[Clinical experience on the management of post-traumatic bone defects of long bones treated with the membrane induction technique]. / Experiencia clínica en el manejo de defectos óseos postraumáticos de huesos largos tratados con la técnica de inducción de membrana.

INTRODUCTION: bone defects drastically alter the patient's quality of life, and can produce serious sequelae such as dysfunctional shortening, angular deformity, joint stiffness and irreversible gait disorder. OBJECTIVE: to describe the experience of managing post-traumatic bone defects of long bones treated with the membrane induction technique. MATERIAL AND METHODS: retrospective observational study of patients with bone defects greater than 3 cm in diaphyseal pseudoarthrosis of long bones, who underwent the Masquelet technique. Period taken from January 2019 to January 2021. All patients underwent vigorous debridement and stabilization of the fracture, to then place the cement spacer. Spacer removal was at 4-6 weeks. The degree of consolidation was assessed, as well as the evolution of the treatment. RESULT: 25 patients were included in the study; the mean age was 36.8 ± 8.9 years. Diameter of bone losses was 3 to 10 cm (84%) and > 10 cm (16%). Bone consolidation occurred in patients with a defect < 10 cm (16%). 32% of patients presented some complication. CONCLUSIONS: bone union was achieved only in a few patients with defects smaller than 10 cm, requiring alternative procedures in most cases. Proper selection of patients is required.

INTRODUCCIÓN: los defectos óseos alteran drásticamente la calidad de vida del paciente y pueden producir serias secuelas como acortamiento disfuncional, deformidad angular, rigidez articular y trastorno irreversible de la marcha. OBJETIVO: describir la experiencia clínica en el manejo de defectos óseos postraumáticos de huesos largos tratados con la técnica de inducción de membrana. MATERIAL Y MÉTODOS: estudio observacional, retrospectivo, de pacientes con defectos óseos mayores de 3 cm con pseudoartrosis diafisaria de huesos largos, a los que se aplicó la técnica de Masquelet. En el período de Enero de 2019 a Enero de 2021. A todos los pacientes se les realizó desbridamiento enérgico y estabilización de la fractura, para posteriormente colocar el espaciador de cemento. El retiro del espaciador fue a las 4-6 semanas. Se valoró el grado de consolidación y la evolución del tratamiento. RESULTADOS: se incluyeron 25 pacientes, la media de edad fue de 36.8 ± 8.9 años. El diámetro de las pérdidas óseas fue de 3 a 10 cm (84%) y > 10 cm (16%). La consolidación ósea se presentó en pacientes con un defecto < 10 cm (16%). Treinta y dos por ciento de los pacientes presentó alguna complicación. CONCLUSIONES: la consolidación ósea se logró sólo en aquellos pacientes con defectos < 10 cm, requiriendo procedimientos alternativos a la técnica de inducción de membrana en la mayoría de los casos. Se requiere una selección adecuada de pacientes para lograr la consolidación ósea por medio de esta técnica.

[Four years follow up in congenital talipes equino varus patients managed with Ponseti method]. / Seguimiento por cuatro años de pacientes con pie equinovaro aducto congénito manejados con método Ponseti.

INTRODUCTION: Congenital talipes equino varus (club foot) is a frequent congenital deformity of the foot. The Ponseti method is the gold standard for treatment. It consists of foot manipulation with weekly serial cast, minimally invasive surgery and Dennis-Brown bar up to five years. OBJECTIVE: To describe the follow-up of patients with PEVAC treated using the Ponseti method. MATERIAL AND METHODS: Descriptive, longitudinal study, during 2013-2019, in patients with PEVAC managed with Ponseti method. We included patients with uni- or bilateral club foot, under two years of age, without prior surgery, whose parents signed informed consent. Patients with other malformations were excluded. Serial weekly cast was placed for 4-8 weeks, a tenotomy of the Achilles tendon was performed, and cast for three more weeks; then reverse footwear with Dennis-Brown bar. The revisions were recorded at day zero, at eight weeks and every three months up to five years of age. Correction of deformity and pain on walking was assessed. RESULTS: There were 22 patients; 17 (77.3%) corrected more than 90% of the deformity, with adequate functionality and 86.3% without pain on gait, mean follow-up 3.9 years (1-7 years); six patients relapsed (27.27%) due to poor attachment, one re-treated with cast, and five with anterior tibial transfer, all successfully. CONCLUSIONS: The club foot managed with Ponseti method corrects more than 90% of the deformity and without or minimal pain with good adherence to treatment. We had a 27.27% recurrence in our series.

