[Installed Capacity Perception Survey for the Training of Residents Program in Orthopedics and Care Needs in Acute and Chronic Musculoskeletal Pathology in Mexico]. / Encuesta de Percepción en Capacidad Instalada para la Formación de Médicos Residentes en Ortopedia (Traumatología) y Necesidades de la Atención en Patología Musculoesquelética Aguda y Crónica en México. Primera Parte.

INTRODUCTION: It is essential that orthopaedic resident physicians be highly proficient in all aspects, considering the balance between supply, demand, need and context. Fundamental to identify the capacity and quality installed for their training in Mexico. MATERIAL AND METHODS: Observational Study, transverse, non-probabilistic sampling-conglomerates, in two phases. The instrument has 8 domains, 57 variables and 4,867 items. 60 graduate professors of 20 states, 50 hospital sites, 22 university programs. RESULTS: 1,038 years of experience (collective intelligence), 17 years of experience/teacher (01 to 50 years). Identified: acute pathology 30 (2 to 90%), chronic pathology 30 (5 to 96%), patients 15 years, 10 (3 to 30%), patients between 15 and 65 years, 47 (2 to 78%), patients 65 years, 20 (2 to 60%), number of beds/seat 20 (2 to 510), number of clinics 3 (1 to 48), number of surgical procedures/headquarters per year at the national level, was 960 (50 to 24,650). The national average per resident doctor is 362 surgeries/year with 1,450 surgical times/year. CONCLUSIONS: The needs and resources for the training of physicians specializing in orthopedics/traumatology are highly heterogeneous, so it should be adapted to the epidemiological needs of the region of influence, in an area of epidemiological transition. 62.2% expressed not having or have bad academic and scientific infrastructure at its headquarters, more than 50% without rotation overseas and 90% without regular scientific production.

INTRODUCCIÓN: Es fundamental que los médicos residentes de ortopedia (traumatología) sean altamente competentes en todos los aspectos, considerando el equilibrio entre la oferta, demanda, necesidad y contexto. Es primordial identificar la capacidad y calidad instalada para su formación en México. MATERIAL Y MÉTODOS: Estudio observacional, transversal, muestreo no probabilístico-conglomerados, en dos fases. El instrumento tiene ocho dominios, 57 variables y 4,867 ítems. Sesenta profesores de postgrado de 20 estados, 50 sedes hospitalarias, 22 programas universitarios. RESULTADOS: 1,038 años de experiencia (inteligencia colectiva), 17 años de experiencia/profesor (01 a 50 años). Se identificó: patología aguda 30 (2 a 90%), patología crónica 30 (5 a 96%), pacientes 15 años, 10 (3 a 30%), pacientes entre 15 y 65 años, 47 (2 a 78%), pacientes 65 años, 20 (2 a 60%), número de camas/sede 20 (2 a 510), número de consultorios 3 (1 a 48), el número de procedimientos quirúrgicos/sede al año a nivel nacional fue de 960 (50 a 24,650). La media nacional por médico residente es de 362 cirugías/año con 1,450 momentos quirúrgicos/año. CONCLUSIONES: Las necesidades y recursos para la formación de médicos especialistas en ortopedia/traumatología son en alto grado heterogéneos, por lo cual se debería adaptar a las necesidades epidemiológicas de la región de influencia, en un ámbito de transición epidemiológica. Sesenta y dos punto dos por ciento expresó no tener o tener deficiente infraestructura académica y científica en su sede, más de 50% sin rotación al extranjero y 90% sin producción científica regular.

[Posterior release in congenital talipes equinovarus adductus]. / Liberación posterior del pie equinovaro aducto congénito (PEVAC).

