Orthopaedic trauma care during the COVID-19 Pandemic: the Latin American perspective.

At first glance, the COVID-19 pandemic and the field of orthopaedics and traumatology do not appear to be related. Although orthopaedists are not considered front-line personnel in the fight against the pandemic, the role of the surgeon as part of the overall health care team is crucial. The specialty of orthopaedics and orthopaedic trauma, due to its extraordinary scope, affects individuals of all ages and timely care affects patients' long-term function and quality of life. Therefore, positioning the type and timing of care for musculoskeletal injuries and conditions, while maintaining the safety of the patient and healthcare providers, is essential. This article reviews the initial approaches to orthopaedic trauma care during the COVID-19 pandemic as established by 4 representative countries in Latin America: Mexico, Argentina, Colombia, and Brazil.

[Type V floating elbow with type III A3 exposure and nerve injury. Initial and definitive treatment with a minimally invasive technique. A case report]. / Codo flotante tipo V con exposición tipo III A3 y lesión nerviosa. Tratamiento inicial y definitivo con técnica minima invasiva. Reporte de un caso.

BACKGROUND: The increased number of high energy accidents has led to the occurrence of several injuries in a single extremity, particularly among youths. Stanitski and Micheli defined the floating elbow as a forearm fracture plus an ipsilateral supracondylar fracture. Its incidence ranges from 3% to 13%, predominant ages are 7 to 11 years, with a 2:2 male:female ratio. The mechanism of injury is as follows: fall from a height with elbow hyperextension and wrist dorsiflexion and pronation of the forearm. OBJECTIVE: To present the case of a child with a type V left open floating elbow injury, severe soft tissue injury and median and radial nerve injury. CLINICAL CASE: A 12-year-old male weighing 70 kg and a height of 170 cm fell from a height of around 50 cm while riding on a skateboard and sustained a type V floating elbow injury. He was managed with a double antibiotic regimen, decontaminating wound care and fracture stabilization with a minimally invasive approach, using crossed Kirschner nails in the elbow, and centromedullary and retrograde nails in the radius and ulna. He underwent early rehabilitation. The patient resumed his usual activities at month 3 and was assessed using the DASH scale. The nerve injury was classified as neurapraxia. RESULTS: The skin healed at ten days. Passive motion of the elbow and wrist was started at week 2. Bone healing of the radio-ulna occurred at 35 days and of the humerus at 30 days. The nerve injury evolved properly without leaving any sensory or motor sequelae. According to the DASH Scale, the functional course was appropriate; the patient resumed his usual activities at month 3. No infection or compartmental syndrome occurred. CONCLUSIONS: The early and thorough washing of these injuries is an important factor to decrease the risk of infection. The minimally invasive approach is perfect to treat these injuries in children; it is less aggressive and preserves the integrity of soft tissues. Early rehabilitation and the prompt management of the nerve injury are fundamental to the functional result. The DASH Scale identifies the functional course, is easy to use and convenient for the patient.

[Analgesic effect of intra-artcular fentanyl in knee arthroscopy to treat patellofemoral lateral hyperpressure syndrome]. / Efecto analgésico del fentanyl intraarticular en artroscopía de rodilla para el síndrome de hiperpresión lateral patelofemoral.

INTRODUCTION: During arthroscopy for the treatment of patellofemoral lateral hyper-pressure syndrome (LHS), intra-articular morphine or its derivatives (fentanyl) may reduce postoperative pain when combined with anesthetics. We therefore decided to determine whether adding fentanyl to epinephrine and bupivacaine produced an increased analgesia. MATERIAL AND METHODS: We randomly distributed 40 patients into two groups. The experimental group (n=20) was given 0.5% bupivacaine (2 mg/kg), epinephrine (100 microg) and fentanyl (2.5 microg/kg). The control group (n=20) received 0.5% bupivacaine (2 mg/kg) and epinephrine (100 microg). Patients underwent chondroplasty and retinacular release, and we assessed pain, time of analgesia and postoperative range of motion at postoperative hours 6 and 24. RESULTS: The age and the grade of patellofemoral chondromalacia (PFC) were similar in both groups (p > 0.05). No differences were found in pain and ranges of motion intraoperatively and at postoperative hours 6 and 24 (p > 0.05) between both groups. The postoperative analgesia time was similar (p > 0.05). CONCLUSIONS: Adding intra-articular fentanyl to the combination of epinephrine plus bupivacaine did not decrease pain, and did not increase neither the analgesia time nor the range of motion in patients with LHS undergoing knee arthroscopy.

[Thoracocentesis in patients with pleural effusion and chronic alcoholic liver disease]. / Toracentesis on pacientes con derrame pleural asociado a enfermedad hepática alcohólica.

BACKGROUND: chronic alcoholic liver disease (EHAC) associates to recurrent pleural effusion. Generally thoracocentesis is not performed for considering this fluid a trasudate. Our objective was to determine the usefulness of thoracocentesis and causes of recurrent pleural effusion. METHODS: we analyzed samples of pleural fluid of patients with chronic alcoholic liver disease, recurrent pleural effusion and respiratory failure. Blood tests, chest x-rays and pleural fluid analyses were evaluated. RESULTS: we included 27 cases. Mean age of patients was >60 year old, mean evolution time of liver disease was approximately 4 years. 55.6% were exudates and 44.4% trasudates. Causes of recurrent pleural effusion were portal hypertension in 12 (44.4%) cases. In patients with exudate, the origin was infectious in 8 (29.6%) cases; in 4 (14.8%) the cause was malignancy; one more with pulmonary embolism, and in other two patients the cause was not identified. CONCLUSIONS: we found that more than half of patients with chronic alcoholic liver disease and recurrent pleural effusion was an exudate, thus thoracocentesis should be frequently performed in these patients.