Resultado de la implantación de consultas telemáticas en cirugía ortopédica y traumatología durante la pandemia COVID-19 / Result of the implementation of telematic consultations in orthopaedic surgery and traumatology during COVID-19 laparoscopic surgery

La pandemia COVID ha hecho de las consultas telemáticas una herramienta básica en la práctica diaria. El objetivo principal del estudio es valorar los resultados de la aplicación de consultas telemáticas para limitar la movilidad de los pacientes. Son objetivos operativos: proponer un plan de consultas, conocer cómo limita la asistencia a las consultas, definir qué patologías se benefician más con este plan. MATERIAL Y MÉTODOS: Se propone un esquema con la creación de consultas previas a las agendadas para valorar idoneidad y posibilidad de realizarla en acto único no presencial. RESULTADOS: Se han realizado 5.619 consultas con una falta de respuesta telefónica del 19%. El 74% de los pacientes fueron resueltos de forma virtual. Existe diferencia entre unidades, siendo más probable la respuesta telefónica para las consultas de unidad, OR = 0,60 o de traumatología general, OR = 0,67 y menos para los derivados desde urgencias. El 20% de las consultas no se acompañaban de pruebas complementarias. Las consultas de traumatología general, OR = 0,34, control postoperatorio, OR = 0,49, y unidades, OR = 0,40, cumplieron mejor este requisito. De los pacientes restantes, las consultas de traumatología general, OR = 0,50, y las derivadas a unidades, OR = 0,54 fueron las que más se resolvieron sin acudir presencialmente. CONCLUSIONES: Se han resuelto de forma no presencial el 74% de los pacientes que atendieron a la llamada telefónica. El 20% de los pacientes acuden a la visita sin pruebas complementarias. Las consultas de seguimiento de osteosíntesis y postoperatorio de cirugía artroscópica son las que más precisan de ser realizadas de forma presencial

The COVID pandemic has made telematic consultations a basic tool in daily practice. AIMS: The main objective of the study is to assess the results of the application of telematic consultations to limit the mobility of patients. The operational objectives are; to propose a consultation plan, to know how attendance limits consultations and to define which pathologies benefit the most from this plan. METHODS: A scheme is proposed with the creation of pre-scheduled clinic to assess suitability and the possibility of carrying them out in a single non face-to-face act. RESULTS: Phone call to 5,619 patients were made with a lack of response of 19%. The cases of 74% of the patients that answered were resolved virtually. There is a difference between units, obtaining a higher answering rate from patients appointed to specific clinic units, OR = 0.60, or to general trauma ones, OR = 0.67. The lowest answering rate was obtained from those derived from the emergency department. Twenty per cent of the consultations were not accompanied by complementary tests that would have favored the resolution in a single act. The general trauma consultations, OR = 0.34, postoperative control, OR = 0.49, and specific unit ones, OR = 0.40, were the ones that better met this requirement. Out of the remaining patients, the general trauma consultations, OR = 0.50, and those referred to units, OR = 0.54, were the ones that had a higher resolution rate without in- person consultation. CONCLUSIONS: The cases of 74% of the patients who answered the phone call were resolved virtually. Cases of 20% of the patients cannot be solved in a single act because they are derived without complementary tests. Osteosynthesis and postoperative arthroscopic follow-up consultations are the ones that need to be carried out in person the most

Result of the implementation of telematic consultations in orthopaedic surgery and traumatology during COVID-19 laparoscopic surgery. / Resultado de la implantación de consultas telemáticas en cirugía ortopédica y traumatología durante la pandemia COVID-19.

The COVID pandemic has made telematic consultations a basic tool in daily practice. AIMS: The main objective of the study is to assess the results of the application of telematic consultations to limit the mobility of patients. The operational objectives are; to propose a consultation plan, to know how attendance limits consultations and to define which pathologies benefit the most from this plan. METHODS: A scheme is proposed with the creation of pre-scheduled clinic to assess suitability and the possibility of carrying them out in a single non face-to-face act. RESULTS: Phone call to 5,619 patients were made with a lack of response of 19%. The cases of 74% of the patients that answered were resolved virtually. There is a difference between units, obtaining a higher answering rate from patients appointed to specific clinic units, OR = 0.60, or to general trauma ones, OR = 0.67. The lowest answering rate was obtained from those derived from the emergency department. Twenty per cent of the consultations were not accompanied by complementary tests that would have favored the resolution in a single act. The general trauma consultations, OR = 0.34, postoperative control, OR = 0.49, and specific unit ones, OR = 0.40, were the ones that better met this requirement. Out of the remaining patients, the general trauma consultations, OR = 0.50, and those referred to units, OR = 0.54, were the ones that had a higher resolution rate without in- person consultation. CONCLUSIONS: The cases of 74% of the patients who answered the phone call were resolved virtually. Cases of 20% of the patients cannot be solved in a single act because they are derived without complementary tests. Osteosynthesis and postoperative arthroscopic follow-up consultations are the ones that need to be carried out in person the most.

