Safety of the modified posteromedial approach in complex ankle fractures: Comparative analysis versus posterolateral access.

INTRODUCTION: The aim of the study was to evaluate the safety of the modified posteromedial approach (MfPM) in the surgical management of complex ankle fractures in terms of local complications. METHODS: Retrospective multicenter review of a series of malleolar fractures surgically treated by posterior ankle approaches between 2016 and 2022. Two approaches were used. In the MfPM group patients were placed in a prone position and the incision was made 1 cm medially to the Achilles tendon. In the posterolateral access (PL) group patients were placed in a prone or lateral decubitus position and the incision was made between the lateral malleolus and the Achilles tendon. Complications evaluated were divided into wound complications, infections, neuritis, vascular alterations and others. RESULTS: 81 ankle fractures with a posterior malleolar fragment treated by open reduction and internal fixation were identified. 20 cases were approached through the MfPM approach and 61 through the PL access. The mean follow up was 18.60 months (range 4-78 months). In the MfPM group the local complication rate was 10% (2/10 patients), both corresponding to minor wound problems which required no surgical intervention. No infection or other neural or vascular complications were found. In the PL group a complication rate of 8,19% (5/61 patients) was found, all of them corresponding to minor wound problems which required no surgical intervention. No infection or other neural or vascular complications were found. There were no significant differences between the two approaches regarding postoperative local complications (z score 0.249 - P: 0.803). CONCLUSION: The MfPM approach is safe and may become as readily used as the PL due to the low incidence of postoperative local complications, especially in fractures with a large fragment and posteromedial extension in which greater access to the posterior pilon can facilitate instrumentation for anatomic reduction and fixation.

Determinación del grado de agresividad tumoral mediante técnicas de inteligencia artificial aplicadas a imágenes de resonancia magnética / Measuring tumor aggressiveness through artificial intelligence

Objetivo: Determinar el grado de agresividad tumoral mediante técnicas de inteligencia artificial utilizando imágenes de resonancia magnética de sarcomas con grado histológico comprobado. Materiales y Métodos: Dos cohortes retrospectivas independientes de pacientes con sarcomas de partes blandas. Para cada paciente de las dos cohortes se adquirieron tres tipos de secuencias de imágenes como indican los protocolos clínicos: potenciadas en T1, en T2 con supresión grasa (T2FS) y STIR. A fin de desarrollar el modelo de inteligencia artificial, se utilizaron 134 imágenes, tanto las de alto grado como las de bajo grado, en T1 y T2 tomando la imagen más representativa del tumor en cualquier corte. Esto se traduce en 36 millones de píxeles que serán analizados por el programa Landing AI. Resultados: La precisión promedio del modelo fue del 84,3% y la sensibilidad, del 73,3%, con un umbral de confianza de 0,66, lo que demuestra inicialmente que se obtuvo un modelo de buena calidad para predecir con imágenes de resonancia magnética el grado de agresividad de un sarcoma de partes blandas antes de la biopsia. Conclusiones: Se presenta un enfoque novedoso para abordar un tipo de enfermedad infrecuente usando técnicas de inteligencia artificial para determinar el grado tumoral en imágenes de resonancia magnética. Según los resultados de nuestro modelo, se lo puede considerar como una segunda opinión experta al realizar los estudios por imágenes antes de la biopsia. Nivel de Evidencia: III

Objective: To determine the degree of tumor aggressiveness by means of artificial intelligence techniques using magnetic resonance images of sarcomas with proven histological grade. Materials and Methods: Two independent cohorts of patients with soft tissue sarcomas (STS) were retrospectively collected. For each patient in the two cohorts, three types of imaging sequences were acquired as indicated by the clinical protocols: T1-weighted (T1), fat-suppressed T2-weighted (FST2) and STIR. For the development of the artificial intelligence model, 134 images were used, both high-grade and low-grade T1 and T2 images, taking the most representative image of the tumor at any slice. This translated into more than 36 million pixels that were analyzed by the Landing AI program. Results: To determine the degree of tumor aggressiveness by means of artificial intelligence techniques using magnetic resonance The model's average accuracy was 84.3%, and its sensitivity was 73.3%, with a confidence threshold of 0.66, indicating that a good quality model was generated for predicting the grade of aggressiveness of an STS prior to biopsy using MRI scans. Conclusions: A novel approach is presented to address a rare pathology using artificial intelligence techniques to determine the tumor grade based on nuclear magnetic resonance images. Based on the results of our model, it can be considered as a second expert opinion when performing imaging studies prior to biopsy. Level of Evidence: III

Talar Neck Fractures: Single or Double Approach?

Correct approach selection in talar neck injuries is crucial to obtain adequate access to the entire fracture site avoiding malreduction and angular deformity. The major concern about a single incision technique is lack of visualization. Combined lateral and medial approaches are strongly recommended in complex talar neck fractures providing better control of dorsal and varus displacement of the talar head.

Tratamiento farmacologico del osteoma osteoide. A proposito de 4 casos / Therapy of osteoid osteoma. Four case reports

Se presentan cuatro pacientes con diagnostico presuntivo de osteoma osteoide tratados con medicacion antiinflamatoria no esteroidea (Naproxeno 500 mg). Se obtuvo la remision de los sintomas a los 6 meses sin registrarse complicaciones inherentes al tratamiento en ninguno de los casos. El tratamiento farmacologico de esta lesion es una excelente opcion, sobre todo en localizaciones espinales o pelvicas en donde otros procedimientos invasivos podrian asociarse a morbilidad considerable. El costo del tratamiento es razonable no superando al de los tratamientos mas agresivos

Tratamiento farmacologico del osteoma osteoide. A proposito de 4 casos / Therapy of osteoid osteoma. Four case reports

Se presentan cuatro pacientes con diagnostico presuntivo de osteoma osteoide tratados con medicacion antiinflamatoria no esteroidea (Naproxeno 500 mg). Se obtuvo la remision de los sintomas a los 6 meses sin registrarse complicaciones inherentes al tratamiento en ninguno de los casos. El tratamiento farmacologico de esta lesion es una excelente opcion, sobre todo en localizaciones espinales o pelvicas en donde otros procedimientos invasivos podrian asociarse a morbilidad considerable. El costo del tratamiento es razonable no superando al de los tratamientos mas agresivos.(AU)

Tratamiento farmacologico del osteoma osteoide. A proposito de 4 casos / Therapy of osteoid osteoma. Four case reports

Se presentan cuatro pacientes con diagnostico presuntivo de osteoma osteoide tratados con medicacion antiinflamatoria no esteroidea (Naproxeno 500 mg). Se obtuvo la remision de los sintomas a los 6 meses sin registrarse complicaciones inherentes al tratamiento en ninguno de los casos. El tratamiento farmacologico de esta lesion es una excelente opcion, sobre todo en localizaciones espinales o pelvicas en donde otros procedimientos invasivos podrian asociarse a morbilidad considerable. El costo del tratamiento es razonable no superando al de los tratamientos mas agresivos.