Comparison of Anatomic Locking Titanium Plate and Intramedullary Nail in the Treatment of Distal Tibial Fractures / 中山大学学报(医学科学版)

ObjectivesTo compare the clinical efficacy and complications of anatomic locking titanium plate （hereinafter referred to as “titanium plate screw”） and intramedullary nail in the treatment of distal tibial fractures.Methods From September 2019 to September 2021， 32 patients diagnosed with AO-A fracture of distal tibia at Sun Yat-sen Memorial Hospital of Sun Yat-sen University were included in this study. Of these， 15 cases were treated with titanium plate screws and 17 cases were treated with intramedullary nails. General surgical indexes， fracture healing time and postoperative operation were compared between the two groups.ResultsAll patients were followed up for 10 to 20 months， with an average of 12 months. The operative time and intraoperative fluoroscopy times of intramedullary nail group were longer than those of titanium plate screw group， but the preoperative waiting time and hospitalization days was less or were fewer than those of titanium plate screw group， the difference was statistically significant （P < 0.05）. There was no significant difference in fracture healing time between the two groups （P> 0.05）. At 6 weeks after operation， VAS scores in both groups were lower than those before operation， with statistically significant difference （P<0.05）. There was no significant difference in VAS scores between the intramedullary nail group and the titanium plate screw group （P> 0.05）. AOFAS scores 6 months after surgery， ankle joint motion and complication rate 1 year after surgery in intramedullary screw group were better than those in titanium plate screw group， and the differences were statistically significant （P< 0.05）. There was no significant difference in AOFAS scores between the two groups at 1 year after operation （P> 0.05）.ConclusionTitanium plate screw and intramedullary nail are both effective methods for the treatment of distal tibial AO-A fracture， and there is no significant difference in long-term clinical efficacy. Intramedullary nail has fewer soft tissue complications， less impact on ankle motion， faster recovery and higher safety， while titanium plate screw has a higher probability of postoperative soft tissue infection. We suggest that in clinical work， preoperative evaluation of patients should be done well. Under the premise of grasping the indications， intramedullary nail has fewer complications and certain advantages.

Meta-analysis of the efficacy of invisible orthodontic appliances for maxillary molar distalization in adult patients / 口腔疾病防治

Objective@#To evaluate the clinical efficacy of invisible orthodontic appliances without brackets for the distal movement of maxillary molars to improve the ability of orthodontists to predict treatment outcomes.@*Methods@#Web of Science, Cochrane Library, Embase, PubMed, Wanfang Database, CNKI Database, and VIP Database were searched for studies investigating the efficacy of invisible orthodontic appliances for distal movement of maxillary molars in adult patients and published from database inception to August 1, 2023. A total of three researchers screened the studies and evaluated their quality and conducted a meta-analysis of those that met quality standards.@*Results@#This study included 13 pre- and postcontrol trials with a total sample size of 281 patients. The meta-analysis revealed no significant differences in the sagittal or vertical parameters of the jawbone after treatment when compared with those before treatment (P>0.05). The displacement of the first molar was MD=-2.34, 95% CI (-2.83, -1.85); the displacement was MD=-0.95, 95% CI (-1.34, -0.56); and the inclination was MD=-2.51, 95% CI (-3.56, -1.46). There was a statistically significant difference in the change in sagittal, vertical, and axial tilt of the first molar before and after treatment. After treatment, the average adduction distance of the incisors was MD=-0.82, 95% CI (-1.54, -0.09), and the decrease in lip inclination was MD=-1.61, 95% CI (-2.86, -0.36); these values were significantly different from those before treatment (P<0.05).@*Conclusion@#Invisible orthodontic appliances can effectively move the upper molars in a distal direction and control the vertical position of the molars. When the molars move further away, there is some degree of compression and distal tilt movement, which is beneficial for patients with high angles. The sagittal movement of incisors is beneficial for improving the patient's profile.

Distal tibiofibular syndesmosis fibular notch typing and its clinical significance based on CT / 解剖学报

Objective To investigate the morphological typing and clinical significance of the distal tibiofibular syndesmosis fibular notch based on CT images. Methods According to the inclusion and exclusion ceiteria‚ the imaging data of patients undergoing ankle joint CT examination were analyzed‚ and the inferior tibiofibular joint fibula notch was classified according to the morphological characteristics. The measurements included 8 distances. There were 123 males and 102 females‚ all of whom were Han nationality‚ aged 18-60 years old. Results Retrospectively analyzed the result of 225 patients from December 2013 to December 2022. The distal tibiofibular syndesmosis fibular notch was divided into four types according to morphological characteristics‚ C-shaped (50. 67%)‚ V-shaped (26. 67%)‚ flat-shaped (15. 11%) and L-shaped (7. 56%). The angle between the anterior and posterior facets of the flat shape (145. 56 ± 9. 25)° was the largest and the angle between the anterior and posterior facets of the L shape (125. 07 ± 13. 54)° was the smallest(P< 0. 05); the depth of the notch in the flat shape (3. 11 ± 0. 83) mm was the smallest and in the L shape (4. 47±1. 11) mm was the largest(P<0. 05);The posterior facet length (13. 06 ± 3. 56) mm and anterior tibiofibular gap (3. 83±1. 49) mm on left were larger than on the right side (P<0. 05); The posterior facet length (13. 36 ± 3. 46) mm‚ fibular notch depth (3. 93 ± 1. 10) mm and vertical distance of tibiofibular overlap (9. 10 ± 2. 55) mm larger in men than in women (P<0. 05). Conclusion In this study‚ the data related to the inferior tibiofibular syndesmosis notch were measured and divided into four types according to the shape. The flat inferior tibiofibular syndesmosis notch is more likely to have chronic ankle instability‚ and the fibula is more likely to move forward during anatomical reduction. The inferior tibiofibular syndesmosis of L-shaped and C-shaped notches is more prone to posterior displacement of fibula or poor rotation reduction during anatomical reduction.

