Menor mortalidad y reingreso en pacientes con pocas comorbilidades intervenidos de fractura de cadera y con alta precoz / Lower mortality and readmission in patients with few comorbidities who underwent hip fracture surgery and were discharged early

Introducción: El retraso preoperatorio en pacientes intervenidos de fractura de cadera (FC) se ha asociado a peores resultados; sin embargo, el momento óptimo del alta hospitalaria tras cirugía ha sido poco estudiado. El objetivo de este estudio fue determinar resultados de mortalidad y de reingreso en pacientes con FC con y sin alta hospitalaria precoz. Material y métodos: Se realizó un estudio observacional retrospectivo seleccionando a 607 pacientes mayores de 65años con FC intervenidos entre enero de 2015 y diciembre de 2019, de los que se incluyeron para el análisis 164 pacientes con menos comorbilidades y ASA ≤II y se dividieron según su estancia hospitalaria postoperatoria en alta precoz o estancia ≤4días (n=115) y alta no precoz o estancia postoperatoria >4días (n=49). Se registraron características demográficas; características relacionadas con la fractura y el tratamiento quirúrgico; tasas de mortalidad a los 30días y al año postoperatorio; tasa de reingreso hospitalario a los 30días postoperatorios, y causa médica o quirúrgica. Resultados: En el grupo alta precoz todos los resultados fueron mejores frente al grupo no alta precoz: menor tasa de mortalidad a los 30días postoperatorios (0,9% frente al 4,1%, p=0,16) y al año postoperatorio (4,3% frente al 16,3%, p=0,009), así como una menor tasa de reingreso hospitalario por razones médicas (7,8% frente al 16,3%, p=0,037). Conclusiones: En el presente estudio el grupo de alta precoz obtiene mejores resultados en indicadores de mortalidad a los 30días y al año postoperatorio, así como de reingreso por causas médicas.(AU)

Introduction: Preoperative delay in patients with hip fracture surgery (HF) has been associated with poorer outcomes; however, the optimal timing of discharge from hospital after surgery has been little studied. The aim of this study was to determine mortality and readmission outcomes in HF patients with and without early hospital discharge. Material and methods: A retrospective observational study was conducted selecting 607 patients over 65years of age with HF intervened between January 2015 and December 2019, from which 164 patients with fewer comorbidities and ASA ≤II were included for analysis and divided according to their postoperative hospital stay into early discharge or stay ≤4 days (n=115), and non-early or post-operative stay >4days (n=49). Demographic characteristics; fracture and surgical-related characteristics; 30-day and one-year postoperative mortality rates; 30-day postoperative hospital readmission rate; and medical or surgical cause were recorded. Results: In the early discharge group all outcomes were better compared to the non-early discharge group: lower 30-day (0.9% vs 4.1%, P=.16) and 1-year postoperative (4.3% vs 16.3%, P=.009) mortality rates, as well as a lower rate of hospital readmission for medical reasons (7.8% vs 16.3%, P=.037). Conclusions: In the present study, the early discharge group obtained better results 30-day and 1-year postoperative mortality indicators, as well as readmission for medical reasons.(AU)

[Translated article] Lower mortality and readmission in patients with few comorbidities who underwent hip fracture surgery and were discharged early / Menor mortalidad y reingreso en pacientes con pocas comorbilidades intervenidos de fractura de cadera y con alta precoz

Introducción: El retraso preoperatorio en pacientes intervenidos de fractura de cadera (FC) se ha asociado a peores resultados; sin embargo, el momento óptimo del alta hospitalaria tras cirugía ha sido poco estudiado. El objetivo de este estudio fue determinar resultados de mortalidad y de reingreso en pacientes con FC con y sin alta hospitalaria precoz. Material y métodos: Se realizó un estudio observacional retrospectivo seleccionando a 607 pacientes mayores de 65años con FC intervenidos entre enero de 2015 y diciembre de 2019, de los que se incluyeron para el análisis 164 pacientes con menos comorbilidades y ASA ≤II y se dividieron según su estancia hospitalaria postoperatoria en alta precoz o estancia ≤4días (n=115) y alta no precoz o estancia postoperatoria >4días (n=49). Se registraron características demográficas; características relacionadas con la fractura y el tratamiento quirúrgico; tasas de mortalidad a los 30días y al año postoperatorio; tasa de reingreso hospitalario a los 30días postoperatorios, y causa médica o quirúrgica. Resultados: En el grupo alta precoz todos los resultados fueron mejores frente al grupo no alta precoz: menor tasa de mortalidad a los 30días postoperatorios (0,9% frente al 4,1%, p=0,16) y al año postoperatorio (4,3% frente al 16,3%, p=0,009), así como una menor tasa de reingreso hospitalario por razones médicas (7,8% frente al 16,3%, p=0,037). Conclusiones: En el presente estudio el grupo de alta precoz obtiene mejores resultados en indicadores de mortalidad a los 30días y al año postoperatorio, así como de reingreso por causas médicas.(AU)

