[Comparison of treatment with plates for distal tibia fractures]. / Comparación del tratamiento con placas en fractura de tibia distal.

INTRODUCTION: Currently the surgical treatment of fractures of extraarticular distal tibia is controversial for the multiple techniques and materials of osteosynthesis, the Minimally Invasive Percutaneous Techniques (MIPO) allow us to preserve the periosteal circulation, crucial point in the natural processes of convalescence of the patient, so this technique takes relevance in our study. OBJECTIVE: To observe that this approach to fractures of the distal tibia has fewer complications and better functional result than fixation with open technique. MATERIAL AND METHODS: A longitudinal, ambispective and analytical study was conducted in the period from July 2018 to September 2019 in patients with closed fracture of the extraarticular distal tibia in patients over 18 years of age without previously diagnosed musculoskeletal comorbidities, the calculation was performed with the WinPEPI program (Programs for Epidemiologists for Windows) version 11.43 based on the study by Paul Toogooda et al (2018) with a confidence interval of 95% a minimum total of 20 patients for each group. Measures of central tendency, correlations between technique and variable were used. RESULTS: Two groups of 20 patients were analyzed comparing MIPO vs conventional technique in a period of 6 months postsurgical evaluating risk of infection, wound dehiscence, radiographic bone consolidation, joint functionality and demographic data; showing positive statistical superiority for MIPO technique. CONCLUSION: Relevant data were obtained in favor of MIPO with bone consolidation and higher functional score at six months.

INTRODUCCIÓN: Actualmente el tratamiento quirúrgico de fracturas de tibia distal extraarticular es controversial por las múltiples técnicas y materiales de osteosíntesis, las técnicas Mínimo Invasivo Percutánea (MIPO) nos permiten preservar la circulación perióstica, punto crucial en los procesos naturales de convalecencia del paciente, por ello esta técnica es de gran relevancia en nuestro estudio. OBJETIVO: Observar que este abordaje de fracturas de tibia distal tiene menos complicaciones y mejor resultado funcional que la fijación con técnica abierta. MATERIAL Y MÉTODOS: Se realizó un estudio de tipo longitudinal, ambispectivo y analítico en el período de Julio de 2018 a Septiembre de 2019 en pacientes adultos con fractura cerrada de tibia distal extraarticular sin comorbilidades, el cálculo se realizó con el programa WinPEPI (Programs for Epidemiologists for Windows) versión 11.43 basado en el estudio de Paul Toogooda, con un intervalo de confianza de 95% se obtuvo un total mínimo de 20 pacientes por cada grupo. Se usaron medidas de tendencia central, correlaciones entre técnica y variable. RESULTADOS: Se analizaron dos grupos de 20 pacientes comparando la técnica MIPO vs. la convencional en un período de seis meses postquirúrgico evaluando riesgo de infección, dehiscencia de herida, consolidación ósea radiográfica, funcionalidad articular y datos demográficos, mostrando superioridad estadística positiva para la técnica MIPO. CONCLUSIONES: Se obtuvieron datos relevantes a favor de MIPO con consolidación ósea y mayor puntaje funcional articular a los seis meses.

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 / Installed Capacity Perception Survey for the Training of Resident's Program in Orthopedics and Care Needs in Acute and Chronic Musculoskeletal Pathology in Mexico

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Abstract: 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.

[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.

[Results of the treatment of high energy tibial pylon fractures]. / Resultados del tratamiento de las fracturas del pilón tibial por alta energía.

BACKGROUND: Several treatment are available for these injuries. In developed countries they are currently treated with minimally invasive plates. This paper describes the results obtained using external fixators in patients with tibial pylon fractures. METHODS: A retrospective, cross-sectional study was conducted from 1999 to 2009 at Querétaro General Hospital. A total of 39 patients were operated on; 18 met the inclusion criteria; follow-up ranged from 1 to 9 years. RESULTS: Of the 18 patients enrolled, 22% were females and 78% males. The most frequent fracture was 43 A2 of the AO classification accounting for 67%. Mean age was 41.2 years +/- 9.3, mean healing time was 14.9 weeks +/- 7.26, with p = 0.005; mean follow-up was 4.1 +/- 4.9 years. Twenty-two percent were Gustilo type II open fractures; 78.2% required open reduction plus an external fixator; 22.8% underwent closed reduction plus external fixator; the mean score in the SF-36 scale was 78.05 +/- 14.76. Only one patient required another surgery; 94.4% returned to their usual daily activities. Among the latter, 77.7% had normal gait, 22.2% had full range of motion, 72.2% had a pain score of four in the VAS and 27.7% were pain free. CONCLUSIONS: The use of external fixators for the definitive management of these fractures is effective, as it helps avoid additional surgeries (up to 35%) and has a shorter healing time.