RESUMEN
PURPOSE: The objective of this study was to describe the use of retrograde gentamicin-coated tibial intramedullary nail (ETN PROtect™) in patients with tibial defects who required a tibiotalocalcaneal arthrodesis (TTC). METHODS: Consecutive series case review of seven men treated with TTC using retrograde PROtect™ between January 2018 and December 2023. The main outcomes evaluated were fracture union, complications, and the health-related quality of life using the EuroQol five-dimension three-level questionnaire (EQ-5D-3L). RESULTS: The mean age was 45.3 ± 8.0 years. Six patients had a clinical history of chronic osteomyelitis, and one case underwent TTC for congenital pseudoarthrosis. Fracture union was achieved in 5 of 7 patients between 4 and 11 months after surgery. Three patients developed complications; two patients had fistulas, and one had persistent pain. At the end of the follow-up, a median of 70 points (interquartile range: 60 to 90) on the EQ-5D-3L was reported. No complications directly attributed to the use of the PROtect™ were reported. CONCLUSION: TTC with retrograde PROtect™ is a prophylactic treatment option in patients with tibial defects treated with external fixation requiring a tibiotalar and subtalar arthrodesis. This novel use of PROtect™ allows simultaneous fixation of the tibiotalocalcaneal joint and protection of the regenerated bone, facilitating earlier rehabilitation in patients at high risk for postoperative infections.
Asunto(s)
Artrodesis , Clavos Ortopédicos , Gentamicinas , Osteomielitis , Tibia , Humanos , Artrodesis/métodos , Artrodesis/instrumentación , Artrodesis/efectos adversos , Masculino , Gentamicinas/administración & dosificación , Gentamicinas/uso terapéutico , Persona de Mediana Edad , Tibia/cirugía , Adulto , Osteomielitis/cirugía , Osteomielitis/etiología , Osteomielitis/prevención & control , Articulación del Tobillo/cirugía , Fijación Intramedular de Fracturas/instrumentación , Fijación Intramedular de Fracturas/métodos , Fijación Intramedular de Fracturas/efectos adversos , Antibacterianos/uso terapéutico , Antibacterianos/administración & dosificación , Seudoartrosis/cirugía , Seudoartrosis/prevención & control , Seudoartrosis/etiología , Calidad de Vida , Calcáneo/cirugíaRESUMEN
PURPOSE: This multicenter, retrospective cohort study aimed to compare the risk of ulnar nerve injury in pediatric supracondylar humeral fractures treated with percutaneous lateral-pins, blinded-crossed-pins, and crossed-pins with a mini-incision. METHODS: Data were collected from 1705 children treated between January 2010 and December 2023 at four orthopedic centers in Colombia. The incidence of postoperative ulnar nerve injury was compared among three fixation techniques: lateral-pin, blinded-crossed-pin, and crossed-pin with a mini-incision. RESULTS: A statistically significant difference in nerve injury rates was observed between the lateral-pin and both blinded-crossed-pin and mini-incision crossed-pin techniques (p < 0.001), with the lateral-pin technique demonstrating a significantly lower risk of injury. No significant difference was found between the blinded-crossed-pin and mini-incision crossed-pin techniques (p = 0.67). CONCLUSION: Crossed-pin fixation was associated with a higher incidence of ulnar nerve injury, regardless of the use of a mini-incision. The lateral-pin technique remains the safest option for minimizing iatrogenic nerve injury. There is insufficient evidence to support the mini-incision as a safer alternative to traditional crossed-pin fixation.
Asunto(s)
Hilos Ortopédicos , Fijación Interna de Fracturas , Fracturas del Húmero , Nervio Cubital , Humanos , Fracturas del Húmero/cirugía , Niño , Estudios Retrospectivos , Masculino , Femenino , Fijación Interna de Fracturas/efectos adversos , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Nervio Cubital/lesiones , Preescolar , Traumatismos de los Nervios Periféricos/etiología , Traumatismos de los Nervios Periféricos/prevención & control , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/epidemiología , Incidencia , Clavos Ortopédicos/efectos adversos , Colombia/epidemiologíaRESUMEN
SUMMARY: The objective of this study was to compare and analyze the clinical efficacy of different approaches of intramedullary nailing with blocking screws for proximal tibial fractures. One hundred cases of proximal tibial fractures treated in the orthopedic department from April 2021 to September 2023 were included in the study and divided into control and treatment groups using a random number table. A control group (n=50) treated with infrapatellar intramedullary nailing with blocking screws, and a treatment group (n=50) treated with suprapatellar intramedullary nailing with blocking screws. We observed the excellent and good rates in both groups, compared various perioperative indicators, changes in joint range of motion (ROM), Visual Analog Scale (VAS) pain scores, Lysholm knee joint function scores, changes in inflammatory factors, and various bone markers before and after treatment, and analyzed postoperative complications. There were no significant differences in baseline data such as age, sex, body mass index, fracture site, concomitant fibular fractures, time from fracture to surgery, injury mechanism, and AO/OTA fracture classification between the two groups (P>0.05). The excellent and good rate in the treatment group after treatment was 90.00 % (45/50), significantly higher than 72.00 % (36/50) in the control group (P0.05). However, the treatment group had shorter surgical times and fewer fluoroscopy times than the control group (P<0.05). After treatment, both groups showed increased ROM and Lysholm scores, as well as decreased VAS scores. Moreover, compared to the control group, the treatment group had higher ROM and Lysholm scores and lower VAS scores (P<0.05). Inflammatory factors including interleukin-1β (IL-1β), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), osteocalcin (BGP), and calcitonin (CT) increased in both groups after treatment, while total n- terminal propeptide of type I procollagen (Total-PINP) and b-C-terminal telopeptide of type I collagen (β-CTX) decreased. Compared to the control group, the treatment group exhibited greater increases in inflammatory factors and lower levels of Total-PINP and β-CTX, but higher BGP and CT levels (P<0.05). The incidence of postoperative complications was 8.00 % (4/50) in the treatment group and 24.00 % (12/50) in the control group, with statistically significant differences (P=4.762, X2=0.029). In the treatment of proximal tibial fractures, intramedullary nailing with blocking screws using the suprapatellar approach achieves significant clinical efficacy. It reduces surgical time, minimizes radiation exposure to healthcare workers and patients, improves knee joint range of motion and function, decreases postoperative pain and complication rates, suppresses inflammatory reactions, and promotes the improvement of bone markers related to fracture healing.
