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1.
Acta ortop. mex ; 28(5): 315-318, sep.-oct. 2014. ilus
Article in Spanish | LILACS | ID: lil-740976

ABSTRACT

Introducción: Las fracturas múltiples en la columna cervical son una entidad relativamente infrecuente, acerca de la cual la información disponible a nivel mundial es escasa. Existe una tendencia en los casos reportados a manejar dicha entidad de manera conservadora, con combinación de tracciones esqueléticas y diversas órtesis, con resultados variables. Existen pocos reportes de fracturas múltiples manejadas quirúrgicamente. Objetivo: Reportar un caso clínico de fractura múltiple cervical manejado quirúrgicamente en dos tiempos y su seguimiento, en el Centro de Atención a Lesionados Raquimedulares de la Ciudad de México, en el Hospital General "La Villa" de los SSDF. Material y métodos: Se presenta el caso clínico de un paciente masculino de 46 años de edad quien sufre accidente automovilístico con trauma raquimedular con fracturas de C2 a C6, ASIA C. Se decide su tratamiento quirúrgico a dos tiempos con instrumentación posterior y anterior sucesivamente. Se reporta el seguimiento clínico y radiológico a casi dos años de evolución. Resultados: A 19 meses de seguimiento el paciente se encuentra neurológicamente en ASIA D, con un leve déficit motor en el miembro torácico izquierdo. Reincorporado a su trabajo habitual y con movilidad aceptable en la columna cervical. Conclusiones: La evolución satisfactoria presentada por el paciente, tanto en su recuperación neurológica como en la reincorporación a sus labores cotidianas permite recomendar el manejo quirúrgico de fracturas múltiples, individualizando cada caso e interviniendo de acuerdo con la personalidad de cada fractura, con lo cual se puede esperar la obtención de resultados favorables.


Introduction: Multiple cervical spine fractures are a relatively infrequent entity and thus the available information on them is scarce worldwide. The cases reported are usually managed conservatively, with a combination of skeletal traction and various braces, with variable results. There are only a few reports of multiple fractures treated surgically. Objective: This is a report of a clinical case of a multiple cervical fracture treated surgically in 2 stages at the Mexico City Center for Patients with Spine and Spinal Cord Injury (Centro de Atención a Lesionados Raquimedulares de la Ciudad de México), located at "La Villa" General Hospital, SSDF. Material and methods: We report the clinical case of a male, 46 year-old patient involved in a motor vehicle accident who sustained spine and spinal cord injuries consisting of ASIA C C2-C6 fractures. It was decided to perform two-stage surgery with posterior and anterior instrumentation. We report the 19-month clinical and radiological follow-up. Results: In the 19-month follow-up visit, the patient was found to be ASIA D according to the neurological assessment, with mild motor deficit of the left thoracic limb. The patient had returned to his usual job and had acceptable cervical spine mobility. Conclusions: The patient's appropriate course from the neurological perspective and his return to his daily activities leads to recommending the surgical management of multiple fractures, customizing it in each case according to the fractures' characteristics. Favorable results may be expected from this approach.


Subject(s)
Humans , Male , Middle Aged , Multiple Trauma , Spinal Fractures , Multiple Trauma , Multiple Trauma/surgery , Spinal Fractures , Spinal Fractures/surgery
2.
Acta ortop. mex ; 28(3): 173-178, may.-jun. 2014. ilus
Article in Spanish | LILACS | ID: lil-725133

ABSTRACT

Antecedentes: El modelo por competencias plantea que lo más importante es poseer elementos para la solución de problemas, ya que una preparación en abstracto no cuenta con suficientes herramientas para solucionarlos. Para ello utiliza competencias centrales y auxiliares que están vinculadas a valores destacando las actitudes. Para explorar estas competencias se hizo el presente estudio. Material y métodos: Estudio transversal, observacional y descriptivo. Se aplicó una encuesta anónima con datos del perfil de médicos residentes de Ortopedia y Traumatología que contenía 14 preguntas que se aplicaron a residentes que cursan diferentes grados académicos. Resultados: En la encuesta participaron 24 residentes de los 35 registrados en el curso. En 100% de ellos aceptó responder la encuesta, 54% cursaban el segundo grado, 29% primer grado y 17% cuarto grado. El 75% manifestó desarrollo de competencias auxiliares, 13% no respondió, 8% desarrollaron competencias centrales y 4% lo ignora. Conclusiones: Se manifestaron tres factores principales que influyen negativamente para mejorar el saber hacer en Ortopedia. El más relevante es que los médicos residentes describen una mala actitud de los médicos adscritos, falta de disponibilidad para enseñar y la mala relación interpersonal entre ellos. Se debe crear conciencia en los especialistas en formación de Ortopedia, que poseer sólo conocimientos y habilidades no es suficiente para abordar integralmente los problemas de salud para cada paciente, ya que se debe motivar el desarrollo de mejores competencias, en especial las centrales.


