Resultados del seguimiento a seis meses del manejo del pie equino varo aducto congenito con el metodo Ponseti

Clasificacion de Dimeglio

Atención tanatológica para mejorar el bienestar espiritual de los pacientes hospitalizados con quemaduras / Thanatology care to improve spiritual well-being of hospitalized patients with burns

Resumen:

Objetivo: evaluar el efecto de la atención tanatológica en pacientes con quemaduras, a través de la escala de bienestar espiritual FACIT-Spl2.

Metodología: el estudio se realizó en pacientes con quemaduras de diversos grados. Se recolectaron datos sociodemográficos y a los pacientes se les aplicó la encuesta FACIT-Spl2 para evaluar su bienestar espiritual al inicio y al final de su estancia hospitalaria. Se les proporcionó atención de tanatología durante todo el periodo de hospitalización. El análisis incluyó estadística descriptiva y no paramétrica.

Resultados: se seleccionaron 107 pacientes que obtuvieron un promedio de 35.7 puntos en la encuesta FACIT-Spl2 aplicada al inicio. La puntuación aumentó a 40.7 al final del tratamiento hospitalario, lo que nos indica una mejoría en el bienestar espiritual de los pacientes, puesto que la diferencia fue estadísticamente significativa (Z = -6.53, p = 0.000).

Conclusiones: la atención tanatológica debe incluirse en el tratamiento integral proporcionado a pacientes con quemaduras, ya que demostró que mejoraba su bienestar espiritual, influyendo positivamente en su recuperación durante su estancia hospitalaria.

Abstract:

Objective: to evaluate the effect of Thanatology counseling in burn patients through the FaCIT-Spl2 spiritual well-being scale.

Methodolog: the study population comprised of hospitalized patients with several burn injuries. Socio-demographic information was collected, and participants completed the FACIT-Spl2 scale for spiritual well-being assessment the first and last day of hospital stay. Thanatology counseling was provided to them through the complete hospitalization time. Descriptive statistics was calculated for socio-demographic variables and non-parametric tests to calculate differences between obtained scores.

Results: the sample included 107 burn patients and scored 35.7 in the FACIT-Spl2 scale applied at baseline. This score increased to 40.7 at the end of treatment, which indicates an improvement in the spiritual well-being of patients and this difference was statistically significant (Z = -6.53, p = 0.000).

Conclusions: thanatology counseling should be included as part of the integral treatment given to burn patients because it has showed to improve their spiritual well-being, therefore it has a positive effect in their recovery during their hospital stay.

Distal femoral dome varus osteotomy: surgical technique with minimal dissection and external fixation.

UNLABELLED: The results obtained when employing distal femoral varus osteotomy are variable. Our objective was to describe a surgical technique involving minimal dissection, semicircular osteotomy with external fixation for valgus angular deformities, and early weight bearing. DESIGN: Series of cases. SETTING: Orthopedic Referral Trauma Center. PATIENTS: Sixteen patients with valgus angular deformities of >12°. INTERVENTION: Wedge varus osteotomy, minimal dissection with external fixation using a standard system, multidirectional Newfix. Main outcome measurements included pain, surgical time, knee flexion and extension angles, and assessment of knee function based on the Hospital Special Surgery knee rating scale (HSSkrs). RESULTS: Of 16 patients, 14 were evaluated to the end of the study. When we compared preoperative values with those obtained postoperatively at a mean of 24±2.1months, pain measurement was reduced from 7 to 2.1 (p=0.002), angle of flexion was reduced from 105.4±14.6° to 105.3±11.1° (p=0.06), and angle of extension, from -1.67 to -1.25° (p=0.6), while HSSkrs assessment increased from 67.5±2.7 to 79.4±5 (p=0.003). Two patients were excluded from the study, one due to infection that developed along the trajectory of a screw, and the other patient underwent complete arthroplasty of the knee, which was performed to combat the pain that was not being alleviated. CONCLUSIONS: The technique improves function and reduces pain while facilitating early rehabilitation in 83% of cases.

Monoarthritis of the knee with unusual lesions in adults associated with varicella-zoster virus infection.

Varicella-zoster virus-associated arthritis has not been well documented in adults. We present the case of a 27-year-old female patient with monoarthritis of the knee associated with clinical symptoms typical of varicella. Arthroscopic examination showed unusual oval and circular lesions in cartilage, some of which measured 5 +/- 3 mm in diameter in weight-supporting zones. Such lesions have not been described previously and were type III-A lesions on the Noyes scale or grade IV on the Outerbridge scale. On microscopic observation, synovial fluid cultures and hemocultures were negative for the presence of bacteria. A biopsy sample and synovial liquid from the affected knee produced a positive polymerase chain reaction for varicella-zoster virus, genotype E. These findings suggest a strong relation between clinical varicella infection and important lesion invasion in the knee articulation of such a young adult, probably related to the virus. However, it remains necessary to corroborate this relation between cartilage destruction and clinical symptoms of varicella associated with monoarthritis of an adult knee. Nevertheless, it is advisable to initiate the appropriate antiviral treatment in adults with varicella-related gonalgia because the lesions produce the most severe effects on exposure to the knee bone.