El objetivo de este estudio fue comparar y analizar la eficacia clínica de diferentes abordajes de clavo intramedular con tornillos de bloqueo para las fracturas de tibia proximal. Se incluyeron en el estudio 100 casos de fracturas de tibia proximal tratados en el departamento de ortopedia desde abril de 2021 hasta septiembre de 2023 y se dividieron en grupos de control y de tratamiento mediante una tabla de números aleatorios. Un grupo control (n=50) tratado con clavo intramedular infrapatelar con tornillos de bloqueo, y un grupo tratamiento (n=50) tratado con clavo intramedular suprapatelar con tornillos de bloqueo. Observamos excelentes y buenas tasas en ambos grupos, comparamos varios indicadores perioperatorios, cambios en el rango de movimiento articular (ROM), puntuaciones de dolor en la escala visual analógica (EVA), puntuaciones de función Lysholm de la articulación de la rodilla , cambios en factores inflamatorios y varios marcadores óseos, antes y después del tratamiento, y se analizaron las complicaciones postoperatorias. No hubo diferencias significativas en los datos iniciales como edad, sexo, índice de masa corporal, sitio de fractura, fracturas de fíbula concomitantes, tiempo desde la fractura hasta la cirugía, mecanismo de lesión y clasificación de fractura AO/OTA entre los dos grupos (P>0,05). La tasa de excelente y buena en el grupo con tratamiento después del tratamiento fue del 90,00 % (45/50), significativamente mayor que el 72,00 % (36/50) en el grupo control (P0,05). Sin embargo, el grupo con tratamiento tuvo tiempos quirúrgicos más cortos y menos tiempos de fluoroscopía que el grupo control (P <0,05). Después del tratamiento, ambos grupos mostraron un aumento de las puntuaciones de ROM y Lysholm, así como una disminución de las puntuaciones de VAS. Además, en comparación con el grupo control, el grupo con tratamiento tuvo puntuaciones ROM y Lysholm más altas y puntuaciones EVA más bajas (P <0,05). Los factores inflamatorios que incluyen interleucina-1β (IL-1β), proteína C reactiva (CRP), factor de necrosis tumoral-α (TNF-α), osteocalcina (BGP) y calcitonina (CT) aumentaron en ambos grupos después del tratamiento, mientras que el total disminuyó el propéptido n-terminal del procolágeno tipo I (Total-PINP) y el telopéptido β-C-terminal del colágeno tipo I (β-CTX). En comparación con el grupo control, el grupo con tratamiento mostró mayores aumentos en los factores inflamatorios y niveles más bajos de Total-PINP y β-CTX, pero niveles más altos de BGP y CT (P <0,05). La incidencia de complicaciones postoperatorias fue del 8 % (4/50) en el grupo de tratamiento y del 24 % (12/50) en el grupo control, con diferencias estadísticamente significativas (P=4,762, X2=0,029). En el tratamiento de las fracturas de tibia proximal, el clavo intramedular con tornillos de bloqueo mediante el abordaje suprapatelar logra una eficacia clínica significativa. Reduce el tiempo quirúrgico, minimiza la exposición a la radiación de los trabajadores de la salud y los pacientes, mejora el rango de movimiento y la función de la articulación de la rodilla, disminuye el dolor postoperatorio y las tasas de complicaciones, suprime las reacciones inflamatorias y promueve la mejora de los marcadores óseos relacionados con la curación de las fracturas.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Adulto Joven , Fracturas de la Tibia/cirugía , Tornillos Óseos , Fijación Interna de Fracturas/instrumentación , Fijación Interna de Fracturas/métodos , Clavos Ortopédicos , Dimensión del Dolor , Rango del Movimiento Articular , Resultado del Tratamiento , Fijación Intramedular de Fracturas , Fijación Intramedular de Fracturas/instrumentaciónRESUMEN
In elastic stable intramedullary nailing (ESIN), there are different opinions among surgeons on whether to leave the nail buried in the same arm or to leave it exposed. OBJECTIVE: To determine the risk of re-fracture in patients with a nail buried directly into the amr or left exposed as a treatment for forearm fractures, and to investigate postoperative complications. PATIENTS AND METHOD: The study included 113 pediatric patients with a forearm fracture of both diaphyses. Two groups were formed according to whether the nail was buried (Group B, n: 53) in the same arm or left exposed (Group E, n: 60). Data on the number of open reductions, the time to nail removal, the anesthesia type used for its removal, the number of re-fractures, skin infection, and nail entry site irritation were analyzed. RESULTS: The mean union times between the groups were not significantly different (P = 0.371). The mean time of nail removal in group B (16.02 ± 1.29 weeks) was significantly longer than that of group E (6.65 ± 0.95 weeks) (P < 0.001). Open reduction rates were similar between groups (P = 0.401). The general anesthesia rate for nail removal in group B (77.4%) was significantly higher than group E (11.7%) (P < 0.001). The re-fracture rate was higher in patients who underwent open reduction in both groups (P < 0.001). CONCLUSION: The results of this study demonstrated that, despite the increased infection rate, leaving the nail exposed did not increase the re-fracture rate, which was associated with open reduction.
Asunto(s)
Clavos Ortopédicos , Fijación Intramedular de Fracturas , Fracturas del Radio , Fracturas del Cúbito , Humanos , Niño , Femenino , Masculino , Fijación Intramedular de Fracturas/instrumentación , Fijación Intramedular de Fracturas/efectos adversos , Fijación Intramedular de Fracturas/métodos , Fracturas del Cúbito/cirugía , Fracturas del Radio/cirugía , Complicaciones Posoperatorias/etiología , Remoción de Dispositivos , Preescolar , Recurrencia , Adolescente , Estudios Retrospectivos , Factores de Tiempo , Traumatismos del Antebrazo/cirugíaRESUMEN
PURPOSE: To report the functional results of our experience and to describe intraoperative findings and complications due to the techniques used in our service. METHODS: From January 2018 to December 2022, 27 Pediatric patients aged from 8 to 16 years underwent surgery to treat proximal humerus fractures. Their demographic characteristics were evaluated, as well as their clinical characteristics on admission, type of reduction (closed/open), presence of interposition in open reductions, type of implant, complications, and functional range of movement according to two shoulder functional scores. RESULTS: Mean age was 11.2 years (8-15), there was a predominance of males, who accounted for 70% of the cases, and sports accidents were the cause of injury in 44% of the cases. Anatomical location was balanced between patients, including 55% of physeal fractures and 45% of metaphyseal ones. Overall, 81.5% of patients required open reduction to achieve axis correction, and that 55.5% of fractures were fixed with Kirschner wires, and 44, 4% with elastic titanium nails. Mean QuickDASH score was 0.58 (0-1.7), and Constant score was 9 (3-24). There were no major complications, but 27% of cases subjected to open reduction presented a hypertrophic scar. CONCLUSION: Surgical treatment of severely displaced proximal humerus fractures is successful, both with closed and open reduction; type of implant does not play a key role and should be selected based on the characteristics of each case. Surgical training should prevail at the time of decision-making. When these recommendations are followed, results can be excellent and sequelae are infrequent.
