Minimally invasive plate osteosynthesis (MIPO) versus open reduction and internal fixation (ORIF) in the treatment of distal fibula Danis-Weber types B and C fractures.

BACKGROUND: Minimally invasive plate osteosynthesis (MIPO) has been reported to be superior to open reduction and internal fixation (ORIF) in the treatment of different long bone fractures. Nevertheless, in distal fibula fractures, the evidence of MIPO remains scarce. The aim of this retrospective study was to compare the clinical and radiological outcomes of the minimally invasive techniques applied to the distal fibula with open reduction and internal fixation within a 12 months follow-up. METHODS: A consecutive series of patients who underwent surgery using either ORIF or MIPO for the treatment of distal fibula fractures between 2010 and 2014 were retrospectively analyzed. All distal fibular fractures requiring an operative treatment (Danis-Weber type B ≙ AO type 44 B1, 2, 3 and Danis-Weber type C ≙ AO type 44 C1, 2) were included (ORIF n = 35, MIPO n = 35). Patients were assessed for postoperative pain using a visual analog scale (VAS) for pain (ranging from 0 to 10) and classified into 4 groups: "no pain" for VAS = 0, "low" for VAS = 1-3, "moderate" for VAS = 3-5, and "severe" for VAS = 5-10. In addition, complications of postoperative fracture-related infection, wound healing disorders, vascular and nerve injury and development of nonunion were evaluated and analyzed. Radiologic outcome measures assessing the talocrural angle, lateral and medial clear space, tibiofibular overlap, and talar tilt angle were evaluated postoperatively. RESULTS: The overall complication rate showed to be lower in the MIPO group compared to the ORIF group (14% vs. 37%, p = 0.029). Even though not statistically significant, specific surgery-related complications such as skin necrosis (3% vs. 9%, p = 0.275), nonunion (0% vs. 6%, p = 0.139), infections and wound healing disorders (9% vs. 20%, p = 0.141), as well as postoperative pain (17% vs. 26%, p = 0.5) were found more frequently in the ORIF group. The tibiofibular overlap demonstrated to be significantly lower in the ORIF group (3.3 mm vs. 2.7 mm, p = 0.033). The talocrural angle, talar tilt angle, and lateral and medial clear space showed to be equivalent in both groups. CONCLUSION: In this retrospective single-center consecutive series, MIPO was superior to ORIF in the surgical treatment of distal fibula fractures with respect to the overall complication rate. TRIAL REGISTRATION: EKNZ Project-ID: 2019-02310 , registered on the 20th of December 2019 with swissethics.

Meniscal pathologies on MRI correlate with increased bone tracer uptake in SPECT/CT.

OBJECTIVES: To assess the relationship of subchondral bone tracer uptake (BTU) on SPECT/CT and meniscal pathologies on MRI in patients with painful knees. METHODS: Twenty-five patients who had MRI and SPECT/CT within 3 months without knee surgery or grade ≥3 cartilage lesions were prospectively included. Maximum values of each subchondral femorotibial area were quantified and a ratio was calculated in relation to a femoral shaft reference region, which represented the BTU background activity. Meniscal lesions were graded (intact/degeneration/tear) and meniscal extrusion (no/yes) was assessed using MRI by two musculoskeletal radiologists blinded to the SPECT/CT findings. One-tailed Spearman correlations served for statistics (p < 0.05). RESULTS: Knees with meniscal degeneration or tear showed a significantly higher BTU in the medial femorotibial compartment (p = 0.045) when compared to intact menisci. Meniscal degeneration was associated with an increased BTU in the lateral femorotibial compartment; however, this was not statistically significant (p = 0.143). Patients with an extruded meniscus showed significantly higher BTU compared to a non-extruded meniscus (p < 0.020). CONCLUSIONS: Medial femorotibial BTU in SPECT/CT was associated with meniscal pathologies. Highest BTU was found in patients with meniscal tears. SPECT/CT appears to be a useful imaging modality to identify patients with overloading or early osteoarthritis. KEY POINTS: • Meniscal degeneration and tears correlate significantly with increased BTU using SPECT/CT. • Medial meniscus extrusion is associated with an increased BTU in SPECT/CT. • SPECT/CT allows detection of overloading and early osteoarthritis.

