Tratamiento quirúrgico de las fracturas periprotésicas de húmero y algoritmo de actuación / Surgical treatment of periprosthetic humerus fractures and algorithm

INTRODUCCIÓN: Las fracturas periprotésicas de húmero son infrecuentes y su manejo, difícil. La bibliografía es limitada y no existe consenso sobre su tratamiento. MATERIAL Y MÉTODO: Hemos realizado un estudio observacional retrospectivo de 10pacientes con fractura periprotésica de húmero con un seguimiento de 25,1 meses (6-87). Valoramos los resultados clínicos, radiológicos y funcionales, como las complicaciones. Utilizamos el cuestionario Quick-DASH y UCLA Shoulder Score (UCLASS). Realizamos una búsqueda sistemática para comparar la serie presentada y los protocolos de tratamiento publicados. RESULTADOS: Diez pacientes con una media de edad de 69,4 años (37-91) fueron intervenidos quirúrgicamente: 8 mediante reducción abierta y fijación interna (RAFI), en otro se realizó un recambio protésico colocando una nueva prótesis con un vástago más largo, y en el último se retiró la prótesis y se realizó una osteosíntesis con un clavo endomedular. Nueve de 10 pacientes consolidaron en un tiempo de 6,2 meses (rango 5-12); el restante sufrió una nueva fractura 5 meses después, siendo reintervenido, realizándole una nueva osteosíntesis, con aporte de aloinjerto óseo, que consolidó a los 8meses de la última fractura. En relación con la situación previa a la fractura, los pacientes tenían como promedio un descenso notable de la función, que era de 10,66 puntos en el test de UCLASS y un ascenso de 27,3 puntos en el cuestionario Quick-DASH. CONCLUSIONES: Nuestra serie tiene similitudes con las publicadas en relación con los aspectos demográficos, las complicaciones y el tiempo de consolidación. Sin embargo, en otros aspectos, como el dolor y los resultados funcionales, encontramos gran variabilidad

INTRODUCTION: Periprosthetic humerus fractures are infrequent and sometimes difficult to treat. There is limited literature and no consensus on the handling of these fractures. The objective of this study was to compare our results with those published in the literature, in order to improve our care and propose a management algorithm. MATERIAL AND METHOD: Observational study of 10 cases of periprosthetic humerus fractures with a mean follow-up of the patients of 23 months. An analysis of sociodemographic, radiological and surgical variables was performed. They were reviewed clinically and by telephone using the UCLA Shoulder Score and Quick-DASH scales. A systematic search was made in Pubmed for periprosthetic humerus fractures, for a literature review with which to compare our series. RESULTS: We analysed 10 patients with an average age of 69.4 years (37-91). Of the patients, 90% underwent surgery through open reduction and internal fixation. Nine of the ten patients consolidated in a mean time of 6.2months (range 5-12), the remaining suffered a new fracture 5 months after the intervention, who were reoperated and a new osteosynthesis performed with bone allograft. In the UCLA scale there was a decrease of 10.66 points, and an increase of 27.3 points in the Quick-DASH, at the end of the follow-up. CONCLUSIONS: In our series of cases we found similarities in the literature, in relation to demographic aspects and obtaining good radiographic results, which do not correspond to the functional outcome of patients

Análisis de la mortalidad tras el tratamiento quirúrgico de las fracturas periprotésicas de fémur distal / Analysis of mortality after surgical treatment of periprosthetic distal femur fractures

INTRODUCCIÓN: Está aumentando la incidencia de las fracturas periprotésicas de rodilla debido al incremento en el número de artroplastias totales de rodilla realizadas, junto al envejecimiento poblacional. Encontramos escasos estudios que analicen en nuestro medio la mortalidad a largo plazo tras la intervención quirúrgica. Nuestro objetivo fue evaluar la mortalidad y la supervivencia tras el tratamiento quirúrgico de las fracturas periprotésicas de fémur distal en nuestro medio. MATERIAL Y MÉTODOS: Realizamos un estudio observacional retrospectivo de una serie consecutiva de 97 pacientes intervenidos quirúrgicamente en nuestro centro por fractura periprotésica de rodilla entre los años 2007 y 2015, con un seguimiento mínimo de 12 meses. Se analizaron estadísticamente diversas variables sociodemográficas, clínicas y quirúrgicas. Se realizó una consulta al índice nacional de defunciones del Ministerio de Sanidad para el análisis de mortalidad y se analizó la supervivencia utilizando el método Kaplan-Meier. RESULTADOS: Revisamos un total de 97 pacientes con edad media de 75años, de los cuales 86 fueron mujeres y 11 fueron hombres. El 50,5% de los pacientes presentaban alguna comorbilidad. La demora media hasta la intervención fue de 3,1 días. Respecto al tratamiento, 45 pacientes fueron intervenidos mediante osteosíntesis con placa (49,5%), 40 de ellos con clavo intramedular (41,2%) y en 9 se realizó una revisión de la artroplastia (9,3%). Se registraron un total de 30 defunciones durante el seguimiento, con una mortalidad acumulada al año, a los 3años y a los 10 años del 7,2, del 17,5 y del 30,9%, respectivamente, aumentando progresivamente en mayores de 75 años. No hubo diferencias significativas en las tasas de mortalidad respecto al método de osteosíntesis. La principal complicación fue la seudoartrosis (6,2%). CONCLUSIONES: Las fracturas periprotésicas de rodilla se asocian a altas tasas de complicaciones y de mortalidad, siendo la edad del paciente y la propia lesión factores no modificables que pueden influir en la mortalidad tras la cirugía, mientras que otras variables, como el tipo de intervención o la demora quirúrgica, no mostraron diferencias en las tasas de mortalidad en nuestro estudio

