Actualización de la osteotomía tibial en el genu varo / Update on tibial osteotomy in genu varum

La osteoartrosis en el compartimento medial de la rodilla es una causa frecuente de dolor cróni-co e impotencia funcional en nuestro medio. Los tratamientos clínicamente efectivos incluyen el tratamiento conservador, la artroplastia unicom-partimental y la osteotomía. Si bien la prótesis unicompartimental puede ser una buena elección en determinados casos, para pacientes jóvenes con una mala alineación de los miembros inferiores se prefieren las osteotomías alrededor de la rodilla con el propósito de redistribuir el eje de carga. Las osteotomías son variadas dependiendo del grado de deformidad y su localización. La más utilizada en la actualidad es la osteotomía tibial valguizan-te, debido a que la mayoría de genu varo artrósico está causada por una deformidad en tibia. Dentro de las osteotomías valguizantes de tibia podemos encontrar: la osteotomía de adición medial, la de sustracción lateral y la osteotomía tridimensional. (AU)

Medial comparment osteoarthritis of the knee is a frequent cause of chronic pain and disability in our environment. Clinically effective treatments include conservative treatment, unicompartmental arthroplasty and osteotomy. Although the unicom-partmental arthroplasty may be a good choice in certain cases, for young patients with lower limb malalingment, osteotomies around the knee are preferred, for the purpose of redistributing the me-chanical axis. Osteotomies are varied depending on the degree of deformity and its location. Valgus tibial osteotomy is the most commonly used, due to the mayority of genu varus arthritis is caused by a tibial deformity. Within the valgus tibial osteoto-mies, we can find: medial opening wedge, lateral closing wedge and tridimensional osteotomy. (AU)

Técnica sandwich para tumores de células gigantes alrededor de la rodilla / Sandwich technique for giant cell tumors around the knee

Objetivo Describir algunos detalles quirúrgicos de la técnica sandwich empleada en la resección de tumores de células gigantes en la rodilla, una localización que pone en riesgo la articulación. Material y métodos Se presenta el caso de un paciente con tumor de células gigantes en tibia proximal. Debido a las características de la lesión, se decide legrado completo del tumor y relleno con autoinjerto y cemento. Resultados A los 8 meses del postoperatorio, las radiografías de control confirmaron la integración del injerto y la ausencia de recidiva tumoral. Conclusión La técnica sandwich es un procedimiento de reconstrucción en tumores de células gigantes que conserva las ventajas del cemento y evita la posible necrosis térmica del cartílago en pacientes jóvenes. (AU)

Objetive To describe some surgical details of the sand-wich technique, used in the resection of giant cell tumors in the knee, a location that puts the joint at risk. Material and methods A case with a giant cell tumor in the proximal tibia is presented. Due to the the characteristics of the lesion, a complete curettage of the tumor and filling with bone autograft and cement was performed. Results At 8 months postoperatively, the control x-rays confirmed the integration of the graft ant the ab-sence of tumor recurrence. Conclusion The sandwich technique is a reconstruction procedure for giant cell tumors that preserve the advantages of cement and avoids possible thermal necrosis of cartilage in young patients. (AU)

Actualización de la osteotomía tibial en el genu varo / Update on tibial osteotomy in genu varum

La osteoartrosis en el compartimento medial de la rodilla es una causa frecuente de dolor cróni-co e impotencia funcional en nuestro medio. Los tratamientos clínicamente efectivos incluyen el tratamiento conservador, la artroplastia unicom-partimental y la osteotomía. Si bien la prótesis unicompartimental puede ser una buena elección en determinados casos, para pacientes jóvenes con una mala alineación de los miembros inferiores se prefieren las osteotomías alrededor de la rodilla con el propósito de redistribuir el eje de carga. Las osteotomías son variadas dependiendo del grado de deformidad y su localización. La más utilizada en la actualidad es la osteotomía tibial valguizan-te, debido a que la mayoría de genu varo artrósico está causada por una deformidad en tibia. Dentro de las osteotomías valguizantes de tibia podemos encontrar: la osteotomía de adición medial, la de sustracción lateral y la osteotomía tridimensional. (AU)