Asunto(s)
Hilos Ortopédicos , Rango del Movimiento Articular , Fracturas del Hombro , Humanos , Masculino , Fracturas del Hombro/cirugía , Fracturas del Hombro/fisiopatología , Adolescente , Niño , Femenino , Resultado del Tratamiento , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/efectos adversos , Clavos Ortopédicos , Reducción Abierta/métodos , Reducción Abierta/efectos adversos , Estudios Retrospectivos , Complicaciones Posoperatorias/etiologíaRESUMEN
OBJECTIVES: The aim of the study was to investigate the clinical effect of stainless-steel wire fixation on the early mouth-opening movement of an intracapsular fracture involving the condylar process. MATERIALS AND METHODS: In this study, patients who underwent mandibular condylar intracapsular fracture surgery in our hospital from 2012 to 2020 were selected as research subjects. A total of 44 patients received steel wire internal fixation treatment, 32 patients received titanium plate-and-nail rigid internal fixation, and 28 patients underwent conservative non-surgical treatment. RESULTS: For the patients in the stainless-steel wire group, the degree of mouth opening reached normal levels of 3.7 cm approximately 10 days after surgery. The recovery time for the patients in the titanium plate-and-nail rigid internal-fixation group was 21 days, while the patients in the conservative treatment group needed 60 days to recover. CONCLUSION: The treatment of fixation with a stainless-steel wire for intracapsular condylar fracture reduced the time taken to perform mouth-opening exercises and improved the recovery rate of patients.
OBJETIVO: Explorar el efecto clínico de la fijación de alambre de acero inoxidable en el movimiento temprano de apertura de la boca en la fractura interna del cóndilo. MÉTODO: Este estudio seleccionó a pacientes que se sometieron a cirugía de fractura intracapsular de cóndilo en nuestro hospital de 2012 a 2020 como sujetos de investigación. Un total de 44 pacientes recibieron tratamiento de fijación interna de alambre de acero, 32 recibieron placa de titanio y fijación interna con clavos, y 28 recibieron tratamiento conservador no quirúrgico. RESULTADOS: En los pacientes del grupo de alambre de acero inoxidable, alrededor de 10 días después de la cirugía el grado de apertura de la boca alcanzó un valor normal de 3.7 cm. El tiempo de recuperación de los pacientes en el grupo de fijación interna con clavos y placa de titanio fue de 21 días, mientras que los pacientes en el grupo de tratamiento conservador tardaron 60 días en recuperarse. CONCLUSIONES: La fijación con alambre de acero inoxidable para el tratamiento de la fractura intracapsular del cóndilo acorta el tiempo hasta la apertura de la boca y mejora la tasa de recuperación de los pacientes.
Asunto(s)
Placas Óseas , Hilos Ortopédicos , Fijación Interna de Fracturas , Cóndilo Mandibular , Fracturas Mandibulares , Acero Inoxidable , Humanos , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Fracturas Mandibulares/cirugía , Cóndilo Mandibular/lesiones , Cóndilo Mandibular/cirugía , Masculino , Femenino , Adulto , Persona de Mediana Edad , Titanio , Rango del Movimiento Articular , Clavos Ortopédicos , Adulto Joven , Estudios RetrospectivosRESUMEN
INTRODUCTION: health promotion policy requires the identification of barriers to the adoption of public policies. Paraguay's national healthcare system is inequitable, expensive, and inefficient. The Ministry of Public Health and Social Welfare (MSPyBS) is the entity responsible for covering the needs of a significant portion of the population. In January 2022, the MSPyBS financed the purchase of titanium elastic nails through a National Public Tender for Osteosynthesis Materials (LPN 02/22) to provide them for free in the pediatric service. Using research as a tool, we seek to analyze the impact of the implementation of LPN 02/22 at the Trauma Hospital, believing that this action would help streamline administrative and bureaucratic processes, making them more efficient with the assistance of the hospital's human resources. MATERIAL AND METHODS: a retrospective, analytical, and comparative study conducted at a high-complexity trauma center in Asunción, Paraguay. Patients aged 4 to 14 years with an indication for stabilization with elastic nails were included. Demographic data, the mechanism of injury, time elapsed from hospital arrival to surgical treatment, length of hospital stay, and the average hospital cost were analyzed based on the daily expense of pediatric patient hospitalization. RESULTS: 52 patients, divided into 25 cases in 2021 before implementation and 27 cases after implementation. The time elapsed from hospital arrival to definitive treatment was six days in the pre-implementation period, with an average stay from admission to discharge of 7.4 days. After implementation, the time from hospital arrival to definitive treatment was 4.3 days, and the average discharge time for the Post group was six days. The potential savings per patient amount to 332 dollars, offset by the institution's implant supply cost of 197 dollars, resulting in an approximate savings of 135 dollars per patient for the ministry. CONCLUSIONS: we view the implementation of free titanium elastic nails for pediatric femur fracture patients positively. We encourage the institution to continue with similar policies and strive to achieve even greater benefits for users.
INTRODUCCIÓN: la política de promoción de la salud requiere la identificación de los obstáculos para la adopción de políticas públicas. El sistema nacional de salud de Paraguay es inequitativo, caro e ineficiente. El Ministerio de Salud Pública y Bienestar Social (MSPyBS) es el ente que cubre las necesidades de gran parte de la población. El MSPyBS en Enero del 2022 financió, mediante la Licitación Pública Nacional de Materiales de Osteosíntesis (LPN 02/22), la compra de clavos elásticos de titanio para disponer de su uso gratuito en el Servicio de Pediatría; usando a la investigación como herramienta, buscamos analizar el impacto de la implementación de la LPN 02/22 en el Hospital de Trauma, creyendo que esta acción ayudaría a dinamizar los procesos administrativos y burocráticos, haciéndolos más eficientes con la ayuda de los recursos humanos del hospital. MATERIAL Y MÉTODOS: estudio retrospectivo, analítico y comparativo, realizado en un centro de trauma de alta complejidad de Asunción, Paraguay. Fueron incluidos los pacientes con edad comprendidas entre cuatro y 14 años, con indicación de estabilización con clavos elásticos. Se analizaron los datos demográficos, el mecanismo de trauma, el tiempo transcurrido desde la llegada al hospital hasta el tratamiento quirúrgico, así como el tiempo de estadía hospitalaria. Se evaluó el costo hospitalario promedio, basados en el gasto diario de la internación de un paciente pediátrico. RESULTADOS: cincuenta y dos pacientes, separados en 25 casos en el 2021 previo a la implementación y 27 casos posterior a la implementación. El tiempo transcurrido desde la llegada al hospital hasta el tratamiento definitivo fue de seis días para la etapa previa a la implementación; el promedio desde el ingreso hasta el alta fue de 7.4 días. Desde la implementación se tuvo un transcurso de 4.3 días desde la llegada al hospital hasta el tratamiento definitivo. El egreso del grupo Post tuvo un promedio de seis días. El ahorro probable en relación con cada paciente es de 332 dólares; a esto debemos contrarrestar el monto que paga la institución para la provisión del implante (197 dólares), por lo que el ahorro del ministerio sería de aproximadamente 135 dólares por cada paciente. CONCLUSIONES: vemos como positiva la implementación de la gratuidad de los clavos elásticos de titanio en los pacientes en edad pediátrica con fractura de fémur. Alentamos a la institución a seguir con políticas similares y tratar de lograr mayores beneficios para los usuarios.
