All-Arthroscopic Management of Locked Posterior Shoulder Dislocation: Reduction Under Direct Visualization and Treatment of Intra-articular Pathologies.

Locked posterior shoulder dislocation (LPSD) is a rare condition often overlooked. In most cases, the humeral head remains stuck behind the glenoid, causing an impression fracture in 40% to 90% of LPSD cases, known as a reverse Hill-Sachs lesion. The condition also affects the posterior capsulolabral complex and leads to the formation of scar tissue under the coracoid and subscapularis tendon, making it challenging to reduce without surgery. Although open treatment has been successful, it does not address the posterior capsulolabral complex. Arthroscopic-assisted reduction provides a more detailed view and better exposure to the posterior structures. This article details a reproducible arthroscopic surgical technique for treating the locked dislocation and all intra-articular pathology in a single-stage procedure for patients with less than 25% reverse Hill-Sachs bone loss.

Manejo racional de las neuropatías diabéticas: consenso multidisciplinario de expertos / Rational management of the diabetic neuropathies: a multidisciplinary expert group consensus

Resumen: La diabetes mellitus, un padecimiento crónico y progresivo, ocupó el tercer lugar en defunciones durante el período comprendido de enero a junio de 2021 en México. Su complicación crónica más frecuente es la neuropatía diabética que tiene un impacto importante en el sistema nervioso. En la Ciudad de México se reunió un grupo multidisciplinario de expertos para establecer un algoritmo de tratamiento que considere los aspectos sintomáticos y etiopatogénicos de la neuropatía diabética. Se utilizó un método Delphi en tiempo real con dos rondas de preguntas interactivas. La implementación del algoritmo propuesto permitirá abordar de manera integral al paciente diabético con neuropatía dolorosa y no dolorosa, tanto en el terreno de los síntomas como en la etiopatogenia. Este abordaje brinda la oportunidad de mejorar la calidad de vida y lograr la reinserción a la vida familiar y laboral. El panel de expertos recomienda al ácido tióctico como tratamiento etiopatogénico de primera línea en la neuropatía diabética.

Abstract: Diabetes mellitus, a chronic and progressive condition, was the third most common cause of death in Mexico between January and June 2021. Its most frequent chronic complication is diabetic neuropathy, which has a major impact on the nervous system. A multidisciplinary group of experts met in Mexico City to establish a treatment algorithm considering the symptomatic and etiopathogenic aspects of diabetic neuropathy. A real-time Delphi method with two rounds of interative questions was used. The implementation of the proposed algorithm will allow a comprehensive approach to the diabetic patient with painful and non-painful neuropathy, both in terms of symptoms and etiopathogenesis. This approach provides the opportunity to improve quality of life and achieve reintegration into family and work life. The expert panel recommends thioctic acid as the first line etiopathogenic treatment for diabetic neuropathy.

[Clinical and radiographic correlation after anterior cruciate ligament reconstruction]. / Correlación clínica y radiográfica después de reconstrucción de ligamento cruzado anterior.

UNLABELLED: The purpose of this work is to correlate the clinical, functional and radiographic results of the anterior cruciate ligament (ACL) reconstruction with the angulation and orientation of the femoral and tibial tunnels. INTRODUCTION: The ACL is one of the most frequently injured articular structures of the knee. The reason for this being that it is the primary limiting structure of anterior tibial translation; its tear causes kinematic alterations and results in long-term degenerative and functional changes. Repair can restore the kinematics. MATERIAL AND METHODS: 26 patients, 20-50 years old, post-ACL reconstruction with the semitendinous-gracilis technique. From November 2006 to July 2007. Clinical and functional assessments: Tegner and Lysholm. Radiographic assessment: anteroposterior view with knee extension and lateral view with 30 degrees flexion. Pearson correlations (r) were used in the analysis. RESULTS: 26 patients (100%), 20 males (76.92%), 6 females (23.08%). Mean of 2.4 in the Lysholm scale (fair to good); standard deviation 1.2. Bernard-Lysholm quadrant r = -0.772. Tegner quadrant r = 0.790. CONCLUSIONS: The Lysholm and Tegner scale is associated with the graft quadrant. The situation of the tibial implant in the saggital plane is associated with the Lysholm scale. The correlation of patients with an inadequate placement with respect to the quadrants was associated with good-to-excellent results and fair-to-good results. Two patients had a poor clinical outcome; the orientation of the AP angle and the quadrant were within acceptable parameters, with the exception of the lateral angle-shaft axis.