INTRODUCCIÓN: El pie equinovaro aducto congénito (PEVAC) es una deformidad congénita frecuente del pie. El método Ponseti es el estándar de oro para el tratamiento. Consiste en la manipulación del pie con yesos seriados semanales, una cirugía mínimamente invasiva y barra Dennis-Brown hasta los cinco años. OBJETIVO: Describir el seguimiento de los pacientes con PEVAC tratados mediante método Ponseti. MATERIAL Y MÉTODOS: Estudio descriptivo, longitudinal, durante 2013-2019, en pacientes con PEVAC manejados con método Ponseti. Se incluyeron pacientes con PEVAC uni- o bilateral, menores de dos años, sin cirugía previa, cuyos padres firmaron consentimiento informado. Se excluyeron pacientes con otras malformaciones. Se colocó yeso semanal seriado por cuatro a ocho semanas, se realizó tenotomía del tendón de Aquiles y yeso por tres semanas más; luego calzado de horma inversa con barra Dennis-Brown. Se registraron las revisiones al día cero, a las ocho semanas y cada tres meses hasta los cinco años de edad. Se valoró la corrección de la deformidad y el dolor a la marcha. RESULTADOS: Fueron 22 pacientes; 17 (77.3%) corrigieron más de 90% de la deformidad, con adecuada funcionalidad y 86.3% sin dolor a la marcha, seguimiento medio de 3.9 años (uno a siete años); seis pacientes tuvieron recidiva (27.27%) por mal apego, uno retratado con yesos y cinco con transferencia de tibial anterior, todos con éxito. CONCLUSIONES: El PEVAC manejado con método Ponseti corrige más de 90% de la deformidad y sin o mínimo dolor con buen apego al tratamiento. Tuvimos una recidiva de 27.27% en nuestra serie.

[Analysis to determine optimal age for surgical management of equinus foot in patients with childhood cerebral palsy]. / Análisis para determinar la edad óptima para el manejo quirúrgico del pie equino en pacientes con parálisis cerebral infantil.

INTRODUCTION: Childhood cerebral palsy, a non-progressive brain injury, occurs before, during or after delivery, with variable neurological damage from mild to disabling. The deformity in equine is treated conservatively at an early age, but when is surgical management indicated? OBJECTIVE: Our goal was to determine the optimal age for surgical management of the equine foot in CCP patients. MATERIAL AND METHODS: Retrospective study, in patients diagnosed with CCP (all types), treated surgically with open or percutaneous Achilles tendon elongation, assessed with external consultation notes, in patients aged 1-16 years, and average follow-up of 6 years, evaluating progress with relapse of deformity and gait with plantigrade support. RESULTS: 55 patients, 74 equinus feet (29 in girls, 45 in boys) were analyzed with surgical treatment. Those treated before six years old presented relapses, with vulnerable period in 4-6 years. Monoplegia presented 100% relapses, and triplegia presented 0%. Open surgery presented 50% recurrence and percutaneous technique only 19%. CONCLUSION: In our institution, the optimal age is suggested in 6-12 years. Percutaneous technique over the open, should be preferred, and greater attention should be paid to monitoring monoplexy.

