Infección asociada a fractura ¿Qué nos dice la literatura? / Fracture related infection - What does the literature tell us?

La infección asociada a fracturas (IAF) es una de las complicaciones más frecuentes y desafiantes del traumaortopédico, sin embargo, su importancia ha sido subestimada existiendo históricamente una falta de estandarización en su manejo. En los últimos años la evidencia científica disponible ha ido en aumento, ya consecuencia de ello múltiples guías clínicas y consensos de expertos han sido publicados. El objetivo de este trabajo es proporcionar una actualización, dirigida principalmente a especialistas en Ortopedia y Traumatología, buscado estandarizar criterios diagnósticos y de tratamiento basado en evidencia científica reciente.

Fracture-related infection (FRI) is one of the most frequent and challenging complications of orthopedic trauma; however, its importance has been underestimated. Historically, there has been a lack of standardization in its management. However, the available scientific evidence has increased in recent years, given multiple clinical guidelines and expert consensus. This review aims to provide an update oriented to orthopedic trauma surgeons to standardize diagnostic and treatment criteria based on recent scientific evidence

Caso Clínico. Fracturas Interprotésicas. Presentación de caso clínico / Case Report. Interprosthetic Fractures

PRESENTACION DEL CASO: Paciente de 78 años con antecedente de artroplastia total de cadera derecha de 4 años post operatorio, y prótesis de rodilla derecha con vástago de 2 años postoperatorio, sufre una caída en su domicilio. Al ingreso presenta dolor e impotencia funcional con deformidad y desviación a nivel del muslo derecho.

CASE PRESENTATION: A 78-year-old patient with a history of right total hip arthroplasty 4 years postoperative, and right knee prosthesis with stem 2 years postoperative. Patient suffered a fall at home. On admission presented pain and functional impotence with deformity and devia- tion at the level of the right thigh.

Efecto del shiatsu sobre el dolor en personas con fracturas de extremidades: ensayo clínico / Efeito do shiatsu sobre a dor de pessoas com fraturas nos membros: ensaio clínico / Effects of shiatsu on pain in people with limb fractures: clinical trial

The postoperative period for limbs fractures is characterized by different levels of pain intensity. Shiatsu is a therapy applied with the hands on meridians and tsubos (points similar to acupuncture) related to pain. Objective: To evaluate the effect of shiatsu on postoperative pain in men with arm and leg fractures. Method: Non-randomized and uncontrolled clinical trial, with assessment of pain levels using the Visual Numerical Scale (VNS) (0­10) and measurement of salivary cortisol. The R software and the Wilcoxon test and Fisher's exact test were used. Results: 41 people participated in the research; the initial mean value of salivary cortisol concentration was 0.39 µg/dl and, after shiatsu intervention, it decreased to 0.32 µg/dl (p<0.0001). The Mean pain value was 4.93 (VNS) before the intervention and 3.90 (p<0.0001) after. Conclusion: The application of shiatsu contributed to reducing pain and cortisol levels in people undergoing orthopedic surgery. (AU)

O pós-operatório de fraturas dos membros superiores e inferiores é caracterizado por diversos níveis de intensidade dolorosa. O shiatsu é uma terapia aplicada com as mãos nos meridianos e tsubos (pontos similares aos da acupuntura) relacionados à dor. Objetivo: Avaliar o efeito do shiatsu sobre a dor no pós-operatório de homens com fraturas dos braços e pernas. Método: Ensaio clínico não randomizado e não controlado, com avaliação dos níveis de dor por meio da Escala Numérica Visual (ENV) (0­10) e de mensuração do cortisol salivar. Foi utilizado o software R e o teste de Wilcoxon e o teste exato de Fisher. Resultados: 41 pessoas participaram da pesquisa; o valor médio inicial da concentração salivar de cortisol foi de 0,39 µg/dl e, depois da intervenção com shiatsu, diminuiu para 0,32 µg/dl (p<0,0001). O valor médio da dor foi 4,93 (ENV) antes da intervenção e 3,90 (p<0,0001) depois. Conclusão: A aplicação do shiatsu contribuiu para reduzir os níveis de dor e cortisol em pessoas submetidas a cirurgias ortopédicas. (AU)

El postoperatorio de fracturas de miembros superiores e inferiores se caracteriza por diferentes niveles de intensidad del dolor. El Shiatsu es una terapia que se aplica con las manos sobre meridianos y tsubos (puntos similares a la acupuntura) relacionados con el dolor. Objetivo: Evaluar el efecto del Shiatsu sobre el dolor postoperatorio en hombres con fracturas de brazo y pierna. Método: ensayo clínico no aleatorizado y no controlado, con evaluación de los niveles de dolor mediante la Escala Numérica Visual (ENV) (0­10) y medición de cortisol salival. Se utilizó el software R, la prueba de Wilcoxon y la prueba exacta de Fisher. Resultados: Participaron de la investigación 41 personas y el valor medio inicial de la concentración de corti-sol salival fue de 0,39 µg/dl y después de la intervención de Shiatsu disminuyó a 0,32 µg/dl (p<0,0001). El valor promedio del dolor fue de 4,93 (ENV) antes de la intervención y de 3,90 (p<0,0001) después de la intervención. Conclusión: La aplicación de Shiatsu contribuyó a reducir el dolor y los niveles de cortisol en personas sometidas a cirugía ortopédica. (AU)

