Dermotracción por bandas: estudio retrospectivo sobre su efectividad en el cierre diferido de defectos de cobertura en la pierna / Dermatotraction: A retrospective study on its effectiveness in the closure of soft tissue leg defects

Introducción: Una propiedad característica del tegumento humano es la viscoelasticidad. La piel y el tejido celular subcutáneo traccionados por una fuerza constante pueden llegar a cubrir áreas expuestas en lapsos relativamente breves. El objetivo de este estudio fue analizar una serie de casos con defectos de cobertura de la pierna. Se realizó la síntesis tegumentaria con técnica de dermotracción mediante "bandas de tracción", con la finalidad de poder precisar qué lesiones pueden beneficiarse de este método. Materiales y Métodos: Estudio retrospectivo, descriptivo, longitudinal realizado entre 2012 y 2019. Los criterios de inclusión fueron: 1) heridas con déficit de cobertura tegumentaria en la pierna, de etiología traumática diversa (dehiscencia de abordajes quirúrgicos, fasciotomías por síndrome compartimental, fracturas expuestas y heridas abiertas con déficit de partes blandas). Resultados: Se analizó a 36 pacientes (edad promedio 28 años) que tenían lesiones con pérdida de cobertura localizadas en distintas regiones de la pierna. En 27 pacientes (75%), se logró el cierre sin necesidad de procedimientos complementarios. En el 8,3%, se logró la reducción del área expuesta y fue necesario un procedimiento complementario (injerto de piel). Seis pacientes requirieron técnicas reconstructivas de partes blandas miocutáneas y fasciocutáneas. Conclusiones: Esta técnica es efectiva, simple y económica para lograr el cierre diferido de las heridas complejas o fasciotomías. La dermotracción permite el cierre diferido en pocos días luego del trauma. Nivel de Evidencia: IV

Introduction: Viscoelasticity is a distinctive characteristic of the human skin. A constant force pulling on the skin and subcutaneous tissue allows it to cover exposed areas in relatively short periods of time. The objective of this study is to analyze a series of cases with soft tissue leg defects where integumentary closure was accomplished with a skin stretching technique using 'traction bands' in order to determine which injuries can benefit from this treatment. Materials and Methods: This is a retrospective, descriptive, longitudinal study carried out in the period between 2012 and 2019. The inclusion criteria for this study were: 1) wounds with a soft-tissue coverage deficit in the leg of diverse traumatic etiology (surgical wound dehiscence, fasciotomies due to compart-ment syndrome, open fractures, and open wounds with soft tissue deficit). Results: 36 patients (mean age: 28 years) with injuries with loss of coverage in different regions of the leg were analyzed. Closure was achieved in 27 patients (75%), without the need for additional procedures. In three patients (8.3%), the exposed area was reduced, requiring skin grafting as a complementary procedure. Six patients required myocutaneous and fasciocutaneous soft tissue reconstructive procedures. Conclusions: This technique is effective, simple, and economical for closing complex wounds and/or fasciotomies. Dermatotraction allows closure a few days after the trauma. Level of Evidence: IV

Fracturas de tibia por estrés y hallazgos patológicos asociados en reclutas / Tibial stress fractures and associated pathologies in military recruits

Introducción: Las fracturas de tibia por estrés son un cuadro muy frecuente en el personal militar recién incorporado. Nuestro objetivo fue demostrar que existe una asociación entre fracturas por estrés y otros hallazgos patológicos. materiales y métodos: Se evaluaron retrospectivamente 42 fracturas por estrés en 34 pacientes, entre noviembre de 2012 y septiembre de 2014. Todos se habían incorporado recientemente al Ejército Argentino y consultaron por cuadros dolorosos en la tibia. Se realizó el diagnóstico clínico y centellográfico de fractura por estrés. Se documentaron datos filiatorios, hallazgos patológicos asociados y factores de riesgo. Los criterios de inclusión fueron: reciente incorporación, mismo entrenamiento, edad 16-23 años. Se excluyó a pacientes con traumatismos, enfermedad tumoral o centellograma negativo, y a los simuladores. Resultados: Se evaluaron 42 fracturas por estrés en 34 pacientes (14 hombres y 20 mujeres). La edad promedio era de 20 años. No hubo diferencias significativas en el número de lesiones respecto al miembro afectado. El 64,7% tenía hallazgos patológicos asociados (mujeres 73%, hombres 27%). El 80% de las mujeres y el 43% de los hombres tenían un hallazgo patológico asociado. Se detectaron diversos hallazgos patológicos asociados con desejes de miembros inferiores en varo y en valgo, los primeros fueron los que más se asociaron con fracturas. Conclusiones: La tasa de asociación con hallazgos patológicos en los miembros inferiores fue alta, con predominio de los desejes en varo. Las mujeres con fracturas por estrés tenían más hallazgos patológicos asociados que los hombres. Nivel de Evidencia: IV

Introduction: Tibial stress fractures are a very common condition in military recruits. Our objective is to demonstrate that stress fractures are associated with other pathologies. materials and methods: 42 stress fractures in 34 patients were retrospectively evaluated. Every patient had recently joined the Argentine Army and consulted for painful symptoms in the tibia. A clinical and scintigraphic diagnosis of stress fracture was made. Patient data, associated pathologies, and risk factors were documented. Inclusion criteria: recent incorporation, same training, age between 16 and 23 years. Trauma, simulators, tumoral pathology, and cases with negative scintigraphy were excluded. Results: We studied 42 stress fractures in 34 patients, 14 were men and 20 were women. The average age was 20 years. There were no significant differences in the number of injuries regarding the affected limb. 64.7% had associated pathologies, 73% in women and 27 % in men. Among the women with stress fractures, 80% had associated pathologies, compared to 43% for men. Different pathologies were found with lower limb varus and valgus imbalances. Varus was the most associated with fractures. Conclusions: A high rate of associated pathologies was found in patients with tibial stress fractures with a predominance of lower limb varus imbalances. Associated pathologies were more likely to be found in women with stress fractures than in men. Level of Evidence: IV

Cuidados pós-operatórios em reconstrução com retalhos de ferida traumática em membro inferior: revisão de escopo / Postoperative care in reconstruction with flaps of a traumatic lower limb wound: scope review / Cuidados postoperatorios en reconstrucción con colgajos de herida traumática de miembro inferior: revisión del alcance