Introduction: Preoperative delay in patients with hip fracture surgery (HF) has been associated with poorer outcomes; however, the optimal timing of discharge from hospital after surgery has been little studied. The aim of this study was to determine mortality and readmission outcomes in HF patients with and without early hospital discharge. Material and methods: A retrospective observational study was conducted selecting 607 patients over 65years of age with HF intervened between January 2015 and December 2019, from which 164 patients with fewer comorbidities and ASA ≤II were included for analysis and divided according to their postoperative hospital stay into early discharge or stay ≤4 days (n=115), and non-early or post-operative stay >4days (n=49). Demographic characteristics; fracture and surgical-related characteristics; 30-day and one-year postoperative mortality rates; 30-day postoperative hospital readmission rate; and medical or surgical cause were recorded. Results: In the early discharge group all outcomes were better compared to the non-early discharge group: lower 30-day (0.9% vs 4.1%, P=.16) and 1-year postoperative (4.3% vs 16.3%, P=.009) mortality rates, as well as a lower rate of hospital readmission for medical reasons (7.8% vs 16.3%, P=.037). Conclusions: In the present study, the early discharge group obtained better results 30-day and 1-year postoperative mortality indicators, as well as readmission for medical reasons.(AU)

[Translated article] Lower mortality and readmission in patients with few comorbidities who underwent hip fracture surgery and were discharged early.

INTRODUCTION: Pre-operative delay in patients with hip fracture surgery (HF) has been associated with poorer outcomes; however, the optimal timing of discharge from hospital after surgery has been little studied. The aim of this study was to determine mortality and readmission outcomes in HF patients with and without early hospital discharge. MATERIAL AND METHODS: A retrospective observational study was conducted selecting 607 patients over 65years of age with HF intervened between January 2015 and December 2019, from which 164 patients with fewer comorbidities and ASA≤II were included for analysis and divided according to their post-operative hospital stay into early discharge or stay ≤4 days (n=115), and non-early or post-operative stay >4days (n=49). Demographic characteristics; fracture and surgical-related characteristics; 30-day and one-year post-operative mortality rates; 30-day post-operative hospital readmission rate; and medical or surgical cause were recorded. RESULTS: In the early discharge group all outcomes were better compared to the non-early discharge group: lower 30-day (0.9% versus 4.1%, p=.16) and 1-year post-operative (4.3% versus 16.3%, p=.009) mortality rates, as well as a lower rate of hospital readmission for medical reasons (7.8% versus 16.3%, p=.037). CONCLUSIONS: In the present study, the early discharge group obtained better results 30-day and 1-year post-operative mortality indicators, as well as readmission for medical reasons.

Lower mortality and readmission in patients with few comorbidities who underwent hip fracture surgery and were discharged early. / Menor mortalidad y reingreso en pacientes con pocas comorbilidades intervenidos de fractura de cadera y con alta precoz.

INTRODUCTION: Preoperative delay in patients with hip fracture surgery (HF) has been associated with poorer outcomes; however, the optimal timing of discharge from hospital after surgery has been little studied. The aim of this study was to determine mortality and readmission outcomes in HF patients with and without early hospital discharge. MATERIAL AND METHODS: A retrospective observational study was conducted selecting 607 patients over 65years of age with HF intervened between January 2015 and December 2019, from which 164 patients with fewer comorbidities and ASA ≤II were included for analysis and divided according to their postoperative hospital stay into early discharge or stay ≤4 days (n=115), and non-early or post-operative stay >4days (n=49). Demographic characteristics; fracture and surgical-related characteristics; 30-day and one-year postoperative mortality rates; 30-day postoperative hospital readmission rate; and medical or surgical cause were recorded. RESULTS: In the early discharge group all outcomes were better compared to the non-early discharge group: lower 30-day (0.9% vs 4.1%, P=.16) and 1-year postoperative (4.3% vs 16.3%, P=.009) mortality rates, as well as a lower rate of hospital readmission for medical reasons (7.8% vs 16.3%, P=.037). CONCLUSIONS: In the present study, the early discharge group obtained better results 30-day and 1-year postoperative mortality indicators, as well as readmission for medical reasons.