Association of serum magnesium and distal symmetric peripheral neuropathy among Filipino patients with Type 2 Diabetes Mellitus

Objective@#This study aims to determine the association of serum magnesium with distal symmetric peripheral neuropathy among persons with type 2 diabetes mellitus (DM).@*Methodology@#A cross-sectional analytical study among adult Filipinos with Type 2 DM. Logistic regression was used to determine the association of serum magnesium with DSPN diagnosed by the Michigan Neuropathy Screening Instrument. The null hypothesis was rejected at 0.05α-level of significance.@*Results@#The average serum magnesium levels were similar between those with versus without DSPN (2.06 ± 0.32 vs 2.05 ± 0.23, p = 0.873); the same was seen for corrected magnesium. There is insufficient evidence to demonstrate a significant statistical difference between those with and without DSPN in relation to glycemic control (HbA1c and FBS). Likewise, there is no significant statistical correlation between serum magnesium levels with HbA1c, FBS, BMI, or duration of diabetes.@*Conclusion@#This present study could not demonstrate any association between DSPN and serum magnesium, even after adjusting for age, sex, and comorbidity.

Fracturas del extremo distal del radio en el esqueleto inmaduro: estudio epidemiológico en el Centro Hospitalario Pereira Rossell / Fraturas da extremidade distal do rádio no esqueleto imaturo: estudo epidemiológico no Hospital Pereira Rossell / Fracture of the distal end of the radius in children: epidemiological study at the Pereira Rossell Hospital Center

Objetivo principal: Conocer la epidemiologia de las fracturas del cuarto distal del radio en el esqueleto en crecimiento y el tratamiento realizado en el CHPR en los años 2017 y 2018. Objetivos específicos: Valorar re-desplazamiento, necesidad de re manipulación, complicaciones, re-fractura. Metodología: Estudio observacional descriptivo retrospectivo. Criterios de inclusión: pacientes de 0 a 14 años con fractura de radio distal (fisaria, metafisaria y suprametafisaria) valorados en el CHPR entre 1 enero del 2017 y 31 diciembre del 2018. Criterios de exclusión: pacientes con radiografía normal, fracturas en miembros con malformaciones, infecciones óseas, patología tumoral maligna o benigna. Obtención de datos: Valoración de radiografías de puño y antebrazo realizadas en el CHPR en 2017 y 18, iniciales y evolutivas. Se analizaron: edad, sexo, fecha fractura, topografía de la fractura, desplazamiento inicial, tratamiento, evolución radiográfica y complicaciones. Resultados: se incluyeron 662 pacientes. Siendo en su mayoría de género masculino (65%), con una media de 9 años, miembro derecho (61%), en los meses de verano (36%). En cuanto a la topografía se evidenció una frecuencia mayor en fracturas tipo rodete y metafisarias (31.72% y 31.57%), seguido por suprametafisaria (18.43%) y fisaria (18.28%). El tratamiento realizado fue ortopédico en el 86.56% de los casos, mientras que quirúrgico fue el 12.84%, en su gran mayoría con alambres de Kirschner (11,2%). El tiempo de inmovilización promedio fue de 6 semanas, con un porcentaje de complicaciones del 14.05% del total de las fracturas. Conclusiones: Se valoraron las características de los pacientes y fracturas de radio distal en el CHPR en los años 2017 y 18, siendo un total de 662 fracturas, en las que su mayoría se realizó tratamiento ortopédico con un índice de complicaciones que ronda el 14%, siendo mayor cuanto mayor es el desplazamiento inicial de la fractura.

Objetivo principal: Conhecer a epidemiologia das fraturas do quarto distal do rádio no esqueleto em crescimento e o tratamento realizado no CHPR nos anos de 2017 e 2018. Objetivos específicos: Avaliar re-deslocamento, necessidade de remanipulação, complicações, refratura. Metodologia: Estudo observacional descritivo retrospectivo. Critérios de inclusão: pacientes de 0 a 14 anos com fratura do rádio distal (fisário, metafisário e suprametafisário) avaliados no CHPR entre 1º de janeiro de 2017 e 31 de dezembro de 2018. Critérios de exclusão: pacientes com radiografias normais, fraturas em membros com malformações, osso infecções, patologia tumoral maligna ou benigna. Coleta de dados: Avaliação das radiografias de punho e antebraço realizadas no CHPR em 2017 e 18, inicial e evolutiva. Foram analisados: idade, sexo, data da fratura, topografia da fratura, deslocamento inicial, tratamento, evolução radiográfica e complicações. Resultados: 662 pacientes foram incluídos. Sendo maioritariamente do sexo masculino (65%), com média de 9 anos, membro direito (61%), nos meses de verão (36%). Em relação à topografia, foi evidenciada maior frequência nas fraturas da borda e metafisárias (31,72% e 31,57%), seguidas das suprametafisárias (18.43%) e fisárias (18.28%). O tratamento realizado foi ortopédico em 86.56% dos casos, enquanto cirúrgico em 12.84%, sendo a maioria com fios de Kirschner (11,2%). O tempo médio de imobilização foi de 6 semanas, com percentual de complicações de 14.05%. Conclusões: Foram avaliadas as características dos pacientes e fraturas do rádio distal no CHPR nos anos de 2017 e 18, com um total de 662 fraturas (0,9 por dia), em que a maioria foi submetida a tratamento ortopédico com índice de complicações que fica em torno de 14%, sendo maior quanto maior for o deslocamento inicial da fratura.

Title: Fractures of the distal end of the radius in the immature skeleton. Epidemiological study at the Pereira Rossell Hospital Center. Main objective: To know the epidemiology of fractures of the distal fourth of the radius in the growing skeleton and the treatment carried out in the CHPR in the years 2017 and 2018. Specific objectives: To assess re-displacement, need for re-manipulation, complications, re- fracture. Methodology: Retrospective descriptive observational study. Inclusion criteria: patients aged 0 to 14 years with distal radius fracture (physeal, metaphyseal and suprametaphyseal) evaluated at the CHPR between January 1, 2017 and December 31, 2018. Exclusion criteria: patients with normal radiographs, fractures in limbs with malformations, bone infections, malignant or benign tumor pathology. Data collection: Assessment of fist and forearm X-rays performed at the CHPR in 2017 and 18, initial and evolutionary. The following were analyzed: age, sex, fracture date, fracture topography, initial displacement, treatment, radiographic evolution and complications. Results: 662 patients were included. Being mostly male (65%), with an average of 9 years, right limb (61%), in the summer months (36%). Regarding the topography, a higher frequency was evidenced in rim and metaphyseal fractures (31.72% and 31.57%), followed by suprametaphyseal (18.43%) and physeal (18.28%). The treatment performed was orthopedic in 86.56% of the cases, while surgical was 12.84%, mostly with Kirschner wires (11.2%). The average immobilization time was 6 weeks, with a percentage of complications of 14.05%. Conclusions: The characteristics of the patients and fractures of the distal radius in the CHPR in the years 2017 and 18 were evaluated, with a total of 662 fractures (0.9 per day), in which the majority underwent orthopedic treatment with an index of complications that is around 14%, being greater the greater the initial displacement of the fracture.

