¿Cómo planifico una cirugía de escoliosis idiopática del adolescente? Sistematización de un método de planificación preoperatoria / How do I plan adolescent idiopathic scoliosis surgery? Systematization of a preoperative planning method

La planificación preoperatoria resulta fundamental en la cirugía de escoliosis idiopática del adolescente (EIA) para determinar los niveles a fusionar y realizar el procedimiento con mayor precisión y diligencia. Sin embargo, su realización protocolizada no está tan extendida entre los especialistas en formación. El objetivo de este artículo es describir en detalle el método de planificación preoperatoria en la EIA empleado en una unidad especializada de raquis infantil y del adolescente de un centro de referencia, así como, la logística y la táctica, apoyado en un software gratuito de medición digital semiautomática y planificación. Se muestran 3 casos representativos de diferentes deformidades vertebrales, intervenidos mediante una artrodesis vertebral posterior tras una planificación preoperatoria según el método descrito. Este método resulta muy adecuado para el cirujano en formación al aunar las ventajas de los métodos tradicionales y los más modernos, y ser sencillo, de bajo coste, accesible, reproducible y con carácter formativo.(AU)

Preoperative planning is essential in adolescent idiopathic scoliosis (AIS) surgery to determine the fusion levels and to perform the procedure with greater precision and diligence. However, the protocolized performance of such planning is not as widespread among specialists in training. The aim of this article is to describe in detail the preoperative planning method for AIS used in a specialized pediatric and adolescent spine unit of a referral center, as well as the logistics and the tactics, supported a free semi-automatic digital measurement and planning software. Three representative cases of different vertebral deformities, treated by posterior spinal fusion after preoperative planning according to the method, are shown. This method is highly suitable for the trainee surgeon as it combines the advantages of traditional and modern methods, and is simple, low cost, accessible, reproducible and with an educational character.(AU)

[Translated article] How do I plan adolescent idiopathic scoliosis surgery? Systematization of a preoperative planning method / ¿Cómo planifico una cirugía de escoliosis idiopática del adolescente? Sistematización de un método de planificación preoperatoria

La planificación preoperatoria resulta fundamental en la cirugía de escoliosis idiopática del adolescente (EIA) para determinar los niveles a fusionar y realizar el procedimiento con mayor precisión y diligencia. Sin embargo, su realización protocolizada no está tan extendida entre los especialistas en formación. El objetivo de este artículo es describir en detalle el método de planificación preoperatoria en la EIA empleado en una unidad especializada de raquis infantil y del adolescente de un centro de referencia, así como, la logística y la táctica, apoyado en un software gratuito de medición digital semiautomática y planificación. Se muestran 3 casos representativos de diferentes deformidades vertebrales, intervenidos mediante una artrodesis vertebral posterior tras una planificación preoperatoria según el método descrito. Este método resulta muy adecuado para el cirujano en formación al aunar las ventajas de los métodos tradicionales y los más modernos, y ser sencillo, de bajo coste, accesible, reproducible y con carácter formativo.(AU)

Preoperative planning is essential in adolescent idiopathic scoliosis (AIS) surgery to determine the fusion levels and to perform the procedure with greater precision and diligence. However, the protocolized performance of such planning is not as widespread among specialists in training. The aim of this article is to describe in detail the preoperative planning method for AIS used in a specialized pediatric and adolescent spine unit of a referral center, as well as the logistics and the tactics, supported a free semi-automatic digital measurement and planning software. Three representative cases of different vertebral deformities, treated by posterior spinal fusion after preoperative planning according to the method, are shown. This method is highly suitable for the trainee surgeon as it combines the advantages of traditional and modern methods, and is simple, low cost, accessible, reproducible and with an educational character.(AU)

[Translated article] How do I plan adolescent idiopathic scoliosis surgery? Systematization of a preoperative planning method.

Preoperative planning is essential in adolescent idiopathic scoliosis (AIS) surgery to determine the fusion levels and to perform the procedure with greater precision and diligence. However, the protocolized performance of such planning is not as widespread among specialists in training. The aim of this article is to describe in detail the preoperative planning method for AIS used in a specialised paediatric and adolescent spine unit of a referral centre, as well as the logistics and the tactics, supported a free semi-automatic digital measurement and planning software. Three representative cases of different vertebral deformities, treated by posterior spinal fusion after preoperative planning according to the method, are shown. This method is highly suitable for the trainee surgeon as it combines the advantages of traditional and modern methods, and is simple, low-cost, accessible, reproducible and with an educational character.

