E. Guerado

Result of a pyrocarbon prosthesis after comminuted and unreconstructable radial head fractures

BACKGROUND The purpose of this study is to analyze the results of treating unreconstructable acute radial head fractures associated with other elbow fractures and soft-tissue injuries with a pyrocarbon radial head prosthesis replacement, as well as repair of the associated injuries. MATERIALS AND METHODS Twenty-eight patients with Mason type III unreconstructable and unstable radial head fractures and with associated injuries (according to Hotchkiss classification modified by van Riet) were treated with a pyrocarbon radial head prosthesis replacement; repair of collateral ligaments and associated elbow fractures was also carried out. Patients were evaluated in accordance with the Mayo Elbow Performance Score, measuring pain, grip strength, range of motion, and stability, as well as radiographic images. RESULTS After a mean of 32 months postoperatively (range, 12-62 months), the mean Mayo Elbow Performance Score was 92 points. The result was considered excellent or good in 25 patients, with a high degree of satisfaction and functional restoration. CONCLUSION The results of treating Mason type III radial head fractures with additional elbow fractures and soft-tissue injuries with pyrocarbon radial head prostheses are satisfactory; nevertheless, long-term follow-up is still necessary.

Complicaciones de la reparación artroscópica del ligamento cruzado anterior sin ingreso hospitalario

OBJECTIVE To study postoperative complications of arthroscopic anterior cruciate ligament (ACL) reconstruction performed as an outpatient compared with same surgery performed as a regular admission (inpatient). MATERIAL AND METHOD A study was conducted on a historical cohort of 342 patients (115 outpatients vs 227 inpatients) who underwent arthroscopic ACL primary ligamentoplasty (2004-2012). A review was performed on the demographic, surgical and hospital variables. A study was made of early complications (60 days postoperative) including visits to emergency department and readmissions. A descriptive and bivariate distribution analysis was performed between groups, with the grouping criterion: performing of the surgery with or without admission. The Chi-square test was used for qualitative variables and Mann-Whitney U test for quantitative. Limit significance p<0.05. RESULTS Overall, there were 13.2% emergency department visits (mean of 1.24 visits) with an average delay of 8.22 days after discharge. COMPLICATIONS pain not controlled with analgesia (6.7%), hemarthrosis that required arthrocentesis (4.4%), fever (3.2%), deep vein thrombosis (0.6%), cellulitis (0.6%), septic arthritis that required arthroscopic debridement (0.3%), and others (1.2%) including problems with immobilization. The hospital readmissions (2.3%) were for surveillance and monitoring of the surgical wound. In the bivariate analysis no statistically significant differences were found between groups as regards the sociodemographic characteristics of the patients or the complications recorded. DISCUSSION The most frequent complications recorded were acute pain, hemarthrosis and fever. Serious complications (deep vein thrombosis, septic arthritis or need for hospital readmission) were rare. Outpatient arthroscopic ACL repair is a common technique that can be performed safely by surgery without admission, with an overall low complication rate with no differences between outpatients and inpatients.

Luxación traumática del tendón tibial posterior por avulsión del retináculo flexor. Reconstrucción con suturas con anclajes

INTRODUCTION Traumatic dislocation of the posterior tibial tendon (PTT) has a very low prevalence. It presents with pain and recurrent snapping on the posterior side of the medial malleolus after an ankle sprain while practicing sports. The diagnosis is based on clinical examination, supported by imaging techniques. The treatment must be always surgical. CASE REPORT A 28 year old man sprained ankle his ankle while jogging. He was treated in an emergency department with an elastic bandage. Once he recovered, he went back to running, noticing a projection with ankle pain. In the physical examination the PTT was reproduced with inversion maneuvers and forced dorsiflexion. Ultrasound and MRI were performed on the ankle. The patient was operated on, leaving a stable ankle with no projection. Three months later he had no pain and restarted his physical activities. CONCLUSION Surgical treatment of PTT dislocation by re-anchoring the flexor retinacula provides an excellent functional outcome.

Concordancia en el diagnóstico radiológico de las fracturas del raquis toracolumbar

INTRODUCTION Thoracolumbar spine fractures are frequent and severe. Early diagnosis and appropriate treatment to obtain good clinical results is essential, with many classifications being proposed for this purpose. OBJECTIVE To determine the external validity of radiographic and computed tomography (CT) measurements for the most used classifications, and decide on the type of treatment required. The working hypothesis is the existence of external validity of radiographic measurements. MATERIAL AND METHOD A sample of patients with thoracolumbar fracture was selected. Three spine specialists and a resident performed measurements on anteroposterior and lateral radiographic images as well as coronal, sagittal and axial CT slices. Fractures were classified as stable or unstable, evaluating the degree of intra-and interobserver agreement based on a standard observer. Sagittal index of Farcy, lateral wedging, Beck Index, traumatic regional angulation and channel occupancy were studied. RESULTS All indicators studied, except the lateral wedging, showed a high degree of concordance. CONCLUSIONS Instability determinants studied with radiographs and CT, which had obtained statistical significance, are reliable and accurate for the classification of thoracolumbar fractures and, therefore, to indicate an appropriate treatment.

Concordancia interobservador de la clasificación de Eaton-Littler de la artrosis trapeciometacarpiana

OBJECTIVE To study the concordance of the radiographic classification of Eaton-Littler for the diagnosis of basal thumb joint osteoarthritis (BTJO). The null hypothesis was that the concordance was due to chance and the alternative was that the concordance was not due to chance. MATERIAL AND METHOD We have observed the x-rays of 46 patients with symptoms and clinical signs of BTJO. They were independently classified by five physicians: three experts in upper extremity, one in radiology and a fourth year resident of Orthopedics. We studied the concordance in the observations through the global Kappa. DISCUSSION The diagnosis of BTJO is based primarily on clinical exploration, radiology is a complementary method of confirmation. The classification of Eaton-Littler proposes 4 stages of the disease, with a therapeutic involvement. CONCLUSIONS The concordance of the radiographic classification of Eaton-Littler is moderate.