Situaciones transoperatorias en pacientes pediátricos con fractura supracondílea del húmero

Introducción: Las fracturas supracondíleas del húmero en el niño, por lo general, son tratadas de manera quirúrgica, durante esa intervención se pueden presentar situaciones específicas en este tipo de enfermos. Objetivo: Actualizar y brindar información sobre algunas de las situaciones transoperatorias en pacientes con fractura supracondílea del húmero. Métodos: La búsqueda y análisis de la información se realizó en un periodo de 61 días (primero de septiembre al 31 de octubre de 2022) y se emplearon palabras de búsqueda relacionadas con la investigación. A partir de la información obtenida, se realizó una revisión bibliográfica de un total de 245 artículos publicados en las bases de datos: PubMed, Hinari, SciELO y Medline, mediante el gestor de búsqueda y administrador de referencias EndNote, de ellos, se utilizaron 29 citas seleccionadas para realizar la revisión, 28 de los últimos cinco años. Resultados: Se hace referencia a cuatro de las situaciones transoperatorias más frecuentes en este tipo de fractura. Se mencionan la conminución de la pared medial, como identificar esta situación y su conducta. En relación a las lesiones asociadas, se recomienda primero estabilizar el antebrazo y luego la fractura supracondílea. Para las fracturas inestables en flexión se recomienda la técnica a emplear. Por su parte, la conversión de la reducción cerrada a abierta está justificada en ciertas circunstancias que de forma detallada se describen en el trabajo. Conclusiones: Las fracturas supracondíleas del húmero en el niño son tratadas en su mayoría mediante tratamiento quirúrgico. Durante el transoperatorio se pueden presentar situaciones para las cuales el médico tratante debe estar preparado.

Introduction: Supracondylar fractures of the humerus in children are generally treated surgically, during surgery intervention may occur specific situations in this type of patient. Objective: To update and provide information on some of the intraoperative situations in patients with supracondylar fracture of the humerus. Methods: The search and analysis of the information was carried out in a period of 61 days (September 1st to October 31st, 2022) and search words related to the investigation were used. Based on the information obtained, a bibliographic review of a total of 245 articles published in the PubMed, Hinari, SciELO and Medline databases was carried out using the EndNote search manager and reference administrator, of which 29 selected citations were used to carry out the review, 28 of the last five years. Results: Reference is made to four of the most frequent intraoperative situations in this type of fracture. Comminution of the medial wall, how to identify this situation and its behavior are mentioned. In relation to associated injuries, it is recommended to first stabilize the forearm and then the supracondylar fracture. For unstable fractures in flexion, the technique to be used is recommended. For its part, the conversion from closed to open reduction is justified in certain circumstances that are described in the article. Conclusions: Supracondylar fractures of the humerus in children are mostly treated by surgical treatment. During the trans-operative period situations may arise for which the treating physician must be prepared.

Fijación externa en pacientes pediátricos con fracturas supracondíleas del húmero

Introducción: Las fracturas supracondíleas del húmero en el niño son por lo general de tratamiento quirúrgico, mediante reducción cerrada o abierta asociada a la colocación de alambres. Por su parte, la fijación externa es una opción aceptada en ciertas circunstancias. Objetivo: Actualizar sobre el uso de la fijación externa en pacientes con fractura supracondílea del húmero en el niño. Métodos: Se realizó una búsqueda y análisis de la información en un periodo de 61 días (primero de junio al 31 de julio de 2023) y se emplearon las siguientes palabras: pediatric supracondylar humeral fractures AND external fixation, external fixation AND elbow, complex fractures AND pediatric supracondylar. A partir de la información obtenida se realizó una revisión bibliográfica de un total de 177 artículos publicados en las bases de datos PubMed, Hinari, SciELO y Medline mediante el gestor de búsqueda y administrador de referencias EndNote. De ellos, se utilizaron 34 citas seleccionadas para realizar la revisión, 32 de los últimos cinco años. Resultados: Se hizo referencia a las indicaciones y contraindicaciones, además de las ventajas de la fijación externa. Se mencionaron las principales diferencias entre la fijación con alambres de Kirschner y la fijación externa. Se expuso la técnica en cinco pasos. Se plasmaron los cuidados posoperatorios, complicaciones y comentarios sobre los resultados. Conclusiones: La fijación externa constituye una modalidad de tratamiento efectiva para pacientes pediátricos con patrones de fractura complejos. Es una técnica factible de realizar y reproducir. Los resultados son iguales o superiores al ser comparados con las otras modalidades quirúrgicas.

Introduction: Supracondylar humerus fractures in children are generally treated surgically, through closed or open reduction associated with placement of the wires. For its part, external fixation is an accepted option in certain circumstances. Objective: To update on the use of external fixation in patients with supracondylar fracture of the humerus in children. Methods: The search and analysis of the information was carried out in a period of 61 days (June 1st to July 31st, 2023) and the following words were used: pediatric supracondylar humeral fractures AND external fixation, external fixation AND elbow, complex fractures AND pediatric supracondylar. Based on the information obtained, a bibliographic review of a total of 177 articles published in the PubMed, Hinari, SciELO and Medline databases was carried out using the EndNote search engine and reference administrator. Of these, 34 selected citations were used to carry out the review, 32 of the last five years. Results: References are made to the indications and contraindications, in addition to the advantages of external fixation. The main differences between Kirschner wire fixation and external fixation are mentioned. The technique is exposed in five steps. Postoperative care, complications and comments on the results are reflected. Conclusions: External fixation is an effective treatment modality for pediatric patients with complex fracture patterns. It is a feasible technique to perform and reproduce. The results are equal or superior when compared with other surgical modalities.

