Modification of Burton and Pellegrini trapeziectomy technique: Medium-term comparative analysis.

INTRODUCTION: Ligament reconstruction and tendon interposition (LRTI) arthroplasty is the procedure of choice of most hand surgeons in the treatment of basal joint arthritis of the thumb. Progressive and natural collapse after trapeziectomy is a common problem. DESCRIPTION OF TECHNIQUE: We performed LRTI with flexor carpi radialis (FCR) hemitendon technique, then proceeded to block the hemitendon plasty with a bone fragment at the base of the metacarpal. This technique allows us to maintain tension and to obtain immediate stability. PATIENTS AND METHODS: We conducted a single-center retrospective longitudinal observational study including 51 patients with diagnosis of symptomatic osteoarthritis of the trapeziometacarpal joint. Group A consisted of 24 thumbs treated with trapeziectomy with LRTI with FCR hemitendon using the Burton-Pellegrini technique. Group B included 27 thumbs treated using the modified technique. The postoperative height of the Scaphometacarpal (SM) space was analyzed. Clinical outcome, opposition, retroversion, patient satisfaction and surgical timing were studied. RESULTS: The difference of the SM space, after applying correction factor, at one and six months postoperative is significantly less in the modified technique group (p=0.033 and p=0.001 respectively). The average height loss of the SM space from one to six months postoperative measurement was smaller in the study group, showing greater stability of the plasty. CONCLUSIONS: The use of a bone fragment to block the FCR plasty improves the results at one and six months postoperatively, showing a diminished height loss of the SM space, improved thumb opposition and without prolonging surgical timing in our series.

Modification of Burton and Pellegrini trapeziectomy technique: Medium-term comparative analysis. / [Artículo traducido] Modificación de la técnica de trapeciectomía de Burton-Pellegrini: análisis comparativo a medio término.

INTRODUCTION: Ligament reconstruction and tendon interposition (LRTI) arthroplasty is the procedure of choice of most hand surgeons in the treatment of basal joint arthritis of the thumb. Progressive and natural collapse after trapeziectomy is a common problem. DESCRIPTION OF TECHNIQUE: We performed LRTI with flexor carpi radialis (FCR) hemitendon technique, then proceeded to block the hemitendon plasty with a bone fragment at the base of the metacarpal. This technique allows us to maintain tension and to obtain immediate stability. PATIENTS AND METHODS: We conducted a single-center retrospective longitudinal observational study including 51 patients with diagnosis of symptomatic osteoarthritis of the trapeziometacarpal joint. Group A consisted of 24 thumbs treated with trapeziectomy with LRTI with FCR hemitendon using the Burton-Pellegrini technique. Group B included 27 thumbs treated using the modified technique. The postoperative height of the Scaphometacarpal (SM) space was analyzed. Clinical outcome, opposition, retroversion, patient satisfaction and surgical timing were studied. RESULTS: The difference of the SM space, after applying correction factor, at one and six months postoperative is significantly less in the modified technique group (P = .033 and P = .001, respectively). The average height loss of the SM space from one to six months postoperative measurement was smaller in the study group, showing greater stability of the plasty. CONCLUSIONS: The use of a bone fragment to block the FCR plasty improves the results at one and six months postoperatively, showing a diminished height loss of the SM space, improved thumb opposition and without prolonging surgical timing in our series.

[Translated article] Sagittal imbalance influences outcome of vertebroplasty in patients with osteoporotic vertebral compression fracture.

BACKGROUND AND OBJECTIVES: The correlation between sagittal balance of the spine and clinical outcome after vertebroplasty (VP) in patients with osteoporotic vertebral compression fractures (OVCF) is poorly investigated. We analysed the clinical outcome of patients with OVCF undergoing VP taking into account sagittal balance. METHODS: The primary endpoint was the change in axial back pain; disability and health-related quality of life using VAS, ODI and SF-36 respectively in correlation to the parameters that define sagittal balance (SVA). Radiographic assessment included full spine standing lateral films. Imaging and clinical data were collected pre and post procedure at 1, 3 and 12 months. RESULTS: Fifty-one patients were included presenting a total of 113 OVCF. Thirty patients (60.7%) had multiple OVCF. Comparing the evolution of VAS and ODI throughout the follow-up it does not seem that there are significant differences in their behaviour between the SVA>50mm and the SVA<50mm groups (p>0.05). On the contrary, preVP SF-36 scores showed worst results in the SVA>50mm group in the physical functioning section (PF) (p<0.05) and in the physical component score (PCS) (p<0.05). These differences were maintained until 3 months of follow-up in the case of the PCS and until the end of follow-up in the case of the PF (p<0.05). CONCLUSIONS: Patients with a SVA>50mm showed a slower recovery of their quality of life after VP for OVCF, but without significant differences with respect to pain or disability, when compared with patients with SVA<50mm.

