'Absolute' inter-observer classifications agreement for proximal humeral fractures with a single shoulder anteroposterior X-ray.

PURPOSE: Several studies have been carried out, and there is no classification for proximal humeral fractures (PHF) exempted from variability in interpretation and with questioned reliability. In the present study, we investigated the 'absolute diagnostic reliability' of the most currently used classifications for PHFs on a single anterior-posterior X-ray shoulder image. METHODS: Six orthopaedic surgeons, with varying levels of experience in shoulder pathology, evaluated radiographs from 30 proximal humeral fractures, according to the 'absolute reliability' criteria. Each of the observers rated each fracture according to Neer, Müller/AO and Codman-Hertel's classification systems. RESULTS: The overall inter-observer agreement (κ) has been 0.297 (CI95% 0.280 to 0.314) for the Neer's classification system, 0.206 (CI95% 0.193 to 0.218) for the Müller/AO classification system, and 0.315 (CI95% 0.334 to 0.368) for the Codman-Hertel classification system. We found loss of agreement in Neer's classification as the study progressed, low agreement in the AO classification, and stable values in the different evaluations with the best degree of agreement for Codman-Hertel classification, with a moderate agreement in the second evaluation among the six evaluators. CONCLUSION: The Neer, AO, and Hertel-Codman classification systems for PHF with a single radiographic projection have a difficult interpretation for orthopaedic surgeons of varying levels of experience, and therefore substantial agreements are not obtained.

Trapeziectomy With Ligament Reconstruction and Tendon Interposition Versus a Trapeziometacarpal Prosthesis for the Treatment of Thumb Basal Joint Osteoarthritis.

Numerous surgical procedures have been described to treat trapeziometacarpal osteoarthritis, but no approach is currently considered superior. Good long-term outcomes have been reported with multiple procedures. No studies have been published comparing outcomes of the Arpe joint replacement (Biomet, Valence, France) with those of ligament reconstruction and tendon interposition (LRTI) using the Burton-Pellegrini technique. The study objective was to compare clinical outcomes between these techniques. Sixty-five patients with Eaton stage III osteoarthritis of the thumb were included in this retrospective follow-up study. Patients were assigned to LRTI (LRTI group) or total joint replacement (Arpe group) and were followed for a mean of 4.8 years. The LRTI group included 34 patients and the Arpe group included 31. Clinical outcome variables were determined preoperatively and every 6 months postoperatively. Pain relief and functional improvement were similar between groups. Pinch strength and range of motion were superior in the Arpe group. Metacarpophalangeal hyperextension appeared to be prevented in the Arpe group but increased over the follow-up period in the LRTI group. However, the complication rate was higher in the Arpe group. Arthroplasty with the Arpe prosthesis can be considered in selected patients who require greater strength and range of motion, although it has been associated with a higher complications rate. [Orthopedics. 2017; 40(4):e681-e686.].

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Evaluación clínico radiográfica de una serie de 18 carpectomías de la primera hilera / Functional and radiographic outcomes following proximal row carpectomy in 18 patients

Objetivos: Analizar los resultados funcionales y grado de satisfacción de la carpectomía en una serie de 18 pacientes. Material y métodos: Estudio retrospectivo de una serie de 18 pacientes sometidos a una carpectomía (4-SNAC, 6-SLAC, 5-Kiembock, 1-pseudoartrosis de escafoides, 1-Preisser, y 1-luxación perilunar del carpo crónica), seguimiento medio de 34 meses. Se realizó una evaluación clínica mediante Mayo Wrist Score, Quick DASH, EVA, rango de movilidad, grado de satisfacción; y una valoración de los cambios radiográficos. Resultados: Tras la intervención el dolor preoperatorio mejora en 4,13 puntos, y la puntuación del Quick Dash se reduce en 39,41. El rango de movilidad medio es de 38º de flexión, 46º de extensión, 11º de desviación radial y 22º de desviación cubital. La fuerza de prensión media fue de 33.2 kg. Existen diferencias significativas entre el EVA y Quick DASH (p<0.001), además de una correlación positiva entre la edad y el dolor postoperatorio. Conclusiones: La carpectomía es un procedimiento con pocas complicaciones, que proporciona resultados de movilidad, mejoría del dolor y fuerza superiores a los criterios funcionales de Palmer. Hemos observado los mejores resultados en mujeres y pacientes de mayor edad. La aplicación de un colgajo de interposición no evita una degeneración radiográfica

Objectives: To analyze functional outcomes and satisfaction in a series of 18 carpectomies. Materials and Methods: Retrospective study of a series of 18 cases who underwent proximal row carpectomy (4-SNAC, 6-SLAC, 5 Kienböck, 1-scaphoid nonunion, 1-Preisser, and 1-perilunar chronic carpal dislocation), mean follow- up of 34 months. Clinical evaluation through Mayo Wrist Score, Quick DASH, VAS, range of motion, degree of satisfaction; and an assessment of radiographic changes. Results: Preoperative pain improved 4.13 points, and Quick Dash score was reduced 39.41 points. The range of motion average was: flexion 38º , extension 46 º, 11 º 22 º radial and ulnar deviation. The mean grip strength was 33.2 kg after surgery. There were signifi cant differences between preoperative VAS and Quick DASH and postoperative scores (p <0.001). A positive correlation between age and postoperative pain was found. Conclusions. The carpectomy is a procedure with low complication rate, which preserve funtional mobility and grip strength acording to Palmer’s criteria, and provides sustantial pain improvement. We observed the best results in women and older patients. The flap interposition doesn't prevent radiographic degeneration

