Importance of the gender and preoperative knee sagittal alignment to avoid unnecessary tibial resection in TKR.

BACKGROUND: Standard resections according to the TKR manufacturers can lead to unnecessary bone resections in some patients. The objective of this study was to determine in which patients is recommended to perform a minimal tibial resection (MTR) that could restore the joint line height (JLH). METHODS: Navigation records of 108 consecutive posterior cruciate-substituting TKR performed by one surgeon were analyzed. Optimal tibial resection depth to restore the JLH (0 mm) was calculated by an algorithm. Postoperatively, the knees were distributed in two groups: those in which a MTR (depth ≤ 8 mm) would have been enough to restore the JLH and those in which a standard resection depth would have been necessary. ROC curves and Youden index were used to determine the cutoff point of the coronal and sagittal mechanical axis that predicted a MTR restoring the JLH. Multivariate analysis was used to identify independent factors associated with requiring an MTR. RESULTS: A MTR could be required in 20 (18.5%) knees. In the ROC curve analyses, the cutoff points that best discriminated between minimal and standard tibial resection was ≤ 3° of varus and < 2° of flexion preoperative deformity. Multivariate analysis showed that female gender and preoperative flexion < 2° were significant predictors of requiring a MTR to restore JLH. CONCLUSION: A MTR with the JLH restoration could be possible in female patients with a preoperative sagittal deformity less than 2° of flexion. Preoperative coronal alignment had no influence to discriminate when a MTR is required.

Complications of computer-assisted navigation in total knee replacement: retrospective cohort of eight hundred and seventy eight consecutive knees.

PURPOSE: The main objective was to analyze the computer-assisted navigation (CAN)-specific complications that forced to switch to conventional procedure in primary total knee replacement (TKR). The secondary objective was to determine the influence of those complications on TKR short-term survival. METHODS: Retrospective study of 878 primary TKR in 753 patients. Two consecutive versions of the OrthoPilot navigation system (Braun Aesculap, Germany) were used during the study time. Specific complications of CAN were defined as those due to the instrumentation (hardware or software failures), which were classified in one of two categories according to whether they occurred during the registration or tracking process. RESULTS: There were 20 (2.3%) complications related to the navigation system use that forced to switch to conventional surgery: in 11 (1.2%) knees due to loosening of the tracking pins, and in the other nine (1.0%) there were information system failures. There was a trend for a higher conversion rate to conventional surgery with the use of the first version of the software. There were no fractures, infections, or nerve injuries at the pin site. We found no differences in the distribution of baseline variables among those with or without conversion to conventional surgery. There was no significant difference (p = 0.488) in the two year survival between patients with or without conversion. CONCLUSION: CAN for primary TKR is a safe method with few specific complications that forced to switch from the navigated to the conventional procedure. Conversion to conventional surgery did not affect the short-term survival of TKR.

Búsqueda en Internet de información no cualificada sobre el tratamiento de la artrosis por la población española / Internet searches by the Spanish population for unqualified information on the treatment of osteoarthritis

OBJETIVO: Existe una tendencia actual en la población sobre la búsqueda de información médica no cualificada en Internet que puede influir sobre las recomendaciones aportadas en una consulta especializada. El objetivo de este estudio fue analizar la tendencia de la población española sobre la búsqueda de información no cualificada en Internet respecto de los tratamientos actuales de la artrosis. MATERIAL Y MÉTODO: Para analizar la información recabada en Internet se utilizó la herramienta informática Google Trends, combinando potenciales términos clave de búsqueda que se relacionaban con el tratamiento actual de la artrosis. Para cada término, se calculó el volumen relativo de búsquedas, y su tendencia entre 2009 y 2019. La dirección de la tendencia se estudió mediante la correlación de Spearman. RESULTADOS: Todos los métodos de infiltración tuvieron tendencias crecientes sin encontrar diferencias estadísticamente significativas entre ellos (p = 0,769). El término que mostraba una mejor correlación a lo largo del tiempo fue «prp», con un valor para la correlación de Spearman de 0,90 y el que mayor volumen relativo de búsquedas tuvo fue «factores de crecimiento». El tratamiento protésico generó más interés que los tratamientos conservadores, fue mayor para la sustitución protésica de rodilla que para la de cadera (p < 0,001). CONCLUSIÓN: En España, la búsqueda de información no cualificada sobre el tratamiento de la artrosis se ha incrementado en los últimos 10 años. El interés sobre el tratamiento protésico es mayor que sobre tratamientos más conservadores. La prótesis de rodilla genera mayor interés que la de cadera. No hay diferencias respecto a los distintos métodos de infiltración intraarticular

