Patients with trochanteric hip fractures and pre-existing osteoarthritis can be treated with nailing osteosynthesis without significant decrease in functional status.

PURPOSE: Functional outcome in patients after trochanteric fracture fixation with pre-existing radiographic osteoarthritis (OA) is unclear. Analyzing their function and independence, before and after fracture, could optimize their treatment and decrease the socioeconomic burden in this particular group. METHODS: The influence of pre-existing radiographic hip OA on functional outcome was retrospectively analyzed with a cohort of patients undergoing proximal femoral nailing for trochanteric fracture. OA was graded according to the Tonnis classification. Functional outcome was assessed preoperatively and 12 months after surgery by the Parker Mobility Score (PMS). We consider a meaningful reduction a difference between preoperatively PMS and 12 months after surgery ≥ 2. In order to evaluate if OA is related to PMS reduction ≥ 2, we calculate the SubHazard ratio (SHR) performing a competing risk regression model considering death as a competing risk event, adjusting by confounders. Death, reoperations, readmissions, surgical time, and fracture reduction quality in patients with and without osteoarthritis were recorded. RESULTS: 375 trochanteric hip fractures treated with cephalomedullary nails were included, from which 80 (21% CI95% 17%-21%) were classified as Tonnis 2 or 3. This group of patients with pre-existing OA was significantly older (mean age of 88.6 [SD 5.65] vs 85.5 years [SD 6.95]) than the group without OA. The preoperatively PMS score was 6.28 (2.71) in non-OA patients and 5.69 (2.67) in OA patients. The mean PMS reduction 12 months after surgery was 1.3 (SD 2.05) in OA patients and 1.07 (SD 2.2) in non-OA patients (p = 0.43). Competing risks analysis, adjusted by confounders had an SHR of 1.15 (IC95% 0.77 - 1.69). Death, readmission, reoperations, surgical time, and fracture reduction quality did not differ in both groups. CONCLUSIONS: Patients with pre-existing radiographic OA treated with femoral nailing have a similar reduction in functional outcomes compared to the non-OA group at one-year follow-up. Further studies will be needed to compare the results of the functional outcome in arthroplasty with those of femoral nailing for the treatment of trochanteric femur fractures in patients with OA.

Very early prescription of range of motion exercises in ankle fractures treated with ORIF does not increase the rate of complications and reoperations: A survival risk analysis.

BACKGROUND: Ankle fractures are commonly treated with non-surgical or surgical (preferably ORIF) approaches based on fracture characteristics. The postoperative care regimens vary widely, and the impact of very early mobilization on complications and reoperation rates in ankle fractures treated with ORIF remains unclear. METHODS: A retrospective analysis was conducted on ankle fractures treated between January 2014 and November 2020. Demographic and fracture characteristic data were collected. Very early prescription of range of motion exercises was defined as initiation within the first week after surgery, typically between the second and seventh postoperative day. Complications, reoperations, and time to these events were analyzed. Kaplan Meier survival analysis was performed to assess the risk of complications with very early mobilization. RESULTS: A total of 299 patients met the inclusion criteria. The cohort included 83 unimalleolar, 77 bimalleolar, and 138 trimalleolar fractures. Of the patients, 116 (38.8%) underwent very early range of motion. Complications occurred in 45 events among 39 patients (13%), with 16 events (41%) in the very early range of motion group. Reoperations were required for 23 patients (3.67% of the cohort). No statistically significant differences were found in the analysis of complications, with a hazard ratio (HR) of 1.17, and in the adjusted analysis with an HR of 1.12. Similarly, the reoperation analysis showed no significant differences, with an HR of 0.85 and 0.68 in the adjusted analysis. CONCLUSION: Very early prescription of range of motion exercises in ankle fractures treated with ORIF is a safe approach, as it does not increase the rates of complications or reoperations compared to early or late mobilization. This study supports the use of very early mobilization as a rehabilitation method for ankle fractures.

Outcomes, risk factors, and conversion rate in acetabular fractures in patients over 65 years of age. Analysis at a mean follow-up of 6 years.

