Distal femoral osteotomy and patellar tendon advancement for the treatment of crouch gait in patients with bilateral spastic cerebral palsy.

BACKGROUND: Crouch gait, or flexed knee gait, represents a common gait pattern in patients with spastic bilateral cerebral palsy (CP). Distal femoral extension and/or shortening osteotomy (DFEO/DFSO) and patellar tendon advancement (PTA) can be considered as viable options when knee flexion contractures are involved. Better outcomes have been reported after a combination of both, independently of the presence of knee extensor lag. In this study, we evaluated the clinical and kinematic outcomes of these procedures. PATIENTS AND METHODS: We reviewed a cohort of 52 limbs (28 patients) who were treated for crouch gait by DFEO/DFSO alone (group 1, n = 15) or DFEO/DFSO + PTA (group 2, n = 37) as a part of single event multilevel surgery (SEMLS). The mean age at surgery was 14 years, and the mean follow-up time was 18 months. The physical examination data and three-dimensional standardized gait analysis were collected and analyzed before the surgery and postoperatively. RESULTS: Overall knee range of motion improved in all limbs. The knee flexion decreased significantly in both groups at initial, mid, and terminal stance. Hip flexion significantly decreased in mid-stance for limbs in group 2. Both clinical and gait parameters were most improved in limbs who underwent DFEO/DFSO + PTA. Increased pelvic tilt was observed in both groups after surgery. CONCLUSION: Although DFEO/DFSO alone was successful in correcting knee flexion contractures, PTA has helped to improve knee extensor lag and knee extension during gait. LEVEL OF EVIDENCE: Therapeutic level IV.

A gait functional classification of adolescent idiopathic scoliosis (AIS) based on spatio-temporal parameters (STP).

BACKGROUND: Therapeutic decisions for patients with adolescent idiopathic scoliosis (AIS) are mostly based on static measurements performed on two-dimensional standing full-spine radiographs. However, the trunk plays an essential role in the human locomotion, and the functional consequences during daily activities of this specific and common spinal deformity are not factored in. RESEARCH QUESTION: Does patients with AIS have specific gait patterns based on spatio-temporals parameters measurements ? METHODS: 90 AIS patients (aged 10-18 years) with preoperative simplified gait analysis were retrospectively included for analysis between 2017 and 2020. Spatio-temporal parameters (STP) were measured on a 3-m baropodometric gaitway and included the measurement of 15 normalized gait parameters. A hierarchical cluster analysis was performed to identify group of patients based on the similarities of their gait patterns, and functional variables' inter-group differences were also measured. The subject distribution was calculated to identify the structural characteristics of the subjects according to their gait patterns. RESULTS: Three gait patterns were identified. Cluster 1 (46%) was defined by asymmetry, Cluster 2 (16%) by instability, and Cluster 3 (36%) by variability. Each cluster was significantly different from the other ones on at least 6 different parameters (p < 0.05). Furthermore, each cluster was associated with one type of curve: Lenke 1 for Cluster 1 (57.5%), Lenke 6 for Cluster 2 (40%) and Lenke 5 for Cluster 3 (43.5%). SIGNIFICANCE: Patients with severe AIS have a dynamic signature during gait identified on STP. Understanding consequences of this deformity on gait may be an interesting avenue to study the pathological mechanisms involved in their dynamic motor organization. Furthermore, these results might also be a first step to study the effectiveness of the different therapies.

Perioperative protocol to reduce blood transfusions in total knee o hip replacement patients / [Implementación de protocolo perioperatorio para disminuir tasa de transfusiones en pacientes sometidos a reemplazo total de cadera o rodilla primarios]

Introduction: Patient Blood Management (PBM) programs improve patient care and reduce health costs. It includes detection of presurgical anemia, reduction of blood loss and improvement of patient-specific anemic reserve. The aim of this study is to assess the effect of a PBM program on transfusion rate, length of stay (LOS) and adverse events. Methods: We developed a retrospective observational study. We included patients who underwent total hip (THR) o knee replacement (TKR). Our PBM involved preoperative assessment, administration of 2 doses of tranexamic acid, application of restrictive transfusion criteria and use of IV iron. We compared results between the group of patients before and the one after the PBM implementation. Results: We included 179 patients (80 TKR and 99 THR) who underwent surgery before PBM implementation from January to December 2014 (Group A), and 187 patients (103 TKR and 84 THR) who underwent arthroplasty after PBM application from January to November 2016 (Group B). In Group A, hemoglobin drop was larger than in Group B, for TKR (5.1±1.2 vs. 4.2±1.2 g/dl; p<0,05) and for THR (4.7±1.3 vs. 3.8±1.3 g/dl; p<0,05). In group A, more patients were transfused (31.8% vs. 2.7%; p<0.001). LOS was longer for patients in group A, in both surgeries (for TKA, 3.98±1.4days vs. 2.99±0.95 days; p<0.0001; for THA 3.68±1.06days vs. 2.88±0.75days; p<0.0001). No significant differences were found regarding adverse events. Conclusion: Our PBM program saved transfusions after primary TKR and THR and lowered LOS, without risking patients to higher number of complications or death.