Manejo de las metástasis vertebrales en la charnela cervico-occipital / Management of vertebral metastases in the cervico-occipital junction

Las metástasis a nivel occipito-cervical corresponden solo al 0,5% de las metástasis del raquis. El manejo de estas lesiones es complejo y conlleva múltiples estudios radiológicos, tales como la radiología simple, la tomografía computarizada (TAC) o la resonancia magnética (RM). Ante la sospecha de afectación vascular también será recomendable la realización de pruebas que valoren la permeabilidad vascular (angio-TC, angio-RM). Este tipo de lesiones, debido a su compleja localización, puede precisar distintos tipos de vías de abordaje; comúnmente será el abordaje posterior, pero en ocasiones se necesitarán abordajes anteriores o anterolaterales asistidos por cirujanos maxilofaciales u otorrinolaringólogos para una correcta exéresis de la tumoración. El dolor con los giros puede orientarnos al diagnóstico en una columna inestable. La RM es la prueba de elección para diagnosticar y estudiar estas lesiones. La presencia de inestabilidad o de clínica neurológica progresiva es indicación de cirugía.(AU)

Occipito-cervical metastases correspond to 0.5% of spinal metastases. The management of these lesions is complex and involves multiple radiological studies, such as simple radiology, computed tomography (CT), magnetic resonance imaging (MRI). Is vascular involvement is suspected, tests to assess vascular permeability are also recommended (angioCT). This type of lesion, due to its complex location, may require different types of approaches, commonly it will be the posterior approach, but sometimes anterior or anterolateral approaches will be needed assisted by maxillofacial surgeons or otorhinolaryngologists for correct excision of the tumor. Pain with head turning can guide us to the diagnosis in an unstable spine. Magnetic resonance is the test of choice to diagnose and study these lesions. The presence of instability or progressive neurological symptoms are an indication for surgery.(AU)

[Translated article] Management of vertebral metastases in the cervico-occipital junction / Manejo de las metástasis vertebrales en la charnela cervicooccipital

Las metástasis a nivel occipito-cervical corresponden solo al 0,5% de las metástasis del raquis. El manejo de estas lesiones es complejo y conlleva múltiples estudios radiológicos, tales como la radiología simple, la tomografía computarizada (TAC) o la resonancia magnética (RM). Ante la sospecha de afectación vascular también será recomendable la realización de pruebas que valoren la permeabilidad vascular (angio-TC, angio-RM). Este tipo de lesiones, debido a su compleja localización, puede precisar distintos tipos de vías de abordaje; comúnmente será el abordaje posterior, pero en ocasiones se necesitarán abordajes anteriores o anterolaterales asistidos por cirujanos maxilofaciales u otorrinolaringólogos para una correcta exéresis de la tumoración. El dolor con los giros puede orientarnos al diagnóstico en una columna inestable. La RM es la prueba de elección para diagnosticar y estudiar estas lesiones. La presencia de inestabilidad o de clínica neurológica progresiva es indicación de cirugía.(AU)

Occipito-cervical metastases correspond to 0.5% of spinal metastases. The management of these lesions is complex and involves multiple radiological studies, such as simple radiology, computed tomography (CT), magnetic resonance imaging (MRI). Is vascular involvement is suspected, tests to assess vascular permeability are also recommended (angioCT). This type of lesion, due to its complex location, may require different types of approaches, commonly it will be the posterior approach, but sometimes anterior or anterolateral approaches will be needed assisted by maxillofacial surgeons or otorhinolaryngologists for correct excision of the tumor. Pain with head turning can guide us to the diagnosis in an unstable spine. Magnetic resonance is the test of choice to diagnose and study these lesions. The presence of instability or progressive neurological symptoms are an indication for surgery.(AU)

[Translated article] Management of vertebral metastases in the cervico-occipital junction.

Occipito-cervical metastases correspond to 0.5% of spinal metastases. The management of these lesions is complex and involves multiple radiological studies, such as simple radiology, computed tomography (CT), magnetic resonance imaging (MRI). Is vascular involvement is suspected, tests to assess vascular permeability are also recommended (angioCT). This type of lesion, due to its complex location, may require different types of approaches, commonly it will be the posterior approach, but sometimes anterior or antero-lateral approaches will be needed assisted by maxillofacial surgeons or otorhinolaryngologists for correct excision of the tumour. Pain with head turning can guide us to the diagnosis in an unstable spine. Magnetic resonance is the test of choice to diagnose and study these lesions. The presence of instability or progressive neurological symptoms is an indication for surgery.

