Evaluación final voluntaria para médicos residentes de Cirugía Ortopédica y Traumatología: balance de resultados y mirada al futuro / Final voluntary assessment for Traumatology and Orthopaedic Surgery medical residents: a report on the results and a look at the future

Introducción. La conveniencia de establecer una prueba que acredite la formación de los especialistas en Cirugía Ortopédica y Traumatología (COT) al término de su período de formación como médicos internos residentes es objeto de controversia. Con la intención de favorecer y estimular el desarrollo de esta prueba, los actuales vocales de la Comisión Nacional de la Especialidad (CNE) han realizado una revisión de los datos obtenidos en las pasadas ediciones. Material y métodos. Resultados de las pruebas de evaluación voluntaria de final de residencia y de las encuestas de valoración rellenadas por los participantes de la prueba entre los años 2006 y 2011. Resultados. En total han intervenido 231 personas en la evaluación, incrementándose el número de participantes desde 19 en 2005, hasta 71 en 2011. La media de puntuación global a lo largo del período analizado (2006-2011) es de 6,72 puntos. Los no aptos en estos 6 años han sido 9 participantes (4,25%). La media de puntuación en el test es de 7,57 puntos. La puntuación global media de las mesas es de 6,57. Generalidades es la mesa que obtiene peores resultados. La mesa de miembro inferior reconstructivo no ha sido suspendida nunca. La mesa de miembro superior es la que obtiene los mejores resultados medios. Discusión. La prueba está arraigada en la estructura de la formación especializada de la COT en nuestro país. Debemos reconocer favorablemente a aquellos candidatos que optan por presentarse. Este reconocimiento será el mejor estímulo para las futuras promociones (AU)

Introduction. The idea of establishing an examination that accredits the training of the specialists in orthopaedic surgery at the end of their educational period as residents is subject to controversy. With the aim of encouraging the development of this examination, the present members of the National Commission of the Specialty of Orthopaedics (CNE) have reviewed the results obtained in previous examination. Materials and Methods. The results of the voluntary final exam for Orthopaedics residents, and of the surveys of participant opinions for the years 2006 to 2011 are presented. Results. The total number of participants was 231, growing from 19 in 2005, to 71 in 2011. The overall mean score in the period reviewed (2006-2011) was 6.72 out of 10 points. In these 6 years, 9 participants failed (4.25%). The mean score for the test was 7.57. The overall mean score of the oral exam was 6.57. The worst results were obtained in the general knowledge section of the oral examination. Nobody has ever failed the section on reconstruction of the lower extremity. The upper extremity section in the oral examination achieves the best average results. Discussion. The examination has established its place in the structure of orthopaedic resident training in our country, even without making it official by the Administration. We must positively acknowledge those candidates who chose to take the examination and be evaluated by their peers in order to prove their qualification and distinction. This recognition will be the best encouragement for future generations (AU)

[Final voluntary assessment for Traumatology and Orthopaedic Surgery medical residents: a report on the results and a look at the future]. / Evaluación final voluntaria para médicos residentes de Cirugía Ortopédica y Traumatología: balance de resultados y mirada al futuro.

INTRODUCTION: The idea of establishing an examination that accredits the training of the specialists in orthopaedic surgery at the end of their educational period as residents is subject to controversy. With the aim of encouraging the development of this examination, the present members of the National Commission of the Specialty of Orthopaedics (CNE) have reviewed the results obtained in previous examination. MATERIALS AND METHODS: The results of the voluntary final exam for Orthopaedics residents, and of the surveys of participant opinions for the years 2006 to 2011 are presented. RESULTS: The total number of participants was 231, growing from 19 in 2005, to 71 in 2011. The overall mean score in the period reviewed (2006-2011) was 6.72 out of 10 points. In these 6 years, 9 participants failed (4.25%). The mean score for the test was 7.57. The overall mean score of the oral exam was 6.57. The worst results were obtained in the general knowledge section of the oral examination. Nobody has ever failed the section on reconstruction of the lower extremity. The upper extremity section in the oral examination achieves the best average results. DISCUSSION: The examination has established its place in the structure of orthopaedic resident training in our country, even without making it official by the Administration. We must positively acknowledge those candidates who chose to take the examination and be evaluated by their peers in order to prove their qualification and distinction. This recognition will be the best encouragement for future generations.

