Subspine femoroacetabular impingement: retrospective study of a series of patients treated by hip arthroscopic resection.

BACKGROUND: Femoroacetabular impingement syndrome (FAIS) is a common hip pathology that causes pain and functional limitation in young patients. subspine femoroacetabular impingement (SFAI) is an increasingly diagnosed extra-articular subtype that occurs from mechanical conflict of the anteroinferior iliac spine (AIIS) with the cervico-diaphyseal junction during hip flexion, which is poorly described in the literature. QUESTIONS/PURPOSES: We aimed to describe the clinical, functional, and radiological results of the arthroscopic treatment of a group of patients with SFAI treated in our Hip Unit. STUDY DESIGN: Case series. METHODS: We present a retrospective study of ten patients with SFAI treated between 2013 and 2020 with arthroscopic resection. Clinical results were assessed with scales such as visual analog scale (VAS); modified Harris Hip Score (mHHS), and Hip disability and Osteoarthritis Outcome Score (HOOS). Radiological results were assessed with radiological measurements, magnetic resonance imaging (MRI), and computed tomography (CT) reconstructions. RESULTS: Six patients had a Type III AIIS and four of them had Type II. Two patients had previously been surgically treated for FAIS. The range of motion improved in flexion from 107 ± 11 degrees before surgery to 127.5 ± 6 degrees (p = 0.005). MHHS improved from 48.1 (38-75.3) before surgery to 83.1 (57-91) (p = 0.007) and HOOS improved from 65.2 (58-75) to 89 (68.1-100) (p = 0.007). VAS improved from 7.3 (5-9) pre-surgical to 2.5 (0-8) post-surgical (p = 0.005). We did not have significant complications except for an asymptomatic case of heterotopic ossification (Brooker I). CONCLUSION: Arthroscopic decompression of AIIS in SFAI patients is a safe procedure that provides satisfactory short-term functional results, improving clinical symptoms, function, sports performance, and range of motion in our study.

Blood transfusion and surgical treatment increase mortality in patient with proximal humeral fractures.

INTRODUCTION: Proximal humeral fractures (PHFs) often occur in elderly patients with osteoporosis and associated comorbidities. These patients constitute a special risk group. This study aimed to identify associations between comorbidities, treatment type, and mortality risk. PATIENTS AND METHODS: We conducted a retrospective chart review of a cohort of 350 patients with a diagnosis of PHF and a mean follow-up of 4.5 years. We analysed the 19 prefracture comorbidities included in the Charlson Comorbidity Index (CCI), haemoglobin (Hb) levels, blood transfusion needs, and treatment administered (surgery versus conservative). The nonparametric Kaplan-Meier method and Cox proportional hazards model were used to estimate the mortality risk. RESULTS: Over a 4.5-year average follow-up of 350 patients, primarily elderly females, with proximal humerus fractures, several factors were associated with increased mortality. The Charlson Comorbidity Index (CCI) was a significant predictor, with patients having a CCI > 5 facing higher mortality risks, especially if they underwent surgery. Additionally, osteosynthesis was linked to a lower mortality rate compared to arthroplasty. Age, dementia, medical complications, and postfracture Hb level also influenced mortality rates. CONCLUSIóN: These findings emphasize the importance of considering comorbidities, specifically the Charlson Comorbidity Index (CCI), in determining patient outcomes, especially amongst elderly patients with proximal humerus fractures. Factors like age, dementia, and postfracture Hb level also play a crucial role in influencing mortality rates. TRIAL REGISTRATION: The study received written approval from the regional Ethics Committee for Clinical Research (code 2016/125).

Association Between Hounsfield Units in Preoperative Wrist Computed Tomography Scans and Outcomes After Wrist Fracture Surgery.

