[Clinical and functional evaluation of patellofemoral resurfacing arthroplasties]. / Evaluación clínica y funcional de las artroplastías de resuperficialización patelofemoral.

BACKGROUND: The patellofemoral articulation is a biomechanical system susceptible to accelerated wear, affecting 25% of women. Currently, the treatment of osteoarthrosis Patelofermoral has resurfaced thanks to the creation of anatomical and biomechanically appropriate systems, with precise indications, earlier stages and with a better functional result. MATERIAL AND METHODS: A cohort of 24 patients was analyzed during the period from 2010 to 2012, treated with a resurfacing prostheses HemiCap Patello Femoral Resurf (Franklin MA, USA), placed by 2 surgeons. Patients were assessed preoperatively and 2, 4, 6, 12, 18, 24 months postoperative with the Knee Society Score. RESULTS: Twenty-four patients with follow-up of 2 years on average were included. 87.5% were women, an average age of 62 years (45-80 years); an average of 29.5 of body mass index, the right laterality predominated in 54%. An improvement in KSS scale results was observed: in clinical appearance there was an improvement of 35.2% and the functional scale 41.62%. Only two patients were revised by complications of functional limitation, treated one with manipulation under anesthesia and the other with arthroscopic adhesion lysis. CONCLUSION: The patellofemoral prosthesis is an option as a treatment for isolated patellofemoral arthrosis, since the two-year survival rate is good, providing pain relief and improving knee functionality; However, more follow-up time will be required to evaluate the end result of this implant.

ANTECEDENTES: La articulación patelofemoral (PF) es un sistema biomecánico susceptible a desgaste acelerado, afecta a 25% de las mujeres. Actualmente, el tratamiento de la osteoartrosis patelofemoral (OAPF) ha resurgido gracias a la creación de sistemas anatómicos y biomecánicamente adecuados, con indicaciones precisas, estadios más tempranos y con mejor resultado funcional. MATERIAL Y MÉTODOS: Se analizó una cohorte de 24 pacientes durante el período de 2010 a 2012, tratados con prótesis de resuperficialización patelofemoral (PPF) HemiCap Patelofemoral Resurf (Franklin MA, EUA), colocadas por dos cirujanos. Se evaluaron los pacientes prequirúrgicos y a los dos, cuatro, seis, 12, 18, 24 meses postquirúrgicos con la escala Knee Society Score (KSS). RESULTADOS: Se incluyeron 24 pacientes con seguimiento de dos años en promedio. En 87.5% fueron mujeres, edad promedio de 62 años (45-80 años); una media de 29.5 de índice de masa corporal (IMC), la lateralidad derecha predominó en 54%. Se observó una mejoría en los resultados de la escala KSS: en el aspecto clínico hubo una mejoría de 35.2% y en la escala funcional de 41.62%. Sólo dos pacientes fueron reintervenidos por complicaciones de limitación funcional, uno de ellos tratado con manipulación bajo anestesia y el otro con liberación artroscópica de adherencias. CONCLUSIÓN: La PPF es una opción como tratamiento de AOPF aislada, pues la tasa de supervivencia a dos años es buena, proporciona alivio del dolor y mejoría en funcionalidad de la rodilla; sin embargo, se requerirá mayor tiempo de seguimiento para evaluar el resultado final de este implante.

[Installed Capacity Perception Survey for the Training of Residents Program in Orthopedics and Care Needs in Acute and Chronic Musculoskeletal Pathology in Mexico]. / Encuesta de Percepción en Capacidad Instalada para la Formación de Médicos Residentes en Ortopedia (Traumatología) y Necesidades de la Atención en Patología Musculoesquelética Aguda y Crónica en México. Primera Parte.

