[Translated article] Type III acromioclavicular dislocation: Mid term results after operative and non-operative treatment.

INTRODUCTION: Controversy exists in the literature about the best treatment for type III acromioclavicular dislocations. The aim of this study is to compare functional results between surgical and conservative treatment in type III acromioclavicular joint dislocations. MATERIAL AND METHOD: We retrospectively evaluated the records of 30 patients from our area with acute type III acromioclavicular dislocations that were treated from January 1st, 2016 to December 31st, 2020. Fifteen patients were treated surgically and 15 conservatively. Follow-up mean time was 37.93 months in operative group and 35.73 months in non-operative group. Results obtained on the Constant score was the main variable analysed and results obtained on the Oxford score and the Visual Analogue Scale for pain were the secondary variables. Epidemiological variables were analysed, as well as range of mobility in injured shoulder and subjective and radiological variables (distance between the superior border of the acromion and the superior border of the clavicle's distal end and presence of osteoarthritis in the acromioclavicular joint). RESULTS: Functional evaluation scores did not show differences between the two groups (Constant: operative 82/non-operative 86.38, p 0.412; Oxford: operative 42/non-operative 44.80, p 0.126) nor did Visual Analogue Scale (operative 1/non-operative 0.20, p 0.345). Subjective evaluation of the injured shoulder was excellent or good in 80% of the patients in both groups. Measurement of the distance between the superior border of the acromion and the superior border of the clavicle's distal end were significantly higher in non-operative group (operative 8.95/non-operative 14.21, p 0.008). CONCLUSIONS: Although radiographic results were better in the surgical treatment group, functional evaluation scores did not show significant differences between the two groups. These results do not support the routine use of surgical treatment for grade III acromioclavicular dislocations.

[Translated article] A systematic review of the literature: The use of metaphyseal sleeves in revision total knee arthroplasty.

BACKGROUND AND OBJECTIVES: The purpose of this study is to analyse the indications, complications, survivorship and clinical/functional outcome of metaphyseal sleeves as a treatment option in revision total knee arthroplasty. MATERIAL AND METHOD: A systematic review was made following the PRISMA recommendations on the use of metaphyseal sleeves for revision total knee arthroplasty. We included prospective and retrospective studies published in the last 10 years looking at implant survivorship, clinical and functional outcome with a minimum follow-up of 2 years. RESULTS: The included studies showed good both functional and clinical outcomes. The overall reoperation rate was 16.2%, with an overall survival rate of 92.2% and aseptic survivorship of 98.2%. CONCLUSIONS: Metaphyseal sleeves are a good treatment option for this surgery, especially in AORI II or III type bone defects, achieving good intraoperative and primary stability of the implant, with good and rapid osseointegration.

A systematic review of the literature: The use of metaphyseal sleeves in revision total knee arthroplasty. / Una revisión sistemática de la literatura: el uso de vainas metafisarias en cirugía de revisión de artroplastia de rodilla.

BACKGROUND AND OBJECTIVES: The purpose of this study is to analyze the indications, complications, survivorship and clinical/functional outcome of metaphyseal sleeves as a treatment option in revision total knee arthroplasty. MATERIAL AND METHOD: A systematic review was made following the PRISMA recommendations on the use of metaphyseal sleeves for revision total knee arthroplasty. We included prospective and retrospective studies published in the last 10 years looking at implant survivorship, clinical and functional outcome with a minimum follow-up of 2 years. RESULTS: The included studies showed good both functional and clinical outcomes. The overall reoperation rate was 16.2%, with an overall survival rate of 92.2% and aseptic survivorship of 98.2%. CONCLUSIONS: Metaphyseal sleeves are a good treatment option for this surgery, especially in AORI II or III type bone defects, achieving good intraoperative and primary stability of the implant, with good and rapid osseointegration.

Sección del ligamento transverso del carpo de forma percutánea ecoguiada vs. cirugía abierta para el tratamiento quirúrgico del síndrome del túnel del carpo (STC) / Percutaneous ultrasound-guided section of the transverse carpal ligament vs open surgery for the surgical treatment of carpal tunnel syndrome (CTS)

Antecedentes y objetivo: El gold standard del tratamiento del síndrome del túnel carpiano (STC) es la sección del ligamento transverso del carpo, siendo la técnica más común la incisión cutánea palmar. Se han desarrollados técnicas percutáneas, aunque su relación riesgo/beneficio sigue siendo controvertida. Objetivo: Analizar el resultado funcional de los pacientes intervenidos de STC de forma percutánea ecoguiada y compararlo con cirugía abierta. Material y método: Estudio de cohortes observacional prospectivo de 50 pacientes intervenidos de STC (25 percutáneos con técnica Walant y 25 por cirugía abierta con anestesia local y manguito de isquemia). La cirugía abierta se realizó mediante una incisión palmar corta. La técnica percutánea se realizó de forma anterógrada utilizando el bisturí Kemis® H3 (Newclip). Se realizó una valoración preoperatoria y postoperatoria a las dos semanas, seis semanas y tres meses. Se recogieron datos demográficos, presencia de complicaciones, fuerza de prensión y puntuación del test de Levine (BCTQ). Resultados: La muestra consta de 14 hombres y 36 mujeres con edad media de 51,4 años (IC 95%: 48,4-54,5). Todos los pacientes mejoraron de su clínica de STC sin obtener diferencias estadísticamente significativas en la puntuación BCTQ, ni en la presencia de complicaciones (p > 0,05). Los pacientes intervenidos de forma percutánea recuperaron más rápida la fuerza de prensión a las seis semanas, pero fue similar en la revisión final. Conclusiones: En vista de los resultados obtenidos, la cirugía percutánea ecoguiada es una buena alternativa para el tratamiento quirúrgico del STC. Esta técnica requiere su curva de aprendizaje y familiarización con la visualización ecográfica de las estructuras anatómicas a tratar.(AU)

