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Total Elbow Arthroplasty and Antegrade Posterior Interosseous Flap for Infected Posttraumatic Arthritis with an Active Fistula. A Rationale for Comprehensive Treatment. Case Report.

The indication for total elbow arthroplasty (TEA) for primary and posttraumatic elbow arthritis has increased, however, its indication after infection remains elusive. Wound closure about the elbow increases the challenge of treating a previously infected elbow, often necessitating soft tissue coverage with local or regional flaps. We present a 75-year-old male patient with an elbow infection following a failed complex intraarticular fracture open reduction and internal fixation of the distal humerus. Initially, he presented with severe functional impairment and pain, also with an active fistula with serous exudate, whose culture was positive for Cutinebacterium acnes. Septic hardware loosening, and septic nonunion with intraarticular involvement of the left elbow was diagnosed. The patient underwent hardware removal, fistulectomy, serial irrigation and debridement and a pedicled antegrade posterior interosseous artery (PIA) flap on staged surgical treatment. Finally, after ruling out infection persistence, a TEA was performed. We aim to report the outcome of a patient treated with a TEA in the context of a previously infected elbow with soft tissue coverage with an antegrade PIA flap. Comprehensive treatment must be done in an appropriate manner, to obtain an expedited and desirable outcome.

Identification of high-risk COVID-19 patients using machine learning.

The current COVID-19 public health crisis, caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), has produced a devastating toll both in terms of human life loss and economic disruption. In this paper we present a machine-learning algorithm capable of identifying whether a given patient (actually infected or suspected to be infected) is more likely to survive than to die, or vice-versa. We train this algorithm with historical data, including medical history, demographic data, as well as COVID-19-related information. This is extracted from a database of confirmed and suspected COVID-19 infections in Mexico, constituting the official COVID-19 data compiled and made publicly available by the Mexican Federal Government. We demonstrate that the proposed method can detect high-risk patients with high accuracy, in each of four identified clinical stages, thus improving hospital capacity planning and timely treatment. Furthermore, we show that our method can be extended to provide optimal estimators for hypothesis-testing techniques commonly-used in biological and medical statistics. We believe that our work could be of use in the context of the current pandemic in assisting medical professionals with real-time assessments so as to determine health care priorities.

Transplant trends in Mexico during the COVID-19 pandemic: Disparities within healthcare sectors.

Healthcare systems worldwide were challenged during the COVID-19 pandemic. In Mexico, the public hospitals that perform most transplants were adapted to provide care for COVID-19 patients. Using a nationwide database, we describe the first report of the impact of COVID-19 and related transplantation healthcare policies in a middle-income country by comparing statistics before and during the pandemic (pre-COVID: March 2019-February 2020 vs. COVID era: March 2020-February 2021) and by type of institution (public vs. private). The global reduction in transplantation was higher in public institutions compared with private institutions, 89% versus 62%, respectively, p < .001. When analyzing by organ, kidney transplantation decreased by 89% at public versus 57% at private, p < .001; cornea by 88% at public versus 64% at private, p < .001; liver by 88% at public versus 35% at private, p < .001; and heart by 88% in public versus 67% at private institutions, p = .4. The COVID-19 pandemic along with the implemented health policies were associated with a decrease in donations, waiting list additions, and a decrease in transplantation, particularly at public institutions, which care for the most vulnerable.

Análisis tomográfico de la alineación del retropié en pacientes con coaliciones tarsianas / A computed tomography assessment of hindfoot alignment in patients with tarsal coalitions