Management of vertebral metastases in the cervico-occipital junction. / Manejo de las metástasis vertebrales en la charnela cervico-occipital.

Occipito-cervical metastases correspond to 0.5% of spinal metastases. The management of these lesions is complex and involves multiple radiological studies, such as simple radiology, computed tomography (CT), magnetic resonance imaging (MRI). Is vascular involvement is suspected, tests to assess vascular permeability are also recommended (angioCT). This type of lesion, due to its complex location, may require different types of approaches, commonly it will be the posterior approach, but sometimes anterior or anterolateral approaches will be needed assisted by maxillofacial surgeons or otorhinolaryngologists for correct excision of the tumor. Pain with head turning can guide us to the diagnosis in an unstable spine. Magnetic resonance is the test of choice to diagnose and study these lesions. The presence of instability or progressive neurological symptoms are an indication for surgery.

How do I plan adolescent idiopathic scoliosis surgery? Systematization of a preoperative planning method. / ¿Cómo planifico una cirugía de escoliosis idiopática del adolescente? Sistematización de un método de planificación preoperatoria.

Preoperative planning is essential in adolescent idiopathic scoliosis (AIS) surgery to determine the fusion levels and to perform the procedure with greater precision and diligence. However, the protocolized performance of such planning is not as widespread among specialists in training. The aim of this article is to describe in detail the preoperative planning method for AIS used in a specialized pediatric and adolescent spine unit of a referral center, as well as the logistics and the tactics, supported a free semi-automatic digital measurement and planning software. Three representative cases of different vertebral deformities, treated by posterior spinal fusion after preoperative planning according to the method, are shown. This method is highly suitable for the trainee surgeon as it combines the advantages of traditional and modern methods, and is simple, low cost, accessible, reproducible and with an educational character.

Planificar fracturas es sencillo: desarrollo de un método básico de planificación digital basado en la técnica tradicional con lápiz y papel / Fracture planning is easy: Development of a basic method of digital planning based on the traditional pencil and paper technique

Introducción: La planificación preoperatoria constituye una herramienta fundamental en el manejo de fracturas; sin embargo, su aplicación práctica dista de lo deseado, quizá debido a la ausencia de un método básico y sencillo, adaptado a los tiempos actuales. Describimos un método de planificación digital, entre lo tradicional y lo tecnológico, que conserva su esencia educativa, permite comprender la fractura e individualizar la osteosíntesis. Material y métodos: Tras el análisis inicial de la fractura y características del paciente, se realizan diferentes mediciones en las imágenes de Rx y TC con un programa de imagen médica digital. Estas imágenes se copian en un programa de presentación (Microsoft® PowerPoint o Keynote ©Apple Inc.), en el que se reproducen con el puntero del ordenador los principales fragmentos y líneas de fractura. A continuación, estos se mueven a una posición reducida y se representan gráficamente los implantes para la fijación interna junto con un guion de la estrategia quirúrgica. Resultados: Mostramos 4 casos de diferentes tipos de fracturas intervenidas mediante reducción y osteosíntesis tras una planificación preoperatoria según el método descrito. Se detallan los puntos básicos para la planificación quirúrgica, logística, táctica y los resultados radiológicos postoperatorios de cada caso. Conclusiones: A pesar del auge de programas informáticos avanzados de planificación, los métodos tradicionales con lápiz y papel siguen siendo fundamentales, más aún para el traumatólogo en formación. El método de planificación digital descrito resulta muy adecuado para este objetivo, al aunar las ventajas de ambos métodos: sencillez, accesibilidad, rapidez, bajo coste, reproducibilidad, carácter formativo y eficacia y por posibilitar la simulación, correcciones y la reutilización de casos.(AU)

Introduction: Preoperative planning constitutes a fundamental tool in the management of fractures; however, its practical application is far from the desired, perhaps due to the absence of a basic and simple method, adapted to the current times. We describe a digital planning method, halfway between the traditional and the technological, which preserves its educational essence, allows the understanding of the fracture and the individualization of the osteosynthesis. Material and methods: After the initial analysis of the fracture and the patient's characteristics, different measurements are made on X-ray and CT images with a digital medical imaging software. These images are then copied into a presentation program (Microsoft® PowerPoint or Keynote ©Apple Inc.), in which the main fragments and fracture lines are traced with the computer pointer. These are subsequently moved into a reduced position and the implants for internal fixation are graphically represented together with a guide of the surgical strategy. Results: We show 4 cases of different types of fractures operated through reduction and osteosynthesis after preoperative planning according to the described method. The basic points for the surgical planning, logistics, tactics and postoperative radiological results of each case are detailed. Conclusions: Despite rise of advanced planning software, traditional paper and pencil methods are still fundamental, even more so for the trauma surgeon in training. The digital planning method described is very appropriate for this purpose, as it combines the advantages of both methods: simplicity, accessibility, quickness, low-cost, reproducibility, educational character, efficiency and possibility of simulation, corrections and reuse of cases.(AU)