Fracturas intraarticulares de calcáneo. ¿Las placas bloqueadas mantienen la reducción mejor que las convencionales? / Intra-articular calcaneal fractures. Do locking plates keep the reduction better than conventional plates?

Introducción: Desde el desarrollo de las placas bloqueadas, las fracturas de calcáneo han sido consideradas como ideales para este tipo de fijación, debido a la necesidad de mantener la altura de la articulación subastragalina tras las fracturas con hundimiento, en una localización donde la calidad ósea suele ser pobre. Sin embargo, no contamos con estudios comparativos que apoyen la superioridad teórica de estas placas frente a las convencionales. El objetivo de este estudio es comparar los resultados de las fracturas intraarticulares de calcáneo tratadas mediante placas bloqueadas versus convencionales, en cuanto a pérdida de reducción radiológica, complicaciones y número de reintervenciones. Material y métodos: Diseñamos un estudio comparativo de fracturas de calcáneo intervenidas en nuestro centro mediante abordaje en «L». Se establecieron 2 grupos: grupo B, formado por 15 pacientes intervenidos entre los años 2010 y 2015 con placas bloqueadas de calcáneo, y grupo A, formado por una muestra aleatoria estratificada de 23 pacientes extraídos de una cohorte histórica de 90 pacientes intervenidos en nuestro centro entre 1997 y 2007 con placas convencionales de calcáneo. Se registraron datos demográficos (edad, sexo, diabetes mellitus, tabaquismo) y datos relacionados con la fractura (tipo de fractura según la clasificación de Sanders, complicaciones, demora prequirúrgica). Para evaluar la pérdida de reducción se evaluaron radiográficamente la angulación en varo del calcáneo (medida en la proyección axial), el ángulo de Böhler y el ángulo de Gissane. Dichos ángulos se midieron preoperatoriamente, en el postoperatorio inmediato y al final del seguimiento. Finalmente, se registraron las complicaciones y el número de reintervenciones. Resultados: No hubo diferencias en cuanto a la edad, el sexo y el tipo de fractura entre ambos grupos. Hubo mayor pérdida de la angulación en varo en el grupo A, 0,6 vs. 0,41°, también hubo mayor disminución del ángulo de Böhler en el grupo A, 3,79 vs. 2,6°, mientras que el ángulo de Gissane disminuyó más en el grupo B, 4,13 vs. 2,52°. No hubo diferencias significativas en la proporción de complicaciones y reintervenciones entre ambos grupos. Conclusión: En nuestro estudio no se observan diferencias significativas entre ambos grupos en cuanto a la pérdida de reducción radiológica, las complicaciones y el número de reintervenciones. Sin embargo, observamos una mayor pérdida de reducción en el ángulo de Böhler en los pacientes intervenidos con placas convencionales

Introduction: Since the development of locking plates, calcaneal fractures have been considered ideal for this type of fixation, due to the need to maintain the height of the subastragaline joint after depression fractures in a location where bone quality tends to be poor. However, there are no comparative studies that support the theoretical superiority of these plates over conventional plates. The aim of this study was to compare the results of intraarticular calcaneal fractures treated using locking plates vs. conventional plates in terms of radiological reduction, complications and number of reinterventions. Material and methods: We designed a comparative study of calcaneal fractures operated in our centre using the "L" approach. Two groups were established: group B, comprising 15 patients operated between 2010 and 2015 with calcaneal locking plates, and group A, comprising a stratified random sample of 23 patients taken from a historical cohort of 90 patients operated in our centre between 1997 and 2007 using conventional calcaneal plates. Demographic data were recorded (age, sex, diabetes mellitus, smoking) and data relating to the fracture (type of fracture according to Sander's classification system, complications, presurgical delay). To evaluate loss of reduction, varus angulation of the calcaneus (measured from the axial view), Böhler's angle and Gissane's angle were assessed radiographically. These angles were measured preoperatively, immediately postoperatively, and at the end of follow-up. Finally, we recorded complications and the number of reinterventions. Results: There were no differences in terms of age, sex or fracture type between the 2 groups. There was greater loss of varus angulation in group A, 0.6 vs. 0.41°, and there was greater reduction in Böhler's angle in group A, 3.79 vs. 2.6°, while Gissane's angle decreased more in group B, 4.13 vs. 2.52°. There were no significant differences in the proportion of complications and reinterventions between the 2 groups. Conclusion: In our study we observed no significant differences between the 2 groups in terms of radiological reduction, complications or number of reinterventions. However, we did observe a greater loss of reduction of Böhler's angle in the patients who were operated using conventional plates

Intra-articular calcaneal fractures. Do locking plates keep the reduction better than conventional plates? / Fracturas intraarticulares de calcáneo. ¿Las placas bloqueadas mantienen la reducción mejor que las convencionales?