Asunto(s)
Fracturas del Fémur , Humanos , Niño , Estudios Retrospectivos , Adolescente , Preescolar , Femenino , Masculino , Fracturas del Fémur/cirugía , Fracturas del Fémur/economía , Paraguay , Tiempo de Internación/estadística & datos numéricos , Clavos Ortopédicos , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/economía , Fijación Interna de Fracturas/instrumentación , Costos de Hospital/estadística & datos numéricos , Centros Traumatológicos/organización & administración , TitanioRESUMEN
The objective of this study was to test a composite of polyester resin and fiberglass in the form of an intramedullary nail for osteosynthesis of femoral fractures in calves. The methodology was established based on a previous study that used a bovine femur finite element model to simulate fractures, which were then stabilized by the same nails as proposed in this study. General anesthesia was induced in six calves followed by fracture creation via an oblique incision in the middle third of the femoral diaphysis, and osteosynthesis was immediately performed by retrograde insertion of the composite nail. Locking was achieved by drilling the bone and nail without using a jig and introducing two stainless steel screws proximal and two distal to the fracture line. Five of the six calves achieved complete fracture healing after 60 days. No signs of incompatibility or toxicity of the composite were observed. However, limitations were observed during the surgery, such as difficulty in drilling the nail and trimming the remainder portion of the nail that extended beyond the length of the bone. Small fragments produced by these maneuvers were considered irritating to soft tissues during the postoperative period. It was also found that small cracks in the nail tended to propagate in the form of longitudinal fractures. In conclusion, an intramedullary nail made of polyester resin and fiberglass (a low-cost and easy-to-acquire material) was considered biocompatible and capable of allowing bone healing of femoral fractures in young cattle. However, the development of solutions for the reported limitations is crucial prior to recommending the proposed composite for clinical use.
Asunto(s)
Fracturas del Fémur , Fijación Intramedular de Fracturas , Vidrio , Animales , Bovinos , Fijación Intramedular de Fracturas/métodos , Clavos Ortopédicos/veterinaria , Poliésteres , Fracturas del Fémur/cirugía , Curación de Fractura , Fémur/cirugíaRESUMEN
Ankle arthrodesis is the gold standard for treatment of end-stage arthritis. The goal of ankle arthrodesis is to obtain bony union between the tibia and the talus. Retrograde intramedullary nailing is typically reserved for ankle and subtalar joints arthrodesis. The purpose of this study is to evaluate the effect of two different materials, two locking pin configurations and two nail designs of a retrograde locked intramedullary nail used for ankle arthrodesis. Using the finite element analysis, a numerical study of ankle arthrodesis was developed to evaluate the effect of materials: TI-6Al-4V and stainless steel AISI 316 LVM; two locking pin configurations: five and six pins, on two intramedullary nails: Ø10 × 180 mm and Ø11 × 200 mm. A model of a healthy foot was created from tomographic scans. It was found that the mechanical stimulus required to achieve bone fusion were higher for Ø10 × 180 nails (6.868 ± 0.047) than the Ø11 × 200 nails (5.918 ± 0.047; p < 0.001; mean ± SEM). We also found that six-pin configuration had a higher mechanical stimulus (6.470 ± 0.047) than the five-pin configuration (6.316 ± 0.046; p = 0.020). Similarly, it was higher for titanium (6.802 ± 0.047) than those for stainless steel (5.984 ± 0.046; p < 0.001). Finally, the subtalar zone presented higher values (7.132 ± 0.043) than the tibiotalar zone (5.653 ± 0.050; p < 0.001). The highest mechanical stimulus around the vicinity of tibiotalar and subtalar joint was obtained by Ø10 × 180 nails, made of titanium alloy, with 6P.
Asunto(s)
Tobillo , Fijación Intramedular de Fracturas , Análisis de Elementos Finitos , Acero Inoxidable , Titanio , Clavos Ortopédicos , Articulación del Tobillo/diagnóstico por imagen , Articulación del Tobillo/cirugía , Fijación Intramedular de Fracturas/métodos , ArtrodesisRESUMEN
INTRODUCTION: Both bone forearm fractures are common injuries in children. Most can be treated with reduction and casting. Those that fail nonoperative management can be treated with a plate or intramedullary fixation; however, refracture remains a problem. The goal of this study is to evaluate the refracture rate in both bone forearm fractures based on the mode of fixation. METHODS: Institutional board review approval was obtained. A retrospective chart review from 2010 to 2021 at a single tertiary care institution was conducted for all operative patients <18 years who sustained a both bone forearm fracture. Groups were stratified based on initial operative fixation type: both bones fixated using nails, 1 bone fixated with a nail; both bones plated, and 1 bone plated. Further review was conducted to identify refractures following initial operative treatment. Statistical analyses were conducted using the χ 2 test of independence and Fisher's exact test. RESULTS: In all, 402 operatively treated both bone forearm fracture patients were identified. Two hundred fifty-six of these patients underwent intramedullary fixation (average age 10.3y/o), while 146 patients received plate fixation (average age 13.8y/o). Fracture location was similar across the nailing and plating cohorts, most often occurring in the mid-shaft region. Patients aged ≤10 years refractured at a significantly higher rate than patients aged >10 years across all operative fixation cohorts (12.5% vs. 2.5%, P <0.001). Among the 256 patients who underwent intramedullary fixation, 61.3% had both bones treated (n=157/256), whereas 38.7% received single bone fixation (n=99/256). Of the 146 plate fixations, 84.4% had both bones fixed (n=123/146), and only 15.8% were treated with single bone fixation (n=23/146). In the intramedullary group, 15 patients sustained refractures, 11 of whom were treated with single bone fixation (11.1%, n=11/99) versus 4 with both both fixation (2.5%, n=4/157). Among the plating group, 7 patients sustained refractures, 6 with both bone fixation (4.9%, n=6/123) and 1 in single bone fixation (4.3%, n=1/23). Refractures were found to be significantly more prevalent among patients treated with single bone compared with both bone intramedullary nail fixation (11.1% vs. 2.5%, P =0.006). By fixated bone, single bone ulna fixations had a higher refracture rate compared with both bone fixations (12.1% vs. 3.6%, P =0.003). CONCLUSION: The overall refracture rate following operative treatment of both bone fractures is 5.5% and is similar between intramedullary and plate fixations. Overall, patients ≤10 years of age had a higher rate of refracture. Among single bone fixations, higher refracture was seen with intramedullary fixations, and when the radius was treated nonoperatively. Surgeons may be able to reduce the refracture rate by performing intramedullary fixation of both bones instead of only one bone. Effective postoperative counseling among younger patients may also decrease refracture rates.