[A comparision of the prevalence of radial nerve lesion after fixation of humeral shaft fractures with dynamic compression plate versus intramedullary nailing]. / Lesión del nervio radial posterior a la fijación diafisaria del húmero con placa de compresión dinámica y enclavado endomedular.

MATERIAL AND METHODS: We conducted this study in the thoracic extremity surgery module, from the Trauma and Orthopedic Surgery Hospital "Lomas Verdes" of the Instituto Mexicano del Seguro Social (IMSS) from September 2001 to 2004. Eighty-seven patients were included with ages between 16 to 81 years, with the diagnosis of humeral shaft fracture without previous neurologic lesion and were treated with intramedullary nail or dynamic compression plate (DCP) with a 2 year follow up. RESULTS: Eighty seven patients were evaluated; mean age 42.2 +/- 3.2 years; male gender (61%) vs. female gender (39%) (p<0.05); more frequently affected extremity: left (59.7) vs. right (40.3%); acute period fracture: 59.7%; non union 25.3% and delay of consolidation: 15%. Implant used: DCP plate (80%) vs. intramedullary nailing (20%) (p<0.05%). Radial nerve lesion at the beginning and end of the study: 15 (22%) of 70 patients vs. 1 (5.5%) of 17 patients operated with DCP plate vs. intramedullary nail respectively. Of the 16 radial nerve lesions on total (100%), 12 presented with neuroapraxia (10.4%) that included a patient treated with intramedullary nailing and 4 (3.4%) axonotmesis treated with open reduction and internal fixation with DCP. CONCLUSION: The preference of treatment on our hospital is the use of DCP in humeral shaft fractures. The surgical technique with DCP represents a higher incidence of radial nerve lesion probably due to the exposure and proximity to the radial nerve during surgery. It will be necessary to verify these results in a clinical controlled trial.

[Transpatellar "W" cerclage with anterior tension band for fixation of transverse fractures of the patella]. / Lazada "W" transpatelar con banda anterior para fijación de fracturas transversales desplazadas de patela.

OBJECTIVE: To evaluate functional outcomes in postoperative period in patients with displaced transverse fracture of the patella treated with anterior tension band and double knot fixation. MATERIAL AND METHODS: Multicentric case series: Traumatology and Orthopedic Surgery Hospitals "Lomas Verdes" and "Magdalena de las Salinas" of the Instituto Mexicano del Seguro Social (IMSS). PATIENTS: eighteen patients with displaced transverse fracture of the patella, treated with open reduction and fixation with 1.2 mm ASIF wire in a parallel transpatellar and anterior tension band with a double knot disposition. VARIABLES OF INTEREST: Flexion, knee function, visual analogous scale (VAS) for pain, surgical procedure time, and consolidation. RESULTS: Male 13 (68.4%); female 5 (26.3%); surgical procedure time 63.2 +/- 11.2 minutes; age 38.2 +/- 12.8; body mass index (BMI) 15.6 +/- 3.8; height 163 cm +/- 12.2; flexion at 4 weeks follow-up 6.3 +/- 0.9, at 8 weeks follow-up 91.5 +/- 13.2 and at 24 months follow-up 101.1 +/- 12.2; VAS for pain at 4 weeks follow-up 6.3 +/- 0.9, vs. pain at 8 weeks follow-up 3.5 +/- 1.2 (p < 0001); IKDC at 8 weeks follow-up 71.3 +/- 6, at 12 months follow-up 76.7 +/- 5.2, vs. IKDC at 24 months follow-up 84.9 +/- 7.7 (p<0.05). Fracture consolidation was accomplished at 12 weeks in 94%, and 1 patient presented infection (6%). CONCLUSIONS: We accomplished satisfactory functional outcomes in patients with transverse patellar fractures using this technique.

Workplace accident-related finger-fracture at the Mexican Institute of Social Security. Resolution time, economic impact and sequelae.