Background and objective: The gold standard of carpal tunnel syndrome (CTS) treatment is the section of the transverse carpal ligament, the most common technique being the palmar cutaneous incision. Percutaneous techniques have been developed, although their risk/benefit ratio remains controversial. Objective: To analyze the functional outcome of patients undergoing CTS percutaneously ultrasound-guided and compare it with those of open surgery. Material and method: Prospective observational cohort study of 50 patients undergoing CTS (25 percutaneous with WALANT technique and 25 by open surgery with local anesthesia and tourniquet). Open surgery was performed using a short palmar incision. The percutaneous technique was performed anterograde using the Kemis® H3 scalpel (Newclip). A preoperative and postoperative assessment was performed at 2 weeks, 6 weeks and 3 months. Demographic data, presence of complications, grip strength and Levine test score (BCTQ) were collected. Results: The sample consists of 14 men and 36 women with a mean age of 51.4 years (95% CI: 48.4-54.5). Percutaneous technique was performed anterograde using the Kemis® H3 scalpel (Newclip). All patients improved from their CTS clinic without obtaining statistically significant differences in BCTQ score, nor in the presence of complications (p> 0.05). Patients operated on percutaneously recovered faster grip strength at 6 weeks, but it was similar in the final review. Conclusions: In view of the results obtained, percutaneous ultrasound-guided surgery is a good alternative for the surgical treatment of CTS. Logically, this technique requires its learning curve and familiarization with the ultrasound visualization of the anatomical structures to be treated.(AU)

[Translated article] Percutaneous ultrasound-guided section of the transverse carpal ligament vs. open surgery for the surgical treatment of carpal tunnel syndrome (CTS) / Sección del ligamento transverso del carpo de forma percutánea ecoguiada vs. cirugía abierta para el tratamiento quirúrgico del síndrome del túnel del carpo (STC)

Antecedentes y objetivo: El gold standard del tratamiento del síndrome del túnel carpiano (STC) es la sección del ligamento transverso del carpo, siendo la técnica más común la incisión cutánea palmar. Se han desarrollados técnicas percutáneas, aunque su relación riesgo/beneficio sigue siendo controvertida. Objetivo: Analizar el resultado funcional de los pacientes intervenidos de STC de forma percutánea ecoguiada y compararlo con cirugía abierta. Material y método: Estudio de cohortes observacional prospectivo de 50 pacientes intervenidos de STC (25 percutáneos con técnica Walant y 25 por cirugía abierta con anestesia local y manguito de isquemia). La cirugía abierta se realizó mediante una incisión palmar corta. La técnica percutánea se realizó de forma anterógrada utilizando el bisturí Kemis® H3 (Newclip). Se realizó una valoración preoperatoria y postoperatoria a las dos semanas, seis semanas y tres meses. Se recogieron datos demográficos, presencia de complicaciones, fuerza de prensión y puntuación del test de Levine (BCTQ). Resultados: La muestra consta de 14 hombres y 36 mujeres con edad media de 51,4 años (IC 95%: 48,4-54,5). Todos los pacientes mejoraron de su clínica de STC sin obtener diferencias estadísticamente significativas en la puntuación BCTQ, ni en la presencia de complicaciones (p > 0,05). Los pacientes intervenidos de forma percutánea recuperaron más rápida la fuerza de prensión a las seis semanas, pero fue similar en la revisión final. Conclusiones: En vista de los resultados obtenidos, la cirugía percutánea ecoguiada es una buena alternativa para el tratamiento quirúrgico del STC. Esta técnica requiere su curva de aprendizaje y familiarización con la visualización ecográfica de las estructuras anatómicas a tratar.(AU)

Background and objective: The gold standard of carpal tunnel syndrome (CTS) treatment is the section of the transverse carpal ligament, the most common technique being the palmar cutaneous incision. Percutaneous techniques have been developed, although their risk/benefit ratio remains controversial. Objective: To analyze the functional outcome of patients undergoing CTS percutaneously ultrasound-guided and compare it with those of open surgery. Material and method: Prospective observational cohort study of 50 patients undergoing CTS (25 percutaneous with WALANT technique and 25 by open surgery with local anesthesia and tourniquet). Open surgery was performed using a short palmar incision. The percutaneous technique was performed anterograde using the Kemis® H3 scalpel (Newclip). A preoperative and postoperative assessment was performed at 2 weeks, 6 weeks and 3 months. Demographic data, presence of complications, grip strength and Levine test score (BCTQ) were collected. Results: The sample consists of 14 men and 36 women with a mean age of 51.4 years (95% CI: 48.4-54.5). Percutaneous technique was performed anterograde using the Kemis® H3 scalpel (Newclip). All patients improved from their CTS clinic without obtaining statistically significant differences in BCTQ score, nor in the presence of complications (p> 0.05). Patients operated on percutaneously recovered faster grip strength at 6 weeks, but it was similar in the final review. Conclusions: In view of the results obtained, percutaneous ultrasound-guided surgery is a good alternative for the surgical treatment of CTS. Logically, this technique requires its learning curve and familiarization with the ultrasound visualization of the anatomical structures to be treated.(AU)

Type III acromioclavicular dislocation: Mid term results after operative and non-operative treatment. / Luxación acromioclavicular grado III. Resultados a medio plazo tras tratamiento conservador y quirúrgico.