Asunto(s)
Traumatismos del Antebrazo , Fijación Intramedular de Fracturas , Fracturas del Radio , Fracturas del Cúbito , Humanos , Niño , Adolescente , Fracturas del Radio/cirugía , Fracturas del Cúbito/cirugía , Fracturas del Cúbito/etiología , Antebrazo , Estudios Retrospectivos , Traumatismos del Antebrazo/cirugía , Fijación Intramedular de Fracturas/efectos adversos , Placas Óseas , Clavos Ortopédicos , Resultado del TratamientoRESUMEN
Abstract Total knee arthroplasty (TKA) is one of the most effective operations to relieve pain and improve function in the end stage of osteoarthritis (when bone on bone contact occurs). The intraoperative complications of TKA include fracture, tendon or ligament injury, and nerve or vascular complications. We herein describe an unusual complication of intramedullary pin migration within the femoral canal during TKA. A 72-year-old male patient underwent TKA with a posterior stabilization system with sacrifice of the posterior cruciate ligament. The distal femur was sectioned and balance was checked in extension. Then to make anterior, posterior, chamfer and notch cuts, the five-in-one anteroposterior (AP) cutting block was placed on the distal femur and the cuts were initiated. As there was a medial overhang of the cutting block, it was shifted laterally. While doing so, the pins had to be shifted too, and one of them was inadvertently hammered into the previously-created medullary canal opening of the femur. As usual orthopedic instruments, like the long straight artery forceps and pituitary rongeurs, failed to remove the migrated pin, an extralong laparoscopic grasper was used under fluoroscopy control to locate, grasp, and remove the migrated pin.
Resumo A artroplastia total do joelho (ATJ) é uma das cirurgias mais eficazes para alívio da dor e melhora da função no estágio final da artrose (quando ocorre contato entre os ossos). As várias complicações intraoperatórias da ATJ incluem fratura, lesão em tendão ou ligamentos, e complicações nervosas ou vasculares. Neste artigo, descrevemos uma complicação incomum: a migração do pino intramedular dentro do canal femoral durante a ATJ. Um paciente do sexo masculino de 72 anos foi submetido a ATJ com sistema de estabilização posterior e sacrifício do ligamento cruzado posterior. A porção distal do fêmur foi seccionada, e o equilíbrio foi verificado em extensão. Em seguida, um bloco anteroposterior (AP) cinco em um foi utilizado para seção anterior, posterior, de chanfro, e entalhe. Por apresentar uma saliência medial, o bloco foi deslocado em sentido lateral. Ao fazê-lo, os pinos também tiveram de ser deslocados, e um deles foi inadvertidamente inserido na abertura do canal medular do fêmur criado. Como instrumentos ortopédicos usuais, como pinça reta longa e saca-bocado pituitário não conseguiram remover o pino migrado, uma pinça laparoscópica extralonga foi usada sob controle fluoroscópico para localizar, agarrar e remover o pino migrado.
Asunto(s)
Humanos , Masculino , Anciano , Clavos Ortopédicos , Procedimientos Ortopédicos , Artroplastia de Reemplazo de Rodilla , Complicaciones IntraoperatoriasRESUMEN
INTRODUCTION: Charcot's arthropathy is a disabling non-infectious, progressive condition characterized by bony and articular destruction in patients with sensory neuropathy. In advanced cases with deformities and ankle instability, it requires a more invasive treatment as an ankle fusion with a retrograde locked intramedullary nail. It is unknown if, in these patients, the functional results of AOFAS (American Orthopaedic Foot and Ankle Society) correlate with the quality of life ones from the EuroQol-5D test and the possible postoperative complications. MATERIAL AND METHODS: the design is experimental, longitudinal prospective with ambispective data analysis (retrospective and prospective) to evaluate the functional results and life quality with a year of following patients with Charcot's arthropathy diagnosis treated with a retrograde locked nail from January 1, 2010, to November 1, 2018. RESULTS: this study resulted in complete consolidation from nine out of 11 cases, with a success rate of 81.2%, and only two cases (18.2%) developed nonunion. AOFAS and EuroQol-5D tests correlate positively in agreement with the Pearson correlation. CONCLUSIONS: AOFAS and EuroQol-5D correlate positively, having a 45 and 63% of acceptable and satisfactory results, respectively, for both tests.
INTRODUCCIÓN: la artropatía de Charcot es una condición incapacitante, no infecciosa, progresiva, que se caracteriza por destrucción ósea y articular en pacientes con neuropatía sensorial. En casos avanzados, en los que se tiene deformidad severa e inestabilidad de tobillo, se requieren procedimientos más invasivos como la artrodesis de tobillo con clavo centromedular retrógrado bloqueado. Se desconoce si en estos pacientes las puntuaciones de la valoración funcional postquirúrgica con la escala de AOFAS (American Orthopaedic Foot and Ankle Society) correlaciona con las puntuaciones de la escala de calidad de vida medida con el test EuroQol-5D y las posibles complicaciones postquirúrgicas. MATERIAL Y MÉTODOS: se trata de un ensayo autocontrolado de práctica clínica habitual, cuasiexperimental, longitudinal y prospectivo con recolección ambispectiva (retrospectiva y prospectiva) de datos para evaluar los resultados funcionales y de calidad de vida a un año de seguimiento de los pacientes con artropatía de Charcot tratados mediante artrodesis de tobillo con clavo centromedular retrógrado bloqueado del 1 de Enero de 2010 al 1 de Noviembre de 2018. RESULTADOS: la consolidación se logró en nueve casos de un total de 11 pacientes para una tasa de éxitos de 81.8% y únicamente dos casos (18.2%) en los cuales no se observó consolidación. Las escalas de AOFAS y EuroQol-5D se correlacionaron positivamente de acuerdo con la correlación de Pearson. CONCLUSIONES: las escalas de AOFAS y EuroQol-5D se correlacionan positivamente, obteniéndose 45 y 63% con resultados aceptables y satisfactorios respectivamente en ambas escalas.
