Insuficiente aplicación de Medicina Natural y Tradicional en afecciones relacionadas con la ortopedia y la traumatología / Unsatisfactory Application of Natural and Traditional Medicine in Conditions Related with Orthopedics and Traumatology

La Medicina Natural y Tradicional aplica sus diferentes modalidades en la práctica médica moderna, segura, económica, inocua y simple; y con pocos efectos colaterales resuelve grandes problemas de salud en situaciones especiales o de desastres con recursos limitados. De ahí que el egresado de programas de especialización de las ciencias médicas cuenta con sólidos conocimientos para su aplicación, especialmente en las afecciones osteomioarticulares, donde la especialidad de ortopedia y traumatología tiene un papel primordial para identificar las causas y consecuencias de la insuficiencia de su aplicación en pacientes portadores de afecciones relacionadas con esta especialidad. A través de un estudio crítico reflexivo basado en el análisis y la síntesis, así como de la constatación de la validez de los puntos de vista asumidos como referentes en el proceso de superación del especialista de ortopedia y traumatología, se pudo mostrar cómo se ha concebido la superación profesional en el Hospital General Dr. Juan Bruno Zayas Alfonso, al integrar adecuadamente los conocimientos y las competencias. Esto se expresó en la elaboración e implementación de una estrategia de superación profesional, que permitió la actualización de relevantes conocimientos necesarios en el campo de la MNT para el desempeño de este profesional. Se concluyó que era insuficiente el nivel de conocimiento de los contenidos, como también los cursos ofertados para su desarrollo, lo que trajo como consecuencia una atención médica sin calidad(AU)

Natural and traditional medicine applies its different modalities in modern, safe, economical, innocuous and simple medical practice; with few collateral effects, it solves major health problems in special or disaster situations with limited resources. Hence, the graduate of specialization programs in medical sciences possesses solid knowledge for its application, especially in osteomyoarticular conditions, in which the specialty of orthopedics and traumatology has a key role in identifying the causes and consequences of its unsatisfactory application in patients with conditions related to this specialty. Through a reflexive and critical study based on analysis and synthesis, as well as the verification of the validity of the viewpoints assumed as referents in the process of improvement of the orthopedics and traumatology specialist, it was possible to show how professional improvement has been conceived at Hospital General Dr. Juan Bruno Zayas Alfonso, by adequately integrating knowledge and competences. This was expressed through the elaboration and implementation of a professional improvement strategy, which allowed updating relevant knowledge necessary in the field of natural and traditional medicine for the performance of this professional. The level of knowledge about the contents was concluded to be insufficient, while the courses offered for its development were so, which resulted in a medical care without quality(AU)

Correlación funcional radiológica en pacientes tratados mediante osteotomía de SCARF en el servicio de traumatología y ortopedia del Hospital Obrero N° 1, durante las gestiones 2011 ­ 2016 / Functional radiological correlationship in patients treated by SCARF osteotomy in the traumatology and orthopedics service of Hospital Obrero No. 1, term 2011 ­ 2016

INTRODUCCIÓN: la marcha es una actividad compleja, que requiere de un balance estricto, donde toda la extremidad inferior actúa de manera conjunta para realizar el movimiento y donde el pie es la única parte que actúa sobre el suelo. Por ello cualquier alteración anatómica y biomecánica del pie repercute en la ambulación. OBJETIVO: determinar el grado de correlación funcional ­ radiológica en pacientes tratados mediante osteotomía de scarf. MATERIAL Y MÉTODOS: rstudio correlacional y transversal. Se estudiaron 78 pacientes con diagnóstico de hallux valgus. Se realizó la valoración funcional (Escala AOFAS) y radiológica de todos los pacientes con hallux valgus operados mediante la osteotomía de scarf; se estableció además la correlación entre la valoración funcional y radiológica de cada paciente mediante la prueba de chi cuadrado. RESULTADOS: habiéndose obtenido el valor crítico de Chi ­ cuadrado (X2 c = 12.992), se comprobó que este es menor que el valor del Chi ­ cuadrado calculado, tanto para el ángulo metatarso-falángico (X2 = 40.715) y el ángulo inter-metatarsiano (X2 = 16.539); lo que significa que la hipótesis nula no se aceptó (Los resultados funcionales no se correlacionan con los resultados radiológicos de manera inversamente proporcional). CONCLUSIÓN: se determinó un grado de correlación inverso entre los resultados funcionales y radiológicos en pacientes tratados mediante osteotomía de scarf; α = 0.05; p = 0.95. Significa que a mayor gradación de hallux valgus (leve, moderado y severo), menor es el puntaje de la escala AOFAS (pobre, aceptable, bueno y excelente).

