Resultado de la implantación de consultas telemáticas en cirugía ortopédica y traumatología durante la pandemia COVID-19 / Result of the implementation of telematic consultations in orthopaedic surgery and traumatology during COVID-19 laparoscopic surgery

La pandemia COVID ha hecho de las consultas telemáticas una herramienta básica en la práctica diaria. El objetivo principal del estudio es valorar los resultados de la aplicación de consultas telemáticas para limitar la movilidad de los pacientes. Son objetivos operativos: proponer un plan de consultas, conocer cómo limita la asistencia a las consultas, definir qué patologías se benefician más con este plan. MATERIAL Y MÉTODOS: Se propone un esquema con la creación de consultas previas a las agendadas para valorar idoneidad y posibilidad de realizarla en acto único no presencial. RESULTADOS: Se han realizado 5.619 consultas con una falta de respuesta telefónica del 19%. El 74% de los pacientes fueron resueltos de forma virtual. Existe diferencia entre unidades, siendo más probable la respuesta telefónica para las consultas de unidad, OR = 0,60 o de traumatología general, OR = 0,67 y menos para los derivados desde urgencias. El 20% de las consultas no se acompañaban de pruebas complementarias. Las consultas de traumatología general, OR = 0,34, control postoperatorio, OR = 0,49, y unidades, OR = 0,40, cumplieron mejor este requisito. De los pacientes restantes, las consultas de traumatología general, OR = 0,50, y las derivadas a unidades, OR = 0,54 fueron las que más se resolvieron sin acudir presencialmente. CONCLUSIONES: Se han resuelto de forma no presencial el 74% de los pacientes que atendieron a la llamada telefónica. El 20% de los pacientes acuden a la visita sin pruebas complementarias. Las consultas de seguimiento de osteosíntesis y postoperatorio de cirugía artroscópica son las que más precisan de ser realizadas de forma presencial

The COVID pandemic has made telematic consultations a basic tool in daily practice. AIMS: The main objective of the study is to assess the results of the application of telematic consultations to limit the mobility of patients. The operational objectives are; to propose a consultation plan, to know how attendance limits consultations and to define which pathologies benefit the most from this plan. METHODS: A scheme is proposed with the creation of pre-scheduled clinic to assess suitability and the possibility of carrying them out in a single non face-to-face act. RESULTS: Phone call to 5,619 patients were made with a lack of response of 19%. The cases of 74% of the patients that answered were resolved virtually. There is a difference between units, obtaining a higher answering rate from patients appointed to specific clinic units, OR = 0.60, or to general trauma ones, OR = 0.67. The lowest answering rate was obtained from those derived from the emergency department. Twenty per cent of the consultations were not accompanied by complementary tests that would have favored the resolution in a single act. The general trauma consultations, OR = 0.34, postoperative control, OR = 0.49, and specific unit ones, OR = 0.40, were the ones that better met this requirement. Out of the remaining patients, the general trauma consultations, OR = 0.50, and those referred to units, OR = 0.54, were the ones that had a higher resolution rate without in- person consultation. CONCLUSIONS: The cases of 74% of the patients who answered the phone call were resolved virtually. Cases of 20% of the patients cannot be solved in a single act because they are derived without complementary tests. Osteosynthesis and postoperative arthroscopic follow-up consultations are the ones that need to be carried out in person the most

Result of the implementation of telematic consultations in orthopaedic surgery and traumatology during COVID-19 laparoscopic surgery. / Resultado de la implantación de consultas telemáticas en cirugía ortopédica y traumatología durante la pandemia COVID-19.

The COVID pandemic has made telematic consultations a basic tool in daily practice. AIMS: The main objective of the study is to assess the results of the application of telematic consultations to limit the mobility of patients. The operational objectives are; to propose a consultation plan, to know how attendance limits consultations and to define which pathologies benefit the most from this plan. METHODS: A scheme is proposed with the creation of pre-scheduled clinic to assess suitability and the possibility of carrying them out in a single non face-to-face act. RESULTS: Phone call to 5,619 patients were made with a lack of response of 19%. The cases of 74% of the patients that answered were resolved virtually. There is a difference between units, obtaining a higher answering rate from patients appointed to specific clinic units, OR = 0.60, or to general trauma ones, OR = 0.67. The lowest answering rate was obtained from those derived from the emergency department. Twenty per cent of the consultations were not accompanied by complementary tests that would have favored the resolution in a single act. The general trauma consultations, OR = 0.34, postoperative control, OR = 0.49, and specific unit ones, OR = 0.40, were the ones that better met this requirement. Out of the remaining patients, the general trauma consultations, OR = 0.50, and those referred to units, OR = 0.54, were the ones that had a higher resolution rate without in- person consultation. CONCLUSIONS: The cases of 74% of the patients who answered the phone call were resolved virtually. Cases of 20% of the patients cannot be solved in a single act because they are derived without complementary tests. Osteosynthesis and postoperative arthroscopic follow-up consultations are the ones that need to be carried out in person the most.