Introducción: Los protocolos de manejo de anemia perioperatoria mejoran el cuidado del paciente y disminuyen los costos en salud. El objetivo de este estudio fue identificar el efecto de dicho programa en pacientes sometidos a reemplazo total de cadera (RTC) o rodilla (RTR), en la tasa de transfusiones, tiempo de estadía hospitalaria y eventos adversos. Métodos: Se realizó un estudio observacional retrospectivo, incluyendo pacientes sometidos a RTC o RTR primarios. El programa abarcó la valoración preoperatoria, el uso de 2 dosis de ácido tranexámico, la aplicación de transfusiones restringidas, y el uso de hierro suplementario. Se compararon los resultados entre pacientes pre y post implementación del protocolo. Resultados: Se incluyeron 179 pacientes (80 RTR y 99 RTC) pre protocolo entre enero y diciembre 2014 (grupo A) y 187 casos (103 RTR y 84 RTC) post protocolo entre enero y noviembre 2016 (grupo B). En el grupo A, la caida de hemoglobina fue mayor que en el grupo B en RTR (5,1±1,2 vs. 4,2±1,2 g/dl; p<0,05) y en RTC (4,7±1.3 vs. 3,8±1.3 g/dl; p<0,05). Hubo mayor requerimiento transfusional en el grupo A (31,8% vs. 2,7%; p<0,001). El tiempo de estadía hospitalaria (TEH) fue mayor en el grupo A para ambas cirugías (en RTR 3,98±1,4días vs. 2,99±0,95 días; p<0,0001; en RTC 3,68±1,06días vs. 2,88±0,75días; p<0,0001). No se encontraron diferencias significativas respecto a eventos adversos. Conclusión: En ambas artroplastias, nuestro programa disminuyó la cantidad de transfusiones, la caída de hemoglobina y la estadía hospitalaria, sin aumentar el número de complicaciones.

Fracturas atípicas de fémur proximal asociadas al uso prolongado de bifosfonatos / Atypical fractures of proximal femur associated with prolonged use of bisphosphonates

Introducción: Los bifosfonatos constituyen el tratamiento de primera elección de la enfermedad osteoporótica. Algunos efectos adversos ponen en duda su uso prolongado, como las fracturas atípicas de fémur proximal. Los objetivos de este estudio fueron determinar la relación entre consumo de bifosfonatos y fracturas atípicas de fémur, y mostrar la incidencia en nuestra institución. Materiales y Métodos: Estudio retrospectivo, observacional, análisis de caso-control no pareado. Se incluyeron pacientes >55 años, con fractura de fémur que ingresaron entre el 1 de enero de 2009 y el 31 de mayo de 2015. Las variables consideradas fueron: sexo, edad, tipo de fractura; uso, tipo y tiempo de consumo de bifosfonatos. Las fracturas se distribuyeron en típicas: pertrocantéricas, y cuello femoral, y atípicas: subtrocantéricas y diafisarias. Se consideraron como casos las fracturas atípicas y como controles, las pertrocantéricas. Resultados: Se incluyó a 517 pacientes que cumplieron los criterios de inclusión. Cuarenta y dos fracturas eran atípicas y 236, típicas. Hubo predominio del sexo femenino (81,4% en los casos y 83% en los controles). La edad promedio fue de 76 y 80 años, respectivamente. La asociación con bifosfonatos fue del 44,2% en los casos y 15,3% en los controles (11,6% y 0,8% en las fracturas pertrocantéricas, respectivamente). Conclusiones: El alendronato se asoció significativamente con fracturas atípicas de fémur. No se halló relación con el tiempo de consumo; sin embargo, la incidencia fue más alta luego de 4.5-5 años de consumo. Nivel de Evidencia: IV

Introduction: Bisphosphonates are currently considered a first-choice treatment for osteoporotic disease. A number of adverse effects call into question its long-term administration, such as proximal femoral pathological fractures. The purposes of this study were to determine the relationship between consumption of bisphosphonates and atypical femoral fractures, and to report the incidence in our institution. Methods: Retrospective, observational study, case-control unpaired analysis. Patients >55 years old with femoral fractures admitted from January 1, 2009 to May 31, 2015 were included. Considered variables were: sex, age, type of fracture, use, type and time of consumption of bisphosphonates. Fractures were divided into typical: pertrochanteric, and femoral neck, and atypical: subtrochanteric and diaphyseal. Atypical fractures were cases, and typical fractures functioned as controls. Results: A total of 517 patients met the inclusion criteria and were included in the study. Forty-two fractures were atypical and 236 were typical. Female sex predominated (81.4% of cases, and 83% of controls). Average age was 76 and 80 years, respectively. Association with bisphosphonates was observed in 44.2% of the cases, and 15.3% of controls (11.6% and 0.8% in pertrochanteric fractures, respectively). Conclusions: Alendronate was significantly associated with atypical femoral fractures. A relationship with length of consumption was not detected; however, incidence was higher after 4.5-5 years of use. Level of Evidence: IV