[Translated article] Fracture planning is easy: Development of a basic method of digital planning based on the traditional pencil and paper technique / Planificar fracturas es sencillo: desarrollo de un método básico de planificación digital basado en la técnica tradicional con lápiz y papel

Introducción: La planificación preoperatoria constituye una herramienta fundamental en el manejo de fracturas; sin embargo, su aplicación práctica dista de lo deseado, quizá debido a la ausencia de un método básico y sencillo, adaptado a los tiempos actuales. Describimos un método de planificación digital, entre lo tradicional y lo tecnológico, que conserva su esencia educativa, permite comprender la fractura e individualizar la osteosíntesis. Material y métodos: Tras el análisis inicial de la fractura y características del paciente, se realizan diferentes mediciones en las imágenes de Rx y TC con un programa de imagen médica digital. Estas imágenes se copian en un programa de presentación (Microsoft® PowerPoint o Keynote ©Apple Inc.), en el que se reproducen con el puntero del ordenador los principales fragmentos y líneas de fractura. A continuación, estos se mueven a una posición reducida y se representan gráficamente los implantes para la fijación interna junto con un guion de la estrategia quirúrgica. Resultados: Mostramos 4 casos de diferentes tipos de fracturas intervenidas mediante reducción y osteosíntesis tras una planificación preoperatoria según el método descrito. Se detallan los puntos básicos para la planificación quirúrgica, logística, táctica y los resultados radiológicos postoperatorios de cada caso. Conclusiones: A pesar del auge de programas informáticos avanzados de planificación, los métodos tradicionales con lápiz y papel siguen siendo fundamentales, más aún para el traumatólogo en formación. El método de planificación digital descrito resulta muy adecuado para este objetivo, al aunar las ventajas de ambos métodos: sencillez, accesibilidad, rapidez, bajo coste, reproducibilidad, carácter formativo y eficacia y por posibilitar la simulación, correcciones y la reutilización de casos.(AU)

Introduction: Preoperative planning constitutes a fundamental tool in the management of fractures; however, its practical application is far from the desired, perhaps due to the absence of a basic and simple method, adapted to the current times. We describe a digital planning method, halfway between the traditional and the technological, which preserves its educational essence, allows the understanding of the fracture and the individualization of the osteosynthesis. Material and methods: After the initial analysis of the fracture and the patient's characteristics, different measurements are made on X-ray and CT images with a digital medical imaging software. These images are then copied into a presentation program (Microsoft® PowerPoint or Keynote ©Apple Inc.), in which the main fragments and fracture lines are traced with the computer pointer. These are subsequently moved into a reduced position and the implants for internal fixation are graphically represented together with a guide of the surgical strategy. Results: We show 4 cases of different types of fractures operated through reduction and osteosynthesis after preoperative planning according to the described method. The basic points for the surgical planning, logistics, tactics and postoperative radiological results of each case are detailed. Conclusions: Despite rise of advanced planning software, traditional paper and pencil methods are still fundamental, even more so for the trauma surgeon in training. The digital planning method described is very appropriate for this purpose, as it combines the advantages of both methods: simplicity, accessibility, quickness, low-cost, reproducibility, educational character, efficiency and possibility of simulation, corrections and reuse of cases.(AU)

[Translated article] Fracture planning is easy: Development of a basic method of digital planning based on the traditional pencil and paper technique.

