RESUMO
Resumen: Introducción: Las fracturas del cóndilo femoral en el plano coronal o fracturas de Hoffa se encuentran entre las fracturas más raras del miembro pélvico, pero son aún más raras las del cóndilo medial. El éxito en el manejo de estos pacientes radica en el diagnóstico oportuno y la consecuente reducción anatómica de la superficie articular del fémur. Caso clínico: El objetivo de este reporte es presentar a un paciente con el diagnóstico de fractura de Hoffa medial derecha, registrado como caso único en los archivos de nuestro hospital. El paciente acudió referido en Noviembre de 2011, con evolución de 10 días tras sufrir caída de caballo, presentando mecanismo de varo forzado y contusión directa de la rodilla derecha. Mostró radiografías anteroposterior y lateral de rodilla derecha, donde se observó de forma sutil solución de la continuidad en el plano coronal de la base del cóndilo medial, corroborado por resonancia magnética y asociado a lesiones parciales no quirúrgicas de ambos meniscos y del ligamento cruzado anterior. Se intervino quirúrgicamente el día 27 de Noviembre de 2011 mediante reducción abierta con abordaje medial y fijación interna con dos tornillos canulados de 7.0 mm. Se egresó al paciente indicando la movilización temprana y continua de la rodilla, difiriendo el apoyo y rehabilitación hasta la sexta semana. Actualmente el paciente se encuentra con posibilidad de deambulación, asintomático y con arcos de movilidad completos. El respeto del aparato extensor mediante un abordaje medial y la superficie articular con tornillos canulados se refleja en la adecuada evolución de nuestro paciente, pudiendo regresar a sus actividades diarias, incluso el montar.
Abstract: Introduction: Knee femoral condyle coronal fractures or Hoffa fractures are among the rarest fractures of the pelvic limb, being even more rare those of the medial condyle. The success in the management of these patients lies in the timely diagnosis and the consequent anatomical reduction of the femoral articular surface. Clinical case: The objective of this article is to present a patient with right medial Hoffa fracture, registered as a single case in the archives of our hospital. The patient was referred to us on November 2011, with a 10-day course after suffering a fall from horse ridding, presenting a forced varus mechanism and direct contusion of the right knee. He shows an anteroposterior and lateral knee X-rays showing a subtle solution of continuity in the coronal plane of the base of the medial condyle, corroborated with magnetic resonance imaging and was also associated with a non-surgical partial injury of both menisci and the anterior cruciate ligament. Surgical intervention was performed on 27th/11/2011, through open reduction with a medial approach and internal fixation with 7.0 mm (x2) cannulated screws. The patient was discharged with early and continuous mobilization of the knee, deferring support and rehabilitation until the 6th week. He is currently a wandering patient, asymptomatic, with complete range of motion. Because respecting the extensor apparatus through a medial approach and the articular surface with cannulated screws, it was observed in consequence an adequate evolution of our patient, being able to return to his daily activities, even remount.
RESUMO
resumen está disponible en el texto completo
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.