Posterior sternoclavicular dislocation. Report of two cases.

Posterior sternoclavicular dislocation is a relatively uncommon lesion, but must always be considered in the event of trauma to the scapulothoracic area in which initial radiology does not show signs of fracture. Its diagnosis and treatment must be carried out promptly because of the possible serious complications that may occur through the clavicle compressing nearby structures. The authors report two cases, which were diagnosed by CT-scan. In the first case, treatment consisted in orthopedic reduction, while in the second case open reduction and fixation with Kirschner wires was required. The result was satisfactory in both cases, and the patients remain asymptomatic three and five years after trauma.

Complete dorsal tarsometatarsal dislocation of the first metatarsal.

The authors describe a rare case of Lisfranc's dislocation that occurred after a 13-year-old boy kicked the ground while playing soccer. He presented with complete pure dorsal tarsometatarsal dislocation of the first metatarsal. He was treated succesfully by closed reduction and percutaneous K-wire fixation. No complication was found and he returned to his preinjury lifestyle at 3 months. No sequelae are found 3.5 years later.

Chronic exertional compartment syndrome of the legs in adolescents.

We present our experience in the management and treatment of chronic exertional compartment syndrome (CECS) of the legs in 23 adolescents. Twenty-one patients were affected in the anteroexternal compartment, one in the deep posterior compartment, and one in both. Seventeen of the patients were in-line competitive skaters; the rest practiced soccer or athletics. Mean age at the time of diagnosis was 16 (range, 14-18) years, and the age at the onset of symptoms was 15 (range, 13-17) years. After a careful differential diagnosis, the diagnosis was established on the basis of clinical signs and symptoms and confirmed by intracompartmental pressure (ICP) measurements. Based on our results, the following criteria are considered to be adequate: baseline ICP (at rest) >10 mm Hg, >20 mm Hg 1 minute after stopping exercise, >20 mm Hg 5 minutes later, and >15 minutes to achieve ICP normalization. All patients but one accepted surgical treatment (complete subcutaneous fasciotomy). No major complication was observed and only one minor complication occurred. All patients returned to the practice of their sports without any symptomatology 6 weeks after the surgery (mean follow-up, 4.8 years). To date there have been no relapses.

Fibrous dysplasia of both alae of the sacrum.

A case of monostotic fibrous dysplasia involving both alae of the sacrum is reported. Only 2 cases of monostotic sacral involvement were published previously. The lesion was detected in a 42-year-old man suffering from lumbosacral pain after minimal trauma. Radiographic studies revealed cystic images on both alae of the sacrum, with internal condensations and some liquid contents. A trephine biopsy did not produce enough diagnostic data, and a posterior surgical approach was elected. Curettage and refilling with allograft were performed. The pathologic anatomy study diagnosed a fibrous dysplasia. Two years after surgery, the patient was asymptomatic.

Resultados del tratamiento quirúrgico del síndrome compartimental crónico de esfuerzo de EEII / Results of the surgical treatment of the chronic exertional compartment syndrome of the leg

Se revisan 31 pacientes afectos de síndrome compartimental crónico de esfuerzo de las piernas con afectación bilateral en todos excepto en uno. Todos realizaban actividades deportivas de larga duración: 21 practicaban patinaje en línea de alto nivel competitivo y el resto, atletismo y fútbol. En 29 se afectaba el compartimento antero-externo, en uno el posterior y otro con afectación mixta. El diagnóstico se realizó por la clínica, comprobándose en todos los casos por medición de las presiones intracompartimentales. Uno de ellos optó por rechazar el tratamiento quirúrgico, y a los otros 30 se les practicó fasciotomía subcutánea completa. El seguimiento medio fue de 4,5 años.Todos los pacientes mejoraron completamente de la sintomatología, sin recidiva posterior. Reincorporándose a los entrenamientos a las seis semanas (AU)

