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Introducción: La fractura del extremo distal del húmero afecta la superficie articular y puede provocar incapacidad biomecánica de la articulación si no se trata adecuadamente. Objetivo: Presentar una paciente con fractura del capitellum, tratada mediante osteosíntesis. Presentación del caso: Paciente femenina de 49 años que se cayó sobre su mano en extensión. Presentó dolor intenso en el codo izquierdo y se le diagnosticó una fractura del capitellum desplazada. Se trató con osteosíntesis. Conclusiones: El tratamiento mediante osteosíntesis de la fractura del capitellum constituye la mejor opción para la rápida rehabilitación del paciente.

Introduction: The fracture of the distal end of the humerus affects the articular surface and it can cause biomechanical disability of the joint if it is not treated properly. Objective: To report the case of a patient with capitellum fracture, treated by osteosynthesis. Case report: This is the case of a 49-year-old female patient who fell on her outstretched hand. She complained of severe pain in her left elbow and she was diagnosed with a displaced capitellum fracture. The pateinmet was treated with osteosynthesis. Conclusions: The treatment by osteosynthesis of the capitellum fracture is the best option for the rapid rehabilitation of the patient.

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Abstract Introduction The surgical management of jugulotympanic paragangliomas has remained challenging. They are the second most common type of tumor of the temporal bone after acoustic neuroma. It has been noticed by the authors that the jugulotympanic paragangliomas may have extensions to the epitympanum and aditus in addition to the mesotympanum and hypotympanum. The modified technique could be an alternative to the conventional facial recess technique for complete removal of the tumors. Objective To highlight the modified surgical technique for the surgical treatment of jugulotympanic paragangliomas. Methods This is a retrospective review of 34 cases of jugulotympanic paragangliomas treated in a tertiary center with respect to clinical presentation, diagnosis, and surgical treatment. Tinnitus and hearing loss were predominant symptoms. A modified technique of postauricular transcanal posterior tympanectomy with extended hypo-tympanic access was performed in 29 patients. Only two cases were operated with a classical transcanal approach. A canal wall down the mastoidectomy was required in three patients. Results The patients operated on with the modified technique had complete excision evident by absence of any lesion in computed tomography and the disappearance of tinnitus. However, two patients had recurrence of symptoms and presence of tumor in the follow-up period. These two patients underwent revision surgery. None of the patients required postoperative radiotherapy or gamma knife therapy. Conclusions Jugulotympanic paragangliomas can be effectively managed with the modified technique to ensure complete removal of the lesions. This technique has not been reported earlier in the literature.

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Introduction The surgical management of jugulotympanic paragangliomas has remained challenging. They are the second most common type of tumor of the temporal bone after acoustic neuroma. It has been noticed by the authors that the jugulotympanic paragangliomas may have extensions to the epitympanum and aditus in addition to the mesotympanum and hypotympanum. The modified technique could be an alternative to the conventional facial recess technique for complete removal of the tumors. Objective To highlight the modified surgical technique for the surgical treatment of jugulotympanic paragangliomas. Methods This is a retrospective review of 34 cases of jugulotympanic paragangliomas treated in a tertiary center with respect to clinical presentation, diagnosis, and surgical treatment. Tinnitus and hearing loss were predominant symptoms. A modified technique of postauricular transcanal posterior tympanectomy with extended hypotympanic access was performed in 29 patients. Only two cases were operated with a classical transcanal approach. A canal wall down the mastoidectomy was required in three patients. Results The patients operated on with the modified technique had complete excision evident by absence of any lesion in computed tomography and the disappearance of tinnitus. However, two patients had recurrence of symptoms and presence of tumor in the follow-up period. These two patients underwent revision surgery. None of the patients required postoperative radiotherapy or gamma knife therapy. Conclusions Jugulotympanic paragangliomas can be effectively managed with the modified technique to ensure complete removal of the lesions. This technique has not been reported earlier in the literature.

