A comparison of three techniques for the osteosynthesis after minimal invasive osteotomies for hallux valgus.

PURPOSE: Third and fourth-generation minimal invasive osteotomies (MIO) for the treatment of hallux valgus (HV) have become popular procedures worldwide with promising results due to the improvement in the fixation method. The tricortical cannulated screw placement remains a complex procedure that is technically challenging and requires a long skill learning curve with high radiation exposure mainly in the form of intensifier shots (IS) required for the MIO fixation. This study aims to compare the number of X-ray IS required using three different techniques for the cannulated guide placement. METHODS: A retrospective cross-sectional observational and comparative study was conducted to assess the number of X-rays IS required for correct cannulated screw guide placement using three different techniques: traditional perforator, the drill and joystick, and K-wire first techniques. RESULTS: A total of 53 MIS procedures from thirty-one patients in two different hospitals were included. IS X-rays were 155.1 ± 29.7 in the traditional technique (n = 14), 143.0 ± 43.2 in the drill and joystick technique (n = 22), and 85 ± 18.7 in the K-wires first technique (n = 17), p = < 0.001 using one-way ANOVA. CONCLUSIONS: The K-wire first technique statistically significantly decreases X-ray IS numbers p ≤ 0.001. There were no statistically significant differences between the traditional (after osteotomy K-wire placement) and the drill and joystick techniques (p = 0.36).

Bilateral bipartite lunate misdiagnosed as carpal fracture: a case report and brief review of literature.

Bilateral bipartite lunate is a very rare congenital anomaly of the lunate. A 36-year-old military European male was referred to our service diagnosed with a lunate fracture. Symptoms began 3 months before our encounter, after falling on his outstretched left hand. The patient was misdiagnosed with a lunate fracture, therefore treated with a cast and then transitioned to a removable splint over 2 months in total; When the patient presented to our facility, on physical examination, he referred pain over the dorso-ulnar side of the wrist, especially the ulnar snuff. Tenderness to palpation over the fovea and positive triangular fibrocartilage complex axial compression test was encountered. Bilateral wrist X-rays were taken, and a diagnosis of bilateral bipartite lunate was made by our team. The patient was treated for ulnar-sided wrist pain with steroid injection and physical rehabilitation. A literature review on bipartite lunate was conducted, and cases share three basic common features: unilateral involvement, incidentally diagnosed after a traumatic event, and absence of positive clinical findings related to the bipartition.

A Prospective, Randomized, Controlled Clinical Trial to Assess Use of 2% Lidocaine Irrigation to Prevent Abdominal Surgical Site Infection.

Surgical site infections (SSI) are the third most common nosocomial infection, increasing morbidity and mortality rates of patients as well as their costs of care, but longer-term follow up studies and data are limited. Lidocaine, in addition to being a readily available and accessible local anesthetic, is known to have bacteriostatic properties. A prospective, descriptive, controlled, randomized clinical trial was conducted among patients scheduled to undergo abdominal sur- gery in the general surgical unit of a Mexican hospital. The purpose of the study was to assess the incidence of SSIs in general and to compare the 30-day postoperative infection outcomes of saline irrigation to saline irrigation followed by 2% lidocaine application before skin closure in wounds grade II to IV per the Centers for Disease Control and Prevention surgical wound classi cation. All patients received systemic antibiotics before surgery. Eighty-four (84) patients (40 men and 44 women; mean age 49.02 ± 19.9 years, range 18-92 years), 39 in the control and 45 in the experimental group, completed the 30-day follow-up without experiencing nonsurgery-related complications. The overall incidence of SSIs (speci cally, seromas and abscesses) was 17.86%; the incidence of abscess formation was 7.14%. The overall incidence of SSIs in the lidocaine group was 8.89% compared to 28.2% in the saline only group (P = .02); the relative risk was 1.8 (P = .02; 95% CI 1.19-2.74) and 0.45 (P = .02; 95% CI 0.19-1.06) in the saline and lidocaine groups, respectively. Hemoglobin and albumin levels were signi cantly lower in patients who did compared to those who did not develop an SSI (P = .02 and .04, respectively). No signi cant SSI rate differences were seen between patients who did and did not have a drain placed. In patients who developed an abscess, Escherichia coli was the most prevalent bacteria and present in 40% of collected uid. While carefully controlled clinical studies are needed, lidocaine appears to be a viable option to decrease the incidence of SSI if applied as irrigation before wound closure in patients undergoing abdominal surgery.

An age- and gender-related three-dimensional analysis of rotator cuff transverse force couple volume ratio in 304 shoulders.

PURPOSE: The rotator cuff transverse force couple (RCTFC) is fundamental in the shoulder biomechanics, as the balance of its muscle components (the subscapularis relative to the infraspinatus and teres minor) provides stability to the joint. The chronic progression of rotator cuff tears usually present alterations in muscle volume, along with atrophy and compensatory hypertrophy, which can be determined using imaging techniques. The aim of this study was to quantify RCTFC muscle volume in a large sample taking into account the age and gender of the participants involved. METHODS: An observational, retrospective, cross-sectional, descriptive and comparative study was conducted, evaluating thoracic computed tomography scans from 152 patients (304 shoulders) of indistinct gender, with ages ranging between 18 and 85 years. The RCTFC muscle volume was quantified with an oblique/multiplanar segmentation technique. Measuring time was also documented. RESULTS: We observed that muscle volume decreases among the different age (p < 0.04) and gender (p < 0.001) groups. However, the RCTFC volume ratio remained constant at 1.02 ± 0.18 without significant differences throughout all age and gender groups evaluated (p > 0.298). CONCLUSION: The decrease in the RCTFC muscle volume is proportional during the different stages of life, maintaining a constant ratio between its components (physiological RCTFC muscle atrophy). The time-saving segmentation method and volume ratio formula proposed in this study contribute to the management and understanding of rotator cuff tear/pathology.

[New arthroscopic portal for performing tenotomy/tenodesis procedures on the long head of the biceps brachii tendon]. / Nuevo portal artroscópico para la realización de procedimientos de tenotomía/tenodesis del tendón de la cabeza larga del músculo bíceps braquial.

BACKGROUND: Shoulder arthroscopy is the standard technique for performing procedures involving the intertubercular groove. Current techniques continue to produce excessive soft tissue manipulation and neurovascular injury. MATERIALS AND METHODS: A cross-sectional, observational and descriptive study was conducted on a cohort of 24 shoulders following the standard surgical protocol and using punch dissection. The neurovascular structures with risk of damage by the standard lateral portal were evaluated during the study to establish a secure area for a new arthroscopic portal. Finally, the safety of the new proposed site was evaluated. RESULTS: The presence of 24 venous structures, with a mean diameter was 1.05mm (SD: 0.71) was documented. A tendency was observed in locating these structures in the lower half of the dissecting field for the left shoulders and a hypovascular area between the 7 and 10hours circle dissected relative to the right shoulder. The new site was determined at a point 1.5 cm anterolateral to the anterolateral border of the acromion at an angle of 60° degrees to the horizontal axis of the acromion and towards the intertubercular groove of the humerus. CONCLUSIONS: The methodology used in this study is innovative, reproducible and applicable for the study of all existing shoulder arthroscopic portals procedures, as well as any joint. The results provided by this study will be helpful for clinicians to improve tenotomy/tendon tenodesis procedures of the long head of the biceps brachii tendon.