Radiological Evaluation of Volar Cortical Angle in the Anatolian Population / Evaluación Radiológica del Ángulo Cortical Volar en la Población Anatoliana

SUMMARY: Distal radius fractures are the most common fractures of the upper limb. The most commonly used method in the repair of these fractures is volar locking plates. Recently, the frequency of removal of volar locking plates after surgery has increased. There are many factors in its reduction. Anatomically, incompatibility of the distal end of the radius with volar locking plates is one of them. In previous studies, different volar cortical angle (VCA) values were found in other races. For this reason, this study aimed to determine the mean values by making VCA measurements of the Anatolian population. The study was designed retrospectively. In the study, measurements were made on computed tomography (CT) images of the distal end of the radius of 53 men and 28 women. Radial width, intermediate volar angle, and radial volar angle were measured in the images. On average, the radius width was 23.35±1.96 mm, and the intermediate volar angle was 26.02±.3.83°, radial volar angle was 24±3.07°. Radial width, intermediate volar angle, and radial volar angle differed significantly by gender (p<0.001). A significant correlation was found between radius width, intermediate volar angle, and radial volar angle values (p<0.001). It has been determined that the Anatolian population has a different VCA value than the European, Asian, and other populations. When using volar locking plates in distal radius fracture surgery, volar locking plates should be selected by considering the average values of the races.

Las fracturas del radio distal son las fracturas más comunes del miembro superior. El método más utilizado en la reparación de estas fracturas son las placas de bloqueo volar. Recientemente, ha aumentado la frecuencia de extracción de placas de bloqueo volar después de la cirugía. Existen muchos factores en su reducción y anatómicamente, la incompatibilidad de la extremidad distal del radio con las placas de bloqueo volar es una de ellas. En estudios anteriores, se encontraron diferentes valores del ángulo cortical volar (VCA) en otras grupos. Por esta razón, este estudio tuvo como objetivo determinar los valores medios, realizando mediciones de VCA de la población de Anatolia. El estudio fue diseñado de manera retrospectiva. En el estudio, se realizaron mediciones en imágenes de tomografía computarizada (TC) de la extremidad distal del radio de 53 hombres y 28 mujeres. En las imágenes se midieron el ancho radial, el ángulo volar intermedio y el ángulo volar radial. En promedio, el ancho del radio fue de 23,35 ± 1,96 mm, el ángulo volar intermedio fue de 26,02 ± 3,83° y el ángulo volar radial fue de 24 ± 3,07°. El ancho radial, el ángulo volar intermedio y el ángulo volar radial difirieron significativamente según el sexo (p<0,001). Se encontró una correlación significativa entre los valores del ancho del radio, el ángulo volar intermedio y el ángulo volar radial (p<0,001). Se ha determinado que la población de Anatolia tiene un valor de VCA diferente al de las poblaciones europeas, asiáticas y otras. Cuando se utilizan placas de bloqueo volar en cirugía de fractura de la extremidad distal del radio, las placas deben seleccionarse considerando los valores promedio de los individuos de diferentes grupos.

Quiste hidatídico primario de páncreas: reporte de caso

Introducción. El quiste hidatídico puede localizarse en cualquier órgano del cuerpo. El quiste hidatídico en el páncreas (QHP)se presenta con una prevalencia menor a 1%, la localización más frecuente es la cabeza en 61% a 69%, en el cuerpo y cola en 31% a 39%. No es fácil diferenciar el quiste hidatídico pancreático de otros tumores quísticos del páncreas, por lo que esta patología debe tenerse en cuenta en el diagnóstico diferencial de lesiones quísticas pancreáticas. Caso Clínico. Paciente femenino de 66 años quien desde el año 2016 se encontraba en control por una tumoración quística de la cola pancreática de 1,7 cm, diagnosticada en forma incidental. La paciente cursó asintomática y se controló en forma anual. El año 2021 la lesión alcanzó un tamaño de 4,7 cm. En este contexto se decide la resección quirúrgica por vía laparoscópica. Se resecó una pieza quirúrgica de 8 cm de longitud que incluye la cola del páncreas y el quiste. La histología describe la membrana prolígera y múltiples escólex viables. Conclusión. La localización primaria en la cola del páncreas de un quiste hidatídico confunde el diagnóstico con un tumor quístico mucinoso. El tratamiento quirúrgico actual en los quistes distales debería ser la resección laparoscópica.

Introduction. The hydatid cyst can be located in any organ of the body. The hydatid cyst in the pancreas occurs with a prevalence of less than 1%, the most frequent location is the head in 61% to 69%, the body and tail in 31% to 39%. It is not easy to differentiate the pancreatic hydatid cyst from other cystic tumors of the pancreas, so this pathology must be taken into account in the differential diagnosis of pancreatic cystic lesions. Clinical Case. The present report discusses a 66-year-old female patient who had been in control since 2016 for a 1.7 cm cystic tumor of the pancreatic tail. The patient was asymptomatic and was controlled annually. In 2021, the lesion reached a size of 4.7 cm. In this context, laparoscopic surgical resection was decided. An 8 cm long surgical specimen was resected, including the tail of the pancreas and the cyst. Histology describes prolific membrane and multiple viable scolexes. Conclusion. The primary location in the tail of the pancreas of a hydatid cyst confuses the diagnosis with a mucinous cystic tumor. The current surgical treatment for distal cysts should be laparoscopic resection.

