Factores predictivos de la mortalidad al año en pacientes mayores de 80 años intervenidos de fractura del cuello femoral / Factors predicting one-year mortality of patients over 80 years operated after femoral neck fracture

Introducción: En la población española los estudios previos relacionados con la mortalidad tras fractura de cadera están basados en pacientes con edades entre 60 a 102años y no estratificaban los pacientes de acuerdo con el tipo de fractura. El objetivo de este estudio fue identificar los factores con influencia sobre la mortalidad al año postoperatorio en pacientes de 80años o más que sufrieron una fractura cervical de cadera. Material y método: Estudio retrospectivo de casos y controles. Fueron incluidos los pacientes consecutivos intervenidos entre 2015 y 2016. Se estudiaron las características basales, los antecedentes y la medicación previa, los parámetros analíticos, el índice de Charlson, la escala ASA, el índice de Barthel y el cuestionario Pfeiffer. Se registraron los datos quirúrgicos y las complicaciones durante el seguimiento. La supervivencia se evaluó mediante el método de Kaplan-Meier y las variables que la afectaban mediante la regresión de Cox. Resultados: La mortalidad al año postoperatorio fue del 21,1% y la supervivencia media de 10,3meses (IC95%: 9,7-10,9). La regresión de Cox mostraba que la edad >87años, la puntuación de Barthel ≤85 y la combinación de anticoagulantes con INR ≥1,5 eran predictores significativos de mortalidad durante el primer año de seguimiento. Conclusión: Los factores predictores de mortalidad durante el primer año postoperatorio por fractura cervical de cadera en pacientes octogenarios o mayores fueron la edad >87años, la dependencia física medida a través de una puntuación en el índice de Barthel ≤85 y el uso de anticoagulantes con un INR ≥1,5 al ingreso

Introduction: In the Spanish population, previous studies related to mortality after hip fracture are based on patients aged 60 to 102years and did not stratify patients according to the type of fracture. The objective of this study was to identify the factors with influence on mortality at one postoperative year in patients aged 80years or older after a femoral neck fracture. Material and method: Retrospective study of cases and controls. Consecutive patients operated between 2015 and 2016 were included. Baseline characteristics, medical history and previous medication, analytical parameters, Charlson index, ASA scale, Barthel index and Pfeiffer questionnaire were studied. Surgical data and complications were recorded during follow-up. Survival was assessed by the Kaplan-Meier method and the variables that affected it by Cox regression. Results: Mortality one year postoperatively was 21.1% and mean survival 10.3months (95%CI: 9.7-10.9). The Cox regression showed that age >87years, Barthel score ≤85 and the combination of anticoagulants with INR ≥1.5 were significant predictors of mortality during the first year of follow-up. Conclusion: The predictors of mortality during the first postoperative year after femoral neck fracture in octogenarian or older patients were: age>87years, physical dependence measured by a Barthel index score ≤85, and the use of anticoagulants with a INR ≥1.5 at admission

Factors predicting one-year mortality of patients over 80 years operated after femoral neck fracture. / Factores predictivos de la mortalidad al año en pacientes mayores de 80 años intervenidos de fractura del cuello femoral.

INTRODUCTION: In the Spanish population, previous studies related to mortality after hip fracture are based on patients aged 60 to 102years and did not stratify patients according to the type of fracture. The objective of this study was to identify the factors with influence on mortality at one postoperative year in patients aged 80years or older after a femoral neck fracture. MATERIAL AND METHOD: Retrospective study of cases and controls. Consecutive patients operated between 2015 and 2016 were included. Baseline characteristics, medical history and previous medication, analytical parameters, Charlson index, ASA scale, Barthel index and Pfeiffer questionnaire were studied. Surgical data and complications were recorded during follow-up. Survival was assessed by the Kaplan-Meier method and the variables that affected it by Cox regression. RESULTS: Mortality one year postoperatively was 21.1% and mean survival 10.3months (95%CI: 9.7-10.9). The Cox regression showed that age >87years, Barthel score ≤85 and the combination of anticoagulants with INR ≥1.5 were significant predictors of mortality during the first year of follow-up. CONCLUSION: The predictors of mortality during the first postoperative year after femoral neck fracture in octogenarian or older patients were: age>87years, physical dependence measured by a Barthel index score ≤85, and the use of anticoagulants with a INR ≥1.5 at admission.