Asunto(s)
Tobillo , Artropatía Neurógena , Humanos , Estudios Retrospectivos , Estudios de Seguimiento , Articulación del Tobillo/cirugía , Estudios Prospectivos , Calidad de Vida , Artropatía Neurógena/cirugía , Artrodesis/métodos , Clavos Ortopédicos , Resultado del TratamientoRESUMEN
ANTECEDENTES En el marco de la metodología ad hoc para evaluar solicitudes de tecnologías sanitarias, aprobada mediante Resolución de Instituto de Evaluación de Tecnologías en Salud e Investigación N° 111-IETSI-ESSALUD-2021, y ampliada con Resolución N°97-IETSIESSALUD-2022, se ha elaborado el presente dictamen, el cual expone la evaluación de la eficacia y seguridad del clavo intramedular trocantérico con mecanismo antirrotatorio (Proximal Femoral Nail Antirotation, PFNA, por sus siglas en inglés) para pacientes adultos mayores con fracturas trocantéricas inestables. De este modo, el Dr. Daniel Cauti De la Cruz, médico traumatólogo del servicio de fracturas y osteosíntesis del Hospital Nacional Edgardo Rebagliati Martins (HNERM), siguiendo la Directiva N° 001- IETSI-ESSALUD-2018, envió al Instituto de Evaluación de Tecnologías en Salud e Investigación (IETSI) la solicitud de inclusión del dispositivo médico "clavo intramedular trocantérico canulado con hoja espinal angulaciones con cementación". ASPECTOS GENERALES: Las fracturas trocantéricas, también conocidas como fracturas proximales del fémur, representan una creciente preocupación de salud pública en la población adulta mayor, principalmente debido a la vulnerabilidad del hueso envejecido a lesiones menores o de baja energía (Court-Brown & McQueen, 2016). Se estima que, en el 2050, más de 6.3 millones de estas fracturas ocurrirán anualmente a nivel mundial (Gullberg et al., 1997). Además, estas fracturas están asociadas con altos índices de morbilidad y mortalidad. Según la OMS, la mortalidad al año después de una fractura de cadera en adultos mayores es de hasta el 30 % (World Health Organization, s/f). Las tendencias demográficas actuales, que indican un rápido envejecimiento de la población global, anticipan una creciente carga de morbilidad y mortalidad asociada a estas fracturas en las próximas décadas (United Nations, 2019). En la actualidad, el manejo de las fracturas trocantéricas inestables en adultos mayores se realiza mediante estrategias que intentan favorecer la movilización temprana y disminuir las complicaciones postoperatorias (Fischer et al., 2021). El sistema de placa con tornillo dinámico de cadera (DHS por sus siglas en inglés) es una opción comúnmente utilizada en este contexto. Con este dispositivo la placa se fija extramedularmente, mediante la colocación de tornillos a nivel del cuello femoral y del fémur (Parker, 1992). Aunque algunos estudios han reportado que el DHS puede ser efectivo en el manejo de las fracturas trocantéricas (Anglen & Weinstein, 2008; Bhandari et al., 2009), otros informes han identificado varias limitaciones con este dispositivo. Las complicaciones reportadas incluyen la falla de la fijación, pérdida de reducción y complicaciones relacionadas con la herida debido a la incisión significativa que se requiere para su colocación (Lindskog & Baumgaertner, 2004). Asimismo, el tornillo deslizante de compresión dinámica (Dynamic Compression Screw, DCS por sus siglas en inglés) es un dispositivo de fijación extramedular, similar al DHS, empleado en el tratamiento de las fracturas trocantéricas en adultos mayores. A diferencia del DHS, el DCS permite fijación rígida a la fractura y evita el deslizamiento del tornillo, lo que podría fomentar la compresión y cicatrización de la fractura porque mantiene los fragmentos de hueso firmemente unidos sin permitir su desplazamiento, lo cual podría favorecer la estabilidad en determinados tipos de fracturas (Müller et al., 1990). METODOLOGÍA: Se realizó una búsqueda bibliográfica exhaustiva con el objetivo de identificar la mejor evidencia sobre la eficacia y seguridad del clavo intramedular trocantérico con mecanismo antirrotatorio para pacientes adultos mayores con fracturas trocantéricas inestables. La búsqueda bibliográfica se realizó en las bases de datos Medline, Cochrane library, Web of Science3y LiLACS. Así mismo se realizó una búsqueda manual dentro de las páginas web pertenecientes a la Centro Nacional de Excelencia Tecnológica en Salud (CENETEC), la Agency for Healthcare Research and Quality's (AHRQ), Scottish Intercollegiate Guidelines Network (SIGN), The Guidelines International Network (GIN), National Health and Medical Research Council (NHMRC), la Comissáo Nacional de Incorporagáo de Tecnologias no Sistema Único de Saúde (CONITEC), el Instituto de Evaluación Tecnológica en Salud (IETS), el Instituto de Efectividad Clínica y Sanitaria (IECS), la Hauté Autorité de Santé (HAS), la Unidad de Análisis y Generación de Evidencias en Salud Pública (UNAGESP), el National Institute for Health and Care Excellence (NICE), la Canadian Agency for Drugs and Technologies in Health (CADTH), el Scottish Medicines Consortium (SMC), el Scottish Intercollegiate Guidelines Network (SIGN), el Institute for Clinical and Economic Review (ICER), el Instituto de Calidad y Eficiencia en la Atención de la Salud (IQWiG, por sus siglas en alemán), la Base Regional de Informes de Evaluación de Tecnologías en Salud de las Américas (BRISA), la Organización Mundial de la Salud (OMS), el Ministerio de Salud del Perú (MINSA) y el IETSI, a fin de poder identificar guías de práctica clínica (GPC) y evaluaciones de tecnología sanitarias (ETS) de relevancia que pudiesen haber sido omitidas por la estrategia de búsqueda o que no hayan sido publicadas en las bases de datos consideradas. RESULTADOS: Luego de la búsqueda bibliográfica hasta el 27 de junio del 2023 se incluyeron dos GPC (NICE, 2023; O'Connor & Switzer, 2022), una RS (Y. R. Zhang et al., 2019) y tres ECA (Huang et al., 2017; Xu et al., 2010a; Zehir et al., 2015) provenientes de las referencias de la RS. CONCLUSIÓN: Por lo expuesto, el Instituto de Evaluación de Tecnologías en Salud e Investigación no aprueba el uso del clavo intramedular trocantérico con mecanismo antirrotatorio para pacientes adultos mayores con fracturas trocantéricas inestables en comparación con las tecnologías disponibles en la institución.
Asunto(s)
Humanos , Clavos Ortopédicos/provisión & distribución , Fijación Intramedular de Fracturas/instrumentación , Fracturas de Cadera/terapia , Eficacia , Análisis Costo-Beneficio/economíaRESUMEN
Introducción. El objetivo del estudio fue describir las características sociodemográficas, tratamiento y complicaciones pre y posquirúrgicas de las fracturas supracondíleas del húmero distal en niños que requirieron manejo quirúrgico en un hospital de Santander, Colombia. Metodología. Se trata de un estudio observacional, descriptivo, de corte transversal con 58 pacientes que cumplieron los siguientes criterios de inclusión: edad entre 3 a 14 años, fracturas supracondíleas de manejo quirúrgico; como criterios de exclusión se tomó: antecedente de enfermedad ósea o neurológica previa y fracturas de más de 7 días de evolución. Para las variables continuas se usó medidas de tendencia central y dispersión, las categóricas en porcentajes y frecuencias absolutas. Resultados. La edad media de presentación fue de 6.2 años, el principal mecanismo de trauma fue caídas de altura con un 96.5%. El 65.5% provenía de zonas urbanas. El 13.8% se asoció con fracturas de antebrazo, y el 3.4% de epitróclea. La fijación se realizó en un 75% con técnica cruzada y un 17.2% se asoció con lesión iatrogénica del nervio ulnar. Discusión. En el estudio no se informaron lesiones vasculares; sin embargo, se documentó una alta prevalencia de lesión neurológica con la fijación medial, similar a lo descrito en la literatura (1.4%-17.7%); algunos autores describen técnicas que disminuyen estas lesiones hasta en un 0%. Conclusión. Las características sociodemográficas de nuestra población coinciden con la estadística publicada mundialmente; la principal complicación fue la lesión iatrogénica nervio ulnar, que se puede disminuir con un uso racional del pin medial y con el empleo de técnicas que busquen rechazar directamente el nervio. Palabras clave: Fracturas del Húmero; Fijación Interna de Fracturas; Clavos Ortopédicos; Codo; Niño; Nervio Cubital.