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BACKGROUND: Kommerell's aneurysm is a saccular or fusiform dilatation found in 3-8% of Kommerell's diverticulum cases. A non-dissecting rupture rate of 6% has been reported. If ruptured, emergent surgical correction is usually granted. However, evidence regarding the optimal surgical approach in this acute setting is scarce. In this case report series, we aim to describe our experience managing type-1 non-dissecting ruptured Kommerell's aneurysm with hybrid emergent surgical approaches. CASES PRESENTATION: From January 2005 to December 2020, three cases of type-1 non-dissecting ruptured Kommerell's aneurysm requiring emergent surgical repair were identified. The mean age was 66.67 ± 7.76 years, and 3/3 were male. The most common symptoms were atypical chest pain, dyspnoea, and headache (2/3). The mean aneurysm's diameter was 63.67 ± 5.69 mm. Frozen Elephant Trunk was the preferred surgical approach (2/3). The Non-Frozen Elephant Trunk patient underwent a hybrid procedure consisting of a supra-aortic debranching and a zone-2 stent-graft deployment. We found a mean clamp time of 140 ± 60.75 min, cardiac arrest time of 51.33 ± 3.06 min, and a hospital stay of 13.67 ± 5.51 days. The most common complications were surgical-site infection and shock (2/3). Only one patient died (1/3). CONCLUSION: Evidence of management for non-dissecting ruptured Kommerell's aneurysms is scarce. Additional, robust, and more extensive studies are required. The selection of the appropriate surgical approach is challenging, and each patient should be individualized. Frozen Elephant Trunk was feasible for patients requiring emergent surgical repair in our centre. However, other hybrid or open procedures can be performed.

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Resumen El objetivo de este artículo fue evaluar la evidencia sobre el uso de una aparatología ortopédica prequirúrgica (AOP) en pacientes con labio y paladar hendido. Se realizó una búsqueda en las siguientes bases de datos: Medline/PubMed, Google Scholar, Clinical Trails.gov, ProQuest y Web of Science. En la búsqueda, se encontraron 7.926 registros, de los cuales se analizaron 105 artículos de texto completo; de éstos se incluyeron 23 estudios en pacientes con uso de AOP, asi como su grupo control sin el uso del AOP, previo al mismo tipo de cirugía. Los aparatos más utilizados para la AOP en el manejo de LPH fueron: el paladar pasivo (Paladar de Hotz), el modelador nasolaveolar (NAM), aparato McNeil y por último el T-traction; los principales desenlaces evaluados fueron: la estética facial y apariencia nasal; la evaluación de medidas cefalométricas, de vías aéreas superiores, nasales, del ancho de la fisura y así como puntos de referencia anatómicos como la distancia inter-canina e inter-tuberosidad. Además, se encontraron estudios que evaluaron oclusión y la fonación. La evidencia de esta literatura sugiere que el uso de aparatos activos tiene un mejor efecto que la placa pasiva, en términos de estética facial y aproximación de los segmentos maxilares para el cierre de la fisura. Sin embargo, la heterogeneidad, el riesgo de sesgo y la baja calidad de los estudios no permite tener conclusiones sólidas.

Abstract This review article aimed to evaluate the evidence on the use of a presurgical orthopedic appliance (POP) in patients with cleft lip and palate. The search was conducted using Medline/PubMed, Scholar Google, Clinical Trails, ProQuest, Scopus, and Web of Science databases. During the search, 7,926 records were found, of which 105 full-text articles were analyzed, and 23 studies included analysis in patients with the use of POP, and their control groups without the use of POP prior to the same type of surgery. The devices most used for POP in the management of LPH were: the passive palate (Hotz palate), the nasolaveolar moulding (NAM), the McNeil device, and finally, the T-traction. The primary outcomes evaluated were: facial aesthetics and nasal appearance; the evaluation of cephalometric measurements, upper airways, nasal fissure width, as well as anatomical references such as inter-canine and intertuberosity distances. In addition, studies that evaluated occlusion and phonation were found. The evidence from this literature suggests that the use of active appliances had a better effect than passive appliances in terms of facial aesthetics and approximation of the maxillary segments for the closure of the fissure. However, the heterogeneity, the risk of bias, and the low quality of the studies do not allow to state firm conclusions.

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Neurofibromatosis is an autosomal dominant disorder characterized by tumors of the nervous system and skin. Plexiform neurofibromas are common complications of neurofibromatosis type 1 and can cause large facial deformities. Vascular anomalies are in turn a rare manifestation of neurofibromatosis. We present the case of a 48-year-old female patient with right hemifacial neurofibromatosis associated with venous vascular malformation, previously treated surgically and then with sclerosing agents, determining severe residual facial deformity. Her surgical approach using a modified facelift technique associated with partial tumor debulking and lipofilling seems to be a valid technical alternative for these highly complex cases that require a customized approach after exhaustive preoperative evaluation.

