Comparativa de corrección de la deformidad triplanar del Hallux Valgus mediante dos técnicas quirúrgicas. Análisis radiológico y funcional / A comparison of two surgical procedures for the triplanar correction of hallux valgus deformity. Functional and radiological evaluation

Objetivo Comparar los resultados radiológicos en el plano coronal y axial y los resultados funcionales en los pacientes intervenidos de Hallux Valgus mediante la artrodesis de Lapidus modificada y la osteotomía de Austin-Chevron. Material y método Estudio de cohortes retrospectivo entre enero de 2018 y enero de 2020 en el que se incluyeron pacientes intervenidos de Hallux Valgus mediante artrodesis de Lapidus modificada y la osteotomía de Austin-Chevron con al menos 1 año de seguimiento. Se analizaron variables radiológicas: Ángulo Intermetatarsiano, Ángulo de Hallux Valgus, Posición de sesamoideo medial pre y postquirúrgico. Los resultados funcionales fueron evaluados según la escala AOFAS. Resultados 78 pacientes fueron incluidos. No se encontraron diferencias estadísticamente significativas en el valor del ángulo intermetatarsiano y la técnica quirúrgica utilizada (p=0,367). Se encontraron diferencias estadísticamente significativas en el valor de ángulo de Hallux Valgus y la posición del sesamoideo medial según la técnica quirúrgica utilizada ( p=0,010 y p=0,000). Se encontraron diferencias estadísticamente significativas en cuanto al valor de la escala AOFAS y la técnica quirúrgica utilizada (p=0,032) y el valor de la escala AOFAS y la posición del sesamoideo medial (p=0,035; R=-0,245). Conclusión La técnica de Lapidus modificada corrige la deformidad presente en el plano axial y coronal en la patología del Hallux Valgus, encontrando mejores resultados funcionales y radiológicos que en la técnica de Austin-Chevron convencional. (AU)

Objetive To compare radiographic outcomes in the cor-onal and axial planes and functional results in pa-tients who underwent hallux valgus surgery using modified Lapidus arthrodesis and Austin-Chevron osteotomy. Methods Retrospective cohort study conducted from 2018 to January 2020 with patients who underwent hallux valgus surgery using modified Lapidus arthrodesis and Austin-Chevron osteotomy with a minimum 1-year follow-up. The analysed radiographic variables were pre- and postoper-ative intermetatarsal angle, hallux valgus angle, and tibial sesamoid position. Functional outcomes were assessed using the AOFAS score. Results 78 patients were included. No statistically sig-nificant differences were found in the measurement of the intermetatarsal angle by surgical procedure (p=0.367). Statistically significant differences were found in the measurement of the hallux val-gus angle and tibial sesamoid position according to the surgical procedure (p=0.010 and p=0.000). Statistically significant differences were found for the AOFAS score by surgical procedure (p=0.032) and for the AOFAS score by tibial sesamoid position (p=0.035); R=-0.245). Conclusion The modified Lapidus procedure corrects the coronal and axial plane deformity in hallux valgus, resulting in better functional and radiographic outcomes than the conventional Austin-Chevron procedure. (AU)

Comparativa de corrección de la deformidad triplanar del Hallux Valgus mediante dos técnicas quirúrgicas. Análisis radiológico y funcional / A comparison of two surgical procedures for the triplanar correction of hallux valgus deformity. Functional and radiological evaluation

Objetivo Comparar los resultados radiológicos en el plano coronal y axial y los resultados funcionales en los pacientes intervenidos de Hallux Valgus mediante la artrodesis de Lapidus modificada y la osteotomía de Austin-Chevron. Material y método Estudio de cohortes retrospectivo entre enero de 2018 y enero de 2020 en el que se incluyeron pacientes intervenidos de Hallux Valgus mediante artrodesis de Lapidus modificada y la osteotomía de Austin-Chevron con al menos 1 año de seguimiento. Se analizaron variables radiológicas: Ángulo Intermetatarsiano, Ángulo de Hallux Valgus, Posición de sesamoideo medial pre y postquirúrgico. Los resultados funcionales fueron evaluados según la escala AOFAS. Resultados 78 pacientes fueron incluidos. No se encontraron diferencias estadísticamente significativas en el valor del ángulo intermetatarsiano y la técnica quirúrgica utilizada (p=0,367). Se encontraron diferencias estadísticamente significativas en el valor de ángulo de Hallux Valgus y la posición del sesamoideo medial según la técnica quirúrgica utilizada ( p=0,010 y p=0,000). Se encontraron diferencias estadísticamente significativas en cuanto al valor de la escala AOFAS y la técnica quirúrgica utilizada (p=0,032) y el valor de la escala AOFAS y la posición del sesamoideo medial (p=0,035; R=-0,245). Conclusión La técnica de Lapidus modificada corrige la deformidad presente en el plano axial y coronal en la patología del Hallux Valgus, encontrando mejores resultados funcionales y radiológicos que en la técnica de Austin-Chevron convencional. (AU)