OBJECTIVE: There is a current trend in the population to search the Internet for unqualified medical information that may affect the recommendations given in specialist consultation. The aim of this study was to analyse the tendency of the Spanish population to search the Internet for unqualified information on current treatments for osteoarthritis. MATERIAL AND METHOD: Google Trends was used analyse the information gathered from the Internet, combining potential key search terms related to the current treatment of osteoarthritis. For each term the relative search volume was calculated, and its trend between 2009 and 2019. Spearman's correlation was used to study the direction of the trend. RESULTS: All the infiltration methods had increasing trends and no statistically significant differences were found between them (P=.769). The term that showed the best correlation over time was «prp» with Spearman's correlation =.90, and the term with the highest relative search volume was «growth factors». Prosthetic treatment generated more interest than conservative treatments, where there was more interest in knee replacement than hip replacement (P<.001). CONCLUSION: In Spain, the search for unqualified information on the treatment of osteoarthritis has increased over the past 10 years. There is more interest in prosthetic treatment than the more conservative treatments. There is more interest in knee replacement than hip replacement. There are no differences with regard to the different methods of joint injections

El uso del WhatsApp(R) en nuestra práctica clínica: estudio piloto / Using WhatsApp(R) in our clinical practice: a pilot study

OBJETIVO: Evaluar el uso del WhatsApp como una herramienta clínica y determinar la percepción de los cirujanos ortopédicos sobre su utilidad. MATERIAL Y MÉTODO: Se invitó a los cirujanos ortopédicos asistentes a una reunión científica a completar in situ una encuesta anónima y estructurada sobre el uso de la aplicación en el ámbito clínico. RESULTADOS: En total 41 (38%) encuestas fueron correctamente completadas. La totalidad de los que respondieron habían sido emisores o receptores de información clínica a través de la aplicación. El 93% había utilizado la aplicación para consultar con relación a un caso clínico. El 78% pertenecían a un grupo de WhatsApp en el cual se compartía información clínica. El 71% se mostró de acuerdo con que la comunicación entre clínicos a través del Whatsapp es una herramienta útil para la toma de decisiones terapéuticas. CONCLUSIÓN: El uso del WhatsApp para fines clínicos de los cirujanos ortopédicos está generalizado. La mayoría de estos lo consideran una herramienta útil en la toma de decisiones terapéuticas

OBJECTIVE: To evaluate the use of WhatsApp as a clinical tool and determine the perception of orthopaedic surgeons of its usefulness. MATERIAL AND METHODS: Orthopaedic surgeons attending a scientific meeting were invited to complete an anonymous and structured survey on the use of the application in the clinical setting. RESULTS: A total of 41 (38%) surveys were correctly completed. Of the respondents, 100% had been either senders or receivers of clinical information via the application. Ninety-three percent had used the application to consult in relation to a clinical case. Of the respondents, 78% belonged to a WhatsApp group in which clinical information is shared: 71% agreed that communication between clinicians through WhatsApp is a useful tool for making therapeutic decisions. CONCLUSION: The use of WhatsApp for clinical purposes by orthopaedic surgeons is widespread. Most consider it a useful tool in therapeutic decision making

Using WhatsApp® in our clinical practice: a pilot study. / El uso del WhatsApp® en nuestra práctica clínica: estudio piloto.