INTRODUCTION: Since the development of locking plates, calcaneal fractures have been considered ideal for this type of fixation, due to the need to maintain the height of the subastragaline joint after depression fractures in a location where bone quality tends to be poor. However, there are no comparative studies that support the theoretical superiority of these plates over conventional plates. The aim of this study was to compare the results of intraarticular calcaneal fractures treated using locking plates vs. conventional plates in terms of radiological reduction, complications and number of reinterventions. MATERIAL AND METHODS: We designed a comparative study of calcaneal fractures operated in our centre using the "L" approach. Two groups were established: group B, comprising 15 patients operated between 2010 and 2015 with calcaneal locking plates, and group A, comprising a stratified random sample of 23 patients taken from a historical cohort of 90 patients operated in our centre between 1997 and 2007 using conventional calcaneal plates. Demographic data were recorded (age, sex, diabetes mellitus, smoking) and data relating to the fracture (type of fracture according to Sander's classification system, complications, presurgical delay). To evaluate loss of reduction, varus angulation of the calcaneus (measured from the axial view), Böhler's angle and Gissane's angle were assessed radiographically. These angles were measured preoperatively, immediately postoperatively, and at the end of follow-up. Finally, we recorded complications and the number of reinterventions. RESULTS: There were no differences in terms of age, sex or fracture type between the 2 groups. There was greater loss of varus angulation in group A, 0.6 vs. 0.41°, and there was greater reduction in Böhler's angle in group A, 3.79 vs. 2.6°, while Gissane's angle decreased more in group B, 4.13 vs. 2.52°. There were no significant differences in the proportion of complications and reinterventions between the 2 groups. CONCLUSION: In our study we observed no significant differences between the 2 groups in terms of radiological reduction, complications or number of reinterventions. However, we did observe a greater loss of reduction of Böhler's angle in the patients who were operated using conventional plates.

Análisis de las causas de demora quirúrgica y su influencia en la morbimortalidad de los pacientes con fractura de cadera / Analysis of surgical delay and its influence on morbimortality in patients with hip fracture

Introducción: El tratamiento quirúrgico demorado en fracturas de cadera (>48h) se ha asociado con una mayor frecuencia de eventos clínicos adversos. Sin embargo, no está clara la influencia de los motivos de demora en estos resultados. El objetivo de este estudio es el análisis de las causas de demora quirúrgica y su influencia en la morbimortalidad en pacientes con fractura de cadera con indicación de tratamiento quirúrgico. Material y método: Se revisó retrospectivamente una cohorte de 376 fracturas de cadera intervenidas en nuestro centro entre enero de 2012 y diciembre de 2016. Se excluyó a pacientes menores de 65 años y fracturas patológicas. De ellos, 280 pacientes fueron intervenidos con una demora quirúrgica de>48h. Las causas de la demora fueron: antiagregación (AG), anticoagulación (AC), motivos médicos (MM), test cardíacos preoperatorios o motivos administrativos/organizativos. Se compararon las complicaciones de la herida quirúrgica, las complicaciones generales y la mortalidad. Resultados: Hubo una mayor proporción de complicaciones de la herida quirúrgica en los AC (p=0,063). Los pacientes de los grupos AG, AC y MM se asociaron a mayores tasas de complicaciones generales (p=0,3). El 7,51% de los pacientes incluidos falleció al año de la cirugía. La tasa de mortalidad al año fue mayor en el grupo MM (p=0,005). Conclusión: La tasa de mortalidad fue mayor de forma estadísticamente significativa en el grupo MM. Al comparar resultados, los pacientes de los grupos AG, AC y MM presentaron mayores tasas de complicaciones generales

