Revision reverse shoulder arthroplasty for the management of baseplate failure: an analysis of 676 revision reverse shoulder arthroplasty procedures.

BACKGROUND: Baseplate failure in reverse shoulder arthroplasty (RSA) is a rare but potentially catastrophic complication owing to poor patient outcomes and significant glenoid bone loss. The purpose of this study was to report on the prevalence, causes, and outcomes of revision RSA (rRSA) for baseplate failure or loosening. METHODS: A retrospective review of our institutional database was performed to identify all patients treated for a failed RSA from 2006 to 2021 who required revision to another RSA (rRSA) performed by a single surgeon. A total of 676 failed RSA procedures were identified, and further analysis identified 46 patients (6.8%) who underwent rRSA for baseplate failure with a confirmed loose baseplate at the time of rRSA. The primary outcome was repeated failure of the reimplanted baseplate following rRSA. The mode of failure associated with baseplate failure was stratified into 1 of 3 groups: aseptic, septic, or traumatic. Twenty-four patients underwent primary revision, and 22 had undergone >1 previous arthroplasty prior to undergoing re-revision. Five patients underwent previous rRSA for baseplate failure performed by an outside surgeon. The criteria for secondary outcome analysis of final American Shoulder and Elbow Surgeons score, Simple Shoulder Test score, and range of motion were met by 32 patients and 23 patients at 1- and 2-year follow-up, respectively. RESULTS: Three patients (6.5%) had repeated baseplate failure requiring re-revision; 2 had baseplate failure at <1 year with associated periprosthetic infections and underwent conversion to hemiarthroplasty. The third patient experienced traumatic failure at 10 years and underwent successful rRSA. The mean American Shoulder and Elbow Surgeons scores at 1 and 2 years were 62.3 and 61.7, respectively. There was no significant difference in outcomes based on mode of baseplate failure (P = .232) or total arthroplasty burden (P = .305) at 1 year. There were 13 total complications in 11 patients, 5 of which required reoperation for reasons other than baseplate failure. CONCLUSION: In this study, rRSA for baseplate failure constituted 6.8% of all revisions performed over a period of 15 years. Re-revision for recurrent baseplate failure was required in 3 of 46 patients (6.5%). Complications and reoperation rates were higher than those for primary RSA but outcomes were comparable for revision of failed anatomic shoulder arthroplasty.

Acute versus staged fixation of bicondylar tibial plateau fractures: a dual centre international study.

BACKGROUND: Bicondylar tibial plateau fractures pose many treatment challenges due to their complex fracture patterns and associated soft tissue compromise. We aim to evaluate outcomes of acute ORIF (aORIF) versus staged ORIF (sORIF) of high energy bicondylar tibial plateau fractures. METHODS: We retrospectively reviewed 186 patients at two high-volume Level I trauma centers. One hundred one patients underwent aORIF and 85 underwent sORIF between 2011 and 2019. Clinical outcomes of interest included operative time, wound dehiscence, superficial and deep infection, nonunion, flap coverage, arthrodesis, and early conversion to arthroplasty. RESULTS: Patients had a median follow up of 12 months (6-98 months). The sORIF group had a higher ISS (p = 0.02) and a higher rate of open fractures (24.7% vs 11.9%, p = 0.03). The groups were statistically similar in other demographics and co-morbidities. Operative time was significantly shorter in the aORIF group (157 vs 213 min., p < 0.001). There was no statistical difference in wound dehiscence, deep infection, flap coverage, nonunion, unplanned reoperation, or post-traumatic arthritis between groups. However, aORIF was associated with a significantly lower rate of superficial infection (p = 0.01), arthroplasty (p = 0.003) and unplanned reoperation (p = 0.005). Subgroup analysis of only the 41C3 fractures showed a lower rate of superficial infections in the aORIF group (p = 0.04). No difference in complications was found between the fracture subgroups. CONCLUSION: We found no increased risk of complications with aORIF compared to sORIF for bicondylar tibial plateau fractures. While not all injuries may be appropriate for aORIF, our results demonstrate the safety of aORIF when patients are properly selected by experienced fracture surgeons. LEVEL OF EVIDENCE: Level III.