INTRODUCTION: Controversy exists in the literature about the best treatment for type III acromioclavicular dislocations. The aim of this study is to compare functional results between surgical and conservative treatment in type III acromioclavicular joint dislocations. MATERIAL AND METHOD: We retrospectively evaluated the records of 30 patients from our area with acute type III acromioclavicular dislocations that were treated from January 1st, 2016 to December 31st, 2020. Fifteen patients were treated surgically and 15 conservatively. Follow up mean time was 37.93 months in operative group and 35.73 months in non-operative group. Results obtained on the Constant score was the main variable analysed and results obtained on the Oxford score and the Visual Analogue Scale for pain were the secondary variables. Epidemiological variables were analysed, as well as range of mobility in injured shoulder and subjective and radiological variables (distance between the superior border of the acromion and the superior border of the clavicle's distal end and presence of osteoarthritis in the acromioclavicular joint). RESULTS: Functional evaluation scores did not show differences between the two groups (Constant: operative 82/non-operative 86.38, p 0.412; Oxford: operative 42/non-operative 44.80, p 0.126) nor did Visual Analogue Scale (operative 1/non-operative 0.20, p 0.345). Subjective evaluation of the injured shoulder was excellent or good in 80% of the patients in both groups. Measurement of the distance between the superior border of the acromion and the superior border of the clavicle's distal end were significantly higher in non-operative group (operative 8.95/non-operative 14.21, p 0.008). CONCLUSIONS: Although radiographic results were better in the surgical treatment group, functional evaluation scores did not show significant differences between the two groups. These results do not support the routine use of surgical treatment for grade III acromioclavicular dislocations.

[Translated article] Percutaneous ultrasound-guided section of the transverse carpal ligament vs. open surgery for the surgical treatment of carpal tunnel syndrome (CTS).

BACKGROUND AND OBJECTIVE: The gold standard of carpal tunnel syndrome (CTS) treatment is the section of the transverse carpal ligament, the most common technique being the palmar cutaneous incision. Percutaneous techniques have been developed, although their risk/benefit ratio remains controversial. OBJECTIVE: To analyse the functional outcome of patients undergoing CTS percutaneously ultrasound-guided and compare it with those of open surgery. MATERIAL AND METHOD: Prospective observational cohort study of 50 patients undergoing CTS (25 percutaneous with WALANT technique and 25 by open surgery with local anaesthesia and tourniquet). Open surgery was performed using a short palmar incision. The percutaneous technique was performed anterograde using the Kemis H3® scalpel (Newclip). A preoperative and postoperative assessment was performed at 2 weeks, 6 weeks and 3 months. Demographic data, presence of complications, grip strength and Levine test score (BCTQ) were collected. RESULTS: The sample consists of 14 men and 36 women with a mean age of 51.4 years (95% CI: 48.4-54.5). Percutaneous technique was performed anterograde using the Kemis H3® scalpel (Newclip). All patients improved from their CTS clinic without obtaining statistically significant differences in BCTQ score, nor in the presence of complications (p>0.05). Patients operated on percutaneously recovered faster grip strength at 6 weeks, but it was similar in the final review. CONCLUSIONS: In view of the results obtained, percutaneous ultrasound-guided surgery is a good alternative for the surgical treatment of CTS. Logically, this technique requires its learning curve and familiarisation with the ultrasound visualisation of the anatomical structures to be treated.

Percutaneous ultrasound-guided section of the transverse carpal ligament vs open surgery for the surgical treatment of carpal tunnel syndrome (CTS). / Sección del ligamento transverso del carpo de forma percutánea ecoguiada vs. cirugía abierta para el tratamiento quirúrgico del síndrome del túnel del carpo (STC).

BACKGROUND AND OBJECTIVE: The gold standard of carpal tunnel syndrome (CTS) treatment is the section of the transverse carpal ligament, the most common technique being the palmar cutaneous incision. Percutaneous techniques have been developed, although their risk/benefit ratio remains controversial. OBJECTIVE: To analyze the functional outcome of patients undergoing CTS percutaneously ultrasound-guided and compare it with those of open surgery. MATERIAL AND METHOD: Prospective observational cohort study of 50 patients undergoing CTS (25 percutaneous with WALANT technique and 25 by open surgery with local anesthesia and tourniquet). Open surgery was performed using a short palmar incision. The percutaneous technique was performed anterograde using the Kemis® H3 scalpel (Newclip). A preoperative and postoperative assessment was performed at 2 weeks, 6 weeks and 3 months. Demographic data, presence of complications, grip strength and Levine test score (BCTQ) were collected. RESULTS: The sample consists of 14 men and 36 women with a mean age of 51.4 years (95% CI: 48.4-54.5). Percutaneous technique was performed anterograde using the Kemis® H3 scalpel (Newclip). All patients improved from their CTS clinic without obtaining statistically significant differences in BCTQ score, nor in the presence of complications (p> 0.05). Patients operated on percutaneously recovered faster grip strength at 6 weeks, but it was similar in the final review. CONCLUSIONS: In view of the results obtained, percutaneous ultrasound-guided surgery is a good alternative for the surgical treatment of CTS. Logically, this technique requires its learning curve and familiarization with the ultrasound visualization of the anatomical structures to be treated.