OBJECTIVE: To show the utility of posterior release to correct adduct congenital talipes equinovarus (CTE) and describe the surgical technique. MATERIAL AND METHODS: This clinical trial was conducted from February 2002 to November 2008. Patients ages 0-24 months old with a diagnosis of adduct CTE were enrolled. Surgical treatment consisted of a posterior approach to the foot with Z-plasty of the tibialis posterior, flexor digitorum longus and flexor hallucis longus, capsulotomy, adductor hallucis release, and cast immobilization for 8 weeks. ANALYSIS: The sampling was non-randomized, non-probabilistic; patients were enrolled based on the diagnosis. The statistical analysis included the central trend and scatter measures, the Student "t" test, RR, and homogeneity chi square test. RESULTS: Twenty-five patients were enrolled, 13 females and 12 males, with a total of 30 feet, 10 left and 6 right, and 7 bilateral patients. Median age was 15 years (range 11-24 years). Correction was achieved and maintained in 27 feet. Three cases had adduct relapse and were managed conservatively. The statistical analysis showed the effectiveness of treatment. The result of the Student "t" test and the chi square test was p < 0.0002. DISCUSSION: The proposed treatment was effective to correct the adduct CTE, with a proven effectiveness of more than 90% in the patients included in this study. The age of onset of treatment > 18 months was a risk factor for residual adduct with a RR = 3.7.

[The Ludloff-Ferguson approach for congenital hip dislocation in children ages 2-4 years]. / Vía de Ludloff-Ferguson para luxación congénita de caderas en niños de 2 a 4 años.

OBJECTIVE: The objective of this study is to show that the Ludloff-Ferguson approach is feasible in patients aged 2-4 years and as an outpatient procedure. MATERIAL AND METHODS: Prospective, longitudinal, clinical-trial type of study, conducted from January 2008 to December 2009. Patients aged 2-4 years with a diagnosis of congenital hip dislocation were included. All of them underwent open reduction using the Ludloff-Ferguson approach as an outpatient procedure and they wore a Callot type of cast for 6 weeks. Bilateral hips were treated in a single stage. The study variables included the age, sex, operative time, bleeding, anesthetic time, infections and avascular necrosis of the femoral head. A nonrandomized, non-probabilistic sampling was performed; the statistical analysis included the central trend and scatter measurements, the relative risk, the Spearman correlation and chi2. RESULTS: Fifteen patients were included, 8 females and 7 males, for a total of 21 hips. The latter included 4 left and 3 right hips, and 7 cases were bilateral. Median age was 3 years (range 2-4 years). The mean bleeding was 20 cc with a SD of 5 cc (range: 15-30 cc). The mean operative time was 25 minutes, SD = 7 minutes (range: 17-30 minutes). The chi2 test rejected the Ho for sex and necrosis, and age and avascular necrosis, with a P = 0.005. The results of the Spearman test for sex and necrosis were r = 0.23, P = 0.002, for age and necrosis r = 0.25, and a P = 0.003, for the operative time and avascular hip necrosis r = 0.28, P = 001. There were no infections. DISCUSSION: The open reduction technique with the Ludloff-Ferguson approach is feasible in patients aged 2-4 years as an outpatient procedure, and the risk of avascular necrosis was minimum.

[Growing pains. Simplified treatment regimen]. / Dolores de crecimiento. Régimen simplificado de tratamiento.

OBJECTIVES: The purpose of this study is to show that a simplified stretching exercise regimen for the pelvic limbs, together with analgesics and physical therapy, may improve growing pains during an 8-week period. The Evans and Scutter diagnostic criteria modified by Peterson were used. MATERIAL AND METHODS: Prospective, longitudinal study of the clinical trial type, conducted from November 2002 to December 2008. The following tests were requested from patients: CBC, rheumatoid factor, antistreptolysins and a pharyngeal smear. A simplified regimen consisting of three stretching exercises for the adductors, the knee extensors and the hamstrings, plus analgesics and physical therapy was used. Both parents and patients were instructed on the regimen. The treatment was performed by parents at home. ANALYSIS: The sampling was non-randomized; patients were selected based on the diagnosis. The statistical analysis included the central tendency measurements and scatter plots, the Z-test for comparison of means, and the linear correlation. RESULTS: The correlation between treatment and pain relief resulted in an r = 0.97, the correlation between pain and the study variables resulted in the following: sports practice r = 0.82, obesity r = 0.86. The Z-test corroborates the improvement in the clinical picture with the treatment provided, with p = 0.0001. CONCLUSION: The simplified treatment regimen was effective to improve growing pains in the patients in the study. The high risk factors were: age, male gender and practicing sports.