Endoscopic Calcaneoplasty in Haglund Disease: Surgical Technique, Clinical and Subjective Outcomes.

BACKGROUND: During the last decade, arthroscopic procedures have been replacing open techniques in Haglund disease treatment because of their considerable advantages. Endoscopic calcaneoplasty is a technique that allows resection of posterosuperior calcaneal exostosis and retrocalcaneal bursitis. The objective of this article was to describe this technique and report its clinical and subjective outcome. METHODS: A retrospective study was performed of consecutive patients undergoing endoscopic Haglund resection surgery between July 2014 and March 2020 at a single academic institution. All patients were surveyed in person about the level of pain (visual analog scale), its location (central, lateral, medial or diffuse), its relation with rest, or physical activity. Clinical evaluation was assessed using the hindfoot scale designed by the American Orthopedics Foot & Ankle Society AOFAS. RESULTS: In this study, 14 endoscopic calcaneoplasties were performed in 14 patients, with an average follow-up of 40 months. The visual analog scale score improved from a preoperative average value of 9.07 to 1.8 after surgery (P > .0001). The AOFAS scale rose from 38.7 before surgery to 94.6 postoperative (P > .0001). Good subjective results were observed in 12 patients (85.7%), and all of them would have surgery again. There were no wound complications or infections. No patient required reoperation. CONCLUSION: In this relatively small cohort, we found that endoscopic calcaneoplasty was associated with good clinical and subjective results with few complications.

[Women's role in Orthopedic Training programs: What Proportion Do They Represent Today?] / Las mujeres y la residencia de ortopedia y traumatología en Argentina: ¿Qué proporción representan hoy?

Introduction: The objective of the study was to analyze all orthopedics residency programs of Argentina and determine:1)The proportion of females; 2) Social and demographics differences between genders: 3) The factors that influence positively or negatively in female decision to choose orthopedics. Method: An observational and descriptive study was carried out in two phases. First phase: analyze the database of the "Argentine Orthopedic Association during the period 2016-2017. Second phase: a survey was developed and sent to all the orthopedic residents focus on demographics, social and job preferences questions. Results and conclusion: A total of 933 residents were included for analysis. 121 (13%) were female and 812 (87%) were male. We got back 259 survey responses. We found statistically significant differences in terms of marriage or in union: female (16%) vs male (42 %) (p< 0.001); paternity (23.3%) vs maternity (4.5%) (p< 0.001). We observed that female mainly prefer pediatrics, foot and ankle and hand, while the primary choice of men is arthroplasty and arthroscopy. Focus on women analysis, the three main reasons that led them to choose the orthopedics residency program were: avidity for manual work (59%), personal desire (56%) and positive experience in orthopedics during the university (56%). The negative factors that influence female to choose an orthopedic training program are mainly related with the idea of physical demand and a male predominant work environment. In Argentina, women represent only 13% of all the orthopedics residents and this number is similar to other international reports.

Introducción: El objetivo del estudio fue analizar las residencias ortopedia y traumatología en Argentina y determinar: 1) La proporción de mujeres; 2) Diferencias sociales y demográficas entre géneros: 3) Los factores que influyen positiva o negativamente en las mujeres al elegir ortopedia. Métodos: Se realizó un estudio observacional y descriptivo en dos fases. Primera fase: se analizó la base de datos de la "Asociación Argentina de Ortopedia y Traumatología¨ durante el período 2016-2017. Segunda fase: se desarrolló una encuesta, enfocada en cuestiones demográficas, sociales y laborales, y se envió a todos los residentes de ortopedia. Resultados y conclusión: Se incluyeron 933 residentes,121 (13%) eran mujeres y 812 (87%) eran hombres. Recibimos 259 (28%) respuestas de la encuesta. En las características demográficas encontramos diferencias estadísticamente significativas en términos de matrimonio o convivencia: mujeres (16%) vs hombres (42%) (p <0,001); paternidad (23.3%) vs maternidad (4.5%) (p <0.001). Observamos que las mujeres prefieren principalmente ortopedia infantil, pie y el tobillo y mano, mientras que la elección primaria de los hombres es la artroplastia y la artroscopia. Focalizándonos en las mujeres, las tres razones principales para elegir esta residencia fueron: gusto por el trabajo manual (59%), deseo personal (56%) y experiencia positiva en ortopedia durante la universidad (56%). Dentro de los factores disuasivos se relacionan principalmente con la idea de la gran demanda física y un ambiente de trabajo predominantemente masculino. En Argentina, las mujeres representan solo el 13% de todos los residentes de ortopedia y este número es similar a otros informes internacionales.