INTRODUCTION: Preoperative planning constitutes a fundamental tool in the management of fractures; however, its practical application is far from the desired, perhaps due to the absence of a basic and simple method, adapted to the current times. We describe a digital planning method, halfway the traditional and the technological, which preserves its educational essence, allows for the understanding of the fracture and the individualisation of the osteosynthesis. MATERIAL AND METHODS: After the initial analysis of the fracture and the patient's characteristics, different measurements are made on X-ray and CT images with a digital medical imaging software. These images are then copied into a presentation programme (Microsoft® PowerPoint or Keynote ©Apple Inc.), in which the main fragments and fracture lines are traced with the computer pointer. These are subsequently moved into a reduced position and the implants for internal fixation are graphically represented together with a guide of the surgical strategy. RESULTS: We show 4 cases of different types of fractures operated through reduction and osteosynthesis after preoperative planning according to the described method. The basic points for the surgical planning, logistics, tactics and postoperative radiological results of each case are detailed. CONCLUSIONS: Despite the rise of advanced planning software, traditional paper and pencil methods are still fundamental, even more so for the trauma surgeon in training. The digital planning method described is very appropriate for this purpose, as it combines the advantages of both methods: simplicity, accessibility, quickness, low cost, reproducibility, educational character, efficiency and possibility of simulation, corrections and reuse of cases.

Suprapatellar tibial nailing, why have we changed? / Enclavado de tibia suprapatelar, ¿por qué hemos cambiado?

INTRODUCTION: Endomedullary nailing using the infrapatellar approach (IP) is considered the gold standard for the treatment of tibial diaphyseal fractures, however, it has been associated with greater difficulty in reduction and complications such as malalignment in procurvatum and anterior knee pain. The suprapatellar approach (SP) arises as an alternative to solve these aspects, also being associated with a shorter intraoperative time and a lower dose and fluoroscopy time. MATERIAL AND METHODS: Retrospective comparative study between a group of 22 fractures treated by SP approach and another of 30 fractures intervened by IP transtendinous approach. Perioperative variables were analyzed, as well as clinical, radiological, and functional aspects in outpatient visits at 3, 6 and 12 months. RESULTS: No differences were found between groups in terms of intraoperative time, anemization, quality of reduction or complications during follow-up, among others. At 12 months, 12 (54.5%) SP cases and 16 (53.3%) IP presented anterior knee pain, without significant differences. In the evaluation scales, significant differences were recorded in the IKDC (International Knee Documentation Committee) in favor of the SP technique 88.45 (76.44-91.1) vs. IP 69 (49.95-80) (p=.006), with no significant differences in other functional scales analyzed. CONCLUSIONS: According to what has been described so far in the literature, the present study supports the tendency toward SP nailing by improving the functional results (IKDC) in the medium term compared to the traditional IP technique, without increasing complications. Likewise, surgeons perceive greater technical ease for reduction and simplicity in obtaining intraoperative radiological images.

Enclavado de tibia suprapatelar, ¿por qué hemos cambiado? / Suprapatellar tibial nailing, why have we changed?

Introducción: El enclavado endomedular mediante abordaje infrapatelar (IP) se considera el gold estándar del tratamiento de las fracturas diafisarias de tibia, sin embargo, se ha asociado a mayor dificultad para la reducción y complicaciones como la mala alineación en procurvatum y al dolor anterior de rodilla. El abordaje suprapatelar (SP) surge como alternativa para solventar estos aspectos, asociándose también con un menor tiempo intraoperatorio y menor dosis y tiempo de fluoroscopia. Material y métodos: Estudio retrospectivo comparativo entre: un grupo de 22 fracturas intervenidas mediante abordaje SP y otro de 30 fracturas intervenidas por abordaje IP trastendinoso. Se analizaron variables perioperatorias y aspectos clínicos, radiológicos y funcionales en consulta a los 3, 6 y 12 meses. Resultados: No se encontraron diferencias entre grupos en cuanto a tiempo intraoperatorio, anemización, calidad de la reducción, o complicaciones en el seguimiento, entre otros. A los 12 meses, 12 (54,5%) casos SP y 16 (53,3%) IP presentaban dolor anterior de rodilla, sin diferencias significativas. En las escalas de evaluación, se registraron diferencias significativas en la IKDC (International Knee Documentation Committee) a favor de la técnica SP (88,45 [76,44-91,1] vs. IP 69 [49,95-80]) (p=0,006), sin diferencias significativas en otras escalas funcionales analizadas. Conclusiones: En consonancia con lo hasta ahora descrito en la literatura, el presente estudio apoya la tendencia hacia el enclavado SP por mejorar los resultados funcionales (IKDC) a medio plazo respecto a la técnica tradicional IP, sin aumentar las complicaciones. Asimismo se percibe por los cirujanos una mayor facilidad técnica para la reducción y sencillez en la obtención de imágenes radiológicas intraoperatorias.(AU)

