Hip fracture in centenarians, what can we expect? / Fractura de cadera en pacientes centenarios, ¿qué podemos esperar?

INTRODUCTION: Hip fractures in centenarians are rising due to the increase in life expectancy. The objective of this study is to compare the characteristics of centenarians' hip fracture with a younger control group, and to analyze whether there are differences in terms of in-hospital mortality, complications, and short-medium-term survival between them. MATERIAL AND METHODS: Retrospective case-control study, with a series of 24 centenarians and 48 octogenarians with a hip fracture. Comorbidities and Charlson index, surgical delay, complications and mortality during admission, and hospital stay were analyzed. At discharge, early mortality, survival after one year, and return to previous functionality were assessed. RESULTS: No significant differences were found in baseline parameters or comorbidities (P>.05), and the type of was a woman with an extracapsular fracture. Hospital stay was longer in the control group (P=.038), and the most frequent complication was anemia requiring transfusion (23/24 in centenarians, P<.0001). In-hospital mortality and accumulated at one year in the centenarians was 33 and 67%, respectively, compared to 10 and 25% in the octogenarians (P=.017, OR=4.3 [1,224-15,101] and P=.110). Only 2 centenarian patients were able to walk again after the intervention, while in the control group 53.84% returned to the previous functional situation (P=.003). CONCLUSIONS: Compared to a control group of younger patients, in-hospital mortality and in the first year after a hip fracture is significantly higher in centenarians, and very few recover activity prior to the fracture.

Primary total hip arthroplasty for acetabular fractures in elderly patients. / Artroplastia total de cadera primaria en fractura de acetábulo en el paciente anciano.

INTRODUCTION: Life expectancy has risen, leading to an increase in acetabular fractures in fragile patients. Total hip arthroplasty with a reinforcement cage is a technically complex option, but allows fracture control and early mobilization. Our aim is to assess whether the use of Burch-Schneider cage in fragile patients with acetabular fractures allows immediate load stabilization without threatening the early survival of the arthroplasty. MATERIAL AND METHODS: Descriptive study of a series of 14 patients with acetabular fractures treated by a reinforcement cage associated with autologous bonegraft plus a cemented acetabular cup, and mobilization and bearing. Judet Letournel fracture types, surgical delay, and complications during admission were analyzed. Following hospital discharge we recorded the incorporation of grafts according to Gie's classification, presence of calcifications according to Brooker, consolidation of the fracture, loosening of implants and functional aspects according to the HHS and Merlé D'Aubigné Postel score. RESULTS: The most common fracture was both columns (6/14), with a surgical delay being of 11 days mean and 21,5 days of length of stay. One patient died after surgery. The mean follow-up was 34.4 months. All fractures healed and the bonegraft was incorporated in all cases. The mean HHS was 82 points and the Merle Score was 15/18. There were no complications related to arthroplasty. CONCLUSIONS: Total hip arthroplasty with Burch-Schneider cage on bonegraft and no added osteosynthesis is a good option of treatment of all types of displaced acetabular fractures in a fragile patient.

Outcomes of basicervical femoral neck fracture treated with percutaneous compression plate (PCCP).

INTRODUCTION: Basicervical femoral neck fracture is associated with high rates of failure due instability patterns, mainly collapse and rotational instability. The purpose of this study was to evaluate the clinical-radiological results of a group of patients with a bascervical proximal femoral fractures treated with Percutaneous Compression Plate (PCCP). MATERIAL AND METHODS: Among 5817 patients with a hip fracture who were admitted in our hospital from January 2005 to December 2017, 234 factures (4%) were diagnosed of basicervical femoral fracture. 30 of them were treated with a PCCP, 22 women and 8 men, mean age was 81.2 years (63-94). Demographic and perioperative variables were collected. The patients were followed up at 1, 3 and 6 months clinically and radiologically. RESULTS: There were no intra-operative complications and no conversions to open surgery. There was no early implant failure. No surgical wound infection was diagnosed. Crude mortality was 13% the first year and 87% were able to walk at the 6 months. The last follow-up x-rays revealed 97% fracture healing and the collapse at fracture site occurred in 4 hips. No instances of cut-out were observed. In one case, a fatigue failure of the lag screws of a PCCP plate was observed at 3 months from osteosynthesis. CONCLUSION: PCCP is an appropriated implant for basicervical femoral neck fractures.