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Background: The surgical ressection of petroclival meningiomas is challenging due to its deep location and relationship with vital neurovascular structures. Usually they are benign injuries, but they can involve or infiltrate skull base bones, dura mater and brainstem. This makes the total removing very difficult or impossible without causing neurological deficits. The objective of this study is to review the surgical approaches used on the treatment of petroclival meningiomas and the knowledge which we achieved upon the surgical management of 30 cases. Methods: Series of 30 petroclival meningioma-cases. In the beginning of our series we used petrous approach for all the cases, however, with the acquiring of experience, we are indicating the retrosigmoid approach, leaving the petrous and skull-orbito-zigomatics approaches for selected cases. Results: Owing to the difficulty of the access, the petroclival meningiomas usually require different surgical approaches and have distint surgical difficulties. There are three main approaches: fronto-orbito-zigomatics and variants; petrous and variants and retrosigmoid, and they can be combined. The choice for a surgical approach is usually on the location and size of the tumor, on the skull shape, the involvement of venous structures and according to the surgeon´s experience. Conclusion: Petroclival meningiomas are rare and complex on the skull base. The adequate choice is crucial to achieve the good surgical result.

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Donkeys are a public health concern in the Northeast region of Brazil, with thousands of stray animals. Orchiectomy is an important population control measure; however, the long postoperative period with daily treatment of open wounds in the scrotum makes it difficult to perform a large number of castrations in sheltering centers. We evaluate a novel surgical procedure for orchiectomy in donkeys using parascrotal access. Twelve donkeys were used, divided into two groups: I - submitted to orchiectomy through parascrotal surgical access (novel procedure), and II - submitted to orchiectomy through scrotal access (conventional). Postoperative evaluations consisted of a macroscopic evaluation of the surgical wound (bleeding and intensity of edema), hematological parameters, and peritoneal fluid, which occurred in both groups at the moments (M): M0 - before the surgical procedure. The others moments occurred after surgery: M12 (twelve hours); M24 (twenty-four hours); M48 (forty-eight hours); M72 (seventy-two hours); M8D (eight days); and M16D (sixteen days). The surgical techniques did not generate an important systemic inflammatory response to the point detected by the leukogram, fibrinogen dosage, and peritoneal fluid. The parascrotal technique required long surgery but promoted less bleeding, less edema, and faster healing. The techniques used did not promote sufficient systemic inflammation to alter the number of leukocytes and the fibrinogen concentration; however, evaluation of the peritoneal fluid proved to be important for evaluating inflammatory processes involving the scrotum and inguinal canal. We describe a novel surgical procedure for orchiectomy in Donkeys using a parascrotal access that promoted less risk of bleeding, shorter period of edema, and healing time, but required longer surgery time.

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PURPOSE: This study aimed to review the cases of giant adenomas that were operated on from 2012 to 2020 and to analyze the epidemiological profile, complications, and resection rates using the transseptal/transnasal endoscopy technique. We also compared the results with data from revised literature. METHODS: This is an observational, retrospective study includes a review of the medical records of 26 patients diagnosed with giant adenomas (diameter > 4 cm or volume >10 cm3) who underwent 28 surgical procedures. RESULTS: Of the 57 patients operated for pituitary adenoma, 26 (50.8%) had giant adenomas. The mean volume was 17.28 cm3 (95% confidence interval [CI], 8.3359-26.2241). Moreover, 64.28% of the patients were graded Knosp 3 (p < 0.0001). Most cases were of nonsecretory adenomas (88.46%). Visual impairment was present in 89.2% of the patients and hormonal deficit and headache affected 53.5% of them. The visual impairment improved in 60% of the patients. The most common surgical complication was cerebrospinal fluid fistula (10.71%). Tumor resection > 90% was achieved in 53.56% of the cases, and the mean resection rate was 78.36% (95% CI, 71.316-87.956). CONCLUSIONS: The endoscopic endonasal technique is a good treatment option for giant adenomas, showing satisfactory optic apparatus decompression rates and a low incidence of complications when performed by surgeons with expertise in this approach.