Sagittal imbalance influences outcome of vertebroplasty in patients with osteoporotic vertebral compression fracture. / Influencia del desequilibrio sagital en el resultado clínico de la vertebroplastia en pacientes con fractura por compresión vertebral osteoporótica.

BACKGROUND AND OBJECTIVES: The correlation between sagittal balance of the spine and clinical outcome after vertebroplasty (VP) in patients with osteoporotic vertebral compression fractures (OVCF) is poorly investigated. We analysed the clinical outcome of patients with OVCF undergoing VP taking into account sagittal balance. MATERIAL AND METHOD: The primary endpoint was the change in axial back pain, disability and health-related quality-of-life using Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and SF-36, respectively, in correlation to the parameters that define sagittal balance (SVA). Radiographic assessment included full spine standing lateral films. Imaging and clinical data were collected pre- and post-procedure at 1, 3 and 12 months. RESULTS: 51 patients were included presenting a total of 113 OVCF. 30 patients (60.7%) had multiple OVCF. Comparing the evolution of VAS and ODI throughout the follow-up it does not seem that there are significant differences in their behaviour between the SVA>50mm and the SVA<50mm groups (p>0.05). On the contrary, pre-VP SF-36 scores showed worst results in the SVA>50mm group in the physical functioning (PF) section (p<0.05) and in the physical component score (PCS) (p<0.05). These differences were maintained until 3 months of follow-up in the case of the PCS and until the end of follow-up in the case of the PF (p<0.05). CONCLUSIONS: Patients with a SVA>50mm showed a slower recovery of their quality-of-life after VP for OVCF, but without significant differences with respect to pain or disability, when compared patients with SVA<50mm.

Cross-linked polyethylene does not reduce wear in total knee arthroplasty. / El polietileno de alto entrecruzamiento no reduce el desgaste en la artroplastia total de rodilla.

AIM: To compare two different types of inserts: Ultra-high molecular weight polyethylene (UHMWPE) and cross-linked polyethylene with a quantitative and qualitative study of polyethylene wear particles in synovial fluid 3 years after total knee arthroplasty. MATERIAL AND METHODS: A prospective, randomized, controlled cohort study with blinded evaluation was carried out on 25 patients undergoing staged bilateral total knee replacement, 6 months apart. Knee arthrocentesis was performed on 12 patients 3 years after surgery, and the polyethylene particles were analyzed. RESULTS: No significant differences were found in the number of particles generated by the two different types of inserts at 3 years from total knee arthroplasty (3,000×: x¯ cross-linked=849.7; x¯ UHMWPE=796.9; P=.63; 20,000×: x¯ cross-linked=66.3; x¯ UHMWPE=73.1; P=.76). Likewise, no differences in the probability of finding elongated (χ2=0.19; P=.66) or rounded (χ2=1.44; P=.23) particles in both types of inserts were observed. However, the probability of finding fibrillar particles is 3.08 times greater in UHMWPE. CONCLUSIONS: Cross-linked polyethylene does not significantly reduce the generation of polyethylene particles in patients with total knee arthroplasty, 3 years after the surgical procedure.

Necrotizing fasciitis attended in the Emergency Department in a tertiary Hospital: Evaluation of the LRINEC scale. / Infecciones necrosantes de partes blandas atendidas en un servicio de urgencias de tercer nivel: evolución y correlación con la escala laboratory risk indicator for necrotizing fasciitis (LRINEC).