Introduction: Endomedullary nailing using the infrapatellar approach (IP) is considered the gold standard for the treatment of tibial diaphyseal fractures, however, it has been associated with greater difficulty in reduction and complications such as malalignment in procurvatum and anterior knee pain. The suprapatellar approach (SP) arises as an alternative to solve these aspects, also being associated with a shorter intraoperative time and a lower dose and fluoroscopy time. Material and methods: Retrospective comparative study between a group of 22 fractures treated by SP approach and another of 30 fractures intervened by IP transtendinous approach. Perioperative variables were analyzed, as well as clinical, radiological, and functional aspects in outpatient visits at 3, 6 and 12 months. Results: No differences were found between groups in terms of intraoperative time, anemization, quality of reduction or complications during follow-up, among others. At 12 months, 12 (54.5%) SP cases and 16 (53.3%) IP presented anterior knee pain, without significant differences. In the evaluation scales, significant differences were recorded in the IKDC (International Knee Documentation Committee) in favor of the SP technique 88.45 (76.44–91.1) vs. IP 69 (49.95–80) (p=.006), with no significant differences in other functional scales analyzed. Conclusions: According to what has been described so far in the literature, the present study supports the tendency toward SP nailing by improving the functional results (IKDC) in the medium term compared to the traditional IP technique, without increasing complications. Likewise, surgeons perceive greater technical ease for reduction and simplicity in obtaining intraoperative radiological images.(AU)

Suprapatellar tibial nailing, why have we changed? / Enclavado de tibia suprapatelar, ¿por qué hemos cambiado?

Introduction: Endomedullary nailing using the infrapatellar approach (IP) is considered the gold standard for the treatment of tibial diaphyseal fractures, however, it has been associated with greater difficulty in reduction and complications such as malalignment in procurvatum and anterior knee pain. The suprapatellar approach (SP) arises as an alternative to solve these aspects, also being associated with a shorter intraoperative time and a lower dose and fluoroscopy time. Material and methods: Retrospective comparative study between a group of 22 fractures treated by SP approach and another of 30 fractures intervened by IP transtendinous approach. Perioperative variables were analyzed, as well as clinical, radiological, and functional aspects in outpatient visits at 3, 6 and 12 months. Results: No differences were found between groups in terms of intraoperative time, anemization, quality of reduction or complications during follow-up, among others. At 12 months, 12 (54.5%) SP cases and 16 (53.3%) IP presented anterior knee pain, without significant differences. In the evaluation scales, significant differences were recorded in the IKDC (International Knee Documentation Committee) in favor of the SP technique 88.45 (76.44–91.1) vs. IP 69 (49.95–80) (p=.006), with no significant differences in other functional scales analyzed. Conclusions: According to what has been described so far in the literature, the present study supports the tendency toward SP nailing by improving the functional results (IKDC) in the medium term compared to the traditional IP technique, without increasing complications. Likewise, surgeons perceive greater technical ease for reduction and simplicity in obtaining intraoperative radiological images.(AU)

Introducción: El enclavado endomedular mediante abordaje infrapatelar (IP) se considera el gold estándar del tratamiento de las fracturas diafisarias de tibia, sin embargo, se ha asociado a mayor dificultad para la reducción y complicaciones como la mala alineación en procurvatum y al dolor anterior de rodilla. El abordaje suprapatelar (SP) surge como alternativa para solventar estos aspectos, asociándose también con un menor tiempo intraoperatorio y menor dosis y tiempo de fluoroscopia. Material y métodos: Estudio retrospectivo comparativo entre: un grupo de 22 fracturas intervenidas mediante abordaje SP y otro de 30 fracturas intervenidas por abordaje IP trastendinoso. Se analizaron variables perioperatorias y aspectos clínicos, radiológicos y funcionales en consulta a los 3, 6 y 12 meses. Resultados: No se encontraron diferencias entre grupos en cuanto a tiempo intraoperatorio, anemización, calidad de la reducción, o complicaciones en el seguimiento, entre otros. A los 12 meses, 12 (54,5%) casos SP y 16 (53,3%) IP presentaban dolor anterior de rodilla, sin diferencias significativas. En las escalas de evaluación, se registraron diferencias significativas en la IKDC (International Knee Documentation Committee) a favor de la técnica SP (88,45 [76,44-91,1] vs. IP 69 [49,95-80]) (p=0,006), sin diferencias significativas en otras escalas funcionales analizadas. Conclusiones: En consonancia con lo hasta ahora descrito en la literatura, el presente estudio apoya la tendencia hacia el enclavado SP por mejorar los resultados funcionales (IKDC) a medio plazo respecto a la técnica tradicional IP, sin aumentar las complicaciones. Asimismo se percibe por los cirujanos una mayor facilidad técnica para la reducción y sencillez en la obtención de imágenes radiológicas intraoperatorias.(AU)

Fracture planning is easy: Development of a basic method of digital planning based on the traditional pencil and paper technique. / Planificar fracturas es sencillo: desarrollo de un método básico de planificación digital basado en la técnica tradicional con lápiz y papel.

