Screws versus plate with screws for osteosynthesis of the posterior malleolus: a systematic review and meta-analysis / Tornillos frente a placa con tornillos para la osteosíntesis del maléolo posterior: una revisión sistemática y meta-análisis

Abstract: Introduction: fractures involving the posterior malleolus (PM) of the ankle can have significant functional and clinical implications if not properly treated. The optimal treatment approach for these fractures remains uncertain. This review aims to compare the use of cannulated screws versus plate with screw fixation in terms of their impact on the development of postoperative ankle osteoarthritis and functional outcomes in patients with PM fractures. Material and methods: a comprehensive search was conducted in PubMed, EMBASE, and Cochrane Library databases to identify studies directly comparing cannulated screws versus plate with screw fixation for PM fractures and their association with the development of postoperative osteoarthritis and functional outcomes. The quality of the included studies was assessed using appropriate assessment tools. The data on osteoarthritis development and functional outcomes were extracted and analyzed. Results: a total of 691 articles were screened, and several studies were included for analysis. The findings revealed no statistically significant difference in the development of postoperative ankle osteoarthritis between the cannulated screws and plate with screw fixation groups. Similarly, there was no significant difference in functional outcomes between the two treatment approaches. Conclusion: based on the available evidence, there is no significant difference in the development of postoperative ankle osteoarthritis or functional outcomes between cannulated screws and plate with screw fixation for PM fractures. However, further research is needed to strengthen these findings and provide more conclusive evidence.

Resumen. Introducción: las fracturas que involucran el maléolo posterior (MP) del tobillo pueden tener importantes implicaciones funcionales y clínicas si no se tratan adecuadamente. El enfoque de tratamiento óptimo para estas fracturas sigue siendo incierto. El objetivo de esta revisión es comparar el uso de tornillos canulados versus placa con fijación de tornillos en cuanto a su impacto en el desarrollo de la osteoartrosis de tobillo postoperatoria y los resultados funcionales en pacientes con fracturas del MP. Material y métodos: se realizó una búsqueda exhaustiva en las bases de datos de PubMed, EMBASE y Cochrane Library para identificar estudios que compararan directamente tornillos canulados versus placa con fijación de tornillos para fracturas de MP y su asociación con el desarrollo de osteoartrosis postoperatoria y los resultados funcionales. La calidad de los estudios incluidos se evaluó utilizando herramientas de evaluación adecuadas. Los datos sobre el desarrollo de osteoartrosis y los resultados funcionales se extrajeron y analizaron. Resultados: se revisaron un total de 691 artículos y se incluyeron varios estudios para su análisis. Los hallazgos revelaron que no hay una diferencia estadísticamente significativa en el desarrollo de osteoartrosis de tobillo postoperatoria entre los grupos de tornillos canulados y placa con fijación de tornillos. Del mismo modo, no hubo una diferencia significativa en los resultados funcionales entre los dos enfoques de tratamiento. Conclusión: según la evidencia disponible, no hay una diferencia significativa en el desarrollo de osteoartrosis de tobillo postoperatoria o en los resultados funcionales entre los tornillos canulados y la placa con fijación de tornillos para las fracturas del MP. Sin embargo, se necesita más investigación para fortalecer estos hallazgos y proporcionar evidencia más concluyente.

Safety window for the transsphenoidal approach for pituitary tumours: a computed tomographic angiography study.

BACKGROUND: The aims are to evaluate the morphometry of the sellar region and propose a safety window on the floor of the sella turcica for the transsphenoidal approach in a Hispanic population. MATERIALS AND METHODS: We retrospectively analysed 150 computed tomographic angiography sellar region images from asymptomatic patients. The images were evaluated intraobservatory by an expert radiologist. We measured: intercarotid distance of cavernous segment; depth of sella turcica; skull base angle; anterior distance, the distance between anterior spinal nasal and floor of the sella turcica; posterior distance, the distance between anterior spinal nasal and posterior wall of the sella turcica; anterior surgical angle, formed between the floor of the nostril and superior limit of the anterior wall of the sella turcica; and posterior angle, formed between the floor of the nostril and the inferior limit of the posterior wall of the sella turcica. RESULTS: Safety window was based on two measures: the intercarotid distance and depth. The mean of the safety window is 151.13 mm² and 147.60 mm² for men and women, respectively. The intercarotid distance was 17.83 mm. The depth of the sella turcica was 8.46 mm. The skull base angle was 112.13 grades. The anterior distance was 76.34 mm. The posterior distance was 87.59 mm. The anterior surgical angle was 32.76 grades. The posterior surgical angle was 87.59 grades. CONCLUSIONS: The surgical approach space is smaller in females. It could significate a more complicated surgery in this population. Anatomical understanding could reduce complications in hospitals without a neuronavigation system.

Cochlear morphometry in healthy ears of a mexican population: A comparison of measurement techniques.