OBJECTIVE: To identify resolution time and economic impact of occupational finger fracture with permanent disability. METHODS: A cross-sectional study was conducted in 2004; the main variables were age; sex; disability days and sequelae. The International Classification of Diseases (ICD 10) was used for the study. The analysis included frequency, exceeded disability days and estimation of cost of disabilities, pensions and direct costs. Chi square test was used to identify the differences. RESULTS: 13,410 Fractures occurred nationwide: multiple finger fractures (803); thumb fractures (1982) and other finger fractures (10,625). Days of resolution time were: 70.5 days for multiple finger fractures and 51.1 days for another finger fractures. Permanent disability partial rate of thumb fracture was 5.3/100, 15.8/100 multiple finger fractures and 5.9 fractures of other finger. The estimated cost by temporary disability in the Instituto Mexicano del Seguro Social was on $10,669,000 U.S., while permanent disability costs in cases of settlements and annual pension payments were $758,536 U.S. CONCLUSIONS: Finger-fracture is a prevalent pathology whichever needs that medical procedures are review, also identify factors that decrease resolution time and establish improve actions that create boundaries on the workers damage health. It must be considered that this condition affects enterprise' productivity and decrease the quality of life from workers.

Resultado con hidrodisección del paratendón del tendón rotuliano, en reconstrucción del ligamento cruzado anterior de rodilla / Result of hydrodissection of the paratendon of the patellar tendon during bone-tendon-bone graft reconstruction of the anterior cruciate ligament

Objetivo: evaluar el efecto clínico-funcional de la hidrodisección del paratendón en el periodo posoperatorio de pacientes sometidos a reconstrucción de ligamento cruzado anterior, para lo cual se midió funcionalidad de la rodilla, dolor, extensión y flexión. Material y métodos: estudio clínico no controlado realizado en el Hospital de Ortopedia “Victorio de la Fuente Narváez”, Unidad de Medicina de Alta Especialidad “Magdalena de las Salinas”, Instituto Mexicano del Seguro Social, en el que se incluyeron pacientes en quienes se efectuó injerto hueso-tendón-hueso, 22 con hidrodisección del paratendón y 23 sin hidrodisección. Resultados: el grupo con hidrodisección estuvo integrado por 20 hombre y dos mujeres, y el grupo sin hidrodisección, por 22 hombres y una mujer (p = 0.581); edad de 29 ± 4.6 años vs. 26 ± 6.2 años (0.946); peso de 68 ± 8.8 kg vs. 72 ± 6.2 kg; (p = 0.190); altura de 160 ± 4.8 cm vs. 162 ± 7.5 cm; (p = 0.909); lado afectado, derecho 5 vs. 5, izquierdo 17 vs. 18 (p = 0.937); puntuación en la Escala de Valoración de la Sociedad de Rodilla, 84 ± 4 vs. 70 ± 8; evaluación del dolor mediante EVA a los 10 días, 3.7 ± 1.6 vs. 6.2 ± 1.4; y a las cuatro semanas, 1.3 ± 1.6 vs. 4.1 ± 2.1 (p < 0.001); flexión 95 ± 6.7 grados vs. 86 ± 6.1 grados (p < 0.001). Conclusiones: en el periodo posoperatorio mediato (10 días y cuatro semanas), con la hidrodisección disminuyó el dolor y aumentaron los rangos de movilidad; la rehabilitación de inicio se lleva cabo con menor dificultad.

BACKGROUND: We undertook this study to evaluate the clinical and functional effect of hydrodissetion of the paratendon in the postoperative period of patients submitted to surgery of reconstruction of anterior cruciate ligament. METHODS: A non-controlled clinical study was conducted at the Unidad de Alta Especialidad de Ortopedia y Traumatología [quot ]Magdalena de las Salinas,[quot ] Instituto Mexicano del Seguro Social, Mexico City. Twenty two patients and 23 controls were included. Surgical intervention consisted of a bone-tendon-bone technique with hydrodissection and without hydrodissection of the paratendon. RESULTS: The following results were obtained: functionality of the knee, pain, extension and flexion. Male: 20 vs. 22; female: 2 vs. 1 (p = 0.581), age: 29 +/- 4.6 years vs. 26 +/- 6.2 (0.946); weight: 68 +/- 8.8 vs. 72 +/- 6.2 (p = 0.190); height: 1.60 m +/- 4.8 vs. 1.62 m +/- 7.5 (p =0.909). Side: right: 5 vs. 5; left: 17 vs. 18 (p = 0.937). Evaluation scale of Knee Index: 84 +/- 4 vs. 70 +/- 8; pain: 10 days: 3.7 +/- 1.6 vs. 6.2 +/- 1.4, 4 weeks: 1.3 +/- 1.6 vs. 4.1 +/- 2.1 (p <0.001) flexion: 95 +/- 6.7 degrees vs. 86 +/- 6.1 degrees (p <0.001) group of hydrodissection vs. no hydrodissection, respectively. CONCLUSIONS: In the immediate postoperative period (4 weeks), pain is diminished and range of mobility increases as a result of the decrease of pain.