Objetivo: mapear os cuidados pós-operatórios em reconstrução com retalhos cirúrgicos de ferida traumática em membro inferior. Método: revisão de escopo desenvolvida de acordo com as recomendações do Joanna Briggs Institute Reviewer's Manual em bases de dados referenciais, portais de informação e literatura cinzenta. Foram traçadas duas estratégias de busca para amplo alcance das publicações. Resultados: identificados dez cuidados pós-operatórios nas reconstruções com retalhos cirúrgicos em membro inferior relacionados a momentos específicos desta fase. Sendo categorizados em: 1) Cuidados no pós-operatório imediato, 2) Cuidados no pós-operatório mediato e 3) Transição do Cuidado. Conclusão: embora as reconstruções com retalhos cirúrgicos sejam um tratamento consolidado, a assistência pós-operatória ainda é incipiente quanto aos cuidados recomendados. Não há consenso sobre a implementação dos cuidados no manejo pós-operatório. O monitoramento dos retalhos cirúrgicos, clínico ou por dispositivos, foi o único cuidado contemplado em todas as publicações selecionadas, considerado essencial no pós-operatório independente da fase(AU)

Objective: to map postoperative care in reconstruction with surgical flaps of a traumatic wound in the lower limb. Method: scope review developed according to the recommendations of the Joanna Briggs Institute Reviewer's Manual in reference databases, information portals and gray literature. Two search strategies were designed for the wide reach of publications. Results: ten postoperative care procedures were identified and related to specific moments in this phase. Being categorized into: 1) Care in the immediate postoperative period, 2) Care in the mediate postoperative period and 3) Transition of Care. Conclusion: although reconstructions with surgical flaps are a consolidated treatment, postoperative care is still incipient in terms of recommended care. There is no consensus on the implementation of care in postoperative management. The monitoring of surgical flaps, clinical or by devices, was the only care considered in all selected publications, considered essential in the postoperative period, regardless of the phase(AU)

Objetivo: mapear los cuidados postoperatorios en la reconstrucción con colgajos quirúrgicos de una herida traumática en miembro inferior. Método: revisión del alcance desarrollada según las recomendaciones del Joanna Briggs Institute Reviewer's Manual (Manual del Revisor del Instituto Joanna Briggs) en bases de datos referenciales, portales de información y literatura gris. Se diseñaron dos estrategias de búsqueda para el amplio alcance de las publicaciones. Resultados: se identificaron diez procedimientos de cuidados postoperatorios relacionados con momentos específicos de esta fase. Siendo categorizados en: 1) Atención en el postoperatorio inmediato, 2) Atención en el postoperatorio mediato y 3) Transición de la Atención. Conclusión: si bien las reconstrucciones con colgajos quirúrgicos son un tratamiento consolidado, los cuidados postoperatorios aún son incipientes. No existe consenso sobre la implementación de los cuidados en el manejo postoperatorio. El seguimiento de los colgajos quirúrgicos, clínico o por dispositivo, fue el único cuidado abordado en todas las publicaciones seleccionadas, considerado fundamental en el postoperatorio, independientemente de la etapa(AU)

Ruptura bilateral do músculo fibular terceiro em bovino / Bilateral rupture of the peroneus tertius muscle in bovine

Background: The peroneus tertius muscle is responsible for tarsal flexion and coordinate extension of the stifle joint. The most common causes of rupture are excessive effort when trying to rise on a slippery surface, mounting, or being mounted. Rupture of the peroneus tertius muscle is characterized by an inability to flex the hock. Most cases are not curable, presenting an unfavorable to poor prognosis, and the animal has to be euthanized. This study aimed to report the clinical picture and treatment of a bilateral rupture of the peroneus tertius muscle in a cow from the municipality of Castanhal, state of Pará (Amazonian biome). Case: We report the clinical picture and treatment of a bilateral rupture of the peroneus tertius muscle in a 4-year-old cow, mixed breed, weighing approximately 400 kg, calved 3 months ago, belonging to a batch of 40 cattle kept on extensive breeding system in a pasture of Urochloa (Brachiaria) brizantha. The clinical signs appeared after the cow was mounted by a 1,100 kg bull and consisted of lameness, falling into sternal decubitus with hind limbs extended backward, hyperextension of the hocks with flexed stifle, with the tibia and metatarsus in a straight line, which lead to a 90-degree position of the femur and knee. Abrasions in the dorsal region of the fetlocks reinforce evidence of dragging hooves. Diagnosis of bilateral rupture of the peroneus tertius muscle was performed by a clinical examination and semiological test. Nonsteroidal anti-inflammatory drugs (flunixin meglumine, 2,2 mg/kg, every 24 h for 4 days) were prescribed for treatment, in addition to resting in a paddock with good availability of pasture, water, and mineral salt. After 3 months, we observed an improvement of the clinical signs, and after 6 months, an almost complete recovery. Only a slight difficulty in flexing the hock when moving remained. Discussion: In the present report, bull mounting was the probable cause of the hyperextension of both hocks and the bilateral rupture of the peroneus tertius muscle. According to the handler, these clinical signs were only evidenced after the animal was mounted. As stated in the literature, accidents such as falls, slips, mounting or being mounted, as well as excessive traction and over-elevation of the limb are considered predisposing factors for the onset of the disease. Rupture of the peroneus tertius muscle is unusual in production animals; therefore, the low occurrence of reports on this kind of rupture in the literature makes this case even more unique. The bilateral injury differs from cases described in the literature, in which the reported injuries were always unilateral. Our findings reinforce the hypothesis that the act of mounting was the triggering factor for the bilateral rupture of the animal peroneus tertius muscle. The breeding system also differs from the cases diagnosed by the same authors, since they describe the disease in bovines kept on intensive or semi-intensive breeding. In the present case, the cattle were kept on an extensive breeding system. The extension and flexion tests used in the clinical examination allowed for the diagnosis of rupture of the peroneus tertius muscle in both limbs, similarly to what has been reported by other authors. Anamnesis, clinical findings, and exclusion of different diagnoses were decisive for establishing the diagnosis. The treatment chosen was efficient, even though the case was severe, as the injury occurred in both hind limbs.