Background: The competence model states that what is most important is to have the elements to solve problems since abstract training does not provide enough tools to solve them. Therefore, it uses key and auxiliary competences that are linked to values such as attitudes. This study was performed to explore these competences. Material and methods: This is a cross sectional, observational and descriptive trial. An anonymous survey with profile data of Orthopedics and Trauma residents was given, it contained 14 questions for residents of different academic levels. Results: 24 residents participated out of the 35 registered in the course. 100% agreed to answer the survey, 54% was in the second year, 29% in the first year and 17% in the fourth year. 75% expressed auxiliary competences, 13% did not respond, 8% developed key competences and 4% don't know. Conclusions: Three main factors that are a negative influence to improve the knowledge of orthopedics were expressed. The most relevant is that residents describe a bad attitude from attending physicians, lack of willingness to teach and poor interpersonal relationships. Awareness should be raised among orthopedics specialists so they understand that having the knowledge and skills is not enough to approach health issues in a comprehensive manner for each patient and the development of better competences should be fostered, especially key competences.


Subject(s)
Female , Humans , Male , Clinical Competence , Internship and Residency , Orthopedics/education , Cross-Sectional Studies , Hospitals , Mexico , Prospective Studies , Surveys and Questionnaires
3.
Acta Ortop Mex ; 28(5): 315-8, 2014.
Article in Spanish | MEDLINE | ID: mdl-26021097

ABSTRACT

INTRODUCTION: Multiple cervical spine fractures are a relatively infrequent entity and thus the available information on them is scarce worldwide. The cases reported are usually managed conservatively, with a combination of skeletal traction and various braces, with variable results. There are only a few reports of multiple fractures treated surgically. Objective: This is a report of a clinical case of a multiple cervical fracture treated surgically in 2 stages at the Mexico City Center for Patients with Spine and Spinal Cord Injury (Centro de Atenci6n a Lesionados Raquimedulares de la Ciudad de Mexico), located at "La Villa" General Hospital, SSDF. MATERIAL AND METHODS: We report the clinical case of a male, 46 year-old patient involved in a motor vehicle accident who sustained spine and spinal cord injuries consisting of ASIA C C2-C6 fractures. It was decided to perform two-stage surgery with posterior and anterior instrumentation. We report the 19-month clinical and radiological follow-up. RESULTS: In the 19-month follow-up visit, the patient was found to be ASIA D according to the neurological assessment, with mild motor deficit of the left thoracic limb. The patient had returned to his usual job and had acceptable cervical spine mobility. CONCLUSIONS: The patient's appropriate course from the neurological perspective and his return to his daily activities leads to recommending the surgical management of multiple fractures, customizing it in each case according to the fractures' characteristics. Favorable results may be expected from this approach.


Subject(s)
Multiple Trauma , Spinal Fractures , Humans , Male , Middle Aged , Multiple Trauma/diagnostic imaging , Multiple Trauma/surgery , Radiography , Spinal Fractures/diagnostic imaging , Spinal Fractures/surgery
4.
Acta Ortop Mex ; 28(3): 173-8, 2014.
Article in Spanish | MEDLINE | ID: mdl-26021113

ABSTRACT

BACKGROUND: The competence model states that what is most important is to have the elements to solve problems since abstract training does not provide enough tools to solve them. Therefore, it uses key and auxiliary competences that are linked to values such as attitudes. This study was performed to explore these competences. MATERIAL AND METHODS: This is a cross sectional, observational and descriptive trial. An anonymous survey with profile data of Orthopedics and Trauma residents was given, it contained 14 questions for residents of different academic levels. RESULTS: 24 residents participated out of the 35 registered in the course. 100% agreed to answer the survey, 54% was in the second year, 29% in the first year and 17% in the fourth year. 75% expressed auxiliary competences, 13% did not respond, 8% developed key competences and 4% don't know. CONCLUSIONS: Three main factors that are a negative influence to improve the knowledge of orthopedics were expressed. The most relevant is that residents describe a bad attitude from attending physicians, lack of willingness to teach and, poor interpersonal relationships. Awareness should be raised among orthopedics specialists so they understand that having the knowledge and skills is not enough to approach health issues in a comprehensive manner for each patient and the development of better competences should be fostered, especially key competences.


Subject(s)
Clinical Competence , Internship and Residency , Orthopedics/education , Cross-Sectional Studies , Female , Hospitals , Humans , Male , Mexico , Prospective Studies , Surveys and Questionnaires
5.
Acta Ortop Mex ; 27(1): 27-32, 2013.
Article in Spanish | MEDLINE | ID: mdl-24701747

ABSTRACT

BACKGROUND: Achilles tendon tear is a prevalent condition in our setting. There is no consensus in the literature regarding the ideal treatment modality or the right immobilization period before starting physiatrics. The harmful effect of prolonged immobilization is widely known, so the functional results of early versus late physical therapy are compared in patients subjected to surgery for Achilles tendon tear. MATERIAL AND METHODS: Ambispective, longitudinal, comparative study in patients over 16 years of age with Achilles tendon rupture treated surgically and referred to rehabilitation; they followed the management protocol established at the service. Retrospective record review was performed for discharged patients and patients admitted after the study initiation date were followed-up prospectively. The evaluation continued by means of a phone interview; results were recorded according to the Achilles Tendon Rupture Score. RESULTS: A total of 115 patients were included; they were classified into two groups according to the time elapsed between the surgery and the onset of physical therapy, as follows: 31 patients in group A, with onset between postoperative days 0 and 21; and 84 patients in group B, with onset after postoperative day 21. Two infectious complications were reported and no re-ruptures. Functional results were 6.52 for group A and 8.18 for group B. CONCLUSIONS: The duration of rehabilitation was similar in all patients, regardless of the protocol. The time elapsed between surgery and discharge was shortest in patients who underwent early physical therapy. The functional score is independent from the onset of physical therapy. Surgery followed by early mobilization is a safe practice that does not increase complications and shortens the total time the patients need to resume their daily activities.