Introduction: Surgical delay for hip fractures (>48h) has been associated with greater adverse clinical events. However, the influence of the reasons for delay is unclear. The objective of this study was to analyse the causes of surgical delay and its influence on morbidity and mortality, in patients with hip fracture with indication for surgical treatment. Material and method: A cohort of 376 hip fractures operated at our centre between January 2012 and December 2016 was retrospectively reviewed. Patients younger than 65 years and pathological fractures were excluded. Of these, 280 patients were operated with a surgical delay>48h. The causes of the delay were: antiaggregation (AG), anticoagulation (AC), medical reasons (MM), preoperative cardiac tests or administrative/organizational reasons. Surgical wound complications, general complications and mortality were compared. Results: There was a greater proportion of surgical wound complications in the AC group (P=.063). Patients in the AG, AC, and MM groups had higher rates of general associated complications (P=.3). Seven point fifty-one percent of the patients included died one year after surgery. The mortality rate at one year was highest in the MM group (P=.005). Conclusion: The mortality rate was statistically significantly higher in the MM group. When comparing results, patients in the AG, AC, and MM groups presented higher rates of general complications

Analysis of surgical delay and its influence on morbimortality in patients with hip fracture. / Análisis de las causas de demora quirúrgica y su influencia en la morbimortalidad de los pacientes con fractura de cadera.

INTRODUCTION: Surgical delay for hip fractures (>48h) has been associated with greater adverse clinical events. However, the influence of the reasons for delay is unclear. The objective of this study was to analyse the causes of surgical delay and its influence on morbidity and mortality, in patients with hip fracture with indication for surgical treatment. MATERIAL AND METHOD: A cohort of 376 hip fractures operated at our centre between January 2012 and December 2016 was retrospectively reviewed. Patients younger than 65 years and pathological fractures were excluded. Of these, 280 patients were operated with a surgical delay>48h. The causes of the delay were: antiaggregation (AG), anticoagulation (AC), medical reasons (MM), preoperative cardiac tests or administrative/organizational reasons. Surgical wound complications, general complications and mortality were compared. RESULTS: There was a greater proportion of surgical wound complications in the AC group (P=.063). Patients in the AG, AC, and MM groups had higher rates of general associated complications (P=.3). Seven point fifty-one percent of the patients included died one year after surgery. The mortality rate at one year was highest in the MM group (P=.005). CONCLUSION: The mortality rate was statistically significantly higher in the MM group. When comparing results, patients in the AG, AC, and MM groups presented higher rates of general complications.

[Femoral superficial vein thrombosis due to a large iliopsoas bursitis secondary to polyethylene wear debris in total hip arthroplasty]. / Trombosis de la vena femoral superficial por gran bursitis en psoas secundaria a enfermedad de las partículas en artroplastia total de cadera.

A 76 year old male patient with a history of implantation of a total hip arthroplasty Perfecta (Orthomet(®)), who presented with an iliac fossa mass, increased diameter of the thigh, and pain during hip flexion and extension. CT and ultrasound show the presence of a giant cystic mass in left iliac fossa about 7 cm in diameter next to the prosthesis. A pseudo-tumour secondary to wear debris after placement of a total arthroplasty is rare. We present a case of a large iliopsoas bursitis caused by polyethylene particles, which caused compression and thrombosis of the superficial femoral vein.

Trombosis de la vena femoral superficial por gran bursitis en psoas secundaria a enfermedad de las partículas en artroplastia total de cadera / Femoral superficial vein thrombosis due to a large iliopsoas bursitis secondary to polyethylene wear debris in total hip arthroplasty

Paciente varón de 76 años, con antecedente de implantación de prótesis total de cadera tipo Perfecta (Orthomet®), que consulta por masa en fosa ilíaca, con aumento del diámetro del muslo y dolor flexión y extensión de la cadera. Los estudios complementarios de ecografía y tomografía evidencian la presencia de una tumoración quística gigante lobulada en fosa ilíaca izquierda de unos 7cm de diámetro en la proximidad de la prótesis. La formación quística ocasionada por la enfermedad del polietileno tras la colocación de una artroplastia total de cadera es poco frecuente. Presentamos un caso de bursitis del psoas de gran tamaño, secundaria a la liberación de partículas del polietileno, que ocasionó compresión y trombosis de la vena femoral superficial (AU)

A 76 year old male patient with a history of implantation of a total hip arthroplasty Perfecta (Orthomet®), who presented with an iliac fossa mass, increased diameter of the thigh, and pain during hip flexion and extension. CT and ultrasound show the presence of a giant cystic mass in left iliac fossa about 7cm in diameter next to the prosthesis. A pseudo-tumour secondary to wear debris after placement of a total arthroplasty is rare. We present a case of a large iliopsoas bursitis caused by polyethylene particles, which caused compression and thrombosis of the superficial femoral vein (AU)

[Superficial femoral vein thrombosis due to large psoas bursitis secondary to particle disease in total hip arthroplasty]. / Trombosis de vena femoral superficial por bursitis del psoas posterior a artroplastía total de cadera.