Manejo ortoplástico de fractura expuesta de pierna grave: a propósito de un caso / Orthoplastic management of severe open fractures: case report / Tratamento ortoplástico das fraturas expostas grave: relato de caso

Las fracturas expuestas de pierna son lesiones frecuentes, sus principales complicaciones son la infección y la dificultad en la consolidación ósea. El abordaje ortoplástico implica llevar a cabo principios y prácticas de ambas especialidades en forma conjunta, evitando el tratamiento por separado de los problemas que surgen de estas lesiones graves y así intentar disminuir al mínimo las complicaciones. Nuestro objetivo es transmitir la importancia del enfoque ortoplástico en las fracturas expuestas. Se reporta el caso de un paciente adulto, con una fractura de pierna, tibia y peroné expuesta, que requirió múltiples procedimientos quirúrgicos en vistas a preservar el miembro. Fueron necesarias variadas estrategias para controlar la infección ósea y reconstruir las partes blandas y óseas. Con el estímulo de la movilidad del tobillo y pie, se logró comenzar a restituir la función del miembro desde el inicio; permitiendo, a las 6 semanas de evolución, el apoyo del miembro mediante una fijación ósea estable. A los 24 meses de seguimiento clínico y radiográfico evidenciamos paciente y familia satisfechos con un excelente resultado funcional según score ASAMI. Se concluye que en pacientes con fracturas expuestas graves, es clave el abordaje ortoplástico para lograr mejores resultados.

Open leg fractures are frequent injuries; the infection and difficulty in bone healing are their main complications. The orthoplastic approach involves carrying out principles and practices of both specialties together, avoiding separate treatment of the problems that arise from these serious injuries and thus minimizing complications. The objective of the article is to convey the importance of the orthoplastic approach in open fractures. We report the case of an adult patient, with an open fractured leg, to required multiple surgical procedures to preserve the limb. Various strategies were necessary to cure the bone infection and reconstruct the soft tissue and bone. The limb function restore was possible promoting the ankle and foot mobility from the beginning and it allowed weight-bearing on the limb through stable bone fixation, at 6 weeks of evolution. We evidenced a patient and family satisfied with an excellent functional result according to the ASAMI score, at 24 moths of clinical and radiographic follow-up. It is concluding that in patients with severe open fractures, the orthoplastic approach is key to obtain better results.

As fraturas expostas da perna são lesões frequentes, suas principais complicações são infecção e dificuldade de consolidação óssea. A abordagem ortoplástica envolve a realização conjunta de princípios e práticas de ambos ases especialidades, evitando o tratamento separado dos problemas decorrentes dessas lesões graves e minimizando assim as complicações. Nosso objetivo é transmitir a importância da abordagem ortoplástica nas fraturas expostas. É relatado o caso de um paciente adulto, com fratura de perna, tíbia e fíbula expostas, necessitando de múltiplos procedimentos cirúrgicos para preservação do membro. Várias estratégias foram necessárias para curar a infecção óssea e reconstruir os tecidos moles e o osso. Foi possível começar a restaurar a função do membro desde o início, com a estimulação da mobilidade do tornozelo e do pé; com 6 semanas de evolução, concedendo cargas ao membro por meio de fixação óssea estável. Apresentou boa evolução, aos 24 meses de acompanhamento clínico y radiográfico, constatamos a satisfação do paciente e família. com um excelente resultado funcional de acordo a pontuação ASAMI. Conclui-sé que em pacientes com fraturas expostas graves, a abordagem ortoplástica é fundamental para obter melhores resultados.

Experiencia en el manejo del trauma de guerra con un enfoque de control de daños en el hospital para pacientes con fracturas de fémur o tibia / Experience in managing war trauma with a damage control approach in the hospital for patients with femur or tibia fractures

Introducción: El Hospital Militar Central cuenta con un grupo especial para la atención de pacientes con trauma de guerra que incluye una evaluación inicial y manejo urgente de las lesiones que amenacen la vida, mediante un enfoque de control de daños que busca preservar la vida del paciente, salvar la extremidad y conservar su función. Materiales y Métodos: Estudio observacional, descriptivo, transversal de pacientes de las fuerzas militares de Colombia, que sufrieron fracturas de fémur o tibia por trauma de guerra entre 2012 y 2020; y tratados mediante fijación externa en este Hospital. Objetivos: Describir las complicaciones del trauma de guerra tras un año de manejo de pacientes con fracturas de fémur o tibia utilizando un protocolo de control de daños en el Hospital Militar Central, centro de referencia para este tipo de trauma en el país. Resultados: Se realizó una revisión retrospectiva de pacientes con fracturas femorales o tibiales por traumas de guerra entre 2012 y 2020, manejados con un protocolo de control de daños. Se seleccionaron 72 soldados, el 96% de las fracturas eran abiertas, el 91% (66 casos) sufrió alguna complicación, como lesión nerviosa, lesión vascular, defecto de cobertura, infección, falta de consolidación. Conclusiones: El trauma de guerra continúa representando una de las etiologías de politraumatismo en pacientes jóvenes de nuestro país que, a su vez, sigue teniendo grandes implicaciones clínicas y económicas. Las lesiones óseas de las extremidades requieren un manejo por etapas basado en la fijación externa según los principios de control de daños. Nivel de Evidencia: IV

Introduction: The Central Military Hospital of Bogotá, Colombia has a specialized team for treating war trauma patients. They conduct an initial assessment of patients and promptly manage potentially fatal injuries using a damage control approach that aims to save the patient's life, save the limb, and preserve its function. Materials and Methods: An observational, descriptive, cross-sectional study was conducted on patients from the Colombian armed forces who, between 2012 and 2020, had femur or tibia fractures as a result of war trauma; these patients were treated using external fixation by the orthopedics and traumatology service of the Central Military Hospital in Bogotá, Colombia. Objectives: To describe the complications associated with war trauma following a year of treatment for femur and/or tibia fractures under a damage control protocol at the Central Military Hospital, the nation's reference facility for this kind of trauma. Results:A retrospective review of war trauma patients between 2012 and 2020 with femoral or tibial fractures treated with DCO was performed. Fisher's Exact tests were used for comparisons. Seventy-two soldiers were selected, 96% of fractures were open, 91% (66 cases) had some type of complication such as nerve injury, vascular injury, coverage defect, infection, and nonunion. Conclusions: In our country, war trauma persists as one of the causes of polytrauma in young patients, which has significant clinical and financial implications. Bone injuries of severely affected extremities require staged management based on external fixation according to damage control principles. Level of Evidence: IV