Tratamiento de la osteomielitis asociada a úlceras alrededor de la pelvis / Treatment of pressure ulcer-related pelvic osteomyelitis

Introducción: El tratamiento de la osteomielitis crónica asociada a úlceras alrededor de la pelvis es complejo y multidisciplinario. Un tratamiento antibiótico, dirigido a más de un microorganismo, sumado a la cirugía permitiría disminuir la recurrencia de la infección. El objetivo de este estudio fue analizar los resultados en pacientes con osteomielitis crónica asociada a úlceras por presión, con gran defecto de cobertura alrededor de la pelvis, tratados con desbridamiento del lecho y un colgajo para el defecto de cobertura. Materiales y Métodos: Se realizó un estudio descriptivo, retrospectivo, basado en los datos de las historias clínicas de pacientes que requirieron cobertura quirúrgica de úlceras por presión, entre octubre de 2010 y febrero de 2017. Los pacientes fueron tratados con un procedimiento en dos tiempos quirúrgicos: desbridamiento y luego colgajo de cobertura del defecto remanente. Resultados: Se trataron 27 úlceras (9 sacras, 13 isquiáticas y 5 trocantéricas) en 15 pacientes (edad promedio 44. 9 años [rango 22-81]). Tres úlceras desarrollaron un solo germen, en el resto, los cultivos fueron polimicrobianos. Se administraron antibióticos intravenosos durante un mínimo de 4-6 semanas. Los valores iniciales de eritrosedimentación y proteína C reactiva ultrasensible fueron 72 mm/h y 55 mg/l, respectivamente, y disminuyeron a 49 mm/h y 20 mg/l, respectivamente, a los 3 meses. Conclusiones: Nuestro protocolo acorta los tiempos de tratamiento, ya que no se espera a terminar la antibioticoterapia para realizar el colgajo. Consideramos que la cobertura inmediata del defecto de partes blandas permite controlar el acceso de nuevos microorganismos a la región afectada. Así hemos obtenido buenos resultados con una baja tasa de recidiva comparada con la de otras series. Nivel de Evidencia: IV

Introduction: Treatment of chronic osteomyelitis secondary to pressure ulcers around the pelvis is complex and multidisciplinary. Antibiotic treatment, usually aimed at more than one microorganism, in addition to surgery would reduce the recurrence of infection. The goal of this study was to analyze results in patients with pressure ulcer-related osteomyelitis around the pelvis, being treated with debridement and a flap to cover the soft tissue defect. Methods: A descriptive, retrospective study was carried out with data obtained from medical records of patients requiring surgical coverage of pressure sores, between October 2010 and February 2017. Patients were treated in two surgical times: debridement and then a flap to fill the remaining soft tissue defect. Results: Twenty-seven pressure ulcers were treated (sacral 9, ischial 13, trochanteric 5) in 15 patients (average age 44. 9 years [range 22-81]). Only a single microorganism was detected in three ulcers, the remaining ulcers developed more than one microorganism. Intravenous antibiotics for at least 4-6 weeks were administered. Initially erythrocyte sedimentation rate and ultrasensitive protein C reactive values were 72 mm/h and 55 mg/L, respectively, after three months of flap surgery, and they decreased to 49 mm/h and 20 mg/L, respectively. Conclusions: Our protocol reduces length of treatment, since we do not wait until the cessation of antibiotics to perform the flap. We consider that soft tissues defect coverage as soon as possible reduces colonization of new microorganisms in the involved region. We obtained good results with a low recurrence rate compared to other series. Level of Evidence: IV

Tratamiento artroscópico de fractura de platillo tibial en una paciente embarazada. Actualización / Arthroscopic treatment of pregnant patients with tibial plateau fractures

En el manejo de pacientes embarazadas con fracturas se debe tener en cuenta no solo la vida de la madre sino del feto. Los cambios anatómicos y los cambios fisiológicos en el embarazo aumentan la complejidad del tratamiento. Presentamos el caso de una paciente femenina de 29 años cursando embarazo de 34 semanas quien presenta fractura del platillo tibial de su rodilla derecha Schatzker tipo 2 (AO 41 B3) tratada mediante reducción y osteosíntesis bajo asistencia artroscópica. Describimos un decálogo de tratamiento quirúrgico en pacientes embarazadas en el cual mencionamos los puntos esenciales a tener en cuenta al momento de planificar el tratamiento definitivo. Destacamos puntos como el posicionamiento de la paciente, la profilaxis antibiótica, el tipo de anestesia, la radiación tolerable y la tromboprofilaxis. El trabajo con un equipo médico multidisciplinario hizo posible realizar la cirugía controlando en forma segura a la paciente y el feto. La asistencia artroscópica permite tener visión directa de la superficie articular disminuyendo al mínimo la irradiación y logrando una reducción anatómica. Tipo de estudio: Reporte de caso. Nivel de evidencia: IV.

In the management of pregnant patients with fractures, both, the mother and the fetus risk of life must be taken into account. Anatomical and physiological changes in pregnancy increase the complexity of the treatment. We present the case of a 29-year-old female ongoing a 34-week pregnancy period. She presented tibial plateau fracture of her right knee classified as Schatzker type 2 (AO 41 B3). Treatment was done by reduction and osteosynthesis under arthroscopic assistance. We describe a decalogue of surgical treatment in pregnant patients in which we mention the essential points to take into account when planning the definitive treatment. We highlight points such as positioning of the patient, antibiotic prophylaxis, type of anesthesia, tolerable radiation and thromboprophylaxis. A safe surgical procedure with an optimal control of the patient and the fetus was possible by working with a multidisciplinary medical team. Arthroscopic assistance allows direct vision of the articular surface, minimizing irradiation and achieving anatomical reduction. Type of study: Case report. Level of evidence: IV.