Intra- and inter-observer reliability of a new standardized diagnostic method using SPECT/CT in patients with osteochondral lesions of the ankle joint.

BACKGROUND: Single Photon Emission Computed Tomography-Computed Tomography (SPECT/CT) gains an important part of diagnostics in patients with osteochondral lesions (OCL). SPECT/CT is a hybrid imaging modality, which combines a 3D scintigraphy (SPECT) and computerized tomography (CT) into one single procedure and combines metabolic data, structural and mechanical information. The purpose of the study was to develop and evaluate a standardized method to anatomically localize and quantitatively analyze the bone SPECT tracer activity of the ankle joint using SPECT/CT. METHODS: OCL on the talus were diagnosed in 16 patients by 99mTc-HDP-SPECT/CT and MRI by specialized orthopedic surgeons and radiologists and retrospectively included. The articular superior surface of the talus was subdivided in six anatomical regions (T1-T6). Using customized software, absolute bone SPECT values for each anatomical area were analyzed. Relative bone tracer uptake was calculated in relation to specific reference regions representing bone SPECT tracer background activity. All measurements were performed twice by two independent observers, blinded to clinical information. Intraclass correlation coefficients (ICC) were calculated for inter- and intra-observer reliability. The intraclass correlation coefficients (ICC) showed an excellent inter- and intra-observer reliability. RESULTS: The intraclass correlation coefficients (ICC) of all six regions are between 1.00 and 0.84 which is defined as very good. Results from region T1 to T6 impair slightly due to measurement regime. All ICCs of observer 1 were nearly the same as the results of observer 2 in all regions. CONCLUSION: The presented standardized SPECT/CT algorithm is clinically feasible and showed high inter- and intra-observer reliability. It might help to better understand the complex pathology of OCL on the talar dome. The major potential benefit of SPECT/CT is the assessment of the subchondral bone plate and the subchondral bone.

Assessment of the loading history of patients after high tibial osteotomy using SPECT/CT--a new diagnostic tool and algorithm.

BACKGROUND: Single photon emission computerized tomography and conventional computerized tomography (SPECT/CT) tracer uptake has been shown to reflect the loading history of the tibiofemoral knee joint and correlate with the mechanical and anatomical alignment. It was our primary purpose to develop a novel standardized SPECT/CT algorithm for patients undergoing high tibial osteotomy, evaluate the inter- and intra-observer reliability (OR), and assess the clinical applicability for follow-up of patients before and after high tibial osteotomy. METHODS: The localization scheme defines 9 femoral, 8 patellar, and 13 tibial zones to accurately map the examined tracer uptake volume in each anatomical area of interest. Maximum values for each area (mean ± standard deviation, median, and range) of the localization scheme were recorded as well as normalized values for the intensity of SPECT/CT tracer uptake calculated. The inter- and intra-OR was assessed for SPECT/CT localization and tracer activity. Pre- and postoperative mechanical alignment was assessed in SPECT/CT using a custom-made specialized software. The median inter- and intra-observer differences of the measured mechanical alignment were calculated along with the inter- and intra-OR. RESULTS: The localization scheme showed near-perfect inter- and intra-OR (intra-class correlation coefficient (ICC) > 0.9) for the measurement of tracer activity and localization in all anatomical regions. For measurements of mechanical alignment, there was a strong agreement between the two observers (an inter-OR of ICC = 0.99 and an intra-OR of ICC = 0.98). CONCLUSIONS: The presented SPECT/CT algorithm is highly reliable and clinically feasible. Combined with mechanical alignment analysis, it provides the surgeon with helpful information about realignment effects of high tibial osteotomies (HTOs) and might help identify the optimal personalized degree of correction in HTO surgery.

Técnica del abdomen contenido para el tratamiento de las colecciones purulentas intraperitoneales / The open packing laparostomy technique for treatment of the intraabdominal abscess

Se presenta una técnica de laparostomía que consiste en colocar una malla multiperforada de polietileno de alta densidad entre las vísceras y la cara interna de la pared abdominal sin ningún tipo de fijación, suturando además dos mallas de fibra poliamídica a los bordes del peritoneo y aponeurosis tomados conjuntamente. Se cierra luego la brecha enhebrando una aguja de tejer en las mallas de fibra poliamídica. Diariamente se quita la aguja y se observa el contenido abdominal para lavar o drenar focos sépticos. Al reinsertar la aguja se procura una progresiva reducción del diámetro transversal de la herida. Se emplea el procedimiento en 25 casos. No hubo complicaciones imputables al método