Artrodesis de la articulación metacarpofalángica del pulgar con tornillos intramedulares entrelazados de ángulo fijo XMCP(TM) / Metacarpophalangeal joint of the thumb arthrodesis using intramedullary interlocking screws XMCP(TM)

El objetivo de estudio fue valorar el resultado de la artrodesis de la articulación metacarpofalángica del pulgar mediante el sistema de tornillos intramedulares de ángulo fijo a 25°, XMCP(TM) (Extremity Medical, Parsippany, NJ). En las radiografías se evaluó el ángulo de artrodesis, el tiempo de fusión ósea y fijación del implante. Los resultados clínicos y funcionales se evaluaron mediante el cuestionario DASH y la escala EVA. Se observó cualquier complicación encontrada durante la cirugía o el período de seguimiento. Se estudiaron 9 pacientes. El seguimiento medio fue de 27,6 meses. Los pacientes presentaron evidencia clínica y radiológica de fusión en un promedio de 8 semanas, y el ángulo de fusión promedio fue de 25°. No se presentaron complicaciones y no se ha tenido que retirar ningún implante. En conclusión, el sistema XMCP(TM) proporciona un método fiable para la artrodesis metacarpofalángica del pulgar para una variedad de indicaciones, y puede usarse junto con otros procedimientos en la mano compleja

The study objective was to assess the results of a thumb metacarpophalangeal joint (MCPJ) arthrodesis using intramedullary interlocking screws at 25°, XMCP (TM) (Extremity Medical, Parsippany, NJ). Radiographs evaluated the angle of arthrodesis, time of fusion and fixation of the implant. Clinical and functional outcomes were assessed using the DASH questionnaire and the VAS scale. Any complications found during surgery or the follow-up period were noted. We studied 9 patients. The mean follow-up was 27.6 months. Patients showed clinical and radiological evidence of fusion in an average of 8 weeks, the angle of fusion was 25°. There were no complications and no implant had to be removed. The XMCP(TM) system provides a reliable method for MCPJ arthrodesis for several indications and can be used with other procedures in the complex hand

Artrodesis de la articulación Interfalángica proximal del 4° y 5° dedo utilizando un dispositivo de tornillos entrelazados a compresión en el tratamiento de la recidiva grave de la enfermedad de Dupuytren / Arthrodesis of the proximal interphalangeal joint of the 4th and 5th finger using an interlocking screw device to treat severe recurrence of Dupuytren's disease

Objetivo: Valorar el resultado radiológico y funcional de la artrodesis de la articulación IFP del 4.° o 5.° dedo de la mano mediante el sistema intramedular de tornillos entrelazados a compresión APEX(TM) (Extremity Medical, Parsippany, NJ) en pacientes afectos de recidiva grave de la enfermedad de Dupuytren. Material y método: Los resultados clínicos se valoraron mediante el cuestionario DASH y la escala EVA. En las radiografías se evaluó el ángulo de artrodesis, el tiempo de fusión ósea y la fijación del implante. Se observó cualquier complicación encontrada durante la cirugía o en el periodo de seguimiento. Resultados: La muestra estuvo representada por 6 pacientes. El seguimiento medio fue de 19,6 meses. Todos presentaron evidencia clínica y radiológica de fusión en 8 semanas, con un ángulo de fusión de 30° (3) y 45° (3). No se presentaron complicaciones y no se tuvo que retirar ningún implante. Los resultados funcionales en este tipo de pacientes fueron pobres. Conclusión: El sistema proporciona un método fiable para la artrodesis de la IFP en un ángulo preciso. Promueve una fijación estable que no requiere inmovilización prolongada. Puede usarse junto con otros procedimientos en la mano afecta por recidiva grave de ED. Los resultados funcionales con el uso de este dispositivo en este grupo de pacientes fueron pobres