Meta-analysis of the role of fibular fixation in tibiofibular fractures / 中国骨伤

OBJECTIVE@#To compare the role and importance of fibular fixation in tibiofibular fractures by Meta-analysis.@*METHODS@#The literature related to the comparison of the efficacy of fixation of the fibula with or without fixation on the treatment of tibiofibular fractures was searched through the databases of China Knowledge Network, Wipu, Wanfang, The Cochrane Library, Web of science and Pubmed, and statistical analysis was performed using RevMan 5.3 software. The rates of malrotation, rotational deformity, internal/external deformity, anterior/posterior deformity, non-union, infection, secondary surgery and operative time were compared between the fibula fixation and non-fixation groups.@*RESULTS@#A total of 11 publications were included, six randomised controlled trials and five case-control trials, eight of which were of high quality. A total of 813 cases were included, of which 383 were treated with fibula fixation and 430 with unfixed fibulae.Meta-analysis results showed that fixation of the fibulae in the treatment of tibiofibular fractures reduced the rates of postoperative rotational deformity[RR=0.22, 95%CI(0.10, 0.45), P<0.000 1] and internal/external deformity[RR=0.34, 95%CI(0.14, 0.84), P=0.02] and promoted fracture healing [RR=0.76, 95%CI(0.58, 0.99), P=0.04]. In contrast, the rates of poor reduction [RR=0.48, 95% CI(0.10, 2.33), P=0.36], anterior/posterior deformity[RR=1.50, 95%CI(0.76, 2.96), P=0.24], infection[RR=1.43, 95%CI(0.76, 2.72), P=0.27], secondary surgery[RR=1.32, 95%CI(0.82, 2.11), P=0.25], and operative time[MD=10.21, 95%CI(-17.79, 38.21), P=0.47] were not statistically significant (P>0.05) for comparison.@*CONCLUSION@#Simultaneous fixation of the tibia and fibula is clinically more effective in the treatment of tibiofibular fractures.

O-arm navigation versus C-arm navigation for guiding percutaneous long sacroiliac screws placement in treatment of Denis type Ⅱ sacral fractures / 中国修复重建外科杂志

OBJECTIVE@#To compare the effectiveness of O-arm navigation and C-arm navigation for guiding percutaneous long sacroiliac screws in treatment of Denis type Ⅱ sacral fractures.@*METHODS@#A retrospective study was conducted on clinical data of the 46 patients with Denis type Ⅱ sacral fractures between April 2021 and October 2022. Among them, 19 patients underwent O-arm navigation assisted percutaneous long sacroiliac screw fixation (O-arm navigation group), and 27 patients underwent C-arm navigation assisted percutaneous long sacroiliac screw fixation (C-arm navigation group). There was no significant difference in gender, age, causes of injuries, Tile classification of pelvic fractures, combined injury, the interval from injury to operation between the two groups ( P>0.05). The intraoperative preparation time, the placement time of each screw, the fluoroscopy time of each screw during placement, screw position accuracy, the quality of fracture reduction, and fracture healing time were recorded and compared, postoperative complications were observed. Pelvic function was evaluated by Majeed score at last follow-up.@*RESULTS@#All operations were completed successfully, and all incisions healed by first intention. Compared to the C-arm navigation group, the O-arm navigation group had shorter intraoperative preparation time, placement time of each screw, and fluoroscopy time, with significant differences ( P<0.05). There was no significant difference in screw position accuracy and the quality of fracture reduction ( P>0.05). There was no nerve or vascular injury during screw placed in the two groups. All patients in both groups were followed up, with the follow-up time of 6-21 months (mean, 12.0 months). Imaging re-examination showed that both groups achieved bony healing, and there was no significant difference in fracture healing time between the two groups ( P>0.05). During follow-up, there was no postoperative complications, such as screw loosening and breaking or loss of fracture reduction. At last follow-up, there was no significant difference in pelvic function between the two groups ( P>0.05).@*CONCLUSION@#Compared with the C-arm navigation, the O-arm navigation assisted percutaneous long sacroiliac screws for the treatment of Denis typeⅡsacral fractures can significantly shorten the intraoperative preparation time, screw placement time, and fluoroscopy time, improve the accuracy of screw placement, and obtain clearer navigation images.