INTRODUCTION: It is essential that orthopaedic resident physicians be highly proficient in all aspects, considering the balance between supply, demand, need and context. Fundamental to identify the capacity and quality installed for their training in Mexico. MATERIAL AND METHODS: Observational Study, transverse, non-probabilistic sampling-conglomerates, in two phases. The instrument has 8 domains, 57 variables and 4,867 items. 60 graduate professors of 20 states, 50 hospital sites, 22 university programs. RESULTS: 1,038 years of experience (collective intelligence), 17 years of experience/teacher (01 to 50 years). Identified: acute pathology 30 (2 to 90%), chronic pathology 30 (5 to 96%), patients 15 years, 10 (3 to 30%), patients between 15 and 65 years, 47 (2 to 78%), patients 65 years, 20 (2 to 60%), number of beds/seat 20 (2 to 510), number of clinics 3 (1 to 48), number of surgical procedures/headquarters per year at the national level, was 960 (50 to 24,650). The national average per resident doctor is 362 surgeries/year with 1,450 surgical times/year. CONCLUSIONS: The needs and resources for the training of physicians specializing in orthopedics/traumatology are highly heterogeneous, so it should be adapted to the epidemiological needs of the region of influence, in an area of epidemiological transition. 62.2% expressed not having or have bad academic and scientific infrastructure at its headquarters, more than 50% without rotation overseas and 90% without regular scientific production.

INTRODUCCIÓN: Es fundamental que los médicos residentes de ortopedia (traumatología) sean altamente competentes en todos los aspectos, considerando el equilibrio entre la oferta, demanda, necesidad y contexto. Es primordial identificar la capacidad y calidad instalada para su formación en México. MATERIAL Y MÉTODOS: Estudio observacional, transversal, muestreo no probabilístico-conglomerados, en dos fases. El instrumento tiene ocho dominios, 57 variables y 4,867 ítems. Sesenta profesores de postgrado de 20 estados, 50 sedes hospitalarias, 22 programas universitarios. RESULTADOS: 1,038 años de experiencia (inteligencia colectiva), 17 años de experiencia/profesor (01 a 50 años). Se identificó: patología aguda 30 (2 a 90%), patología crónica 30 (5 a 96%), pacientes 15 años, 10 (3 a 30%), pacientes entre 15 y 65 años, 47 (2 a 78%), pacientes 65 años, 20 (2 a 60%), número de camas/sede 20 (2 a 510), número de consultorios 3 (1 a 48), el número de procedimientos quirúrgicos/sede al año a nivel nacional fue de 960 (50 a 24,650). La media nacional por médico residente es de 362 cirugías/año con 1,450 momentos quirúrgicos/año. CONCLUSIONES: Las necesidades y recursos para la formación de médicos especialistas en ortopedia/traumatología son en alto grado heterogéneos, por lo cual se debería adaptar a las necesidades epidemiológicas de la región de influencia, en un ámbito de transición epidemiológica. Sesenta y dos punto dos por ciento expresó no tener o tener deficiente infraestructura académica y científica en su sede, más de 50% sin rotación al extranjero y 90% sin producción científica regular.

[Functional comparison in the treatment of Weber type B ankle fractures with suture device versus screw]. / Comparación funcional en el tratamiento de las fracturas de tobillo B de Weber con implante y sutura versus tornillo situacional.

BACKGROUND: Ten percent of all ankle fractures, 20% of the fractures treated surgically, and 1-18% of all sprains involve a syndesmosis injury. The methods used for reduction are metal or bioabsorbable syndesmotic set screws, direct repair, and sutures with or without buttons. The purpose of this study was to compare the clinical function of patients who sustained Weber B ankle fractures and were treated with the TightRope system or a syndesmotic set screw. MATERIAL AND METHODS: An observational, comparative, cross-sectional study was conducted between March 2012 and March 2015. The AOFAS ankle scale was used to assess function in patients with Weber B fractures with a syndesmosis injury treated with a 3.5 mm tricortical set screw or with the TightRope system. RESULTS: Forty-three patients were included, their mean age was 47 years. The single-factor ANOVA test was used to compare the results of both groups. The latter showed that at 3, 6 and 12 months the TightRope group showed a significant improvement based on the AOFAS score, compared with the set screw group (p = 0.05). DISCUSSION: The use of the TightRope system results in better clinical function in the short term compared with the 3.5 mm tricortical set screw, according to the AOFAS scale.

