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BACKGROUND: The introduction of firearms has increased deaths, assassinations and suicides. Firearm projectile injuries (PAF) increasingly affect civilian populations (500,000 injuries annually), it is the second cause of death in young people. Half required fracture treatment (45%), accompanied by reports of 6% who developed a deep infection. MATERIAL AND METHODS: Retrospective, observational, cross-sectional study in four hospitals of the Secretary of Health of CDMX of the frequency of infection in fractures exposed by PAF and if there is any other factor that is associated with the infection. RESULTS: In the review of the files of the four hospitals, 67 patients were found, men, with an incidence of infections of 4.5%, when analyzing the risk factors these did not present a significant association. DISCUSSION: No risk factor has statistical significance for any infectious process to occur, probably due to a good initial treatment.

ANTECEDENTES: La introducción de armas de fuego ha incrementado las muertes, asesinatos y suicidios. Las lesiones por proyectil de arma de fuego (PAF) afectan cada vez más a poblaciones civiles (500,000 lesiones anualmente) y es la segunda causa de muerte en jóvenes. La mitad requiere tratamiento de fracturas (45%), acompañado de reportes de 6% que desarrollaron una infección profunda. MATERIAL Y MÉTODOS: Estudio retrospectivo, observacional y transversal en cuatro hospitales de la Secretaría de Salud de la CDMX de la frecuencia de infección en fracturas expuestas por PAF y si existe algún otro factor que acompañe a la infección. RESULTADOS: Se encontraron en la revisión de los expedientes de los cuatro hospitales a 67 pacientes, hombres, con una incidencia de infecciones de 4.5%, al analizar los factores de riesgo éstos no presentaron asociación significativa. DISCUSIÓN: Ningún factor de riesgo posee significancia estadística de que se presente algún proceso infeccioso, probablemente por un buen tratamiento inicial.

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Resumen: Antecedentes: La introducción de armas de fuego ha incrementado las muertes, asesinatos y suicidios. Las lesiones por proyectil de arma de fuego (PAF) afectan cada vez más a poblaciones civiles (500,000 lesiones anualmente) y es la segunda causa de muerte en jóvenes. La mitad requiere tratamiento de fracturas (45%), acompañado de reportes de 6% que desarrollaron una infección profunda. Material y métodos: Estudio retrospectivo, observacional y transversal en cuatro hospitales de la Secretaría de Salud de la CDMX de la frecuencia de infección en fracturas expuestas por PAF y si existe algún otro factor que acompañe a la infección. Resultados: Se encontraron en la revisión de los expedientes de los cuatro hospitales a 67 pacientes, hombres, con una incidencia de infecciones de 4.5%, al analizar los factores de riesgo éstos no presentaron asociación significativa. Discusión: Ningún factor de riesgo posee significancia estadística de que se presente algún proceso infeccioso, probablemente por un buen tratamiento inicial.

Abstract: Background: The introduction of firearms has increased deaths, assassinations and suicides. Firearm projectile injuries (PAF) increasingly affect civilian populations (500,000 injuries annually), it is the second cause of death in young people. Half required fracture treatment (45%), accompanied by reports of 6% who developed a deep infection. Material and methods: Retrospective, observational, cross-sectional study in four hospitals of the Secretary of Health of CDMX of the frequency of infection in fractures exposed by PAF and if there is any other factor that is associated with the infection. Results: In the review of the files of the four hospitals, 67 patients were found, men, with an incidence of infections of 4.5%, when analyzing the risk factors these did not present a significant association. Discussion: No risk factor has statistical significance for any infectious process to occur, probably due to a good initial treatment.

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Resumen: Antecedentes: El síndrome de Escobar o de pterigium múltiple en su variante no letal es una entidad con tipo de herencia autosómica recesiva ligada al cromosoma X; se caracteriza por presentar múltiples pterigiones -de ahí su nombre-, principalmente localizados en cuello (95%) y axilas (55%), así como otras malformaciones de tipo ortopédico como astrágalo vertical, luxación congénita de cadera y escoliosis congénita. Objetivo: Dar a conocer una técnica quirúrgica opcional para el manejo de deformidades vertebrales severas en pacientes con este síndrome. Caso clínico: Femenina de 12 años de edad con diagnóstico de síndrome de Escobar con escoliosis severa que condiciona malformaciones de la caja torácica con compromiso pulmonar, produciendo restricción de la mecánica ventilatoria e incrementando el riesgo de infección severa de vías aéreas inferiores. Se realiza instrumentación posterior con manos libres y sistema PASS LP más osteotomías de Smith-Petersen. Conclusiones: Mejora del ángulo de Cobb de 62° a 23°, así como del balance sagital de 125 mm a 73 mm.