INTRODUCTION: The incidence of periprosthetic fractures of the knee is increasing due to the increase in the number of total knee arthroplasties performed, together with population aging. We found few studies that analyze mortality in our setting after surgery. Our objective was to evaluate mortality and survival after surgical treatment of periprosthetic fractures of the distal femur in our environment. MATERIAL AND METHOD: We conducted a retrospective observational study of a consecutive series of 97 patients surgically treated in our centre for periprosthetic knee fracture between 2007-2015, with a minimum follow-up of 12 months. Diverse sociodemographic, clinical and surgical variables were analyzed. A consultation was made to the National Death Index of the Ministry of Health for the analysis of mortality and survival was analyzed using the Kaplan-Meier method. RESULTS: We reviewed a total of 97 patients with an average age of 75 years, of which 86 were women and 11 were men. Of the patients, 50.5% of patients had some comorbidity. The average delay until the intervention was 3.1 days. With respect to the treatment, 45 patients were operated by osteosynthesis with plate (49.5%), 40 with intramedullary nail (41.2%) and 9 with revision of the arthroplasty (9.3%). A total of 30 deaths were recorded during the follow-up, with cumulative mortality in the first year, at 3 and at 10 years of 7.2%, 17.5% and 30.9%, respectively, progressively increasing in people over 75 years. There was no significant difference in mortality rates with the osteosynthesis method. The main complication was pseudoarthrosis (6.2%). CONCLUSIONS: Periprosthetic knee fractures are associated with high rates of complications and mortality. The patient's age and the lesion itself are non-modifiable factors that can influence mortality after surgery, while other variables such as the type of intervention or surgical delay did not show differences in mortality rates in our study

Analysis of mortality after surgical treatment of periprosthetic distal femur fractures. / Análisis de la mortalidad tras el tratamiento quirúrgico de las fracturas periprotésicas de fémur distal.

INTRODUCTION: The incidence of periprosthetic fractures of the knee is increasing due to the increase in the number of total knee arthroplasties performed, together with population aging. We found few studies that analyze mortality in our setting after surgery. Our objective was to evaluate mortality and survival after surgical treatment of periprosthetic fractures of the distal femur in our environment. MATERIAL AND METHOD: We conducted a retrospective observational study of a consecutive series of 97 patients surgically treated in our centre for periprosthetic knee fracture between 2007-2015, with a minimum follow-up of 12months. Diverse sociodemographic, clinical and surgical variables were analyzed. A consultation was made to the National Death Index of the Ministry of Health for the analysis of mortality and survival was analyzed using the Kaplan-Meier method. RESULTS: We reviewed a total of 97 patients with an average age of 75years, of which 86 were women and 11 were men. Of the patients, 50.5% of patients had some comorbidity. The average delay until the intervention was 3.1days. With respect to the treatment, 45 patients were operated by osteosynthesis with plate (49.5%), 40 with intramedullary nail (41.2%) and 9 with revision of the arthroplasty (9.3%). A total of 30 deaths were recorded during the follow-up, with cumulative mortality in the first year, at 3 and at 10 years of 7.2%, 17.5% and 30.9%, respectively, progressively increasing in people over 75years. There was no significant difference in mortality rates with the osteosynthesis method. The main complication was pseudoarthrosis (6.2%). CONCLUSIONS: Periprosthetic knee fractures are associated with high rates of complications and mortality. The patient's age and the lesion itself are non-modifiable factors that can influence mortality after surgery, while other variables such as the type of intervention or surgical delay did not show differences in mortality rates in our study.

Surgical treatment of periprosthetic humerus fractures and algorithm. / Tratamiento quirúrgico de las fracturas periprotésicas de húmero y algoritmo de actuación.

INTRODUCTION: Periprosthetic humerus fractures are infrequent and sometimes difficult to treat. There is limited literature and no consensus on the handling of these fractures. The objective of this study was to compare our results with those published in the literature, in order to improve our care and propose a management algorithm. MATERIAL AND METHOD: Observational study of 10cases of periprosthetic humerus fractures with a mean follow-up of the patients of 23months. An analysis of sociodemographic, radiological and surgical variables was performed. They were reviewed clinically and by telephone using the UCLA Shoulder Score and Quick-DASH scales. A systematic search was made in Pubmed for periprosthetic humerus fractures, for a literature review with which to compare our series. RESULTS: We analysed 10patients with an average age of 69.4years (37-91). Of the patients, 90% underwent surgery through open reduction and internal fixation. Nine of the ten patients consolidated in a mean time of 6.2months (range 5-12), the remaining suffered a new fracture 5months after the intervention, who were reoperated and a new osteosynthesis performed with bone allograft. In the UCLA scale there was a decrease of 10.66points, and an increase of 27.3points in the Quick-DASH, at the end of the follow-up. CONCLUSIONS: In our series of cases we found similarities in the literature, in relation to demographic aspects and obtaining good radiographic results, which do not correspond to the functional outcome of patients.