Objetive To compare radiographic outcomes in the cor-onal and axial planes and functional results in pa-tients who underwent hallux valgus surgery using modified Lapidus arthrodesis and Austin-Chevron osteotomy. Methods Retrospective cohort study conducted from 2018 to January 2020 with patients who underwent hallux valgus surgery using modified Lapidus arthrodesis and Austin-Chevron osteotomy with a minimum 1-year follow-up. The analysed radiographic variables were pre- and postoper-ative intermetatarsal angle, hallux valgus angle, and tibial sesamoid position. Functional outcomes were assessed using the AOFAS score. Results 78 patients were included. No statistically sig-nificant differences were found in the measurement of the intermetatarsal angle by surgical procedure (p=0.367). Statistically significant differences were found in the measurement of the hallux val-gus angle and tibial sesamoid position according to the surgical procedure (p=0.010 and p=0.000). Statistically significant differences were found for the AOFAS score by surgical procedure (p=0.032) and for the AOFAS score by tibial sesamoid position (p=0.035); R=-0.245). Conclusion The modified Lapidus procedure corrects the coronal and axial plane deformity in hallux valgus, resulting in better functional and radiographic outcomes than the conventional Austin-Chevron procedure. (AU)

Positioning of the metaglene in reverse shoulder arthroplasty: deltopectoral versus anterosuperior approach: a prospective randomized trial.

BACKGROUND: The primary objective of this study was to determine whether there are differences in metaglene positioning related to the approach used (deltopectoral vs. anterosuperior) in primary reverse shoulder prosthesis (reverse shoulder arthroplasty) implantation. The hypothesis was that there would be no differences in metaglene positioning between the 2 approaches. METHODS: A prospective randomized trial was designed to evaluate metaglene positioning in primary reverse shoulder arthroplasty. The patients included were allocated to either the deltopectoral approach (group I) or the anterosuperior approach (group II). Glenosphere overhang and glenosphere tilt were assessed using the methods described by Lévigne et al, Simovitch et al, and Kempton et al, and the beta angle was assessed as described by Maurer et al. The functional outcome was assessed with the Constant score at 2 years' follow-up. Scapular notch development and complication rates were also recorded. RESULTS: A total of 98 patients (77 women and 21 men) were randomized and allocated to group I (49 patients) or group II (49 patients). The mean age of the patients was 74.4 years (standard deviation, 6.3 years). Glenosphere overhang did not show significant differences between groups (6.5 mm in group I vs. 6.1 mm in group II by the Lévigne method, P = .482; 2.2 mm in group I vs. 2.1 mm in group II by the Simovitch method, P = .08). Glenosphere tilt was significantly different between groups (94.6° in group I vs. 86.8° in group II by the Lévigne method, P < .001; 125.9° in group I vs. 119.4° in group II by the Kempton method, P = .002). This was also the case for the prosthesis-scapular neck angle (94.6° in group I vs. 86.8° in group II, P < .001). Moreover, the postoperative beta angle was significantly different between groups (78.6° in group I vs. 73.8° in group II, P = .001). No significant differences were noted in terms of functional outcomes as measured with the Constant score (P = .16). No significant differences between groups were noted relative to scapular notch development and the overall complication rate. DISCUSSION: The deltopectoral and anterosuperior approaches do not differ relative to the craniocaudal positioning of the metaglene, but a slight superior tilt can be expected when using the anterosuperior approach. Both approaches yield comparable functional outcomes, scapular notch development, and complication rates at 2 years' follow-up.

