used, the purpose of treatment was the anatomical reduction of the involved joints. Based on our experience, we think that the use of Kirschner nails is effective, as it provides enough stiffness and stability. In general terms, this injury is not as disabling as it had been considered in the literature. Patients consider their discomfort as tolerable and compatible with the demands of their activities of daily living and they may perform their work considering the time limitations.

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The ankle soft tissue pathology represents a very painful disorder for patients who, often times, are not precisely diagnosed. Anterolateral ankle impingement is a condition that occurs in young people and athletes due to a plantar flexion-inversion mechanism. We report a case of anterolateral ankle impingement describing the arthroscopic technique and making the differential diagnosis considering other conditions.

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INTRODUCTION: Early fracture fixation is increasingly common in medical practice, and femur shaft fractures are the perfect prototype of the lesion warranting early surgery in polytraumatized patients. Damage control orthopedics (DCO) is defined as the minimally-traumatic interventions intended to provide quick stabilization of orthopedic injuries to minimize the systemic inflammatory response. MATERIAL AND METHODS: By means of an evidence-based medicine tool (CAT) we approach the benefit of long-bone fracture stabilization in polytraumatized patients trying to answer a specific clinical question from a concrete situation: What is the evidence of the safety and benefit of early stabilization of long-bone fractures in polytraumatized patients? RESULTS: The patient group whose fractures were stabilized after 48 hours had more clinical complications, alterations of lung parameters and a longer hospital stay. There is no complete evidence showing that early stabilization of long bones in patients with moderate or severe head trauma worsens or improves the outcomes. CONCLUSIONS: Urgent fracture stabilization should be an adjuvant to resuscitation. Early fracture stabilization contributes to reducing the ICU stay, the incidence of acute respiratory distress syndrome (ARDS), multiple organ failure (MOF) and sepsis, thus improving patient survival.

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La patología de partes blandas del tobillo supone trastornos muy dolorosos para los pacientes que en muchas ocasiones carecen de diagnóstico preciso. El pinzamiento anterolateral de tobillo es una patología que aparece en gente joven y deportistas por mecanismo de flexión plantar-inversión. Se presenta un caso de pinzamiento anterolateral de tobillo, describiendo la técnica artroscópica y planteando el diagnóstico diferencial con otras patologías (AU)

Diseases of the ankle soft tissues are very painful disorders for patients for whom many times there is no accurate diagnosis. Anterolateral ankle impingement is a condition occurring in young people and athletes for plantar-inversion flexion mechanism. We report the case of anterolateral ankle impingement with a description of the arthroscopic technique and considering the differential diagnosis with other diseases (AU)

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Objetivos. Los objetivos de este estudio son analizar las características epidemiológicas de las fracturas vertebrales osteoporóticas no quirúrgicas en mujeres, así como la posible relación que se da entre refractura y la existencia o no de tratamiento preventivo secundario contra la misma tras la primera fractura vertebral en un período de seguimiento de diez años. Métodos. Se realiza un estudio de cohortes clínicas retrospectivas de un total de 77 mujeres con fractura vertebral osteoporótica no quirúrgica con un tiempo de seguimiento de diez años. Como variable dependiente se considera el riesgo de refractura y como variables independientes la edad al ingreso, el número de fracturas vertebrales osteoporóticas, los cambios en la actividad de la vida, el dolor de espalda, el tratamiento, el tratamiento previo con corticoides, las benzodiacepinas o psicotrópicos, el tabaco, el consumo de alcohol, el déficit estrogénico, el peso, la vida sedentaria, el déficit visual, la patología tiroidea y la dificultad para levantarse de la silla. Resultados. El riesgo de nueva fractura vertebral o no vertebral a los 10 años tras la primera fractura es del 26%. Al comparar los riesgos de refractura atendiendo las características epidemiológicas, observamos que el porcentaje de refracturas aumenta con respecto al número de fracturas vertebrales en el primer episodio, siendo del 21,4% en el caso de una fractura vertebral, del 25,4% en el caso de dos fracturas vertebrales y del 50% cuando se trata de tres. La mayoría de las fracturas ocurren tras accidentes dentro de la rutina de la vida diaria. Sin embargo, no todos los pacientes experimentan un restablecimiento completo tras la fractura, ya que alrededor del 35% de estos enfermos sufren síntomas persistentes. Conclusiones. Los factores relacionados estadísticamente con la refractura son la edad mayor de 70 años, la deprivación de estrógenos y la dificultad para levantarse de la silla. Las pacientes que han recibido tratamiento frente a la osteoporosis tras la primera fractura vertebral tienen menos riesgo de refractura (odds ratio [OR]: 0,32) con respecto al grupo que no ha recibido tratamiento alguno frente a la osteoporosis(AU)

Objectives. This study has aimed to study the epidemiological characteristics of non-surgical osteoporotic vertebral fractures in women and the possible relationship existing between refracture and the existence or non-existence of secondary preventive treatment against it after the first vertebral fracture in a 10-year follow-up period. Methods. A clinical retrospective study of cohorts of a total of 77 women with non-surgical osteoporotic vertebral fracture with a 10-year follow-up period was performed. The dependent variable was considered to be risk of refracture and independent variables as age on admission, number of osteoporotic vertebral fractures, changes in life activity, back pain, treatment, previous treatment with corticosteroids, benzodiazepines or psychotropics, tobacco, alcohol consumption, estrogen deficit, weight, sedentary lifestyle, visual deficit, thyroid disease and difficulty getting up from the chair. Results. The risk of a new vertebral or non-vertebral fracture at 10 years after the first fracture is 26.0%. When the risks of refracture are compared according to the epidemiological characteristics, we observe that the percentage of refractures increases in regards to the number of vertebral fractures in the first episode, this being 21.4% in the case of one vertebral fracture, 25.4% in the case of two vertebral fractures and 50% when there are three vertebral fractures. Most of the fractures occur after accidents within the daily life routine. However, not all the patients have complete restablishment after the fracture, since approximately 35% of these patients suffer persistent symptoms. Conclusions. The factors that are statistically related with refracture are age over 70 years, estrogen deprivation and difficulty getting out of the chair. Patients who received treatment for osteoporosis after the first vertebral fracture have a lower risk of refracture (OR of 0.32) in regards to the group that did not receive any treatment for osteoporosis(AU)

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