Purpose: This work aims to evaluate the hypothesis that the value of Hounsfield units (HU), as a marker of bone density, in preoperative wrist computed tomography (CT) scans correlates with the functional outcomes as measured by patient reported outcomes (PROs) after distal radius fracture surgery with volar locking plate fixation. Methods: Of a database of 92 wrist fractures operated on in our hospital between 2011 and 2020, with a preoperative CT scan performed, we selected the cases with a minimum follow-up period of 12 months. After applying the exclusion criteria, the final cohort comprised 64 patients. Three measurements of HU were performed in correlative coronal sections of the capitate bone. PROs were determined using two functional questionnaires (DASH and PRWE) and one quality of life questionnaire (SF-12). The statistical relationship between PROs and the HU measurements obtained via a CT scan was analyzed. Results: Patients were classified into two groups, osteoporotic (OST) or non-osteoporotic (non-OST), according to the optimal cut-off value of 323 HU selected using a ROC curve. The median DASH questionnaire score in the OST group was significantly higher (1.7 vs 10.0, p = 0.003). Conclusion: HU values in preoperative wrist CT scans may help to identify osteoporotic bone in patients prior to wrist fracture surgery and lead to an improved surgical indication and treatment strategy. Level of Evidence: Level of evidence: Prognostic III.

Impact of Heart Failure on In-Hospital Outcomes after Surgical Femoral Neck Fracture Treatment.

BACKGROUND: Femoral neck fracture (FNF) is a common condition with a rising incidence, partly due to aging of the population. It is recommended that FNF should be treated at the earliest opportunity, during daytime hours, including weekends. However, early surgery shortens the available time for preoperative medical examination. Cardiac evaluation is critical for good surgical outcomes as most of these patients are older and frail with other comorbid conditions, such as heart failure. The aim of this study was to determine the impact of heart failure on in-hospital outcomes after surgical femoral neck fracture treatment. METHODS: We performed a retrospective study using the Spanish National Hospital Discharge Database, 2007-2015. We included patients older than 64 years treated for reduction and internal fixation of FNF. Demographic characteristics of patients, as well as administrative variables, related to patient's diseases and procedures performed during the episode were evaluated. RESULTS: A total of 234,159 episodes with FNF reduction and internal fixation were identified from Spanish National Health System hospitals during the study period; 986 (0.42%) episodes were excluded, resulting in a final study population of 233,173 episodes. Mean age was 83.7 (±7) years and 179,949 (77.2%) were women (p < 0.001). In the sample, 13,417 (5.8%) episodes had a main or secondary diagnosis of heart failure (HF) (p < 0.001). HF patients had a mean age of 86.1 (±6.3) years, significantly older than the rest (p < 0.001). All the major complications studied showed a higher incidence in patients with HF (p < 0.001). Unadjusted in-hospital mortality was 4.1%, which was significantly higher in patients with HF (18.2%) compared to those without HF (3.3%) (p < 0.001). The average length of stay (LOS) was 11.9 (±9.1) and was also significantly higher in the group with HF (16.5 ± 13.1 vs. 11.6 ± 8.7; p < 0.001). CONCLUSIONS: Patients with HF undergoing FNF surgery have longer length of stay and higher rates of both major complications and mortality than those without HF. Although their average length of stay has decreased in the last few years, their mortality rate has remained unchanged.

Does Clinical Photography Influence Satisfaction With Surgery in Adult Patients Operated on for Spinal Deformity?