Diagnóstico del síndrome compartimental crónico de esfuerzo de EEII / Diagnosis of chronic exertional compartment syndrome of the leg

El objetivo de este trabajo es intentar establecer criterios diagnósticos objetivos suficientes del síndrome compartimental crónico de esfuerzo en las piernas. Para ello, se hizo un estudio de 31 pacientes, diagnosticados de síndrome compartimental crónico de esfuerzo, entre los pacientes remitidos por dolor en las piernas al realizar esfuerzo que cedía con el reposo. El diagnóstico se estableció en base a una clínica compatible, tras establecer un minucioso diagnóstico diferencial, y confirmado mediante determinación de presiones intracompartimentales, observando que el criterio más fiable de forma aislada es el tiempo de normalización de las presiones superior a 15 minutos (AU)

Legg-Calvé-Perthes disease and passive smoking.

We carried out a case-control study with 90 patients with Legg-Calvé-Perthes disease (LCPD) and 183 normal children, as controls, selected at random to determine whether the condition of passive smoking is related to the disease. Seventy-one of 90 of the LCPD group (78.9%) were passive smokers. Only 79 of 183 (43.2%) in the control group were passive smokers (p = 0.00000). We did not find any statistical relationship between passive smoking and evolution of the condition (p = 0.42883), Catterall extension (p = 0.60544), final Stulberg result (p = 0.53201), or presence of sequelae (p = 0.53256). We also could not find any statistical difference between ages (p = 0.18). The odds ratio was 5.3203 (95% confidence interval 2.92-9.69). The association between LCPD and passive smoking, after controlling for age and gender, became significant (p = 0.0000). Thus the risk of LCPD in passive smoking children is more than five times higher than in children who are not exposed to smoke. It seems that passive smoking is a factor directly or indirectly associated with LCPD.

Transverse stress fracture of the patella in a child.

Transverse stress fracture of the patella in a child is an exceptional injury in childhood. Only one case has been previously reported. The present study reports a new case of a 12-year-old boy with anterior knee pain misdiagnosed for 5 months as Sinding-Larsen-Johansson disease who developed sudden anterior right knee pain and pop while running in a soccer match. Surgery was performed. The evolution was favorable without any immobilization required and the patient achieved full recovery.

Triplane fractures in the hand.

Two new cases of triplane fracture of the distal tibia are reported in the proximal phalanx of the thumb and the distal radius, respectively, of a 12-year-old girl and a 13-year-old boy. Neither fracture showed any displacement, achieving healing at 4 weeks of external immobilization. Triplane fractures can occur across growth plates other than the distal tibia. Because of the rapid physiologic physeal arrest, the potential for growth deformity is null. In cases without displacement, these fractures should be treated conservatively by external immobilization, as one would treat a one-plane fracture.

L5 root compression caused by degenerative spinal stenosis of the L1-L2 and L2-L3 spaces.

STUDY DESIGN: A severe bilateral L5 root lesion associated with spinal stenosis at L1-L2 and L2-L3 is described. OBJECTIVE: To describe clinical findings and the difficulty in obtaining a correct diagnosis of L5 Root Compression. SUMMARY OF BACKGROUND DATA: The disorder reported in this study has not been reported previously. Only one similar case has been described in the literature: an L5 root compression at L1-L2 caused by disc herniation. METHODS: Diagnosis was obtained by using computed tomography scanning, magnetic resonance imaging, and computed tomography myelography. The findings at L5-S1 were minimal to justify the patient's clinical symptoms, but a detailed study of the upper levels revealed spinal stenosis at L1-L2 and L2-L3, which could have been causing L5 and S1 root compression. A decompressive laminectomy and partial facetectomy in both levels were performed. RESULTS: The patient's pain and claudication disappeared, and clinical symptoms associated with the right L5 root improved. The left L5 root deficit remained stable. CONCLUSION: An unusual case of L5 root compression caused by degenerative stenosis of L1-L2 and L2-L3 is described.

Open anterior dislocation of the hip in a child.

We report a case of a 10-year-old child with open anterior dislocation of the left hip. After debridement and reduction, he suffered deep infection and avascular necrosis of the hip and finally experienced its destruction.