Core stability training effects on lower limb rehabilitation of judokas / Efeitos do treino de estabilidade do core na reabilitação em membros inferiores de judocas / Efectos del entrenamiento de la estabilidad del core en la rehabilitación de los miembros inferiores de judokas

ABSTRACT Introduction Judo is a sport that presents a high incidence of sports injuries. Judo athletes want to master their skills to the maximum. Good physical conditioning is necessary to decrease the incidence of surgeries and achieve better results. Core stability exercises can discretely reduce the likelihood of lower limb injuries in judo athletes. Objective This paper examines the rehabilitation of core stability training effects on lower limb injuries in judokas by case studies. Methods A Chinese judo team member with a lower limb injury underwent core stability training. Isokinetic strength tests, body composition tests, and functional checks explored the athlete's physical recovery after training. Results The athletes' lower limbs progressed with good recovery (P<0.05). Additionally, a recovery in fitness level was also noted (P<0.05). Conclusion Core stability training positively affects recovery from lower limb injuries in judokas. Evidence level II; Therapeutic Studies - Investigating the results.

RESUMO Introdução O judô é um esporte com alta incidência de lesões esportivas. Atletas de judô querem dominar o máximo de suas habilidades. Para diminuir a incidência de cirurgias e alcançar melhores resultados é necessário um bom condicionamento físico. Os exercícios de estabilidade do core podem reduzir discretamente a probabilidade de lesões nos membros inferiores em judocas. Objetivo Este artigo analisa o efeito da reabilitação com treino de estabilidade do core em lesões de membros inferiores de judocas por meio de estudos de caso. Métodos Um membro da equipe chinesa de judô com lesão de membro inferior realizou treinamento de estabilidade do core. Foram utilizados testes de força isocinética, testes de composição corporal e verificações funcionais para explorar a recuperação física do atleta após o treino. Resultados Os membros inferiores dos atletas evoluíram com boa recuperação (P<0,05). Adicionalmente, notou-se também uma recuperação no nível de aptidão física (P<0,05). Conclusão O treinamento de estabilidade do core afeta positivamente a recuperação de lesões de membros inferiores em judocas. Nível de evidência II; Estudos terapêuticos - Investigação de resultados.

RESUMEN Introducción El judo es un deporte con alta incidencia de lesiones deportivas. Los atletas de judo quieren dominar el máximo de sus capacidades. Para reducir la incidencia de las cirugías y lograr mejores resultados, es necesario un buen acondicionamiento físico. Los ejercicios de estabilidad del core pueden reducir discretamente la probabilidad de lesiones de las extremidades inferiores en los judokas. Objetivo Este artículo examina el efecto de la rehabilitación con el entrenamiento de la estabilidad del core en las lesiones de las extremidades inferiores en los judokas mediante el estudio de casos. Métodos Un miembro del equipo de judo chino con una lesión en las extremidades inferiores se sometió a un entrenamiento de estabilidad del core. Se utilizaron pruebas de fuerza isocinética, pruebas de composición corporal y controles funcionales para explorar la recuperación física del atleta después del entrenamiento. Resultados Los miembros inferiores de los atletas evolucionaron con una buena recuperación (P<0,05). Además, también se observó una recuperación del nivel de aptitud física (P<0,05). Conclusión El entrenamiento de la estabilidad del core afecta positivamente a la recuperación de las lesiones de las extremidades inferiores en los judokas. Nivel de evidencia II; Estudios terapéuticos - Investigación de resultados.

Reconstruction Options for Lower Extremity Traumatic Wounds.

The senior author first coined the "orthoplastic" approach to traumatic lower extremity reconstruction, by which multidisciplinary surgeons and specialists work together for optimal patient success. The goals of lower extremity salvage are to optimize limb appearance, restore unrestricted pain-free ambulation, and improve quality of life. Composite traumatic defects require an organized approach, and the reconstructive ladder is used for strategies of varying complexity for repair of soft-tissue wounds. The lower rungs of the ladder include simpler reconstructive options such as the use of skin grafts and local flaps, and the higher rungs represent complex techniques such as free tissue transfer. Although there is no notable difference between muscle and fasciocutaneous/perforator flaps in reconstructive outcomes, there has been a trend toward perforator flaps to minimize donor site morbidity.

Effects of Foot Orthoses on Pain and the Prevention of Lower Limb Injuries in Runners: Systematic Review and Meta-Analysis.

CONTEXT: A variety of approaches have been proposed to prevent lower limb injuries in runners. However, the evidence for the effectiveness of interventions to reduce lower limb pain and injury after intensive running is very weak. OBJECTIVE: The authors performed a systematic review to investigate the effects of foot orthoses on pain and the prevention of lower limb injuries in runners. EVIDENCE ACQUISITION: The authors searched the MEDLINE/PubMed, Physiotherapy Evidence Database, Scielo, and Cochrane Central (from inception to February 2022) databases for randomized controlled trials that evaluated the effects of foot orthoses in runners. The authors then calculated mean differences and 95% confidence intervals from these trials. Heterogeneity was assessed using the I2 test. Furthermore, the authors compared the criteria between runners with foot orthoses and ones with no intervention (control group). EVIDENCE SYNTHESIS: Twelve studies (5321 runners) met our review criteria. The control and the foot orthoses group sustained 721 (37%) and 238 (24%) injuries, respectively. Compared with the control group, the use of foot orthoses resulted in a significant reduction in lower limb injury risk (risk ratio = 0.6; 95% confidence interval, 0.5-0.7; P = .00001, I2 = 54%; 7 studies, N = 2983: moderate-quality evidence). Moreover, the foot orthoses group corresponded to a 40% reduction in the risk of developing lower limb injuries. CONCLUSIONS: The use of foot orthoses may help reduce the incidence of lower limb injuries and pain in runners.

Enclavado endomedular en fracturas de tibia. ¿Existe una relación entre el punto de entrada para la inserción del clavo y su alineación final? / Intramedullary nailing of tibial fractures. Is there a relationship between the entry point and its final alignment?

