Functional outcome after calcaneus fractures: a comparison between polytrauma patients and isolated fractures.

BACKGROUND: Displaced intra-articular calcaneal fractures (DIACFs) can have long-term consequences in terms of foot pain and disability. This injury frequently occurs in the context of polytrauma patients and its influence in long-term functional prognosis is well known. The purpose of this study is to compare the etiology, severity, and functional outcome of the operated DIACFs between polytrauma patients and isolated cases. METHODS: Eighty-six patients with operated displaced intra-articular calcaneal fractures through open reduction and internal fixation (ORIF) were managed at our institution between January 1, 2008 and December 31, 2015. Eighty patients completed the follow-up, nine of them with both calcaneus operated (89 calcaneus) by ORIF with a plate. Two groups were established; one included 11 (14%) polytrauma patients, three of them with operated bilateral calcaneus, and 69 (86%) patients without polytrauma diagnosis. Severity of trauma, injury patterns, psychiatric background, associated fractures, second surgeries and functional questionnaire (adjusted American Orthopedic Foot and Ankle Society - AOFAS - ankle-hindfoot scale and SF-36) were collected. A detailed comparative statistical analysis is provided. RESULTS: There was significant statistical relationship between polytrauma patients and those with psychiatric comorbidities, severe trauma or severe injury, but not with second surgeries, later subtalar arthrodesis or outcome measures. Only calcaneal fractures with comminution according to Sanders classification was associated with second surgeries and later subtalar arthrodesis. The AOFAS score was solely related to trauma severity (71.5 vs 77; p = 0.29) and calcaneal fracture's comminution according to Sanders classification (79.4 type II and 79.3 type III vs 69.2 type IV; p = 0.000 and p = 0.008, respectively) and SF-36 score only with trauma severity (67.4 vs 78.1; p = 0.00) and psychiatric comorbidities (62.2 vs 75.8; p = 0.048). CONCLUSION: No differences in outcome measures and second surgeries were found between polytrauma patients and isolated fractures. For DIACFs, the severity of the impact was correlated with a higher number of second surgeries and worse functional outcomes. Following a DIACF, patients with psychiatric comorbidities presented worse health-related quality of life than people without this background.

Resultados a corto plazo de XLIF asociado a instrumentación posterior en la escoliosis degenerativa del adulto / Short-term results of XLIF (Extreme lateral interbody fusion) with posterior instrumentation in adult degenerative scoliosis

Introducción: Se ha demostrado ampliamente que las técnicas mini invasivas, mejoran el tiempo y el sangrado quirúrgico, siendo el caso del XLIF (Artrodesis Intersomática Lumbar Extralateral). Objetivo: Valorar los parámetros clínicos y radiológicos, tras XLIF en la escoliosis degenerativa del adulto. Material y Métodos: Revisamos retrospectivamente 16 pacientes tratados mediante XLIF e instrumentación posterior mini-invasiva con diagnóstico de escoliosis degenerativa entre enero del 2013 y marzo del 2016. La edad media fue de 64.2 años, se colocaron cajas intersomáticas lumbares por XLIF como media en 2 niveles, e instrumentamos posteriormente todos los casos con un tiempo medio de seguimiento de 442 días. Resultados: Obtuvimos una tasa de consolidación de 80.5%, con una pérdida de altura media por nivel de 2.43 mm. El ángulo de Cobb medio pre y postoperatorio fue de 42’45º y 20'27º, respectivamente. La lordosis lumbar, el balance coronal y sagital medio variaron de manera no estadísticamente significativa en nuestra serie. La EVA media postoperatoria varió a 4'5 y el 73'3 % de los pacientes tenían discapacidad mínima-moderada. Conclusión: Nuestros resultados sugieren que el XLIF asociado a una instrumentación posterior, mejoran tanto los parámetros radiográficos como los clínicos en la escoliosis degenerativa del adulto

Introduction: It has been widely demonstrated that mini-invasive techniques improve surgical time and bleeding; this is the case of XLIF (Extreme lateral interbody fusion). Objective: To assess clinical and radiological parameters after mini-invasive surgery (XLIF) in adult degenerative scoliosis. Material and methods: We retrospectively reviewed 16 patients treated using XLIF and mini-invasive posterior instrumenttation with diagnosis of degenerative scoliosis between january 2013 and march 2016. Our average age was 64.2 years. XLIF was performed, and interbody cages were placed on an average of 2 levels, associating posterior instrumentation with a mean follow-up of 442 days. Results: We obtained a rate of 80.5% consolidation in our series. Our average height loss per level was 2.43 mm. Our pre and postoperative Cobb angle was 42.45º and 20.27º, respectively. No differences were found between pre and postoperatory lumbar lordosis, coronal and sagittal balance. The mean postoperative VAS was 4.5 and 73.3% of the patients had minimal-moderate disability. Conclusions: Our results suggest that XLIF associated with posterior instrumentation improves both radiographic and clinical parameters in degenerative adult scoliosis

Parachordoma of soft tissues of the arm: a very rare tumour.

Parachordoma is an infrequent neoplasm that bears some histologic resemblance to chordoma. It affects both sexes, occurs typically during the fourth decade of life, and tends to present as a slow-growing painless mass at the level of the soft tissues of the extremities. Diagnosis should be based on immunohistochemical and cytogenetic studies, as the findings of imaging techniques are often unspecific. Although it is considered a benign lesion, its behavior tends to be locally aggressive, with reports of a recurrence rate of up to 20% and of several cases of metastasis. Fewer than 60 cases have been published in the English-speaking literature. In this paper we present the case of a 32-year-old male with a two-year history of parachordoma in the right wrist.

Multicentric and prospective study of the Summit cementless stem.

We assess early clinical and radiographic results of a multicentric and prospective study of 485 Summit porous-coated stems implanted in 5 hospitals. Of the patients, 171 had a hydroxyapatite (HA) coating and 314 had non-HA porous-coated stems. The mean follow-up was 4.2 years (range 2.5-6 years). The median size of the stem was 5. A standard femoral offset stem was used in 366 hips (75.5%) and a high femoral offset in 119 hips (24.5%). Dislocation was the most frequent postoperative complication (16 hips). Clinical results according to the Harris scale were 30.17 points (range 10-52) before surgery and 95 points (range 90-100) at the last follow-up evaluation. All stems were radiographically osseointegrated. Femoral stem position was neutral in 395 hips (81.4%), and femoral canal filling was related with implant position. No stem subsidence greater than 5 mm has been found in any hip. No osteolysis was found around the femoral stem. No differences have been found between HA coating and non-HA porous-coated stems. Although the present follow-up in this series is too short to allow definite conclusions, the Summit stem with and without HA coating has provided excellent short-term results.