Fracturas supracondíleas en pacientes pediátricos tratados quirúrgicamente con Técnica de Cruzada. Hospital Central San Cristóbal / Supracondylar humerus fractures in childrens surgically treated by Crossed Wiring Technique. San Cristóbal Central Hospital

Las fracturas supracondíleas en niños se asocian con algunas complicaciones. Su tratamiento estándar es la reducción cerrada y la fijación con alambres en distintas configuraciones. Se realizó un estudio observacional, analítico, prospectivo y longitudinal con pacientes pediátricos que ingresaron con fracturas supracondíleas de húmero tratados quirúrgicamente con alambres de Kirschner con "Técnica Cruzada" en el Hospital Central San Cristóbal enero a junio de 2022. Se incluyeron 30 pacientes. La edad promedio fue 6,3±2,2(3-10) años. La causa más frecuente del traumatismo fue la precipitación de altura en 63,3% de los casos. La posición del codo al momento del accidente fue en extensión en 90%. Todas las fracturas fueron cerradas. El tiempo promedio desde el accidente hasta su atención en emergencia fue de 8,5±13,4(2-72) horas. Los signos clínicos más frecuentes fueron dolor en 100,0%, limitación funcional en 96,7%, aumento de volumen 73,3% y deformidad 50,0%. Según la clasificación AO la más frecuente fue del tipo 13-M/3. 1 III en el 50% de los casos y según Gartland, las tipo IIIA en 53,3%. A las 4 semanas, 100,0% de las fracturas consolidaron, 13,3% presentó valgo y 6,7% varo en la radiografía anteroposterior. Mientras que, en la lateral, 33,3% antecurvatum. La media del ángulo de Baumann fue de 20,27±1,39 grados. La tasa de complicaciones fue de 16,66%, 2(6,7%) casos presentaron neuropraxia y 3(10,0%) granuloma. En conclusión, la Técnica Cruzada es segura en términos de reducción, funcionalidad y tasas de complicaciones en el seguimiento a medio plazo(AU)

Supracondylar fractures in children are associated with some complications. Its standard treatment is closed reduction and fixation with wires in different configurations. An observational, analytical, prospective and longitudinal study was made, with pediatric patients admitted with supracondylar humeral fractures surgically treated with Kirschner wires with the "Cross Technique" at the Hospital Central San Cristóbal from January to June 2022. 30 patients were included. The mean age was 6,3±2,2(3-10) years. The most frequent cause of trauma was high altitude precipitation in 63,3% of the cases. The position of the elbow at the time of the accident was 90% extended. All fractures were closed. The mean time from the accident to emergency care was 8,5±13,4(2-72) hours. The most frequent clinical signs were pain in 100,0%, functional limitation in 96.7%, volume increase in 73,3%, and deformity in 50,0%. According to the AO classification, the most frequent was type 13-M/3. 1 III in 50% of cases and according to Gartland, type IIIA in 53,3%. At 4 weeks, 100,0% of the patients consolidated, 13,3% presented valgus and 6,7% varus on the anteroposterior radiograph. While, on the side, 33,3% antecurvatum. The mean Baumann angle was 20,27 ± 1.39 degrees. The rate of complications was 16,66%, 2 (6,7%) cases presented neuropraxia and 3 (10,0%) granuloma. In conclusion, the Crossover Technique is safe in terms of reduction, functionality, and complication rates in medium-term follow-up(AU)

A STUDY OF OUTCOMES OF DISTAL END RADIUS FRACTURES MANAGED BY EXTERNAL FIXATOR

BACKGROUND: Fractures of the distal radius continue to be the most common skeletalinjuries treated by the orthopedic surgeon. Unstable fractures of the distal part of the radiushave shown an inherent tendency towards loss of reduction after non-operative treatment.External skeletal fixation has been popular for the treatment of displaced, unstable fracturesof the distal part of the radius because it combines a minimally invasive procedure withreduction by ligamentotaxis.METHOD: A retrospective study of 70 patients of fracture of distal end radius treated withexternal fixator came to OPD at tertiary care hospital during the study period of 2 years fromJuly 2020 to June 2022, were included in the study after obtaining permission frominstitutional review board.RESULT: All 70 patients were assessed in the form of the functional and radiologicaloutcome based on Subjective evaluation by Modified Demerit Point System of Gartland andWerley (Functional) and Lidstorm and Frykman Criteria modified by Sarmiento(Anatomical). We obtained “excellent” results in 47.15%; “good” in 35.72% cases; “fair” in14.28% and “poor” in 2.85% cases with a mean G & W score of 6.35.CONCLUSION: Finding of this study shows that external fixator is an easy, cost effective,reliable and most suitable treatment in treating intraarticular and unstable extraarticular distalend radial fractures by the principle of ligamentotaxis.

Sural nerve conduction: Amplitude and distal latency of sensory nerve action potential

Background: The sensory nerve action potential (SNAP) is an important factor in the electro diagnostic evaluation of a patient with suspected peripheral neuropathy. Sural nerve is the most frequently studied nerve in the electrophysiology. For proper diagnosis sural sensory conduction abnormalities, a reference data are required for each electrophysiology laboratory. Aims and Objectives: The aim of the study was to find out normative reference data of amplitude and distal latency (DL) of sural SNAP for Northern Kerala population. Materials and Methods: The study was designed as cross-sectional and observational study and analysis of values was done using SPSS version 16. A total of 250 healthy subjects of age 15–50 from Northern Kerala participated in the study which included equal number of males and females. Results: Normative reference data for sensory amplitude and DL were derived in the present study. Sensory amplitude was more and DL was found to be less in female population, indicating faster nerve conduction in female. Conclusion: The reference data derived here can be utilized to detect any abnormality sural nerve sensory conduction. The gender effect on sural nerve sensory conduction parameters can be attributed to the height difference, as nerve conduction velocity is inversely proportional to height.

Tratamiento quirúrgico del colangiocarcinoma extrahepático / Surgical Treatment of Extrahepatic Cholangiocarcinoma

Introducción: El colangiocarcinoma constituye la neoplasia de la vía biliar más frecuente, la cual es responsable de una alta morbimortalidad. Objetivo: Determinar la morbilidad y la mortalidad por colangiocarcinoma extrahepático en el Servicio de Cirugía del Hospital Universitario Manuel Ascunce Domenech. Métodos: Se realizó un estudio descriptivo, prospectivo y observacional de pacientes que ingresaron en el Servicio de Cirugía General con diagnóstico de colangiocarcinoma extrahepático entre septiembre de 2018 y enero del 2022. El universo estuvo conformado por 21 pacientes que cumplieron con los criterios de inclusión. Se utilizaron métodos estadísticos descriptivos y cálculos con valores porcentuales. Resultados: La mayor incidencia de los pacientes fueron del sexo masculino y blancos, con el 71,4 por ciento y el 85,7 por ciento respectivamente. Predominó el adenocarcinoma como variedad histológica con un 85,7 por ciento, así como el colangiocarcinoma proximal y la variante esclerosante de su clasificación. El 71,4 por ciento de los pacientes egresaron vivos y con una cirugía con finalidad curativa. Conclusiones: La mayoría de los pacientes fueron masculinos, de color blanco y de procedencia rural. Los hallazgos más frecuentes fueron la localización proximal y la variante esclerosante. A más de la mitad de los pacientes se les realizó procedimiento de Hess y Whipple con finalidad curativa. La fuga biliar, el adenocarcinoma como tipo histológico y el estado al egreso vivo prevaleció en todos los pacientes(AU)