Subject(s)
Achilles Tendon/surgery , Immobilization/methods , Tendon Injuries/rehabilitation , Tendons/surgery , Achilles Tendon/injuries , Adolescent , Adult , Aged , Casts, Surgical , Female , Follow-Up Studies , Humans , Male , Middle Aged , Physical Therapy Modalities , Prospective Studies , Recovery of Function , Recurrence , Retrospective Studies , Rupture/rehabilitation , Rupture/surgery , Splints , Surgical Wound Infection/etiology , Tendon Injuries/surgery , Time Factors , Trauma Severity Indices , Young Adult
6.
Acta Ortop Mex ; 26(6): 369-74, 2012.
Article in Spanish | MEDLINE | ID: mdl-24712204

ABSTRACT

OBJECTIVE: To assess the efficacy of two antimicrobial prophylaxis regimens, a short cycle and the standard one, on the prevalence of acute postoperative infection in orthopedic surgery for acute and chronic disease of a thoracic and a pelvic limb. MATERIAL AND METHODS: Prospective, observational, experimental randomized, double-blind trial in patients undergoing orthopedic surgery due to acute or chronic disease, between April and September 2009. The sample size was determined using the formula to calculate the finite population. Two groups were formed: one was given cefalotin for 24 hours plus ten additional days of dicloxacillin, the standard regimen and a second one that received cefalotin for 24 hours and placebo for ten days. The wound was assessed during hospitalization and it was checked on days 5, 8, 14 and 30. A statistical software was used for the statistical analysis, which included Student's t-test and chi2, and descriptive statistics for percentages, frequencies, means and standard deviations. The protocol was approved by the local health research committee. RESULTS: One hundred and thirty-one patients were included. Group I included 62 patients with cefalotin/dicloxacillin and Group II 69 patients with cafalotin/placebo for 10 days. In Group I one patient had infection and in Group II there were 3 cases, with p = 0.50 when chi2 was applied. CONCLUSIONS: Antimicrobial prophylaxis with 24 hour-cefalotin has the same effect on the prevalence of postoperative infection than a prolonged cycle of cefalotin plus dicloxacillin, according to the chi2 test. It is clear that there is no considerable benefit in giving antibiotics indiscriminately and for long periods of time compared with protection from infection in clean wounds.


Subject(s)
Antibiotic Prophylaxis/methods , Orthopedic Procedures , Surgical Wound Infection/epidemiology , Surgical Wound Infection/prevention & control , Double-Blind Method , Elective Surgical Procedures , Female , Humans , Longitudinal Studies , Male , Orthopedic Procedures/methods , Prevalence , Prospective Studies , Wounds and Injuries/surgery
7.
Acta Ortop Mex ; 25(6): 366-71, 2011.
Article in Spanish | MEDLINE | ID: mdl-22512100

ABSTRACT

BACKGROUND: Knowledge of the morphometric anatomy of cervical pedicles is essential for the safe and accurate placement of pedicle screws during instrumentation of the cervical spine. Screw placement in the lumbar and thoracic vertebrae is considered as a safe practice, unlike the cervical vertebrae due to the risks involved. There are few reports on this technique. The little available information comes from populations different from the Mexican population. Knowing the measurements of each cervical vertebra will provide proper screw orientation and selection at the time of screw placement. METHODS: Prospective, cross-sectional, descriptive study in subjects who presented at the outpatient and emergency services. Patient's in whom a CAT scan of the cervical spine was ordered as part of the work-up protocol, from April 1st 2010 to October 31st 2010, were included. A morphometric anatomic study was undertaken using the CAT software. In a saggital view: a) Saggital angle, b) Saggital diameter. In an axial view: a) Work distance, b) Cross-sectional angle and c) Cross-sectional diameter. RESULTS: The following measurements were obtained for each segment from C2 to C7: mean, standard deviation, range and minimal and maximal values. CONCLUSIONS AND CLINICAL RELEVANCE: Appropriate preoperative planning prior to cervical transpedicular instrumentation is essential to achieve greater accuracy during screw placement. The information obtained allows performing the procedure. As a result of this, a report based on out center's experience may be disseminated thus sharing our technique with the medical community.


Subject(s)
Cervical Vertebrae/anatomy & histology , Adolescent , Anthropometry , Cross-Sectional Studies , Humans , Mexico , Prospective Studies
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