AIM: To describe mortality and complications of patients seen in the emergency room, diagnosed with necrotizing soft tissue infection (NSTI) and the correlation of such complications with the Laboratory Risk Indicator for Necrotizing fasciitis scale (LRINEC). METHODS: Retrospective observational study including patients with a diagnosis of NSTI in the emergency room of a tertiary hospital over 7 years. The results are shown as median, interquartile range and absolute range for quantitative variables. In the case of qualitative variables, the results are shown as absolute and relative frequency. The comparison between the categories of the LRINEC scale was performed through a post-hoc comparison from a non-parametric ANOVA analysis. Comparisons between LRINEC groups in the qualitative variables were performed using Fisher's Exact test. RESULTS: 24 patients with a mean age of 51.9 years were identified. The LRINEC scale was used on 21 patients: in 10, the value indicated low risk (<6), in 4 it indicated intermediate risk (6 or 7) and in 7 it indicated high risk (≥8). The amputation rate in patients with low, intermediate and high risk was 10%, 25% and 66% respectively with a mortality of 4.2%. There was an increase in hospital stay between the low and high level of the scale (p=0,007). CONCLUSIONS: In general, a change in the prognosis between the medium and high levels of the LRINEC scale could not be recorded, but was recorded in hospital stay between the low and the high level, practically tripling the median of days of hospital stay.

[Assessment of parental satisfaction in a neonatal unit]. / Valoración de la satisfacción de los padres en una unidad neonatal.

INTRODUCTION: Parental satisfaction in a neonatal unit needs to be checked as a quality element in health care. OBJECTIVES: 1/To measure how the severity of the newborn condition influences parental satisfaction. 2/To compare the results before and after moving to a new building. METHODS: Parental satisfaction in 87 of the newborns admitted to our neonatal unit over a 10 month period was documented using a questionnaire survey. The newborns were divided into 2 categories, depending on the severity of their condition. Parental satisfaction as regards human and environmental issues was checked as to whether it was affected by the severity of the illness. The impact of the move to a new building on satisfaction was also analysed. Statistical descriptive studies and multivariate models were used. RESULTS: A polarised tendency was seen between human and environmental aspects. The following issues were statistically significant: visiting hours for parents, and criticisms about furniture, light and physical space. Parents of seriously ill children appreciated the visiting hours but judged the environment negatively. Pain perception in procedures was higher in serious illnesses, and 66% of parents would rather be present during those procedures. When comparing both hospitals, the only significant value regarding the new centre, was the lower perception of information given by the staff. Breastfeeding improved significantly. General satisfaction was high. CONCLUSIONS: Parents of seriously ill newborns are mainly concerned about access hours and comfort. Parent visiting hours and lack of noise and light are significant parameters predicting satisfaction in children with long stays. Perception of access to information got worse in the new hospital, probably due to lack of staff adaptation.

[Monitoring neurodevelopment in children born as a result of using assisted reproduction techniques]. / Seguimiento del neurodesarrollo de niños nacidos por tecnicas de reproducción asistida.

INTRODUCTION: In recent years a number of publications have reported a higher incidence of congenital defects or chromosome abnormalities linked to conventional in vitro fertilisation (IVF), and some other publications have suggested that intracytoplasmic sperm injection (ICSI) may have a negative influence on neurodevelopment. AIM. To determine whether there were any differences in the medical development and the neurodevelopment of children conceived using conventional IVF techniques and those conceived using ICSI techniques. SUBJECTS AND METHODS: Our sample consisted of 17 babies born after IVF (nine males and eight females) and 40 infants born after ICSI (23 males and 17 females). All of them were the result of pregnancies induced by IVF and ICSI achieved in the assisted reproduction service at our hospital and followed up by the same team of obstetricians and specialists in maternal-foetal medicine. At the chronological age of 24 months all the patients were submitted to a paediatric examination and a neuropsychological examination. The examination was performed in one single session. Neurodevelopment was evaluated specifically by means of the Bayley scales of infant development. RESULTS AND CONCLUSIONS: The health and neurodevelopment of infants from conventional IVF and from ICSI in our study were similar to those of the general population at the age of two years. ICSI proved to be as safe as conventional IVF as regards the children's medical and cognitive progression.