[Clinical association between patellofemoral pain with arthroscopic findings]. / Asociación clínica entre dolor patelofemoral y los hallazgos artroscópicos.

UNLABELLED: The purpose of this study was to associate patellofemoral pain with the findings of arthroscopic procedures. A visual analogue scale was used considering that 1 represented no pain and 10 severe pain, the functional Lysholm scale for function, and the Outerbridge classification to determine the grade of the articular cartilage lesion. MATERIAL AND METHODS: The study population was composed of an heterogeneous group of patients with chondral lesions. This is a retrospective, observational and longitudinal study undertaken for a period of 18 months. Sixty-nine patients had patellofemoral pain, and traumatic knee injuries were excluded. RESULTS: Sixty-eight patients were found to have a chondral lesion, only one patient did not. In the latter only loose body removal was performed. The most frequent procedure was articular lavage, debridement and chondroplasty in 98.5%. Thirty-five patients were found to have knee arthrosis grade IV (50.7%); the broadest functional improvement range occurred in patients with arthrosis grades I and III. DISCUSSION: Patients with mild-to-moderate knee arthrosis grades I to III are the ones with the highest chance of success from the perspective of pain relief and functionality of arthroscopic surgery.

[Clinical and functional course of patients after arthroscopic repair of a Bankart lesion]. / Evolución clínica y funcional en pacientes operados vía artroscópica con inestabilidad unidireccional anterior del hombro.

OBJECTIVE: Show the experience of the Orthopedics Service at Lic. Adolfo López Mateos Regional ISSSTE Hospital, in the management of anterior unidirectional shoulder instability with an arthroscopic technique consisting of reattaching the labrum in the glenoid with anchored sutures and capsular tightening with radiofrequency. MATERIAL AND METHODS: Twenty-six patients with anterior unidirectional shoulder instability who were operated-on between August 2006 and November 2008 were included. Twelve patients underwent capsular retightening with radiofrequency and in 14 patients the latter was combined with sutured anchors. The patients selected had a history of relapsing glenohumeral dislocations and subluxations with anterior instability, with or without associated Bankart lesions, and all of them were young. RESULTS: The results were assessed basically with the functional UCLA scale and considering the occurrence of any instability-related event during the postoperative follow-up; from this perspective, there were no cases of recurrent instability. Two cases reported severe postoperative pain, and one had irritation of the sutures; 6 patients had residual limitation of combined lateral rotation and abduction movements, with a mean of 10 degrees compared with the sound contralateral limb. The most frequent incident was infiltration of solutions into the soft tissues due to the operative time. CONCLUSIONS: Capsular retightening with radiofrequency, whether combined or not with other repair techniques, has proven highly satisfactory from the perspective of the glenohumeral stabilization for anterior unidirectional instability. The arthroscopic approach offers the known advantages of being less aggressive to the soft tissues and a shorter time to resume work activities when rehabilitation therapy and exercises are followed.

[Bone tissue response to the echelon-type uncemented femoral component in revision total hip arthroplasty (THA)]. / Respuesta del tejido óseo al componente femoral no cementado tipo Echelon en la artroplastia total de cadera (ATC) de revisión.

INTRODUCTION: We present the preliminary, short-term results of a cohort study of revision THA focused on aseptic loosening and aimed at assessing the metadiaphyseal bone ingrowth biological response of an uncemented femoral implant with an extensive porous coating. MATERIAL AND METHODS: The clinical, X-ray and personal satisfaction outcomes (SF-36) of four patients were assesessed. We had performed four exchange THAs due to a diagnosis of clinical and radiographic aseptic prosthetic loosening, with symptoms of anterior thigh pain. Three THAs were primary and one was a hemiarthroplasty. Mean follow-up after the prosthetic exchange was 41.5 weeks. RESULTS: As of postoperative week six, a radiographic improvement of the bone appearance was seen due to mineralization and decrease in the radiolucent areas in the interfaces. As of week 20, variable degrees of bone ingrowth were seen. No femoral subsidence has occurred and anterior thigh pain was relieved in all cases. DISCUSSION: Stem size, stiffness,stiffness, the geometry and the extension of the porous coating seem to affect bone remodeling. Implants with an extensive porous-coated surface seem to assure a reliable, long-term fixation and provide a circumferential seal against debris.