Introducción: Las fracturas de tibia representan aproximadamente el 2% de las fracturas del adulto. El enclavado endomedular es hoy el procedimiento de elección para tratar fracturas diafisarias de tibia; sin embargo, esta técnica no está exenta de complicaciones, la desalineación en el plano coronal es una de las más frecuentes y temidas por los cirujanos. El objetivo de este estudio fue investigar la relación entre el punto de entrada del clavo y la desalineación en el plano coronal después de la cirugía. Materiales y Métodos: Se realizó un estudio retrospectivo, descriptivo, observacional, entre enero de 2015 y enero de 2019, de pacientes con fracturas diafisarias de tibia, tratadas con clavo endomedular. Se obtuvieron radiografías en el posquirúrgico inmediato y luego cada dos meses, se tuvo en cuenta la radiografía del octavo mes, en la que se observaban signos francos de consolidación ósea, para valorar la alineación tibial. Resultados:Cuando el punto de entrada del clavo fue central, hubo apenas un 0,021 de posibilidades (o 2,1%) de alguna desalineación significativa en el posquirúrgico inmediato y luego de 8 meses. En cambio, cuando fue medial, las posibilidades de una tendencia al valgo fueron >0,85 (u 85%) ya al tomar la primera imagen, i.e., poscirugía; y cuando fue lateral, esta posibilidad se modifica y profundiza según el tiempo transcurrido hasta la imagen lograda en el paciente. Conclusión: Se observó una relación marcada y continua entre el punto de entrada del clavo endomedular y la alineación de la tibia después de la consolidación ósea. Nivel de Evidencia: IV

Introduction: Tibial fractures represent approximately 2% of adult fractures. Today, intramedullary nailing is the procedure of choice to treat diaphyseal fractures of the tibia; however, this technique is not exempt from complications, misalignment in the coronal plane is one of the most frequent and feared by surgeons. The aim of this study was to investigate the relationship between nail entry point and misalignment in the coronal plane after surgery. Materials and Methods: We carried out a retrospective, descriptive, observational study between January 2015 and January 2019 of patients with diaphyseal fractures of the tibia, treated with intramedullary nailing. Radiographs were obtained in the immediate postoperative period and then every two months. The eighth-month radiograph, in which clear signs of bone consolidation could be observed, was taken into account to assess tibial alignment. Results: When the nail entry point was central, there was only a 0.021 chance (or 2.1%) of any significant misalignment in the immediate postoperative period and after 8 months. In contrast, when it was medial, the chances of a valgus tendency were >0.85 (or 85%) already at the first image, i.e., post-surgery; and when it was lateral, this possibility was modified and deepenedaccording to the time elapsed until the image achieved in the patient. Conclusion: A marked and continuous relationship wasobserved between the entry point of the intramedullary nail and the alignment of the tibia after bone consolidation..Level of Evidence: IV

The Use of Physical Screening Tools to Identify Injury Risk Within Pre-Professional Ballet Dancers: An Integrative Review / El uso de herramientas de cribado física para identificar el riesgo de lesiones en los bailarines de ballet preprofesionales: Una revisión integradora

Objective. To conduct an integrative review of all relevant research investigating the physical risk factors for injury within pre-professional ballet dancers, to provide insight that may benefit practitioners within these institutions and highlight areas for future research within this specialised population.Design. Studies were identified from the following electronic databases: MEDLINE via PubMed, SPORTDiscus via EBSCOhost, and Web of Science Core Collection via Web of Science. 8,415 titles were identified during the electronic search process. Five studies satisfied the inclusion criteria and were included in the review. The mod-ified Agency for Healthcare Research and Quality (AHRQ) scale for observational studies was used to assess study quality.Results. The review identified that the following physical characteristics may influ-ence prospective injury risk in pre-professional ballet dancers: age and maturation status, anthropometrics and body composition, strength and power, joint mobility and range of motion, specific dance function, and cardiorespiratory fitness.Limitations. The research identified lacked methodological quality. This, com-bined with the low number of studies identified, makes the design of screening pro-tocols challenging for practitioners.Originality. Despite the number of pre-professional balletic institutions worldwide, previous reviews have not used a systematic search strategy or investigated both sexes in this cohort. Due to the unique demands of ballet, an understanding of the inter-action between injury and physical characteristics is a critical step in order to reduce injury burden. Conclusions. This review succeeded in determining risk factors for injury within this population, but, due to insufficient evidence, could not provide robust screening recommendations

Objetivo. Llevar a cabo una revisión integradora de toda la investigación relevante sobre los factores de riesgo físico de las lesiones en los bailarines de ballet preprofesionales, para proporcionar una visión que pueda beneficiar a los profesionales de estas instituciones y resaltar las áreas para futuras investigaciones en esta población especializada. Diseño. Los estudios se identificaron en las siguientes bases de datos electrónicas: MEDLINE vía PubMed, SPORTDiscus vía EBSCOhost y Web of Science Core Collection vía Web of Science. Se identificaron 8.415 títulos durante el proceso de búsqueda electrónica. Cinco estudios cumplieron los criterios de inclusión y se incluyeron en la revisión. Para evaluar la calidad de los estudios, se utilizó la escala modificada de la Agency for Healthcare Research and Quality (AHRQ) para estudios observacionales. Resultados. La revisión identificó que las siguientes características físicas pueden influir en el riesgo prospectivo de lesiones en los bailarines de ballet preprofesionales: edad y estado de maduración, antropometría y composición corporal, fuerza y potencia, movilidad articular y amplitud de movimiento, función específica de la danza y aptitud cardiorrespiratoria. Limitaciones. La investigación identificada carecía de calidad metodológica. Esto, combinado con el bajo número de estudios identificados, hace que el diseño de protocolos de detección sea un reto para los profesionales. Originalidad. Las revisiones anteriores no han utilizado una estrategia de búsqueda sistemática ni han investigado ambos sexos en esta cohorte. Debido a las exigencias únicas del ballet, la comprensión de la interacción entre las lesiones y las características físicas es un paso fundamental para reducir la carga de lesiones. Conclusiones. Esta revisión logró determinar los factores de riesgo de lesiones dentro de esta población, pero, debido a la insuficiencia de evidencia, no pudo proporcionar recomendaciones sólidas de cribado.

