Trend in Spain in the use of total ankle arthroplasty versus arthrodesis in the period 1997-2017. / Tendencia en España en el uso de artroplastia total de tobillo frente a artrodesis en el periodo 1997-2017.

OBJECTIVE: The main objective of this study is to compare proportionally the incidence of total ankle arthroplasty (TAA) versus ankle arthrodesis and to determine the variables that may have influenced its indication. The secondary objective is to analyse the trend in the use of TAA using a population-based analysis and to compare our results with those reported by national registries in other countries. MATERIAL AND METHOD: A retrospective review of the Minimum Basic Data Set from 1997-2017 was performed. Subjects were categorised according to surgical procedure. Their temporal evolution was analysed and hospital variables associated with the indication (age, sex, hospital complexity) were identified. In order to compare the trend in Spain with respect to other countries, the information was standardised as number of procedures per 100,000 inhabitants/year and a projection was made for the five-year period 2020-2025. RESULTS: In the period 1997-2017, 11,669 ankle arthrodesis and 1,049 TAAs were performed. The trend was increasing and significant for both procedures, however, in the last 10 years analysed the proportional trend of TAA decreased significantly. Being female (OR 1.32), being 65 years or older (OR 1.50) and being operated in a complex hospital (OR 1.31) were associated with the indication for a TAA. Compared to other countries, Spain has much lower rates of TAA utilisation, with minimal growth estimated for the year 2025. CONCLUSION: Although the use of TAA has increased, its growth has been lower than that of ankle arthrodesis and its current trend is proportionally decreasing, with female sex, age≥65 years and the patient being operated in a medium/high complexity hospital being associated with the indication for TAA. Compared with other countries, Spain has much lower rates of use and its projection over the next five years, although increasing, is expected to be minimal.

Tratamiento del hallux valgus moderado y severo mediante doble osteotomía percutánea del primer metatarsiano / Treatment of moderate and severe hallux valgus by performing percutaneous double osteotomy of the first metatarsal bone

Objetivo. Evaluar los resultados clínicos y radiológicos en el tratamiento del hallux valgus moderado y grave mediante la realización de una doble osteotomía percutánea. Material y métodos. Se presenta un estudio retrospectivo de 45 pies intervenidos en 42 pacientes diagnosticados de hallux valgus moderado-severo, operados en un solo centro y por el mismo cirujano entre mayo del 2009 y marzo del 2013. Dos pacientes no acudieron a los controles posquirúrgicos. Se registraron los resultados clínicos y radiológicos. Resultados. Según la escala de la American Orthopedic Foot and Ankle Society (AOFAS) se obtuvo una mejoría de la puntuación de 48,14 ± 4,79 puntos a 91,28 ± 8,73 puntos. Radiográficamente se obtuvo una disminución en el AIM de 16,88 ± 2,01 a 8,18 ± 3,23 y en el AHV de 40,02 ± 6,50 a 10,51 ± 6,55. Hubo un caso de hallux varus, un caso de seudoartrosis, un síndrome doloroso regional complejo tipo I, una infección que se resolvió con antibióticos y un caso de movilización de la osteosíntesis usada que requirió reintervención abierta. Discusión. Las osteotomías percutáneas distales aisladas del primer metatarsiano muestran limitaciones a la hora de enfrentarse a casos de hallux valgus moderado y severo. La técnica descrita añade las ventajas de la cirugía mínimamente invasiva, ampliando las indicaciones a deformidades severas. Conclusiones. La doble osteotomía percutánea es una técnica reproducible que permite la corrección de deformidades severas con buenos resultados clínicos y radiológicos y con una tasa de complicaciones similares a otras técnicas, con tiempos operatorios más cortos y menor daño de partes blandas (AU)