INTRODUCTION: Acetabular fractures are devastating injuries that can affect patients of different ages, as well as being associated with high or low energy trauma. Conversion to total hip arthroplasty (THA) results in increased complication rates, resource use and costs compared to primary THA due to osteoarthritis. The aim of this paper is to describe a retrospective cohort of patients over 65 years of age who presented with an acetabular fracture and were treated with open reduction and internal fixation (ORIF). METHODS: A retrospective cohort study was conducted from January 2002 to December 2017. The study identified all patients over 65 years of age who suffered an acetabular fracture and were treated primarily with ORIF. The quality of reduction, fracture pattern and associated poor prognostic factors for fracture were analyzed. RESULTS: A total of 50 cases of acetabular fractures in patients over 65 years of age were included. Six of them required conversion to THA (12%). In 3 of these cases conversion surgery was performed because of pre-existing osteoarthritis, pain, and postoperative progression of osteoarthritis. The main factors involved in the conversion cases were intra-articular fragments, femoral head protrusion and posterior wall comminution. Postoperative intra-articular gap had a p = 0.01 in linear regression analysis for conversion to arthroplasty. CONCLUSION: The conversion rate reported in our cohort of elderly patients is similar to that reported in the literature in patients of all age ranges. The quality of reduction was a significant factor in predicting progression to conversion to THA.

Comparison between functionality and quality of reduction between suprapatellar vs infrapatellar approaches in the treatment of diaphyseal and distal tibial fractures.

INTRODUCTION: Intramedullary nailing is the most frequent procedure used for the treatment of tibial fractures that do not involve the articular surfaces. The goal of this study is to analyse the clinical outcomes, time of surgery and use of fluoroscopy in patients with midshaft and distal tibial fractures treated with suprapatellar and infrapatellar nailing and compare the results between these different groups. METHODS: A retrospective study was conducted, and patients were selected between the period of March 2018 and October 2019. The following variables were studied: age, gender, AO classification, time of surgery (minutes), time of fluoroscopy (seconds), quality of reduction in postoperative controls and 1 year follow-up (using the angles MPTA, LDTA, PPTA, ADTA). Functional outcomes were studied at 1 month and 1 year follow-up. The visual analogue scale was used to study and compare the postoperative pain of the patients. The Lysholm Knee Score was used to evaluate the functional outcomes of the patients. RESULTS: A total of 80 patients meeting the inclusion criteria were included in this study. The suprapatellar approach was used in 44 patients and the infrapatellar in 36 patients. The time of surgery (p=0.008) and the mean time of use of fluoroscopy (p <0.001) difference were significant in favour of the suprapatellar approach. In the quality of reduction analysis, we have statistically significant results in the LDTA and ADTA angles. Also, in the evaluation of postoperative pain, significant difference was found in favour of the suprapatellar approach. CONCLUSION: In conclusion, our study compared the suprapatellar approach and the infrapatellar approach for the treatment of midshaft and distal tibia fractures with intramedullary nailing. The results showed lesser time of surgery and use of fluoroscopy, lower knee pain, and lower rate of malalignment with the suprapatellar approach than with the infrapatellar approach.

Fractura de Tillaux en adultos. Reporte de un caso y revisión de la bibliografía / Tillaux fracture in adults. Case report and literature review

Introducción: La fractura de la región anterolateral de la epífisis distal de la tibia, o tubérculo de Tillaux-Chaput, es conocida como fractura de Tillaux. Se trata de una fractura extremadamente rara en los adultos, pero tiene una importancia fundamental, porque compromete la superficie articular tibio-astragalina, la estabilidad de la sindesmosis y, en algunos casos, la incisura peronea. Se presenta el caso de una mujer de 45 años con un traumatismo rotatorio del tobillo izquierdo e impotencia funcional y dolor en la región anterolateral del tobillo. Las radiografías generaron la sospecha de un trazo de fractura correspondiente al tubérculo de Tillaux-Chaput. Por lo tanto, se realizó una tomografía computarizada que confirmó una fractura de Tillaux, que tenía un desplazamiento >2 mm y compromiso de la incisura peronea. La paciente fue sometida a reducción abierta y fijación interna. La fractura consolidó a los 3 meses. Al año de la cirugía, su estado clínico y funcional es excelente. Conclusión: La sospecha diagnóstica que surge de una completa anamnesis y un meticuloso examen físico, y la confirmación mediante estudios por imágenes son esenciales para abordar correctamente patrones de fracturas raros, como la fractura de Tillaux. Nivel de Evidencia: IV

