RESUMEN
Venous thromboembolism (VTE) is a worldwide public health problem, with an annual incidence of 1-2 cases/1,000 individuals in the general population and a 1-5% associated mortality. Orthopedic surgery is a major surgical risk factor for VTE, but the problem is more important for patients with hip and knee joint replacement, multiple traumatisms, severe damage to the spine, or large fractures. Thromboprophylaxis is defined as the strategy and actions necessary to diminish the risk of VTE in high-risk orthopedic surgery. Antithrombotics may prevent VTE. At the end of this paper, we describe a proposal of thromboprophylaxis actions for patients requiring high-risk orthopedic surgery, based on the opinion of specialists in Orthopedics and Traumatology who work with high-risk orthopedic surgery patients. A search for evidence about this kind of surgery was performed and a 100-item inquiring instrument was done in order to know the opinions of the participants. Then, recommendations and considerations were built. In conclusion, this document reviews the problem of VTE in high-risk orthopedic surgery patients and describes the position of the Colegio Mexicano de Ortopedia y Traumatología related to VTE prevention in this setting.
Asunto(s)
Procedimientos Ortopédicos/efectos adversos , Tromboembolia Venosa/etiología , Tromboembolia Venosa/prevención & control , Humanos , Riesgo , Factores de RiesgoRESUMEN
OBJECTIVE: The purpose of this study was to compare the diagnostic performance of magnetic resonance imaging with arthroscopy for intra-articular knee conditions. MATERIAL AND METHOD: Between January 2000 and February 2007, 93 patients with medial meniscal tear, lateral meniscal tear, anterior cruciate ligament rupture, and articular cartilage pathology were prospectively assessed. After the physical exam, magnetic resonance imaging studies and arthroscopic surgery of the knee were performed. The sensitivity, specificity, positive and negative predictive values and the diagnostic odds ratio were estimated to compare the magnetic resonance imaging diagnoses with the arthroscopic findings. RESULTS: Fifty-two patients were males and 41 females; mean patient age was 42.6 years (16-68 years). The diagnostic odds ratio was significant for medial meniscal tear, anterior cruciate ligament rupture and the coexistence of both meniscal and ligament lesions. CONCLUSION: The strength of the diagnostic association confirms the usefulness of magnetic resonance imaging for medial meniscal tears, anterior cruciate ligament rupture and the coexistence of both lesions. We do not recommend ordering a routine preoperative magnetic resonance imaging study as a condition for performing knee arthroscopy.
Asunto(s)
Artroscopía , Traumatismos de la Rodilla/diagnóstico , Imagen por Resonancia Magnética , Adolescente , Adulto , Anciano , Lesiones del Ligamento Cruzado Anterior , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Estudios Prospectivos , Rotura , Sensibilidad y Especificidad , Lesiones de Menisco TibialRESUMEN
OBJECTIVE: Evaluate the experience acquired in the surgical management of hip fractures. MATERIAL AND METHODS: Retrospective study of 206 patients undergoing surgical treatment of hip fracture from June 2005 to June 2007. Besides the demographic variables, the following variables were recorded: Fracture classification, interval between the occurrence of the fracture and its surgical treatment, physical status according to the American Society of Anesthesiology classification, preoperative comorbid conditions, type of implant used, approach used if a prosthesis was used, operative time, prophylaxis with antibiotics and for thromboembolic events, complications during the postoperative period and during a 24-month follow-up period. A descriptive statistical analysis was carried out. RESULTS: Fifty patients were males and 156 females, mean age was 80 years (50-99 years). The most frequent types of fractures were the intertrochanteric fracture (130 patients) and the displaced intracapsular fracture (38 patients). The most frequent surgical procedures were the placement of a compression ring and plate (133 patients) and hemiarthroplasty (49 patients). Ten patients had various postoperative complications. Two patients died during the follow-up period (24 months). CONCLUSIONS: Fixation was performed in young patients with undisplaced fractures and in all patients with an impacted and stable subcapital fracture. Arthroplasty was preferred in patients with a displaced fracture.