Fracturas de maléolo posterior: indicaciones de fijación y vías de abordaje / Posterior malleolar fractures: Indications and surgical approaches

Las fracturas del maléolo posterior están presentes en 7-44% del total de fracturas de tobillo.El objetivo de esta revisión es conocer la evidencia actual sobre las indicaciones de fijación interna y la elección del abordaje quirúrgico para el tratamiento de estas fracturas.Las indicaciones clásicas de fijación eran el tamaño mayor a 25-30% de la superficie articular y el desplazamiento mayor a 2 mm; sin embargo, la evidencia actual sugiere que, en lugar del tamaño, se deben considerar factores tales como la inestabilidad sindesmal, el escalón articular mayor a 1-2 mm, la impactación de la superficie articular y la presencia de fragmentos intercalares.Al comparar las vías de abordaje, la bibliografía apoya el uso de los abordajes posteriores, reservando la recomendación de abordaje anterior para casos excepcionales.Para el tratamiento de esta lesión es fundamental conocer la anatomía del tobillo y considerar los factores descritos, además de la presencia de lesiones concomitantes.(AU)

Posterior malleolus fractures are frequent injuries, present in 7–44% of all ankle fractures.The objective of this study is to review the evidence to indicate the fixation of this fracture and to choose the appropriate surgical approach.The classic indications for fixation were fragment size greater than 25–30% of the articular surface and displacement greater than 2 mm. However, current evidence suggests that, rather than size, factors such as syndesmotic instability, intra-articular step-off greater than 1–2 mm, plafond impaction and the presence of intercalary fragments should be considered.When comparing the different surgical approaches, the literature supports the use of posterior approaches and reserves the recommendation of the traditional approach for exceptional cases.For the treatment of this injury it is essential to know the anatomy of the ankle and to consider all the factors described above, in addition to the presence of concomitant injuries.(AU)

[Translated article] Posterior malleolar fractures: Indications and surgical approaches / Fracturas de maléolo posterior: indicaciones de fijación y vías de abordaje

Las fracturas del maléolo posterior están presentes en 7-44% del total de fracturas de tobillo.El objetivo de esta revisión es conocer la evidencia actual sobre las indicaciones de fijación interna y la elección del abordaje quirúrgico para el tratamiento de estas fracturas.Las indicaciones clásicas de fijación eran el tamaño mayor a 25-30% de la superficie articular y el desplazamiento mayor a 2 mm; sin embargo, la evidencia actual sugiere que, en lugar del tamaño, se deben considerar factores tales como la inestabilidad sindesmal, el escalón articular mayor a 1-2 mm, la impactación de la superficie articular y la presencia de fragmentos intercalares.Al comparar las vías de abordaje, la bibliografía apoya el uso de los abordajes posteriores, reservando la recomendación de abordaje anterior para casos excepcionales.Para el tratamiento de esta lesión es fundamental conocer la anatomía del tobillo y considerar los factores descritos, además de la presencia de lesiones concomitantes.(AU)

Posterior malleolus fractures are frequent injuries, present in 7–44% of all ankle fractures.The objective of this study is to review the evidence to indicate the fixation of this fracture and to choose the appropriate surgical approach.The classic indications for fixation were fragment size greater than 25–30% of the articular surface and displacement greater than 2 mm. However, current evidence suggests that, rather than size, factors such as syndesmotic instability, intra-articular step-off greater than 1–2 mm, plafond impaction and the presence of intercalary fragments should be considered.When comparing the different surgical approaches, the literature supports the use of posterior approaches and reserves the recommendation of the traditional approach for exceptional cases.For the treatment of this injury it is essential to know the anatomy of the ankle and to consider all the factors described above, in addition to the presence of concomitant injuries.(AU)

Posterior malleolar fractures: Indications and surgical approaches. / Fracturas de maléolo posterior: indicaciones de fijación y vías de abordaje.