Introduction: The fracture of the anterolateral region of the distal tibial epiphysis, or Tillaux-Chaput tubercle, is known as Tillaux fracture. It is an exceptional entity in adults, but it has significant importance because it affects the tibiotalar joint surface, the stability of the syndesmosis, and, in some cases, the fibular notch. We present the case of a 45-year-old woman treated in the Emergency Service due to rotational trauma to the left ankle and functional impairment and pain in the anterolateral region of the ankle. The radiographs led to the suspicion of a fracture line corresponding to the Tillaux-Chaput tubercle. Therefore, a CT scan was performed, which confirmed a Tillaux fracture with a >2 mm displacement and involvement of the fibular notch. The patient underwent open reduction and internal fixation. The fracture consolidated after 3 months. One year after surgery, her clinical and functional status was excellent. Conclusion:Diagnostic suspicion through meticulous physical examination and anamnesis and confirmation by imaging studies are essential for the proper management of rare fracture patterns, such as Tillaux fractures. Level of Evidence: IV

[Conservation surgery and early rehabilitation in massive necrotizing fasciitis of the lower limbs] / Cirugía de conservación y rehabilitación temprana en fascitis necrotizante masiva de miembros inferiores.

Necrotizing fasciitis is a life-threatening infection. Early diagnosis and treatment are essential. Reconstruction techniques and rehabilitation protocols have been poorly described. The objective of this work is to describe the results of timely treatment for limb preservation and early rehabilitation in a case of massive necrotizing fasciitis of the lower limbs. We present a case of necrotizing fasciitis in the lower limbs, treated surgically with a negative aspiration system, muscle flaps, and skin graft. We describe his rehabilitation protocol and the results at one year of follow-up.

La fascitis necrotizante es una infección potencialmente letal. Es esencial un diagnóstico y tratamiento temprano. Las técnicas de reconstrucción y los protocolos de rehabilitación han sido escasamente descritos. El objetivo de este trabajo es describir los resultados del tratamiento oportuno para la conservación de miembros y la rehabilitación temprana en un caso de fascitis necrotizante masiva de miembros inferiores. Presentamos un caso de fascitis necrotizante en miembros inferiores, tratado quirúrgicamente mediante sistema de aspiración negativa, colgajos musculares e injerto cutáneo. Describimos su protocolo de rehabilitación y los resultados al año de seguimiento.

Enclavado endomedular suprarrotuliano vs. infrarrotuliano en el tratamiento de fracturas diafisarias y distales de tibia: análisis comparativo y técnica quirúrgica / Suprapatellar vs. infrapatellar intramedullary nailing for the treatment of distal and diaphyseal tibial fractures: Comparative analysis and surgical technique

Introducción: Las fracturas diafisarias y distales de tibia son lesiones frecuentes en personas jóvenes que sufren un trauma de alta energía y en ancianos por un trauma de baja energía. El objetivo de este estudio fue comparar el tiempo quirúrgico, el uso de radioscopia, la evaluación funcional y el dolor en el tratamiento de fracturas diafisarias y distales de tibia mediante una técnica suprarrotuliana y una infrarrotuliana. Materiales y métodos: Se realizó un estudio retrospectivo entre marzo de 2018 y octubre de 2019. La información de los pacientes se obtuvo de la historia clínica electrónica. Se incluyó a pacientes con fracturas diafisarias y distales de tibia. Se estudiaron y compararon los tiempos de radioscopia y de cirugía. El dolor posoperatorio se evaluó mediante la escala analógica visual y la función, con el puntaje de Lysholm. Resultados:Ochenta pacientes cumplían con los criterios de inclusión. Sus datos sociodemográficos fueron pareados en dos grupos similares. Treinta y seis pacientes fueron tratados con la técnica infrarrotuliana y 44, con la técnica suprarrotuliana. Se obtuvieron diferencias estadísticamente significativas en el tiempo de cirugía, el tiempo de radioscopia y en el puntaje de la escala analógica visual para dolor al año. Conclusiones: Los resultados mostraron un menor tiempo de cirugía y de radioscopia, y mejores resultados en la escala analógica visual para dolor con la técnica suprarrotuliana para el tratamiento de las fracturas mediodiafisarias y distales de tibia. Nivel de Evidencia: III