Introduction. The objective of this study was to describe sociodemographic characteristic, treatment, and pre- and post-surgical complications of supracondylar fractures of the distal humerus in children who required surgical management at a hospital in Santander, Colombia. Methodology. This was an observational, descriptive, and cross-sectional study involving 58 patients who met inclusion criteria: age between 3 and 14 years old, supracondylar fractures with surgical management; exclusion criteria include previous bone or neurological illness and fractures with more than 7 days of evolution. Central tendency and dispersion measures were used for continuous variables, and categorical variables in percentages and absolute frequencies. Results. The average age at presentation was 6.2 years old, the main mechanism of trauma was fall from height (96.5%). 65.5% came from urban zones. The 13.8% were associated with forearm fractures, and 3.4% with epitrochlear fractures. Pinning was performed at 75% with crossed technique and 17.2% were associated with iatrogenic ulnar nerve injury. Discussion. Study didn't inform vascular injuries. However, a high prevalence of neurological injury with medial pinning was documented, similar to that describe in the literature (1.4%-17.7%); some author described techniques that reduce these lesions by 0%. Conclusion. The sociodemographic characteristics of our population match with worldwide published statistics; the main complication was iatrogenic ulnar nerve injury, which can be reduced with the rational use of medial pin and with the application of techniques that seek to directly spare the nerve. Keywords: Humeral Fractures; Fracture Fixation, Internal; Bone Nails; Elbow; Child; Ulnar Nerve.
Introdução. O objetivo do estudo foi descrever as características sociodemográficas, o tratamento e as complicações pré e pós-cirúrgicas das fraturas supracondilianas do úmero distal em crianças que precisaram de tratamento cirúrgico em um hospital de Santander, Colômbia. Metodologia. Trata-se de um estudo observacional, descritivo e transversal com 58 pacientes que atenderam aos seguintes critérios de inclusão: idade entre 3 e 14 anos, fraturas supracondilianas tratadas cirurgicamente. Os critérios de exclusão foram: histórico de doença óssea ou neurológica prévia e fraturas com duração superior a 7 dias de evolução. Para variáveis contínuas foram utilizadas medidas de tendência central e dispersão, as categóricas em percentuais e frequências absolutas. Resultados. A média de idade de apresentação foi de 6.2 anos, o principal mecanismo de trauma foi a queda de altura com 96.5%. 65.5% vieram de áreas urbanas. 13.8% estavam associados a fraturas de antebraço e 3.4% a epitróclea. A fixação foi realizada em 75% com técnica cruzada e 17.2% esteve associada à lesão iatrogênica do nervo ulnar. Discussão. Nenhuma lesão vascular foi relatada no estudo. No entanto, foi documentada alta prevalência de lesão neurológica com fixação medial, semelhante à descrita na literatura (1.4%-17.7%). Alguns autores descrevem técnicas que reduzem essas lesões em até 0%. Conclusão. As características sociodemográficas da nossa população coincidem com as estatísticas publicadas mundialmente. A principal complicação foi a lesão iatrogênica do nervo ulnar, que pode ser reduzida com o uso racional do pino medial e com o uso de técnicas que buscam rejeitar diretamente o nervo. Palavras-chave: Fraturas do Úmero; Fixação Interna de Fraturas; Pinos Ortopédicos; Cotovelo; Criança; Nervo Ulnar
Asunto(s)
Fijación Interna de Fracturas , Nervio Cubital , Clavos Ortopédicos , Niño , Codo , Fracturas del HúmeroRESUMEN
PURPOSE: This retrospective study aimed to assess the impact of distal nail placement on misalignment and healing rates in distal tibial fractures. METHODS: We reviewed all patients with distal tibial fracture treated with intramedullary nailing between 2015 and 2021, and a minimum follow-up of 12 months. Distal nail positioning was determined according to the Triantafillou zones. We related these positioning zones to misalignments (alignment ≥ 3°) and too bony union disorders (delayed union, non-union). RESULTS: Out of the 62 patients included, 56 (90.3%) show bone union without additional procedure, 3 (4.8%) with dynamization, and 3 (4.8%) showed non-union. Twenty-one (33.8%) presented misalignment, with valgus in the coronal plane being the most frequent (76.19%). In patients with and without misalignment, the most frequent distal nail position was 2-2 in 47.6% and 80.5%, respectively (p = 0.01). In multivariate analysis, distal nail positioning in the 2-2 zone showed a significant protective effect against misalignment (OR 0.18; p = 0.018), while nail positioning in the 3-2 zone generated a significant risk of misalignment (OR 18.55; p = 0.009). CONCLUSION: In intramedullary nailing of distal tibial fractures, distal positioning of the nail slightly lateral to the center of the talus in the coronal plane and slightly posterior in the sagittal plane (zone 2-2) allows high alignment percentages to be obtained. Positioning medial to this point in the coronal plane (zone 3) is associated with more significant misalignment and should be avoided.
Asunto(s)
Fijación Intramedular de Fracturas , Fracturas de la Tibia , Humanos , Estudios Retrospectivos , Clavos Ortopédicos , Curación de Fractura , Fracturas de la Tibia/diagnóstico por imagen , Fracturas de la Tibia/cirugía , Fijación Intramedular de Fracturas/efectos adversos , Fijación Intramedular de Fracturas/métodos , Resultado del TratamientoRESUMEN
PURPOSE: Infection at the pin site remains the most common complication of external fixators (EFs). It is known that hydroxyapatite (HA)-coated pins increase bone adhesion and may lead to reduced rates of reported infections. The present study compares the rates of pin track infection associated with stainless steel and HA-coated pins. METHODS: This is a prospective, multicenter, nonrandomized, comparative intervention study among patients undergoing surgical treatment with EFs of any type between April 2018 and October 2021. Patients were followed up until the removal of the EF, or the end of the study period (ranging from 1 to 27.6 months). The definition of pin track infection was based upon the Maz-Oxford-Nuffield (MON) pin infection grading system. RESULTS: Overall, 132 patients undergoing external fixation surgery were included. Of these, 94 (71.2%) were male, with a mean age of 36.9 years (SD ± 18.9). Infection of any type (score > 1) was observed in 63 (47.7%) patients. Coated and uncoated-pin track-infection occurred in 45.7% and 48.5% of patients, respectively (P= 0.0887). The probability of developing infection (defined as a score ≥ 2) adjusted for comorbidities and follow-up time was not statistically higher among those who received uncoated pins compared to those who received pins coated with HA (odds ratio (OR) = 1.56, 95% confidence interval (95% CI): 0.67-3.67, p <0.05). CONCLUSION: In the present study, the external fixator pin infection rates were similar when using HA coating and standard steel pins.
