Desarrollo de criterios de uso adecuado para la artroscopia de cadera en pacientes con choque femoroacetabular / Development of appropriateness criteria for hip arthroscopy in patients with femoroacetabular impingement

Introducción: El uso de la artroscopia de cadera como tratamiento del choque femoroacetabular (CFA) ha aumentado exponencialmente en los últimos años sin que exista evidencia robusta o consenso sobre los pacientes que se benefician de ella. Objetivo: Elaborar criterios explícitos para la indicación adecuada de la artroscopia de cadera en CFA. Método: Se realizó un panel de expertos con 11 traumatólogos siguiendo el método RAND/UCLA para identificar los criterios de uso adecuado de la artroscopia de cadera en pacientes con CFA. El panel realizó evaluaciones independientes de cada indicación usando una escala de adecuación de nueve puntos, posteriormente se reunió presencialmente para votar usando un proceso iterativo de discusión. Se estudió la influencia de las variables en la puntuación final, utilizando modelos de regresión logística multinomial. Se utilizó el análisis Classification and Regression Tree (CART) para resumir los resultados en forma de árboles de decisión. Resultados: De los 192 escenarios evaluados en la reunión presencial, el 23,4% fue considerado adecuado (acuerdo del 40%), el 26,6% dudoso y el 50% inadecuado (acuerdo del 75%). Las variables más influyentes para considerar adecuado el uso de la artroscopia fueron: clínica articular compatible con test de choque, duración de los síntomas, funcionalidad, edad y escala Hip Outcome Score (HOS). Conclusiones: Hemos desarrollado un conjunto explícito de criterios de uso adecuado de la artroscopia de cadera en CFA mediante el método RAND/UCLA, proporcionando una herramienta que permitiría identificar pacientes potencialmente candidatos a tratamiento quirúrgico mediante cirugía artroscópica de cadera

Introduction: The use of hip arthroscopy as a treatment for femoroacetabular impingement (FAI) has increased exponentially in recent years without robust evidence or consensus about the patients who benefit from it. Objective: To develop explicit criteria for the appropriate indication of hip arthroscopy in FAI. Method: A panel of experts was formed with 11 traumatologists following the RAND/UCLA method to identify the appropriateness criteria for hip arthroscopy in patients with FAI. The panel made independent evaluations of each indication using a nine-point adequacy scale, then met face-to-face to vote using an iterative discussion process. The influence of the variables on the final score was studied using multinomial logistic regression models. The Classification and Regression Tree (CART) analysis was used to summarize the results in the form of decision trees. Results: Twenty-three point four percent of the 192 scenarios evaluated in the face-to-face meeting was considered appropriate (40% agreement), 26.6% uncertain and 50% inappropriate (75% agreement). The most influential variables in considering the use of arthroscopy appropriate were: joint symptoms compatible with shock test, duration of symptoms, functionality, age and Hip Outcome Score (HOS) scale. Conclusions: We developed an explicit set of criteria for the appropriate use of hip arthroscopy in FAI using the RAND/UCLA method, providing a tool that would identify patients who are potential candidates for surgical treatment using arthroscopic hip surgery

Development of appropriateness criteria for hip arthroscopy in patients with femoroacetabular impingement. / Desarrollo de criterios de uso adecuado para la artroscopia de cadera en pacientes con choque femoroacetabular.

INTRODUCTION: The use of hip arthroscopy as a treatment for femoroacetabular impingement (FAI) has increased exponentially in recent years without robust evidence or consensus about the patients who benefit from it. OBJECTIVE: To develop explicit criteria for the appropriate indication of hip arthroscopy in FAI. METHOD: A panel of experts was formed with 11 traumatologists following the RAND/UCLA method to identify the appropriateness criteria for hip arthroscopy in patients with FAI. The panel made independent evaluations of each indication using a nine-point adequacy scale, then met face-to-face to vote using an iterative discussion process. The influence of the variables on the final score was studied using multinomial logistic regression models. The Classification and Regression Tree (CART) analysis was used to summarize the results in the form of decision trees. RESULTS: Twenty-three point four percent of the 192 scenarios evaluated in the face-to-face meeting was considered appropriate (40% agreement), 26.6% uncertain and 50% inappropriate (75% agreement). The most influential variables in considering the use of arthroscopy appropriate were: joint symptoms compatible with shock test, duration of symptoms, functionality, age and Hip Outcome Score (HOS) scale. CONCLUSIONS: We developed an explicit set of criteria for the appropriate use of hip arthroscopy in FAI using the RAND/UCLA method, providing a tool that would identify patients who are potential candidates for surgical treatment using arthroscopic hip surgery.