Introducción: El objetivo de este estudio es describir la morfología del retropié mediante cortes coronales con tomografía com-putarizada en pacientes con coaliciones tarsianas. materiales y métodos: Se incluyeron 85 pies de 78 pacientes de entre 9 y 17 años. Fueron divididos en 3 grupos: 1) grupo de control (n = 29), 2) con coaliciones calcáneo-escafoideas (CCE) (n = 31) y 3) con coaliciones astrágalo-calcáneas (CAC) (n = 25). Dos observadores valoraron cinco medidas: Inftal-Suptal, Inftal-Hor, Inftal-Supcal, Suptal-Infcal y el ángulo astrágalo-calcáneo (AAC). Resultados: Los grupos no presentaron diferencias en la distribución por edad y sexo. Los pacientes con coaliciones tarsianas tuvieron valores significativamente superiores en todas las mediciones comparados con el grupo de control (p <0,05 Kruskall-Wallis/ANOVA). Las mediciones del AAC en los pacientes con CCE y CAC fueron significativamente superiores a las del grupo de control (10,09 ± 4,60; 17,77 ± 11,28 y 28,66 ± 8,89, respectivamente, p <0,0001). La distribución del AAC fue muy variable en los pacientes con CCE, mientras que, en la mayoría del grupo CAC, tuvo un patrón de alineación en valgo. No hubo una correlación directa entre los valores del AAC e Inftal-Hor (Spearman 0,27013; p = 0,1916). Conclusiones: En los pacientes con coaliciones tarsianas, la orientación del valgo del retropié suele estar aumentada. La magnitud de esta deformidad es mayor en pacientes con CAC, mientras que, en aquellos con CCE pueden manifestarse con una gran variabilidad. El aumento del valgo del retropié no implica necesariamente un aumento de la inclinación de la articulación subastragalina, por lo que esta última debe evaluarse por separado en la planificación preoperatoria. Nivel de Evidencia: III

Background: The aim of this study is to analyze the hindfoot alignment with computed tomography (CT-scan) in patients with tarsal coalitions. Materials and Methods: Eighty-five patients (78 feet) between 9 and 17 years of age were included and divided into 3 groups: A) without coalitions (control group, N 29 ), B) with calcaneal-navicular coalitions (CNC group, N 31), and C) with talo-calcaneal coalitions (TCC group, N 25). Five measurements were assessed: Inftal-Suptal, Inftal-Hor, Inftal-Supcal, Suptal-Infcal, and Talo-calcaneal angle (TCA). Results: Demographic data revealed no differences between groups with respect to patient's age and sex (p = 0.3630 and 0.2415 respectively). Patients with tarsal coalitions presented significantly higher values ​​in all measurements compared to the control group (p = <0.05 Kruskall-Wallis / ANOVA). TCA measurements in the patients with CNC and TCC were significantly superior to the control group (10.09 ± 4.60, 17.77 ± 11.28 and 28.66 ± 8.89 respectively, p = <0.0001). TCA distribution in the patients with CNC presented great variability, while group 3 (TCC) presented mostly a valgus alignment pattern. We did not find a direct correlation between the TCA and Inftal-Hor values ​​(Spearman 0.27013, p = 0.1916). Conclusion: Patients with tarsal coalitions show an increased valgus orientation of the hindfoot. The deformity is greater in patients with TCC, while in those with CNC demonstrated a great variability. The increase in the hindfoot valgus does not necessarily indicate an increase in the inclination of the subtalar joint, so the latter must be evaluated separately at the time of preoperative planning. Level of Evidence: III

Medial Epicondyle Fractures: Current Practices and Preferences Between SLAOTI Members (Sociedad Latinoamericana de Ortopedia y Traumatología Infantil).

BACKGROUND: Medial epicondyle fractures represent up to 20% of elbow fractures in children and adolescents. There is a growing body of literature to support surgical fixation for displaced fractures. However, controversy regarding imaging modality for displacement measurement and surgical indications remain controversial. The purpose of this survey was to gauge Latin American surgeons' practices and preferences for the evaluation and treatment of medial epicondyle fractures. METHODS: A web-based survey containing 19 questions was distributed to active members of SLAOTI (Sociedad Latinoamericana de Ortopedia y Traumatología Infantil) in November 2018. The survey elicited information regarding surgeon demographics, evaluation methods, the factors involved in the decision to perform surgery, and their experience in cases of symptomatic nonunion. Categorical variables were summarized using frequencies and proportions. Analysis of associations between surgeon demographics and treatment preferences were carried out. RESULTS: A total of 193 out of 354 completed questionnaires were returned (54% response rate). In total, 74% of the participants (142/193) favored radiographs for the evaluation of the fracture displacement, and 25.4% (49/193) added a computed tomography scan for a more detailed evaluation. The majority of respondents (48.2%) would consider a 5 mm displacement as the cutoff for surgical treatment, 21.8% 2 mm, 20.7% 10 mm, and 9.3% 15 mm. There were no differences between the experience of the participants, academic versus private setting, or training regarding surgical/nonsurgical management. CONCLUSIONS: There are significant differences in opinions between SLAOTI members as to the optimal management of medial epicondyle fractures. Implications of disagreement in evaluation and treatment support the need for multicenter prospective studies to develop evidence-based guidelines for the management of this fracture. LEVEL OF EVIDENCE: Level V-expert opinion. Cross-sectional electronic survey.