Actuación del cirujano general ante el traumatismo renal y de las vías urinarias / The general surgeons in the initial management of renal and urinaries lesions

Se señala el papel del cirujano general en el manejo inicial de las lesiones renales y de vías urinarias, mediante un conocimiento adecuado de la normatización diagnóstica y terapéutica de estas lesiones. Para ello es preciso efectuar diagnóstico oportuno y dejar en algunos casos, eventualmente, el tratamiento definitivo para el especialista. Los comunicantes confirman esta aseveración con su experiencia de 116 pacientes con lesiones renales y de vías urinarias, de los que se operaron 98 en un período de 15 años. El 42.05%fueron lesiones renales puras, 7%ureterales, 26%vesicales, 11%uretrales y el resto combinación de ellas. La morbilidad general fue del 27.44%y la específica del 13.17%. La mortalidad, por complicación de lesiones asociadas, fue del 13.72%, no observándose mortalidad específica

Técnica del abdomen contenido para el tratamiento de las colecciones purulentas intraperitoneales / The open packing laparostomy technique for treatment of the intraabdominal abscess

Se presenta una técnica de laparostomía que consiste en colocar una malla multiperforada de polietileno de alta densidad entre las vísceras y la cara interna de la pared abdominal sin ningún tipo de fijación, suturando además dos mallas de fibra poliamídica a los bordes del peritoneo y aponeurosis tomados conjuntamente. Se cierra luego la brecha enhebrando una aguja de tejer en las mallas de fibra poliamídica. Diariamente se quita la aguja y se observa el contenido abdominal para lavar o drenar focos sépticos. Al reinsertar la aguja se procura una progresiva reducción del diámetro transversal de la herida. Se emplea el procedimiento en 25 casos. No hubo complicaciones imputables al método

Actuación del cirujano general ante el traumatismo renal y de las vías urinarias / The general surgeon's in the initial management of renal and urinaries lesions

Se señala el papel del cirujano general en el manejo inicial de las lesiones renales y de vías urinarias, mediante un conocimiento adecuado de la normatización diagnóstica y terapéutica de estas lesiones. Para ello es preciso efectuar diagnóstico oportuno y dejar en algunos casos, eventualmente, el tratamiento definitivo para el especialista. Los comunicantes confirman esta aseveración con su experiencia de 116 pacientes con lesiones renales y de vías urinarias, de los que se operaron 98 en un período de 15 años. El 42.05%fueron lesiones renales puras, 7%ureterales, 26%vesicales, 11%uretrales y el resto combinación de ellas. La morbilidad general fue del 27.44%y la específica del 13.17%. La mortalidad, por complicación de lesiones asociadas, fue del 13.72%, no observándose mortalidad específica

Traumatismo del duodeno / Duodenal injuries

Se presenta una serie de 27 casos de lesiones duodenales. Tres casos fueron por contusión y el resto por traumatismo penetrante. La segunda fue la porción duodenal más afectada. En las contusiones los síntomas son confusos y tardíos y en los traumatismos abiertos son generalmente debidos a lesiones asociadas. La T.A.C. y ecografía parecen ser los métodos diagnósticos más efectivos. Efectuamos la sutura primaria en lesiones menores y agregamos ligadura de píloro y gastroenteroanastomosis en las más complejas. La morbimortalidad atribuíble al método fue de 3,7%. Destacamos al método efectuado como una variante importante para el tratamiento de las lesiones duodenales

Traumatismo del duodeno / Duodenal injuries

Se presenta una serie de 27 casos de lesiones duodenales. Tres casos fueron por contusión y el resto por traumatismo penetrante. La segunda fue la porción duodenal más afectada. En las contusiones los síntomas son confusos y tardíos y en los traumatismos abiertos son generalmente debidos a lesiones asociadas. La T.A.C. y ecografía parecen ser los métodos diagnósticos más efectivos. Efectuamos la sutura primaria en lesiones menores y agregamos ligadura de píloro y gastroenteroanastomosis en las más complejas. La morbimortalidad atribuíble al método fue de 3,7%. Destacamos al método efectuado como una variante importante para el tratamiento de las lesiones duodenales