Manejo de heridas complejas en fractura de cadera con terapia de presión negativa / Complex wound management after hip fracture with vacuum assisted therapy

Introducción: La Terapia con Presión Negativa (TPN) se considera un método avanzado para el manejo de las heridas, ya que promueve la curación de éstas mediante la aplicación de presión negativa, de manera que el uso de niveles controlados de presión subatmosférica y succión, acelera la resolución de las heridas favoreciendo la vascularización y el desbridamiento. Material y Métodos: Presentamos el caso de una fractura extracapsular de fémur en una paciente con obesidad mórbida, en el que con el uso de la TPN se consiguió un excelente resultado clínico. Resultados Tras 4 meses de uso continuado de TPN, se consiguió la curación completa de la herida con la resolución del caso. Conclusiones: Según la evidencia científica, el tratamiento con terapia de presión negativa, constituye un avance importante en el cuidado de las heridas, tiene un importante impacto en salud, y contribuye a reducir en gran medida las posibles complicaciones

Introduction: Negative pressure therapy is considered an advanced method for handling wounds because it promotes healing by applying negative pressure, so that the use of controlled levels of subatmospheric pressure and suction accelerates resolution of wounds by promoting vascularization and debridement. Material and methods: We present the case of extracapsular hip fracture in a patient with morbid obesity, in which case, with the use of negative pressure therapy, it was achieved an excellent clinical outcome. Results After four months of continuous use of negative pressure therapy, complete wound healing was achieved with the resolution of the case. Conclusions: According to scientific evidence, treatment with negative pressure therapy is a relevant progress in wound care, it has an important impact on health and helps to greatly reduce potential complications

Artroplastia total invertida de hombro. Evaluación de resultados clínicos y complicaciones tras una serie de 52 casos / Total reverse shoulder replacement. Evaluation of the clinical results and complications in a series of 52 cases

Objetivo. Evaluar los resultados clínicos y analizar las complicaciones de las prótesis totales invertidas de hombro realizadas en nuestro centro en un periodo de 8 años. Material y método. Se ha realizado un estudio retrospectivo sobre 50 pacientes (52 hombros), con edad promedio de 70,15 años en un rango de 51 a 84 años entre diciembre del 2004 y diciembre del 2012, a los que se les ha implantado una prótesis total invertida de hombro, todos intervenidos por el mismo cirujano. Se han evaluado los resultados según la clínica, el estudio radiográfico, la encuesta de satisfacción y la escala de Constant con un seguimiento mínimo de 16 meses. Cinco de los casos (9,62%) se han intervenido por fracturas de la extremidad proximal de húmero, 6 casos (11,53%) como consecuencia de cirugías de revisión protésica, 10 casos (19,23%) por secuelas de fracturas y 31 casos (59,62%) corresponden a pacientes con artropatía por rotura masiva del manguito rotador. Resultados. Tras un seguimiento medio de 35,78 meses (rango 16-82), en los que se han obtenido resultados clínicos satisfactorios en más del 80% de los casos con un Constant preoperatorio promedio de 22,7 puntos y alcanzando los 67,1 puntos a los 12 meses de la intervención. En la escala visual analógica se han obtenido 8,25 puntos en el preoperatorio hasta disminuir a los 2,25 puntos transcurridos 12 meses. La tasa de complicaciones es del 15,38%. Estas corresponden a: fractura intraoperatoria (1,92%), fractura de acromion (1,92%), infección profunda (3,84%), inestabilidad (3,84%) y aflojamiento mecánico precoz (3,84%). En el análisis del estudio radiográfico, se observa notching escapular en 9 casos (17,3%). Discusión y conclusiones. Tras los resultados obtenidos, podemos decir que la prótesis total invertida de hombro consigue resultados alentadores a corto plazo para el tratamiento de la artrosis glenohumeral y los desgarros masivos del manguito rotador. Al analizar nuestras series, comprobamos cómo la tasa de complicaciones es mucho más elevada cuando se usa para tratar secuelas de fracturas en las que tenemos una pérdida del stock óseo del húmero proximal (AU)