Fracturas pediátricas de cabeza y cuello de radio / Radial head and neck fractures in children

Objetivo. Analizar los casos de fractura de cabeza y cuello de radio en pacientes pediátricos y compararlos con los de la bibliografía. Material y métodos. Estudio retrospectivo y descriptivo de 21 pacientes pediátricos con fractura de cabeza y cuello de radio, en los que se recogieron los siguientes parámetros: datos demográficos, afección asociada, tipo de fractura, tratamiento, necesidad de rehabilitación, déficit de balance articular, tiempo de recuperación y complicaciones. Resultados. Del total de la serie, 11 eran varones. La edad media fue de 8,3 años. En 14 pacientes el lado lesionado fue el derecho. Doce casos asociaron lesiones en codo ipsilateral. Según la clasificación de Chambers, 15 casos pertenecieron al grupo A, mientras que en la clasificación de Steele-Graham, 12 casos fueron del grupo I. Once pacientes se trataron solo con inmovilización, 4 percutáneamente y 6 mediante reducción abierta y fijación interna (RAFI). Once casos precisaron rehabilitación, de los que 8 no recuperaron movilidad completa. El tiempo medio para obtener el mayor arco de movilidad fue de 4,71 meses. Ocho pacientes presentaron complicaciones, destacando neuroapraxia y la deformidad en valgo del codo. Discusión y conclusiones El tratamiento de la fractura de cabeza y cuello de radio en pacientes pediátricos ha de ser escalonado, desde la simple inmovilización, reducción manual y/o percutánea, hasta la RAFI, la cual cada vez está menos indicada. En este aspecto, debe evitarse la colocación de una aguja transcapitelar y/o la exéresis de la cabeza radial. La complicación más frecuente es el déficit de pronosupinación, sobre todo en casos tratados mediante RAFI. Del resto de las complicaciones observadas, la neuroapraxia del interóseo posterior fue la más común (AU)

Objective. To analyse cases of radial head and neck fractures in children and compare them with the literature. Method. Retrospective and descriptive study of 21 children with radial head and neck fractures. The following parameters were collected: demographics, comorbidity, classification, treatment, need for rehabilitation, lack of range of motion (ROM), time for recovery and complications. Results. The series included 11 males, and the mean age was 8.3 years. The right side was affected in 14 patients. Twelve cases had an associated ipsilateral elbow injury. According to the Chambers classification, 15 cases belonged to group A, while in the Steele-Graham classification, 12 cases were in group I. Eleven patients were treated with immobilization only, 4 percutaneously, and 6 by open reduction and internal fixation (ORIF). Eleven of them needed rehabilitation and despite this, 8 did not achieve full mobility. The mean time to obtain the greatest ROM was 4.71 months. Eight patients had complications, with the most common being neuroapraxia and valgus deformity of the elbow. Discussion and conclusions. Treatment of paediatric radius head and neck fractures must be step-wise, from immobilization only, manual and/or percutaneous reduction, to ORIF, whichever is less indicated. In this respect, both the transcapital needle and/or removal the radius head should be avoided. The most common complication is lack of supination, especially in cases treated by ORIF. The posterior interosseous neuroapraxia was the most common of the rest of complications (AU)

[Radial head and neck fractures in children]. / Fracturas pediátricas de cabeza y cuello de radio.

OBJECTIVE: To analyse cases of radial head and neck fractures in children and compare them with the literature. METHOD: Retrospective and descriptive study of 21 children with radial head and neck fractures. The following parameters were collected: demographics, comorbidity, classification, treatment, need for rehabilitation, lack of range of motion (ROM), time for recovery and complications. RESULTS: The series included 11 males, and the mean age was 8.3 years. The right side was affected in 14 patients. Twelve cases had an associated ipsilateral elbow injury. According to the Chambers classification, 15 cases belonged to group A, while in the Steele-Graham classification, 12 cases were in group I. Eleven patients were treated with immobilization only, 4 percutaneously, and 6 by open reduction and internal fixation (ORIF). Eleven of them needed rehabilitation and despite this, 8 did not achieve full mobility. The mean time to obtain the greatest ROM was 4.71 months. Eight patients had complications, with the most common being neuroapraxia and valgus deformity of the elbow. DISCUSSION AND CONCLUSIONS: Treatment of paediatric radius head and neck fractures must be step-wise, from immobilization only, manual and/or percutaneous reduction, to ORIF, whichever is less indicated. In this respect, both the transcapital needle and/or removal the radius head should be avoided. The most common complication is lack of supination, especially in cases treated by ORIF. The posterior interosseous neuroapraxia was the most common of the rest of complications.