Biomechanical behavior of retrograde intramedullary nails in distal femoral fractures.

Fractures of the distal femur affect three different groups of individuals: younger people suffering high-energy trauma, elderly people with fragile bones and people with periprosthetic fractures around previous total knee arthroplasty. Main indications of intramedullary nailing are for supracondylar fractures type A or type C of the AO classification. The main objective of the present work is to analyze, by means of FE simulation, the influence of retrograde nail length, considering different blocking configurations and fracture gaps, on the biomechanical behavior of supracondylar fractures of A type. A three dimensional (3D) finite element model of the femur from 55-year-old male donor was developed, and then a stability analysis was performed for the fixation provided by the retrograde nail at a distal fracture with different fracture gaps: 0.5 mm, 3 mm y 20 mm, respectively. Besides, for each gap, three nail lengths were studied with a general extent (320 mm, 280 mm and 240 mm), considering two transversal screws (M/L) at the distal part and different screw combinations above the fracture. The study was focused on the immediately post-operative stage, without any biological healing process. In view of the obtained results, it has been demonstrated new possibilities of blocking configuration in addition to the usual ones, which allows establishing recommendations for nail design and clinical practice, avoiding excessive stress concentrations both in screws, with the problem of rupture and loss of blocking, and in the contact of nail tip with cortical bone, with the problem of a new stress fracture.

Salvage of cephalomedullary nail cutout with the variable angle proximal femoral plate.

INTRODUCTION: Excellent results have been published in the treatment of the trochanteric fractures in the elderly with cephalomedullary nails or compression hip screws but not free of complications. The perforation of the lag screw through the superior cortex of femoral neck or head followed by rotation and varus collapse of the head-neck fragment, also known as cut-out, is one of them. Probably total hip arthroplasty is the most common solution, but there is no systematic technique for treatment. The objective of this study is to evaluate the results obtained in the treatment of this complication using a variable angle femoral plate. MATERIAL AND METHODS: This retrospective study concerns patients over 65 years with peritrochanteric fractures treated with cephalomedullary nail with cut-out failure solved by re-osteosyntesis with variable angle femoral plate between 1st January 2000 and 31 st December 2017. The series includes 29 patients, 26 women and 3 men with average age 87,3. Patients were followed up clinically and radiologically at regular intervals until fracture consolidation at least 9 months. RESULTS: No patients died at the first 9 months after surgery. Fracture mean consolidation has occurred in all patients in 14th weeks (6-20). Operative time was 93,2 minutes (62-129) including removal of nail. No intraoperative complications were observed. Five patients experienced medical complications and two had a superficial wound infection. The mean tip-apex distance (TAD) was 5mm (2-7mm). The neck-shaft angle was 127 degrees. The mean valgization achieved was 32 degrees (15-40). Only one patient needed a second revision surgery due to aseptic hip joint subluxation after 8 weeks of the surgery solved with total hip arthroplasty. CONCLUSIONS: The use of variable angle femoral plate in the cut-out treatment is an attractive option which allows the valgization of the fracture to virtually physiological limits and the placement of the cephalic screw in the most sutiable position with good outcomes and few complications.

Is the mortality higher in patients who have suffered a hip fracture? / ¿Es mayor la mortalidad en los pacientes que han sufrido una fractura de cadera?