Introduction: Fractures of the medial and distal tibial segment often occur in young patients with high-energy trauma and older patients with low-energy trauma. The objective of this study is to compare the time of surgery, time of use of fluoroscopy, functional outcomes, and postoperative pain in patients treated with the suprapatellar vs. infrapatellar technique for tibial nailing. materials and methods: We carried out a retrospective study between March 2018 and October 2019. All the data was collected from the electronic clinical record (ECR). We included patients with diaphyseal and distal tibial fractures. The variables analyzed were: fluoroscopy and surgery time, pain evaluation, and functional outcomes of the patients using the Lysholm score. Results: 80 patients met all the inclusion criteria. Sociodemographic data were divided into 2 similar groups. The suprapatellar approach was used in 44 patients and the infrapatellar in 36 of them. A statistical difference was obtained in the analysis for the time of surgery, use of fluoroscopy, and pain evaluation in favor of the suprapatellar technique. Conclusions: The results of our study showed shorter surgery and fluoroscopy times with the use of the suprapatellar technique compared with the infrapatellar technique. The suprapatellar technique also yielded better pain results in the visual analog scale. Level of Evidence: III

Intramedullary nail for the surgical treatment of unstable fractures of the femur in previously amputated patients / [Clavo endomedular para el tratamiento quirúrgico de fracturas inestables de fémur en pacientes previamente amputados]

Introduction: Femoral fractures in previously amputated patients (PAP) have been poorly reported in international literature, however it is worth mentioning that advances in the manufacture of orthotics for lower limbs have allowed these patients to remain functionally active. Surgery is then an option but difficulties may appear in positioning the patient for surgery due to the absence of the foot or ankle from where to pull and optimize the fracture reduction. Objective: We report 3 cases of PAP with ipsilateral unstable femur fractures, treated surgically with cervicodiaphyseal endomedular nail. The surgical technique used in each case is described. Results: Good long-term results were obtained demonstrating the effectiveness of surgical treatment and the reduction technique used. Conclusion: Surgical treatment of unstable fractures of the proximal femur with an endomedullary nail should be considered a valid therapeutic option.

Introducción: Las fracturas de fémur en pacientes previamente amputados (PPA) han sido escasamente reportadas en la literatura internacional, sin embargo, cabe mencionar que los avances en la fabricación de ortesis para miembros inferiores han permitido que estos pacientes, se mantengan funcionalmente activos. La cirugía entonces es una opción, pero representa una dificultad en el posicionamiento del paciente a la hora de planificar su cirugía debido a la ausencia del pie o tobillo del cual traccionar y optimizar la reducción de la fractura. Objetivo: Reportamos a continuación 3 casos de PPA con fracturas inestables ipsilaterales de fémur, tratadas mediante reducción y osteosíntesis con clavo endomedular cervicodiafisario. Se describe la técnica quirúrgica utilizada en cada caso. Resultados: Se obtuvieron buenos resultados a largo plazo demostrando la efectividad del tratamiento quirúrgico y la técnica de reducción utilizada. Conclusión: El tratamiento quirúrgico de fracturas inestables de fémur proximal con clavo endomedular, ha de ser considerado una opción terapéutica válida.

Versatilidad del clavo endomedular retrógrado largo de tibia para artrodesis tibio-talo-calcánea en pacientes con lesiones asociadas en el mismo segmento / Versatility of the tibia long retrograde intramedullary nail for tibiotalocalcaneal arthrodesis in patients with associated lesions in the same segment

Introducción: La afección articular que lleva a la necesidad de una artrodesis tibio-calcánea puede estar acompañada de una segunda lesión en el mismo segmento óseo, y los clavos de diseño para artrodesis no tienen la longitud adecuada para cubrir ambas lesiones. No hallamos opciones terapéuticas para este tipo de lesiones en la bibliografía. Objetivo: Presentar una serie de casos en los que se utilizó un único clavo de tibia (de colocación anterógrada) de forma retrógrada, con el doble objetivo de efectuar una artrodesis tibio-talo-calcánea, sumada al tratamiento de una lesión asociada en un mismo tiempo quirúrgico. Materiales y métodos: Se evaluó, en forma retrospectiva, desde septiembre de 2009 hasta junio de 2019, a un grupo de 12 pacientes que requirió una artrodesis tibio-talo-calcánea sumada a la necesidad de resolver simultáneamente un defecto secundario local. La edad promedio fue de 43.7 años, y el seguimiento global fue de 43.9 meses. Resultados: Todos los pacientes lograron una artrodesis tibio-calcánea constatada en radiografías de frente y de perfil, y el 83,3% recuperó el stock óseo de manera completa. Conclusión: Ante la ausencia en el mercado de osteosíntesis para resolver las patologías asociadas en un mismo paciente, proponemos el uso del clavo endomedular largo de tibia colocado de manera retrógrada como una opción de tratamiento, porque se ha demostrado que es eficaz para lograr la artrodesis tibio-calcánea. Además, se lo pudo utilizar como guía en el alargamiento y el transporte óseo, y como estabilización para tratar lesiones simultáneas. Nivel de Evidencia: IV