Inestabilidad femoropatelar. Controversia y evidencia / Patellofemoral instability. Controversy and evidence

La inestabilidad rotuliana se debe a una alteración del mecanismo extensor de la rodilla, que involucra a diferentes estructuras anatómicas. La anamnesis, la exploración física y las pruebas complementarias son cruciales para determinar el manejo adecuado. Una las estructuras anatómicas más importantes es el ligamento patelofemoral medial (LPFM), siendo su reconstrucción la técnica quirúrgica más empleada para resolver el problema de la inestabilidad. Existen diversas formas de realizar la reconstrucción del LPFM y se pueden añadir otros gestos quirúrgicos según las alteraciones anatómicas del paciente.(AU)

Patellofemoral instability is due to a disorder of the knee extensor mechanism which involves several anatomic structures. Medical history, clinical examination and radiological assessment are essential to determine the right handling. One of the most important anatomic structures is the medial patellofemoral ligament (MPFL), and its reconstruction is the most practiced surgical technique to solve the instability problem. There are different options to carry out the MPFL reconstruction and some other surgical options can be used depending on the anatomic alterations of the patient.(AU)

Relación entre delirium postoperatorio y mortalidad tras la cirugía de fractura trocantérica en el paciente anciano / Relationship between postoperative delirium and mortality after trochanteric fracture surgery in elderly patients

INTRODUCCIÓN: El delirium postoperatorio en el paciente anciano con fractura trocantérica se ha relacionado con la mortalidad postoperatoria. OBJETIVO: Determinar los factores de riesgo asociados al delirium postoperatorio del paciente anciano con fractura trocantérica y la relación de éste con la mortalidad postoperatoria. MATERIAL Y MÉTODO: Estudio de cohortes histórico en el que se analizan los factores de riesgo para la aparición de delirium postoperatorio y su relación con la mortalidad postoperatoria en 264 pacientes intervenidos de fractura trocantérica. RESULTADOS: Se ha encontrado asociación estadística significativa entre la aparición de delirium postoperatorio e insuficiencia renal crónica (p = 0,01), demencia (p = 0,000) y una edad superior a 80 años (p = 0,016). Se encontró asociación estadística significativa entre delirium postoperatorio y mortalidad tras el alta hospitalaria, tanto en el primer mes tras la cirugía (p = 0,003 RR 1,11 IC 95% 1,01-1,23), como durante el primer año tras la misma (p = 0,000 RR 1,46 IC 95% 1,17-1,81). Sin embargo, no se encontró asociación estadística significativa entre el delirium postoperatorio y la mortalidad intrahospitalaria (p = 0,1). CONCLUSIÓN: La presencia de delirium postoperatorio en el paciente anciano intervenido de fractura trocantérica podría aumentar el riesgo de fallecimiento durante el primer año tras el alta hospitalaria

INTRODUCTION: Postoperative delirium in the elderly patient with trochanteric fracture has been associated with postoperative mortality. Objective: To determine the risk factors associated with postoperative delirium atfer trochanteric surgery in elderly patients. MATERIAL AND METHODS: Retrospective cohort study was designed, analyzing delirium risk factors and postoperative mortality in 264 elderly patients operated from trochanteric hip surgery. RESULTS: We reported statistical association between the happening of delirium and also and chronic renal failure (p = 0,01), dementia (p = 0,000), age over 80 years (p = 0,016). We reported statistical association between postoperative delirium and mortality after discharge within the first month after surgery (p = 0,003 RR 1,11 IC 95% 1,01-1,23) and within the first year after surgery (p = 0,000 RR 1,46 IC 95% 1,17-1,81). No statistical association was reported difference between postoperative delirium and intrahospitalary mortality (P = 0,1). CONCLUSION: Postoperative delirium an elderly patient during the stay in the hospital due to a trochanteric hip fracture would increase the risk of mortality after the discharge during the first year after surgery

Fibular-Lengthening Osteotomy in Patient with Progressive Valgus Deformity After an Ankle Fracture.

BACKGROUND The fibular fracture requires an anatomical reduction. When a malunion occurs, it can lead to a valgus deformity with an opening of the ankle mortise. CASE REPORT This case deals with a 23-year-old patient with pain and limited movement in the right ankle, caused by a fracture healed in an incorrect position, with shortening of the fibula and progressive displacement of the valgus, after surgery 12 months earlier for an ankle fracture. The patient underwent a corrective procedure consisting of extemporaneous lengthening of the fibula, with interposition of autologous bone graft and fixation using a compression plate. Six months after surgery, the patient did not present pain or limited movement, and was able to return to his habitual sporting activity. CONCLUSIONS Fibular-lengthening osteotomy is a procedure indicated for patients with malunion fracture of the distal fibula, with shortening and progressive valgus deformity. This surgery allows the restoration of the joint surface, reduces stress on the cartilage and prevents the development of arthropathy of the ankle.