Posterior malleolus fractures are frequent injuries, present in 7-44% of all ankle fractures. The objective of this study is to review the evidence to indicate the fixation of this fracture and to choose the appropriate surgical approach. The classic indications for fixation were fragment size greater than 25-30% of the articular surface and displacement greater than 2 mm. However, current evidence suggests that, rather than size, factors such as syndesmotic instability, intra-articular step-off greater than 1-2 mm, plafond impaction and the presence of intercalary fragments should be considered. When comparing the different surgical approaches, the literature supports the use of posterior approaches and reserves the recommendation of the traditional approach for exceptional cases. For the treatment of this injury it is essential to know the anatomy of the ankle and to consider all the factors described above, in addition to the presence of concomitant injuries.

[Translated article] Posterior malleolar fractures: Indications and surgical approaches.

Posterior malleolus fractures are frequent injuries, present in 7-44% of all ankle fractures. The objective of this study is to review the evidence to indicate the fixation of this fracture and to choose the appropriate surgical approach. The classic indications for fixation were fragment size greater than 25-30% of the articular surface and displacement greater than 2mm. However, current evidence suggests that, rather than size, factors such as syndesmotic instability, intra-articular step-off greater than 1-2mm, plafond impaction and the presence of intercalary fragments should be considered. When comparing the different surgical approaches, the literature supports the use of posterior approaches and reserves the recommendation of the traditional approach for exceptional cases. For the treatment of this injury it is essential to know the anatomy of the ankle and to consider all the factors described above, in addition to the presence of concomitant injuries.

Economic impact of periprosthetic hip fractures / Impacto económico de las fracturas periprotésicas de cadera

Introduction: Hip replacement is one of the most successful operations in orthopaedic surgery. Periprosthetic hip fractures (PPHF) have very serious consequences for the patient, and they also entail a very important economic impact on healthcare systems. The aim of the study was to provide the first detailed cost analysis of PPHF in a traumatology and orthopaedics service in a third level hospital in Spain. Methods: The study included all patients admitted between 2009 and 2019 with a diagnosis of “PPHF”. We assessed hospital stay cost, total cost of the operating theatre, cost of the implants used, analyses, consultations with other specialists, rehabilitation sessions, radiological tests, microbiology, blood transfusions and other surgical operations during the same admission. Results: 78 patients were included in the study, 49 women and 29 men, with a mean age of 78.74 years (R 45–92). 69 patients received surgical treatment, 75% had open reduction and internal fixation (ORIF), and 25% had revision surgery. The total cost was €1,139,650.17. The average cost was €14,610.90. Significantly higher costs were incurred for revision compared to ORIF treatments, admissions that lasted more than 30 days, and patients who required more than one operation during admission. The most costly factors were the hospital stay (46%), the cost of the surgery itself (35%), and the implants (24%). Conclusions: Revision arthroplasty versus ORIF treatment, admissions lasting more than 30 days, and patients requiring more than one operation on admission incurred significantly higher costs. The average cost, from a hospital perspective, generated by a PPHF was €14,610.90. The most costly factors were, in descending order, the hospital stay, the cost of the surgery itself, and the implants. It is necessary to establish protocols and updated therapeutic algorithms in the perioperative management of PPHF in order to reduce both morbidity rates and associated costs.(AU)

Introducción: La artroplastia de cadera es una de las operaciones con mejores resultados en cirugía ortopédica. Las fracturas periprotésicas de cadera (FPPC) tienen consecuencias muy graves para el paciente y además suponen un impacto económico muy importante para los sistemas sanitarios. El objetivo del estudio es realizar el primer análisis detallado de los costes de las FPPC en un Servicio de Cirugía Ortopédica y Traumatología en un hospital universitario de tercer nivel en España. Métodos: El estudio incluyó a todos los pacientes ingresados entre 2009 y 2019 con el diagnóstico de «FPPC». Se evaluaron el coste de la estancia hospitalaria, el coste total del quirófano, el coste de los implantes utilizados, los análisis de sangre, las consultas con otros especialistas, las sesiones de rehabilitación, las pruebas radiológicas, la microbiología, las transfusiones de sangre y otras intervenciones quirúrgicas durante el mismo ingreso. Resultados: Se incluyó a un total de 78 pacientes, 49 mujeres y 29 hombres, con una edad media de 78,74 años (R 45-92); 69 pacientes recibieron tratamiento quirúrgico, el 75% se sometió a reducción abierta y fijación interna (RAFI) y el 25% a revisión protésica. El coste total fue de 1.139.650,17 €. El coste medio fue de 14.610,90 €. Los costes fueron significativamente más elevados en la revisión protésica que en la RAFI, en los ingresos que duraron más de 30 días y en los pacientes que requirieron más de una intervención quirúrgica durante el ingreso. Los factores que más influyeron en el coste fueron la estancia hospitalaria (46%), el coste de la intervención quirúrgica (35%) y el de los implantes (24%). Conclusiones: La cirugía de revisión protésica frente a RAFI, los ingresos de más de 30 días y los pacientes que requirieron más de una intervención quirúrgica durante el ingreso supusieron costes significativamente mayores. El coste medio, desde el punto de vista hospitalario, generado por una FPPC fue de 14.610,90 €.(AU)