What factors can reduce the need for repeated revision for humeral loosening in revision total elbow arthroplasty?

BACKGROUND: This study aimed to determine the re-revision rate in a cohort of patients who underwent revision total elbow arthroplasty (rTEA) for humeral loosening (HL) and identify factors contributing to re-revision. We hypothesized that proportional increases in the stem and flange lengths would stabilize the bone-implant interface significantly more than a disproportional increase in stem or flange length alone. Additionally, we hypothesized that the indication for the index arthroplasty would impact the need for repeated revision for HL. The secondary objective was to describe the functional outcomes, complications, and presence of radiographic loosening after rTEA. METHODS: We retrospectively reviewed 181 rTEAs performed from 2000-2021. We included 40 rTEAs for HL performed on 40 elbows that either required a subsequent revision for HL (10 rTEAs) or had a minimum of 2 years of clinical or radiographic follow-up. One hundred thirty-one cases were excluded. Patients were grouped based on stem and flange length to determine the re-revision rate. Patients were divided based on re-revision status into the single-revision group and the re-revision group. The stem-to-flange length (S/F) ratio was calculated for each surgical procedure. The mean length of clinical and radiographic follow-up was 71 months (range, 18-221 months and 3-221 months, respectively). RESULTS: Rheumatoid arthritis was statistically significant in predicting re-revision total elbow arthroplasty for HL (P = .024). The overall re-revision rate for HL was 25% at an average of 4.2 years (range, 1-19 years) from the revision procedure. There was a significant increase in stem and flange lengths from the index procedure to revision, on average by 70 ± 47 mm (P < .001) and 28 ± 39 mm (P < .001), respectively. In the cases of re-revision (n = 10), 4 patients underwent an excisional procedure; in the remaining 6 cases, the size of the re-revision implant increased on average by 37 ± 40 mm for the stem and 73 ± 70 mm for the flange (P = .075 and P = .046, respectively). Furthermore, the average flange in these 6 cases was 7 times shorter than the average stem (S/F ratio, 6.7 ± 2.2). This ratio was significantly different from that in cases that were not re-revised (P = .03; S/F ratio, 4.2 ± 2). Mean range of moion was 16° (range, 0°-90°; standard deviation, 20°) extension to 119° (range, 0°-160°; standard deviation, 39°) flexion at final follow-up. Complications included ulnar neuropathy (38%), radial neuropathy (10%), infection (14%), ulnar loosening (14%), and fracture (14%). None of the elbows were considered radiographically loose at final follow-up. CONCLUSION: We show that a primary diagnosis of rheumatoid arthritis and a humeral stem with a relatively short flange relative to the stem length significantly contribute to re-revision of total elbow arthroplasty. The use of an implant where the flange can be extended beyond one-fourth of the stem length may increase implant longevity.

Retrospective and Prospective Outcomes of Distal Radioulnar Joint Prosthesis Arthroplasty at a Single Center.

Purpose: Distal radioulnar joint (DRUJ) arthritis can cause painful and limited motion of the forearm leading to decreased function. When conservative treatment options are exhausted, surgical treatments are the next step. The purpose of this study was to retrospectively and prospectively evaluate outcomes of Scheker DRUJ total arthroplasty at a single center and add to the limited data on this procedure. Methods: In a retrospective and prospective cohort of 12 patients, 13 DRUJ prosthetics implanted from 2014 to 2021 were evaluated from a single center. The primary outcome was patient satisfaction with the procedure, including comparisons of preoperative and postoperative visual analog scale, Disabilities of the Arm, Shoulder, and Hand, and willingness to repeat the procedure. Secondary outcomes included range of motion, subjective grip strength, need for hardware revision, subsequent procedures, and postoperative complaints. Results: Out of 12 patients that were at least 1-year after surgery from DRUJ arthroplasty, 1 was deceased at the time of final survey and 1 underwent bilateral DRUJ arthroplasty. Seven of 12 available patients were surveyed over the phone. On average, patient range of motion after surgery was 76° in each direction for pronation and supination. There was a clinically significant improvement in the Disabilities of the Arm, Shoulder, and Hand score and a statistically significant improvement in visual analog scale pain rating. Seventy-five percent of patients surveyed were satisfied with their outcomes and would undergo the surgery again. Only one patient required additional surgery, and there were no instances of hardware failure at an average follow-up of 40 months. Conclusions: Our study has shown positive outcomes with decrease in pain, improvement in function via Disabilities of the Arm, Shoulder, and Hand evaluation, and subjective patient satisfaction, with a 100% prosthesis survival rate. The DRUJ arthroplasty prosthesis is a viable alternative to other DRUJ salvage procedures. Type of study/level of evidence: Therapeutic Level III.