Single Kocher-Langenbeck approach combined with anterograde channel screw technique in treatment of acetabular transverse and posterior wall fractures / 中国修复重建外科杂志

OBJECTIVE@#To assess the effectiveness of the single Kocher-Langenbeck approach combined with anterograde channel screw technique for the treatment of acetabular transverse and posterior wall fractures.@*METHODS@#Between March 2020 and October 2022, 17 cases of acetabular transverse and posterior wall fractures were treated with the single Kocher-Langenbeck approach combined with anterograde channel screw technique. There were 11 males and 6 females, with an average age of 53.6 years (range, 42-64 years). Causes of injury included traffic accident in 12 cases, and falling from height in 5 cases. The time from injury to operation ranged from 4 to 16 days with an average of 8.8 days. The operation time, intraoperative blood loss, and fluoroscopy frequency were recorded; X-ray films were reviewed regularly after operation to observe the fracture healing, and postoperative complications were recorded. At last follow-up, Matta score was used to evaluate the reduction of fracture, Harris score and modified Merle D'Aubigné-Postel scores system were used to evaluate the hip joint function.@*RESULTS@#The operation time was 150-230 minutes (mean, 185.9 minutes), the intraoperative blood loss was 385-520 mL (mean, 446.2 mL), and the fluoroscopy frequency was 18-34 times (mean, 27.5 times). Postoperative fat liquefaction occurred in 1 case and the other incisions healed by first intention; 3 cases had limb numbness after operation, and the symptoms disappeared after active symptomatic treatment; no urogenital system and intestinal injury occurred. All patients were followed up 12-28 months (mean, 19.9 months). Bone union was achieved in all cases with an average healing time of 10.8 weeks (range, 8-14 weeks). There was no complication such as loosening and breakage of internal fixators. At last follow-up, according to Matta score, 12 cases achieved anatomic reduction, 3 satisfactory reduction, and 2 fair reduction, the satisfactory rate was 88.2%; according to Harris hip function score, 12 cases were excellent, 3 good, and 2 fair, the excellent and good rate was 88.2%; according to the modified Merle D'Aubign Aubigné-Postel scoring system, the results were excellent in 11 cases, good in 3 cases, and fair in 3 cases, with an excellent and good rate of 82.4%.@*CONCLUSION@#The single Kocher-Langenbeck approach combined with anterograde channel screw technique is a minimally invasive method for the treatment of acetabular transverse and posterior wall fractures with less complications, simple operation, and satisfactory effectiveness.

Research progress on mechanism of traumatic brain injury promoting fracture healing / 中国修复重建外科杂志

OBJECTIVE@#To summarize the research progress on the mechanism related to traumatic brain injury (TBI) to promote fracture healing, and to provide theoretical basis for clinical treatment of fracture non-union.@*METHODS@#The research literature on TBI to promote fracture healing at home and abroad was reviewed, the role of TBI in fracture healing was summarized from three aspects of nerves, body fluids, and immunity, to explore new ideas for the treatment of fracture non-union.@*RESULTS@#Numerous studies have shown that fracture healing is faster in patients with fracture combined with TBI than in patients with simple fracture. It is found that the expression of various cytokines and hormones in the body fluids of patients with fracture and TBI is significantly higher than that of patients with simple fracture, and the neurofactors released by the nervous system reaches the fracture site through the damaged blood-brain barrier, and the chemotaxis and aggregation of inflammatory cells and inflammatory factors at the fracture end of patients with combined TBI also differs significantly from those of patients with simple fracture. A complex network of humoral, neural, and immunomodulatory networks together promote regeneration of blood vessels at the fracture site, osteoblasts differentiation, and inhibition of osteoclasts activity.@*CONCLUSION@#TBI promotes fracture healing through a complex network of neural, humoral, and immunomodulatory, and can treat fracture non-union by intervening in the perifracture microenvironment.

Proposta de impressão em 3-D de ossos de pessoas idosas vitimadas de fratura: Considerações preliminares / Proposal for 3-D printing of bones from elderly people suffering from fractures: Preliminary considerations / Propuesta de impresión 3D de huesos de personas mayores con fracturas: Consideraciones preliminares

No ano de 1984, foi criada a primeira impressora do tipo 3-D pelo engenheiro de origem norte-americana, Dr. Charles Hull, sendo que, antes disso, mais especificamente a quatro (04) anos, o japonês Dr. Hideo Kodama, desenvolveu a técnica de estereolitografia, que consistia em uma prototipagem rápida, possuindo enquanto intuito, "criar" objetos usando para este intento, luz ultravioleta (UV), ou ainda, um projetor para endurecer uma resina do tipo líquida em plástico sólido e resistente, ficando posteriormente conhecida como a sigla SLA.1,2 Após dois (02) anos, em 1986, Hull patenteou a SLA e, com isso, ele teve a oportunidade de desenvolver a "3-D Systems Corp", presente até hoje, sendo está uma das maiores empresas do ramo e, desta forma, o primeiro objeto então escolhido pelo Dr. Hull para ser impresso, foi uma lâmpada feita com resina, um plástico sintético.

