Educational impact of a clinical anatomy workshop on 1st-year orthopedic and rheumatology fellows in Mexico City.

We aim to study the educational impact of a clinical anatomy workshop in 1st-year orthopedic and rheumatology fellows. First-year rheumatology fellows (N = 17) and a convenience sample of 1st-year orthopedic fellows (N = 14) from Mexico City in the 9th month of training participated in the study. The pre- and the post- workshop tests included the same 20 questions that had to be answered by identification or demonstration of relevant anatomical items. The questions, arranged by anatomical regions, were asked in five dynamic stations. Overall, the 31 participants showed an increase of correct answers, from a median of 6 (range 1 to 12) in the pre-workshop test, to a median of 14 (range 7 to 19) in the post-workshop test. In the pre-workshop test, the correct median answers were 7 (range 2 to 12) in the orthopedic fellows and 5 (range 1 to 10) in the rheumatology fellows (p = 0.297). Corresponding scores in the post-workshop were 15 (range 10 to 19) and 12 (range 7 to 18) (p = 0.026) showing a significant difference favoring the orthopedic group. Our clinical anatomy workshop was efficacious, in the short term, as a teaching instrument for 1st-year orthopedic and rheumatology fellows. The post-workshop scores, although significantly improved in both groups, particularly in the orthopedic fellows, were still suboptimal. Further refinements of our workshop might yield better results.

Reemplazo femoral total, reporte de tres casos con revisión de la literatura / Total femoral replacement. Three case reports and literature review

Introducción: En la actualidad, la cirugía de recambio articular de cadera y rodilla es un procedimiento común en centros ortopédicos. Sin embargo, sabemos que este tipo de cirugía tiene vigencia y requiere procedimientos de revisión. Estos últimos generalmente conllevan complicaciones importantes como la pérdida de hueso que puede llegar a comprometer la estabilidad de los implantes. Métodos: Se realizaron tres revisiones de artroplastía tanto de cadera como de rodilla que han requerido el reemplazo total del fémur y de las articulaciones involucradas en el período comprendido del 2006 al 2011. El objetivo del presente trabajo es presentar la experiencia con estos implantes en cirugía de revisión de artroplastía. Resultados: El protocolo de manejo del postoperatorio fue estandarizado para todos y cada uno de los pacientes, requirieron manejo mediante desbridamientos y antibioticoterapia específica. Evidenciaron mejora significativa en el puntaje de la escala visual análoga del dolor (8-2.3 puntos p < 0.05) y funcional con la escala de valoración de WOMAC (21.6 preoperatorio a 55 puntos p < 0.05). Conclusiones: El reemplazo femoral total es un procedimiento quirúrgico de salvamento poco frecuente, demandante y complejo, que representa una alternativa ante la desarticulación de la extremidad pélvica en la etapa final de la enfermedad protésica. Se trata de una opción factible de realizar para mejorar la funcionalidad del paciente y disminuir la discapacidad residual para la realización de actividades de manera independiente.

Introduction: Currently hip and knee joint replacement were performed frequently at orthopedic centers. However, these surgeries do not last forever and thus revision procedures are required. The latter usually involve complications like bone loss that may compromise implant stability. Methods: Three hip and knee arthroplasty revisions were performed from 2006 to 2011, which warranted the total replacement of the femur and the joints involved. The purpose of this paper is to describe our experience with these implants used in arthroplasty revision surgery. Results: A standardized postoperative management protocol was used in all patients. They required debridement and specific antibiotic therapy. They had a significant improvement in the pain visual analog scale (VAS) (the score went from 8 to 2.3, p < 0.05) and in function, measured with the WOMAC score (from a preoperative score of 21.6 to 55, p < 0.05). Conclusions: Total femoral replacement is an infrequent, demanding and complex salvage surgery that represents an alternative to the disarticulation of the pelvic limb at the end stage of prosthetic disease. This is a feasible option used to improve patient functionality and decrease residual capacity for performing activities independently.

[Total femoral replacement. Three case reports and literature review]. / Reemplazo femoral total, reporte de tres casos con revisión de la literatura.

INTRODUCTION: Currently hip and knee joint replacement were performed frequently at orthopedic centers. However, these surgeries do not last forever and thus revision procedures are required. The latter usually involve complications like bone loss that may compromise implant stability. METHODS: Three hip and knee arthroplasty revisions were performed from 2006 to 2011, which warranted the total replacement of the femur and the joints involved. The purpose of this paper is to describe our experience with these implants used in arthroplasty revision surgery. RESULTS: A standardized postoperative management protocol was used in all patients. They required debridement and specific antibiotic therapy. They had a significant improvement in the pain visual analog scale (VAS) (the score went from 8 to 2.3, p < 0.05) and in function, measured with the WOMAC score (from a preoperative score of 21.6 to 55, p < 0.05). CONCLUSIONS: Total femoral replacement is an infrequent, demanding and complex salvage surgery that represents an alternative to the disarticulation of the pelvic limb at the end stage of prosthetic disease. This is a feasible option used to improve patient functionality and decrease residual capacity for performing activities independently.