INTRODUCTION: walking is a complex activity, requiring a strict balance, where the entire lower limb acts together to perform the movement and where the foot is the only part that acts on the ground. Therefore, any anatomical and biomechanical alteration of the foot has an impact on the ambulation. OBJECTIVE: to determine the degree of functional ­ radiological correlation in patients treated by the scarf osteotomy. MATERIAL AND METHODS: correlational and cross-sectional study. 78 patients diagnosed with hallux valgus were studied. Functional and radiological (AOFAS Scale) assessment was performed on all patients with hallux valgus operated by scarf osteotomy; the correlation between each patient's functional and radiological assessment was also established using the squared chi test. RESULTS: having obtained the critical value of Chi ­ squared ((X2c x 12,992), it was found that this is less than the value of the Chi ­ calculated square, both for the phalangeal metatarsus angle (X2 x 40.715) and the inter-metatarsal angle (X2 x 16,539); which means that the null hypothesis was not accepted (Functional results do not correlate with radiological results inversely proportional). CONCLUSION: a degree of reverse correlation between functional and radiological results was determined in patients treated with scarf osteotomy; α = 0.05; p = 0.95. ­ meaning that the greater the gradation of hallux valgus (mild, moderate and severe), the lower the AOFAS scale score (poor, acceptable, good and excellent).

Correlación clínica y ultrasonográfica con los hallazgos intra-operatorios de pacientes con diagnóstico de ruptura de manguito rotador en el servicio de traumatología del Hospital Obrero Nº 1, durante el periodo 2010 ­ 2014 / Clinical and ultrasonographic correlation with the intra-operative findings of patients with diagnosis of division of muff rotador in the service of traumatology of the Hospital Obrero Nº 1, during period 2010 ­ 2014

INTRODUCCIÓN: una gran parte de la población adulta padece dolor de hombro en algún momento de su vida. Dejando aparte las enfermedades neoplásicas, sistémicas y traumáticas directas, una de las causas de dolor de hombro es la patología inflamatoria o degenerativa del manguito rotador, que puede ser responsable de una limitación funcional importante adulto. OBJETIVO: determinar el grado de correlación clínica y ultrasonográfica con los hallazgos intra-operatorios en pacientes con diagnóstico de ruptura de manguito rotador en el servicio de Traumatología del Hospital Obrero Nº 1, durante el periodo 2010 ­ 2014. MATERIAL Y MÉTODOS: estudio descriptivo transversal y analítico. Se estudiaron 56 pacientes de ambos sexos, internados en el servicio de Traumatología y Ortopedia del Hospital Obrero Nº1, durante el periodo del 1° de enero del 2010 al 31 de diciembre del año 2014. Se realizó la valoración clínica (maniobra de Jobe y manobra de Yocum) y ultrasonográfica y se compararon los resultados con los hallazgos intra-operatorios, para determinar la validez y la seguridad de la clínica y la ecografía. RESULTADOS: se determina que el test diagnóstico clínico tiene mayor validez (Sensibilidad: 92,7-87,8% y Especificidad: 73,3-60%) y seguridad (Valor Predictivo Positivo: 90,5-85,7% y Valor Predictivo Negativo: 78,6-64,3%) que el test diagnóstico ultrasonográfico (Sensibilidad: 85,4%, Especificidad: 66,7%, Valor Predictivo Positivo: 87,5% y Valor Predictivo Negativo: 62,5%). CONCLUSIÓN: se determina que existe una correlación clínica y ultrasonográfica con los hallazgos intra-operatorios en pacientes con diagnóstico de ruptura de manguito rotador en el servicio de Traumatología del Hospital Obrero Nº 1

INTRODUCTION: a great part of the adult population suffers shoulder pain at some moment of life. Leaving aside direct neoplastic systems and traumatic diseases, one of the causes of pain of shoulder is the inflammatory or degenerative pathology of the muff rotator, which can result in an important functional limitation. OBJECTIVE: determining the degree of clinical and ultrasonographic correlation with the intra-operative findings in patients with yielding-point diagnosis of muff rotator in the service of Traumatology of the Hospital Obrero Nº 1, during the period 2010 ­ 2014. MATERIAL AND METHODS: cross-sectional descriptive and analytical study. 56 patients of both sexes were surveyed, inpatients in the service of Traumatology y Orthopedic of the Hospital Obrero Nº 1, during the period January 1 of 2010 to December 31 of 2014. The clinical assessment was carried out (maneuver of Jobe and maneuver of Yocum) and ultrasonographic and the results were compared with the intra operative findings, in order to determine the value and security of the clinic and the echography. RESULTS: it is determined that the diagnostic test has higher validity (Sensitivity: 92,7-87,8% and specificity: 73,3-60%) and certainty (Positive Predictive Value: 90,5-85,7% and Negative Predictive Value: 78,6-64,3%) than the diagnostic ultrasonographic test (Sensitivity: 85.4%, Specificity: 66.7%, Positive Predictive Value: 87.5% and Negative Predictive Value: 62.5%). CONCLUSIONS: it is determined that there is a clinical and ultrasonographic correlation with the intra operative findings in patients with yielding-point diagnosis of muff rotator at the service of Traumatology of the Hospital Obrero Nº 1