Lesiones del ángulo posterolateral de la rodilla / Posterolateral corner injuries of the knee

El ángulo posterolateral (APL) de la rodilla presenta una anatomía compleja que permite mantener la estabilidad frente al varo, la rotación externa y la traslación posterior. Las lesiones del APL suelen pasar desapercibidas. Se relacionan con accidentes de tráfico y deportivos. La exploración física resulta fundamental en el diagnóstico. La gravedad de la lesión determina el tipo de tratamiento, conservador o quirúrgico. El tratamiento quirúrgico se asocia a una alta incidencia de complicaciones, como la artrofibrosis y la pérdida de movilidad

The posterolateral corner of the knee has a complex anatomy that allows maintaining stability against varus, external rotation and posterior translation. These injuries usually go unnoticed. They are related to traffic accidents and sports. The physical examination is fundamental in the diagnosis. The severity of the injury determines the type of treatment, conservative or surgical. Operative treatment is associated with a high incidence of complications, such as arthrofibrosis and loss of mobility

Impacto de la analgesia multimodal en los programas de recuperación rápida en artroplastia total de cadera: Estudio de Cohortes prospectivo / Impact of multimodal analgesia in "Fast-Track" programs in total hip arthroplasty: Prospective cohort study

Objetivo: Evaluar el dolor a las 24h de la ATC utilizando dos protocolos analgésicos establecidos con el servicio de Anestesiología mediante el EVA y su relación con el tiempo de hospitalización. Material y método: Estudio de cohortes prospectivos entre 2017 y 2018. Criterios de inclusión: ATC por coxartrosis sin intervenciones previas. Se evaluó el dolor a las 24h mediante EVA según dos protocolos analgésicos: Protocolo A (1 g/100ml paracetamol IV + 2g/5ml metamizol IV cada 8 h + 50mg/2ml dexketoprofeno IV a demanda) y Protocolo B (50mg tramadol + 50mg dexketoprofeno en 500 ml de suero a 60 ml/h cada 8h + 1 g/100 ml paracetamol IV cada 6h). Resultados: En los pacientes del protocolo A, el valor medio del EVA fue 5,9 ± 2,2 puntos (0-10). En los pacientes del protocolo B, el valor medio del EVA fue 4,37 ± 2,6 puntos (0-10). Disminución media del dolor en 1,53 puntos (P=0,001). El tiempo medio de hospitalización fue de 4,3 ± 1,7 (1-12) días. No hubo diferencias en el tiempo de hospitalización entre grupos (P=0,221). Conclusiones: Los pacientes intervenidos de ATC con el protocolo B obtienen una mejor satisfacción del dolor a las 24h, sin repercutir en la hospitalización

Objetives: Evaluate postoperative pain at 24 hours after THA using two analgesic protocols established with the anestesiologists using the EVA score and its relationship with the time of stay in hospital. Material and Method: Prospective cohorts study from 2017 to 2018. Inclusion criteria: THA for hip osteoarthritis without previous surgery. We evaluated the postoperative pain at 24 hours after THA using EVA in base of two analgesic protocols: A protocol (1 g/100 ml paracetamol IV alternating 2g/5ml metamizol IV each 8 hours plus 50mg/2 ml dexketoprofen IV a demand) and B Protocol (50 mg tramadol alternating 50 mg dexketoprofen administered in 500 ml saline serum at 60 ml/h each 8 hours plus 1 g/100 ml paracetamol IV each 6h). Results: In patients of A protocol, the mean EVA score was 5,9 ± 2,2 points (0-10) while in patients of B protocol, the mean EVA score was 4,37 ± 2,6 points (0-10), with a mean descrease of pain in 1,53 points (P=0,001). The mean days of hospitalization was 4,3 ± 1,7 (1-12) days, without no statistical differences between both groups (P=0,221). Conclusions: Patients operated of THA gets better points in EVA score using B protocol without that affect in the time of stay in hospital