Epidemiology of Bone Fractures in the Hand in Adult Population Using the ICD-10 Classification.

PURPOSE OF THE STUDY The purpose of this study was to conduct an epidemiological study of hand fractures in adult population. MATERIAL AND METHODS A retrospective observational study in a population of 470,000 habitants was performed. Over the course of three years, all patients over 16 years of age who were diagnosed with fracture or fracture-dislocation at the level of a carpal bone, metacarpal and/or phalange were included. These fractures were classified according to the International Classification of Diseases 10th edition (ICD-10). Incidence rates, along with gender and age distribution were also studied. RESULTS 1,267 patients with a total of 1,341 hand fractures were included. They represented 29.7% of all upper limb fractures and 7.6% of all traumatological emergencies involving a bone fracture during that period. The most frequent ICD-10 group was S62.3, with the fifth metacarpal as the most often affected bone (39.7%). The most frequent location at the level of the phalanges (S62.5) was the proximal third of the proximal phalanx of the fifth radius. The global incidence rate was 99 fractures per 100,000 persons/year. No seasonal variation was observed. Only 10.2% of hand fractures received surgical treatment. DISCUSSION Several epidemiological studies have been published on fractures in the hand, but none have used the ICD-10 classification. Although the distribution of our stratified sample by age and gender was similar to those previously published, the incidence rate in our study was much lower. We may possibly extrapolate our results to the rest of the Spanish population and even to the rest of the population of southern Europe, given the scarcity of epidemiological studies on this matter in these geographical areas. CONCLUSIONS The ICD-10 classification is useful for the description and classification of hand fractures. The most often affected group is that including metacarpals of the long fingers (S62.3), being the distal level of the fifth metacarpal in young male patients the most frequent one. Most fractures are treated conservatively and in case of surgical treatment, the preferred surgical techniques include K-wire fixation, interfragmentary compression screws and plate osteosynthesis. Key words: epidemiology, incidence, fracture, fracture dislocation, carpal bones, metacarpals, finger phalanges.

Prospective study about orthopaedic treatment of fifth metacarpal neck fractures. / Estudio prospectivo sobre el tratamiento conservador de las fracturas de cuello de quinto metacarpiano.

INTRODUCTION: The fifth metacarpal neck fracture is traditionally treated with closed reduction and intrinsic plus cast immobilization. Another alternative and more functional treatment is the syndactylia. The aim of our study is to compare both treatments searching for any differences in their functional outcomes. METHOD: We did a prospective, controlled, masked, randomized cohort study with patients over 18 years old attended from May 2019 to May 2020 in Vigo's Sanitary Area with this injure and an angle below 40°. The collected data was: sex, age, fracture angle, range of motion of the metacarpophalangeal articulation (MCFA), grip strength, pain, fracture consolidation, Quick DASH and comfort 4 and 6 weeks after the injury. RESULTS: 39 men and 1 woman were included in the sample. 36.1 years old as the age average. 90% of the injuries affected the right hand, being all the patients right-handed, finding statistically significant differences in MCFA flexion within 4 weeks and in grade of discomfort, both in favour of the syndactylia (p<0.05). Any of the other collected data was statistically significant. Every fracture achieved consolidation at the end of the follow-up. CONCLUSION: Following the results, we consider both immobilizations good treatment options of these fractures; nevertheless, syndactylia has proven an earlier MCFA flexion recovery and a better tolerance.

Estudio prospectivo sobre el tratamiento conservador de las fracturas de cuello de quinto metacarpiano / Prospective study about orthopaedic treatment of fifth metacarpal neck fractures

Introducción: La fractura de cuello del quinto metacarpiano se trata tradicionalmente mediante la reducción cerrada e inmovilización con férula en intrínseco plus. Una alternativa es el tratamiento funcional mediante sindactilia. Nuestro objetivo es comparar ambos tratamientos buscando diferencias de resultado funcional entre ambas opciones. Método: Realizamos un estudio de cohortes prospectivo, controlado, enmascarado y aleatorizado con pacientes mayores de 18años con esta lesión y angulación<40°, atendidos entre mayo de 2019 y mayo de 2020 en el Área Sanitaria de Vigo. Se recogieron las variables: sexo, edad, lado, angulación de la fractura, movilidad de la articulación metacarpofalángica (MCF), fuerza de prensión, dolor, consolidación de la fractura, Quick DASH y grado de satisfacción y confort. Esta información fue recogida a las 4 y a las 6 semanas. Resultados: La muestra constó de 39 hombres y una mujer. La edad media fue de 36,1años. El 90% afectó a la mano derecha siendo todos los pacientes diestros, encontrando diferencias estadísticamente significativas en la flexión de la articulación MCF a las 4 semanas y en el grado de molestia de la inmovilización, ambos en favor de la sindactilia (p<0,05). El resto de variables recogidas no mostraron significación estadística. En todos los pacientes se consiguió la consolidación de la fractura. Conclusión: A raíz de los resultados obtenidos, consideramos que ambas inmovilizaciones pueden utilizarse en el tratamiento de estas fracturas; sin embargo, la sindactilia demuestra una movilidad en flexión de la articulación MCF más temprana y mejor tolerancia.(AU)