OBJECTIVE: To evaluate the use of WhatsApp as a clinical tool and determine the perception of orthopaedic surgeons of its usefulness. MATERIAL AND METHODS: Orthopaedic surgeons attending a scientific meeting were invited to complete an anonymous and structured survey on the use of the application in the clinical setting. RESULTS: A total of 41 (38%) surveys were correctly completed. Of the respondents, 100% had been either senders or receivers of clinical information via the application. Ninety-three percent had used the application to consult in relation to a clinical case. Of the respondents, 78% belonged to a WhatsApp group in which clinical information is shared: 71% agreed that communication between clinicians through WhatsApp is a useful tool for making therapeutic decisions. CONCLUSION: The use of WhatsApp for clinical purposes by orthopaedic surgeons is widespread. Most consider it a useful tool in therapeutic decision making.

Internet searches by the Spanish population for unqualified information on the treatment of osteoarthritis. / Búsqueda en Internet de información no cualificada sobre el tratamiento de la artrosis por la población española.

OBJECTIVE: There is a current trend in the population to search the Internet for unqualified medical information that may affect the recommendations given in specialist consultation. The aim of this study was to analyse the tendency of the Spanish population to search the Internet for unqualified information on current treatments for osteoarthritis. MATERIAL AND METHOD: Google Trends was used analyse the information gathered from the Internet, combining potential key search terms related to the current treatment of osteoarthritis. For each term the relative search volume was calculated, and its trend between 2009 and 2019. Spearman's correlation was used to study the direction of the trend. RESULTS: All the infiltration methods had increasing trends and no statistically significant differences were found between them (P=.769). The term that showed the best correlation over time was «prp¼ with Spearman's correlation =.90, and the term with the highest relative search volume was «growth factors¼. Prosthetic treatment generated more interest than conservative treatments, where there was more interest in knee replacement than hip replacement (P<.001). CONCLUSION: In Spain, the search for unqualified information on the treatment of osteoarthritis has increased over the past 10 years. There is more interest in prosthetic treatment than the more conservative treatments. There is more interest in knee replacement than hip replacement. There are no differences with regard to the different methods of joint injections.

Factores predictivos de la mortalidad al año en pacientes mayores de 80 años intervenidos de fractura del cuello femoral / Factors predicting one-year mortality of patients over 80 years operated after femoral neck fracture

Introducción: En la población española los estudios previos relacionados con la mortalidad tras fractura de cadera están basados en pacientes con edades entre 60 a 102años y no estratificaban los pacientes de acuerdo con el tipo de fractura. El objetivo de este estudio fue identificar los factores con influencia sobre la mortalidad al año postoperatorio en pacientes de 80años o más que sufrieron una fractura cervical de cadera. Material y método: Estudio retrospectivo de casos y controles. Fueron incluidos los pacientes consecutivos intervenidos entre 2015 y 2016. Se estudiaron las características basales, los antecedentes y la medicación previa, los parámetros analíticos, el índice de Charlson, la escala ASA, el índice de Barthel y el cuestionario Pfeiffer. Se registraron los datos quirúrgicos y las complicaciones durante el seguimiento. La supervivencia se evaluó mediante el método de Kaplan-Meier y las variables que la afectaban mediante la regresión de Cox. Resultados: La mortalidad al año postoperatorio fue del 21,1% y la supervivencia media de 10,3meses (IC95%: 9,7-10,9). La regresión de Cox mostraba que la edad >87años, la puntuación de Barthel ≤85 y la combinación de anticoagulantes con INR ≥1,5 eran predictores significativos de mortalidad durante el primer año de seguimiento. Conclusión: Los factores predictores de mortalidad durante el primer año postoperatorio por fractura cervical de cadera en pacientes octogenarios o mayores fueron la edad >87años, la dependencia física medida a través de una puntuación en el índice de Barthel ≤85 y el uso de anticoagulantes con un INR ≥1,5 al ingreso