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SUMMARY: Surgical operations regarding to skull base are challenging and reliable anatomical landmarks are required. There is a lack of knowledge on anatomical variations in this region. The aim of this study was to determine the safe extracranial landmarks for surgical approach to the skull base. In this study, 23 adult dry skulls were evaluated: the age and sex of the specimens were unknown. All measurements were taken from external surface of inferior aspect of the skull by using digital calipers accurate to 0.01 mm. In right and left sides; the distances between the external acoustic meatus (EAM) and the following anatomical landmarks were measured: articular tubercle (AT); anterior margin of squamous suture (ASS); superior margin of squamous suture (SSS); posterior margin of squamous suture (PSS); end point of styloid process (SP); midpoints of pterygomaxillary fissure (PMF); foramen ovale (FO); foramen spinosum (FS); and of carotid canal (CC).The distances of the external acoustic meatus to the anatomical structures on the right and left sides were: EAM-SP; 24.24±3.19 mm, 23.16±3.17 mm; EAM-PMF; 46.56±4.51mm, 46.25±3.96 mm; EAM-FO; 27.57±2.87 mm, 28.70±2.85 mm; EAM-FS; 22.53±3.19 mm, 22.72±3.47 mm; EAM-CC; 17.35±3.56 mm, 17.19±3.39 mm; EAM-AT; 19.31±3.79 mm, 18.95±3.42 mm; EAM-ASS; 43.14±4.80 mm, 46.82±4.61 mm; EAM-SSS; 49.17±4.74 mm, 48.83±3.34 mm and EAM-PSS; 36.15±4.24 mm, 35.39±4.25 mm, respectively. We think that the findings obtained from this study related to external acoustic meatus can be an important reference for surgical anatomy and surgical procedures in skull base.

RESUMEN: Las cirugías relacionadas con la base del cráneo son un desafío, las cuales requieren puntos de referencia anatómicos confiables. Existe una falta de conocimiento sobre las variaciones anatómicas en esta región. El objetivo de este estudio fue determinar los puntos de referencia extracraneales seguros para el abordaje quirúrgico de la base del cráneo. En este estudio se evaluaron 23 cráneos secos adultos: se desconocía la edad y el sexo de los ejemplares. Las medidas se tomaron de la superficie externa de la cara inferior del cráneo utilizando calibradores digitales con una precisión de 0,01 mm. En lados derecho e izquierdo se midieron las distancias entre el meato acústico externo (MAE) y los siguientes puntos de referencia anatómicos: tubérculo articular (TA); margen anterior de la sutura escamosa (MASE); margen superior de sutura escamosa (MSSE); margen posterior de sutura escamosa (MPSE); punto final del proceso estiloides (PFPE); puntos medios de la fisura pterigomaxilar (PMFP); foramen oval (FO); foramen espinoso (FE); y del canal carotídeo (CC). Las distancias del meato acústico externo a las estructuras anatómicas de los lados derecho e izquierdo fue- ron: MAE-PFPE; 24,24 ± 3,19 mm, 23,16 ± 3,17 mm; MAE-PMFP; 46,56 ± 4,51 mm, 46,25 ± 3,96 mm; MAE-FO; 27,57 ± 2,87 mm, 28,70 ± 2,85 mm; MAE-FE; 22,53 ± 3,19 mm, 22,72 ± 3,47 mm; MAE-CC; 17,35 ± 3,56 mm, 17,19 ± 3,39 mm; MAE-TA; 19,31 ± 3,79 mm, 18,95 ± 3,42 mm; MAE-MASE; 43,14 ± 4,80 mm, 46,82 ± 4,61 mm; MAE-MSSE; 49,17 ± 4,74 mm, 48,83 ± 3,34 mm y MAE-MPSE; 36,15 ± 4,24 mm, 35,39 ± 4,25 mm, respectivamente. Creemos que los hallazgos obtenidos de este estudio relacionados con el meato acústico externo pueden ser una referencia importante para la anatomía quirúrgica y los procedimientos quirúrgicos en la base del cráneo.

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Odontomas are common benign odontogenic tumors, being often detected on routine radiographs during the first two decades of life. Rarely, odontoma can interfere with jaw movements, causing mouth opening limitation. A 28-year-old male patient was referred complaining of restriction of mouth opening and mandibular movements, which started 6 months ago. Clinical examination revealed a painless increase of volume on the right maxilla, which interfered the mandibular movements, being associated with pain in these attempts. A well-defined, oval radiopaque lesion in close relationship with the impacted maxillary right third molar was detected in tomographic reconstructions. A surgical excision of the lesion was performed, and microscopy revealed complex odontoma. After 4 months of follow-up, the patient achieved adequate mouth opening and recovered mandibular movements. In the current case, the lesion was placed in a difficult access site, which directly interfered with the displacement of coronoid process. Odontoma should be included in the differential diagnosis when assessing causes of restricted mouth opening.