Complex Clubfoot Treatment With Ponseti Method: A Latin American Multicentric Study.

BACKGROUND: Complex clubfoot is a term used to describe those feet that present after treatment with a short first metatarsal, severe plantar flexion of all metatarsals, rigid equinus, and deep folds through the sole of the foot and above the heel. Ponseti has described a modification of his original technique for the treatment of the deformity. Few series have reported the treatment outcomes of this group of patients. The purpose of this study is to analyze mid-term results and complications of a large multicenter cohort. METHODS: Patients with complex clubfoot treated at 6 tertiary-care institutions with a minimum of 1-year follow-up were retrospectively analyzed. Demographic data, previous treatment, number of casts, Achilles tenotomy, recurrences, complications, and additional procedures were documented. The patients were clinically evaluated at the time of presentation, after treatment, and at the last follow-up according to the Pirani score. All variables had a nonparametric distribution and are thus described as median (interquartile range (IQR), minimum-maximum). A comparison between the variables was performed using a Mann-Whitney U test, the change within each group was performed with a Wilcoxon-designated range test. A P-value <0.05 was used to indicate statistical significance. RESULTS: One hundred twenty-four feet (79 patients) were evaluated. The median age at initial treatment was 7 months (IQR, 15; min-max, 1 to 53 mo). The mean follow-up was 49 months (IQR, 42; min-max, 12 to 132 mo). A median of 5 casts (IQR, 5; min-max, 3 to 13) was required for correction. Percutaneous tenotomy of the Achilles tendon was performed in 96% of the feet. One hundred twenty-two feet (98%) were initially corrected; 2 feet could not be corrected and required a posteromedial release. The Pirani score improved significantly from a pretreatment mean of 6 points (IQR, 1; min-max, 4.5 to 6) to 0.5 (IQR, 0.5; min-max, 0 to 2.5) at the last follow-up (P <0.001). Seven feet (6%) presented minor complications related to casting. Relapses occurred in 29.8% (37/124). In this subgroup, the number of casts required at initial treatment was higher (6; IQR, 5; min-max, 1 to 12 vs. 4 IQR, 4; min-max, 1 to 13; P<0.001), and follow-up was significantly longer (62 mo; IQR, 58; min-max, 28 to 132 vs. 37 mo; IQR, 48, min-max, 7 to 115; P<0.001). CONCLUSIONS: Ponseti method is safe and effective for the correction of complex clubfeet. Early diagnosis and strict adherence to the Ponseti principles are key to achieve deformity correction. Patients with complex clubfoot require frequent follow-up because of a higher recurrence rate. LEVEL OF EVIDENCE: Level III-therapeutic study.

Osteotomía de la tuberosidad anterior de la tibia en adolescentes y adultos jóvenes: resultados funcionales y complicaciones / Anterior tibial tubercle osteotomy in adolescents and young adults: functional results and complications