INTRODUCCIÓN: La parálisis cerebral infantil es una lesión cerebral no progresiva que ocurre antes, durante o después del parto y provoca daño neurológico variable que oscila de leve hasta discapacitante. La deformidad en el pie equino se trata conservadoramente en edades tempranas, pero ¿cuándo está indicado el manejo quirúrgico? OBJETIVO: Determinar la edad óptima para el manejo quirúrgico del pie equino en pacientes con PCI. MATERIAL Y MÉTODOS: Estudio retrospectivo realizado en pacientes con diagnóstico de PCI (todos los tipos), tratados quirúrgicamente con alargamiento del tendón de Aquiles abierto o percutáneo y valorados con notas de la consulta externa; los pacientes tuvieron de 1-16 años y un seguimiento promedio de seis años, valorándose la marcha con recidiva de deformidad y la marcha plantígrada. RESULTADOS: Se analizaron 55 pacientes, 74 con pie equino (29 niñas y 45 niños); de éstos, presentaron más recidivas los operados antes de los seis años de edad, con un período vulnerable entre los cuatro y seis años. La monoplejía registró 100% de recidivas, mientras que la triplejía 0%. La cirugía abierta se asoció con recurrencia en 50% y la cirugía percutánea sólo en 19%. CONCLUSIONES: En nuestra institución, se sugiere que la edad óptima de la cirugía esté entre los 6-12 años. Es preferible la técnica percutánea sobre la abierta, debiendo poner mayor atención en el seguimiento de la monoplejía.

[Acromioclavicular dislocation management with use of Tight Rope luxation acromioclavicular con Tight Rope]. / Manejo quirúrgico de la luxación acromioclavicular grado III con sistema de anclaje doble botón.

INTRODUCTION: The acromioclavicular joint, important part of the shoulder complex is formed by clavicular lateral end and acromial medial border, with high index of injury in different grades, associated to physical activity and work accidents, most commonly in active young adults. OBJECTIVE: To analyze functional outcomes in patients with acromioclavicular dislocation with use of tight rope in one year. Material and methods: Descriptive, prospective, longitudinal, unicentric study, from March 2015 and July 2016 in post-operated patients with diagnosis of acromioclavicular dislocation grade III in Hospital de Traumatología y Ortopedia de Puebla. Patients aged 18 to 45 years were included, active workers, with evolution time 7 days. RESULTS: 17 patients with diagnosis of acromioclavicular dislocation, fourteen (82.4%) male and 3 (17.6%) female. Average age: 29.5 (19 to 44 years) ± 7.475 years; lesion occurred 9 (52.9%) patients in right shoulder and 8 (47.1%) in left side. Average time of the injury: 2.88 (1-7) ± 2,147 days. Average inability granted: 42.06 days. CONCLUSIONS: The open reduction technique and dynamic stabilization of the joint with Tight Rope offers short hospital stay, short time of inability and rapid reintegration to work activity, at 1 year of evolution.

INTRODUCCIÓN: La articulación acromioclavicular es parte importante del complejo articular del hombro, formada por el extremo lateral de la clavícula y el borde medial del acromion. Tiene un alto índice de lesión en grados asociados a actividad física y accidentes laborales. Predomina en jóvenes laboralmente activos. OBJETIVO: Analizar la funcionalidad a un año en pacientes con luxación acromioclavicular grado III, operados con sistema anclaje doble botón. MATERIAL Y MÉTODOS: Estudio descriptivo, prospectivo, longitudinal, unicéntrico, durante Marzo de 2015 a Julio de 2016, en pacientes con luxación acromioclavicular grado III en el Hospital de Traumatología y Ortopedia de Puebla. Se incluyeron pacientes con edad de 18 a 45 años, trabajadores, con evolución mayor de siete días. La estadística fue descriptiva. RESULTADOS: Fueron 17 pacientes; 14 (82.4%) hombres y tres (17.6%) mujeres. Edad promedio: 29.5 (19 a 44 años) ± 7.475 años; nueve (52.9%) pacientes en el hombro derecho y ocho (47.1%) en el izquierdo. Promedio de evolución: 2.88 (1 a 7) ± 2.147 días. Incapacidad promedio: 42.06 días. CONCLUSIONES: La reducción abierta y estabilización dinámica mediante el sistema anclaje doble botón (Tight Rope) ofrece estancia intrahospitalaria corta, poco tiempo de incapacidad, reintegración rápida a la actividad laboral y resultados funcionales adecuados a un año de evolución.

[Results of percutaneous discectomy in the management of lumbar disc herniation]. / Resultados de la nucleotomía percutánea en el manejo de la hernia discal lumbar.