Prótesis de cadera no cementada, sistema CLS / Non cemented prosthesis of the hip with the CLS

Se realizó un estudio retrospectivo, descriptivo, observacional en pacientes a quienes se les colocó una prótesis total de cadera no cementada, con el sistema CLS, durante el periodo comprendido de noviembre de 1991 a diciembre de 1996. Se aplicó un protocolo de acuerdo con los parámetros del Dr. Spotorno. Se administraron antibióticos profilácticos y terapia antiembólica. Se operó siguiendo en forma estricta la técnica sugerida por la casa comercial. Se colocaron un total de 48 protesis totales primarias con el sistema CLS, se excluyeron los casos en que este implante se colocó en revisiones, en dos casos la prótesis se colocó en forma bilateral. La indicación más frecuente fue la artrosis. Se permitió apoyar la extremidad operada hasta las 6 semanas siguientes a la cirugía en los casos que no presentaron complicaciones. Se revisaron los expedientes clínicos y radiográficos, así como a los pacientes operados. En 8 casos se presentaron fisuras estables en la región del calcar, sólo 6 casos presentaron líneas radiolúcidas a nivel acetabular, 16 por ciento de los fémures presentaron líneas radiolúcidas a nivel del hombro de la prótesis. En dos casos se presentó dolor en la cara anterior del muslo durante más de tres meses. La movilidad y la funcionalidad de la cadera operada mejoraron en el 100 por ciento de los casos. El sistema de prótesis de cadera no cementada CLS Spotorno es un buen sistema en reemplazos de cadera primarios, requisito es que el cótilo sea esférico o tenga poca deformidad, como en el resto de las prótesis no cementadas, se debe de realizar una selección cuidadosa en pacientes con adecuado stock óseo

Artroscopía de la rodilla con anestesia local / Arthroscopy of the knee with local anesthesia

Se reporta la experiencia de 73 pacientes operados por artroscopía bajo anestesia local con bupivacaína al 0.5 por ciento con epinefrina al 1:250,000, combinados con lidocaína al 2 por ciento con epinefrina y sedación con midazolam. Se compara el uso de este medio anestésico con el bloqueo epidural y con el uso de anestesia general. Se describe la técnica y se exaltan sus ventajas

Tratamiento de la pseudoartrosis post-traumática de la clavícula mediante enclavamiento intramedular bloqueado o fijación a compresión con placa AO y tornillos / Treatment of the post-traumatic non-union of the clavicle by intramedullary interloked-pinning or compression AO-plating

Se presentan los resultados de un estudio retrospectivo, observacional, descriptivo y transversal, sin beneficio económico. La serie se constituyó con 22 pacientes: 19 del sexo masculino y tres del femenino, con pseudoartrosis de clavícula, atendidos entre los meses de enero de 89 y septiembre de 93, en el Módulo de Extremidad Torácica del Servicio de Ortopedia del Hospital Regional Gral. Ignacio Zaragoza del ISSSTE. Todos los pacientes tenían el antecedente de haber sufrido fractura de la clavícula, tratada de forma incruenta. Doce de las fracturas iniciales presentaban desplazamiento grave de los fragmentos, nueve de los pacientes se retiraron la inmovilización en forma temprana sin autorización médica. El motivo de consulta inicial fue: dolor en 18 pacientes, limitación funcional en dos pacientes y cosmético en dos más. El diagnóstico se estableció entre tres y 12 meses después de la lesión. Se emplearon dos técnicas: la primera la del enclavado intramedular con bloqueo (cinco pacientes), y la segunda la osteosíntesis a compresión bajo los principios A-O (17 pacientes). Se obtuvo la consolidación en todos. En el grupo tratado bajo osteosíntesis a complicaciones. En el caso de la fijación intramedular tres pacientes presentaron complicaciones: uno migración de los clavillos y en dos pacientes fracaso que motivó colocación de placa A-O, obteniéndose la consolidación de las fracturas