Comparación cuantitativa de la ejecución de la maniobra de Lachman para su estandarización a través de software para dispositivo móvil / Quantitative comparison of the execution of the Lachman maneuver for its standardization through software for mobile devices

Introducción: la maniobra de Lachman es ampliamente empleada como recurso diagnóstico para detectar lesiones en el ligamento cruzado anterior (LCA) y, por su simplicidad, se tiende a pensar que no existe una variabilidad significativa en su ejecución. El presente estudio comparativo está centrado en utilizar los sensores integrados en un dispositivo móvil para encontrar, a través del índice de correlación intraclase, si las variaciones tanto intraobservador como interobservador son significativas. Materiales y métodos: se efectuaron dos ensayos llamados "Lachmatón", con doce residentes de ortopedia a modo de evaluadores y sujetos de prueba; el primer ensayo ayudó a identificar y describir las diferencias de los gestos de ejecución entre los evaluadores, mientras que el segundo permitió medir el incremento de la similitud de ejecución entre estos al ser instruidos, en contraste con el primer ensayo, donde no habían recibido ninguna instrucción; esto fue posible al medir la similitud características estadísticas y morfológicas de las señales adquiridas a través del índice de correlación intraclase. Resultados: se identificaron dos gestos importantes y que emiten señales con distinta forma al aplicarse, o no, a la ejecución de la maniobra: 1) fijar el pie y, 2) fijar el fémur. Se encontró una diferencia significativa entre ambos ensayos, así como entre los dos estilos más usados por los evaluadores. Conclusión: el uso de los sensores integrados en un dispositivo móvil para medir diferencias en la ejecución de la maniobra de Lachman ayudó a determinar los gestos que permiten una mayor reproducibilidad de esta maniobra. Nivel de Evidencia: III

Introduction: the Lachman maneuver was amplified as a diagnostic resource to detect injuries in the anterior cruciate ligament (ACL) and it tends to be thought, due to its simplicity, that there is no significant accumulation in its execution. This comparative study focuses on using the sensors integrated into a mobile device to find out whether the intraobserver or interobserver variations are significant, through the intraclass correlation coefficient. Materials and methods: two trials called "Lachmatón" will be carried out with twelve orthopedic residents as evaluators and test subjects; the first trial helped to identify and describe the differences in performance gestures between raters, while the second allowed measuring the increase in performance similarity between raters as instructors, in contrast to the first trial, where neither could instruction; This was possible by measuring the similarity of the statistical and morphological characteristics of the signals obtained through the intraclass achievement index.Results: two important gestures were identified, which emit signals in different ways when applied or not to the execution of the maneuver: 1) fix the foot and, 2) fix the femur. You will find that there is a significant difference between you and the evaluators. Conclusion: the use of sensors integrated into a mobile device to measure differences in the execution of the Lachman maneuver helped to determine the gestures that allow a greater reproducibility of this maneuver. Level of Evidence: III

Estudio y manejo de nódulos tiroideos por médicos no especialistas. Consenso SOCHED / Study and management of thyroid nodes by non specialist physicians: SOCHED consensus

The thyroid nodule is a frequent cause of primary care consultation. The prevalence of a palpable thyroid nodule is approximately 4-7%, increasing up to 67% by the incidental detection of nodules on ultrasound. The vast majority are benign and asymptomatic, staying stable over time. The clinical importance of studying a thyroid nodule is to exclude thyroid cancer, which occurs in 5 to 10% of the nodules. The Board of SOCHED (Chilean Society of Endocrinology and Diabetes) asked the Thyroid Study Group to develop a consensus regarding the diagnostic management of the thyroid nodule in Chile, aimed at non-specialist physicians and adapted to the national reality. To this end, a multidisciplinary group of 31 experts was established among university academics, active researchers with publications on the subject and prominent members of scientific societies of endocrinology, head and neck surgery, pathology and radiology. A total of 14 questions were developed with key aspects for the diagnosis and subsequent referral of patients with thyroid nodules, which were addressed by the participants. In those areas where the evidence was insufficient or the national reality had to be considered, the consensus opinion of the experts was used through the Delphi methodology. The consensus was approved by the SOCHED board for publication.

Utilidad de la monitorización de los colgajos microquirúrgicos / Utility of monitoring microvascular flaps

Objetivo: Evaluar el uso de una sonda Doppler para verificar la permeabilidad y el flujo de la anastomosis en colgajos microquirúrgicos. Material y método: Serie descriptiva prospectiva de los pacientes en los cuales se realizó reconstrucción con colgajo microquirúrgico en la Clínica Alemana entre marzo de 2013 y marzo de 2015, en los cuales se utilizó un monitor Doppler arterial postanastomótico (Coock® Swartz Doppler probe). Resultados: Se registraron 20 pacientes con colgajos microquirúrgicos. Se realizaron 10 colgajos antebraquiales, 7 fíbulas (4 con testigo cutáneo y 3 sin), 2 anterolaterales de muslo y uno recto abdominal. Se realizaron 6 reexploraciones en pabellón. En un caso hubo sospecha tanto clínica como por el cambio en la señal del Doppler; en 4 solo sospecha clínica, y en uno solo por cambio en la señal Doppler. Los hallazgos fueron edema del colgajo en un paciente y 5 hematomas. No hubo pérdida de colgajos. Se utilizó el monitor Doppler por un promedio de 9,5 días. Conclusión: Este método de evaluación no reemplaza a la observación cínica, pero representa una herramienta más para la toma de decisiones en el postoperatorio de este tipo de reconstrucciones en cabeza y cuello.

Aim: To evaluate Doppler probe to assure the flow through the anastomoses at free flaps used in head and neck surgery. Material and method: Descriptive prospective series, of every patient that receive a free flap reconstruction at Clinica Alemana between March 2013 and March 2015, in which a Doppler monitor (Coock® Swartz Doppler probe) on the arterial anastomoses was used. Results: 20 patients with free flaps were recorded. 10 radial flaps, 7 fibulas (4 with a skin paddle and 3 without), 2 antero lateral thigh flaps and 1 abdominis rectus flap. 6 reexplorations were done. In one case the suspicion was clinical, with change in the Doppler signal, 4 patients just clinical suspicion and 1 just because a change in the Doppler signal. The findings were flap edema in 1 patient and 5 hematomas. We didn’t loss any flap. The Doppler monitor was used for an average of 9.5 days. Conclusion: The Doppler monitor doesn’t replace the clinical observation but represents another tool for the decision making during the post operative period in this kind of head and neck reconstructions.