Reports of Maltreatment in a Children's Hospital: Evaluation of the Epidemiological Profile and Its Relationship with the Outcome in Fractures / Notificações de maus-tratos em um hospital infantil: Avaliação do perfil epidemiológico e sua relação com o desfecho em fraturas

Abstract Objective To describe suspected/confirmed cases of child maltreatment related to fractures in a pediatric hospital in southern Brazil. Method Study of the Information System of Notifiable Diseases notifications and the victims' medical records between January/2016 and December/2020. Variables related to the victim, the perpetrator, the type of abuse, the presence of fractures, and their anatomical location and death were evaluated. Logistic regression was performed to identify fracture-related variables, adjusted for sex and age. The results were expressed in odds ratios and their respective 95% confidence intervals. It was considered significant p < 0.05. Results There were 276 cases, 73 infants (26.4%), male predominance (151, 54.7%), with authorship of the mistreatment by relatives (245, 96,0%), 85 (31,5%), they presented fractures, with five deaths (1.9%). Factors related to the presence of fracture: age of the victim (less than two years old; n = 82; or 2.48; 95% CI: 1.45 - 4.25), having more than two aggressors involved (n = 144; or 2.09; 95% CI: 1.16-3.75), the medium being traffic/automobile accident, (n = 52; or 2.65; 95% CI: 1.04-6.75), consult an orthopedist (n = 91; or 6.77 / 95% CI: 3.66-12.51), and the need for surgical intervention (n = 15; OR 36.72; 95% CI: 8.22-164.03). Conclusions The importance of suspicion, early identification of aggression, and the correct completion of notifications for activating the system of guaranteeing rights and removal of the aggressor was emphasized.

Resumo Objetivo Descrever os casos suspeitos/confirmados de maus-tratos infantis relacionados a fraturas, atendidos em um hospital pediátrico no Sul do Brasil. Método Estudo das notificações do Sistema de Informação de Agravos de Notificação e dos prontuários das vítimas, entre janeiro/2016 e dezembro/2020. Avaliadas variáveis relacionadas à vítima, ao autor, à tipologia de maus-tratos, à presença de fraturas e sua localização anatômica e óbito. Regressão logística foi realizada para identificar as variáveis relacionadas à fratura, ajustada para sexo e idade, expressa em razão de chance e seus respectivos intervalos de confiança de 95%. Foi considerado significativo p < 0.05. Resultados Houve 276 casos, 73 lactentes (26,4%), predomínio do sexo masculino (151, 54,7%), com autoria dos maus-tratos por parentes (245, 96,0%), 85 (31,5%), apresentaram fraturas, sendo cinco óbitos (1,9%). Fatores relacionados à presença de fratura: idade da vítima (menor de dois anos; n = 82; RC 2,48; IC 95%: 1,45 - 4,25), ter mais de dois agressores envolvidos (n = 144; RC 2,09; IC 95%: 1,16 - 3,75), o meio ser trânsito/acidente automobilístico, (n = 52; RC 2,65; IC 95%: 1,04-6,75), consultar com ortopedista (n = 91; RC 6,77 / IC 95%: 3,66-12,51), e necessidade de intervenção cirúrgica (n = 15; RC 36,72; IC 95%: 8,22-164,03). Conclusões Ressaltada a importância da suspeição e identificação precoce da agressão, o preenchimento correto das notificações, para o acionamento do sistema de garantia de direitos e afastamento do agressor.

Asistencia artroscópica y fijación interna percutánea en fracturas de Maisonneuve. Evaluación por imágenes de los resultados / Arthroscopy and percutaneous internal fixation in Maisonneuve fractures. Imaging evaluation

Introducción: La fractura de Maisonneuve es una lesión caracterizada por la fractura subcapital del peroné asociada a una lesión capsuloligamentaria de tobillo. Su tratamiento supone la restauración de la anatomía ósea y capsuloligamentaria normal para restablecer las fuerzas de contacto tibioastragalinas fisiológicas. Esta calidad de reducción puede ser difícil de alcanzar, sobre todo, con técnicas percutáneas. Objetivo: Evaluar mediante imágenes la calidad de la reducción de fracturas de Maisonneuve reducidas en forma cerrada (bajo visualización directa artroscópica) y fijadas por vía percutánea. Materiales y Métodos: Se analizaron radiografías e imágenes de tomografía computarizada preoperatorias y posoperatorias, comparativas de los tobillos operado y sano. Resultados: Se evaluaron 13 fracturas. Los parámetros radiográficos posoperatorios (espacio claro medial, solapamiento tibioperoneo distal, espacio claro tibioperoneo) no registraron diferencias, excepto por el intervalo tibioperoneo anterior que aumentó en un caso. La medición tomográfica posoperatoria del solapamiento tibioperoneo distal y el intervalo tibioperoneo anterior reveló que todas las reducciones eran satisfactorias. Dos pacientes tenían valores alterados en la sindesmosis tibioperonea distal con diferencia >2 mm respecto del tobillo sano. Conclusión: Recomendamos la asistencia artroscópica para el manejo de la fractura de Maisonneuve como herramienta de control intraoperatorio para una fijación percutánea más segura. Nivel de Evidencia: IV