Introduction: The fifth metacarpal neck fracture is traditionally treated with closed reduction and intrinsic plus cast immobilization. Another alternative and more functional treatment is the syndactylia. The aim of our study is to compare both treatments searching for any differences in their functional outcomes. Method: We did a prospective, controlled, masked, randomized cohort study with patients over 18 years old attended from May 2019 to May 2020 in Vigo's Sanitary Area with this injure and an angle below 40°. The collected data was: sex, age, fracture angle, range of motion of the metacarpophalangeal articulation (MCFA), grip strength, pain, fracture consolidation, Quick DASH and comfort 4 and 6 weeks after the injury. Results: 39 men and 1 woman were included in the sample. 36.1 years old as the age average. 90% of the injuries affected the right hand, being all the patients right-handed, finding statistically significant differences in MCFA flexion within 4 weeks and in grade of discomfort, both in favour of the syndactylia (p<0.05). Any of the other collected data was statistically significant. Every fracture achieved consolidation at the end of the follow-up. Conclusion: Following the results, we consider both immobilizations good treatment options of these fractures; nevertheless, syndactylia has proven an earlier MCFA flexion recovery and a better tolerance.(AU)

Prospective study about orthopaedic treatment of fifth metacarpal neck fractures / Estudio prospectivo sobre el tratamiento conservador de las fracturas de cuello de quinto metacarpiano

Introduction: The fifth metacarpal neck fracture is traditionally treated with closed reduction and intrinsic plus cast immobilization. Another alternative and more functional treatment is the syndactylia. The aim of our study is to compare both treatments searching for any differences in their functional outcomes. Method: We did a prospective, controlled, masked, randomized cohort study with patients over 18 years old attended from May 2019 to May 2020 in Vigo's Sanitary Area with this injure and an angle below 40°. The collected data was: sex, age, fracture angle, range of motion of the metacarpophalangeal articulation (MCFA), grip strength, pain, fracture consolidation, Quick DASH and comfort 4 and 6 weeks after the injury. Results: 39 men and 1 woman were included in the sample. 36.1 years old as the age average. 90% of the injuries affected the right hand, being all the patients right-handed, finding statistically significant differences in MCFA flexion within 4 weeks and in grade of discomfort, both in favour of the syndactylia (p<0.05). Any of the other collected data was statistically significant. Every fracture achieved consolidation at the end of the follow-up. Conclusion: Following the results, we consider both immobilizations good treatment options of these fractures; nevertheless, syndactylia has proven an earlier MCFA flexion recovery and a better tolerance.(AU)

Introducción: La fractura de cuello del quinto metacarpiano se trata tradicionalmente mediante la reducción cerrada e inmovilización con férula en intrínseco plus. Una alternativa es el tratamiento funcional mediante sindactilia. Nuestro objetivo es comparar ambos tratamientos buscando diferencias de resultado funcional entre ambas opciones. Método: Realizamos un estudio de cohortes prospectivo, controlado, enmascarado y aleatorizado con pacientes mayores de 18años con esta lesión y angulación<40°, atendidos entre mayo de 2019 y mayo de 2020 en el Área Sanitaria de Vigo. Se recogieron las variables: sexo, edad, lado, angulación de la fractura, movilidad de la articulación metacarpofalángica (MCF), fuerza de prensión, dolor, consolidación de la fractura, Quick DASH y grado de satisfacción y confort. Esta información fue recogida a las 4 y a las 6 semanas. Resultados: La muestra constó de 39 hombres y una mujer. La edad media fue de 36,1años. El 90% afectó a la mano derecha siendo todos los pacientes diestros, encontrando diferencias estadísticamente significativas en la flexión de la articulación MCF a las 4 semanas y en el grado de molestia de la inmovilización, ambos en favor de la sindactilia (p<0,05). El resto de variables recogidas no mostraron significación estadística. En todos los pacientes se consiguió la consolidación de la fractura. Conclusión: A raíz de los resultados obtenidos, consideramos que ambas inmovilizaciones pueden utilizarse en el tratamiento de estas fracturas; sin embargo, la sindactilia demuestra una movilidad en flexión de la articulación MCF más temprana y mejor tolerancia.(AU)

Influence of integrated orthogeriatric care on morbidity and mortality and length of hospital stay for hip fracture / Influencia de la atención ortogeriátrica integrada en la morbimortalidad y el tiempo de estancia hospitalaria de la fractura de cadera

Background and objectives: Compare the morbidity and mortality, the length of hospital stay and the economic cost of the fragility fracture of the hip, in two nonconsecutive years thanks to the integrated orthogeriatric care. Material and method: Retrospective observational cohort study with 633 patients with hip fragility fracture with a mean age of 85.5 years, treated in the same Trauma and Orthopaedic Surgery service in two different years (2012 and 2017). Mean stay, surgical delay, perioperative mortality, one month and one year, and perioperative complications such as acute urine retention, pressure ulcers, and need for transfusion were measured. Results: Mortality during admission decreased from 10% in 2012 to 3.6% in 2017 (P=.004 *), while mortality at thirty days (10.5% vs 7%) (P=.123) and one year (28.9% versus 24.9%) (P=.277). Hospital stay times, surgical delay, and postoperative admission time also decreased. The estimated total annual economic savings thanks to integrated orthogeriatric care amounted to €1,017,084.94. Conclusions: Integrated orthogeriatric care of the patient with fragility fracture of the hip, results in a more effective and efficient care model. Both the care and the clinical situation of patients are improved in the perioperative period, both hospital stay and mortality during admission are significantly reduced, and all this with significant associated economic savings.(AU)