ANTECEDENTES: Diez por ciento de todas las fracturas de tobillo, 20% de las fracturas tratadas quirúrgicamente y de 1 al 18% de los esguinces presentan lesión de la sindesmosis. Los métodos utilizados para su reducción son tornillos situacionales metálicos o bioabsorbibles, reparación directa y el uso de suturas con o sin botones. El objetivo de este trabajo fue comparar la función clínica de las fracturas de tobillo B de Weber tratadas con TightRope o con el uso de tornillo situacional. MATERIAL Y MÉTODOS: Se realizó un estudio observacional, comparativo, transversal en el período comprendido de Marzo del 2012 a Marzo del 2015. Se utilizó la escala de AOFAS de tobillo para valorar la función de pacientes con fracturas Weber B con lesión de sindesmosis tratados con tornillo situacional tricortical de 3.5 mm y pacientes tratados con sistema TightRope. RESULTADOS: Se estudiaron 43 pacientes con una media de 47 años de edad. Se realizó la prueba de ANOVA de un factor para comparar los resultados de ambos grupos observando que a los tres, seis y 12 meses el grupo de TightRope presentó una mejoría significativa en cuanto al puntaje de AOFAS en comparación con el grupo de tornillo situacional (p = 0.05). DISCUSIÓN: El uso del sistema TightRope presenta mejor función clínica en comparación con el tornillo situacional tricortical de 3.5 mm en el corto plazo, de acuerdo con la escala de AOFAS.

[Infection prevention during the perioperative period of primary hip and knee arthroplasty]. / Prevención de infecciones en el perioperatorio de la artroplastía primaria de cadera y rodilla.

All surgical wounds are at risk of contamination by pathogens that may get in through the incision. The pre-surgical bath with a skin antiseptic agent 24 hours prior to the surgery, the timing of administration of prophylactic antibiotics, the choice and postoperative duration of the latter, the number of individuals within the OR and the movement inside it, the choice of chlorhexidine gluconate for its long duration against gram-positive and gram-negative organisms, and the use of a hair remover or an electric razor, all of the former concepts, some new and others not so new, led to performing an extensive bibliographic review with the idea of starting a standardization process that could change the way in which institutions operate when performing primary joint replacement, trying to reduce the annual infection rate and upgrade the quality of life of patients.

[Periprosthetic femur fractures. Experience at hospital Español de México with a 2-year follow-up]. / Fracturas periprotésicas del fémur. Experiencia en el hospital Español de México a 2 años de seguimiento.

UNLABELLED: Periprosthetic fractures have had an increasing incidence in the past decades; their resolution is a difficult challenge even for the most experienced orthopedist surgeons. The Vancouver classification has contributed to a great extent to their better characterization and therapeutic guidance. The purpose of this paper is to make a review of the most recent advances on the topic and present our experience in the treatment of these fractures. MATERIAL AND METHODS: We describe the characteristics of a sample of 20 patients with periprosthetic femur fractures treated at our hospital from March 2008 to March 2010 and typed according to the Vancouver classification. RESULTS: Mean age was 74.5 years with a range of 65-87 years. Females were predominant (70%). Five cases were type A in the classification, 10 cases type B, and 5 cases type C. Nineteen underwent surgical treatment. The mean total length of stay was 7 days, with a range of 5-12. The mean healing time for types B and C was 4 months (range 3-6 months). Four patients had complications. The resolution was assessed as excellent in 5 cases (25%), good in 11 cases (55%), and poor in 4 cases (20%). CONCLUSIONS: A thorough individual assessment based on the Vancouver classification, age and the patient's functional requirements are the major parameters for treatment success.