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Durapatita , Fijadores Externos , Humanos , Masculino , Adulto , Femenino , Durapatita/efectos adversos , Fijadores Externos/efectos adversos , Estudios Prospectivos , Acero Inoxidable , Fijación de Fractura/efectos adversos , Clavos Ortopédicos/efectos adversosRESUMEN
Introducción.La Protuberancia Occipital Externa (POE) es una superficie convexa y lisa que tradicionalmente no presenta ningún tipo de irregularidades. La aparición de un entesofito en individuos ha llamado la atención de los investigadores. Objetivo.Determinar la prevalencia, longitud, edad y sexo de una exostosis en forma de gancho desarrollada a nivel de la POE. Metodología.Estudio observacional descriptivo realizado en radiografías laterales de cráneo de individuos jóvenes. De 5065 radiografías, 4017 radiografías cumplieron con los criterios. Se procedió a la detección de la presencia de un gancho óseo en la POE y su medición. Resultados.Se incluyeron personas de ambos sexos entre 13 a 45 años: 2902 mujeres y 1115 varones. De las 4017 radiografías observadas, el 67% presentó la excrecencia en la POE, con rangos desde 5 a 24 mm en longitud, 511 tenían una longitud de 5 mm o mayor, 903 entre 9 a 12 mm de longitud y 253 de 13 a 24mm. Se observó enmayor proporción en el sexo masculino que el femenino(68% vs 32%). En los individuos de 40 años y más, solo un paciente de sexo masculino mostró la presencia del entesofito. Conclusión.Se ha encontrado una alta frecuencia del desarrollo de una protuberancia ósea a nivel del POE en jóvenes y adultos jóvenesde sexo masculino. Este es el primer estudio de este tipo realizado en la población del Paraguay. Para comprender la razón del desarrollo de esta excrecencia ósea, es necesario ampliar el área de investigación. Palabras Clave:ganchos óseos;protuberancia; exostosis; entesopatía.
Introduction.The external occipital protuberance (EOP) is a smooth convex surface which commonly does not present any type of irregularities. The development of an enthesophyte in young population has attracted the attention of researchers. Objective.To determine the prevalence, size, age, and sex of individuals with bony projections that resembles a hook developed in EOP. Methodology.Descriptive observational study. 5065 lateral skull x-rays were observed. 4017 fulfilled all the criteria. The x-rays were reviewed for the presence of a bony excrescence in EOP, and they were measured. Results. From a both sexes population between 13 to 45 years old 2902 were female and 1115 were male. 67% X-rays presented the enthesophyte ranging from 5 24mm in length. 511 out of 1667 had an enthesophyte at or above 5 mm. There were 903 patients with an enthesophyte ranging from 9 12 mm in length and 254 had the protuberance ranging from 13 24 mm. Statistically significant range of 68% vs 32% between males and females were observed. From individuals of 40 years and above, just 1 male patient out of 32 showedthe enthesophyte. Conclusion.Significant association with the development of a bony protuberance at the POE in young and young adult male population has been found. This is the first study of this type in Paraguayan individuals. To expand the field of studies, future research is needed to better examine and understand the reason forthe development of this bony excrescence. Key words:bone hooks; protuberance;exostoses; enthesopathies.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Clavos Ortopédicos , Exostosis , Entesopatía , PuenteRESUMEN
INTRODUCTION: Intramedullary nailing is the most frequent procedure used for the treatment of tibial fractures that do not involve the articular surfaces. The goal of this study is to analyse the clinical outcomes, time of surgery and use of fluoroscopy in patients with midshaft and distal tibial fractures treated with suprapatellar and infrapatellar nailing and compare the results between these different groups. METHODS: A retrospective study was conducted, and patients were selected between the period of March 2018 and October 2019. The following variables were studied: age, gender, AO classification, time of surgery (minutes), time of fluoroscopy (seconds), quality of reduction in postoperative controls and 1 year follow-up (using the angles MPTA, LDTA, PPTA, ADTA). Functional outcomes were studied at 1 month and 1 year follow-up. The visual analogue scale was used to study and compare the postoperative pain of the patients. The Lysholm Knee Score was used to evaluate the functional outcomes of the patients. RESULTS: A total of 80 patients meeting the inclusion criteria were included in this study. The suprapatellar approach was used in 44 patients and the infrapatellar in 36 patients. The time of surgery (p=0.008) and the mean time of use of fluoroscopy (p <0.001) difference were significant in favour of the suprapatellar approach. In the quality of reduction analysis, we have statistically significant results in the LDTA and ADTA angles. Also, in the evaluation of postoperative pain, significant difference was found in favour of the suprapatellar approach. CONCLUSION: In conclusion, our study compared the suprapatellar approach and the infrapatellar approach for the treatment of midshaft and distal tibia fractures with intramedullary nailing. The results showed lesser time of surgery and use of fluoroscopy, lower knee pain, and lower rate of malalignment with the suprapatellar approach than with the infrapatellar approach.
Asunto(s)
Fijación Intramedular de Fracturas , Fracturas de la Tibia , Humanos , Estudios Retrospectivos , Rótula/cirugía , Clavos Ortopédicos/efectos adversos , Fracturas de la Tibia/cirugía , Dolor Postoperatorio/etiología , Fijación Intramedular de Fracturas/efectos adversos , Resultado del TratamientoRESUMEN
INTRODUCTION: The objective of this retrospective study was to assess the effect of the nail to canal ratio and the number and configuration of distal locking screws in bone healing in tibial shaft fractures. METHODS: We analyzed 223 consecutive tibial shaft fractures treated with reamed intramedullary nailing between January 2014 and December 2020. We recorded and evaluated the nail to canal ratio (NCR) and the number and configuration of distal locking screws. Median NCR was 0.87 (IQR 0.82-0.94). Ten (4.48%) fractures were treated with one distal locking screw, 173 (77.57%) with two, and 40 (17.93%) with three. Uniplanar fixation was used in 63 (28.25%), biplanar in 150 (67.26%), and triplanar in 10 (4.48%) cases. Uni-, bi-, and multivariate analyses were performed to compare patients who achieved bone union with those who did not. RESULTS: Bone union was achieved in 195 (87.44%) patients. Uni- and bivariate analyses showed that bone union increased significantly with larger NCR (p = 0.0001) and a greater number of locking planes (p = 0.001) and distal screws (p = 0.046). NCR > 0.78 (OR 48.77 CI 95% 15.39-154.56; p = < 0.0001) and distal locking screw configuration (OR 2.91 CI 95% 1.12-9.91; p = 0.046) were identified as independent variables for union. CONCLUSION: Our findings suggest that in tibial shaft fractures treated with intramedullary nailing, NCR should be equal to or greater than 0.79. Additionally, distal locking screws should be used with a biplanar or triplanar configuration.