Outcomes After Acute Versus Staged Fixation of Complete Articular Tibial Plafond Fractures.

OBJECTIVE: To determine the outcomes after acute versus staged fixation of complete articular tibial plafond fractures. DESIGN: Retrospective cohort study. SETTING: Single Level 1 Trauma center. PARTICIPANTS: 98 skeletally mature patients with OTA/AO 43C type fractures who underwent definitive fixation with plate and screw constructs and had a minimum 6 months of follow-up. INTERVENTION: Acute open reduction internal fixation (aORIF) versus staged (sORIF) definitive fixation. MAIN OUTCOME MEASUREMENT: Rates of wound dehiscence/necrosis and deep infection. RESULTS: Acute (N = 40) versus staged (N = 58) ORIF groups had comparable rates of vascular disease, renal disease, and substance/nicotine use, but aORIF patients had higher rates of diabetes mellitus (10% vs. 0%, P < 0.001), which correlated with higher American Society of Anaesthesiologist scores (>American Society of Anaesthesiologist 3: 37.5% vs. 13.8%, P = 0.02). Both groups achieved anatomic/good reductions, as determined by postoperative CT scans, at rates greater than 90%; however, the sORIF group required modestly longer operative times to achieve this outcome (aORIF vs. sORIF: 121 vs. 146 minutes, P = 0.02). Postoperatively, both groups had similar rates of wound dehiscence (2.5% vs. 6.9%, P = 0.65), superficial infections (10% vs. 17.2%, P = 0.39), and deep infections (10% vs. 8.6%, P = 0.99). While the injury pattern itself required free flap coverage in 1 patient in each group, unplanned free flap coverage occurred in 10.0% and 10.3% of aORIF and sORIF groups, respectively. Overall, rates of unplanned reoperations, excluding ankle arthrodesis, did not differ between groups (aORIF vs. sORIF:12.5% vs. 25.9%, P = 0.13). CONCLUSIONS: In select patients managed by fellowship-trained orthopaedic traumatologists, acute definitive pilon fixation can produce acceptable outcomes. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Comportamiento imagenológico de las deformidades faciales

RESUMEN Fundamento Para el manejo quirúrgico del paciente con deformidad facial resulta vital el uso del examen clínico y radiográfico de cada caso, pues en dependencia de los hallazgos se decide entre las diversas alternativas terapéuticas disponibles en este campo. Objetivo describir el comportamiento imagenológico de las deformidades faciales en pacientes adultos. Métodos se realizó un estudio descriptivo de corte transversal, en 46 pacientes mayores de 18 años, con diagnóstico de deformidad facial, los cuales acudieron al Servicio de Cirugía Maxilofacial, del Hospital Calixto García, en el período comprendido desde noviembre de 2017 a noviembre de 2019. Se analizaron las variables: tipo de tejido, magnitud, y plano en el que se evidenciaron las alteraciones. Se utilizó la prueba exacta de Fisher, con un nivel de confianza al 95 %, para determinar las relaciones analíticas entre las variables; así como los índices tau b de Kendall y el Rho de Spearman. Resultados el 45,7 % de las deformidades se presentó en ambos planos; el 50 % de ellas con magnitudes entre 11-30 mm; y en el 41,3 % de los pacientes afectaron al tejido blando. Las correlaciones entre la distribución de pacientes y los conjuntos de variables plano/tipo de tejido y plano/magnitud resultaron negativas débiles; mientras que tipo de tejido/magnitud presentó una correlación positiva moderada muy significativa, con valores de significación entre 0,001 a 0,003. Conclusión predominaron las deformidades de tejido blando, en ambos planos y con magnitudes entre 11-30 mm. Las variables imagenológicas estudiadas mostraron un comportamiento interdependiente.