Male, 76 year-old patient with a history of total hip arthroplasty who presents with a mass in the iliac fossa with swelling of the thigh and hip pain upon flexion and extension. Complementary ultrasound and computed tomography scan studies show a giant lobulated cystic mass in the left iliac fossa, 7 cm in diameter, near the prosthesis. Cyst formation caused by polyethylene disease after total hip arthroplasty is infrequent. We present a case of large psoas bursitis secondary to the release of polyethylene particles which caused superficial femoral vein compression and thrombosis.

[Thrombosis of the superficial femoral vein due to psoas bursitis secondary to particle disease in total hip arthroplasty]. / Trombosis de la vena femoral superficial por bursitis del psoas secundaria a enfermedad de las partículas en artroplastía total de cadera.

The case of a male 76 year-old patient with a history of total hip replacement surgery is presented herein. The patient had tumors in the iliac fossa with swelling of the thigh and pain upon hip flexion and extension. The complementary ultrasound and computed tomography show a large lobed cystic tumor in the left iliac fossa, 7 cm in diameter, close to the prosthesis. The diagnosis was psoas bursitis secondary to the release of polyethylene particles that caused compression and thrombosis of the superficial femoral vein. Cyst formation caused by polyethylene disease after total hip arthroplasty is infrequent.

Fracturas conminutas de la cabeza radial: estudio comparativo entre resección y fijación interna / Radial head comminuted fractures: a comparative study between resection and internal fixation

Introducción. El tratamiento de las fracturas de cabeza radial continúa siendo controvertido. La reducción abierta y fijación interna (RAFI) está en expansión debido a la mejora de las técnicas y los implantes. Sin embargo, puede ser técnicamente muy demandante y no está exenta de complicaciones. Por otra parte, la resección muestra resultados satisfactorios a largo plazo en codos estables, aunque también asocia complicaciones. Comparamos la resección y la RAFI en fracturas conminutas de la cabeza de radio. Material y método. Se incluyeron 23 pacientes con fracturas Mason tipo iii, 11 sometidos a resección de la cabeza del radio (Grupo A), y 12 a fijación interna de su fractura (Grupo B). La media de edad fue 54 y 45 años, respectivamente. Las fracturas fueron evaluadas clínica y radiológicamente; con un seguimiento medio de 80 meses en el Grupo A y 76 en el B. Resultados. El rango de movilidad fue de 121°–(−11°) de flexo-extensión en el grupo A y de 131°–0° en el grupo B. Según la escala de Broberg y Morrey los resultados funcionales obtenidos son: 82 puntos en el Grupo A y 90,9 puntos en el Grupo B. Discusión. Los pacientes con fracturas conminutas de la cabeza del radio sometidos a reducción abierta y fijación interna tienen un rango de movilidad articular satisfactorio, con mayor fuerza y por tanto, mejor función. Recomendamos la reducción abierta y fijación interna en el tratamiento de estas fracturas, sobre todo en pacientes jóvenes (AU)

Introduction. The treatment of radial head fractures continues to be controversial. The open reduction and internal fixation (ORIF) method is expanding due to improvements in the techniques and the implants. However, it can be very demanding technically and is not free of complications. On the other hand, resection shows satisfactory results in the long term in stable elbows, although it is also associated with complications. We compared resection and ORIF in comminuted fractures of the radial head. Material and Method. A total of 23 patients with type III Mason fractures were included, of which 11 were subjected to resection of the radial head (Group A), and 12 to internal fixation of their fracture (Group B). The mean age was 54 and 45 years, respectively. The fractures were clinically and radiologically evaluated, with a mean follow-up of 80 months in Group A and 76 months in Group B. Results. The flexion-extension movement range was 121°–(−11°) in Group A and 131°–0° in Group B. The functional results obtained according the Broberg and Morrey scale were: 82 points in Group A and 90.9 points in Group B. Discussion. Patients with comminuted fractures of the radial head subjected to open reduction and internal fixation have a satisfactory movement range, with greater strength, and therefore, better function. We recommend open reduction and internal fixation in the treatment of these fractures, particularly in young patients (AU)