BACKGROUND AND OBJECTIVE: The aim of this study is to value whether patients who have suffered a hip fracture have a higher mortality than expected. MATERIAL AND METHODS: A prospective, observational study was carried out where patients with hip fracture were collected as a sample over a year. The study included 284 patients and a minimum follow-up was 2 years. The mean age of these patients was 84.26 years, with 21.48% (61/284) males and 78.5% (223/284) females. Survival and previous diseases that affect mortality, as risk factors, were collected and analyzed using the Kaplan-Meier method and the Cox regression model. Actual mortality was compared with that expected according to the Charlson Comorbidity Index, adjusted for age. RESULTS: Previous pathology was the main mortality factor, with heart disease being the most significant (OR 1.817, CI95%: 1.048; 3.149). The real mortality at one year of the sample was 22.5%, while the estimated annual mortality according to the Charlson Comorbidity Index was 29.68% (CI95%:44,36-15). CONCLUSIONS: Hip fracture does not cause an increase in mortality according to the Charlson Comorbidity Index estimate.

Burch-Schneider ring associated with morselized bone allografts, survival and clinical outcomes after acetabular revision surgery. / Anillo de Burch-Schneider asociado a injerto óseo triturado, supervivencia y resultados clínicos en revisión acetabular.

INTRODUCTION AND OBJECTIVES: Acetabular revision surgery is a challenge due to the appearance of bone defects that make primary fixation of implants difficult when extracting loosened components. Reinforcement rings, such as Burch-Schneider (BS), have been shown to be allies in moderate or severe bone defects. The objective of the study is to evaluate the results and survival of these types of implants in acetabular revision surgery in the medium follow-up. MATERIAL AND METHODS: Retrospective study on a cohort of 64 patients (67 replacements) with BS rings associated with morselized bone allografts in a 2 years minimum follow-up. Data were collected regarding clinical outcomes, graft incorporation, implant mobilization, survival and complications. RESULTS: The mean follow-up was 5.06 years (R=2.2-12). The Merle scale improved from 8 points to 15 points at the end of follow-up (P<.0001) with 76.11% of good or excellent results. Reproduction of the anatomical centre of rotation was associated with a better result (P<.05). There was total or subtotal incorporation of the bone allograft in 97% of the patients, although this did not prevent a significant migration of the ring according to Gill criteria in 6 cases. We observed an overall survival of the implant for any cause of 93.4% at 5 years, and 84.6% at 10 years. CONCLUSIONS: The BS reinforcement ring shows good results in the medium and long term enabling anatomical reconstruction in revision surgery as well as replacement of the bone stock. These results are also comparable and are a vast improvement on other rings.

La importancia de la restauración de la línea articular en la revisión de la artroplastía total de rodilla. Índices funcionales, calidad de vida y supervivencia / The importance of the restoration of the joint line in revision total knee arthroplasty. Clinical indexes, quality of life and survival

Resumen: Introducción: La reproducción de la correcta línea articular podría ser un buen índice para la obtención de resultados satisfactorios en la cirugía protésica de rodilla, aunque en la cirugía de revisión no se ha estudiado ampliamente. Es necesaria la búsqueda de un método sencillo y reproducible para evaluar esos resultados. Material y métodos: Se realizó un estudio retrospectivo entre Enero del 2000 y Diciembre del 2013. Se implantaron 97 artroplastías totales de revisión de rodilla. El grupo de estudio lo conformaron 67 pacientes. Para la realización de nuestro trabajo se evaluó la línea articular según el método descrito por Hofmann A. La evaluación de los resultados clínicos incluyó las siguientes variables primarias: flexión, extensión, rango de movimiento, WOMAC, SF-36, KSS (Knee Society Score) y KSS funcional. Se estudió la supervivencia de las artroplastías. Resultados: Las variables de flexión, extensión y rango de movimiento postoperatorio se correlacionaron estadísticamente con esta medición. El KSS se relacionó estadísticamente en su vertiente articular con la restauración de la línea articular. Para el resto de escalas, SF-36 y WOMAC, las puntuaciones fueron más altas pero no se correlacionó con la significación aceptada. Conclusión: Ante estos resultados podemos afirmar que la restauración de la correcta línea articular mejora los resultados clínicos de la cirugía de revisión de rodilla.