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Epignathus is a rare congenital orofacial teratoma that arises from the sphenoid region of the palate or the pharynx. It occurs in approximately 1:35,000 to 1:200,000 live births representing 2% to 9% of all teratomas. We present the case of a newborn of 39.4 weeks of gestation with a tumor that occupied the entire oral cavity. The patient was delivered by cesarean section. Oral resection was managed by pediatric surgery. Plastic surgery used virtual 3-dimensional models to establish the extension, and depth of the tumor. Bloc resection and reconstruction of the epignathus were performed. The mass was diagnosed as a mature teratoma associated with cleft lip and palate, nasoethmoidal meningocele that conditions hypertelorism, and a pseudomacrostoma. Tridimensional technology was applied to plan the surgical intervention. It contributed to a better understanding of the relationships between the tumor and the adjacent structures. This optimized the surgical approach and outcome.

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BACKGROUND: Cavernous hemangiomas, more accurately defined as cavernous venous malformations, constitute the most common primary intraorbital tumors of adults comprising 4-9% of all tumors,[4] and the second most frequent cause of unilateral proptosis after thyroid-related orbitopathy.[3] Over 80% are located within the intraconal compartment, most commonly in the lateral aspect.[1] Surgical treatment for orbital cavernous hemangioma is generally required in symptomatic cases, optic nerve compression, and cosmetically disfiguring proptosis.[2] Transcranial approaches, the most familiar approaches for neurosurgeons, provide wide access to the entire superior and lateral orbit. They usually offer direct visualization, allowing for a safer dissection, while minimizing significant injury to the native neural and vascular anatomy of the orbit.[5] Although transcranial approaches continue to evolve, in many cases, they have been supplanted by endoscopic skull base approaches and modifications to deep lateral orbitotomy approaches.[5]. CASE DESCRIPTION: A 62-year-old male patient presented with slowly expanding left proptosis, which he had first noticed 3 years before presentation. He was already blind in his right eye due to a history of traumatic amaurosis in childhood. The left eye examination revealed severe proptosis with restricted eye movement in all directions and significant visual impairment (visual acuity of 20/300, expressed by Snellen test, with no improvement on correction). MRI of the orbit showed a large left superolateral intraconal cavernous hemangioma compressing and displacing the optic nerve, with the typical feature of slow gradual irregular enhancement with delayed washout on contrast-enhanced image. A one-piece modified orbitozygomatic approach was performed and a total en block resection was achieved. The bone flap was fixed with titanium miniplates and screws, the temporal muscle and the skin were closed in a standard fashion. The patient did not present any new deficit in the postoperative period. The patient had good functional and cosmetic outcomes with resolution of proptosis, restoration of eye movements, and improvement of visual acuity in the 3-month follow-up. Postoperative MRI showed total resection. CONCLUSION: The orbitozygomatic approach for large orbital cavernous hemangioma provides satisfactory orbital decompression and large working space, reduces traction, and increases visualization and freedom to dissect small vessels and nerves that may be tightly attached to the tumor pseudocapsule.

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BACKGROUND: Hindfoot arthrodesis is used in patients with advanced-stage acquired flatfoot, usually associated with degenerative joint disease. The objective of the present study was to evaluate the clinical and radiographic results of hindfoot arthrodesis using the single-incision medial approach. METHODS: A case series of 18 consecutive patients undergoing surgical correction between 2015 and 2018 with hindfoot arthrodesis using the medial approach was evaluated. The clinical assessment used the visual analog pain scale, AOFAS hindfoot score, SF-36, and foot function index. Radiographs and personal satisfaction criteria were also analyzed. RESULTS: All radiographic parameters evaluated showed a significant improvement (p < .05), except the calcaneal pitch. Pain decreased by 5.1 points (p < .001), and the mean final AOFAS score was 72.6. In three feet, a new surgery was required. Two feet developed talar necrosis. None of the cases presented surgical wound dehiscence, and two presented with superficial infection, which was resolved with the use of oral antibiotics. CONCLUSION: Double arthrodesis (subtalar and talonavicular) to correct adult-acquired valgus flatfoot using a medial approach has a low risk of soft tissue complications and presents satisfactory functional results. Avascular necrosis is a serious complication that was present in 11% of cases.