[Artículo traducido] Impacto económico de las fracturas periprotésicas de cadera / Economic impact of periprosthetic hip fractures

Introduction: Hip replacement is one of the most successful operations in orthopaedic surgery. Periprosthetic hip fractures (PPHF) have very serious consequences for the patient, and they also entail a very important economic impact on healthcare systems. The aim of the study was to provide the first detailed cost analysis of PPHF in a traumatology and orthopaedics service in a third level hospital in Spain. Methods: The study included all patients admitted between 2009 and 2019 with a diagnosis of “PPHF”. We assessed hospital stay cost, total cost of the operating theatre, cost of the implants used, analyses, consultations with other specialists, rehabilitation sessions, radiological tests, microbiology, blood transfusions and other surgical operations during the same admission. Results: 78 patients were included in the study, 49 women and 29 men, with a mean age of 78.74 years (R 45–92). 69 patients received surgical treatment, 75% had open reduction and internal fixation (ORIF), and 25% had revision surgery. The total cost was €1,139,650.17. The average cost was €14,610.90. Significantly higher costs were incurred for revision compared to ORIF treatments, admissions that lasted more than 30 days, and patients who required more than one operation during admission. The most costly factors were the hospital stay (46%), the cost of the surgery itself (35%), and the implants (24%). Conclusions: Revision arthroplasty versus ORIF treatment, admissions lasting more than 30 days, and patients requiring more than one operation on admission incurred significantly higher costs. The average cost, from a hospital perspective, generated by a PPHF was €14,610.90. The most costly factors were, in descending order, the hospital stay, the cost of the surgery itself, and the implants. It is necessary to establish protocols and updated therapeutic algorithms in the perioperative management of PPHF in order to reduce both morbidity rates and associated costs.(AU)

Introducción: La artroplastia de cadera es una de las operaciones con mejores resultados en cirugía ortopédica. Las fracturas periprotésicas de cadera (FPPC) tienen consecuencias muy graves para el paciente y además suponen un impacto económico muy importante para los sistemas sanitarios. El objetivo del estudio es realizar el primer análisis detallado de los costes de las FPPC en un Servicio de Cirugía Ortopédica y Traumatología en un hospital universitario de tercer nivel en España. Métodos: El estudio incluyó a todos los pacientes ingresados entre 2009 y 2019 con el diagnóstico de «FPPC». Se evaluaron el coste de la estancia hospitalaria, el coste total del quirófano, el coste de los implantes utilizados, los análisis de sangre, las consultas con otros especialistas, las sesiones de rehabilitación, las pruebas radiológicas, la microbiología, las transfusiones de sangre y otras intervenciones quirúrgicas durante el mismo ingreso. Resultados: Se incluyó a un total de 78 pacientes, 49 mujeres y 29 hombres, con una edad media de 78,74 años (R 45-92); 69 pacientes recibieron tratamiento quirúrgico, el 75% se sometió a reducción abierta y fijación interna (RAFI) y el 25% a revisión protésica. El coste total fue de 1.139.650,17 €. El coste medio fue de 14.610,90 €. Los costes fueron significativamente más elevados en la revisión protésica que en la RAFI, en los ingresos que duraron más de 30 días y en los pacientes que requirieron más de una intervención quirúrgica durante el ingreso. Los factores que más influyeron en el coste fueron la estancia hospitalaria (46%), el coste de la intervención quirúrgica (35%) y el de los implantes (24%). Conclusiones: La cirugía de revisión protésica frente a RAFI, los ingresos de más de 30 días y los pacientes que requirieron más de una intervención quirúrgica durante el ingreso supusieron costes significativamente mayores. El coste medio, desde el punto de vista hospitalario, generado por una FPPC fue de 14.610,90 €.(AU)