Introduction: In the Spanish population, previous studies related to mortality after hip fracture are based on patients aged 60 to 102years and did not stratify patients according to the type of fracture. The objective of this study was to identify the factors with influence on mortality at one postoperative year in patients aged 80years or older after a femoral neck fracture. Material and method: Retrospective study of cases and controls. Consecutive patients operated between 2015 and 2016 were included. Baseline characteristics, medical history and previous medication, analytical parameters, Charlson index, ASA scale, Barthel index and Pfeiffer questionnaire were studied. Surgical data and complications were recorded during follow-up. Survival was assessed by the Kaplan-Meier method and the variables that affected it by Cox regression. Results: Mortality one year postoperatively was 21.1% and mean survival 10.3months (95%CI: 9.7-10.9). The Cox regression showed that age >87years, Barthel score ≤85 and the combination of anticoagulants with INR ≥1.5 were significant predictors of mortality during the first year of follow-up. Conclusion: The predictors of mortality during the first postoperative year after femoral neck fracture in octogenarian or older patients were: age>87years, physical dependence measured by a Barthel index score ≤85, and the use of anticoagulants with a INR ≥1.5 at admission

Factors predicting one-year mortality of patients over 80 years operated after femoral neck fracture. / Factores predictivos de la mortalidad al año en pacientes mayores de 80 años intervenidos de fractura del cuello femoral.

INTRODUCTION: In the Spanish population, previous studies related to mortality after hip fracture are based on patients aged 60 to 102years and did not stratify patients according to the type of fracture. The objective of this study was to identify the factors with influence on mortality at one postoperative year in patients aged 80years or older after a femoral neck fracture. MATERIAL AND METHOD: Retrospective study of cases and controls. Consecutive patients operated between 2015 and 2016 were included. Baseline characteristics, medical history and previous medication, analytical parameters, Charlson index, ASA scale, Barthel index and Pfeiffer questionnaire were studied. Surgical data and complications were recorded during follow-up. Survival was assessed by the Kaplan-Meier method and the variables that affected it by Cox regression. RESULTS: Mortality one year postoperatively was 21.1% and mean survival 10.3months (95%CI: 9.7-10.9). The Cox regression showed that age >87years, Barthel score ≤85 and the combination of anticoagulants with INR ≥1.5 were significant predictors of mortality during the first year of follow-up. CONCLUSION: The predictors of mortality during the first postoperative year after femoral neck fracture in octogenarian or older patients were: age>87years, physical dependence measured by a Barthel index score ≤85, and the use of anticoagulants with a INR ≥1.5 at admission.

Evolución al año de tratamiento con CCH para la contractura de Dupuytren: estudio prospectivo / One year follow-up after treatment with CCH for Dupuytren's disease: A prospective view

Objetivo: El tratamiento con colagenasa Clostridium histolyticum (CCH) ocupa hoy en día una alternativa para la contractura de Dupuytren. Nuestro objetivo es valorar su eficacia a un año en una serie de pacientes consecutivos. Material y método: Estudio prospectivo con seguimiento mínimo de los pacientes de un año. Valoración de resultados y efectos adversos. Resultados: Se incluye un total de 75 articulaciones tratadas en 51 pacientes. La edad media fue de 65,18 años (DE: 7,288) y el 82,7% eran varones. La contractura media inicial de la MCF fue de 34,0 grados (DE: 27,37), de la IFP 41,5 grados (DE: 31,33) y de la afectación combinada (MCF+IFP) de 75,5 grados (DE: 35,2). Se alcanzó la eficacia en 68 pacientes (90,7%). Los efectos adversos fueron leves y autolimitados. La corrección media para la articulación MCF fue de 28,96 grados (DE: 26,90) y para la IFP fue de 28,72 grados (DE: 24,30). La tasa de recidivas fue de 18 (24,0%) articulaciones en 14 pacientes, siendo más frecuentes en los casos graves. El QuickDASH mostró mínimas diferencias medido antes de la intervención y al año. Discusión: Nuestros resultados presentan mejor evolución en los casos leves; la evolución es más favorable y con mayor tasa de éxitos en la articulación MCF. El QuickDASH no es una herramienta útil para la valoración de la contractura de Dupuytren. Conclusiones: El tratamiento con CCH para la CD es un tratamiento efectivo a medio plazo. Presenta peor evolución en afecciones de articulaciones combinadas, 5.o dedo, IFP y casos graves