Introducción: La osteotomía de la tuberosidad anterior de la tibia (O-TAT) es una técnica quirúrgica que permite restablecer la alineación distal de la rótula en pacientes esqueléticamente maduros. Los objetivos de este estudio fueron evaluar los resultados funcionales y analizar factores que influyeron en el desarrollo de complicaciones. Materiales y Métodos: Se analizaron retrospectivamente pacientes con O-TAT tratados entre 2008 y 2016. Se documentaron datos demográficos y clínicos. Los resultados fueron evaluados según las escalas de Kujala y Tegner-Lysholm, y las complicaciones, con una adaptación de la clasificación de Clavien- Dindo. Resultados: Se analizaron 33 O-TAT en 29 pacientes (17 mujeres). Mediana de la edad: 18 años (RIC 2, mín.-máx. 14-39). Mediana de seguimiento: 49 meses (RIC 2, mín.-máx. 12-115). Mejoría en las escalas de Kujala y Tegner-Lysholm de 61 y 61,5 a 94 y 92,3, respectivamente (p = 0,001). La mediana de tiempo de consolidación fue de 8 semanas. Hubo 9 complicaciones (27%): 1 grado II (infección superficial) y 8 grado III (artrofibrosis, fracturas de tibia y fracturas de TAT, n = 2). La tasa de complicaciones fue más alta en los pacientes sometidos a desinserción de la TAT (51,5% vs. 11,1%, p = 0,029). Conclusiones: La O-TAT representa una técnica eficaz para tratar diversas patologías de la articulación patelofemoral en adolescentes y adultos jóvenes. Hubo complicaciones en un alto porcentaje de los procedimientos, sin que esto afectara el resultado final. El riesgo de complicaciones fue mayor en las osteotomías que requirieron desinserción de la TAT y la reconstrucción ligamentaria. Nivel de Evidencia: IV

Introduction: Tibial tubercle osteotomy (TTO) is a surgical approach that allows for the restoration of distal patellar alignment in skeletally mature patients. The objectives of this study were to evaluate functional results and to analyze the risk factors associated with complications. Methods: We carried out a retrospective analysis of patients subjected to a TTO between 2008 and 2016 and documented demographic and clinical data. Results were evaluated according to Kujala Anterior Knee Pain Scale and Tegner-Lysholm Knee Scoring Scale. Complications were evaluated with a modified Clavien-Dindo classification of Surgical Complications. Results: We evaluated 33 TTOs in 29 patients (17 women) with a median age of 18 years (IQR 2, range 14-39) and a median follow-up time of 49 months (IQR 2, range 12-115). The Kujala and the Tegner-Lysholm scoring improved from 61 and 61.5 to 94 and 92.3, respectively (p=0.001). Union was achieved at a median of 8 weeks. There were 9 complications (27%): a grade II complication (superficial infection) and 8 grade III complications (arthrofibrosis, tibial fractures, and anterior tibial tubercle fractures). Osteotomies in which tibial tubercle was completely detached had a significantly higher rate of complications (51.5% vs. 11.1%, p=0.029). Conclusions: TTO represents an effective approach for the treatment of several conditions of the patellofemoral joint in adolescents and young adults. In our series, a high percentage of the procedures presented complications, although they did not affect the final result. Osteotomies that involve complete detachment of the tubercle and those associated with ligament reconstruction have an increased risk of complications. Level of Evidence: IV

Fat Graft and Bone Wax Interposition Provides Better Functional Outcomes and Lower Reossification Rates Than Extensor Digitorum Brevis After Calcaneonavicular Coalition Resection.

BACKGROUND: Calcaneonavicular coalitions are the most common form of tarsal coalitions. The prefered treatment for symptomatic coalitions is surgical resection; however, there are no published studies that directly compare different interposition techniques. The purpose of the present study was to retrospectively compare pain relief, functional outcomes, and complications of children and adolescents who had a resection of a symptomatic calcaneonavicular coalition with interposition of fat graft, bone wax, or extensor digitorum brevis (EDB). METHODS: In total, 48 patients (56 ft) underwent calcaneonavicular coalition resection-interposition at 3 institutions from July 2008 to July 2015. There were 23 feet in group 1 (fat graft), 18 feet in group 2 (bone wax), and 15 feet in group 3 (EDB). Patient demographic characteristics were similar between all groups for age, sex, coalition type, and symptoms onset. Data concerning clinical and radiographic features, surgical technique, and postoperative complications were obtained from all available medical records. Radiographs were evaluated at last follow-up to determine coalition regrowth. Preoperative and postoperative pain was assessed with the visual analog scale, and function was assessed with use of the American-Orthopaedic-Foot and Ankle Society (AOFAS) score. RESULTS: Pain improved to an average of 0.5 in the first group (range, 0 to 6), 0 in group 2, and 1.7 in group 3 (range, 0 to 5) (P=0.033). The average AOFAS score improved from 59 (range, 33 to 71 points) to 98 points (range, 62 to 100 points) in the fat graft group, from 50 (range, 34 to 62 points) to 98 points (range, 88 to 100 points) in the bone wax group, and from 48 (range, 30 to 60 points) to 75 points (range, 70 to 95 points) in the EDB group (P<0.001). Eight feet had regrowth of the coalition on the postoperative radiographs: 1 in group 1 (4%), 1 in group 2 (6%), and 6 in group 3 (40%) (P=0.004). Five feet from the third group developed progressive symptoms. CONCLUSIONS: In our study, autogenous fat graft and bone wax interposition techniques provided better pain relief, gave better functional scores, and avoided more effectively coalition reossification than EDB technique. Further studies are required to evaluate safety of bone wax as an interposition material. LEVEL OF EVIDENCE: Level III-therapeutic.

