Avulsion Fractures of Posterior Calcaneal Tuberosity: Identification of Prognostic Factors and Classification.

Avulsion fractures of the posterior calcaneal tuberosity are rare injuries, and little is known about the underlying factors, outcomes, and prognosis. Furthermore, classifications described previously focus on fracture morphology, with uncertain clinical utility. We present the results of a retrospective study of 21 patients treated for this pathology from January 2002 to December 2015. Features analyzed were age; sex; mechanism of injury; medical comorbidities; type of fracture, as proposed by Beavis; fracture displacement; fragment size; type of treatment; complications; need for secondary surgery; and the American Orthopaedic Foot and Ankle Society score after treatment and follow-up care. Mean age was 56.95years. A total of 61.9% were females, and 71.4% were secondary to low-energy trauma. In addition, 19% were diabetic. Mean follow-up was 57.24 months. Surgery was performed in 81%. Complications rate was 61.9%, and secondary surgery was needed in 38.1%. Mean fracture displacement was significantly higher when complications occurred (25.91mm versus 7.61 mm) (p = .03) and when soft tissues complications appeared (30.65mm versus 14.68 mm) (p = .02). Female gender was associated with the secondary loss of reduction (p = .04). The Beavis classification was not related significantly with any outcome variable. When fracture displacement was ≥2cm, complication rate increased from 30% to 90.9% (p = .008) and soft tissue compromise increased from 0% to 45.45% (p = .035). A new classification system with prognostic value is described, based on fracture displacement. We present 1 of the largest series published to date; fracture displacement is a major variable that influences the outcomes of these injuries, and a new classification attending to a prognostic factor is developed.

Neuroprotección antenatal en recién nacidos pretérmino. Propuesta de un centro terciario / Prenatal neuroprotection in preterm neonates. A proposal made by a tertiary hospital

Diversos trabajos publicados en últimos años apoyan que el uso del sulfato de magnesio como neuroprotector antenatal administrado ante la inminencia de un parto pretérmino reduce el riesgo de padecer severas secuelas neurológicas en los recién nacidos. Guías clínicas de actuación de diversos países apoyan la instauración de estos tratamientos neuroprotectores. En nuestro trabajo haremos una revisión del problema, de la bibliografía al respecto y realizaremos una propuesta metódica de un protocolo de neuroprotección dirigido a intentar reducir la morbilidad neurológica de los nacidos pretérmino con una terapia que ya ha demostrado su efectividad. Al mismo tiempo, invitamos a diferentes hospitales a sumarse a nuestra propuesta aportando elementos de mejora y participando en estudios multicéntricos que nos permitan evaluar en un tiempo razonable los resultados de esta actuación cotejándolos con los publicados hasta ahora en la literatura (AU)

Several recent studies provide evidence that the use of magnesium sulfate as a prenatal neuroprotector administered in imminent preterm delivery reduces the risk of severe neurologic sequelae in newborns. Clinical guidelines from various countries support the implementation of these neuroprotective therapies. The present study provides a review of the problem and of the pertinent literature and describes a protocol for neuroprotection that attempts to reduce neurological morbidity in preterm newborns by using a treatment with proven effectiveness. At the same time we invite other hospitals to join our proposal, contribute improvements, and participate in multicenter studies that would allow us to evaluate in a timely manner the results of this protocol by comparing them with data published in the literature (AU)