Objective. To evaluate the clinical results and analyse the complications of total reverse shoulder replacement performed in our centre over an 8 year period. Material and method. A retrospective study was conducted on 50 patients (52 shoulders), with a mean age of 70.15 years (range 51 to 84 years) between December 2004 and December 2012, who received a total reverse shoulder replacement, all performed by the same surgeon. The results have been evaluated according to clinical data, radiography study, a satisfaction scale, and the Constant scale, with a minimum follow-up of 16 months. Five of the cases (9.62%) had been intervened due to fractures of the proximal end of the humerus, 6 cases (11.53%) as surgical consequence of a prosthesis revision, 10 cases (19.23%) due to fracture sequelae, and 30 cases (59.62%) were patients with arthropathy due to a massive fracture of the rotator cuff. Results. After a mean follow up of 35.78 months (range, 16-82), satisfactory clinical results were obtained in 80% of cases, with a mean preoperative Constant of 27.7 points, and reaching 67.1 points 12 months after the operation. On the visual analogue scale, 8.25 points were obtained before the surgery, which decreased to 2.25 points 12 months later. The complications rate was 15.38%, which were due to an intra-operative fracture (1.92%), deep infection (3.84%), instability (3.84%), and early mechanical loosening (3.84%). Scapular notching was observed in the radiographic study in 9 (17.3%) cases. Discussion and conclusions. After the results obtained, it could be said that total reverse shoulder replacement achieved encouraging results in the short term for the treatment of glenohumeral arthrosis and massive tears of the rotary cuff. On analysing our series, it can be seen that the complications rate is much higher when it is used to treat fracture sequelae in which there is a loss of proximal humerus bone stock (AU)

[Total reverse shoulder replacement. Evaluation of the clinical results and complications in a series of 52 cases]. / Artroplastia total invertida de hombro. Evaluación de resultados clínicos y complicaciones tras una serie de 52 casos.

OBJECTIVE: To evaluate the clinical results and analyse the complications of total reverse shoulder replacement performed in our centre over an 8 year period. MATERIAL AND METHOD: A retrospective study was conducted on 50 patients (52 shoulders), with a mean age of 70.15 years (range 51 to 84 years) between December 2004 and December 2012, who received a total reverse shoulder replacement, all performed by the same surgeon. The results have been evaluated according to clinical data, radiography study, a satisfaction scale, and the Constant scale, with a minimum follow-up of 16 months. Five of the cases (9.62%) had been intervened due to fractures of the proximal end of the humerus, 6 cases (11.53%) as surgical consequence of a prosthesis revision, 10 cases (19.23%) due to fracture sequelae, and 30 cases (59.62%) were patients with arthropathy due to a massive fracture of the rotator cuff. RESULTS: After a mean follow up of 35.78 months (range, 16-82), satisfactory clinical results were obtained in 80% of cases, with a mean preoperative Constant of 27.7 points, and reaching 67.1 points 12 months after the operation. On the visual analogue scale, 8.25 points were obtained before the surgery, which decreased to 2.25 points 12 months later. The complications rate was 15.38%, which were due to an intra-operative fracture (1.92%), deep infection (3.84%), instability (3.84%), and early mechanical loosening (3.84%). Scapular notching was observed in the radiographic study in 9 (17.3%) cases. DISCUSSION AND CONCLUSIONS: After the results obtained, it could be said that total reverse shoulder replacement achieved encouraging results in the short term for the treatment of glenohumeral arthrosis and massive tears of the rotary cuff. On analysing our series, it can be seen that the complications rate is much higher when it is used to treat fracture sequelae in which there is a loss of proximal humerus bone stock.