Puntaje predictivo de resultado en la cirugía reconstructiva de miembros inferiores. Ensayo preliminar / Predictive outcome score in lower limb reconstructive surgery. Preliminary test

Introducción: Las secuelas postraumáticas en los miembros son un cuadro de muy difícil abordaje por la gravedad de las lesiones, la falta de protocolos de tratamiento y especialmente por la elección de la mejor alternativa. El objetivo de este estudio fue analizar el resultado del tratamiento reconstructivo con un puntaje prequirúrgico diseñado para tal fin y evaluar su predictibilidad de resultado. Materiales y métodos: Se realizó un análisis retrospectivo de tipo cohorte de los resultados del tratamiento con fijación externa en 32 pacientes con secuela traumática de la pierna en los últimos siete años que fueron estadificados con un puntaje preoperatorio elaborado para tal fin y comparado con el resultado obtenido con la tabla de resultados de la ASAMI con dos años de seguimiento mínimo. Resultados:Se obtuvo una relación directa entre la estadificación prequirúrgica y el resultado final. Dicha relación se ve reflejada en el alto porcentaje de excelentes resultados en pacientes de bajo riesgo (50%) y una tasa del 60% de malos resultados en pacientes de alto riesgo. Conclusiones: La evidencia actual es contradictoria y se discute cuál es la mejor opción de tratamiento. Los pacientes considerados de alto riesgo tienen un alto porcentaje de malos resultados y tal vez no se beneficien con la cirugía reconstructiva. Nivel de Evidencia: IV

Introduction: Post-traumatic sequelae in the limbs are a very difficult condition to approach due to the severity of the injuries and the lack of treatment protocols, which considerably hinder the choice of the best treatment alternative. The objective of this study was to analyze the outcomes of reconstructive treatment with a pre-surgical score designed ad-hoc and to evaluate its predictability. Materials and methods: A retrospective cohort-type analysis of the outcomes of external fixation treatment was performed in 32 patients with traumatic leg sequelae in the last 7 years who were staged with a pre-operative score designed ad-hoc. This was compared with the results obtained with the ASAMI score with a minimum 2-year follow-up. Results: We obtained a direct relationship between pre-surgical staging and the final outcome. This relationship is reflected by obtaining a high percentage of excellent outcomes in low-risk patients (50%) and 60% of poor outcomes in high-risk patients. Conclusions: The current evidence is contradictory and there is controversy over which is the best treatment option. We found that high-risk patients have a high percentage of poor outcomes and may not benefit from reconstructive surgery. Level of Evidence: IV

Reconstrucción con colgajo peroneo posterior para cobertura de defectos del tercio distal de la pierna y el tercio proximal del pie / Reconstruction with posterior peroneal flap to cover defects in the distal third of the leg and the proximal third of the foot

El colgajo peroneo posterior es un colgajo fasciocutáneo, que está basado en 4 posibles fuentes como son perforantes fasciocutáneas de la arteria peronea, perforantes fasciocutáneas de la arteria tibial posterior, perforantes venocutáneas de la vena safena menor y perforantes neurocutáneas del nervio sural. El objetivo de este trabajo es describir la técnica quirúrgica y demostrar la versatilidad que tiene el colgajo peroneo posterior para la reconstrucción y cobertura de defectos del tercio distal de la pierna y el tercio proximal del pie, proporcionando el potencial para el cierre simple y eficiente de dichos defectos. Este colgajo proporciona grandes ventajas debido a que es reproducible en cualquier centro quirúrgico y no requiere un entrenamiento específico en microcirugía del cirujano y del resto del equipo quirúrgico. Si bien las complicaciones existen, la mayoría no son graves y en general son de resolución simple. En los últimos años, se ha incrementado el empleo del colgajo fasciocutáneo peroneo posterior para lograr la cobertura de los defectos de partes blandas del tercio distal de la pierna y pie. El éxito de estos colgajos está relacionado con el tipo de paciente y de su lesión: el porcentaje es alto en pacientes jóvenes y sanos en quienes el origen del defecto es traumático.

The posterior peroneal flap is a fasciocutaneous flap, which is based on 4 possible sources such as fasciocutaneous perforations of the peroneal artery, fasciocutaneous perforations of the posterior tibial artery, venocutaneous perforations of the saphenous vein, and neurocutaneous perforators of the sural nerve. The objective of this work is to describe the surgical technique and demonstrate the versatility of the posterior peroneal flap for the reconstruction and coverage of defects in the distal third of the leg and the proximal third of the foot, providing the potential for simple and efficient closure of said defects. It provides great advantages because it is reproducible in any surgical center and does not require specific training in microsurgery of the surgeon and the rest of the surgical team. Although complications do exist, most are not serious and are generally of simple resolution. In recent years, the use of the posterior peroneal flap has been increased to achieve coverage of soft tissue defects of the distal third of the leg and foot. The success of these flaps is related to the type of patient and his injury, the success rate is high in young and healthy patients in whom the origin of the defect is traumatic.

Tratamiento con clavo endomedular de las fracturas metafisarias proximales y distales de tibia: Abordaje pararrotuliano medial en posicion de semiextension / Intramedullary nailing treatment of proximal and distal tibia metaphyseal fractures. Medial parapatellar approach in semi-extended position

Objetivo: El enclavado endomedular de las fracturas metafisarias de tibia se asocia con algunas complicaciones relacionadas con la necesidad de flexionar la rodilla durante la introducción del clavo endomedular con la técnica infrarrotuliana clásica. Es por ello, que se han diseñado diferentes abordajes para la colocación del clavo en una posición de semiextensión de rodilla. El objetivo fue evaluar nuestros resultados, de forma retrospectiva, con el abordaje pararrotuliano medial en semiextensión, para el tratamiento de las fracturas metafisarias proximales y distales de tibia con clavo endomedular. Materiales y Métodos: Se incluyó a 23 pacientes con un seguimiento posoperatorio mínimo de un año. Doce eran fracturas distales de tibia; 9, proximales y 2, segmentarias. Se evaluaron el rango de movilidad de la rodilla, el dolor posoperatorio con la escala de Lysholm, el eje posoperatorio y la tasa de consolidación. Resultados: El arco de movilidad de la rodilla fue de 125° (rango 110-140). Al año de la cirugía, 16 de 23 pacientes no tenían dolor, 5 de 23 refirieron un leve dolor durante la actividad física y 2, dolores intensos durante la actividad física. En todos los casos, se consiguió un eje posoperatorio aceptable y la consolidación ósea. Un paciente requirió un aumento con una placa e injerto óseo. Conclusión: La colocación de un clavo de tibia a través de un abordaje pararrotuliano medial con la rodilla en semiextensión es una técnica segura y simple para el tratamiento de las fracturas metafisarias de tibia. Nivel de Evidencia: IV