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INTRODUCTION: The anterior hip approach was described since 1881, since then several studies have been conducted that have shown significant advantages over the posterior and lateral direct approaches of the hip. MATERIAL AND METHOD: We conducted a descriptive study with continuous non-probabilistic cases at the Institute of Forensic Sciences from October 2015 to July 2017. Anatomy and distances were described to the neurovascular bundles. Correlation of Spearmans Pearson and Rho was performed. RESULTS: 22 dissections were made, the Femorocutaneous Nerve was identified in 9 specimens, the average lateral Femorocutaneous Nerve distance at Smith-Petersen interval was 11.4 mm, We identified the Ascending Lateral Circumflex artery under the femoral rectum towards the central region of the approach, the separators could be placed around the coxofemoral joint without injuring vital structures, the riskier separator we place it in the anterior wall of the acetabulum, below the Psoasyland with an average distance 28.25 mm to the femoral package. The older you go, the longer the neurovascular bundles were located p 0.05. CONCLUSIONS: High level of safety of the previous approach for hip replacement, distances to vital structures have a reasonable margin, hip replacement offers adequate joint exposure, direct acetabulum vision and atraumatic surgical dissection.

INTRODUCCIÓN: El abordaje anterior de cadera fue descrito en 1881, desde entonces se han realizado diversos estudios que han demostrado ventajas significativas frente a los abordajes posterior y lateral directo de cadera. MATERIAL Y MÉTODO: Se llevó a cabo un estudio descriptivo con casos continuos no probabilísticos en el Instituto de Ciencias Forenses de Octubre de 2015 a Julio de 2017. Se describió anatomía y distancias a los paquetes vasculonerviosos. Se realizó correlación de Pearson y Rho de Spearman. RESULTADOS: Se efectuaron 22 disecciones, el nervio femorocutáneo fue identificado en nueve especímenes, la distancia promedio del nervio femorocutáneo lateral al intervalo de Smith-Petersen fue 11.4 mm, se identificó la arteria circunfleja lateral ascendente debajo del recto femoral hacia la región central del abordaje, se colocaron los separadores alrededor de la articulación coxofemoral sin lesionar estructuras vitales, el separador más riesgoso se ubicó en la pared anterior del acetábulo, debajo del músculo iliopsoas con distancia promedio de 28.25 mm al paquete femoral. A mayor edad mayor distancia a los paquetes neurovasculares p 0.05. CONCLUSIONES: Alto nivel de seguridad del abordaje anterior para artroplastía de cadera, las distancias a estructuras vitales presentan un margen razonable, en artroplastía de cadera ofrece adecuada exposición de la articulación, visión directa del acetábulo y disección quirúrgica atraumática.

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BACKGROUND: Giant brain aneurysms account for approximately 5% of all intracranial aneurysms, often presenting with intraluminal thrombosis that causes a mass effect in surrounding neural structures. Although its exact growing mechanism remains unknown, they have to be treated. Despite the most recent advances in neurosurgical fields, the best treatment modality remains unknown and surgery of giant superior cerebellar artery (SCA) aneurysms still is a challenge even for the most experienced neurosurgeons, due to their deep location, surrounding perforating vessels, and intraluminal thrombosis. CASE DESCRIPTION: In this video, we present the case of a 65-year-old woman with progressive hemiparesis and paresis of low cranial nerves. The symptoms were caused by a giant aneurysm located in the origin of the SCA. Despite endovascular embolization of the aneurysm and placement of a flow diverter stent, the aneurysm increased in size causing symptoms progression. In that scenario, we decided to perform a microsurgical decompression of the aneurysm thrombus and coagulation of the vasa vasorum, to reduce the mass effect and prevent the aneurysm from keep growing. CONCLUSION: Through an extensive description of the surgical anatomy, we illustrate an interhemispheric transcallosal transforaminal approach, with the removal of anterior thalamic tubercle to widely expose the aneurysm dome. The surgery was successfully performed, and the patient symptoms improved. The patient signed the Institutional Consent Form, which allows the use of her images and videos for any type of medical publications in conferences and/or scientific articles.