ABSTRACT Background For the surgical management of the patient with facial deformity, the use of the clinical and radiographic examination of each case is vital, since depending on the findings, a decision is made between the various therapeutic alternatives available in this field. Objective to describe the imaging behavior of facial deformities in adult patients. Methods a descriptive cross-sectional study was carried out in 46 patients older than 18 years old, with a diagnosis of facial deformity, who attended the Maxillofacial Surgery Service, Calixto García Hospital, from November 2017 to November 2019. The analyzed variables were: type of tissue, magnitude, and plane in which the alterations were evidenced. Fisher's exact test was used, with a confidence level of 95 %, to determine the analytical relationships between the variables; as well as Kendall's tau b and Spearman's Rho rates. Results The 45.7 % of the deformities presented in both planes; 50 % of them with magnitudes between 11-30 mm; and in 41.3 % of the patients they affected the soft tissue. The correlations between the distribution of patients and the sets of variables plane/tissue type and plane/magnitude were weakly negative; while tissue type/magnitude presented a very significant moderate positive correlation, with significance values between 0.001 and 0.003. Conclusion soft tissue deformities predominated, in both planes and with magnitudes between 11-30 mm. The imaging variables studied showed an interdependent behavior.

Caracterización de pacientes con deformidades faciales / Characterization of patients with facial deformities

Introducción: Las deformidades faciales se expresan como alteraciones métricas perceptibles en la proporción o simetría facial, en desacuerdo con los cánones de belleza y aceptación social históricamente concretos, con repercusión en la psicología del paciente y su entorno. Objetivos: Caracterizar a los pacientes con deformidades faciales de acuerdo al sexo, edad, etiología y localización, así como determinar la relación entre ellas. Método: Las variables estudiadas fueron recogidas durante el examen físico de los pacientes (46), previo consentimiento, vaciadas en una base de datos para su procesamiento, mediante medidas de frecuencias. Para las comparaciones se realizó la prueba exacta de Fisher. Resultados: Predominó el sexo masculino (54,3 por ciento), la etiología traumática con el grupo de edad de 40 - 49 años (19,6 por ciento), el 26,1 por ciento de los pacientes presentaron deformidades de más de una región y no se obtuvieron relaciones estadísticamente significativas en ningunas de las relaciones exploradas. Conclusiones: En los pacientes estudiados prevaleció el sexo masculino, de entre 40 y 49 años, la etiología traumática y localización en una sola región anatómica (AU)

Introduction: Facial deformities are expressed as perceptible metric alterations in facial proportion or symmetry, at odds with historically specific canons of beauty and social acceptance, with repercussions on the psychology of the patient and his or her environment. Objectives: To characterize patients with facial deformities according to sex, age, etiology and location, as well as to determine the relationship between them. Method: The variables studied were collected during the physical examination of the patients (46) with their consent, and were entered into an SPSS Statistics 22 database where statistical processing was carried out with frequency measures. To compare the Fisher's exact test was used. Results: Male sex predominated (54,3 percent ), traumatic etiology with the age group of 40-49 years (19,6 percent), 26,1 percent of the patients presented deformities of more than one region and no statistically significant relationships were obtained in any of the explored relationships. Conclusions: Among the patients studied prevailed male sex, age between 40 and 49 years old, traumatic etiology and located in one anatomical region(AU)

Lipotransferencia: una alternativa para el tratamiento de la deformidad facial adquirida / Lipotransfer: an alternative for the treatment of acquired facial deformity / A lipotransferência: uma alternativa para o tratamento da deformidade facial adquirida