Correction to: The Kidney, Liver, Index surgery and C reactive protein score is a predictor of treatment response in acute prosthetic joint infection.

There is an error in the name of one of the author in the original publication. The correct name is I Rodríguez-Delourme and not Delourne.

The Kidney, Liver, Index surgery and C reactive protein score is a predictor of treatment response in acute prosthetic joint infection.

PURPOSE: This work seeks to verify the utility of the KLIC score as a predictor of treatment success or failure in patients with knee and hip acute prosthetic joint infections (APJI). These patients were treated in our centre, which is not a prosthetic joint infection reference centre. The KLIC score assesses factors such as chronic kidney failure (2 points) (Kidney), liver disease (1.5 points) (Liver), revision surgery or femoral neck fracture (1.5 points)and cemented prosthesis (2 points) (Index surgery) and a C-reactive protein level (CRP) greater than 11.5 mg/dL (2.5 points), as a predictor of treatment success or failure in patients with knee and hip acute prosthetic joint infections (APJI). METHODS: We retrospectively reviewed 30 patients with APJI who were treated using debridement, antibiotics, irrigation and retention (DAIR) treatment between January 2007 and December 2016. Patients' KLIC scores were calculated. The main outcome was success or failure of DAIR treatment of APJI. RESULTS: DAIR treatment succeeded in 21 cases and failed in nine cases. Differences in outcome were found according to the KLIC score. For KLIC scores >2 and ≤4, there were three successes and zero failures; for scores 4-5, there were nine successes and two failures; for scores >5 and ≤7,there were nine successes and four failures; and for scores >7, there were zero successes and three failures (p = 0.025). We found a positive predictive value and negative predictive value of 33% and 100% for scores ≤4 (score for calculations: 3.5), 43% and 84% for scores 4-5 (4.5), 50% and 68% for scores >5 and ≤7 (5.5), and 100% and 76% for scores >7 (7.5), respectively. The area under the ROC curve was 0.762 (95% confidence interval, 0.569-0.955). CONCLUSIONS: The KLIC score was useful in predicting success or failure of DAIR treatment of APJI. This supports the conclusion that with a score < 3.5, treatment is likely to succeed and with a score of >6, it is likely to fail.

Síndrome doloroso Rotuliano. Controversias y evidencias / Patellofemoral Pain Syndrome. Evidence and controversies

El Síndrome Doloroso Rotuliano (SDR) constituye la causa más común de dolor anterior de rodilla. Su diagnóstico es fundamentalmente clínico y se basa en la presencia de dolor retrorrotuliano o perirrotuliano en ausencia de signos propios de otra patología. El ejercicio físico influye positivamente en su prevención y tratamiento. Los AINES, los corticoides y la glucosamina representan una alternativa en la fase aguda, pero no se disponen de datos científicos que avalen su eficacia a largo plazo. De igual manera, no se han realizado trabajos que permitan recomendar las terapias taping, las ortesis plantares y las rodilleras como tratamiento habitual en el SDR. Recientemente se ha promulgado la aplicación de toxina botulínica en el vasto lateral con resultados satisfactorios. El tratamiento quirúrgico podría plantearse tras haber realizado de 6 a 12 meses de tratamiento conservador con resultados fallidos y siempre que exista un hallazgo susceptible de ser corregido

Patellofemoral Pain Syndrome (PFPS), also known as anterior knee pain and patellofemoral joint syndrome, is the most common major cause of anterior knee pain. Diagnosis is mainly clinical and based on the presence of retropatellar or peripatellar pain without signs of any other pathology. Physical exercise has a positive influence on its prevention and treatment. Non-steroidal anti-inflammatory drugs (NSAIDs), corticoids and glucosamine are alternatives for use in acute phases; however there is insufficient scientific data to endorse their long-term efficacy. Similarly, no studies have been performed that allow taping therapies, foot and knee orthoses, to be recommended as a standard PFPS treatment. Recent reports have shown that satisfactory results have been obtained by applying botulinum toxin into the vastus lateralis. Surgical treatment could be considered, as long as that there are indications it could provide benefit, if conservative therapy proves unsuccessful after 6 to 12 months