Introduction: Cholangiocarcinoma is the most frequent biliary tract neoplasm responsible for high morbidity and mortality. Objective: To determine morbidity and mortality due to extrahepatic cholangiocarcinoma in the surgery service of Hospital Universitario Manuel Ascunce Domenech. Methods: A descriptive, prospective and observational study was carried out with patients admitted to the general surgery service with a diagnosis of extrahepatic cholangiocarcinoma between September 2018 and January 2022. The study universe consisted of 21 patients who met the inclusion criteria. Descriptive statistical methods and calculations with percentage values were used. Results: The highest incidence of patients were male and white-skinned, accounting for 71.4 percent and 85.7 percent, respectively. Adenocarcinoma predominated as histological variety, representing 85.7 percent, together with proximal cholangiocarcinoma and the sclerosing variant of its classification. 71.4 percent of the patients were discharged alive and after curative surgery. Conclusions: Most of the patients were male, white-skinned and from rural origin. The most frequent findings were a proximal location and the sclerosing variant. Over half the patients underwent Hess and Whipple procedure with curative purpose. Biliary leakage, adenocarcinoma as histologic type, and the condition of alive at discharge prevailed in all patients(AU)

Radiographic morphometry of the distal end radius in Anatolian population / Morfometría radiográfica del extremo distal del radio en la población de Anatolia

SUMMARY: Distal radius fractures are one of the most common orthopedic injuries encountered by orthopedic surgeons. Correction of dorsal tilt and radial height is essential to restore normal biomechanics of the wrist joint. Comprehensive knowledge of the morphometry of the distal radius of the local population becomes critical for the treating surgeon. This study aims to report the morphometry of the distal radius in the Anatolian population and compare it with similar studies in other races and humans. Radiographs of one hundred and twenty-four people were included in the study. Four radiological parameters were examined on all radiographs: radial height, radial tilt, ulnar variance, and palmar tilt. Radial tilt was 23.35°±1.96; palmar tilt was 15.7°±2,87 radial height (mm) was 10.55±4.34, ulnar variance (mm) was 0.32±1.79. The highest rate of negative ulnar variance was found. According to the study's results, reference data varying by race for anatomical fit should be considered in treating DER injuries.

Las fracturas de la parte distal del radio son probablemente las lesiones ortopédicas más comunes que encuentran los cirujanos ortopédicos. La corrección de la inclinación dorsal y la altura radial es esencial para restaurar la biomecánica normal de la articulación de la muñeca. El conocimiento integral de la morfometría del radio distal de la población local es importante para el cirujano tratante. Este estudio tuvo como objetivo reportar la morfometría de la parte rdistal del radio en la población de Anatolia y compararla con estudios similares en otras razas y humanos. Se incluyeron ciento veinticuatro radiografías simples consecutivas de la articulación de la muñeca. Se examinaron cuatro parámetros radiológicos: altura radial, inclinación radial, variación ulnar e inclinación palmar. El ángulo de inclinación radial fue de 23,35±1,96; el ángulo de inclinación palmar fue de 15,7±, la altura radial (mm) fue de 10,55±4,34, la varianza ulnar (mm) fue de 0,32±1,79. Se encontró la tasa más alta de varianza ulnar negativa (43,5%). Los resultados de este estudio deben tenerse en consideración al tratar fracturas de la parte distal del radio, con datos de referencia que varían según la raza para el ajuste anatómico.

Migración de catéter distal a nivel del recto como complicación de derivación ventriculoperitoneal. Reporte de caso / Catheter Migration Through the Rectum as Ventricular Peritoneal Shunt Complication. Case Report

Resumen La hidrocefalia es una entidad nosológica común que en muchos casos tiene como tratamiento de elección la derivación ventricular hacia cualquier cavidad. Dentro de las complicaciones más frecuentes, tenemos las abdominales con formación de colecciones, así como irrupción a sistema intestinal con posterior migración del mismo con presentación de sintomatología a este nivel. Presentamos el caso de un paciente con nula sintomatología abdominal y migración del catéter distal hacia el recto.

Abstract Hydrocephalus is a common nosological entity, with ventricular shunting towards any cavity as the treatment of choice in many cases. Among the most frequent complications, we have the abdominal ones with the formation of collections, as well as irruption to the intestinal system with subsequent migration of the same with presentation of symptoms at this level. We present the case of a patient with no abdominal symptoms and migration of the distal catheter towards the rectum.

Polirradiculoneuropatía desmielinizante inflamatoria crónica con anticuerpos antineurofascina-155: primer reporte de caso en Perú / Chronic inflammatory demyelinating polyradiculoneuropathy with antineurofascin-155 antibodies: A first case report in Peru

