RESUMEN

Spinocellular carcinoma is a tumor lesion that frequently occurs in photo-exposed areas, presenting characteristics such as keratinization, scaly areas and even ulcerations. Its potential for metastasis makes early identification and diagnosis essential in order to carry out correct treatment of said lesion. In the spectrum of spinocelullar carcinomas is Keratoacanthoma, which has been in debate about its origin and its benignity. We present the clinical evolution, treatment, results, and bibliographic review of a keratoacanthoma.

El carcinoma espinocelular es una lesión tumoral que se da frecuentemente en zonas foto-expuestas, presentando características tales como queratinización, zonas descamativas e incluso ulceraciones. Su potencial de metástasis hace imprescindible la identificación y diagnóstico precoz para poder realizar un correcto tratamiento de dicha lesión. Dentro de su espectro se encuentra el Queratoacantoma, el cual ha estado en debate sobre su origen y su benignidad. Nosotros presentamos la evolución clínica, tratamiento, resultados y revisión bibliográfica de un queratoacantoma.

Asunto(s)

RESUMEN

INTRODUCTION: Coverage defects of the hand and wrist are usually secondary to high-energy trauma, these must be resolved quickly to protect the underlying vital structures, preserve hand functions and allow early rehabilitation. The dorsal ulnar artery flap (Becker flap), in addition to being a non-demanding surgical technique, has the main advantage of preserving the main vascular axes of the forearm. MATERIALS AND METHOD: Retrospective descriptive study in patients with post-traumatic coverage defect in the dorsum-ulnar aspect of the hand, who were managed with a Becker flap between January 2015 and December 2018.Was analyzed age, sex, mechanism of injury, surgical time, size of the defect, type of donor site closure, complications, and functional outcomes/pain/satisfaction/range of motion with the Mayo Modified Wrist score. RESULTS: In total there were 5 cases, all male, with an average age of 53 (31-58) years, who suffered a high-energy trauma. There were 2 complications, one partial epidermolysis and one deep infection with loss of the flap. Follow-up time was 12 weeks for all cases. The results of the Mayo Modified Wrist Score on average were 72 points. CONCLUSION: The Becker flap is a reproducible, rapid dissection, non-demanding, and one-stage technique. The early use of this flap allows the preservation of vital structures, decreases morbidity, allowing early rehabilitation and an early return to work.

Asunto(s)

RESUMEN

Introduction: Periprosthetic infection (PPI) is one of the most devastating complications of total knee arthroplasty (TKA). The incidence described in the literature is 2.4% and the most frequently isolated bacteria are Staphylococcus Aureus and Staphylococcus Coagulase-Negative (Gram positive). Polymicrobial infections represent between 10 to 37% and negative cultures between 7 to 15%. Methodology: Descriptive and retrospective study that consisted of reviewing the TKA database of the Regional Hospital of Talca during the 2018-2020 period, where knee PPIs were identified according to the diagnostic criteria validated in 2018. The cultures of patients diagnosed with PPI were reviewed, analyzing the antibiogram and resistance profile. Results: During 2018-2020, 459 TKAs were performed in our center, diagnosing 30 PPIs of the knee. 47% of PPIs were acute and 53% chronic. The results of the cultures were negative in 26.6%, 23.3% Methicillin Sensitive Staphylococcus Aureus; 13.3% Methicillin Resistant Staphylococcus Epidermidis and 13.3% of the cultures were polymicrobial. Discussion: Highlights the high resistance to methicillin, especially of Staphylococcus Epidermidis. This opportunistic pathogen has the ability to form a biofilm and, thanks to its genomic flexibility, rapidly acquires resistance to antibiotics. Polymicrobial infections have a synergistic effect that favors the persistence of the infection, which is why they will require a greater number of surgeries and prolonged antibiotic therapy. Pruebas especiales como la sonicación podrían aumentar las posibilidad de identificar al microorganismo. Conclusion: In these three years of follow-up, the PPI rate has been higher than reported annually in the literature. Gram-positive microorganisms continue to predominate, but with an increase in the rate of resistant to methicillin. Also, highlight the number of negative cultures. There would be a possible benefit theoretical in optimizing antibiotic prophylaxis in view of the large percentage of methicillin resistance and in seeking new ways to reduce negative cultures.