Parecoxib Provides Analgesic and Opioid-Sparing Effects Following Major Orthopedic Surgery: A Subset Analysis of a Randomized, Placebo-Controlled Clinical Trial.

INTRODUCTION: Orthopedic surgeries are among the most common and most painful surgeries performed. A multimodal analgesic approach is recommended to reduce opioid consumption, provide effective pain relief, and improve outcomes following surgery. This study examined the efficacy and opioid-sparing effects of parecoxib following major orthopedic surgery. METHODS: This subset analysis of a large, multicenter, randomized, double-blind, placebo-controlled study of parecoxib examined treatment effects on postoperative pain severity, pain interference with function, opioid consumption, occurrence of opioid-related symptoms, safety, and patient satisfaction following major orthopedic surgery. RESULTS: Pain scores were significantly lower in the parecoxib group (n = 142) compared with placebo (n = 139) on day 2 (-22%; p < 0.001) and day 3 (-17%; p = 0.004). Pain interference with function scores were also significantly lower in the parecoxib group on day 2 (-32%; p < 0.001) and day 3 (-27%; p = 0.003) relative to placebo. Additionally, significantly less supplemental morphine was required in the parecoxib group relative to placebo through 24 h (-28%; p = 0.008) and 48 h (-33%; p < 0.001). Patients in the parecoxib group had a reduced risk of experiencing opioid-related symptoms including fatigue, drowsiness, inability to concentrate, confusion, nausea, constipation, and confusion on day 2 and/or day 3. Finally, more patients receiving parecoxib (42%) rated treatment as "excellent" compared to those receiving placebo (21%). CONCLUSIONS: These findings support the use of parecoxib for the management of pain following major orthopedic surgery.

Surgical Reconstruction for Talocalcaneal Coalitions With Severe Hindfoot Valgus Deformity.

INTRODUCTION: Coalition resection can restore motion, and improve pain in patients with talocalcaneal coalitions (TCCs) and an aligned foot. However, there is some debate regarding appropriate treatment of patients with associated valgus deformity. The purpose of this study was to present the outcomes and complications following surgical reconstruction, with or without coalition resection, in a series of patients with TCC and severe hindfoot valgus. METHODS: Thirteen consecutive patients (14 feet) were evaluated. Eleven patients were male. Mean age was 14 years. Mean follow-up was 43.8 months. Seven patients (8 feet) underwent simultaneous resection of the coalition and reconstruction, and 6 patients (6 feet) isolated reconstruction. The talar-first metatarsal angle, the talar-horizontal angle, and calcaneal pitch were measured preoperatively and postoperatively. Clinical evaluation was made according to the American Orthopaedic Foot and Ankle Society ankle-hindfoot score. RESULTS: All radiographic values improved significantly and were within the normal ranges postoperatively. The average American Orthopaedic Foot and Ankle Society ankle-hindfoot score had improved from 45 to 98 points (P<0.001) in the group of simultaneous resection and reconstruction, and from 60 to 92.3 points (P=0.002) in the group of isolated reconstruction. All patients were asymptomatic at the last follow-up and were satisfied with the procedure. DISCUSSION: Surgical reconstruction with or without coalition resection can achieve significant functional and radiographic improvements, and symptoms relief in selected patients with TCCs and severe valgus deformity. LEVEL OF EVIDENCE: Level IV-therapeutic study.