background: The joint condition that leads to the need for a tibiocalcaneal arthrodesis may be accompanied by a second injury in the same bone segment, and design nails for arthrodesis are not of adequate length to cover both injuries. We have not found therapeutic options for this type of injury in the literature. Objective: To present a series of cases where a single tibia nail (antegrade placement) was used retrogradely, with the dual objective of performing a tibiotalocalcaneal arthrodesis added to the treatment of an associated injury in the same surgical stage. materials and methods: We retrospectively evaluated a group of 12 patients who required a tibiotalocalcaneal arthrodesis as well as to simultaneously resolve a local secondary defect from September 2009 to June 2019. The average age was 43.7 (27-61) years, and the global follow-up was 43. 9 months. Results: All patients achieved a tibiocalcaneal arthrodesis confirmed in antero-posterior and lateral radiographs, and 83.3% of the patients recovered their bone stock completely. Conclusion: Faced with the lack of osteosynthesis in the market to resolve associated pathologies in the same patient, we propose the use of a long tibial intramedullary nail placed in a retrograde manner as a treatment option since it has proven to be efficient in achieving tibiocalcaneal arthrodesis. In addition, it could be used as a rail for bone lengthening and transport, and as stabilization to treat simultaneous injuries. Level of Evidence: IV

Soporte circunferencial posterior en fracturas de platillo tibial / Posterior circumferential support in tibial plateau fractures

Las técnicas quirúrgicas que más se utilizan en la actualidad para fracturas de platillo tibial no contemplan correctamente la conminución ósea multiplanar ni la presencia de fragmentos óseos posteriores. Nos hemos enfrentado con esta problemática al tratar a un paciente con fractura de platillo tibial tipo Schatzker VI, en la cual se suplementó la osteosíntesis habitualmente utilizada con una placa horizontal circunferencial posterior. Se logró la consolidación ósea y los resultados funcionales a corto plazo fueron buenos. Del análisis de la bibliografía citada, se concluye en que se han desarrollado varias técnicas de contención posterior de los platillos tibiales, y la osteosíntesis circunferencial es una técnica por considerar. Nivel de Evidencia: IV

Surgical techniques commonly used today for tibial plateau fractures do not properly contemplate multiplanar bone comminution nor the presence of posterior bone fragments. We have faced this problem when treating a patient with a Schatzker VI type fracture, in which the commonly used osteosynthesis was supplemented with a posterior horizontal circumferential plate. Bone consolidation and good results were achieved in the short term in the case we present. From the analysis of the cited literature, we concluded that several techniques for containing posterior tibial plateau bone comminution have been developed. Among them, circumferential osteosynthesis is a technique to take into account. Level of Evidence: IV

Cement leakage into the hip joint during TFN-A cement augmentation in a revision surgery of an extra-capsular hip fracture.

INTRODUCTION: The intra-articular migration of the spiral lamina or screw, after close reduction and internal fixation (CRIF) with an intramedullary cervicodiaphyseal nail (cut-through), is one of the most frequent postoperative complications. We present a patient with a cut-through and cement leakage into the hip joint after TFN-A cement augmentation and spiral lamina replacement. METHODS: A 83-year-old man, suffered a cut-through after CRIF of his left extracapsular hip fracture during the third postoperative month. A revision surgery was planned, including spiral lamina replacement and cement augmentation. Cement leakage into the hip joint was confirmed in the immediate postoperative radiograph and a new intervention was indicated with the removal of the third bodies. RESULTS: The patient presented good clinical evolution, without functional limitation or pain. In routinely postoperative radiographic controls, no differences were observed respect to the immediate postoperative one. DISCUSSION: Current literature dealing with implant revision surgery and associated cement augmentation are scarce. CONCLUSION: As far as we are concerned, this is the first case in the literature of a re-revision surgery of an extracapsular hip fracture due to a three months postoperative cut-through and a posterior cement leakage into the hip joint after TFN-A cement augmentation and spiral lamina replacement with the need of a posterolateral approach for removal.