RESUMEN Se presentó el caso de un paciente masculino de 58 años, con antecedentes de salud aparente, que refiere haber recibido tratamiento quirúrgico por fractura compleja de tercio medio facial (fracturas tipo Lefort II y malar III derecha), el mismo refiere inconformidad estética por la deformidad facial postraumática que presenta. Se decidió su ingreso en el Servicio de Cirugía Maxilofacial del Hospital Universitario "General Calixto García" para su tratamiento. Se diagnosticó deformidad postraumática secundaria a una fractura facial compleja y su consiguiente daño estético. Los resultados alcanzados con la utilización de la lipotransferencia de tejido graso abdominal para el tratamiento de la deformidad facial fueron satisfactorios con permanencia y estabilidad en un año, a la vez que cumplió con las expectativas del paciente. La lipotransferencia resulta una alternativa viable en el tratamiento de las deformidades faciales adquiridas.

ABSTRACT The case of a 58-year-old male patient was presented, with a history of apparent health, who reported having received surgical treatment for a complex fracture of the middle facial third (fractures Lefort II and right malar III), the same refers to aesthetic disagreement for the deformity posttraumatic facial presenting. It was decided to enter the Maxillofacial Surgery Service of the University Hospital "General Calixto García" for treatment. Posttraumatic deformity was diagnosed secondary to a complex facial fracture and its consequent aesthetic damage. The results achieved with the use of abdominal fatty tissue lipotransfer for the treatment of facial deformity were satisfactory with permanence and stability in one year, while meeting the patient's expectations. Lipotransfer is a viable alternative in the treatment of acquired facial deformities.

RESUMO Foi apresentado o caso de um paciente do sexo masculino, 58 anos, com histórico aparente de saúde, que relatou ter recebido tratamento cirúrgico para uma fratura complexa do terço facial médio (fraturas de Lefort II e malar III direita), o mesmo se refere a discordância estética quanto à deformidade apresentação facial pós-traumática. Foi decidido entrar no Serviço de Cirurgia Maxilofacial do Hospital Universitário "General Calixto García" para tratamento. A deformidade pós-traumática foi diagnosticada secundária a uma fratura facial complexa e seu conseqüente dano estético. Os resultados obtidos com o uso da lipotransferência de tecido adiposo abdominal para o tratamento da deformidade facial foram satisfatórios com permanência e estabilidade em um ano, atendendo às expectativas do paciente. A lipotransferência é uma alternativa viável no tratamento de deformidades faciais adquiridas.

Phylogenetic and forensic studies of the Southeast Florida Hispanic population using the next-generation forensic PowerPlex® Y23 STR marker system.

The purpose of this study is to examine the robustness and sensitivity of the newly available Y-STR multiplex kit, the PowerPlex® Y23 System, by comparing our data at the 23-loci level to the routinely used 17 loci provided by the AmpFlSTR® Yfiler® PCR Amplification kit. For the first time, allelic and genotypic frequencies for the 23 Y-STR loci included in the PowerPlex® Y23 System are provided for the Southeast Florida Hispanic (SFH) population. In addition, we have characterized the SFH population in terms of intra-population and inter-population parameters. We also compared these indices of forensic and population genetics interest in the SFH population to comparable data of previously published populations to assess their phylogenetic relationships. Our 23-loci data was shown to provide more discriminatory values as compared to the data when using only 17 loci. Also, the RST distance values demonstrate the superior capacity of the PowerPlex® Y23 system to discriminate among populations.

Antiparasitarios y embarazo: revisión bibliográfica / Parasiticide and pregnancy: bibliographic review

Se revisa la bibliografía para determinar el uso, acción, efectos colaterales, precausiones y contraindicaciones de los antiparasitarios más frecuentemente utilizados en el tratamiento del parasitismo en la mujer embarazada. Se determinan los antiparasitarios que ocasionan efectos deletéreos a la gestante. Se recomienda la exclusión de los mismos del arsenal terapéutico, y se sugieren como medicamentos alternativos aquéllos que no ocasionan efectos teratógenos