Artrodesis tibioastragalocalcánea con clavo intramedular retrógado / Tibiotalocalcaneal arthrodesis with a retrograde intramedullary nail

Introducción: El objetivo es valorar los resultados de los pacientes intervenidos de artrodesis tibioastragalocalcánea con clavo intramedular retrógrado. Material y métodos: Se presentan 8 pacientes con una edad media de 60 años con afectación de las articulaciones tibioastragalina y subastragalina con alteración importante de la marcha y dolor intenso, secundarias a artrosis primaria o postraumáticas, seudoartrosis de una artrodesis previa o deformidad grave secundaria a accidente cerebrovascular. Se trató a los pacientes mediante artrodesis tibioastragalocalcánea con clavo intramedular retrógrado, con valoración de los resultados funcionales antes y después de la cirugía, según los criterios de la AOFAS (American Orthopaedic Foot and Ankle Society). Resultados: El seguimiento medio fue de 32 meses (rango: 7 a 61), y los resultados fueron muy satisfactorios, con una puntuación media de 88,6 puntos. Resultados: El tiempo medio de consolidación fue de 18,3 semanas. Las complicaciones más frecuentes fueron una leve necrosis cutánea de los bordes de la herida, una úlcera plantar resuelta con tratamiento conservador y una discrepancia de longitud de 2 cm. Conclusión: La artrodesis tibiotalocalcánea con clavo retrógrado puede ser una técnica excelente en pacientes con afectación grave de las articulaciones tibioastragalina y subastragalina que no respondan al tratamiento conservador y como cirugía de rescate en aquellas técnicas de artrodesis que hayan fracasado previamente (AU)

Introduction: The purpose of this study is to assess the results of patients subjected to a tibiotalocalcaneal arthrodesis with a retrograde intramedullary nail. Materials and methods: We studied 8 patients of a mean age of 60 years that showed involvement of the tibiotalar and subtalar joints with significant gait alterations and acute pain, secondary to either primary or post-traumatic arthritis or pseudoarthrosis of a previous arthrodesis. There was also one case of a severe deformity secondary to acute stroke. Patients were treated by means of tibiotalocalcaneal arthrodesis with a retrograde intramedullary nail. The AOFAS scale was used to assess functional results before and after surgery. Results: Mean follow-up was 32 months (range: 7–61). Overall results were highly satisfactory, with a mean score of 88.6 points. Results: Healing occurred alter a mean 18.3 weeks. The most frequent complications were an instance of mild skin necrosis at the edges of the wound, a plantar ulcer that resolved with conservative treatment and a leg length discrepancy of 2cm.ConclusionTibiotalocalcaneal arthrodesis with a retrograde nail can be an excellent technique for patients with severe involvement of the tibiotalar and subtalar joints who are unresponsive to conservative treatment. It can also be used as salvage surgery in previously failed arthrodesis procedures (AU)

La osteotomía distal percutánea en el tratamiento de la metatarsalgia de los radios menores / Distal percutaneous osteotomy in the treatment of lesser ray metatarsalgia

Objetivo: El objetivo de este estudio fue evaluar los resultados de la osteotomía distal de los metatarsianos menores realizada mediante técnica percutánea. Material y método: Se revisaron retrospectivamente 44 pies de 37 sujetos en los que un mismo cirujano había practicado 110 osteotomías percutáneas desde noviembre de 2002 hasta julio de 2006; se excluyeron previamente las metatarsalgias de origen general o de origen traumático. Todos los sujetos se valoraron radiográfica y funcionalmente (mediante la escala para metatarsianos menores e interfalángicas de la American Orthopaedic Foot and Ankle Society [AOFAS]). ResultadosTras un seguimiento medio de 15 meses, se obtuvo un resultado funcional satisfactorio en el 93,2% de los casos (41 pies) y se alcanzó una puntuación final media de 91 puntos (rango de 65 a 100) en la escala de la AOFAS. En 5 sujetos se apreció recidiva de la enfermedad y en 2 sujetos se apreció metatarsalgia de transferencia (que precisaron osteotomía de los metatarsianos afectados). La movilidad de la articulación metatarsofalángica (MTF) no se vio afectada de forma significativa en ningún caso, aunque en 7 casos se observó deformidad en «dedo flotante». Radiológicamente, se apreció un acortamiento promedio de 2,9mm. Hubo 3 casos de retardo de consolidación, pero finalmente se consiguió en todos los sujetos. Conclusiones: La osteotomía percutánea obtiene buenos resultados clínicos y estéticos sin presentar problemas de consolidación o rigidez de la MTF. Estos resultados permiten afirmar que es una técnica quirúrgica efectiva, segura y recomendable para las metatarsalgias de los radios menores asociada o no a otras cirugías del antepié (AU)