OBJECTIVE: This study describes the cochlear morphometry of a mexican population analysed by laterality and sex. The objective is to compare Cochlear Length (CL) evaluation between Alexiades et al. formula and manual method described by Würfel et al. PATIENTS: Hispanic patients from Mexico, with an age of 18 years or older, were included. Morphometric examination was performed retrospectively on 200 subjects who underwent previously temporal bone imaging for clinical purposes. MATERIALS AND METHODS: Horos for Mac program was used to measure CL, cochlear height, distance A, and distance B. WorkStation AW Volume Share 2 was used to obtain volume. CL was measured in 400 temporal bones (228 females, 172 males). RESULTS: The mean CL was 34.02mm±2.15mm. A significant difference was found in all variables between sex (P=≤0.05) and laterality (P=≤0.05). The Alexiades equation was used for determining CL and compared with the manual formula, with no significant differences (κ=0.71). However, the time consumption was 5 times faster with the calculated method. The Alexiades formula was demonstrated to be a reliable method measurement. CONCLUSION: Preoperative Computed Tomography evaluation of the internal ear helps to plan the Cochlear Implants (CI) surgical approach and allows to choose an appropriate electrode length for each necessity. Our findings may be useful to facilitate and adapt preoperative management of CI surgery by considering the characteristics of cochlear morphology of Latin-American populations.

[The magnetic resonance imaging of the cerebral lesions in a newborn infant with tuberous sclerosis]. / Imagen por resonancia magnética de lesiones cerebrales en un recién nacido con esclerosis tuberosa.

Tuberous sclerosis is a neurocutaneous disease characterized of mental retardation, facial fibroangiomas, hypochromic stain and seizures. Is presented a case of a newborn that in the third day of life presenting seizures and in the physical exam show hypochromic CT scans irregular of 3-10 mm in thorax and limbs. The seizures presented during hospitalization were tonics, it was need treatment with three anticonvulsants for the control; the parents studies were normal. Magnetic resonance showed characteristic images of this pathology like nodular subependymal lesions, hyperintense, in lateral ventricles and a cortical tuberous lesion in the right frontal region. Tuberous sclerosis has a dominant autosomic transmission; the defect is in the chromosome 9, the prenatal diagnosis is not possible and 50-80% the of case are mutations. Affect a different organs as skin, eyes, heart, brain, kidney, bone and lung. The prognostic is variable and death is caused for epileptic state, brain tumor, heart failure, renal or intercurrent infection. The magnetic resonance imaging is the landmark study for diagnosis of this pathology of ample use in the present.

[Hepatic hemangioma in a premature newborn. The magnetic resonance images]. / Hemangioma hepático en un recién nacido prematuro. Imágenes por resonancia magnética.

Hepatic hemangiomas are benign vascular tumors that represent 5-15% of all liver tumors. They occur more often in females than in males (relation 2:1). They may produce cardiac failure, because of high output; less frequently hemolytic anemia, thrombocytopenia or bleeding are observed. We present a case of a newborn premature child with a gestation age of 34 weeks and weight of 1359 g who presents a palpable abdominal tumor in the right hypochondrium without additional symptoms. The diagnosis was confirmed by ultrasound with Doppler system any by means of the magnetic resonance imaging (MRI) both methods were able localize the hemangioma in the posterior segment of the right hepatic lobulus. MRI is a diagnostic tool which can provide finer anatomic details than ultrasound or axial computed tomography in hepatic hemangiomas. MRI has a sensitivity of 90% and specificity of 92%; the treatment depends of the complications which the patient presents.

[A giant follicular cyst of the ovary in a newborn infant]. / Quiste folicular gigante de ovario en una recién nacida.

The tumoral lesions proceeding of ovary in the newborns are the 3-6% of all abdominal tumors. The most frequent tumor is ovarian follicular cyst which will be diagnosed prenatally. As a result of ovarian stimulation by fetal gonadotrophins, maternal estrogen and placenta + gonadotrophins. Maternal antecedents reported diabetes, toxemia and isoimmunization. The most frequent complication is torsion. We present the case of one female newborn, with abdominal mass present by abdominal palpation referred of the first gestation of mother with 27 years of age, with primary sterility of 11 years without treatment, with toxemia during the pregnancy. The abdominal x-film show a intraperitoneal mass the ultrasound show cystic and solid mass, without determined origin, and the scan magnetic resonance (MR) a tumoral mass with origin in the pelvic hole with extension to the infrahepatic zone. The surgical finding was left ovarian cyst with left oophorectomy and salpingectomy.

Ambroxol, nuevo broncosecretolitico en afecciones broncopulmonares en pediatria. / Cambroxol, new bronchosecretolytic in bronchopulmonary disesases in pediatrics

Se presentan los resultados de un estudio clinico multicentrico nacional del tipo abierto no comparativo. Fue realizado en tres centros hospitalarios, en un total de 74 ninos con afecciones agudas y cronicas de las vias respiratorias, cuya manifestacion mas importante era la retencion de secreciones. Como secretolitico, el ambroxol modifico favorablemente el curso del padecimiento en 83.7% de los casos.Solo se uso medicacion antibiotica y/o broncodilatadora cuando se considero necesario. La tolerancia al medicamento fue excelente