INTRODUCTION: Preoperative planning constitutes a fundamental tool in the management of fractures; however, its practical application is far from the desired, perhaps due to the absence of a basic and simple method, adapted to the current times. We describe a digital planning method, halfway between the traditional and the technological, which preserves its educational essence, allows the understanding of the fracture and the individualization of the osteosynthesis. MATERIAL AND METHODS: After the initial analysis of the fracture and the patient's characteristics, different measurements are made on X-ray and CT images with a digital medical imaging software. These images are then copied into a presentation program (Microsoft® PowerPoint or Keynote ©Apple Inc.), in which the main fragments and fracture lines are traced with the computer pointer. These are subsequently moved into a reduced position and the implants for internal fixation are graphically represented together with a guide of the surgical strategy. RESULTS: We show 4 cases of different types of fractures operated through reduction and osteosynthesis after preoperative planning according to the described method. The basic points for the surgical planning, logistics, tactics and postoperative radiological results of each case are detailed. CONCLUSIONS: Despite rise of advanced planning software, traditional paper and pencil methods are still fundamental, even more so for the trauma surgeon in training. The digital planning method described is very appropriate for this purpose, as it combines the advantages of both methods: simplicity, accessibility, quickness, low-cost, reproducibility, educational character, efficiency and possibility of simulation, corrections and reuse of cases.

Renunciations in forefoot surgery. Critical analysis of surgical waiting lists. / Renuncias en cirugía del antepié. Análisis crítico de las listas de espera.

INTRODUCTION: The high prevalence of forefoot pathology generates long surgical waiting lists (SWL). We have detected a considerable number of patients who withdraw surgery, which creates an important distortion in our activity and high expenditure of resources. Our objective is to study the factors related to these resignations, as well as, compare them with other pathologies of high prevalence and ambulatory surgical treatment: carpal tunnel syndrome (CTS) and internal meniscopathy (IM). MATERIAL AND METHODS: Retrospective study of the surgical cancellations on 2,399 patients included in the SWL of the Foot and Ankle Unit of our center for forefoot surgery, between January/2014 and March/2018, both included. RESULTS: We have found 389 renunciations, which represent 16.22% of the inclusions in SWL, with 84.83% of women. The pathologies with the highest rate of resignation have been Morton metatarsalgia (24%) and hallux rigidus (20.16%). The most frequent pathology, hallux valgus, records 15.96% of resignations that occur mostly between 6 and 9 months. In the CTS and IM, the resignation rate has been 17.42 and 8.92%, respectively, with higher resignation rates in the first 3 months. CONCLUSIONS: The withdrawal of a scheduled intervention on the forefoot registers a high frequency in our environment, which can be related to factors such as the type of pathology, its natural history, response to orthopedic interventions, time in LEQ, and other non-specific ones on which we must investigate, to rationalize and establish duties in our SWL.

Hematomas subcutáneos a tensión por anticoagulantes en ancianos: ¿más morbimortalidad precoz que las fracturas de cadera? / Tension subcutaneous haematomas associated with anticoagulants in the elderly: Do they have earlier morbidity and mortality than hip fractures?