Antecedentes y objetivos: Comparar la morbimortalidad, el tiempo de estancia hospitalaria y el gasto económico de la fractura por fragilidad de cadera en 2 años no consecutivos gracias a la atención ortogeriátrica integrada. Material y método: Estudio observacional retrospectivo de cohorte con 633 pacientes con fractura por fragilidad de cadera, con una media de edad de 85,5 años, tratados en un mismo servicio de cirugía ortopédica y traumatología en 2 años diferentes (2012 y 2017). Se midieron la estancia media, la demora quirúrgica, la mortalidad perioperatoria, al mes y al año, y las complicaciones perioperatorias como la retención aguda de orina, las úlceras por presión y la necesidad de transfusión. Resultados: La mortalidad durante el ingreso disminuyó del 10% en 2012 al 3,6% en 2017 (p=0,004), a la vez que la mortalidad a los 30 días (10,5% frente a 7%) (p=0,123) y al año (28,9% frente a 24,9%) (p=0,277). También disminuyeron los tiempos de estancia hospitalaria, la demora quirúrgica y el tiempo de ingreso postoperatorio. El ahorro económico total anual estimado gracias a la atención ortogeriátrica integrada supuso 1.017.084,94€. Conclusiones: La atención ortogeriátrica integrada del paciente con fractura por fragilidad de la cadera resulta en un modelo de atención más efectivo y eficiente. Se mejora tanto la calidad asistencial como la situación clínica de los pacientes en el periodo perioperatorio, se disminuyen significativamente tanto la estancia hospitalaria como la mortalidad durante el ingreso, y todo ello con un importante ahorro económico asociado.(AU)

Influencia de la atención ortogeriátrica integrada en la morbimortalidad y el tiempo de estancia hospitalaria de la fractura de cadera / Influence of integrated orthogeriatric care on morbidity and mortality and length of hospital stay for hip fracture

Antecedentes y objetivos: Comparar la morbimortalidad, el tiempo de estancia hospitalaria y el gasto económico de la fractura por fragilidad de cadera en 2 años no consecutivos gracias a la atención ortogeriátrica integrada. Material y método: Estudio observacional retrospectivo de cohorte con 633 pacientes con fractura por fragilidad de cadera, con una media de edad de 85,5 años, tratados en un mismo servicio de cirugía ortopédica y traumatología en 2 años diferentes (2012 y 2017). Se midieron la estancia media, la demora quirúrgica, la mortalidad perioperatoria, al mes y al año, y las complicaciones perioperatorias como la retención aguda de orina, las úlceras por presión y la necesidad de transfusión. Resultados: La mortalidad durante el ingreso disminuyó del 10% en 2012 al 3,6% en 2017 (p=0,004), a la vez que la mortalidad a los 30 días (10,5% frente a 7%) (p=0,123) y al año (28,9% frente a 24,9%) (p=0,277). También disminuyeron los tiempos de estancia hospitalaria, la demora quirúrgica y el tiempo de ingreso postoperatorio. El ahorro económico total anual estimado gracias a la atención ortogeriátrica integrada supuso 1.017.084,94€. Conclusiones: La atención ortogeriátrica integrada del paciente con fractura por fragilidad de la cadera resulta en un modelo de atención más efectivo y eficiente. Se mejora tanto la calidad asistencial como la situación clínica de los pacientes en el periodo perioperatorio, se disminuyen significativamente tanto la estancia hospitalaria como la mortalidad durante el ingreso, y todo ello con un importante ahorro económico asociado.(AU)

Background and objectives: Compare the morbidity and mortality, the length of hospital stay and the economic cost of the fragility fracture of the hip, in two nonconsecutive years thanks to the integrated orthogeriatric care. Material and method: Retrospective observational cohort study with 633 patients with hip fragility fracture with a mean age of 85.5 years, treated in the same Trauma and Orthopaedic Surgery service in two different years (2012 and 2017). Mean stay, surgical delay, perioperative mortality, one month and one year, and perioperative complications such as acute urine retention, pressure ulcers, and need for transfusion were measured. Results: Mortality during admission decreased from 10% in 2012 to 3.6% in 2017 (P=.004 *), while mortality at thirty days (10.5% vs 7%) (P=.123) and one year (28.9% versus 24.9%) (P=.277). Hospital stay times, surgical delay, and postoperative admission time also decreased. The estimated total annual economic savings thanks to integrated orthogeriatric care amounted to €1,017,084.94. Conclusions: Integrated orthogeriatric care of the patient with fragility fracture of the hip, results in a more effective and efficient care model. Both the care and the clinical situation of patients are improved in the perioperative period, both hospital stay and mortality during admission are significantly reduced, and all this with significant associated economic savings.(AU)

Estudio epidemiológico de las fracturas de la extremidad distal de radio en el área sanitaria de Vigo / Epidemiological study of distal radius fractures in the sanitary area of Vigo