Asunto(s)

RESUMEN

Tibial pilon fractures are a complex injury to treat due to the great involvement of soft and bone tissues. The classic surgical treatment is based on open reduction with internal fixation (ORIF), adding morbidity to the soft tissues, increasing the risk of complications. This has motivated the development of minimally invasive and/or percutaneous techniques to reduce complications, and with the advent of arthroscopy, achieve anatomical reductions. METHODS: A retrospective observational study of twelve patients with tibial pilon fractures who were treated in our center with minimally invasive and/ or percutaneous osteosynthesis with arthroscopic support was carried out between January 2019 and June 2021. Fractures were characterized using the AO/OTA classification for tibial pilon. Age, sex, fracture mechanism, exposure and initial management in the emergency department (cast immobilization or external fixation), definitive treatment, complications and clinical and functional evaluation twelve months after definitive osteosynthesis. For this last point, plantar flexion, dorsiflexion and the AOFAS and FAOS Score were measured. RESULTS: The operated patients were 12, 8 were men (67%) and 4 were women (33%). The average age was 49 (17-68) years. The definitive treatment was carried out after an average of 8 days (5-12 days). Surgical treatment schemes were as follows: percutaneous osteosynthesis with medial anatomical plate and arthroscopic support (OPAA), minimally invasive osteosynthesis with cannulated screws and arthroscopic support (OMIAA) and osteosynthesis with external circular guide and arthroscopic support (OTCAA). In the AOFAS Score, three patients had excellent results (≥ 90 points), 6 patients had good results (≥ 80 points) and 3 patients had acceptable results (≥ 70 points). In the FAOS Score, eight patients had over 80% (good results) and 4 patients had over 60% (accep - table results). DISCUSSION: Historically, tibial pilon fractures have been considered non-reconstructable and with poor long-term results. Initially this paradigm changed with the principles of Rüedi for the reconstruction of the tibial pilon and improve the results. ORIF has been widely used until today, it allows achieving an anatomical joint reduction, it allows to give stability and length to the fibula, graft contribution and sta - bilization with the medial plate. Today this concept is changing again, since the emphasis is on the care of the soft tissues to allow a better recovery of the patient and reduce the complications of the classic approach, it is in this context that the appearance of minimally invasive and/or percutaneous techniques with arthroscopic assistance has allowed us to have excellent functional and clinical results with less da - mage to the soft tissues. CONCLUSION: The proper management and care of the soft tissues in a high-energy fracture of the tibial pilon is essential to obtain favorable clinical results and thus achieve restoration of ankle function. Percutaneous and minimally invasive management has optimized management of the tibial pilon, redu - cing the rates of complications, amputation, and pri - mary arthrodesis.

Asunto(s)

RESUMEN

SPeripheral sympathectomy is a procedure which has shown high rates of decreasing ischemic pain, recover functionality and wound healing, preventing the progression of the disease and further complications. We present a female patient with severe Raynaud´s phenomenon secondary to localized cutaneous systemic sclerosis complicated who presented digital ulcer treated with a sympathectomy of the radial and ulnar artery at the wrist level, undergoing post-operative follow-up.

Asunto(s)

RESUMEN

Calcific tendinitis is a pathology characterized by the deposits of periarticular hydroxyapatite. Its pathophysiology is not completely known. It is clinically characterized by important inflammatory changes with incapacitating pain. It most commonly affects the shoulder joint and it rarely affects the hand and wrist. Given the unusual nature of this localization, we present the clinical case of a woman who developed calcific tendinitis of the third metacarpophalangeal muscle. We present the clinical evolution of the case, the treatments carried out, and a review of the literature related to this unusual localization of calcific tendinitis.

