30-sit-to-stand power is a better tool than isometric knee extensor strength to detect motor impairment in people with haemophilic arthropathy.

INTRODUCTION: Regular assessment of motor impairments is crucial in people with haemophilic arthropathy (PwHA). This study aimed to determine if there are differences in 30-seconds sit-to-stand (30-STS) power and maximal voluntary isometric contraction (MVIC) of the knee extensors between PwHA and healthy control group (CG). The secondary aims were to investigate the correlation between 30-STS power and MVIC of knee extensors with clinical characteristics and to assess their effectiveness in identifying motor impairment in PwHA. METHODS: A cross-sectional study was conducted by collecting data from PwHA (n = 17) and a sedentary CG (n = 15). MVIC (torque) and 30-STS power were normalised to body mass. Correlation analysis and simple linear regression adjusted for age were used to assess the association between tests and clinical variables. Using z-scores derived from the mean and standard deviation of the CG, we compared the MVIC and the 30-STS power in PwHA. RESULTS: PwHA showed lower MVIC and 30-STS power compared to CG (p < .001; large effect size d > .8). Lower 30-STS power was associated with greater joint impairment and greater fear of movement, whereas MVIC showed no association with clinical variables. 30-STS power showed a lower z-score compared to MVIC (p < .001). In addition, 30-STS power detected 47% of PwHA with motor impairment compared to 0% for MVIC (p = .002). CONCLUSIONS: Our results suggest that 30-STS power may be more effective than knee extensors MVIC in detecting motor impairment in PwHA. Consequently, lower limb skeletal muscle power, rather than maximum knee extensor strength, appears to be more affected in PwHA.

Medial placement of trapezoid tunnel leads to higher reduction loss in acute acromioclavicular joint dislocation treated with anatomic coracoclavicular fixation.

Aim: To analyze the association between clavicular tunnel positioning and postoperative reduction loss in patients with acute acromioclavicular (AC) joint dislocation treated with anatomic coracoclavicular (CC) fixation using double clavicular tunnels. Methods: A retrospective review of patients with AC joint dislocation, treated with anatomic CC fixation using double clavicular tunnels, was conducted. Patients with pre-operative, immediate post-operative, and final follow-up Zanca-view X-rays were included. On each X-ray, the obtained measures included: distance from lateral border of clavicle to trapezoid and conoid tunnels, distance between tunnels, clavicle length, and CC distance of affected and un-affected sides. Loss of reduction was calculated as CC distance difference between immediate and final post-operative X-rays. Association between reduction loss and tunnel positioning was analyzed. Results: Conoid, trapezoid and tunnel ratios were 24% ± 4, 15% ± 3, and 9% ± 2, respectively. Significant reduction loss was seen in 21(45.7%) patients. Significantly higher probabilities of reduction loss were associated with trapezoid tunnels placed medial to 24 mm (30.8% vs 65.0%, OR 4.2 (IC95%: 1.2-14.4), p: 0.024) or 15% of the clavicle length (32.1% vs 66.7%, OR 4.2 (IC 95%: 1.2-14.9), p: 0.025). Conclusions: Trapezoid tunnels placed medial to 24 mm or 15% medial to clavicle length could lead to higher probabilities of significant reduction loss. These findings support the importance of clavicular tunnels' proper placement for decreasing significant reduction loss.

Anatomic coracoclavicular ligament reconstruction with triple flip-buttons leads to good functional outcomes and low reduction loss: a case series.

BACKGROUND: The management of acromioclavicular (AC) joint dislocation remains controversial. Recently, anatomic coracoclavicular (CC) fixation with a double clavicular tunnel and three flip-buttons has shown promising results. This study aimed to evaluate functional and radiological outcomes in patients with high-grade AC joint dislocation treated with anatomic CC fixation using double clavicular tunnels and three flip-buttons. METHODS: A retrospective, unicentric study was performed. The study included patients with high-grade AC joint dislocation who underwent surgery with anatomic CC fixation using double clavicular tunnels and three flip-buttons. Demographic data were obtained from medical records. A functional evaluation using subjective shoulder value (SSV), visual analog scale (VAS), and disabilities of the arm, shoulder, and hand (DASH) questionnaires was performed, and an evaluation of preoperative and postoperative comparative Zanca view images was performed. Factors associated with functional outcomes and radiological AC reduction were analyzed. RESULTS: A total of 83 patients completed follow-up and were included in the analysis. The mean SSV, VAS, and DASH scores were 92.8, 0.8, and 6.4, respectively. Patients who had complications experienced significantly worse functional outcomes (DASH: P=0.037). Suboptimal final AC reduction was observed in nine patients (11.1%), and significantly more frequently in patients older than 40 years (P=0.031) and in surgeries performed more than 7 days after injury (P=0.034). There were two reoperations (2.4%). CONCLUSIONS: Anatomic CC fixation with a double clavicular tunnel and three flip-buttons leads to good functional outcomes, low complication rates, and high rates of optimal AC reduction. Level of Evidence: Level IV; Case series.