Colgajo de perforante de la arteria tibial posterior: Serie de casos / Posterior tibial artery perforator flap. Case series

Introducción: Los defectos de cobertura en la pierna son un problema difícil de solucionar debido a las características propias de la región anatómica. Por ello, se han desarrollado distintas estrategias de reconstrucción, y los colgajos de perforante fasciocutáneos son los que se utilizan con más frecuencia. Objetivos: Presentar la alternativa terapéutica, describir la técnica quirúrgica, los resultados y las complicaciones del colgajo de perforante de la arteria tibial posterior para el tratamiento de defectos de cobertura en la pierna. Materiales y Métodos: Se realizó una revisión retrospectiva de los pacientes tratados con colgajo fasciocutáneo en la pierna y operados en nuestro Centro. Se analizaron variables demográficas preoperatorias. Se describen la técnica quirúrgica y las indicaciones en cada paciente. Se analizaron variables posoperatorias, como las complicaciones y la supervivencia del colgajo. Resultados: Se incluyeron 12 hombres tratados con colgajo de perforante de la arteria tibial posterior. El promedio de edad en el momento de la cirugía fue de 52 años (rango 29-77). El seguimiento máximo fue de 55 meses y el mínimo, de 5 meses (promedio 18). Hubo dos colgajos con sufrimiento transitorio, una falla parcial y una falla total. Conclusiones: El colgajo de perforante de la arteria tibial posterior ha de ser considerado una opción válida en el tratamiento de heridas de pequeño y mediano tamaño de la pierna. Provee de tejido similar en grosor, textura y color en el sitio receptor con buenos resultados clínicos y estéticos. Nivel de Evidencia: IV

Introduction: Coverage defects in the leg are a challenge due to the particulars of the anatomy in said area, different reconstruction strategies have been developed, being the fasciocutaneous perforator flaps the most frequently used. The aim of this paper is to discuss the therapeutic alternative and to describe the surgical technique, the results and the complications of the posterior tibial artery perforator flap (PTAPF) to treat coverage defects. Materials and Methods: We performed a retrospective review of patients treated with a fasciocutaneous flap. We analyzed preoperative demographic variables. The surgical technique and the indications in each patient are described. Finally, the postoperative variables, such as complications and flap survival, were analyzed. Results: Twelve patients (all male) treated with PTAPF were included. The average age at the time of surgery was 52 years (range: 29-77 years). The maximum follow-up was 55 months, with a minimum of 5 months (average: 18 months). There were two flaps with transient congestion that reverted spontaneously: one partial failure and one total failure. Conclusions: PTAPF should be considered a viable option for the treatment of small- and medium-sized leg wounds, since they provide similar tissue thickness, texture and color on the recipient site, achieving good clinical and cosmetic results. Level of Evidence: IV

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

Colgajo fasciocutáneo sural para la cobertura del tercio distal de pierna y pie / Fasciocutaneous sural flap for soft tissue coverage in the third distal leg, ankle and foot

Introducción: Los traumatismos de alta energía en miembros inferiores se asocian, con frecuencia, a defectos de partes blandas y su reconstrucción puede presentarse como una tarea desafiante. En el extremo distal de la pierna y el pie, los colgajos de perforantes representan la mejor opción de cobertura. El motivo de este trabajo es comunicar el resultado del tratamiento de lesiones de partes blandas de pierna distal, tobillo y talón utilizando exclusivamente el colgajo de perforantes fasciocutáneo sural. Materiales y Métodos: Entre marzo de 2008 y febrero de 2016, en nuestro Hospital, se realizaron 37 colgajos fasciocutáneos surales en 35 pacientes. El criterio de inclusión fue todo paciente con defecto tegumentario en el tercio distal de tibia y talón con exposición ósea, tendinosa o defecto de la almohadilla plantar. La edad promedio fue de 49.6 años y el seguimiento promedio, de 18 meses. Resultados: Se logró la cobertura completa de defecto de tejidos blandos en 29 casos. Se detectaron tres colgajos con necrosis parcial y cinco con necrosis completa; cuatro de estos pacientes tenían antecedentes de enfermedad vascular. El tamaño del defecto fue de 9,6 x 6,7 cm (15 x 9). Conclusiones: Aunque esta serie no es extensa, los resultados coinciden con los publicados. Creemos que este colgajo es una alternativa viable para lesiones distales de pierna y pie, con una baja tasa de complicaciones y de morbilidad en el miembro afectado, y con resultados satisfactorios. Nivel de Evidencia: IV