Abstract: Introduction: The reproduction of the anatomical joint line could be a good index to obtain good results in knee prosthesis surgery, although in revision surgery has not been enough studied. A search for a simple and reproducible method is needed to review these results. Material and methods: A retrospective study was conducted between January 2000 and December 2013. A total of 97 total revision knee arthroplasties were implanted. Finally, the study group consisted of 67 patients. To perform our study, the joint line was evaluated according to the method described by Hofmann A. The evaluation of the clinical results included the following main variables: Flexion, extension, range of motion, WOMAC, SF-36, KSS (Knee Society Score) and functional KSS. The survival of the arthroplasties was studied. (p = 0.05). Results: The variables of flexion, extension and range of postoperative movement are statistically correlated with this measure. The KSS was statistically related in its joint aspect with the restoration of the joint line. For the other scales, SF-36 and WOMAC, the figures were higher but did not correlate with the accepted p. Conclusion: In view of these results, we can say that the restoration of the anatomical joint line improves the clinical results of revision total knee arthroplasty.

[The importance of the restoration of the joint line in revision total knee arthroplasty. Clinical indexes, quality of life and survival]. / La importancia de la restauración de la línea articular en la revisión de la artroplastía total de rodilla. Índices funcionales, calidad de vida y supervivencia.

INTRODUCTION: The reproduction of the anatomical joint line could be a good index to obtain good results in knee prosthesis surgery, although in revision surgery has not been enough studied. A search for a simple and reproducible method is needed to review these results. MATERIAL AND METHODS: A retrospective study was conducted between January 2000 and December 2013. A total of 97 total revision knee arthroplasties were implanted. Finally, the study group consisted of 67 patients. To perform our study, the joint line was evaluated according to the method described by Hofmann A. The evaluation of the clinical results included the following main variables: Flexion, extension, range of motion, WOMAC, SF-36, KSS (Knee Society Score) and functional KSS. The survival of the arthroplasties was studied. (p = 0.05). RESULTS: The variables of flexion, extension and range of postoperative movement are statistically correlated with this measure. The KSS was statistically related in its joint aspect with the restoration of the joint line. For the other scales, SF-36 and WOMAC, the figures were higher but did not correlate with the accepted p. CONCLUSION: In view of these results, we can say that the restoration of the anatomical joint line improves the clinical results of revision total knee arthroplasty.

INTRODUCCIÓN: La reproducción de la correcta línea articular podría ser un buen índice para la obtención de resultados satisfactorios en la cirugía protésica de rodilla, aunque en la cirugía de revisión no se ha estudiado ampliamente. Es necesaria la búsqueda de un método sencillo y reproducible para evaluar esos resultados. MATERIAL Y MÉTODOS: Se realizó un estudio retrospectivo entre Enero del 2000 y Diciembre del 2013. Se implantaron 97 artroplastías totales de revisión de rodilla. El grupo de estudio lo conformaron 67 pacientes. Para la realización de nuestro trabajo se evaluó la línea articular según el método descrito por Hofmann A. La evaluación de los resultados clínicos incluyó las siguientes variables primarias: flexión, extensión, rango de movimiento, WOMAC, SF-36, KSS (Knee Society Score) y KSS funcional. Se estudió la supervivencia de las artroplastías. RESULTADOS: Las variables de flexión, extensión y rango de movimiento postoperatorio se correlacionaron estadísticamente con esta medición. El KSS se relacionó estadísticamente en su vertiente articular con la restauración de la línea articular. Para el resto de escalas, SF-36 y WOMAC, las puntuaciones fueron más altas pero no se correlacionó con la significación aceptada. CONCLUSIÓN: Ante estos resultados podemos afirmar que la restauración de la correcta línea articular mejora los resultados clínicos de la cirugía de revisión de rodilla.