Objective: To assess the radiological and functional outcome of arthrodesis of the 4th and 5th finger using the APEX(TM) (Extremity Medical, Parsippany,NJ)intermedullary interlocking screw system in patients with severe recurrence of Dupuytren's disease. Material and method: The DASH questionnaire and the VAS scale were used to assess the clinical outcomes. The angle of arthrodesis, fusion time and implant fixation were evaluated on x-rays. The patients were monitored for complications during surgery and the follow-up period. Results: The sample comprised 6 patients. Mean follow up was 19.6 months. All of the patients presented clinical and radiological evidence of fusion at 8 weeks, with fusion angles of 30° (3) and 45° (3). There were no complications and none of the implants had to be removed. The functional outcomes in these patients were poor. Conclusion: The system offers a reliable method for IPJ arthrodesis at a precise angle. It promotes stable fixation that does not require prolonged immobilisation. It can be used together with other procedures on the hand with severe recurrence of DD. The functional outcomes for this group of patients using this device were poor

Arthrodesis of the proximal interphalangeal joint of the 4th and 5th finger using an interlocking screw device to treat severe recurrence of Dupuytren's disease. / Artrodesis de la articulación Interfalángica proximal del 4.° y 5.° dedo utilizando un dispositivo de tornillos entrelazados a compresión en el tratamiento de la recidiva grave de la enfermedad de Dupuytren.

OBJECTIVE: To assess the radiological and functional outcome of arthrodesis of the 4th and 5th finger using the APEX™ (Extremity Medical, Parsippany,NJ)intermedullary interlocking screw system in patients with severe recurrence of Dupuytren's disease. MATERIAL AND METHOD: The DASH questionnaire and the VAS scale were used to assess the clinical outcomes. The angle of arthrodesis, fusion time and implant fixation were evaluated on x-rays. The patients were monitored for complications during surgery and the follow-up period. RESULTS: The sample comprised 6 patients. Mean follow up was 19.6 months. All of the patients presented clinical and radiological evidence of fusion at 8 weeks, with fusion angles of 30° (3) and 45° (3). There were no complications and none of the implants had to be removed. The functional outcomes in these patients were poor. CONCLUSION: The system offers a reliable method for IPJ arthrodesis at a precise angle. It promotes stable fixation that does not require prolonged immobilisation. It can be used together with other procedures on the hand with severe recurrence of DD. The functional outcomes for this group of patients using this device were poor.

Metacarpophalangeal joint of the thumb arthrodesis using intramedullary interlocking screws XMCP™. / Artrodesis de la articulación metacarpofalángica del pulgar con tornillos intramedulares entrelazados de ángulo fijo XMCP™.

The study objective was to assess the results of a thumb metacarpophalangeal joint (MCPJ) arthrodesis using intramedullary interlocking screws at 25°, XMCP ™ (Extremity Medical, Parsippany, NJ). Radiographs evaluated the angle of arthrodesis, time of fusion and fixation of the implant. Clinical and functional outcomes were assessed using the DASH questionnaire and the VAS scale. Any complications found during surgery or the follow-up period were noted. We studied 9 patients. The mean follow-up was 27.6 months. Patients showed clinical and radiological evidence of fusion in an average of 8 weeks, the angle of fusion was 25°. There were no complications and no implant had to be removed. The XMCP™ system provides a reliable method for MCPJ arthrodesis for several indications and can be used with other procedures in the complex hand.

[Comparative study of the management of abscesses of the abdominal wall after cesarean section]. / Estudio comparativo del manejo de abscesos de pared abdominal post-cesárea.

Abdominal wall wound dehiscences, more frequently those involving skin and subcutaneous tissue, are a common surgical complication in Obstetrics and Gynecology. A prospective, longitudinal study was done in 65 patients presenting with wound abscess. The evolution of the wound was compared using the following methods a) Bandage, b) Bandage with 30% iron subcarbonate pomade, c) Silk, d) Silk with 30% iron subcarbonate pomade. Eighty five percent of the patients, with silk used, were completely recovered in less than 10 days; comparing this option with the others used in this study, there were significant statistical differences.