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Abstract: Introduction: It is essential that orthopaedic resident physicians be highly proficient in all aspects, considering the balance between supply, demand, need and context. Fundamental to identify the capacity and quality installed for their training in Mexico. Material and methods: Observational Study, transverse, non-probabilistic sampling-conglomerates, in two phases. The instrument has 8 domains, 57 variables and 4,867 items. 60 graduate professors of 20 states, 50 hospital sites, 22 university programs. Results: 1,038 years of experience (collective intelligence), 17 years of experience/teacher (01 to 50 years). Identified: acute pathology 30 (2 to 90%), chronic pathology 30 (5 to 96%), patients ˂ 15 years, 10 (3 to 30%), patients between 15 and 65 years, 47 (2 to 78%), patients ˃ 65 years, 20 (2 to 60%), number of beds/seat 20 (2 to 510), number of clinics 3 (1 to 48), number of surgical procedures/headquarters per year at the national level, was 960 (50 to 24,650). The national average per resident doctor is 362 surgeries/year with 1,450 surgical times/year. Conclusions: The needs and resources for the training of physicians specializing in orthopedics/traumatology are highly heterogeneous, so it should be adapted to the epidemiological needs of the region of influence, in an area of epidemiological transition. 62.2% expressed not having or have bad academic and scientific infrastructure at its headquarters, more than 50% without rotation overseas and ˃ 90% without regular scientific production.
Subject(s)
Humans , Orthopedics , Orthopedic Procedures , Internship and Residency , Surveys and Questionnaires , MexicoABSTRACT
Resumen: Antecedentes: La articulación patelofemoral (PF) es un sistema biomecánico susceptible a desgaste acelerado, afecta a 25% de las mujeres. Actualmente, el tratamiento de la osteoartrosis patelofemoral (OAPF) ha resurgido gracias a la creación de sistemas anatómicos y biomecánicamente adecuados, con indicaciones precisas, estadios más tempranos y con mejor resultado funcional. Material y métodos: Se analizó una cohorte de 24 pacientes durante el período de 2010 a 2012, tratados con prótesis de resuperficialización patelofemoral (PPF) HemiCap Patelofemoral Resurf (Franklin MA, EUA), colocadas por dos cirujanos. Se evaluaron los pacientes prequirúrgicos y a los dos, cuatro, seis, 12, 18, 24 meses postquirúrgicos con la escala Knee Society Score (KSS). Resultados: Se incluyeron 24 pacientes con seguimiento de dos años en promedio. En 87.5% fueron mujeres, edad promedio de 62 años (45-80 años); una media de 29.5 de índice de masa corporal (IMC), la lateralidad derecha predominó en 54%. Se observó una mejoría en los resultados de la escala KSS: en el aspecto clínico hubo una mejoría de 35.2% y en la escala funcional de 41.62%. Sólo dos pacientes fueron reintervenidos por complicaciones de limitación funcional, uno de ellos tratado con manipulación bajo anestesia y el otro con liberación artroscópica de adherencias. Conclusión: La PPF es una opción como tratamiento de AOPF aislada, pues la tasa de supervivencia a dos años es buena, proporciona alivio del dolor y mejoría en funcionalidad de la rodilla; sin embargo, se requerirá mayor tiempo de seguimiento para evaluar el resultado final de este implante.
Abstract: Background: The patellofemoral articulation is a biomechanical system susceptible to accelerated wear, affecting 25% of women. Currently, the treatment of osteoarthrosis Patelofermoral has resurfaced thanks to the creation of anatomical and biomechanically appropriate systems, with precise indications, earlier stages and with a better functional result. Material and methods: A cohort of 24 patients was analyzed during the period from 2010 to 2012, treated with a resurfacing prostheses HemiCap Patello Femoral Resurf (Franklin MA, USA), placed by 2 surgeons. Patients were assessed preoperatively and 2, 4, 6, 12, 18, 24 months postoperative with the Knee Society Score. Results: Twenty-four patients with follow-up of 2 years on average were included. 87.5% were women, an average age of 62 years (45-80 years); an average of 29.5 of body mass index, the right laterality predominated in 54%. An improvement in KSS scale results was observed: in clinical appearance there was an improvement of 35.2% and the functional scale 41.62%. Only two patients were revised by complications of functional limitation, treated one with manipulation under anesthesia and the other with arthroscopic adhesion lysis. Conclusion: The patellofemoral prosthesis is an option as a treatment for isolated patellofemoral arthrosis, since the two-year survival rate is good, providing pain relief and improving knee functionality; However, more follow-up time will be required to evaluate the end result of this implant.
Subject(s)
Humans , Male , Female , Adult , Arthroplasty, Replacement, Knee , Osteoarthritis, Knee/surgery , Knee Prosthesis , Follow-Up Studies , Treatment Outcome , Middle AgedABSTRACT
Resumen: Antecedentes: Diez por ciento de todas las fracturas de tobillo, 20% de las fracturas tratadas quirúrgicamente y de 1 al 18% de los esguinces presentan lesión de la sindesmosis. Los métodos utilizados para su reducción son tornillos situacionales metálicos o bioabsorbibles, reparación directa y el uso de suturas con o sin botones. El objetivo de este trabajo fue comparar la función clínica de las fracturas de tobillo B de Weber tratadas con TightRope o con el uso de tornillo situacional. Material y métodos: Se realizó un estudio observacional, comparativo, transversal en el período comprendido de Marzo del 2012 a Marzo del 2015. Se utilizó la escala de AOFAS de tobillo para valorar la función de pacientes con fracturas Weber B con lesión de sindesmosis tratados con tornillo situacional tricortical de 3.5 mm y pacientes tratados con sistema TightRope. Resultados: Se estudiaron 43 pacientes con una media de 47 años de edad. Se realizó la prueba de ANOVA de un factor para comparar los resultados de ambos grupos observando que a los tres, seis y 12 meses el grupo de TightRope presentó una mejoría significativa en cuanto al puntaje de AOFAS en comparación con el grupo de tornillo situacional (p = 0.05). Discusión: El uso del sistema TightRope presenta mejor función clínica en comparación con el tornillo situacional tricortical de 3.5 mm en el corto plazo, de acuerdo con la escala de AOFAS.
Abstract: Background: Ten percent of all ankle fractures, 20% of the fractures treated surgically, and 1-18% of all sprains involve a syndesmosis injury. The methods used for reduction are metal or bioabsorbable syndesmotic set screws, direct repair, and sutures with or without buttons. The purpose of this study was to compare the clinical function of patients who sustained Weber B ankle fractures and were treated with the TightRope system or a syndesmotic set screw. Material and methods: An observational, comparative, cross-sectional study was conducted between March 2012 and March 2015. The AOFAS ankle scale was used to assess function in patients with Weber B fractures with a syndesmosis injury treated with a 3.5 mm tricortical set screw or with the TightRope system. Results: Forty-three patients were included, their mean age was 47 years. The single-factor ANOVA test was used to compare the results of both groups. The latter showed that at 3, 6 and 12 months the TightRope group showed a significant improvement based on the AOFAS score, compared with the set screw group (p = 0.05). Discussion: The use of the TightRope system results in better clinical function in the short term compared with the 3.5 mm tricortical set screw, according to the AOFAS scale.