Introduction: Maisonneuve fracture (MF) is an injury characterized by the subcapital fracture of the fibula associated with a capsuloligamentous injury of the ankle. Treatment involves the restoration of normal bone and capsuloligamentous anatomy in order to reestablish physiological tibiotalar contact forces. This quality of reduction can be difficult to achieve, especially with percutaneous techniques. Objective: To evaluate the quality of reduction in Maisonneuve fractures reduced in a closed manner (under direct arthroscopic visualization) and fixed percutaneously. Materials and Methods: We analyzed comparative preoperative and postoperative radiographs and CT scans of the operated and healthy ankles. Results: 13 fractures were evaluated. Radiographic parameters of postoperative procedures (medial clear space, distal tibiofibular overlap, tibiofibular clear space) did not register differences except for the anterior tibiofibular space, which had increased in 1 case. Postoperative tomographic measurements of tibiofibular clear space and anterior tibiofibular space showed 100% satisfactory reductions. Two patients presented altered distal tibiofibular overlap values with a difference greater than 2 mm compared to the healthy ankle. Conclusion: We recommend arthroscopy for the management of MF as an intraoperative control tool for safer percutaneous fixation. Level of Evidence: IV

Fijación con sutura de alta resistencia para fracturas de metacarpianos / High-strength suture fixation in metacarpal fractures

Introducción: Las fracturas de metacarpianos son comunes en la práctica traumatológica. El cirujano dispone de diferentes opciones cuando decide implementar un tratamiento quirúrgico, como fijación percutánea con agujas de Kirschner, reducción abierta y fijación interna con placas y tornillos, tornillos interfragmentarios y tornillos endomedulares, entre otras. materiales y métodos: Se trató a 19 pacientes con fracturas diafisarias oblicuas largas o espiroideas del 2.° al 5.° metacarpiano mediante la reducción abierta y fijación interna con suturas de alta resistencia. El tiempo promedio de seguimiento fue de 20 meses. Se utilizaron radiografías y escalas funcionales para documentar los resultados obtenidos. Resultados: La fractura consolidó en todos los pacientes quienes retornaron a sus actividades en un promedio de 2.3 meses. Un paciente perdió la reducción inicial por no respetar las indicaciones médicas, pero la fractura consolidó sin necesidad de una nueva intervención. Conclusión: El método propuesto proporcionó una reducción anatómica, una fijación estable libre de metal y buenos resultados funcionales. Nivel de Evidencia: IV

Introduction: Metacarpal fractures are highly prevalent in traumatology. When a surgeon determines that surgical treatment is required, numerous techniques are available, including K-wire fixation, open reduction and internal fixation with plates and screws, interfragmentary screws, and intramedullary screws, among others. Materials and methods: This study included 19 patients with long oblique or spiral shaft fractures of the second to fifth metacarpals, who were treated with open reduction and high-strength suture internal fixation. The average follow-up period was 20 months. Radiographs and functional scales were used to document clinical outcomes. Results: Fracture consolidation was achieved in all patients, and they were able to resume their previous activities after an average of 2.3 months. One patient lost the initial reduction due to a failure to comply with medical instructions but achieved fracture consolidation without the need for additional procedures. Conclusion: The technique described herein provided a strong metal-free fixation with good clinical outcomes at a low cost. Level of Evidence: IV

Síndrome de embolia grasa secundario a fracturas de huesos cortos: Presentación de casos / Fat embolism syndrome secondary to short bone fracture. Case presentation

Introducción: Se presenta el caso clínico de un varón de 15 años con fracturas de huesos cortos del pie derecho como consecuencia de un accidente de tránsito. Tras 24 h de evolución, ingresa con disnea, desaturación, pico febril objetivo y posterior desarrollo de insuficiencia respiratoria. Ante la sospecha clínica de síndrome de embolia grasa, se solicita una angiotomografía pulmonar que confirma el diagnóstico. Se trata de una entidad inusual en pacientes con este tipo de fractura. El tratamiento inicial consistió en vigilancia estrecha en la unidad de cuidados intensivos, medidas de soporte con oxígeno suplementario, terapia res-piratoria y manejo quirúrgico de las fracturas. La evolución clínica del paciente fue adecuada y el cuadro respiratorio se resolvió por completo. Conclusiones: El síndrome de embolia grasa secundario a fracturas de huesos cortos es un cuadro infrecuente; por lo tanto, es preciso tener un alto grado de sospecha diagnóstica, no solo en los escenarios más comunes, sino también en este tipo de contextos inusuales y retadores, que permita su identificación temprana y, de esta forma, implementar un manejo oportuno y generar un impacto favorable en los desenlaces clínicos y en la disminución del riesgo de secuelas a largo plazo. Nivel de Evidencia: IV