Asunto(s)

RESUMEN

Benign tumors of peripheral nerves called Schwannomas or neurilemomas, correspond to a rare pathology, represent 5% of all tumors of the upper extremity, and affects, mainly, the ulnar nerve. The incidence of Schwannoma in the literature for the radial nerve is not clearly established given the infrequency of its presentation, there are only reports of isolated cases The following publication presents the case of a male patient with a radial nerve schwannoma. Clinically, presents increased painful volume on palpation, well delimited, of soft consistency in the distal third of the right arm of 3 years of evolution, without history of previous trauma, without irradiation, or paresthesia, with preservation of motor and sensory function of radial, median and ulnar nerve. Considering that the involvement of the radial nerve is very low frequency, a review is carried out in PubMed, in the last 10 years, there are only 9 studies, grouped in case reports and imaging studies for diagnosis.

Asunto(s)

Asunto(s)

RESUMEN

Pain located in the lateral aspect of the elbow is a common cause of consultation in the trauma consultation. The most common cause is "lateral epicondylitis," however there are several differential diagnoses that may require different management. There is a case of radial tunnel syndrome secondary to extrinsic compression, with an emphasis on its diagnosis and surgical technique.

Asunto(s)

RESUMEN

The Coronavirus pandemic (COVID-19) triggered a global health emergency, and as a response, institutions and medical services have implemented different measures regarding the management of these patients in order to maintain medical care, and reduce the spread of the virus in patients and medical staff. The following review aims to present the current recommendations made by international, national and local societies regarding medical action from Traumatology and Orthopaedics. A literature review was done on Medline / Pubmed platforms, The Journal Bone and Joint Surgery (JBJS), Journal of the American Academy of Orthopedic Surgeons (JAAOS), Sociedad Chilena de Ortopedia y Traumatología (SCHOT). The literature was in Spanish and English, comparing it with reality on a local level. The current COVID-19 pandemic led to the complete reform of the trauma care units, starting with the development of subspecialty teams that rotate periodically, which are in charge of the emergency area, treating patients with all personal protection elements (PPE) and categorizing those patients who require emergency trauma surgery, from those that can be managed in a delayed manner. Regarding patients who are hospitalized, a COVID-19 PCR (Polymerase Chain Reaction) test is taken as screening, except for emergency surgeries where all intraoperative protection measures are taken. In addition, for greater safety, all elective surgery was suspended, which reduces the flow of patients in the ward and in the inpatient unit. Outpatient care was optimized in order to protect patients in their periodic check-ups.

Asunto(s)

RESUMEN

Flexor tendon tenosynovitis is an entrapment of the flexor tendons at its entrance to the pulley system. Because there is a high incidence of this pathology, it should be well known by physicians, rheumathologists and orthopaedic surgeons. On this paper we present a literature review, analyzing the anatomic facts, biomechanics, diagnosis, classification, therapeutic options and we propose some general recommendations for physicians.

Asunto(s)

RESUMEN

Dupuytren's disease is the abnormal and progressive proliferation of the palmar fascia, its etiology remains unknown. Percutaneous needle fasciotomy is a minimally invasive procedure, where hypodermic needles are used as a scalpel blade to break the pathological cord in Dupuytren's disease. OBJECTIVE: To evaluate the results of percutaneous needle fasciotomy in patients with 3-year follow-up METHODS: Percutaneous needle fasciotomy was performed in patients from the regional hospital of Talca from January 2014 to January 2017, pre and post-procedure contracture measurement was performed, followed up at 6 weeks, 3 months and annually up to three years. there was a registry of complications, recurrence and functional results with the QuickDASH scale. RESULTS: Of the 17 patients chosen, 13 completed the follow-up. 15 fingers (5 little fingers, 9 ring fingers, 1 middle) and 23 joints. The metacarpophalangeal joints achieved an immediate correction of 89%, maintaining a correction of 48% at three years. The proximal interphalangeal joint achieved a correction of 62%, maintaining 32% at the end of the follow-up. The QuickDash managed to descend from 39.4 to 21.5 points. There was recurrence of 35.7% in the metacarpophalangeal joints and 42.8% in proximal interphalangeal joints. We found that percutaneous fasciotomy is a treatment option.

Asunto(s)