Medial comparment osteoarthritis of the knee is a frequent cause of chronic pain and disability in our environment. Clinically effective treatments include conservative treatment, unicompartmental arthroplasty and osteotomy. Although the unicom-partmental arthroplasty may be a good choice in certain cases, for young patients with lower limb malalingment, osteotomies around the knee are preferred, for the purpose of redistributing the me-chanical axis. Osteotomies are varied depending on the degree of deformity and its location. Valgus tibial osteotomy is the most commonly used, due to the mayority of genu varus arthritis is caused by a tibial deformity. Within the valgus tibial osteoto-mies, we can find: medial opening wedge, lateral closing wedge and tridimensional osteotomy. (AU)

Técnica sandwich para tumores de células gigantes alrededor de la rodilla / Sandwich technique for giant cell tumors around the knee

Objetivo Describir algunos detalles quirúrgicos de la técnica sandwich empleada en la resección de tumores de células gigantes en la rodilla, una localización que pone en riesgo la articulación. Material y métodos Se presenta el caso de un paciente con tumor de células gigantes en tibia proximal. Debido a las características de la lesión, se decide legrado completo del tumor y relleno con autoinjerto y cemento. Resultados A los 8 meses del postoperatorio, las radiografías de control confirmaron la integración del injerto y la ausencia de recidiva tumoral. Conclusión La técnica sandwich es un procedimiento de reconstrucción en tumores de células gigantes que conserva las ventajas del cemento y evita la posible necrosis térmica del cartílago en pacientes jóvenes. (AU)

Objetive To describe some surgical details of the sand-wich technique, used in the resection of giant cell tumors in the knee, a location that puts the joint at risk. Material and methods A case with a giant cell tumor in the proximal tibia is presented. Due to the the characteristics of the lesion, a complete curettage of the tumor and filling with bone autograft and cement was performed. Results At 8 months postoperatively, the control x-rays confirmed the integration of the graft ant the ab-sence of tumor recurrence. Conclusion The sandwich technique is a reconstruction procedure for giant cell tumors that preserve the advantages of cement and avoids possible thermal necrosis of cartilage in young patients. (AU)

Glenohumeral Arthropathy After Arthroscopic Surgery for Shoulder Instability: Outcomes at 16-Year Follow-up.

Background: Glenohumeral arthropathy after surgery for traumatic shoulder instability is a condition whose etiology and long-term course are still unknown. Purpose: To evaluate the risk factors for the onset of arthropathy and to assess the relationship between the degree of arthropathy and final outcomes. Study Design: Case series; Level of evidence, 4. Methods: We included patients who underwent surgery for a shoulder instability at a single institution between 2000 and 2004. The following variables were studied for relationship with functional outcomes: sex, age, body mass index, smoking at the time of surgery, number of episodes of shoulder dislocation, and time from first dislocation to surgery. The number of anchors used and their position were also evaluated. Functional outcomes were assessed using the Constant-Murley, Western Ontario Shoulder Instability Index, and Rowe scores, and results were compared with the onset of arthropathy according to Buscayret classification. Spearman and Pearson correlations were performed for the association between glenohumeral arthritis (Buscayret grade) and the study variables, the Mann-Whitney U test and Student t test were used to compare outcome scores with the study variables, and the Kruskal-Wallis test was used to compare Buscayret grade and outcome scores. Results: A total of 26 shoulders in 25 patients were analyzed, finding a high rate (54%) of arthropathy at a minimum follow-up of 16 years. Patients with Buscayret grade 4 had the worst functional results (P = .007). However, 80% of patients with Buscayret grade ≤3 had excellent Constant-Murley scores. A significant relationship was found between degree of arthropathy and patients who were smokers before surgery (P < .01). No relationship was found between the onset of arthropathy and the other variables analyzed. Conclusion: Postinstability glenohumeral arthropathy was not correlated with functional outcomes except in those patients with advanced arthroplasty (Buscayret grade 4). A direct relationship was found between smoking before surgery and the onset of glenohumeral arthropathy.

Reverse shoulder arthroplasty in complex fractures of the proximal humerus: results after 7 years of follow-up.