Introduction: We present the clinical case of a 15-year-old male who sustained fractures to the short bones of his right foot as a result of a traffic accident. After 24 hours of evolution, he was admitted for dyspnea, desaturation, an objective febrile peak, and the development of respiratory failure. Given the clinical suspicion of fat embolism syndrome, pulmonary angiotomography was requested, which confirmed the diagnosis. This is a rare finding in patients with this type of fracture. The initial treatment included close monitoring in the intensive care unit, supportive measures such as supplemental oxygen, respiratory therapy, and surgical fracture management. The patient's clinical progression was adequate, and the respiratory condition resolved completely. Conclusion: Fat embolism syndrome resulting from short bone fractures is a rare condition; therefore, it is necessary to have a high level of diagnostic suspicion, not only in the most common scenarios, but also in these unusual and challenging contexts, which allows for its early detection and, as a result, timely management, which has a positive impact on clinical outcomes and reduces the risk of long-term sequelae. Level of Evidence: IV

Complicaciones en las artroplastias totales de cadera después de fracturas de acetábulo. Estudio comparativo entre cotilos convencionales y de doble movilidad / Complications in total hip arthroplasties after acetabulum fractures. A comparative study of conventional cups versus dual mobility cups

Introducción: La enfermedad degenerativa de la cadera puede desarrollarse después de una fractura de acetábulo. La artroplastia total de cadera es un procedimiento de salvataje muy utilizado que logra buenos resultados, pero que no está libre de dificultades técnicas y complicaciones. Objetivo: Analizar los resultados clínicos y radiográficos de la artroplastia total de cadera y sus complicaciones a corto y mediano plazo, comparando componentes acetabulares de doble movilidad no cementados y cotilos convencionales no cementados. Materiales y Métodos:Se evaluó retrospectivamente a 37 pacientes sometidos a una artroplastia total de cadera entre 2003 y 2022. Se analizaron los resultados clínicos y funcionales según la escala de Merle D ́Aubigné; los resultados radiográficos, según los criterios modificados de Stauffer; y la estabilidad de los componentes no cementados mediante los parámetros de Engh. Resultados: La muestra estaba compuesta por 37 pacientes (11 mujeres y 26 hombres), con una media de edad de 43.78 años. El tiempo promedio de seguimiento fue de 6.6 años.Los resultados fueron excelentes (54%), buenos (32,4%), regulares (8,1%) y malos (5,5%). Mediante la prueba exacta de Fisher, se comparó entre el tipo de cotilo empleado y el riesgo de complicaciones, y no se encontró una correlación significativa. Conclusiones: La artroplastia total de cadera con cotilos de doble movilidad es una opción muy válida para tratar las secuelas de fracturas acetabulares, logra excelentes resultados y la tasa de complicaciones es muy baja. Nivel de Evidencia: IV

Introduction: Degenerative hip disease can develop after an acetabulum fracture. Total Hip Arthroplasty (THA) is a common salvage procedure that generally yields good outcomes but is not without technical difficulties and complications. Objective: To analyze the clinical and radiological outcomes and short- and medium-term complications of THA by comparing uncemented, dual-mobility acetabular cups with conventional uncemented cups. Materials and Methods: We retrospectively evaluated 37 patients who underwent THA between 2003 and 2022. Clinical and functional outcomes were assessed using the Merle d'Aubigné and Postel scale, while radiographic outcomes were evaluated according to the modified Stauffer criteria and the stability of cementless components based on Engh parameters. Results: The final sample included 37 patients (11 women and 26 men) with an average age of 43.78 years. The average follow-up time was 6.6 years. Outcomes were excellent in 54% of cases, good in 32.4%, fair in 8.1%, and poor in 5.5%. Fisher's exact test showed no significant correlation between the type of cup used and the risk of complications. Conclusions: Total hip arthroplasty using dual-mobility cups is a highly effective treatment option for the sequelae of acetabular fractures, offering excellent outcomes and a very low complication rate. Level of Evidence: IV

Fractura del fragmento de Wagstaffe-Le Fort en un paciente con luxofractura de tobillo. Equivalente cuadrimaleolar. Reporte de un caso / Wagstaffe-Le Fort fracture in a patient with an ankle fracture-dislocation. Quadrimalleolar equivalent. Case report

Se presenta el caso de una paciente que sufre una luxofractura del tobillo izquierdo con compromiso trimaleolar, pero, en la tomografía computarizada prequirúrgica, se documenta el compromiso adicional del tubérculo de Wagstaffe-Le Fort, por lo que se decide considerarlo como un equivalente cuadrimaleolar diferente de los descritos previamente con el compromiso del fragmento anterolateral de la tibia (Tillaux-Chaput). Este caso permite un enfoque de 360° de las lesiones de tobillo que afectan la congruencia articular y se propone un análisis osteo-ligamentario para su tratamiento definitivo, favoreciendo las reparaciones anatómicas para disminuir la necesidad de fijaciones transindesmales sin afectar el desenlace quirúrgico. Nivel de Evidencia: IV