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Resumen: Introducción: El abordaje anterior de cadera fue descrito en 1881, desde entonces se han realizado diversos estudios que han demostrado ventajas significativas frente a los abordajes posterior y lateral directo de cadera. Material y método: Se llevó a cabo un estudio descriptivo con casos continuos no probabilísticos en el Instituto de Ciencias Forenses de Octubre de 2015 a Julio de 2017. Se describió anatomía y distancias a los paquetes vasculonerviosos. Se realizó correlación de Pearson y Rho de Spearman. Resultados: Se efectuaron 22 disecciones, el nervio femorocutáneo fue identificado en nueve especímenes, la distancia promedio del nervio femorocutáneo lateral al intervalo de Smith-Petersen fue 11.4 mm, se identificó la arteria circunfleja lateral ascendente debajo del recto femoral hacia la región central del abordaje, se colocaron los separadores alrededor de la articulación coxofemoral sin lesionar estructuras vitales, el separador más riesgoso se ubicó en la pared anterior del acetábulo, debajo del músculo iliopsoas con distancia promedio de 28.25 mm al paquete femoral. A mayor edad mayor distancia a los paquetes neurovasculares p < 0.05. Conclusiones: Alto nivel de seguridad del abordaje anterior para artroplastía de cadera, las distancias a estructuras vitales presentan un margen razonable, en artroplastía de cadera ofrece adecuada exposición de la articulación, visión directa del acetábulo y disección quirúrgica atraumática.

Abstract: Introduction: The anterior hip approach was described since 1881, since then several studies have been conducted that have shown significant advantages over the posterior and lateral direct approaches of the hip. Material and method: We conducted a descriptive study with continuous non-probabilistic cases at the Institute of Forensic Sciences from October 2015 to July 2017. Anatomy and distances were described to the neurovascular bundles. Correlation of Spearman's Pearson and Rho was performed. Results: 22 dissections were made, the Femorocutaneous Nerve was identified in 9 specimens, the average lateral Femorocutaneous Nerve distance at Smith-Petersen interval was 11.4 mm, We identified the Ascending Lateral Circumflex artery under the femoral rectum towards the central region of the approach, the separators could be placed around the coxofemoral joint without injuring vital structures, the riskier separator we place it in the anterior wall of the acetabulum, below the Psoasyland with an average distance 28.25 mm to the femoral package. The older you go, the longer the neurovascular bundles were located p < 0.05. Conclusions: High level of safety of the previous approach for hip replacement, distances to vital structures have a reasonable margin, hip replacement offers adequate joint exposure, direct acetabulum vision and atraumatic surgical dissection.

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Anatomic reduction of the posterior malleolus is mandatory for a good functional outcome. Preoperative planning with a computed tomography scan's axial view helps to decide which approach and surgical position we should choose. Based on posterior malleolus fracture anatomy, a guideline is suggested to facilitate decision making on which approach seems to give the best exposure with minimum complications.

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Introducción Las fracturas del platillo tibial posterolateral exigen un abordaje que permita una buena visualización de la superficie articular para su restitución anatómica, restablecimiento de la altura y un espacio adecuado para la aplicación del material de osteosíntesis y fijación estable. Hay diversos abordajes descritos en la literatura que no proporcionan la visualización deseada o conllevan múltiples limitaciones y/o complicaciones. El propósito de este estudio es describir una modificación a la técnica quirúrgica de la osteotomía de la fíbula para el manejo de las fracturas de platillo tibial posterolateral. Materiales y métodos Se presentan los resultados clínicos de una serie de casos retrospectiva de 15 pacientes con fracturas de platillo tibial posterolateral que al momento del estudio tenían un seguimiento promedio de 6 meses. Resultados Los resultados funcionales en escala de Lysholm fueron excelentes en 3 pacientes, buenos en 8 y regulares en 4. En todos los pacientes se logró una reducción satisfactoria de la superficie articular de la tibia, sin pérdida de altura de la misma, con alineación adecuada, sin síntomas de inestabilidad, todos con consolidación de la fíbula que no retrasó la rehabilitación, no hubo lesiones del nervio peroneal ni problemas con la piel; se presentó un caso de infección superficial que se manejó con antibióticos orales sin complicaciones. Discusión El abordaje descrito facilita una amplia exposición de la superficie articular, es técnicamente fácil y reproducible, permite la reducción y fijación necesaria, con menor riesgo de complicaciones, con la cual se conserva el aporte vascular de la tibia proximal, se evita el daño a la articulación tibiofibular proximal y se propicia una mayor área de consolidación de la osteotomía. Ésta técnica puede utilizarse sola o en combinación con otros abordajes, para fracturas agudas o crónicas con mala unión. Consideramos que el abordaje con la técnica descrita es una alternativa para el manejo de las fracturas posterolaterales, con resultados alentadores.