BACKGROUND: There is still little information about the long-term results of clinical and radiological evolution in patients older than 65 years with complex proximal humerus fractures (CPHF) treated acutely with reverse shoulder arthroplasty (RSA). The aim of this paper was to evaluate function and results 7 years after surgery. MATERIAL AND METHODS: A prospective cross-sectional cohort study was designed for this purpose. Patients who underwent RSA surgery during 2012 because of a CPHF were included. The surgical approach was randomized (deltopectoral vs anterosuperior). Functional activity, evolution of tuberosities and evidence of scapular notching 7 years after surgery were analyzed. RESULTS: After evaluating 32 patients, the Constant score improved from 64.83 in the first year to 69.54 at 7 years postoperative. Results were independent of the approach used. Functional outcomes were poorer in patients with scapular notching and when tuberosities were resorbed or displaced. CONCLUSIONS: At 7 years, function in patients undergoing RSA after CPHF demonstrated improvement in all patients except those who developed scapular notching or when tuberosities did not consolidate in an anatomical position. These results are completely independent of the approach used. LEVEL OF EVIDENCE: III Controlled cohort study.

¿Cómo ha afectado el confinamiento por la pandemia de SARS-COV-2 a los pacientes con fractura de cadera? / How has confinement from the SARS-COV-2 pandemic affected hip fracture patients?

Objetivo: Este estudio trata de comparar como el confinamiento durante la pandemia del Covid-19 ha afectado al tratamiento, epidemiologia y manejo de los pacientes con fractura de cadera comparándolos con un grupo equivalente de pacientes en el mismo periodo del año anterior. Material y Métodos: Analizamos prospectivamente dos periodos de tiempo desde el 14 de marzo hasta el 2 de mayo de los años 2019 y 2020. Resultados: Encontramos una reducción significativa en la estancia hospitalaria y el tiempo hasta la intervención quirúrgica, además de un incremento en las interconsultas al servicio de medicina interna y en el tiempo hasta acudir al servicio de urgencias (p<0.05). Esto nos permitió crear dos nuevos grupos de estudio: los pacientes que acudieron al servicio de urgencias en menos de 24 horas desde el traumatismo y, por otro lado, los pacientes que acudieron pasadas 24 horas, no encontrando diferencias estadísticamente significativas entre ambos grupos en las variables evaluadas. Concusión: Quizás la adaptación de nuestro hospital para el rápido manejo de estos pacientes y el miedo a la enfermedad hayan dado lugar a los resultados obtenidos.(AU)

Purpose: This study aims to compare how confinement during the Covid-19 pandemic has affected the treatment, epidemiology and management of patients with hip fracture with a group compared with an equivalent group in the same period of the previous year. Methods: We prospectively analyze two periods from 3/14 to 5/2 of the years 2019 and 2020. Results: We found significant reductions in hospital length of stay and time to surgery, as well as an increase in internal medicine consultations and time to emergency care (p<0.05). This led us to create two new groups: on one hand, those patients who came to the emergency care within 24 hours, and, on the other hand, those who came after 24 hours, finding no statistically significant differences in the parameters evaluated. Conclusion: Perhaps the adaptation of the hospital for the rapid management of these patients and the fear of the disease have led to the results obtained.(AU)

Is obesity related with periprosthetic fractures around the knee?

PURPOSE: Periprosthetic fracture (PPF) is a devastating complication following primary total knee arthroplasty. Obesity is currently considered a risk factor for many complications in orthopaedics, but there is no evidence in literature about the relationship between obesity and PPF around the knee. The objective of this study was to determine whether obesity is associated with a higher incidence of PPF. METHODS: All patients diagnosed of a PPF around the knee from January 2010 to December 2013 were enrolled. Forty-nine PPF (47 women and 2 men) were included, and a total of 97 patients (80 women and 17 men) were randomly obtained as a control group. Body mass index (BMI) was obtained in both groups and classified as <25 (normal), overweight (25-29.9), obese (30-34.9), very obese (35-39.9), or morbid obesity (≥40). Both groups, were also divided into subpopulations depending on the age as follows: <70, 70-75, 75-80 and ≥80. Statistical analysis was performed to determine any difference in BMI ≥30 kg/m² distribution between groups. RESULTS: In the PPF group 61.22 % of the patients had a BMI over 30 kg/m² and likewise 62.88 % of the patients in the control group. No association was found between obesity and a higher risk of PPF (p < 0.05). CONCLUSION: As a conclusion, obesity (BMI ≥30 kg/m²) does not have any clinical relationship with the appearance of a periprosthetic fracture around the knee (p < 0.05).