Abstract: Background: The non-lethal variant of the Escobar or multiple pterygium syndrome is an entity of autosomal recessive inheritance linked to the X chromosome; it is characterized by multiple pterygia (hence its name) located mainly in the neck (95%) and armpits (55%), as well as other orthopedic malformations such as a vertical talus, congenital hip dislocation, and congenital scoliosis. Objective: To present an optional surgical technique for the management of severe spinal deformities. Case report: Twelve-year-old female diagnosed with Escobar syndrome with severe scoliosis which conditions malformations of the chest with lung involvement, producing mechanical ventilatory restriction and increasing the risk of severe lower respiratory tract infection. We performed a hands-free posterior instrumentation with PASS LP system and Smith-Petersen osteotomies. Conclusions: The Cobb angle improved from 62° to 23° and the sagittal balance from 125 mm to 73 mm.

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BACKGROUND: The non-lethal variant of the Escobar or multiple pterygium syndrome is an entity of autosomal recessive inheritance linked to the X chromosome; it is characterized by multiple pterygia (hence its name) located mainly in the neck (95%) and armpits (55%), as well as other orthopedic malformations such as a vertical talus, congenital hip dislocation, and congenital scoliosis. OBJECTIVE: To present an optional surgical technique for the management of severe spinal deformities. CASE REPORT: Twelve-year-old female diagnosed with Escobar syndrome with severe scoliosis which conditions malformations of the chest with lung involvement, producing mechanical ventilatory restriction and increasing the risk of severe lower respiratory tract infection. We performed a hands-free posterior instrumentation with PASS LP system and Smith-Petersen osteotomies. CONCLUSIONS: The Cobb angle improved from 62° to 23° and the sagittal balance from 125 mm to 73 mm.

El síndrome de Escobar o de pterigium múltiple en su variante no letal es una entidad con tipo de herencia autosómica recesiva ligada al cromosoma X; se caracteriza por presentar múltiples pterigiones de ahí su nombre, principalmente localizados en cuello (95%) y axilas (55%), así como otras malformaciones de tipo ortopédico como astrágalo vertical, luxación congénita de cadera y escoliosis congénita.

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Resumen: Introducción: La luxación radio-humeral es rara, ya que generalmente se acompaña de fractura de cúbito. En los niños es poco común, y las lesiones crónicas son casos aún más infrecuentes. Objetivo: Presentación de un caso, su tratamiento y su seguimiento a dos años. Material y métodos: Se le realizó reducción abierta y plastía del ligamento anular con aloinjerto de fascia lata, manteniendo la reducción con clavo de Kirschner por seis semanas; se retiró e inició su rehabilitación. Resultado: A los dos años de seguimiento, el paciente se ha reincorporado a sus actividades en la escuela y físicas. Discusión: En cuanto a las técnicas para resolver las luxaciones inveteradas, refieren los autores que se debe acortar el cúbito para que se pueda reducir el radio y mantener. Se realizó una modificación a la técnica descrita convencionalmente, con buenos resultados.

Abstract: Introduction: Radio-humeral dislocation is rare, as it generally occurs with ulnar fracture. It is unusual in children and chronic lesions are even more unusual. Objective: Report of a case, its treatment and two-year follow-up. Material and method: Treatment consisted of open reduction and annular ligamentoplasty with fascia lata allograft, maintaining the reduction with a Kirschner nail for 6 weeks. The latter was then removed and rehabilitation was started. Result: The two-year follow-up report stated that the child has resumed his activities at school and his physical activity. Discussion: The authors report that the techniques used to approach inveterate lesions should include shortening the ulna to be able to reduce the radius and maintain it. The standard technique was modified and good results were obtained.