Factores pronósticos en la cirugía del síndrome del túnel carpiano / Prognostic factors in carpal tunnel syndrome surgerydj

Introducción: El síndrome del túnel carpiano es la neuropatía periférica más frecuente y afecta casi al 3% de la población general. Aunque los estudios electromiográficos se han convertido en el patrón oro para diagnóstico, en la actualidad existe controversia entre la correlación de los datos clínicos y electromiografía para su diagnóstico. Este trabajo tiene como objetivo el estudio de esta correlación, y determinar los posibles factores pronósticos en esta patología. Material y métodos: Se revisaron retrospectivamente a 139 pacientes intervenidos quirúrgicamente entre Enero de 1995 y Diciembre de 2008. A todos se les realizó preoperatoriamente un estudio electromiográfico donde se recogió latencia y velocidad de conducción motoras, velocidad de conducción sensitiva y exploración clínica, en especial los signos de Tinel y Phalen, con el fin de correlacionarlos con la sintomatología postoperatoria final. Para establecer si hubo o no diferencias estadísticamente significativas se determinaron mediante la T-Student y χ². Resultados: Preoperatoriamente existe una correlación clínica (p < 0.05) entre los signos clínicos de Tinel y Phalen con el grado electrofisiológico de compresión. Igualmente, existe correlación entre la persistencia de la clínica en el postoperatorio con la afectación de la latencia y velocidad de conducción motora objetivada en los estudios electrofisiológicos preoperatorios. Conclusión: Los estudios electrofisiológicos en el diagnóstico del síndrome del túnel carpiano poseen un valor añadido pronóstico con respecto al resultado final tras la cirugía.

Introduction: Carpal tunnel syndrome is the most frequent peripheral neuropathy and it affects nearly 3% of the general population. Although electromyography tests have become the gold standard for diagnosis, currently there is controversy between the correlation of clinical data and electromyography for diagnosis. The purpose of this work is to study this correlation and determine the possible prognostic factors in this pathology. Material and methods: 139 patients who underwent surgery were reviewed retrospectively between January 1995 and December 2008. All patients had an electromyography preoperatively to obtain motor conduction rate and latency, sensitive conduction rate and clinical examination, especially the Tinel and Phalen signs in order to correlate them with the final postoperative symptoms. In order to establish if there were statistically significant differences, these were determined through the T-Student and χ2. Results: Preoperatively, there is a clinical correlation (p < 0.05) between the Tinel and Phanel clinical signs with the compression electrophysiological grading. Likewise, there is a correlation between clinical persistence in the postoperative period with motor conduction rate and latency involvement specified in the preoperative electrophysiological tests. Conclusion: Electrophysiological tests in the diagnosis of carpal tunnel syndrome have an added prognostic value with regards to the final result after surgery.

[Prognosis factors in carpal tunnel syndrome surgery]. / Factores pronósticos en la cirugía del síndrome del túnel carpiano.

INTRODUCTION: Carpal tunnel syndrome is the most frequent peripheral neuropathy and it affects nearly 3% of the general population. Although electromyography tests have become the gold standard for diagnosis, currently there is controversy between the correlation of clinical data and electromyography for diagnosis. The purpose of this work is to study this correlation and determine the possible prognostic factors in this pathology. MATERIAL AND METHODS: 139 patients who underwent surgery were reviewed retrospectively between January 1995 and December 2008. All patients had an electromyography preoperatively to obtain motor conduction rate and latency, sensitive conduction rate and clinical examination, especially the Tinel and Phalen signs in order to correlate them with the final postoperative symptoms. In order to establish if there were statistically significant differences, these were determined through the T-Student and chi2. RESULTS: Preoperatively, there is a clinical correlation (p < 0.05) between the Tinel and Phanel clinical signs with the compression electrophysiological grading. Likewise, there is a correlation between clinical persistence in the postoperative period with motor conduction rate and latency involvement specified in the preoperative electrophysiological tests. CONCLUSION: Electrophysiological tests in the diagnosis of carpal tunnel syndrome have an added prognostic value with regards to the final result after surgery.