Guided growth with the tension band plate construct: a prospective comparison of 2 methods of implant placement.

INTRODUCTION: Since its introduction in 2007, the use of 8-plates has gained great popularity for the correction of diverse deformities in skeletally immature patients. In this study, we evaluate 2 different techniques of implant placement. METHODS: A consecutive series of patients with indication of guided growth around the knee (femur or tibia) were included in the study. Patients were randomly divided in 2 groups, with 8-plate inserted using technique as described by Stevens (group A) versus technique modified from Paley (group B). We analyzed operative time, radiation exposure, incision size, and intraoperative complications. Comparisons between groups were performed with a Mann-Whitney test. A 2-tailed P-value <0.05 was considered significant. RESULTS: We evaluated a total of 31 procedures in 18 patients (16 in group A and 15 in group B). Age and sex was similar in both groups (P=0.470 and 0.720). Operative time and radiation exposure was significantly lower in group B: 20 minutes (range, 11.37 to 29.30 min) versus 13.09 minutes (range, 9.31 to 25 min) (P 0.009), and 0.30 µGy (range, 0.10 to 1.30 µGy) versus 0.10 µGy (range, 0.00 to 0.70 µGy) (P=0.013), respectively. The incision size was also smaller in group B: 27 mm (range, 23 to 29 mm) versus 23 mm (range, 18 to 24 mm) (P=0.05). There were no intraoperative complications in any of the 2 groups. CONCLUSIONS: Modified technique for 8-plate placement seems to reduce operative time, radiation exposure, and incision size for guided growth around the knee. STUDY DESIGN: Level of evidence II-prospective randomized study.

Percutaneous trigger thumb release in children: neither effective nor safe.

BACKGROUND: Although percutaneous trigger thumb release has been extensively used in adults, the technique is not widespread in children. The purpose of this study was to evaluate the efficacy and safety of percutaneous trigger thumb release in the pediatric age group. METHODS: Twenty consecutive thumbs of 15 patients scheduled for surgical release of the A1 pulley were included in this cohort. Each patient received first the percutaneous release (PR) followed by an open release (OR) and served as self-controls. Thumb extension was assessed immediately before PR, after PR, and finally after OR, using a goniometer. Extent of the A1 pulley release, iatrogenic injury to the digital nerve and vessels, and flexor tendon laceration was assessed after PR. The distance between the PR and the digital nerve was measured in millimeters. Comparison between thumb extension after PR and OR was made using a paired t test. RESULTS: Preoperative range of motion averaged -45.2 ± 21.7 degrees loss of extension (range, -80 to -10 degrees), decreased to -4 ± 8 degrees loss of extension (range, -25 to 0 degrees) after PR, and to 0 degrees after OR. Clinically, release was complete in 14 cases (70%) and partial in 6 cases (30%). Once the thumb was approached, we confirmed that A1 pulley was completely cut in 4 cases (20%), to >75% in 2 cases (10%), and between 50% and 75% in the remaining 14 cases (70%). There were no neurovascular iatrogenic injuries. Mean distance between the needle and the digital nerve was 2.45 ± 0.9 mm (range, 1 to 4 mm). Lacerations to the flexor tendons were observed in 80% of the cases. CONCLUSIONS: We do not recommend PR in the pediatric thumb given the risk of neurovascular iatrogenic injury or incomplete A1 pulley release. LEVEL OF EVIDENCE: Level II therapeutic study-prospective comparative study.

Crecimiento longitudinal posnatal del primer metatarsiano / Longitudinal postnatal growth of the first metatarsal bone