INTRODUCTION: Percutaneous discectomy is a disc decompression technique approved by the FDA that is useful to improve pain caused by a herniated disc. However, its practice is under discussion because the benefits of the technique are controversial. OBJECTIVES: To describe the clinical course of patients with low lumbar disc herniation (L4-L5, L5-S1) treated by percutaneous surgery within one year of surgery and prove that it is a useful surgical option for the relief of symptoms caused by this pathological entity. MATERIAL AND METHODS: Cohort study; the clinical course of 21 patients with lumbar disc herniation treated with percutaneous discectomy manually during March 2011-November 2013, is presented. The evaluation was made before surgery and at four, 30, 180 and 365 days after surgery by numerical pain scale (NPS), Oswestry (IDO) and MacNab criteria. We used nonparametric inferential statistics (Wilcoxon) for differences in proportions. RESULTS: n = 21, six (28.57%) men, 15 (71.42%) women; average age: 37.95, (14-56) ± 10.60 years; the most affected vertebral level was L4-L5 in 57.14% of the patients; the NPS preoperative average was 7.75 (5-9) ± 1.12; at 365 days: average 2.14 (0-7) ± 2.37. The IDO preoperative average was 37% (28-40%) ± 3.06, and at 365 days: 9.52% (0-40%) ± 13.92. The prognosis (IDO) in the presurgical was good to zero (0%) patients and in 15 (71.42%) at 365 days, regular in five (23.80%) and poor in one (4.78%) (p = 0.00, CI 95% 0.00 to 0.13, Wilcoxon); according to MacNab criteria, in 15 (71.42%) patients were excellent and good, poor in four (19.04%) and bad in two (9.52%) (p = 0.00). CONCLUSIONS: Percutaneous discectomy provides good results for the treatment of lumbar disc herniation (L4-L5, L5-S1) at 365 days after surgery.

La nucleotomía percutánea es una técnica de descompresión discal aprobada por la FDA que ha mostrado ser útil para mejorar el dolor causado por hernia discal. No obstante, su práctica se encuentra en discusión debido a que los beneficios de la técnica son controversiales.

[Resection of an aneurysmal bone cyst in the proximal humerus with a non-vascularized fibular graft. Case report]. / Resección de quiste óseo aneurismático en húmero proximal con aplicación de injerto peroneo no vascularizado. Presentación de un caso.

An aneurysmal bone cyst is a benign lesion involving the marrow of long bones; it accounts for 6% of primary bone lesions and may occur as a secondary lesion with other benign or malignant bone tumors. We describe herein the case of a seven year-old female with an aneurysmal bone cyst which was diagnosed clinically, radiographically and with a CAT scan, and confirmed with histopathology. Resection was performed using the eggshell technique and a non-vascularized left fibular bone graft. The patient did well up to the fourth postoperative year, which is consistent with what has been reported in world literature.

[Cervical arthrodesis by means of interbody fusion with autologous bone and/or interbody spacer for cervical disc disease]. / Artrodesis cervical mediante fusión intersomática con hueso autólogo versus espaciador intersomático en discopatía cervical.

UNLABELLED: The purpose of this study was to compare the results of cervical arthrodesis performed through interbody fusion with autologous bone and/or interbody spacer for cervical disc disease. MATERIAL AND METHODS: Comparative cross-sectional study that included 49 patients who underwent surgery for anterior arthrodesis between January and December 2011, whose clinical records were reviewed. RESULTS: We included 49 patients: 20 (40.8%) males and 29 (59.2%) females. All of them were diagnosed with disc disease (cervical disc herniation) involving one or two levels. Mean operative time was 69.12, with a minimum of 53 and a maximum of 110 +/- 19.61 minutes for cervical arthrodesis with a graft. Mean operative time was 61.18 with a minimum of 50 and a maximum of 96.00 +/- 11.38 minutes for cer vical arthrodesis with an interbody spacer (p = 0.00, Student t test). Patient sociodemographic and clinical characteristics and complications are shown. Patients in whom both surgical techniques were used had appropriate radiological integration, with p = 0.015, considering p < or = a 0.05 as significant, chi2. CONCLUSIONS: In patients with cervical disc disease bone integration is appropriate with the use of either an interbody cage or an autologous iliac crest graft.