Knee haemophilic arthropathy care in Chile: Midterm outcomes and complications after total knee arthroplasty.

INTRODUCTION: Total knee arthroplasty (TKA) can improve knee function in the general population, but challenges arise for TKA use in haemophilic patients (HPs). AIM: This study aimed to evaluate the midterm clinical experience of a single medical centre in TKA in HPs. METHODS: We performed a case series of consecutive TKAs from 2007 to 2013 in HPs. All patients received coagulation factor supplementation according to the institutional protocol. Surgery was performed without a tourniquet by a standard midline medial parapatellar approach. We compared the range of motion (ROM) and flexion contracture before surgery and 1-year postoperative using paired Wilcoxon-non-parametric test (P < .05 was considered significant). The need for revision surgery was considered TKA survival failure. RESULTS: Forty-one HP/60 TKAs were reviewed (19 cases were bilateral). Preoperative median ROM and flexion contracture was 75° (range, 0°-95°) and 20° (range, 5°-80°), respectively. The postoperative median ROM increased to 83° (range, 45°-110°), and median flexion contracture decrease to 0° (range, 0°-40°) a statistically significant difference (P < .01). Postoperative median clinical Knee Society Score (KSS) and functional KSS were 88 (range, 59-97) and 100 (range, 30-100), respectively. Six patients required revision (6.66%) due to infection. TKA survival at 5 years was 92% (range, 82%-96%). CONCLUSION: This study supports that TKA improves function and ROM in haemophilic knee arthropathy. The protocol of coagulation factors used in this cohort is valid as no related complications were reported. A higher incidence of complications, especially infections, must be expected compared with a TKA in non-HPs.

Modelo predictivo de la no unión de tibia / Tibia non union predictive model

OBJETIVOS: Estimar un modelo predictivo para la no-unión en pacientes que presentan fractura de tibia. MATERIALES Y MÉTODOS: Estudio de cohorte retrospectivo, en pacientes con fractura de tibia operadas entre 2012 y 2018, con un mínimo de 12 meses de seguimiento, excluyendo amputaciones traumáticas. Realizamos un modelo de regresión logística con 13 variables descritas en la literatura. Se descartaron las variables estadísticamente no significativas y las que no causaban efecto de confusión. Se evaluó la bondad de ajuste mediante el test de Hosmer-Lemeshow y la discriminación del modelo con la curva ROC. RESULTADOS: Se incluyeron 411 fracturas de tibia, las variables estadísticamente significativas fueron: exposición ósea OR » 2,57(IC:1,15­5,75, p » 0,022), diabetes OR » 3,29 (IC:1,37­7,91, p » 0,008) y uso de tutor externo OR » 1,77(IC:0,81­3,85), el que tuvo efecto de confusión. La bondad de ajuste demostró que los datos se ajustan adecuadamente al modelo (p » 0,35). La curva ROC demuestra un 70,91% de poder discriminatorio. Al evaluar aisladamente las fracturas expuestas, no hubo asociación estadísticamente significativa con ninguna variable. DISCUSIÓN: Al evaluar el modelo, obtuvimos una asociación estadísticamente significativa entre: no unión, exposición ósea, diabetes y uso de tutor externo, información concordante con la literatura. Al estudiar el subgrupo de fracturas expuestas, las demás variables son estadísticamente no significativas. Eso refleja que la exposición ósea es la variable que confiere mayor riesgo. El seguimiento adecuado de esos pacientes es fundamental dado este alto riesgo de evolucionar con no-unión. CONCLUSIÓN: En nuestra serie, la exposición ósea es el factor de riesgo más importante para presentar no unión de tibia.