Introducción: Las fracturas de la extremidad distal de radio (FEDR) representan una carga cada vez mayor para los recursos sanitarios debido a los cambios demográficos de la población y a las estrategias de gestión, por lo que la comprensión precisa de su epidemiología es esencial. Presentamos un estudio epidemiológico de FEDR y lo comparamos con otras áreas de la península y Europa. Método: Se recogieron todas las FEDR de nuestra área sanitaria registradas en 2017 y 2018 en pacientes mayores de 18años de forma retrospectiva y observacional agrupándolos según la clasificación de AO-OTA. Se analizaron las variables de edad, sexo, época del año, mecanismo de fractura, presencia de lesiones asociadas y tratamiento realizado. Resultados: Registramos 1.121 FEDR en 1.108 pacientes, 903 mujeres (81,5%) y 205 varones (18,5%). En 612 casos se vio afectado el lado izquierdo (54,6%) y en 509 el lado derecho (45,4%). La edad media de la muestra fue de 65,9años (IC95%: 65-66,9años). La tasa de incidencia de FEDR fue de 158,5 fracturas por 100.000 habitantes/año. El 49,2% se clasificaron como tipo A de AO-OTA y se intervinieron quirúrgicamente un 19%. Conclusión: La incidencia de FEDR alcanza un máximo en la sexta década tanto en hombres como en mujeres. Las fracturas de tipo A de la clasificación AO-OTA son las más frecuentes. La mayoría se trataron de forma conservadora. El patrón de paciente tratado quirúrgicamente con más frecuencia es el de una mujer mayor de 50años con FEDR articular compleja.(AU)

Introduction: Distal radius fractures (DRF) are being a bigger burden for health resources as changes continue to happen in our population demography and in management strategies, so a precise epidemiologic comprehension is mandatory. We present a DRF epidemiology study and we compared it with other sanitary areas of the Iberian Peninsula and Europe. Method: Every DRF in our sanitary area registered between 2017 and 2018 in patients older than 18 years old were observational and retrospectively recorded and classified using AO-OTA classification. Age, sex, season of the year, mechanism of injury, presence of associated injuries and type of treatment were analysed. Results: 1,121 DRF in 1,108 patients, 903 women (81.5%) and 205 men (18.5%), were registered. Left side was affected in 612 cases (54.6%) and right side in 509 cases (45.4%). The average age of our sample was 65.9 years old (CI95%: 65-67.9 years old). The incidence rate of DRF in our population was 158.5 fractures per 100,000 people-year; 49.2% were classified as type A of AO-OTA classification and 19% were treated surgically. Conclusion: Incidence of DRF had a maximum during males and women sixth decade of age. Type A fractures of AO-OTA classification were the most frequent. Most part of the fractures were treated non-surgically. The usual patient treated surgically was a woman, over 50 years old with a distal radius intraarticular complex fracture.(AU)

Epidemiological study of distal radius fractures in the sanitary area of Vigo / Estudio epidemiológico de las fracturas de la extremidad distal de radio en el área sanitaria de Vigo

Introduction: Distal radius fractures (DRF) are being a bigger burden for health resources as changes continue to happen in our population demography and in management strategies, so a precise epidemiologic comprehension is mandatory. We present a DRF epidemiology study and we compared it with other sanitary areas of the Iberian Peninsula and Europe. Method: Every DRF in our sanitary area registered between 2017 and 2018 in patients older than 18 years old were observational and retrospectively recorded and classified using AO-OTA classification. Age, sex, season of the year, mechanism of injury, presence of associated injuries and type of treatment were analysed. Results: 1,121 DRF in 1,108 patients, 903 women (81.5%) and 205 men (18.5%), were registered. Left side was affected in 612 cases (54.6%) and right side in 509 cases (45.4%). The average age of our sample was 65.9 years old (CI95%: 65-67.9 years old). The incidence rate of DRF in our population was 158.5 fractures per 100,000 people-year; 49.2% were classified as type A of AO-OTA classification and 19% were treated surgically. Conclusion: Incidence of DRF had a maximum during males and women sixth decade of age. Type A fractures of AO-OTA classification were the most frequent. Most part of the fractures were treated non-surgically. The usual patient treated surgically was a woman, over 50 years old with a distal radius intraarticular complex fracture.(AU)

Introducción: Las fracturas de la extremidad distal de radio (FEDR) representan una carga cada vez mayor para los recursos sanitarios debido a los cambios demográficos de la población y a las estrategias de gestión, por lo que la comprensión precisa de su epidemiología es esencial. Presentamos un estudio epidemiológico de FEDR y lo comparamos con otras áreas de la península y Europa. Método: Se recogieron todas las FEDR de nuestra área sanitaria registradas en 2017 y 2018 en pacientes mayores de 18años de forma retrospectiva y observacional agrupándolos según la clasificación de AO-OTA. Se analizaron las variables de edad, sexo, época del año, mecanismo de fractura, presencia de lesiones asociadas y tratamiento realizado. Resultados: Registramos 1.121 FEDR en 1.108 pacientes, 903 mujeres (81,5%) y 205 varones (18,5%). En 612 casos se vio afectado el lado izquierdo (54,6%) y en 509 el lado derecho (45,4%). La edad media de la muestra fue de 65,9años (IC95%: 65-66,9años). La tasa de incidencia de FEDR fue de 158,5 fracturas por 100.000 habitantes/año. El 49,2% se clasificaron como tipo A de AO-OTA y se intervinieron quirúrgicamente un 19%. Conclusión: La incidencia de FEDR alcanza un máximo en la sexta década tanto en hombres como en mujeres. Las fracturas de tipo A de la clasificación AO-OTA son las más frecuentes. La mayoría se trataron de forma conservadora. El patrón de paciente tratado quirúrgicamente con más frecuencia es el de una mujer mayor de 50años con FEDR articular compleja.(AU)

Epidemiological study of distal radius fractures in the sanitary area of Vigo. / Estudio epidemiológico de las fracturas de la extremidad distal de radio en el área sanitaria de Vigo.