Objective. To evaluate the clinical and radiological results in the surgical treatment of moderate and severe hallux valgus by performing percutaneous double osteotomy. Material and method. A retrospective study was conducted on 45 feet of 42 patients diagnosed with moderate-severe hallux valgus, operated on in a single centre and by the same surgeon from May 2009 to March 2013. Two patients were lost to follow-up. Clinical and radiological results were recorded. Results. An improvement from 48.14 ± 4.79 points to 91.28 ± 8.73 points was registered using the American Orthopedic Foot and Ankle Society (AOFAS) scale. A radiological decrease from 16.88 ± 2.01 to 8.18 ± 3.23 was observed in the intermetatarsal angle, and from 40.02 ± 6.50 to 10.51 ± 6.55 in hallux valgus angle. There was one case of hallux varus, one case of non-union, a regional pain syndrome type I, an infection that resolved with antibiotics, and a case of loosening of the osteosynthesis that required an open surgical refixation. Discussion. Percutaneous distal osteotomy of the first metatarsal when performed as an isolated procedure, show limitations when dealing with cases of moderate and severe hallux valgus. The described technique adds the advantages of minimally invasive surgery by expanding applications to severe deformities. Conclusions. Percutaneous double osteotomy is a reproducible technique for correcting severe deformities, with good clinical and radiological results with a complication rate similar to other techniques with the advantages of shorter surgical times and less soft tissue damage (AU)

[Treatment of moderate and severe hallux valgus by performing percutaneous double osteotomy of the first metatarsal bone]. / Tratamiento del hallux valgus moderado y severo mediante doble osteotomía percutánea del primer metatarsiano.

OBJECTIVE: To evaluate the clinical and radiological results in the surgical treatment of moderate and severe hallux valgus by performing percutaneous double osteotomy. MATERIAL AND METHOD: A retrospective study was conducted on 45 feet of 42 patients diagnosed with moderate-severe hallux valgus, operated on in a single centre and by the same surgeon from May 2009 to March 2013. Two patients were lost to follow-up. Clinical and radiological results were recorded. RESULTS: An improvement from 48.14 ± 4.79 points to 91.28 ± 8.73 points was registered using the American Orthopedic Foot and Ankle Society (AOFAS) scale. A radiological decrease from 16.88 ± 2.01 to 8.18 ± 3.23 was observed in the intermetatarsal angle, and from 40.02 ± 6.50 to 10.51 ± 6.55 in hallux valgus angle. There was one case of hallux varus, one case of non-union, a regional pain syndrome type I, an infection that resolved with antibiotics, and a case of loosening of the osteosynthesis that required an open surgical refixation. DISCUSSION: Percutaneous distal osteotomy of the first metatarsal when performed as an isolated procedure, show limitations when dealing with cases of moderate and severe hallux valgus. The described technique adds the advantages of minimally invasive surgery by expanding applications to severe deformities. CONCLUSIONS: Percutaneous double osteotomy is a reproducible technique for correcting severe deformities, with good clinical and radiological results with a complication rate similar to other techniques with the advantages of shorter surgical times and less soft tissue damage.

[Echocardiographic assessment of patients with sickle cell anemia]. / Evaluación ecocardiográfica de pacientes con anemia falciforme.

One hundred and sixty four (164) patients were evaluated. Sixty (60) with Sickle cell disease (SSHg.) and ninety seven (97) with Trait (ASHg.); seventeen (17) were normal control group. The study confirmed that the incidence of cardiomyopathy in Trait (ASHg.) is greater than reported by other clinical investigations. Cardiac arrhythmia, atrial fibrillation, premature ventricular contractions, bundle branch blocks, and T and ST modifications with sub epicardial isquemia were most significant electrocardiographics changes. The possibility of myocardial infarction in SS patients with low or normal hemoglobin is significant. M-Mode and 2-D echo, demonstrated similar end diastolic volumes in AS and SS patients in which cardiomyopathy were diagnosticated. Patients with cardiac failure, treated with cardiotonics, diuretics and ACE were compensated most frequently. To prevent hemosiderosis, antioxydant (alfatocoferol and Ubiquinones) were used with satisfactory response.