In this article, we present the case of a patient who suffered a fracture-dislocation of the left ankle with trimalleolar involvement. However, the preoperative tomography revealed the additional involvement of the Wagstaffe-Le Fort tubercle, so it was decided to approach it as a quadrimalleolar equivalent different from those previously described, with involvement of the anterolateral fragment of the tibia (Tillaux-Chaput). This case allows for a 360° approach to ankle injuries that disrupt joint congruence, and an osteo-ligament analysis is proposed for its definitive treatment, prioritizing anatomical repairs to reduce the need for syndesmotic transfixation, without compromising surgical outcomes. Level of Evidence: IV

Seguridad de la cirugía de luxofracturas vertebrales toracolumbares según la oportunidad quirúrgica / Safety of surgical treatment for thoracolumbar fracture-dislocations according to surgical timing

Introducción: Las luxofracturas vertebrales toracolumbares se producen por traumatismos de alta energía, representan el 10% de las lesiones traumáticas de la columna vertebral y se asocian frecuentemente con otras lesiones. El objetivo de este estudio fue comparar las complicaciones tempranas en pacientes con una luxofractura toracolumbar según la oportunidad quirúrgica, antes o después de las 24 h del trauma. Materiales y métodos: Estudio multicéntrico, analítico, observacional y retrospectivo de una cohorte de pacientes operados por una luxofractura toracolumbar, desde el 1 de enero de 2014 hasta el 1 de enero de 2023. Se inclu-yó a pacientes de ambos sexos, >18 años, operados por una luxofractura vertebral de alta energía. Se los agrupó según si habían sido operados de columna antes o después de las 24 h del trauma. Se registraron las complicaciones totales y agrupadas. Resultados: Se evaluó a 72 pacientes, 64 hombres (88,9%) y 8 mujeres (11,1%), con una edad promedio de 35.94 años. Predominaron las instituciones laborales (n = 60; 83,3%). El mecanismo de lesión más frecuente fueron los accidentes de tránsito (n = 42; 58,3%), seguidos de las caídas de altura (n = 26; 36,1%). El 86% sufrió una o más lesiones asociadas. Se registraron 283 complicaciones en 67 (93,1%) pacientes y 45 complicaciones quirúrgicas en 26 pacientes (36,1%). La mediana de complicaciones fue mayor en pacientes operados tardíamente (p = 0,004). Conclusiones:Los pacientes con luxofractura toracolumbar operados después de las primeras 24 h presentaron una mediana de complicaciones totales significativamente mayor que los operados precozmente. Nnivel de Evidencia: IV

Introduction: Thoracolumbar fracture-dislocations account for 10% of traumatic spinal injuries and typically occur in the context of high-energy trauma. Our objective is to compare early complications in patients with thoracolumbar fracture-dislocation based on surgical timing, either before or after 24 hours from the trauma.materials and methods: This is a multicenter, retrospective cohort study of patients surgically treated for thoracolumbar dislocations, from January 1, 2014 to January 1, 2023. We included adult patients (>18 years old) of any gender, surgically treated for high-energy thoracolumbar fracture-dislocations. Patients were grouped based on when they underwent spinal surgery: before or after 24 hours following trauma. Total and grouped complications were recorded. Results: Our sample comprised 72 patients, with 64 men (88.9%) and 8 women (11.1%) at an average age of 35.94 years. Occupational health care centers were predominant (n=60; 83.3%). Road traffic accidents (n=42; 58.3%) were the most frequent cause of injury, followed by falls from height (n=26; 36.1%). Furthermore, 86% of patients had one or more associated injuries. In total, 283 complications were recorded, with 67 patients (93.1%) suffering at least one complication, and 26 patients (36.1%) experiencing surgical complications. The median number of complications was significantly higher in late-operated patients (p=0.004). Conclusions: Patients with thoracolumbar dislocations who underwent surgery after the first 24 hours following trauma had a significantly higher median rate of complications than those who underwent early surgery. Level of Evidence: IV

Tratamiento de las fracturas cervicales aisladas de tipo "masa lateral flotante": serie de casos / Treatment of isolated "floating lateral mass" fractures of the cervical spine: A case series