Reanimación con control de daños en el trauma grave pediátrico / Damage control resuscitation in pediatric severe trauma

INTRODUCCIÓN: El trauma es una importante causa de morbimortalidad en la población pediátrica, alcanzando el primer lugar en mortalidad en nuestro país, sin considerar las patologías perinatales y las malformaciones congénitas. Un porcentaje importante de las muertes precoces y tardías secundarias a esta causa, así como sus secuelas, podrían prevenirse con una óptima y oportuna reanimación. OBJETIVOS: Revisar -a la luz de la evidencia existente- la atingencia de la reanimación con control de daños (RCD) en el trauma pediátrico grave, con énfasis en el manejo médico. MATERIAL Y MÉTODOS: Se usó la base de datos PubMed, Cochrane Library y Google académico, empleando como términos de búsqueda (MeSH): trauma, politrauma, reanimación, control de daños, líquidos de reanimación, hipotensión permisiva, coagulopatía, transfusión masiva y niños. RESULTADOS: El concepto de RCD puede ser aplicado en el trauma grave en niños, teniendo en cuenta sus particularidades anatomo-fisiológicas. El principio se basa en el manejo de la tríada letal (coagulopatía, acidosis e hipotermia) asociado a una cirugía con control de daños. En este contexto se analiza la limitación de cristaloides, la hipotensión permisiva y la reanimación hemostática en el manejo inicial del trauma pediátrico gra ve. CONCLUSIONES: Estudios futuros deberán establecer el verdadero rol de la hipotensión permisiva, la relación óptima de hemoderivados a transfundir y la mejor estrategia para predecir la activación de protocolos de transfusión masiva y su impacto en niños con trauma grave.

INTRODUCTION: Trauma is an important cause of morbidity and mortality in the pediatric population. It has the first place in mortality in our country without considering perinatal pathologies and congenital malformations. An important percentage of early and late deaths secondary to this cau se, as well as its sequelae, could be prevented with optimal and timely resuscitation. OBJECTIVE: To review the applicability of damage control resuscitation (DCR) in severe pediatric trauma, with emphasis on medical management. Material and Methods: The PubMed, the Cochrane Library and the Google academic database were used. Search terms (MeSH) were: trauma, polytrauma, resuscitation, damage-control, fluids, permissive hypotension, coagulopathy, massive transfusion and children. RESULTS: The concept of DCR can be applied to severe pediatric trauma, taking into account their anatomical and physiological characteristics. The principle is based on the management of the lethal triad (coagulopathy, acidosis and hypothermia) associated with damage control surgery. Limitation of crystalloids, permissive hypotension and hemostatic resuscitation are reviewed in the initial treatment of severe pediatric trauma. CONCLUSION: Future studies should establish the true role of permissive hypotension, the optimal relationship between blood products and the best strategy to predict the activation of massive transfusion protocols and their impact on children with severe trauma.

En nuevo enfoque en el manejo de la marcha agazapada: laboratorio de análisis de la marcha, Hospital Ortopédico Infantil / New approach in the management of the crouch gait: at gait lab, Hospital Ortopédico Infantil

La marcha agazapada es una de las alteraciones más frecuentes en los pacientes con parálisis cerebral infantil, y aunque es fácilmente reconocible, tampoco ha sido claramente definida. En ella, la rodilla carece de una extensión dinámica, durante la fase de apoyo, el tobillo lo podemos encontrar en flexión plantar, dorsal o neutro, y las caderas generalmente están flexionadas y frecuentemente en rotación interna y en aducción. El presente es un estudio prospectivo, realizado en el Hospital Ortopédico Infantil, empleando los datos obtenidos del departamento de historias médicas y del laboratorio de análisis de la marcha, en el cual hemos utilizado la nueva clasificación cinemática de Michael Schwartz, Director de Bioingeniería del Laboratorio de Análisis de la Marcha del Gillette Children´s Hospital, Saint Paul, Minnesota, para sujetos que presentaban excesiva flexión de rodilla al contacto inicial. Con lo cual se obtiene 5 subtipos cinemáticas de marcha agazapada, de acuerdo a los datos obtenidos en el plano sagital, y que a la vez nos permiten saber a qué nivel se encuentran las alteraciones principales de los pacientes, proporcionándonos de esta manera una guía que nos ayude en la decisión del tratamiento a emplear y al mismo tiempo nos permite realizar una valoración post-quirúrgica