Objective: To review the results of a series of metaphyseal tibial fractures treated with intramedullary nailing (IMN) in a semiextended position using a medial parapatellar approach. To report reduction quality, bone consolidation, range of motion (ROM) and postoperative knee pain at final follow-up. Materials and Methods: Twenty-three metaphyseal tibia fractures were treated with IMN. Twelve were distal tibial fractures (AO/OTA 43A), nine were proximal tibial fractures (AO/OTA 41A2/3), and two had segmental tibia fractures (AO/OTA 42C2). The minimum follow-up was 1 year. Results: Radiograph angulation at the fracture site was <5 degrees. All patients achieved bone healing. One patient (AO/OTA 42C2) required plate augmentation and bone autografting. Twenty-one out of 23 patients had knee pain scores of >20 according to the Lysholm scale. Conclusion: The parapatellar approach in a semi-extended position is a safe and useful technique for IMN of metaphyseal tibia fracture with no associated increased postoperative knee pain. Level of Evidence: IV

Colgajo de perforante de la arteria tibial posterior: Serie de casos / Posterior tibial artery perforator flap. Case series

Introducción: Los defectos de cobertura en la pierna son un problema difícil de solucionar debido a las características propias de la región anatómica. Por ello, se han desarrollado distintas estrategias de reconstrucción, y los colgajos de perforante fasciocutáneos son los que se utilizan con más frecuencia. Objetivos: Presentar la alternativa terapéutica, describir la técnica quirúrgica, los resultados y las complicaciones del colgajo de perforante de la arteria tibial posterior para el tratamiento de defectos de cobertura en la pierna. Materiales y Métodos: Se realizó una revisión retrospectiva de los pacientes tratados con colgajo fasciocutáneo en la pierna y operados en nuestro Centro. Se analizaron variables demográficas preoperatorias. Se describen la técnica quirúrgica y las indicaciones en cada paciente. Se analizaron variables posoperatorias, como las complicaciones y la supervivencia del colgajo. Resultados: Se incluyeron 12 hombres tratados con colgajo de perforante de la arteria tibial posterior. El promedio de edad en el momento de la cirugía fue de 52 años (rango 29-77). El seguimiento máximo fue de 55 meses y el mínimo, de 5 meses (promedio 18). Hubo dos colgajos con sufrimiento transitorio, una falla parcial y una falla total. Conclusiones: El colgajo de perforante de la arteria tibial posterior ha de ser considerado una opción válida en el tratamiento de heridas de pequeño y mediano tamaño de la pierna. Provee de tejido similar en grosor, textura y color en el sitio receptor con buenos resultados clínicos y estéticos. Nivel de Evidencia: IV

Introduction: Coverage defects in the leg are a challenge due to the particulars of the anatomy in said area, different reconstruction strategies have been developed, being the fasciocutaneous perforator flaps the most frequently used. The aim of this paper is to discuss the therapeutic alternative and to describe the surgical technique, the results and the complications of the posterior tibial artery perforator flap (PTAPF) to treat coverage defects. Materials and Methods: We performed a retrospective review of patients treated with a fasciocutaneous flap. We analyzed preoperative demographic variables. The surgical technique and the indications in each patient are described. Finally, the postoperative variables, such as complications and flap survival, were analyzed. Results: Twelve patients (all male) treated with PTAPF were included. The average age at the time of surgery was 52 years (range: 29-77 years). The maximum follow-up was 55 months, with a minimum of 5 months (average: 18 months). There were two flaps with transient congestion that reverted spontaneously: one partial failure and one total failure. Conclusions: PTAPF should be considered a viable option for the treatment of small- and medium-sized leg wounds, since they provide similar tissue thickness, texture and color on the recipient site, achieving good clinical and cosmetic results. Level of Evidence: IV

Lower Limb Reconstruction - Fasciocutaneous Sural Flap / Reconstrução de membro inferior- retalho fasciocutâneo sural

Abstract Objective The present study aims to evaluate the use of the reverse-flow sural fasciocutaneous flap to cover lesions in the distal third of the lower limb. Methods A total of 24 cases were analyzed, including 20 traumatic injuries, 3 sports injuries, and 1 case of tumor resection. Results Among the 24 evaluated medical records, 16 patients were male, and 8 were female. Their age ranged from6 to 75 years old. Most of the patients evolved with total healing of the flap (n= 21). There was only one case of total necrosis of the flap in an insulin-dependent diabetic, high blood pressure patient, evolving to subsequent limb amputation. In two cases, there was partial necrosis and subsequent healing by secondary intention; one of these patients was a heavy smoker. Complications were associated with comorbidities and, unlike other studies, no correlation was observed with the learning curve. There was also no correlation with the site or size of the lesion to be covered. Conclusion It is clinically relevant that the success rate of the reverse-flow sural fasciocutaneous flap technique was of 87.5%. This is a viable and effective alternative in the therapeutic arsenal for complex lower limb lesions.

Resumo Objetivo Avaliar o uso do retalho fasciocutâneo sural de fluxo reverso na cobertura de lesões no terço distal dos membros inferiores. Métodos Foram analisados 24 casos, 20 de origem traumática, três por lesões esportivas e um por ressecção de lesão tumoral. Resultados Dos 24 prontuários avaliados, 16 eram homens e oito mulheres. A idade variou de seis a 75 anos. A maioria dos pacientes evoluiu com cicatrização total do retalho (21). Houve apenas um caso de necrose total do retalho em paciente diabético insulinodependente e hipertenso, evoluiu para posterior amputação do membro. Em dois casos, houve necrose parcial composterior cicatrização por segunda intenção, um desses pacientes era tabagista pesado. As complicações foram associadas às comorbidades e, ao contrário do evidenciado por outros estudos, não houve correlação com a curva de aprendizado. Também não houve correlação com o local ou o tamanho da lesão a ser coberta. Conclusão Tem-se como relevância clinica que a técnica de retalho fasciocutâneo sural de fluxo reverso usada obteve 87,5% de sucesso, é uma opção viável e eficaz no arsenal terapêutico das lesões complexas dos membros inferiores.

