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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: El retiro del tornillo de situación es un procedimiento actualmente cuestionado. La mayoría de las publicaciones que exhortan a evitar este procedimiento consideran que la tasa de complicaciones es elevada. El objetivo de este trabajo fue conocer la tasa de complicaciones relacionadas con el retiro del tornillo de situación para comprobar la seguridad del procedimiento y comparar los resultados con la literatura internacional. Material y métodos: Se realizó un estudio descriptivo, observacional, retrospectivo y transversal en el cual se tomó una muestra de todos los casos operados de retiro de tornillo de situación en nuestro hospital de Febrero de 2015 a Enero de 2016 para obtener la prevalencia de las complicaciones relacionadas con este procedimiento. El análisis estadístico fue descriptivo. Resultados: Se estudió un total de 207 pacientes. Se observaron cinco pacientes con complicaciones (2.41%). Dos casos con dehiscencia de la herida, dos casos con infección superficial (1.92%) y un caso con diástasis subsecuente de la sindesmosis con dolor asociado a inestabilidad (0.48%), el cual requirió de cirugía de revisión. Conclusiones: En la muestra estudiada de nuestro hospital, la prevalencia de complicaciones relacionadas con el retiro del tornillo situacional fue menor que la reportada en la literatura hasta el momento; por ende, podríamos afirmar que es un procedimiento seguro, con una baja tasa de infección e inestabilidad postraumática del tobillo.
Abstract: Background: Removal of the syndesmotic screw is a currently-disputed procedure. Most of the publications that promote avoid this procedure considered that the rate of complications is high. The aim of this work was to determine the rate of complications related to the removal of the syndesmotic screw to learn about the safety and compare the results with the international literature. Material and methods: A descriptive, observational, retrospective and cross-sectional study in which took a sample of all cases operated of removal of the syndesmotic screw at our hospital from February 2015 January 2016 for the prevalence of the complications associated with this procedure. The statistical analysis was descriptive. Results: A total of 207 patients were studied. Five patients with complications were observed (2.41%). Two cases with wound dehiscence, two cases with superficial infection (1.92%), and a case with subsequent diastasis of the syndesmosis, with pain associated to instability (0.48%) which required revision surgery. Conclusions: In the sample of our hospital, the prevalence of complications related to the syndesmotic screw removal was less than that reported in the literature so far; Thus we could say that is a safe procedure, with low risk for infection and post-traumatic instability of the ankle.
Subject(s)
Humans , Bone Screws , Ankle Injuries , Device Removal/adverse effects , Fracture Fixation, Internal , Prevalence , Cross-Sectional Studies , Retrospective StudiesABSTRACT
Abstract: The tibiofibular syndesmosis provides stability to the ankle mortise. The ankle syndesmosis is compromised in all Weber C type injuries. The radiographic method described by Merle D'Aubigné considers the bony relationships as a measure of syndesmotic widening. We sought to investigate whether the patients with a C type ankle fracture treated with ORIF and placement of a transyndesmal screw have an increment of the tibiofibular space and decrease of the tibiofibular overlap after the transyndesmal screw is removed. Our sample included 52 patients with Weber C ankle fractures treated by ORIF and transyndesmal screw at a level II trauma center. We measured the tibiofibular clear space and tibiofibular overlap in each phase of the treatment. The transyndesmal screw was removed at day 55.56 (± 21.83). We found an increase of the tibiofibular overlap of 0.20 mm (± 2.29, p = 0.532); and 0.21 mm (± 0.97, p = 0.146) in the tibiofibular clear space. The changes of 2.38% in the tibiofibular overlap and 5.29% in the tibiofibular clear space between the postoperative and post-removal periods were not statistically significant. After removal of the syndesmal screw, there is a slight radiographic broadening of the syndesmosis; however, it is small and statistically not significant.
Resumen: La sindesmosis tibioperonea distal proporciona estabilidad a la mortaja del tobillo, viéndose comprometida en todas las lesiones tipo C de Weber. El método radiográfico descrito por Merle D'Aubigné usa las relaciones óseas como una medida del ensanchamiento de la sindesmosis. Investigamos si los pacientes con una fractura de tobillo tipo C tratados con osteosíntesis y colocación de un tornillo transindesmal tienen un incremento del espacio y disminución de la superposición tibioperonea, después de que el tornillo se retira. 52 pacientes con fracturas de tobillo Weber C tratadas mediante osteosíntesis y colocación del tornillo transindesmal en un centro de trauma de nivel II. Medimos el espacio libre tibioperoneo y la superposición en cada fase del tratamiento. El tornillo se retiró el día 55.56 (± 21.83). Encontrando un aumento de la superposición tibioperonea de 0.20 mm (± 2.29, p = 0.532); y 0.21 mm (± 0.97, p = 0.146) en el espacio libre. El aumento del 2.38% en el solapamiento tibioperoneo y 5.29% en el espacio libre entre el postoperatorio y los períodos posteriores al retiro no fueron estadísticamente significativos. Después del retiro del tornillo sindesmal, hay una ligera ampliación radiográfica de la sindesmosis; sin embargo, es pequeña y estadísticamente no significativa.