Crouch gait is one of the most frequent alterations in patients with cerebral palsy, and although it is easily recognizable, has not been clearly defined. In it, the knee lacks a dynamic extension during the stance phase, the ankle can be found in plantar flexion, dorsal or neutral, and hips are usually bent and often in internal rotation and adduction. This is a prospective study conducted at the Children's Orthopedic Hospital, using data obtained from the department of medical and gait laboratory, which we have used the new classification Schwartz Michaels kinematics, Director of Bioengineering, Laboratory of Analysis of the March of Gillette Children's Hospital, Saint Paul, Minnesota, for subjects with excessive knee flexion initial contact. Thus obtained five subtypes kinematic crouched running, according to data obtained in the sagittal plane and at the same time let us know at what level are the main changes of the patients, thereby providing a guide help us in deciding the treatment to be applied at the same time allows us to perform a post-surgical evaluation

Avaliação do aprendizado em técnica cirúrgica empregando três estagiárias de ensino / Learning evaluation in surgical technique using three teaching strategies

O aprendizado de cirurgia envolve inicialmente um conhecimento técnico seguido de um treinamento prático do aluno. Atividades em laboratório permitem ao aluno conhecer o instrumental cirúrgico e as dificuldades de técnica operatória antes de executar os procedimentos na clínica. Várias metodologias têm sido propostas no processo ensino-aprendizagem de cirurgia, mas tão importante quanto o método de ensino é a avaliação do aprendizado e a competência do aluno. Este trabalho teve como objetivo comparar três métodos diferentes de ensino de técnica cirúrgica, através de avaliações práticas utilizando um modelo que permite as manobras de incisão, divulsão e sutura. Trinta alunos sem conhecimento ou experiência prévia em cirurgia foram divididos em três grupos onde uma estratégia de ensino-aprendizagem diferente foi empregada. Grupo 1 - metodologia ativa, Grupo 2 - leitura prévia de texto e Grupo 3 - leitura prévia de texto com demonstração em vídeo. O conteúdo programático foi o mesmo para todos os grupos. Ao término dessa atividade, todos realizaram o procedimento estudando no modelo, os itens avaliados seguiram um 'checkilist' computando S para questões corretas e N para erratas e transformações em notas de zero a dez. A avaliação no modelo foi repetida em 30 e 60 dias. Para verificar a diferença entre as médias das notas nos grupos foram aplicados procedimentos de análise de variância (ANOVA) e comparação múltipla pelo método de Tukey (nível de significância α=0,05). Os dados mostraram que a metodologia ativa (Grupo 1) apresentou melhores resultados com relação à assimilação imediata do conhecimento, seguida da que utilizou texto e vídeo (p=0,0004) e, por último, a leitura do texto (p=0,0001). Entretanto essa metodologia também não foi totalmente efetiva na retenção do aprendizado da técnica. Baseado nas condições desse estudo, podemos concluir que apesar da metodologia ativa alcançar melhor desempenho inicial em relação às outras em todas as etapas, as três estratégias foram similares na manutenção do que foi aprendido em procedimentos cirúrgicos básicos após 60 dias. Repetições durantes o aprendizado de habilidades manuais são essenciais para assimilação adequada. Avaliações constantes são fundamentais para conferir a evolução do aprendizado, permitindo reforço teórico e repetições do treinamento das habilidades práticas e diferenciando para o tipo de metodologia mais indicada no momento.