Aim: Clostridium histolyticum collagenase (CCH) is nowadays an alternative treatment for the contracture of Dupuytren. Our objective is to assess its effectiveness at one year in a series of consecutive patients. Material and method: Prospective study with minimum follow-up of one year. Evaluation of results and adverse effects. Results: A total of 75 joints treated in 51 patients were included. The average age was 65.18years (SD: 7.288) and 82.7% were males. The initial mean contraction of the MCP was 34.0 degrees (SD: 27.37), PIP 41.5 degrees (SD: 31.33) and combined impairment (MCF+IFP) of 75.5 degrees (SD: 35.2). Efficacy was achieved in 68 patients (90.7%). Adverse effects were mild and self-limiting. The mean correction for the MCP joint was 28.96 degrees (SD: 26.90) and for PIP it was 28.72 degrees (SD: 24.30). The recurrence rate was 18 (24.0%) joints in 14 patients, being more frequent in severe cases. QuickDASH score showed minimal differences measured before the intervention and once a year. Discussion: Our results show a better outcome in mild cases; the outcome was more favourable and with a higher success rate in the MCP joint. QuickDASH score is not a useful tool for the assessment of Dupuytren's contracture. Conclusions: Treatment with CCH for Dupuytren's contracture is an effective treatment in the medium term. It has a poorer outcome in combined joint disorders, 5th finger, PIP and severe cases

One year follow-up after treatment with CCH for Dupuytren's disease: A prospective view. / Evolución al año de tratamiento con CCH para la contractura de Dupuytren: estudio prospectivo.

Aim Clostridium histolyticum collagenase (CCH) is nowadays an alternative treatment for the contracture of Dupuytren. Our objective is to assess its effectiveness at one year in a series of consecutive patients. MATERIAL AND METHOD: Prospective study with minimum follow-up of one year. Evaluation of results and adverse effects. RESULTS: A total of 75 joints treated in 51 patients were included. The average age was 65.18years (SD: 7.288) and 82.7% were males. The initial mean contraction of the MCP was 34.0 degrees (SD: 27.37), PIP 41.5 degrees (SD: 31.33) and combined impairment (MCF+IFP) of 75.5 degrees (SD: 35.2). Efficacy was achieved in 68 patients (90.7%). Adverse effects were mild and self-limiting. The mean correction for the MCP joint was 28.96 degrees (SD: 26.90) and for PIP it was 28.72 degrees (SD: 24.30). The recurrence rate was 18 (24.0%) joints in 14 patients, being more frequent in severe cases. QuickDASH score showed minimal differences measured before the intervention and once a year. DISCUSSION: Our results show a better outcome in mild cases; the outcome was more favourable and with a higher success rate in the MCP joint. QuickDASH score is not a useful tool for the assessment of Dupuytren's contracture. CONCLUSIONS: Treatment with CCH for Dupuytren's contracture is an effective treatment in the medium term. It has a poorer outcome in combined joint disorders, 5th finger, PIP and severe cases.

Efficacy and adverse effects of collagenase use in the treatment of Dupuytren's disease: a meta-analysis.