Introducción: Las complicaciones del tratamiento con fármacos anticoagulantes han sido ampliamente descritas, si bien los hematomas a tensión en extremidades se consideran en muchos casos patologías banales. Material y método: Estudio descriptivo retrospectivo entre 2014 y 2017, incluyendo a pacientes con hematomas tras un mínimo traumatismo en extremidades por anticoagulantes intervenidos por Traumatología. Resultados: Se incluyó a 32 pacientes; el 81% eran mujeres, con una edad media de 83,56 años e ICCa de 5,97. La localización anatómica de los hematomas fue: el 65,6% en pierna/pie, el 15,6% en muslo/glúteo y el 18,8% en miembro superior. El 78,13% consumía acenocumarol, el 15,63% HBPM y el 3,13% NACO, siendo el 59,38% de los casos por FA, el 15,63% por valvulopatías/prótesis valvulares y el 12,5% por TEP/TVP. El tiempo medio desde el diagnóstico al drenaje quirúrgico fue de 2,66 días, principalmente por alteraciones de la coagulación. Un 46,88% fueron reintervenidos para nuevo drenaje, cura o cobertura del defecto cutáneo y 3 pacientes precisaron embolización. Fue necesaria la valoración por otras especialidades en el 78,1%. La estancia media fue de 22,34 días y la tasa de mortalidad intrahospitalaria del 9,38%. Conclusión: Los hematomas a tensión por anticoagulantes en extremidades acontecen en pacientes pluripatológicos y ancianos frágiles. Habitualmente el drenaje quirúrgico se retrasa por multitud de factores, lo que conlleva defectos cutáneos amplios que requieren reintervenciones y estancias hospitalarias prolongadas que se asocian a complicaciones médicas. En nuestro estudio, los datos de estancia media y tasa de mortalidad son superiores a los de las fracturas de cadera, por lo que no debemos subestimar esta patología

Introduction: Complications related to anticoagulant therapy have been widely described, although tension haematomas in the extremities are frequently undervalued, and commonly considered banal pathologies. Material and method: Retrospective descriptive study between 2014 and 2017, including patients with limb haematomas after minimal trauma related with anticoagulant therapy, and surgically treated by Traumatology. Results: 32 cases were eventually included, 81% were women, average age of 83.56 years, and a mean aCCI of 5.97. Anatomical location of haematomas was 65.6% in leg/foot, 15.6% in thigh/buttock, and 18.8% in the upper limb. Seventy-eight point thirteen percent received acenocoumarol, 15.63% LMWH, and 3.13% NOACs. Of the cases, 59.38% were due to AF, 15.63% to valvular heart disease/valve prosthesis, and 12.5% to PE/DVT. The mean time from diagnosis to surgical drainage was 2.66 days, mainly as a result of alterations in coagulation parameters. Forty-six point eighty-eight percent were reoperated for new drainage, cure or skin defect coverage, and 3 patients required embolisation. Of the patients, 78% needed consultation with other specialties. The average length of stay was 22.34 days, and the in-hospital mortality rate was 9.38%. Conclusion: Tension haematomas in the extremities associated with anticoagulants occur in patients with multiple comorbidities that make them vulnerable. Surgical drainage is usually delayed by numerous factors which lead to skin defects that require further surgical operations, and prolonged hospital stays that are associated with medical complications. In our study, the average length of stay and in-hospital mortality rate were higher than those for hip fractures, so we should not underestimate this pathology

Tension subcutaneous haematomas associated with anticoagulants in the elderly: Do they have earlier morbidity and mortality than hip fractures? / Hematomas subcutáneos a tensión por anticoagulantes en ancianos: ¿más morbimortalidad precoz que las fracturas de cadera?

INTRODUCTION: Complications related to anticoagulant therapy have been widely described, although tension haematomas in the extremities are frequently undervalued, and commonly considered banal pathologies. MATERIAL AND METHOD: Retrospective descriptive study between 2014 and 2017, including patients with limb haematomas after minimal trauma related with anticoagulant therapy, and surgically treated by Traumatology. RESULTS: 32 cases were eventually included, 81% were women, average age of 83.56 years, and a mean aCCI of 5.97. Anatomical location of haematomas was 65.6% in leg/foot, 15.6% in thigh/buttock, and 18.8% in the upper limb. Seventy-eight point thirteen percent received acenocoumarol, 15.63% LMWH, and 3.13% NOACs. Of the cases, 59.38% were due to AF, 15.63% to valvular heart disease/valve prosthesis, and 12.5% to PE/DVT. The mean time from diagnosis to surgical drainage was 2.66 days, mainly as a result of alterations in coagulation parameters. Forty-six point eighty-eight percent were reoperated for new drainage, cure or skin defect coverage, and 3 patients required embolisation. Of the patients, 78% needed consultation with other specialties. The average length of stay was 22.34 days, and the in-hospital mortality rate was 9.38%. CONCLUSION: Tension haematomas in the extremities associated with anticoagulants occur in patients with multiple comorbidities that make them vulnerable. Surgical drainage is usually delayed by numerous factors which lead to skin defects that require further surgical operations, and prolonged hospital stays that are associated with medical complications. In our study, the average length of stay and in-hospital mortality rate were higher than those for hip fractures, so we should not underestimate this pathology.