Background Fractures of the posterolateral tibial plateau require an approach that allows a good visualization of the articular surface for its anatomical restitution, restoration of height and an adequate space for the application of osteosynthesis material and stable fixation. There are several approaches described in the literature that do not provide the desired visualization or involve multiple limitations and / or complications. The purpose of this study is to describe a modification to the surgical technique of the fibula osteotomy for the management of posterolateral tibial plate fractures. Methods We present the clinical results of a retrospective case series of 15 patients with posterolateral tibial plate fractures that at the time of the study had an average follow-up of 6 months. Results Functional results in Lysholm scale were excellent in 3 patients, good in 8 and regular in 4. Good results were obtained in all patients with a reduction of the tibia articular surface, without loss of height of the same, with alignment adequate, without symptoms of instability, all with consolidation of the fibula that did not delay rehabilitation, there were no peroneal nerve injuries or problems with the skin; There was a case of superficial infection that was managed with oral antibiotics without complications. Discussion The described approach facilitates a broad exposure of the articular surface, is technically easy and reproducible, allows the necessary reduction and fixation, with a lower risk of complications, with which the vascular supply of the proximal tibia is conserved, the damage is avoided to the proximal tibiofibular joint and a greater area of consolidation of the osteotomy is favored. This technique can be used alone or in combination with other approaches, for acute or chronic fractures with poor union. We consider that the approach with the described technique is an alternative for the management of posterolateral fractures, with encouraging results.

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RESUMO

Resumen: Introducción: Hoy en día no se cuenta con evidencia suficiente que determine la mejor opción del abordaje quirúrgico para artroplastía total primaria de cadera. El objetivo de este estudio es comparar los resultados de satisfacción del paciente con la escala de HOOS entre el acceso quirúrgico anterior, lateral y posterior en pacientes tratados mediante reemplazo articular primario de cadera. Material y métodos: Se compararon los resultados de satisfacción con la escala de HOOS entre el abordaje quirúrgico anterior, lateral y posterior a las 48 horas, al mes y a los tres meses; se aplicó la prueba estadística de ANOVA y una prueba post hoc de Tukey a los resultados obtenidos. Resultados: Se obtuvo mayor puntaje en la escala de HOOS con el abordaje anterior en comparación con el abordaje lateral y el posterior a las 48 horas, al mes y a los tres meses del postoperatorio, con un valor p de 0.012 a las 48 horas, de 0.014 al mes y de 0.047 a los tres meses. Conclusiones: Se concluyó que en nuestro grupo de estudio hubo mayor satisfacción de los pacientes postoperados de artroplastía primaria de cadera con abordaje anterior en comparación con los abordajes lateral y posterior; sin embargo, esta diferencia va disminuyendo a lo largo del tiempo, llegando a tener resultados de satisfacción similares a los tres abordajes al cabo de tres meses.

Abstract: Indroduction: Today, there is insufficient evidence, that determines the best option of the surgical approach for primary total hip replacement. The objective of this study is to compare patient satisfaction results with the HOOS scale between anterior, lateral and posterior surgical access in patients treated with primary hip joint replacement. Material and methods: Satisfaction results were compared with the HOOS scale between the surgical approach anterior, lateral and posterior at 48-hour, monthly, and three-month; the ANOVA statistical test and a Tukey post-hoc test were applied to the results obtained. Results: A higher score on the HOOS scale was obtained with the anterior approach compared to the lateral and posterior. At 48 hour, per month and three months after surgery, with a p-value of 0.012 at 48 hours, 0.014 per month and from 0.047 to three months. Conclusions: It was concluded, that in our study group, there was greater satisfaction of the post-operative patients of primary hip replacement with Anterior approach compared to the lateral and posterior approaches, however this difference decreases over the length of the time, reaching similar satisfaction results with all three approaches at three months.

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