Surgical learning initally involves theory understanding followed by surgical practice training. Laboratories actives allow the student's introduction to special instruments and comprehension of operative technical difficulties before the use and execution on clinical working. Many methodologies have been proposed in teaching and learning of surgery practive but assessment of learning skilis and abilities gained by the student is imperative. The present study was proposed to compare three different methodologies of teaching a basic surgical technique through a practical assessment employing a learning model that allows incision, divulsion and suture procedures. Thirty undergraduate students without any knowledge of previous surgical experience were divided in three groups (n=10) each one received a singular methodological learning strategy: Group 1 - interative methodology, Group 2 - text reading only and Group 3 - text reading and demonstration vídeo. Programmatic issue was the same for all groups. After matter and technical procedures were instructed by one of the strategies apprentices were allowed to execute in the learning model the procedure studied. A structured evaluation test talking to account correct or incorrect maneuvers was applied by a trained observer. Grades from 0-10 were given in each examination. Evaluation trial was repeated 30 and 60 days after the first class. Data from grade's media between groups and periods were considering for statistical analysis by ANOVA and Tukey method (significant level α=0,05). The results showed that interactive methodology (Group 1) presented the best significant learning results in view of the immediately assimiation of procedure comprehension compared to group 3 (p=0,0004) that has used text reading and vídeo and to group 2 (p=0,0001) that had read only the text. However, interactive methodology was not totally effective on mainterance of the learning skils. Based on the controlled conditions of this study, it was also possible to conclude that despite the fact that interactive learning methodology had demonstrated better initial learning reslts, the three strategies were similara on absorption of basic surgery procedures knowiedge after 60 days. Repetition on learning a new manual ability ais essential for asimilation. Evaluation tests to assess learning are fundamental to check teaching strategies and to permit theory feedbacks and proficiency learning.

Reconstruction of body injuries leads to unraveling mystery behind unidentified mutilated skeletonised human remains.

Medico legists are frequently requisitioned by investigating agencies to examine and opine regarding identity, cause, manner & time since death of unidentified mutilated decomposed/ skeletonised human remains. Such an opinion in some of these cases can be very intriguing or even impossible to make. However, availability and examination of relevant facts/ information/ documents with regards to circumstantial evidences and their corroboration with autopsy findings including reconstruction of body injuries and examination of articles pertinent to the case can do wonders in this regard. The case relates to unidentified mutilated human remains in advanced stage of decomposition, partial adipocere formation, near skeletonisation & partial mutilation, recovered from a ground well not in use for drinking water purpose, tied to a heavy stone slab. The pelvis and left Femur bones showed sharp cut injuries in unique and patterned fashion. The paper discusses important issues of reconstructive Forensic Medicine in the light of the given case.

Management of splenic trauma

This work included 90 patients with splenic trauma, 76 [84.4%] males and 14 females [15.6%]. Ages varied between 5 and 50 years with a median of 19.4 years. The highest peak lies between 11 and 20 years. On analysis of the cases of trauma, the patients were divided into 5 groups. Falling from a height accounts for the highest number of cases which was 32 [35.5%] followed by road traffic accidents [24 cases] [26.6%], stab-injuries due to civilian violence accounted for 12 cases [13.3%], fire-arm injuries were seen in 8 cases [8.8%]. Other causes including blunt violence [6 cases] and iatrogenic injuries [8 cases] had good participation. Diagnosis based on rapid history and clinical evaluation with ultrasound examination of all patients. Laboratory tests played a minor role for diagnosis. 28 patients underwent splenectomy. 16 patients were subjected to splenerrhaphy, partial splenectomy was done in 20 cases and splenic autotransplants [after splenectomy] was done in 26 cases. Early postoperative complications were minor and none of the patients died in the early postoperative period. All patients were followed every 3 months for detection of remanents of splenic tissue and for detection of post-splenectomy infection. Only one case of over-whelming post- splenectomy infection [OPSI] was picked-up [following splenic autotransplantation]. It was clear that splenic preservation techniques can be safely done. The impetus is the recognized risk of [OPSI] especially in the pediatric group

Fracturas distales de radio / Distal fractures of the radium

La presente comunicación tiene como objetivo presentar un informe preliminar sobre 20 pacientes tratados en los últimos 2 años con un tutor externo de fabricación regional, a bajo costo, como tratamiento de fracturas articulares distales del radio, en especial, aquellas conminutas y complejas (tipo C según clasificación de la AO International); observando discreta mejoría en relación al anterior tutor de los autores, presentado el año anterior. En especial se logró disminuir las complicaciones presentadas en la muestra anterior

Pseudoartrosis de escafoides evaluación de su tratamiento con técnicas de Matti-Russe / Scaphoid pseudoarthrosis: evaluation of its treatment with Matti-Russe's technique

Se presenta documento tiene como objetivo mostrar los resultados obtenidos para el tratamiento de la pseudoartrosis del escafoides carpiano; utilizando la técnica de Matti-Russe. Dichos resultados son buenos, en razón de tener pocos pacientes con secuelas artrosicas, pero casi todos presentan limitaciones articulares y dolor residual