La polirradiculoneuropatía desmielinizante inflamatoria crónica, es un grupo de neuro-patías periféricas inmunomediadas clínicamente heterogéneas que comparten manifes-taciones neurofisiológicas de desmielinización y disociación albuminocitológica. Se distinguen una forma típica y variantes atípicas, algunas asociadas a anticuerpos con-tra proteínas del nodo de Ranvier, como la neurofascina- 155. Presentamos el caso de un varón de 38 años, que acudió por cuadro de ocho meses de evolución, caracterizado por parestesias y debilidad progresiva de cuatro extremidades, asociado a diplopía y disfagia. El paciente estaba despierto, con cuadriparesia flácida simétrica de predominio distal, hipotrofia en dorso y palma de ambas manos, arreflexia generalizada, temblor postural de baja frecuencia y alta amplitud en miembros superiores de predominio izquierdo, dismetría apendicular, adiadococinesia, oftalmoparesia a la dextroversión en ojo dere-cho, reflejo nauseoso ausente, marcha atáxica con aumento de base de sustentación y signo de Romberg positivo. El líquido cefalorraquideo mostró disociación albuminocitológica y la electromiografía fue compatible con polineuropatía sensitivo- motora primariamente desmielinizante. Por la sospecha clínica, solicitamos anticuerpos antineurofascina- 155, que resultaron positivos. Recibió tratamiento con metilprednisolona a dosis de un gramo al día durante cinco días, seguido de un miligramo por kilogramo durante tres meses de prednisona, con disminución progresiva con lo que mejoró la diplopía y la disfagia, sin mejoría de la fuerza en extremidades e incluso empeoramiento de la funcionabilidad. Por esta razón se inició tratamiento con rituximab en dosis de dos gramos presentando una notable mejoría en la fuerza muscular distal, el temblor, la estabilidad de la marcha, coordinación y de su funcionabilidad medida con la escala de Rankin modificado.

Chronic inflammatory demyelinating polyradiculoneuropathy is a clinically heterogeneous group of immune- mediated peripheral neuropathies that share neurophysiological manifesta-tions of demyelination and albuminocytologic dissociation. There are typical and atypical variants of this disease, some associated with antibodies against proteins of the node of Ranvier, such as neurofascin- 155. We present the case of a 38- year- old male who presented with an eight- month history of par-esthesia and progressive weakness of four limbs associated with diplopia and dysphagia. The patient was conscious, with symmetric flaccid quadriparesis of distal predominance, hyp-otrophy in the dorsum and palm of both hands, generalized areflexia, postural low frequency, and high amplitude tremor in upper limbs of left predominance, appendicular dysmetria, dys-diadochokinesia, ophthalmoparesis to dextroversion in the right eye, absent gag reflex, ataxic gait with an increased base of support and positive Romberg's sign. Cerebrospinal fluid showed albuminocytologic dissociation, and electromyography was com-patible with primarily demyelinating sensory- motor polyneuropathy. Due to clinical suspicion, we requested anti- neurofascin- 155 antibodies, which tested positive. The patient was treated with methylprednisolone at a dose of one gram per day for five days, followed by one milligram per kilogram for three months of prednisone, with progressive de-crease, which improved diplopia and dysphagia, with no effect on limb strength and even worsening of function. For this reason, treatment with rituximab was started in doses of two grams, presenting a substantial improvement in distal muscle strength, tremor, gait stability, coordination, and functionality measured with the modified Rankin scale.

A case report of a successful multidisciplinary management of an abdominal pregnancy / Manejo multidisciplinario exitoso del embarazo abdominal. Reporte de un caso peruano

Abdominal pregnancy is defined as one that occurs outside of the uterus and fallopian tubes in the abdominal cavity. We present the case of a 30-year-old Peruvian female patient from Lima with a surgical history of exploratory laparotomy due to tubal ectopic pregnancy and appendectomy without further relevant personal or family histories. She attended the emergency room of a social security hospital in Peru with a referral from a district hospital and a diagnosis of abdominal pregnancy at 14 weeks of gestational age without previous prenatal controls. Symptomatology at hospital admission was colic-type abdominal pain in the hypogastrium without vaginal bleeding, fluid loss or fever. During hospitalization, she underwent an exploratory laparotomy with embolization of the uterine artery, left salpingectomy, and removal of the abdominal ectopic pregnancy. The evolution was favorable after the surgery, and she was discharged. Without further complications, she continues her controls at the obstetrics and gynecology outpatient service without complications.

El embarazo abdominal es aquel embarazo que ocurre fuera del útero y las trompas de Falopio en la cavidad abdominal. Presentamos el caso de una paciente peruana de 30 años proveniente de la ciudad de Lima, con antecedentes quirúrgicos de laparotomía exploradora por embarazo ectópico tubárico y apendicectomía, sin otras patologías ni antecedentes familiares de importancia. La paciente acude al servicio de urgencias de un hospital del seguro social en Perú derivada de un hospital distrital con diagnóstico de embarazo abdominal a las 14 semanas de edad gestacional, sin controles prenatales previos. La sintomatología al ingreso hospitalario fue dolor abdominal de tipo cólico a nivel del hipogastrio, sin sangrado vaginal, pérdida de líquidos o fiebre. Durante su hospitalización se le realizó una laparotomía exploratoria con embolización de la arteria uterina, salpingectomía izquierda y extracción del embarazo abdominal. La evolución fue favorable tras la intervención quirúrgica, siendo dada de alta. Actualmente continúa sus controles en el servicio de consulta externa del servicio de ginecología y obstetricia sin complicaciones.

FUNCTIONAL OUTCOME FOLLOWING BI-COLUMNAR PLATING OF AO-TYPE 13C DISTAL HUMERUS FRACTURES.

Background: Intra articular fractures of the distal humerus are uncommon injuries and present the most difficult challenge among fractures of the distal end of the humerus. Objective of this study is to evaluate the functional outcome following bicolumnar plating of AO-Type 13C distal humerus fractures. A total of 20 int Materials and Methods: ra articular (AO TYPE C) distal humerus fractures were operated within a period of 2 years in KVG medical college and hospital Sullia were included in the study in which there were 12 males and 8 females.16 cases were due to RTA, 4 were due to self-fall, Out of 20 cases,1 (5%) was of AO C1 type of fracture, 16(80%) were of C2 and 3 (15%) were of C3 type of fractures. All the patients were operated with pre-countered distal humerus locking plates in orthogonal fashion and functional outcome was measured by Mayo's Elbow Performance Score (MEPS). In our series of 20 cases, the Results: average duration of the radiological union was 16±02 weeks. Excellent results were seen in 10, good in 6 and fair in 3, and poor in 1 According to Mayo's Elbow Performance Score (MEPS) at the end of 12 months follow up. Open reduct Conclusion: ion and internal fixation with bicolumnar plating is the ideal fixation for AO 13 type C distal humerus fractures. Use of locking plates, stable fixation, along with early elbow mobilization influence the final functional outcome. Bicolumnar plating provides better stability, allows early elbow range of motion and prevents elbow stiffness.