Frequency and associated factors of poor knee alignment in young Brazilian volleyball players.

Objectives: Poor knee alignment during the deceleration phase of closed kinetic chain movements, such as landings, is a relevant risk factor for injuries in sports. This study assessed the knee alignment and possible associated factors in young Brazilian volleyball athletes Methods: One hundred and seventeen athletes of both genders (9-19 years old) were assessed during a drop jump for the observation of knee alignment. Chi-square test was used to describe the association between poor knee alignment and: gender, age category (≤14 years and ≥15 years), sports experience, participation in competitions, the presence of knee pain during training, and history of lower limb injury Results: Seventy percent of athletes presented poor knee alignment, which was slightly associated with a sports experience lower than one year. Conclusion: Thus, considering the high number of volleyball practitioners and its strong presence in physical education classes, preventive measures should be adopted for young volleyball athletes of both genders, especially in the sports initiation phase.

Reduced Anterolateral Thigh Flap Donor-Site Morbidity Using Incisional Negative Pressure Therapy.

BACKGROUND: Primary closure of the donor-site after harvest of a large anterolateral thigh flap (ALT) is associated with significant morbidity. Incisional negative pressure therapy (INPT) may decrease complications in high-risk incisions. This study assessed if the incidence of complications after primary closure of the ALT flap donor-site decreases with INPT. METHODS: Retrospective cohort study of a prospectively maintained database including patients who underwent upper and lower limb reconstruction, using an ALT free flap with primary closure of the donor-site. Two groups were defined: primary closure and INPT (study group) and primary closure with traditional dressings (control group). Nonparametric statistics were employed to identify prognostic factors, p < 0,05. RESULTS: Fifty-eight free ALT flaps in 58 patients (study group n = 28; control group n = 30) were included. Median flap width and length were 9 cm (range: 5-14) and 25 cm (range: 10-48), respectively. Median follow-up was 19 months (range: 3-78 months). No significant differences in age or flap size were identified in both groups (p > 0.05). The global complication rate was 7.14% (n = 2) in the INPT group, and 37% (n = 11) in the control group (p = 0.007). The study group had a lower dehiscence and skin necrosis rate (p < 0.05). Multivariate logistic regression analysis showed IPNT was associated with a significant reduction of donor-site complications (p = 0.006), especially in patients with defects > 8 cm (p = 0.003). CONCLUSION: In this cohort study the use of INPT significantly reduced the donor-site morbidity after ALT flap harvest.

"Tennis Leg": Resultados de la evacuación bajo guía ecográfica, con o sin aplicación de plasma rico en plaquetas / Tennis Leg. Results of hematoma under ultrasound-guided aspiration with or without platelet-rich plasma application

Introducción: El Tennis Leg o pierna de tenista se llama a el desgarro de la unión miotendinosa distal del gemelo interno, con o sin la formación de hematoma interfascial. Objetivo: Evaluar los resultados de la evacuación del hematoma bajo guía ecográfica con o sin aplicación de plasma rico en plaquetas (PRP). Material y métodos: Se evaluaron retrospectivamente una serie de pacientes con cuadro de pierna de tenista con menos de un mes de evolución a los cuales se le realizó la aspiración del hematoma interfascial bajo guía ecográfica. A un grupo se les aplicó PRP interfascial y en la lesión y a otro grupo no. Se documentó la recidiva del hematoma, tiempo retorno deportivo y complicaciones. Resultados: Se evaluaron 17 pacientes con un seguimiento de 4,7 años (2,1 - 6,3) a nueve se les aplicó PRP (grupo A) y a ocho no se les aplicó PRP (grupo B). En el grupo B, cuatro pacientes (50%) presentaron una recidiva y dos de ellos (25%) una re-recidiva. El grupo A no presentó recidiva del hematoma. El tiempo de retorno al deporte fue para el grupo A de 9,6 semanas (7,8 ­ 12,2) y para el grupo B de 14,3 semanas (8,2 ­ 17,2). Dos pacientes (22,22%) del grupo A y cuatro pacientes (50%) del grupo B presentaron una fibrosis interfascial. Conclusión: Creemos que la evacuación ecoguiada del hematoma interfascial en pacientes con pierna de tenista, es un procedimiento válido para evitar complicaciones. La posterior aplicación del PRP interfacial y en el foco del desgarro disminuye el riesgo de recidiva del hematoma y acorta el tiempo de retorno al deporte. Nivel de evidencia: IV

Introduction: Tennis Leg, or the tear of the distal myotendinous junction of the inner calf muscle, with or without interfascial hematoma, is a frequently underdiagnosed injury. Objective: To evaluate the results of hematoma aspiration under ultrasound guidance, with or without the application of platelet-rich plasma (PRP). Material and methods: A number of patients with a clinical presentation of Tennis Leg were retrospectively evaluated. Those who presented with the case within the last 30 days were included. Ultrasound-guided aspiration of the interfascial hematoma was performed. Only one group received interfascial PRP and into the injury, while the other group did not. Recurrence of the hematoma, return-to-sport time and complications were documented. Results: Seventeen patients were evaluated with an average follow-up time of 4.7 years (2.1 - 6.3). Nine patients (group A) received a PRP injection whereas 8 (group B) did not. In group B, 4 patients (50%) presented with a recurrence of the hematoma and 2 patients (25%) with a re-recurrence of such lesion. On the other hand, group A did not experience a recurrence of the hematoma. On average, the return-to-sport time was 9.6 weeks (7.8 - 12.2) for group A and 14.3 weeks (8.2 - 17.2) for group B. Finally, 2 patients (22.22%) in group A and 4 patients (50%) in group B presented with interfascial fibrosis. Conclusion: We believe that ultrasound-guided aspiration of the interfascial hematoma in Tennis Leg is a fundamental procedure. The application of interfascial PRP and into the tear, lowers the risk of recurrence and reduces the return-to-sport time. Level of evidence: IV