AIMS: The aim of this meta-analysis was to assess the safety and efficacy of collagenase clostridium histolyticum compared with fasciectomy and percutaneous needle fasciotomy (PNF) for Dupuytren's disease. MATERIALS AND METHODS: We systematically searched PubMed, EMBASE, LILACS, Web of Science, Cochrane, Teseo and the ClinicalTrials.gov registry for clinical trials and cohort or case-control studies which compared the clinical outcomes and adverse effects of collagenase with those of fasciectomy or PNF. Of 1345 articles retrieved, ten were selected. They described the outcomes of 425 patients treated with collagenase and 418 treated by fasciectomy or PNF. Complications were assessed using inverse-variance weighted odds ratios (ORs). Clinical efficacy was assessed by differences between the means for movement of the joint before and after treatment. Dose adjustment was applied in all cases. RESULTS: Random-effects modelling showed that patients treated with collagenase had 3.24 increased odds of adverse effects compared with those treated by fasciectomy (OR 4.39) or PNF (OR 1.72,). The effect was lost when only major complications were assessed. Joint movement analysis revealed a difference between means of less than 10%, indicating equivalent clinical efficacy in the short and medium term for collagenase and fasciectomy. We were unable to analyse this for PNF due to a shortage of data. CONCLUSION: There were no significant differences in effect size between collagenase and fasciectomy. The use of collagenase was associated with a higher overall risk of adverse effects than both fasciectomy and PNF. Cite this article: Bone Joint J 2018;100-B:73-80.

Toxic dermatitis secondary to treatment with collagenase clostridium histolyticum for Dupuytren´s disease.

OBJECTIVE: Secondary effects and drug reactions relative to collagenase Clostridium histolyticum treatment for Dupuytren's contracture are frequent. In only a few cases these secondary effects are considered serious. The mechanism that produces these effects of production is not well understood. CLINICAL REPORT: We present the case report of a woman with fifth finger interphalangeal joint treatment with generalized skin rash as a complication of collagenase Clostridium histolyticum treatment. DISCUSSION: We discuss treatment, causes and mechanisms of this rare complication from this treatment and review the bibliography about mechanisms for the different types of immunological reactions that may occur after treatment with collagenase Clostridium histolyticum and the possibility of crossed reactions with Clostridiopeptidase A used to treat skin lacerations.

Enclavado intramedular en fractura de fémur proximal: rotura doble con sistemas de implante distintos / Intramedullary nailing in proximal femur fracture: double breakage with different implants

Presentamos un caso clínico de una doble rotura de clavo en el cual los errores en la técnica quirúrgica pueden explicar, en parte, la causa del fallo de los implantes. Finalmente se resolvió la fractura con el uso de una placa de osteosíntesis con un contrafuerte. Aunque el enclavado intramedular es una de las técnicas más frecuentemente realizadas en COT, tenemos que utilizar una técnica quirúrgica lo más cuidadosa posible, prestando atención para evitar problemas que puedan complicar la evolución (AU)

We present a clinical report of a double failure in which errors in surgical technique can explain, in part, the cause of the breakage of the nails. Finally we resolved the fracture with an osteosynthesis plate with a strut. Although intramedullary nailing is one of the most frequent techniques in orthopedics, we have to use the most accurate technique and pay attention to avoid surgical problems that can complicate the evolution of the healing of the fractures of the hip (AU)

Inestabilidad longitudinal del antebrazo. Fracturas de Essex-Lopresti. Clasificación y tratamiento / Longitudinal instability of the forearm. The Essex-Lopresti fractures. Classification and treatment

Realizamos una revisión de la literatura publicada sobre la clasificación, diagnóstico diferencial y tratamiento del síndrome de Essex-Lopresti. Se revisan todas las opciones de tratamiento, analizando las principales series de pacientes publicadas hasta el momento con los resultados. Se discute sobre la idoneidad o no de los distintos tipos de tratamiento, se valora un posible protocolo de tratamiento y, finalmente, se analizan los resultados y el pronóstico. La inestabilidad longitudinal del antebrazo es una patología infrecuente, pero con unas implicaciones muy importantes en la vida de cada uno de los pacientes que la sufre (AU)

We carry out a review of the literature published on the classification, differential diagnosis and treatment of Essex-Lopresti syndrome. All treatment options are reviewed, analysing the main series of patients published to date with results. It discusses the suitability or otherwise of various treatment types, it then considers a possible treatment protocol and, lastly, it analyses the results and prognosis. Longitudinal instability of the forearm is a rare condition, but it has very significant implications in the life of each patient who suffers from it (AU)