Introducción: Si bien el crecimiento prenatal y posnatal del pie ha sido documentado hace varios años, el crecimiento longitudinal del primer metatarsiano en particular, no ha sido estudiado previamente. El objetivo del estudio es determinar el patrón de crecimiento longitudinal posnatal de este hueso y compararlo con el del pie y los huesos largos del miembro inferior. Materiales y Métodos: Mediante una búsqueda informatizada, se identificaron pacientes <18 años de edad con radiografías informadas como “normal” por el radiólogo. Se analizó una muestra de 886 pacientes divididos en 18 grupos según la edad (0-11 meses, 1 año, 2 años, etc.) y el sexo. El análisis de las imágenes se realizó con un software de imágenes Kodak Carestream PACS. Resultados: El largo promedio en el primer grupo fue de 19,91 mm (3,20; 15,22-25,62). El largo promedio en el último grupo fue de 66,13 mm (5,33; 52,50-77,18). La tasa de crecimiento anual fue de 2,71 mm. La edad promedio al momento del cierre de la fisis fue de 14.85 años (± 1.64) para los varones y 14.77 años (± 3.63) para las niñas. Conclusión: El crecimiento del primer metatarsiano acompaña el crecimiento longitudinal del pie, pero no el de los huesos largos del miembro inferior. Las curvas de crecimiento del primer metatarsiano descritas en este artículo pueden ser aplicadas en patologías que afectan el desarrollo del pie o que requieren cirugía de corrección sobre el primer metatarsiano, o se las puede emplear como estándar de referencia en futuros estudios. Nivel de Evidencia: III.

Background: While prenatal and postnatal growth of the foot has been documented several years ago, longitudinal growth of the first metatarsal has not been previously evaluated. The aim of the study is to determine the postnatal longitudinal growth pattern of this bone and compare it with the foot and lower limb long bones. Methods: Through a computerized image search, we identified patients <18 years old with radiographs reported as “normal” by the radiologist. A sample of 886 patients was divided into 18 groups according to age (0-11 months, 1 year, 2 years, etc.) and sex. Analysis was performed using Kodak Carestream imaging software PACS. Results: The average length in the first group was 19.91 mm (3.20, 15.22-25.62). The average length in the last group was 66.13 mm (5.33, 52.50-77.18). Annual growth rate was 2.71 mm. The average age at the time of physeal closure was 14.85 years (± 1.64) for boys and 14.77 years (± 3.63) for girls. Conclusion: Longitudinal growth of the first metatarsal mimics the growth of foot but not that of the long bones of the lower limb. Growth curves described in this article can be applied to conditions that affect foot development or require corrective surgery on the first metatarsal, as well as a standard reference in future studies. Level of Evidence: III.

Precisión de la resonancia magnética para la medición de la distancia TT-TG en adolescentes / MRI measurement of the TT-TG distance in adolescents

Introducción: La distancia TT-TG representa la medición radiográfica del vector del cuádriceps. Se utiliza en pacientes con patología patelofemoral y se obtiene generalmente con tomografía computada (TAC). Objetivos: 1) Correlacionar las mediciones de la distancia TT-TG realizadas con tomografía computada (TAC) y Resonancia Magnética (RMN). 2) Analizar la variabilidad inter e intraobservador en un grupo de pacientes adolescentes evaluados con RMN. Métodos: 15 pacientes (edad media, 16,7 años) con diagnóstico de inestabilidad patelofemoral fueron evaluados con TAC y RMN. Usando el software PACS se midió la distancia TT-TG con ambos métodos y correlacionamos los resultados. Se calculó el coeficiente de correlación de Pearson. En un segundo grupo de 50 pacientes (edad media, 16 años), tres observadores evaluaron de manera independiente, una serie de 50 Resonancias Magnéticas. Se utilizó un modelo ANOVA de efectos mixtos para calcular los coeficientes de correlación. Este procedimiento se aplicó a los tres observadores (variabilidad inter-observador) y a la prueba­reprueba (variabilidad intra-observador). Un valor p <0.05 a dos colas se consideró estadísticamente significativo. Resultados: Existe una excelente correlación de la distancia TT-TG medida por TAC y RMN (0,984, p <0,001), y una excelente reproducibilidad inter e intraobservador en las mediciones por RMN (0.94 p<0.001, CI 95 por ciento: 0.91-0.97 y 0.96 p<0.001, CI 95 por ciento: 0.93-0.98 respectivamente). Conclusiones: La medición de la distancia TT-TG por RMN es un método fiable y reproducible para la evaluación de alineación distal del aparato extensor en adolescentes. Tipo de Estudio: Diagnóstico. Nivel de evidencia: III.