BACKGROUND: Recently published data suggest that showing patients operated on for adolescent idiopathic scoliosis or kyphosis their preoperative and postoperative photographs may enhance their satisfaction and self-image as measured by Scoliosis Research Society Health-Related Quality of Life Questionnaire (SRS-22) scores. No data exist for adult spinal deformity (ASD) surgery. The aim of this study is to determine the effect on patient postoperative satisfaction and self-image of showing adult deformity patients their preoperative and postoperative whole body photographs. METHODS: This was a nonconcurrent prospective study. Patients operated on for ASD with a minimum 2-year postoperative follow-up who had preoperative full-body photographs taken by a professional photographer were included. Two follow-up visits were arranged 7 days apart. In the first visit, patients completed the SRS-22 questionnaire, and full-body standing photographs were taken. In the second visit, patients were asked to complete again questions 4, 6, 10, 14, 19 (self-image), 21, and 22 (satisfaction) of the SRS-22 after seeing their preoperative and postoperative full-body photographs. RESULTS: Thirty patients (28 female) were included. The median age at surgery was 50 years (26-76). The median follow-up was 51 months (24-120). SRS-22 results at first visit were: activity 2.79 ± 0.75; self-image 2.71 ± 0.82; pain 2.53 ± 1.10; mental health 3.08 ± 0.77; satisfaction 3.46 ± 1.20; global 2.74 ± 0.72. SRS22 results at second visit were: self-image 2.9 ± 0.75; satisfaction 4.02 ± 0.97. After seeing the preoperative and final follow-up photographs, patients experienced an improvement in SRS-22 self-image (P = .000) and satisfaction domains (P = .011). CONCLUSIONS: In patients operated on for ASD, showing preoperative and postoperative photographs improves patient satisfaction with surgery and self-image. LEVEL OF EVIDENCE: 3. CLINICAL RELEVANCE: Our results could be a starting point for introducing full-body clinical photographs as a routine clinical tool in adult deformity patients undergoing surgery.

Proximal humeral fracture in patients with high Charlson comorbidity index: mortality rate according to treatment choice.

BACKGROUND: The purpose of this study was to evaluate the relevance of a commonly used morbidity prognostic tool, the Charlson comorbidity index (CCI), in determining the survival rate of patients with isolated proximal humeral fractures (PHFs) and to determine the impact of surgical treatment according to previous comorbidities (measured with CCI). MATERIALS AND METHODS: All patients who were treated for a single PHF in our institution for 29 consecutive months were included in this retrospective study, with a minimum follow-up of 24 months (mean 52.8 months). Two groups were established according to the type of treatment received (surgical versus non-surgical). Preinjury comorbidities were identified, and the age-adapted CCI was calculated. All complications and mortality rates were prospectively recorded over the complete follow-up period. RESULTS: Patients with elevated preinjury comorbidities (CCI > 5) demonstrated a significant increase in mortality (HR = 4.64) compared to those with CCI ≤ 5. In addition, patients with high comorbidities (CCI > 5) who underwent surgical treatment demonstrated a statistically significant increase in mortality (HR = 6.92) compared to patients with similarly high comorbidities (CCI > 5) who underwent non-surgical treatment. CONCLUSIONS: Patients with high preinjury comorbidities (CCI > 5) experienced an increased mortality risk if they underwent surgical treatment for isolated PHFs. The use of a morbidity prognostic tool, such as the CCI, can help predict the outcome (particularly mortality) in these patients and may aid in making decisions in terms of operative versus non-operative treatment to minimize patient mortality. LEVEL OF EVIDENCE: Level III; Retrospective Comparative Study; Treatment Study.

Photographic sagittal plane analysis and its clinical correlation after surgery for adult spinal deformity: a preliminary study.

PURPOSE: The aim of this study is to determine the correlation between photographic sagittal parameters and patient-reported outcome measures (PROM) results in adult patients operated on spinal deformity. METHODS: Non-concurrent prospective study. INCLUSION CRITERIA: age at surgery older than 25, minimum 2-year follow-up after a 5 or more level fusion for adult spinal deformity (ASD). Full body lateral standing photographs were taken with adhesive markers placed on ten bony landmarks. SRS-22 and SF-36 questionnaires were completed for every patient. The following photographic parameters were measured: lumbar angle, lumbar curve, thoracic inclination (TI), trunk angle, pelvic tilt, head angle, neck angle, cervicothoracic angle, lumbar vector angle (LVA), dorsal vector angle (DVA), cervical vector angle (CVA), cranial pelvic angle (CrPA), cranial sacral angle (CrSA), fibular inclination angle (FIA) and cranial sagittal vertical axis measured to sacrum (Cr-S), greater trochanter (Cr-GT), knee (Cr-K) and ankle (Cr-A). RESULTS: 65 patients (58 female) operated on ASD in a single institution were included. Age at surgery was 61 years (26-67). Postoperative follow-up was 53 months (24-120). Spearman rank order test showed several significant (p ≤ 0.01) correlations. After multivariate linear regression analysis age, LVA and TI remained as predictors for SRS image scores (corrected r2 0.41), LVA for SRS satisfaction (corrected r2 0.27), CrPA and age for SRS total scores (corrected r2 0.33), FIA and age for SF36 physical functioning (corrected r2 0.36) and CrSA for SF36 role physical (corrected r2 0.14). CONCLUSIONS: Some sagittal photographic parameters may predict mid-term clinical results after ASD surgery.