Inestabilidad longitudinal del antebrazo. Fracturas de Essex Lopresti. Concepto, biomecánica y diagnóstico / Longitudinal instability of the forearm. The Essex Lopresti fractures. Concept, biomechanics and diagnosis

Objetivo: realizar una revisión del síndrome de Essex-Lopresti o inestabilidad longitudinal del antebrazo pues aunque es una patología poco frecuente puede pasar desapercibida en urgencias. La implicación de la membrana interósea en la patología es fundamental para comprender tanto sus bases patogénicas como para la instauración de cualquier tipo de tratamiento. Se realiza una revisión de las publicaciones existentes acerca del concepto, epidemiología, diagnóstico y patogenia, prestando especial interés a la biomecánica alterada de la membrana interósea como causante de la perpetuación del cuadro y de sus nefastas consecuencias (AU)

Objetive: To perform a review of Essex-Lopresti syndrome or longitudinal instability of the forearm, since, although it is an uncommon condition, it goes unnoticed in the emergency room. The implication of the interbone membrane in this condition is essential to understand its pathogenic bases and for instituting any type of treatment. A review is performed of the existing publications about the concept, epidemiology, diagnosis and pathogenesis, focusing particularly on the impaired biomechanics of the interbone membrane as the cause of the persistent condition and its harmful consequences (AU)

Comparación clínica entre clavo Gamma(R) y clavo Claufitt(R) en fracturas inestables de fémur proximal / A clinical comparison between the Gamma(R) and the Claufitt(R) nails: in unstable proximal femoral fractures

Objetivo. Evaluar las diferencias entre dos sistemas de osteo-síntesis intramedular en fracturas de extremo proximal de fémur inestables, observando si la presencia de un tornillo antirrotación mejora el resultado final. Material y método. Se diseña un sistema de valoración funcional individualizada por enfermo. Aplicando este sistema se realiza un estudio retrospectivo valorando la colocación y evolución clínica de dos sistemas de enclavado endomedular (Gamma® y Claufitt®). Se valora la situación funcional del paciente a medio plazo en el área de población de un hospital universitario. Se obtiene una base final de datos con 43 casos de Claufitt® aptos para el estudio. Resultados. La valoración funcional real es un método de evaluación sencillo, reproducible y útil para el seguimiento pormenorizado de los enfermos de modo individual y del mismo modo aplicable a cualquier tipo de intervenciones o protocolos de seguimiento. Aunque los resultados no son estadísticamente significativos, el Claufitt® presenta, respecto al clavo Gamma®, un 10% de mejores resultados. Conclusiones. La valoración funcional y la evolución de cada enfermo en particular pueden ser evaluadas de un modo sencillo mediante la valoración funcional real. Las diferencias entre los dos tipos de sistemas de osteosíntesis intramedular no son objetivables ni técnica ni clínicamente. Los datos obtenidos son acordes con la bibliografía publicada

Purpose. To assess the differences that exist between two intramedullary osteosynthesis systems for the treatment of unstable proximal femoral fractures in an attempt to find out whether the use of an antirotation screw improves the final result. Materials and methods. A retrospective study was carried out to analyze the plcement and clinical evolution of both intramedullary nailing systems (Gamma® y Claufitt®). The patients' medium-term functional status was evaluated and benchmarked against the characteristics of the population served by our University Hospital. A final database was obtained made up of 43 cases of Claufitt® that met the criteria of our study. A functional assessment system was custom designed for each patient. Results. Although the results are not statistically significant, the results obtained with Claufitt® proved to be 10% better than those for the Gamma®, nail. The Real Functional Assessment is a straightforward, reproducible and useful evaluation method to perform an detailed individualized follow-up of our patients that can be applied to any type of procedure or follow-up protocol. Conclusions. The data obtained are in line with that published in the literature. The differences between the two intramedullary osteosynthesis systems cannot be quantified technically or clinically. Each patient's functional status and clinical evolution can be determined easily through the Real Functional Assessment (AU)