Influencing factors for inadequate bowel preparation of colonoscopy of different colonic segments / 中华消化内镜杂志

Objective:To investigate the influencing factors for inadequate bowel preparation of colonoscopy.Methods:A total of 677 patients who underwent colonoscopy at Peking Union Medical College Hospital from December 2021 to January 2023 were recruited, and all patients underwent standardized bowel preparation by using 3 L polyglycol electrolyte powder with fractional dose. The quality of bowel preparation was assessed by Boston bowel preparation scale, and the influencing factors for inadequate bowel preparation were analyzed by logistic regression analysis.Results:The rate of inadequate bowel preparation was 31.5% (213/677). Among the patients with inadequate bowel preparation, 85.4% (182/213) inadequate bowel preparation was only in proximal colon, 14.1% (30/213) was in both proximal and distal colon, and 0.5% (1/213) was only in distal colon. Inadequate bowel preparation in distal colon and total colon were combined into inadequate bowel preparation in distal colon. The results of logistic regression analysis showed that inadequate bowel preparation in proximal colon was more likely to occur in men ( P=0.001, OR=2.253, 95% CI: 1.399-3.629), outpatients ( P<0.001, OR=4.175, 95% CI: 2.410-7.231), those with no family history of colorectal cancer ( P=0.001, OR=2.117, 95% CI: 1.365-3.284), and diagnostic colonoscopy ( P=0.003, OR=1.978, 95% CI: 1.261-3.102). And spinal disease ( P=0.044, OR=7.430, 95% CI: 1.051-52.511), outpatients ( P<0.001, OR=135.577, 95% CI: 29.135-630.883),non-compliance of dietary requirements ( P=0.006, OR=4.772, 95% CI: 1.576-14.453), adverse reaction during bowel preparation ( P=0.015, OR=4.341, 95% CI: 1.329-14.179), no family history of colorectal cancer ( P=0.003, OR=7.110, 95% CI: 1.912-26.438), and poor last stool character ( P=0.001, OR=25.922, 95% CI: 3.779-177.832) were risk factors for inadequate bowel preparation in distal colon. Conclusions:The inadequate bowel preparation of colonoscopy mainly occurs in proximal colon, and the risk factors for the inadequate bowel preparation vary in different colonic segments. Therefore, the specific interventions should be performed according to the character of different colon segments to improve the quality of bowel preparation.

Predictive value of proximal and distal ureteral diameter ratio for impacted stones in the middle and upper ureter / 中华泌尿外科杂志

Objective:To evaluate the predictive value of proximal ureteral diameter (D1)to distal ureteral diameter (D2)ratio (DDR) for impacted stones in the middle and upper ureter.Methods:The clinical data of 173 patients with middle and upper ureteral calculi admitted to the Third Hospital of Shanxi Medical University from January 2014 to November 2021 were retrospectively analyzed. There were 75 males and 98 females, with the median age of 56.0 (51.0, 62.0) years old and median body mass index of 26.1 (24.8, 27.2) kg/m 2. The imaging data of the patients were analyzed. The impacted stones were defined as the inability of the contrast agent to pass through the site of obstruction when intravenous urography or CT urography was performed, resulting in the inability of the ureter to visualize normally in parts below the site of obstruction. D1 was defined as the proximal ureteral diameter at the lower pole of the kidney on horizontal CT images. D2 was defined as the ureteral diameter 3 cm from the calculi. The stone diameter, stone CT value, D1, D2, and DDR were compared between impacted stone group and non-impacted stone group. Univariate logistic regression analysis was used to analyze the different indicators. Random number table was used to divide the training set and validation set according to the ratio of 7∶3. Through least absolute shrinkage and selection operator(LASSO) regression analysis, the independent influencing factors were obtained and the nomogram model was established (Model 1). Receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to verify the predictive efficacy of the model, and the other three effective models (Model 2-4) were constructed by stepwise multivariate logistic regression. The deLong test was used to compare whether there was a significant difference in the AUC between Model 1 and the other three models, and the net benefit of patients was analyzed by clinical decision curve analysis(DCA). Results:In this study, 64 cases (37.0%) were impacted ureteral calculi and 109 cases (63.0%) were non-impacted ureteral calculi, and there were significant differences in diameter[7.8(6.2, 8.8)mm vs. 6.3(5.2, 8.1)mm] , CT value[878.5(763.8, 940.5)HU vs.764.0 (613.0, 854.0) HU], D1[11.1(8.9, 14.9) mm vs. 9.1(7.1, 10.8) mm], D2[4.1(3.1, 4.9) mm vs. 5.0(4.1, 5.9) mm] and DDR[3.1(2.3, 3.9) vs. 1.8(1.4, 2.4)] between the two groups( P < 0.05). The results of univariate logistic regression analysis showed that stone diameter ( OR = 1.333, P < 0.001), CT value ( OR = 1.002, P=0.002), D1 ( OR = 1.146, P<0.001), D2 ( OR = 0.652, P < 0.001) and DDR ( OR = 2.995, P<0.001) were the influencing factors of impacted stones. The training set and validation set included 122 cases and 51 cases, respectively, without significant differences in their image characteristics and outcomes ( P > 0.05). The results of LASSO regression analysis showed that λ corresponding to the simplest result in the optimal range was 0.0908, and three variables were included at this time, and the influencing factors of impacted stones were stone diameter (coefficient 0.0700, OR = 1.073), CT value (coefficient 0.0003, OR = 1.001) and DDR (coefficient 0.5960, OR = 1.815). Moreover, Model 1 was established. According to the model fitting results, ROC curves were plotted, and the AUC of Model 1 was 0.862, and the AUCs of Model 2-4 were 0.859, 0.762, and 0.793, respectively. After deLong test, there was no significant difference between Model 1 and Model 2 ( Z = 0.248, P = 0.804). The AUC of Model 1 was superior to that of Model 3 ( Z = 2.888, P = 0.004) and Model 4 ( Z = 2.321, P = 0.020). The DCA suggested that Model 1 could improve the net benefit rate by up to approximately 21% of patients. Conclusions:DDR is the influencing factor of impacted ureteral calculi, and the model constructed by DDR, stone CT value and stone diameter can effectively predict the probability of impacted ureteral calculi in the middle and upper ureter.