Introduction: High energy injuries in lower limbs are frequently associated with soft tissue defect and soft tissue reconstruction can be a challenge. Perforator flaps are the best option to cover soft tissue defects in the lower leg, ankle and foot. The objective of this paper is to report the results after the use of a distally-based reverse fasciocutaneous sural flap in the reconstruction of soft tissue loss around the distal leg, ankle and foot. Methods: A total of 37 fasciocutaneous pedicled reverse sural flaps were performed in 35 patients between March 2008 and February 2016, in our Hospital. The inclusion criterium was a soft tissue defect of the lower third of the leg, ankle and heel in which bone, tendons and sole are exposed. Average age: 49.6 years and average follow-up: 18 months. Results: Complete soft tissue defect coverage was achieved in 29 cases. Three flaps with partial necrosis and five with complete necrosis were observed; four of these patients had history of vascular disease. Defect size averaged 9.6 x 6.7 cm (15 x 9). Conclusions: Although this series is not extensive, results are consistent with those reported in the literature. We consider that this flap is a valid alternative for lesions involving the distal leg, ankle and foot, with a low rate of complications and morbidity, and satisfactory results. Level of Evidence: IV

Gluteal Compartment Syndrome Secondary to Pelvic Trauma.

Gluteal compartment syndrome (GCS) is extremely rare when compared to compartment syndrome in other anatomical regions, such as the forearm or the lower leg. It usually occurs in drug users following prolonged immobilization due to loss of consciousness. Another possible cause is trauma, which is rare and has only few reports in the literature. Physical examination may show tense and swollen buttocks and severe pain caused by passive range of motion. We present the case of a 70-year-old man who developed GCS after prolonged anterior-posterior pelvis compression. The physical examination revealed swelling, scrotal hematoma, and left ankle extension weakness. An unstable pelvic ring injury was diagnosed and the patient was taken to surgery. Measurement of the intracompartmental pressure was measured in the operating room, thereby confirming the diagnosis. Emergent fasciotomy was performed to decompress the three affected compartments. Trauma surgeons must be aware of the possibility of gluteal compartment syndrome in patients who have an acute pelvic trauma with buttock swelling and excessive pain of the gluteal region. Any delay in diagnosis or treatment can be devastating, causing permanent disability, irreversible loss of gluteal muscles, sciatic nerve palsy, kidney failure, or even death.

Institutional Registry of Elderly Patients With Hip Fracture in a Community-Based Tertiary Care Hospital in Argentina (RIAFC).

BACKGROUND: A clinical registry encompasses a selective set of rigorously collected and stored clinical data focused on a specific condition. Hip fracture is a common complication of osteoporosis in elderly patients. Hip fracture substantially increases the risk of death and major morbidity in the elderly patients. Limited data regarding hip fracture are available from Latin America and Argentina. The purpose of this project is to create an institutional registry of elderly patients with hip fracture in order to obtain data that reveal the impact of this disease in our environment, allowing us to evaluate different strategies of patient's care and clinical outcomes. OBJECTIVE: To describe the implementation of an institutional registry of elderly patients with hip fracture in Argentina. METHODS: In this article, we described the creation, implementation, and data management of a prospective registry of elderly patients with hip fracture. The registry contains information on baseline demographics, comorbidities, laboratory, and radiological data. Follow-up at 3 and 12 months postfracture is done by phone interview to assess physical function, readmissions, and morbi-mortality. Clinical Trials registry number NCT02279550. CONCLUSION: In this project, we have created a hip fracture registry. We hope that this registry will provide valuable data that can lead us to new lines of research, addressed to answer questions raised in clinical practice.