Is the Cranial Sagittal Vertical Axis (Cr-SVA) a Better Midterm Predictor of Clinical Results Than C7-SVA in Adult Patients Operated on Spinal Deformity After a Minimum 2-Year Follow-Up?

STUDY DESIGN: This is nonconcurrent prospective study approved by the Institutional Research Ethics Committee. OBJECTIVE: The purpose of this study is to determine if the cranial sagittal vertical axis (Cr-SVA) measured in full spine standing radiographs is a better predictor of clinical results than the C7 sagittal vertical axis (C7-SVA) in adult patients operated on spinal deformity with a minimum 2-year follow-up after surgery. SUMMARY OF BACKGROUND DATA: The Cr-SVA has recently been described as a better predictor of health-related quality of life outcomes than the C7-SVA for patients with adult spinal deformity (ASD) before undergoing surgery. This has not been confirmed in patients after ASD surgery. METHODS: Inclusion criteria were age at surgery more than 25 years and a minimum 2-year follow-up after a ≥5 level fusion for ASD. Full-length standing lateral radiographs (including nasion-inion line, spine, and femoral heads) and Scoliosis Research Society 22 Questionnaire and SF36 questionnaires were available for every patient at the final follow-up. The distance from the Cr-SVA to the posterior corner of S1 (Cr-SVA-S) and to the centers of the hip (Cr-SVA-H) was measured and also the C7-SVA, lumbar lordosis, pelvic incidence, pelvic tilt, and PI-LL. RESULTS: Sixty-five patients (58 female individuals) operated on ASD in a single institution were included. Age at surgery was 61 years (26-67). The mean follow-up was 53 months (24-120). Spearman rank-order test showed several significant correlations. After multivariable analysis, only Cr-SVA-S and age persisted as predictors for Scoliosis Research Society (SRS) image scores, Cr-SVA-H for SRS satisfaction, Cr-SVA-H and age for SRS total scores, Cr-SVA-H and age for SF36 Physical Function, Cr-SVA-S for SF36 Role Physical, Cr-SVA-H for SF36 Bodily Pain, and Cr-SVA-H for SF36 Role Emotional. CONCLUSIONS: The Cr-SVA measured in full spine standing radiographs seems to be a better predictor of health-related quality of life outcomes than the C7-SVA for adults operated on spinal deformity >2 years after surgery.

Is the Charlson comorbidity index a good predictor of mortality and adverse effects in proximal humerus fractures?