OBJECTIVES: Estimate a predictive model for non-union in patients presenting with a tibial fracture. MATERIALS AND METHODS: Retrospective cohort study in patients with tibia fractures operated between 2012 and 2018, with a minimum follow-up of 12 months, excluding traumatic amputations. We performed a multivariate logistic regression model with 13 variables described in the literature. The variables that were statistically non-significant and those variables that do not cause confusion, were discarded. Goodness of fit was evaluated using the Hosmer-Lemeshow test and the discrimination of the model with the ROC curve. RESULTS: 411 tibial fractures were included, the statistically significant variables were: bone exposure OR » 2.57(CI:1.15­5.75, p » 0.022), diabetes OR » 3.29(CI:1.37­7.91, p » 0.008) and use of external fixation OR » 1.77(CI:0.81­3.85), being included in the model because of its confounding effect. Goodness of fit demonstrates that the data fit the model adequately(p » 0.35). The ROC curve demonstrates 70.91% discriminatory power. When evaluating the exposed fractures in isolation, there was no statistically significant association with any variable. DISCUSSION: When evaluating the model, we obtained a statistically significant association between non-union, bone exposure, diabetes and use of external fixation, being consistent with the literature. When studying the subset of exposed fractures, the other variables are statistically non-significant. This reflects that bone exposure is the variable that confers the greatest risk. Proper follow-up of these patients is essential given this high risk of evolving with non-union. CONCLUSION: In our series, bone exposure is the most important risk factor for presenting tibial non-union.

[Radionuclide synoviorthesis in hemophilia: experience in 107 patients]. / Sinoviortesis con radioisótopos en hemofilia: Experiencia de un centro en Chile.

BACKGROUND: In patients with hemophilia, radionuclide synoviorthesis, or the intra-articular injection of a radionuclide to decrease the synovial hypertrophy tissue, aims to decrease or avoid hemarthrosis. AIM: To evaluate the effectiveness of radionuclide synoviorthesis in hemophilia. MATERIAL AND METHODS: Observational retrospective study of the evolution of 107 male patients aged 3 to 54 years who were subjected to radionuclide synoviorthesis between 2007 and 2015. RESULTS: Of 164 treated joints, in 65% treatment was successful, (defined as zero to two hemarthroses and absence of synovitis during the follow up period), in 17% it was partially successful (defined as two or less hemarthroses, but persistence of the synovitis) and failed in 18% of the procedures. No important complications were recorded. CONCLUSIONS: Radionuclide synoviorthesis has an overall 82% success rate, is minimally invasive, can be used at any age and is inexpensive We recommend its implementation in Chilean hemophilia treatment centers.

Sinoviortesis con radioisótopos en hemofilia: Experiencia de un centro en Chile / Radionuclide synoviorthesis in hemophilia: experience in 107 patients

Background: In patients with hemophilia, radionuclide synoviorthesis, or the intra-articular injection of a radionuclide to decrease the synovial hypertrophy tissue, aims to decrease or avoid hemarthrosis. Aim: To evaluate the effectiveness of radionuclide synoviorthesis in hemophilia. Material and Methods: Observational retrospective study of the evolution of 107 male patients aged 3 to 54 years who were subjected to radionuclide synoviorthesis between 2007 and 2015. Results: Of 164 treated joints, in 65% treatment was successful, (defined as zero to two hemarthroses and absence of synovitis during the follow up period), in 17% it was partially successful (defined as two or less hemarthroses, but persistence of the synovitis) and failed in 18% of the procedures. No important complications were recorded. Conclusions: Radionuclide synoviorthesis has an overall 82% success rate, is minimally invasive, can be used at any age and is inexpensive We recommend its implementation in Chilean hemophilia treatment centers.

Sistemática para el estudio Doppler de carótidas / Systematic assessment in carotid doppler ultrasound

La exploración de los ejes carotideo y vertebral resulta sencilla técnicamente, con un aprendizaje relativamente rápido para el que inicia la actividad, especialmente si se establecen protocolos de exámenes estandarizados y fácilmente reproducibles. El objetivo de la sistematización en los servicios de Doppler vascular es que los exámenes realizados por distintos operadores sean similares en cuanto a la técnica y la terminología del informe; a nivel docente la sistematización ofrece al neófito una metodología clara a seguir con el fin de completar las evaluaciones y solidificar el proceso de aprendizaje.