Purpose: The purpose of this study is to evaluate the results of distal osteotomy of lesser metatarsals carried out through a percutaneous technique. Materials and methodsForty-four feet in 37 patients were reviewed, which the same surgeon had subjected to 110 percutaneous osteotomies between November 2002 and July 2006. Metatarsalgias of general or traumatic origin were excluded from the study. All patients were assessed functionally (by means of the AOFAS [American Orthopaedic Foot and Ankle Society] Lesser Metatarsophalangeal-Interphalangeal Scale) and radiographically. ResultsAfter a mean 15-month¿ follow-up, a satisfactory functional result was obtained in 93.2% of cases (41 feet), with a mean final score of 91 (range: 65¿100) on the AOFAS scale. The condition recurred in 5 patients, and 2 developed transfer metratarsalgia (these required an osteotomy of the affected metatarsals). Mobility of the metatarsophalangeal (MTP) joint was not significantly disturbed in any of the cases and 7 patients developed a ¿floating toe¿ deformity. Radiologically a mean shortening of 2.9mm was observed. There were 3 cases of delayed healing, but eventually healing was achieved by all patients. ConclusionsPercutaneous osteotomy affords satisfactory clinical and cosmetic results and leads to no problems in terms of healing or MTP joint stiffness. These results indicate that it is an effective and safe surgical technique that can be recommended for lesser ray metatarsalgia, whether in association with other forefoot procedures or not(AU)

Dolor suprapúbico en escolar de 14 años / Suprapubic pain in a 14 year old schoolchild

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Fractura-luxación de Lisfranc. Osteosíntesis con tornillos frente a agujas de Kirschner / Lisfranc fracture-dislocation: screw vs. K-wire fixation

Introducción. La fractura-luxación de la articulación tarsometatarsiana es una lesión relativamente infrecuente, pero cuyas consecuencias a largo plazo pueden ser devastadoras para el paciente. El objetivo de este estudio fue analizar los resultados del tratamiento quirúrgico.Material y método. Los autores presentan una revisión de26 pacientes tratados entre los años 1995 y 2006. Las fracturas fueron clasificadas según Myerson y Hardcastle. Todos los pacientes fueron tratados quirúrgicamente de urgencia usando tornillos o agujas de Kirschner. Para la valoración de resultados se utilizó la escala de valoración funcional de la AOFAS para el mediopié, analizando también el grado de satisfacción subjetiva de los pacientes.Resultados. Tras un seguimiento medio de 5 años, la puntuación media en la escala AOFAS fue de 85,38 puntos,siendo el grado de satisfacción alto en casi todos los pacientes. Los resultados conseguidos en la osteosíntesis con tornillos fueron ligeramente superiores a los obtenidos con agujas de Kirschner.Conclusiones. Como la mayoría de autores, recomendamosla urgente reducción y síntesis de la lesión para conseguir los mejores resultados, descartando como opción el tratamiento ortopédico e inclinándonos por una reducción abierta y fijación interna con tornillos, siempre que el estado de las partes blandas lo permita

Introduction. Fracture-dislocations of the tarso-metatarsal joint are a relatively rare injury, but their long-term consequences can be devastating for the patient. The aim of this study is to analyze the results obtained by surgical treatment.Materials and methods. The authors reviewed 26 patientsbetween 1995 and 2006. Fractures were classified according to the Myerson & Hardcastle classification. All patients were treated by emergency surgery by means of either screws or K-wires. The AOFAS functional scale was used to assess results in the midfoot; patient satisfaction was also evaluated.Results. After a mean 5-year follow-up, the mean score onthe AOFAS scale was 85.38 points, with a high level of satisfaction in nearly all patients. Results obtained with screw fixation were slightly better than those with K-wires.Conclusions. Like most authors, we believe that the best results are to be obtained by the immediate reduction and fixation of the injury. We rule out nonoperative treatment and favor an ORIF procedure with screws provided that the condition of the soft tissues allows it