INTRODUCTION: Proximal humerus fractures (PHF) are frequent in elderly patients. This population also suffers from a series of associated comorbidities, and PHF increases morbidity and mortality. The Charlson Comorbidity Index (CCI) is a tool used for calculating comorbidity and therefore the mortality risk. HYPOTHESIS: Our hypothesis is that CCI is a good predictor of mortality in patients suffering from PHF, and that there is a relationship between CCI and the development of adverse events. PATIENTS AND METHODS: A retrospective study with prospective data collection of 354 patients who had been diagnosed and treated for a single PHF between August 1st, 2013 and July 31st, 2015 was carried out at our hospital. The minimum follow-up was 24 months (mean 51.1 months). This study included all patients regardless the severity of the fracture, the treatment performed (surgical or conservative treatment) or whether the patient had been admitted to the hospital or was treated as an outpatient. Adverse effects and mortality data were collected and the CCI was calculated. RESULTS: Patients with high CCI (>5) had a higher mortality risk 4.6 (95% CI [2.4-9.0]) compared to those with CCI<5. During follow-up, 40 (11%) patients died, being the mean follow-up of the patients overall 4.3 years 95% CI [4.1-4.4]. Patients suffering from systemic complications had a higher CCI average (p=0.001) compared to those who did not present adverse effects (HR=6.6; 95% CI [3.5-12.4]). No statistically significant relationship between the type of fracture (p=0.473) and mortality was found. CONCLUSION: In our study CCI has proven to be a good predictor of mortality and there is a relationship between CCI and the development of adverse effects in patients suffering from PHF, which maybe should be taken into consideration in our therapeutic decision making. LEVEL OF EVIDENCE: IV, retrospective observational study.

El complejo articular de la muñeca: aspectos anatofisiológicos y biomecánicos, características, clasificación y tratamiento de la fractura distal del radio / The Wrist Joint Complex: Anatomical, Physiological and Biomechanical Aspects, Characteristics, Classification, and Treatment of Distal Radius Fractures

La fractura distal del radio o de la muñeca constituye una de las fracturas más frecuentes tanto en niños como en personas adultas, sobre todo en mujeres. Las causas son diferentes, las primeras se deben sobre todo a traumatismos deportivos, las segundas fundamentalmente a trastornos relacionados con la tercera edad, entre ellos la osteoporosis. El objetivo de este trabajo es realizar una revisión exhaustiva de la fractura radial distal, en la que se incluyen elementos de su historia, diferentes tipos de clasificaciones y aspectos muy actualizados sobre el manejo de los pacientes con esta lesión, incluyendo el uso de fijadores externos. Los autores abordan este tema con una extensa revisión bibliográfica y con imágenes y figuras tomadas de la literatura y confeccionadas por los propios autores.

The distal radius fracture or wrist, is one of the most common fractures in children and in adults, especially in women. The causes are different, in the children is mainly due to sports injuries, the latter primarily related disorders including elderly osteoporosis. The aim of this work is to do review of the distal radial fracture in which elements of their history, different types of classifications and very updated aspects of the management of patients with this injury is included, including the use of external fixators. The authors address this issue with an extensive literature review and images and figures taken from the literature and made by the authors themselves.

Endoprótesis articulares y el nuevo Baremo de tráfico / Endoprosthesis and the new Scale in traffic accidents

El nuevo Baremo en accidentes de tráfico modifica la actual valoración de las secuelas en los lesionados, ya que a la simple valoración numérica de las mismas se deben añadir los gastos previsibles de asistencia sanitaria futura. Este apartado adquiere una especial importancia en las lesiones relativas a la especialidad de Cirugía Ortopédica y Traumatología, especialmente en el ámbito de las endoprótesis articulares (artroplastias de cadera, rodilla, hombro y tobillo). El objetivo del presente trabajo es proporcionar datos válidos para realizar la valoración del daño corporal con el nuevo Baremo de tráfico en pacientes con artrosis postraumática que precisarán una cirugía de implante de prótesis y en pacientes a los que ya se les ha implantado la prótesis y precisarán una cirugía de recambio en el futuro (AU)

The new scale in traffic accidents modifies the current valuation of the sequels on the injured and as the simple numerical assessment of them should be added the foreseeable future healthcare costs. This section is particularly important in injuries related to the specialty of Orthopedics and Traumatology, especially in the field of joint endoprosthesis (hip replacements, knee, shoulder and ankle). The aim of this study is to provide valid data for the damage assessment with the new traffic scale in patients with posttraumatic arthritis necessitating a prosthesis implant surgery and in patients who have been implanted a prosthesis and will require revision surgery in the future (AU)

Closed degloving of the thumb.

We present a work-related injury where the drums of a printing machine caused a closed degloving of the distal phalanx of the thumb, which represents detachment of the soft tissue from the bone.