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.

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)

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

Femoral fracture before removal of an intramedullary nail. A case report.

We describe a patient with a fracture of the femoral shaft treated by intramedullary nailing and who had a further fracture before the nail was removed. We are not aware of any previous reports of this complication.

Sagittal fracture of the second cervical vertebral body.

We describe a patient with a sagittal fracture of the second cervical vertebral without neurological involvement. The mechanism is likely to be axial compression and lateral displacement. The fracture was treated in a Minerva plaster cast.

Breakage of Knowles pins used for femoral neck fractures.

We report the breakage of multiple Knowles pins in two patients with fractures of the femoral neck. The break occurred at the junction of the threaded and smooth sections of the pins before consolidation of the fracture.

[Synchronous multiple carcinomas of the colon and rectum. Presentation of 18 cases and review of the literature]. / Carcinomas múltiples sincrónicos del colon y recto. Presentación de 18 casos y revisión de la literatura.

We reviewed 680 cases of colorectal neoplasms with an incidence of 18 synchronous multiple carcinomas (2.7%). We describe the predominance in females (11/7), the late age of presentation (maximal incidence between 60 and 80 years) and the main symptoms of these patients. We remark the diagnostic difficulty of these tumors, despite all the methods used; the diagnosis of the second mass was intraoperative in 50% of the cases in our series. As treatment, we suggest partial colectomy, except when there is massive colonic affectation, in which we practice a total colectomy. The prognosis in these patients is similar to that of those who have a single carcinoma. We must carry out a rigorous follow-up of these patients to make an early diagnosis of any new metachronous tumors.

[Neoplasms of the rectum. A presentation of 588 cases and review of the literature]. / Neoplasias rectales. Presentación de 588 casos y revisión de la literatura.

We reviewed cancers of the rectum and rectosigmoid operated from 1970 to 1980 in the General Surgery Service of the Hospital La Fe of Valencia (Spain). Of a total of 588 patients, only 370 were resectable (62.9%), which reflects the advanced stage of the disease when these patients are seen. Of the 370 resections, 210 corresponded to lower rectum, 97 to middle rectum and 63 to upper rectum and rectosigmoid. In 80%, abdominoperineal amputation was practiced and in 20%, anterior resection; this was due to the predominance of lower tumors and the fact that at this time mechanical sutures were not in use, since these permit anterior resections that cannot be performed with normal sutures. The 5-year survival was 197 patients, 53.2%. Postoperative mortality affected 4.2%. We found complications and morbidity in 17.1%. The mean hospital stay was 18 days. In no case of anterior resection was discharge colostomy performed.