Resultados del tratamiento quirúrgico en las fracturas de pelvis / Results of the surgical treatment of pelvic fractures

Objetivo. Evaluar los resultados clínicos y radiológicos obtenidos tras el tratamiento quirúrgico de las fracturas del anillo pélvico. Material y método. Se analizan en esta revisión un total de 23 pacientes que han sido tratados quirúrgicamente por presentar una fractura de pelvis y de los que se ha obtenido un seguimiento completo con un mínimo de tres años. Resultados. La edad media de los enfermos en el momento del accidente ha sido de 32 años (13-59) y ha habido un predominio del sexo masculino (19:4). La fractura más frecuente ha sido la de tipo C3 (7 casos). El trayecto de la línea de fractura se ha localizado en 7 ocasiones a través de la región transacroilíaca. Las lesiones acompañantes se han presentado en 21 de los 23 enfermos y ha sido la fractura de algún hueso de la extremidad inferior la que lo ha hecho en más ocasiones (14 veces). El tratamiento más frecuente en urgencias ha sido la inmovilización mediante fijación externa. El tratamiento definitivo se ha realizado de preferencia a través del abordaje a la región posterior. El tiempo medio de seguimiento ha sido de 5,74 años (3,14-10,02). El 48% de los pacientes presentan algún grado de cojera residual y 8 de cada 23 tienen clínica dolorosa. Cuatro enfermos presentan dismetría de miembros inferiores superior a 2 cm. En tres permanece como secuela una oblicuidad pélvica. En los resultados radiológicos se ha conseguido una reducción perfecta en 18 pacientes en la parte anterior del anillo pélvico, y en 13 ocasiones en la parte posterior. En 5 casos se ha diagnosticado un trastorno de la consolidación y en el 86,4% de los pacientes se han evidenciado signos radiológicos compatibles con el diagnóstico de artrosis. Conclusiones. A pesar de una correcta reducción quirúrgica de los fragmentos óseos, la clínica dolorosa, así como la persistencia de dismetría y la cojera son secuelas frecuentes en este tipo de lesiones. A pesar de las cifras porcentuales, probablemente debido a lo limitado de la casuística, no se han podido identificar factores del cuadro inicial, ni características del resultado quirúrgico, relacionados con el resultado final del tratamiento quirúrgico de las fracturas de pelvis

Purpose. To examine the clinical and radiological results obtained after surgical treatment of pelvis ring fractures. Materials and methods. In the course of the present review, a total of 23 patients were assessed, who had been treated surgically for a pelvic fracture and who were followed-up thoroughly for at least three years. Results. Patients' average age at the time of the accident was 32 (13-59) and males outnumbered females(19:4). The mist frequent fracture type was type C3 (7 cases). On 7 occasions, the fracture line ran along the transacroiliac axis. Related lesions were found in 21 out of the 23 patients and most of them involved fractures of some small bone in the lower limb (14 cases). The most usual treatment in the emergency setting was immobilization with an external fixation device. Definitive treatment involved preferably a posterior approach. The mean follow-up period was 5.74 years (3.14-10.02). 48% of patients present with some degree of residual limping and 8 patients have pain. Four patients have lower-limb dysmetria greater than 2 cm. Three have been left with pelvic obliquity. The radiological results reveal that 18 patients achieved a perfect reduction in the anterior part of their pelvis ring and 13 in the posterior part. In 5 cases an integration disorder was detected and in 86.4% of patients radiological signs have been detected that are compatible with the diagnosis of osteoarthritis. Conclusions. Even if a correct surgical reduction of the bone fragments can be achieved, the feeling of pain and the persistence of dysmetria and limping are among the most frequent sequelae of these types of lesions. In spite of the percentages presented, probably because of the small number of cases in the series, it was not possible identify some of the factors of the initial condition or the characteristics of the surgical result related to the final result of the surgical treatment of pelvic fractures