Objetivo: Presentar una serie de casos de pacientes con fracturas cervicales de tipo "masa lateral flotante" con énfasis en describir el rol de la lesión discal en la potencial inestabilidad segmentaria. Materiales y métodos: Se realizó un estudio descriptivo y retrospectivo de una serie de pacientes con fracturas facetarias de tipo "masa lateral flotante", aisladas, diagnosticadas entre el 1 de enero de 2016 y el 1 de enero de 2022. Se incluyeron pacientes con lesiones de tipo "masa lateral flotante" según la clasificación AO, diagnosticadas por tomografía computarizada y, al menos, 6 meses de seguimiento. Se excluyó a aquellos con fracturas patológicas, lesiones por fragilidad ósea y registros incompletos. Resultados: Se analizó a 16 pacientes (media de la edad 42.86; DE 12,396), con predominio del sexo masculino (81,25%). El 68,75% tenía una lesión del disco intervertebral en el segmento fracturado y el 18,75%, anterolistesis. A 11 pacientes se les propuso un tratamiento conservador durante 12 semanas. La fractura consolidó en el 45,4% y 6 (54,6%) evolucionaron con traslación. El fracaso del tratamiento conservador se asoció con lesión del disco intervertebral. Once pacientes fueron operados, en su mayoría, con artrodesis cervical anterior monosegmentaria. Conclusiones: En esta serie de casos, la presencia de una lesión asociada del disco intervertebral fue más frecuente cuando el tratamiento conservador fracasó y cuando se decidió una artrodesis como tratamiento inicial. La mayoría de las cirugías se realizaron por vía anterior con discectomía y artrodesis cervical anterior en un único nivel, y se lograron buenos resultados. Nivel de Evidencia: IV

Introduction: We report a series of patients with "floating lateral mass" cervical fractures, focusing on the role of disc injury in potential segmental instability. materials and methods: We conducted a descriptive and retrospective study on a case series of isolated floating lateral mass facet fractures diagnosed between January 1, 2016 and January 1, 2022. Patients with floating lateral mass lesions according to the AO classification, diagnosed by computed tomography, and at least 6 months of follow-up were included. Patients with pathological fractures, bone fragility injuries and incomplete records were excluded. Results: We included 16 cases, the average age was 42.86 (SD 12.396), and the majority were male (n=13; 81.25%). 68.75% (n=11) had intervertebral disc injury in the fractured segment, while 18.75% (n=3) had anterolisthesis. Conservative treatment was proposed for 12 weeks in 11 patients (68.75%), of whom 5 (45.4%) achieved fracture healing and 6 (54.6%) progressed to translation. Cases where conservative treatment failed were associated with intervertebral disc injury. Eleven patients were treated surgically, mostly with monosegmental anterior cervical arthrodesis. Conclusions: We report a series of cases in which the existence of an associated intervertebral disc injury was more frequent in patients with failed conservative treatment and in those initially treated with arthrodesis. Most of the surgical cases were treated using an anterior approach with discectomy and anterior cervical arthrodesis at a single level, with favorable outcomes. Level of Evidence: IV

Fracturas por avulsión de la tuberosidad posterior del calcáneo "en pico de pato". Evaluación funcional y radiográfica / Avulsion fractures of the posterior calcaneal tuberosity (beak fracture). functional and radiographic evaluation

Objetivos: Comunicar los resultados funcionales y radiográficos en seis pacientes con fractura "en pico de pato" (beak fracture)y realizar una revisión de la bibliografía.materiales y métodos:Se evaluaron los resultados funcionales (escala de la AOFAS) y radiológicos en seis pacientes (3 hombres y 3 mujeres; edad promedio 35.6 años). El tiempo promedio transcurrido entre la lesión y el ingreso en el quirófano fue de 2.83 h. Se realizó la rama vertical del abordaje lateral extendido. Se fijó con tornillos canulados y macizos de 3,5; 4,0 o 4,5 mm solos o combinados con placas de 3,5 y 2,7 mm bloqueadas.Resultados:Después de un seguimiento de entre 8 y 24 meses, todos los pacientes tenían signos francos de consolidación. Al ingresar, todos presentaban signos de sufrimiento de partes blandas sin signos de necrosis. El puntaje de la escala de la AOFAS fue de 82,4 (5, buenos y 1, regular). Las complicaciones fueron: una infección profunda y pérdida de la reducción en el mismo paciente.Conclusiones:Las fracturas "en pico de pato" pueden generar complicaciones de partes blandas si no son tratadas de manera urgente, debido al compromiso inicial de partes blandas. La reducción abierta y la fijación con tornillos y placas es el sistema de fijación más estable. Nivel de Evidencia: IV

Objectives: To present the functional and radiographic outcomes of six patients with beak fractures and to carry out a literature review. materials and methods: The functional (AOFAS Score) and radiological outcomes of six patients were evaluated. Three patients were male and three were female (mean age: 35.6 years). The mean time interval between injury and admission to the operating room was 2.83 hours. The extensile lateral approach was used. The fracture was fixed with 3.5, 4.0, or 4.5mm cannulated and solid screws alone or in combination with 3.5 and 2.7mm locking plates. Results: After a follow-up period of between 8 and 24 months, all the patients had clear signs of consolidation. On admission, all presented signs of soft tissue pain without signs of necrosis. The AOFAS score was 82.4 (5 good and 1 fair). The complications observed were a deep infection and loss of reduction in the same patient. Conclusions: Beak fractures can generate soft tissue complications if they are not treated urgently due to initial soft tissue involvement. Open reduction and fixation with screws and plates is the most stable fixation system. Level of Evidence: IV