Programa de atención integral a pacientes mayores de 65 años con fractura de cadera / Comprehensive care program for elderly patients over 65 years with hip fracture

Objetivos. Presentamos los resultados en salud de un programa de asistencia multidisciplinar a pacientes con fractura de cadera mayores de 65 años. Pacientes y métodos. Hemos desarrollado un modelo de coordinación asistencial para la atención integral del paciente con fractura de cadera, estableciendo qué, quién, cuándo, cómo y dónde intervienen traumatólogos, internistas, médicos de familia de urgencias, intensivistas, fisioterapeutas, anestesistas, enfermeros y trabajadores sociales. Se evaluaron retrospectivamente todos los pacientes mayores de 65 años que ingresaron con diagnóstico de fractura de cadera (años 2006 a 2010). Resultados. Se incluyen 1.000 episodios de fractura de cadera ocurridos en 956 pacientes. La edad media fue de 82 años y la estancia media de 6,7 días, reduciéndose 1,14 días en los 5 años del programa. Antes de las 72h se intervinieron el 85,1%, y el 91,2% a lo largo del programa. La incidencia de infección quirúrgica fue del 1,5% y la mortalidad intrahospitalaria del 4,5% (24,2% a los 12 meses). Al cabo de un año reingresaron el 14,9%, y el 40% de los enfermos consiguieron ser independientes para las actividades básicas de su vida diaria. Conclusiones. Este programa de atención multidisciplinar al paciente con fractura de cadera se asoció a resultados beneficiosos en salud, con un elevado porcentaje de pacientes intervenidos precozmente (más del 90%), una reducida estancia media (menos de 7 días), incidencia de infecciones quirúrgicas, reingresos y mortalidad intrahospitalaria y al año de seguimiento, así como una adecuada recuperación funcional (AU)

Objectives. To report the health outcomes of a multidisciplinary care program for patients over 65 years with hip fracture. Patients and methods. We have developed a care coordination model for the comprehensive care of hip fracture patients. It establishes what, who, when, how and where orthopedists, internists, family physicians, emergency, intensive care, physiotherapists, anesthetists, nurses and workers social intervene. All elderly patients over 65 years admitted with the diagnosis of hip fracture (years 2006 to 2010) were retrospectively evaluated. Results. One thousand episodes of hip fracture, corresponding to 956 patients, were included. Mean age was 82 years and mean stay 6.7 days. This was reduced by 1.14 days during the 5 years of the program. A total of 85.1% were operated on before 72 yours, and 91.2% during the program. Incidence of surgical site infection was 1.5%. In-hospital mortality was 4.5%, (24.2% at 12 months). Readmissions at one years was 14.9%. Independence for basic activity of daily living was achieved by 40% of the patients. Conclusions. This multidisciplinary care program for hip fracture patients is associated with positive health outcomes, with a high percentage of patients treated early (more than 90%), reduced mean stay (less than 7 days), incidence of surgical site infections, readmissions and inpatient mortality and at one year, as well as adequate functional recovery (AU)

Comprehensive care program for elderly patients over 65 years with hip fracture.

OBJECTIVES: To report the health outcomes of a multidisciplinary care program for patients over 65 years with hip fracture. PATIENTS AND METHODS: We have developed a care coordination model for the comprehensive care of hip fracture patients. It establishes what, who, when, how and where orthopedists, internists, family physicians, emergency, intensive care, physiotherapists, anesthetists, nurses and workers social intervene. All elderly patients over 65 years admitted with the diagnosis of hip fracture (years 2006 to 2010) were retrospectively evaluated. RESULTS: One thousand episodes of hip fracture, corresponding to 956 patients, were included. Mean age was 82 years and mean stay 6.7 days. This was reduced by 1.14 days during the 5 years of the program. A total of 85.1% were operated on before 72 yours, and 91.2% during the program. Incidence of surgical site infection was 1.5%. In-hospital mortality was 4.5%, (24.2% at 12 months). Readmissions at one years was 14.9%. Independence for basic activity of daily living was achieved by 40% of the patients. CONCLUSIONS: This multidisciplinary care program for hip fracture patients is associated with positive health outcomes, with a high percentage of patients treated early (more than 90%), reduced mean stay (less than 7 days), incidence of surgical site infections, readmissions and inpatient mortality and at one year, as well as adequate functional recovery.