INTRODUCTION: Distal radius fractures (DRF) are being a bigger burden for health resources as changes continue to happen in our population demography and in management strategies, so a precise epidemiologic comprehension is mandatory. We present a DRF epidemiology study and we compared it with other sanitary areas of the Iberian Peninsula and Europe. METHOD: Every DRF in our sanitary area registered between 2017 and 2018 in patients older than 18 years old were observational and retrospectively recorded and classified using AO-OTA classification. Age, sex, season of the year, mechanism of injury, presence of associated injuries and type of treatment were analysed. RESULTS: 1,121 DRF in 1,108 patients, 903 women (81.5%) and 205 men (18.5%), were registered. Left side was affected in 612 cases (54.6%) and right side in 509 cases (45.4%). The average age of our sample was 65.9 years old (CI95%: 65-67.9 years old). The incidence rate of DRF in our population was 158.5 fractures per 100,000 people-year; 49.2% were classified as type A of AO-OTA classification and 19% were treated surgically. CONCLUSION: Incidence of DRF had a maximum during males and women sixth decade of age. Type A fractures of AO-OTA classification were the most frequent. Most part of the fractures were treated non-surgically. The usual patient treated surgically was a woman, over 50 years old with a distal radius intraarticular complex fracture.

Influence of integrated orthogeriatric care on morbidity and mortality and length of hospital stay for hip fracture. / Influencia de la atención ortogeriátrica integrada en la morbimortalidad y el tiempo de estancia hospitalaria de la fractura de cadera.

BACKGROUND AND OBJECTIVES: Compare the morbidity and mortality, the length of hospital stay and the economic cost of the fragility fracture of the hip, in two nonconsecutive years thanks to the integrated orthogeriatric care. MATERIAL AND METHOD: Retrospective observational cohort study with 633 patients with hip fragility fracture with a mean age of 85.5 years, treated in the same Trauma and Orthopaedic Surgery service in two different years (2012 and 2017). Mean stay, surgical delay, perioperative mortality, one month and one year, and perioperative complications such as acute urine retention, pressure ulcers, and need for transfusion were measured. RESULTS: Mortality during admission decreased from 10% in 2012 to 3.6% in 2017 (P=.004 *), while mortality at thirty days (10.5% vs 7%) (P=.123) and one year (28.9% versus 24.9%) (P=.277). Hospital stay times, surgical delay, and postoperative admission time also decreased. The estimated total annual economic savings thanks to integrated orthogeriatric care amounted to €1,017,084.94. CONCLUSIONS: Integrated orthogeriatric care of the patient with fragility fracture of the hip, results in a more effective and efficient care model. Both the care and the clinical situation of patients are improved in the perioperative period, both hospital stay and mortality during admission are significantly reduced, and all this with significant associated economic savings.

Inyección de pintura a alta presión en la mano: una grave lesión que no debe ser subestimada / High-pressure injection of paint into the hand: a severe injury that should not be underestimated

La inyección de alta presión en la mano causa una pequeña lesión cutánea pero severo daño tisular subcutáneo que puede provocar pérdida funcional permanente o amputación. Un tratamiento urgente y adecuado es determinante. Presentamos el caso de un pintor industrial que se inyectó pintura con base de aceite con su pistola de alta presión en el dedo índice izquierdo. Ingresó en Urgencias, donde se le administró profilaxis antitetánica y antibioterapia intravenosa y, antes de transcurridas cuatro horas, se le realizó un desbridamiento quirúrgico. Al año de la lesión el paciente presentaba movilidad activa y pasiva del dedo completa con palidez cutánea, hipersensibilidad y disfunción con la exposición al frío. Hay que reconocer la severidad de estas lesiones con apariencia inicial benigna y realizar un amplio desbridamiento quirúrgico inmediato de todo el tejido isquémico, ya que el retraso en realizarlo se asocia con altas tasas de complicaciones

High-pressure injection into the hand causes a small skin lesion but severe subcutaneous tissue damage, which can result in permanent functional loss or amputation. Urgent and appropriate treatment is decisive. We present the case of an industrial painter who injected oil-based paint with a high-pressure gun into his left index finger. He was admitted to Accidents and Emergencies, where tetanus prophylaxis and antibiotic therapy were administered. Then, within four hours of his arrival at the hospital, the patient was brought to the operating room for surgical debridement. A year after the injury the finger's active and passive range of motion was complete, although paling of the skin together with hypersensitivity and dysfunction occurred on exposure to cold. The severity of these lesions, even if their initial appearance is benign, must be recognized and an immediate surgical debridement of the entire ischemic tissue should be performed, because delay in treatment is associated with higher rates of complication

[High-pressure injection of paint into the hand: a severe injury that should not be underestimated]. / Inyección de pintura a alta presión en la mano: una grave lesión que no debe ser subestimada.

High-pressure injection into the hand causes a small skin lesion but severe subcutaneous tissue damage, which can result in permanent functional loss or amputation. Urgent and appropriate treatment is decisive. We present the case of an industrial painter who injected oil-based paint with a high-pressure gun into his left index finger. He was admitted to Accidents and Emergencies, where tetanus prophylaxis and antibiotic therapy were adminis-tered. Then, within four hours of his arrival at the hospital, the patient was brought to the operating room for surgical debridement. A year after the injury the finger's active and passive range of motion was complete, although paling of the skin together with hypersensitivity and dysfunction occurred on exposure to cold. The severity of these lesions, even if their initial appearance is benign, must be recognized and an immediate surgical debridement of the entire ischemic tissue should be performed, because delay in treatment is associated with higher rates of complication. Keywords. High-pressure injuries. Paint injection. Hand. Management.