Análisis causal del dolor postartroplastia. Propuesta de un algoritmo diagnóstico-terapéutico / causal analysis of painful arthroplasty. Proposal of a diagnostic and therapeutic algorithm

Objetivo del trabajo: Determinar la incidencia de artroplastia dolorosa de rodilla, realizar un análisis causal exhaustivo del dolor postartroplastia y evaluar los resultados funcionales de los pacientes tratados en nuestro centro. Material y Métodos: Estudio observacional prospectivo en el que se evaluaron 540 pacientes sometidos a ATR primaria cementada durante dos años y se seleccionaron los que sufrían un dolor postartroplastia intenso. Todos los pacientes fueron sometidos a diferentes pruebas complementarias con el fin de determinar la causa más probable de dolor. De igual forma, para cada paciente se instauró un tratamiento quirúrgico específico que pretendía resolver la causa de dolor. Resultados: De las 541 artroplastias primarias practicadas, 63 pacientes presentaron un dolor postartroplastia intenso. La incidencia acumulada de dolor intenso ostartroplastia en nuestro centro durante los dos años de seguimiento fue de un 11,64 %. Las causas mecánicas intraarticulares fueron las más frecuentes, justificando el 52,4 % del dolor postartroplastia severo, seguidas por las causas biológicas intraarticulares que constituyeron el 34,9%. En el 11,1 % de los casos no se pudo determinar ninguna causa específica del dolor postartroplastia, considerando, por tanto el origen del dolor desconocido. Por último, las causas extraarticulares, que constituyeron sólo el 1,6% del dolor postartroplastia. Conclusiones: El dolor postartroplastia es una complicación frecuente de la artroplastia de rodilla que puede padecer uno de cada diez pacientes que se somete a una cirugía de sustitución articular. El dolor protésico tiene un origen multifactorial, por lo el diagnóstico causal es complicado y tedioso. Existen determinados factores, como padecer alteraciones psiquiátricas, la obesidad, y una demanda analgésica elevada antes de la intervención se asocian a una mayor probabilidad de dolor postartroplastia

Objective: The aim of this study was to determine the incidence of painful knee arthroplasty and performance a causal analysis of painful arthroplastyin our center. Material and Methods: A prospective observational study in which 540 patients undergoing primary cemented arthroplasty for two years. Were selected those suffering intense pain postarthroplasty. All patients were subjected to various tests in order to determine the most likely cause of pain. Similarly, for each patient a specific surgical treatment intended to address the cause of pain was realized. Results: Of the 541 primary arthroplasties performed, 63 patients suffered severe pain. The cumulative incidence of severe pain postartroplastia in our center during the two years of follow-up was 11.64 %. Mechanical causes were the most frequent justifying 52.4% of the cases, followed by intraarticular biological causes which constituted 34.9% In 11.1% of cases could not determine any specific cause of painful arthroplasty considering therefore an unknown pain. Finally, extra-articular causes, which constituted only 1.6% of painful arthroplasty. Conclusions: The painful arthroplasty is a common complication of knee arthroplasty can have one in ten patients undergoing joint replacement surgery. The prosthetic pain has a multifactorial etiology, so the causal diagnosis is difficult and tedious. Certain factors, such as having psychiatric disorders , obesity , high demand and analgesic before surgery are associated with a greater likelihood of painful arthroplasty

Intermittent claudication caused by a giant atypical lipoma of the thigh.

The main cause of intermittent claudication in lower limbs is peripheral vascular disease. Less commonly, the etiology can be extrinsic to vascular structures, as in the cases of tumors that, due to their rapid growth, can reduce the blood supply and produce intermittent claudication during gait. We report the case of a 49-year-old patient with intermittent claudication in the left lower limb, reporting the presence of a tumor in the inner side of the left thigh with rapid growth. Doppler and angiography magnetic resonance imaging examinations demonstrated the presence of an adipose tumor that was producing deep and superficial extrinsic compression of the femoral arteries.

Is the fasting calcium/creatinine a bone resorption marker in patients with calcium renal stones?

Osteoporosis and osteopenia are an important endocrine-metabolic disease that affect women and men from a certain age and it has a high risk and health cost. The aim of this short communication is to show that fasting calcium/creatinine ratio in patients with calcium stones is a marker of bone resorption.We studied 180 patients with renal stones with calcium composition and the relationship of them between the calcium/creatinine in urine after 8 h of fasting with bone densitometry (T-score) and values of bone resorption marker ß-crosslaps (ng/ml). The Pearson correlation test was applied for the analysis of linear correlations between quantitative variables.We have observed a statistically significant positive linear correlation between the fasting calcium/creatinine and serum and ß-crosslaps (R = 0.534, p < 0.0001) and a statistically significant negative linear correlation between fasting calcium/creatinine and T-score of bone densitometry in hip (R = -0.237, p = 0.002), femoral neck (R = -0.217, p = 0.009) and lumbar spine (R = 0.292, p = 0.001).The fasting ratio calcium/creatinine in urine is associated with increased levels of ß-crosslaps marker and therefore may be useful as a marker of bone resorption in these patients.