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INTRODUCTION: Radio-humeral dislocation is rare, as it generally occurs with ulnar fracture. It is unusual in children and chronic lesions are even more unusual. OBJECTIVE: Report of a case, its treatment and two-year follow-up. MATERIAL AND METHOD: Treatment consisted of open reduction and annular ligamentoplasty with fascia lata allograft, maintaining the reduction with a Kirschner nail for 6 weeks. The latter was then removed and rehabilitation was started. RESULT: The two-year follow-up report stated that the child has resumed his activities at school and his physical activity. DISCUSSION: The authors report that the techniques used to approach inveterate lesions should include shortening the ulna to be able to reduce the radius and maintain it. The standard technique was modified and good results were obtained.

INTRODUCCIÓN: La luxación radio-humeral es rara, ya que generalmente se acompaña de fractura de cúbito. En los niños es poco común, y las lesiones crónicas son casos aún más infrecuentes. OBJETIVO: Presentación de un caso, su tratamiento y su seguimiento a dos años. MATERIAL Y MÉTODOS: Se le realizó reducción abierta y plastía del ligamento anular con aloinjerto de fascia lata, manteniendo la reducción con clavo de Kirschner por seis semanas; se retiró e inició su rehabilitación. RESULTADO: A los dos años de seguimiento, el paciente se ha reincorporado a sus actividades en la escuela y físicas. DISCUSIÓN: En cuanto a las técnicas para resolver las luxaciones inveteradas, refieren los autores que se debe acortar el cúbito para que se pueda reducir el radio y mantener. Se realizó una modificación a la técnica descrita convencionalmente, con buenos resultados.

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Bone tissue is the most widely used tissue for the treatment of various conditions. As a result of this, allografts are used at an increasing frequency and processes for their harvest, preservation and sterilization have improved. The sterilization method that grants the greatest sterilization is high-dose gamma radiation, which destroys prions and any microorganism thus assuring that patients will not experience any infection. But given that radiation use has proven to deteriorate bone and tendon tissue, efforts have been made to protect the latter. One way to do this is a commercially available substance called Clearant. Studies conducted elsewhere have found that it does protect bone and tendon tissue. This study was therefore conducted with allograft samples exposed to high-dose radiation. Its purpose was to assess, with photon microscopy using various dyes and electron microscopy, the presence of color changes as well as the destruction of the anatomical structure. The same tissue was followed-up throughout the process until it was placed in the patient. The review found no structural changes in bone and tendon tissues exposed to high radiation doses (60 kilograys) when the Clearant process was used, and concluded that the former may be used safely in orthopedic or traumatologic diseases.

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Serious soft tissue lesions in patients with high energy trauma are usually underdiagnosed. They are considered as true surgical emergencies that, without an early diagnosis and treatment, lead to high morbidity and mortality rates. We report herein the case of a patient who sustained a high energy lesion and developed compartmental syndrome of the thigh associated with a Morel-Lavallée lesion, including the therapeutic approach used and the results obtained.

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Rupture of Achilles tendon occurs at 2-6 cm from its attachment in the calcaneus; its frequency is estimated at 7-18 cases per 100,000 population in the United States and it occurs more frequently in males. The diagnosis is made clinically and with ultrasound or magnetic resonance imaging and treatment may be divided into acute or late. We present herein the use of allograft to treat patients with ruptures more than six weeks old; several techniques were used depending on the rupture site and the available allograft. Ten plasties were performed in ten patients with ruptures that occurred a mean of 8 months back; early rehabilitation was instituted and weight bearing was allowed at 4 weeks with a brace, which was removed at 12 weeks; patients could run at 12 weeks. Four wound dehiscence complications were reported, which resolved with second intention healing without the need for any other surgery, with good results and patient satisfaction.

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A patellar tendon tear needs a force equivalent to 15 times the weight to overcome the strength of the tendon. It usually occurs in patients from their twenties on, regardless of gender. The diagnosis is made based on the symptoms of pain, impaired ranges of motion, and limitation upon climbing stairs. Pain subsides at two weeks but the limitation of physical activity continues and patients learn to carry out their activities with that disability and therefore they do not get treatment, so the diagnosis is usually made late. Treatment is difficult, as the tendon shortens upon being torn and requires an external reinforcement or an autologous graft; various techniques for repair may be used. The case of a patient with patellar tendon tear is presented herein. She sought treatment 6 months later and was treated with the Ecker, Lotke and modified Glazer technique with a semitendinous and gracilis allograft. She underwent early rehabilitation and quadriceps strengthening. She currently has 110 degrees of flexion, 0 degrees of extension and can carry out activities of daily living and work activities, as she is a laborer.

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