INTRODUCCIÓN: En la actualidad, la cirugía de recambio articular de cadera y rodilla es un procedimiento común en centros ortopédicos. Sin embargo, sabemos que este tipo de cirugía tiene vigencia y requiere procedimientos de revisión. Estos últimos generalmente conllevan complicaciones importantes como la pérdida de hueso que puede llegar a comprometer la estabilidad de los implantes. MÉTODOS: Se realizaron tres revisiones de artroplastía tanto de cadera como de rodilla que han requerido el reemplazo total del fémur y de las articulaciones involucradas en el período comprendido del 2006 al 2011. El objetivo del presente trabajo es presentar la experiencia con estos implantes en cirugía de revisión de artroplastía. RESULTADOS: El protocolo de manejo del postoperatorio fue estandarizado para todos y cada uno de los pacientes, requirieron manejo mediante desbridamientos y antibioticoterapia específica. Evidenciaron mejora significativa en el puntaje de la escala visual análoga del dolor (8-2.3 puntos p < 0.05) y funcional con la escala de valoración de WOMAC (21.6 preoperatorio a 55 puntos p < 0.05). CONCLUSIONES: El reemplazo femoral total es un procedimiento quirúrgico de salvamento poco frecuente, demandante y complejo, que representa una alternativa ante la desarticulación de la extremidad pélvica en la etapa final de la enfermedad protésica. Se trata de una opción factible de realizar para mejorar la funcionalidad del paciente y disminuir la discapacidad residual para la realización de actividades de manera independiente.

[Inclusion bone cyst in the distal phalanx. Report of three cases]. / Quiste oseo de inclusión en la falange distal. Informe de tres casos.

UNLABELLED: Inclusion bone cysts are cysts of an epidermal lineage containing keratin. They are commonly found in the subcutaneous tissue, occasionally in intratendinous, subungueal or intraosseous tissue. The diagnosis is usually clinical. The most frequent symptom is pain, which may be associated with ungueal deformity. Plain X-rays in two views allow identifying the bone location. The treatment recommended for all cases of epidermoid cyst of the distal phalanx is curettage of the lesion. MATERIAL AND METHODS: The clinical charts of patients with inclusion cysts of the distal phalanx from 1983 to 2010 were reviewed. RESULTS: Three cases were found; 2 males and one female, ages 23, 28 and 47 years. The most frequent symptom was pain with ungueal deformity in 2 cases. In 2 cases the X-rays show the characteristics of the epidermoid cyst. Curettage was performed in the 3 cases; a bone graft was used in 2 cases. The follow-up ranged between 120 and 324 months (mean of 222 months). No relapses or complications were reported. DISCUSSION: Inclusion bone cysts are infrequent tumors of the distal phalanx and have particular characteristics that the orthopedist surgeon should be familiar with.

[Enchondroma of the distal phalanx]. / Encondroma de la falange distal.

Enchondroma is the most frequent benign tumor in hand bones. It occasionally occurs in the distal phalanx of the fingers; it is usually an asymptomatic lesion, but pain may occur when it is associated with a fracture. The most recommended treatment is lesion curettage and application of a bone graft, besides fixation as needed. Five cases with location in the distal phalanx are reported, as well as treatment results from January 1978 to May 2010. Of the 5 patients, 4 were females and one was male. The most frequently affected digit was the middle finger followed by the little finger. The most frequent symptom at the time of diagnosis was pain. Lesion curettage was performed in all cases, with the use of an autologous distal radius bone graft in 4 and coralline graft in one. Mean follow-up was 193 months (2-384 months). No complications or relapses were reported.

[Glomus tumor of the hand]. / Tumor glomus en la mano.

BACKGROUND: Glomus type of tumors are benign tumors of the hand phalanges. Their most frequent location is the nail bed. The diagnosis requires a certain index of suspicion and is usually a clinical one. The recommended approach is surgery. MATERIAL AND METHODS: The clinical files of patients with glomus of the hand were reviewed from June 1978 to May 2010, analyzing the characteristics of their management. RESULTS: Twelve patients with a glomus type of tumor were found; 4 females and 8 males, ages 31-55 years. The distal phalanx and the little finger were the most frequent sites. The diagnosis was mostly clinical and treatment in all cases was surgical. Mean follow-up was 8 years. CONCLUSIONS: The glomus type of tumor is a lesion often involving the distal phalanx, with unique clinical and pathologic characteristics that the orthopedic surgeon should know to determine management.

Arthroscopic treatment of femoroacetabular impingement secondary to paediatric hip disorders.

Open reduction of the prominence at the femoral head-neck junction in femoroacetabular impingement has become an established treatment for this condition. We report our experience of arthroscopically-assisted treatment of femoroacetabular impingement secondary to paediatric hip disease in 14 hips in 13 consecutive patients (seven women, six men) with a mean age of 30.6 years (24 to 39) at the time of surgery. The mean follow-up was 2.5 years (2 to 4). Radiologically, 13 hips had successful restoration of the normal geometry and only one had a residual deformity. The mean increase in the Western Ontario McMasters Osteoarthritis Index for the series at the last follow-up was 9.6 points (4 to 14). No patient developed avascular necrosis or sustained a fracture of the femoral neck or any other complication. These findings suggest that femoroacetabular impingement associated with paediatric hip disease can be treated safely by arthroscopic techniques.