Economic impact of periprosthetic hip fractures. / [Artículo traducido] Impacto económico de las fracturas periprotésicas de cadera.

INTRODUCTION: Hip replacement is one of the most successful operations in orthopaedic surgery. Periprosthetic hip fractures (PPHF) have very serious consequences for the patient, and they also entail a very important economic impact on healthcare systems. The aim of the study was to provide the first detailed cost analysis of PPHF in a traumatology and orthopaedics service in a third level hospital in Spain. METHODS: The study included all patients admitted between 2009 and 2019 with a diagnosis of «PPHF¼. We assessed hospital stay cost, total cost of the operating theatre, cost of the implants used, analyses, consultations with other specialists, rehabilitation sessions, radiological tests, microbiology, blood transfusions and other surgical operations during the same admission. RESULTS: Seventy-eight patients were included in the study, 49 women and 29 men, with a mean age of 78.74 years (R 45-92). Sixty-nine patients received surgical treatment, 75% had open reduction and internal fixation (ORIF), and 25% had revision surgery. The total cost was €1 139 650.17. The average cost was €14 610.90. Significantly higher costs were incurred for revision compared to ORIF treatments, admissions that lasted more than 30 days, and patients who required more than one operation during admission. The most costly factors were the hospital stay (46%), the cost of the surgery itself (35%), and the implants (24%). CONCLUSIONS: Revision arthroplasty versus ORIF treatment, admissions lasting more than 30 days, and patients requiring more than one operation on admission incurred significantly higher costs. The average cost, from a hospital perspective, generated by a PPHF was €14 610.90. The most costly factors were, in descending order, the hospital stay, the cost of the surgery itself, and the implants. It is necessary to establish protocols and updated therapeutic algorithms in the perioperative management of PPHF in order to reduce both morbidity rates and associated costs.

Economic impact of periprosthetic hip fractures.

INTRODUCTION: Hip replacement is one of the most successful operations in orthopaedic surgery. Periprosthetic hip fractures (PPHF) have very serious consequences for the patient, and they also entail a very important economic impact on healthcare systems. The aim of the study was to provide the first detailed cost analysis of PPHF in a traumatology and orthopaedics service in a third level hospital in Spain. METHODS: The study included all patients admitted between 2009 and 2019 with a diagnosis of "PPHF". We assessed hospital stay cost, total cost of the operating theatre, cost of the implants used, analyses, consultations with other specialists, rehabilitation sessions, radiological tests, microbiology, blood transfusions and other surgical operations during the same admission. RESULTS: 78 patients were included in the study, 49 women and 29 men, with a mean age of 78.74 years (R 45-92). 69 patients received surgical treatment, 75% had open reduction and internal fixation (ORIF), and 25% had revision surgery. The total cost was €1,139,650.17. The average cost was €14,610.90. Significantly higher costs were incurred for revision compared to ORIF treatments, admissions that lasted more than 30 days, and patients who required more than one operation during admission. The most costly factors were the hospital stay (46%), the cost of the surgery itself (35%), and the implants (24%). CONCLUSIONS: Revision arthroplasty versus ORIF treatment, admissions lasting more than 30 days, and patients requiring more than one operation on admission incurred significantly higher costs. The average cost, from a hospital perspective, generated by a PPHF was €14,610.90. The most costly factors were, in descending order, the hospital stay, the cost of the surgery itself, and the implants. It is necessary to establish protocols and updated therapeutic algorithms in the perioperative management of PPHF in order to reduce both morbidity rates and associated costs.

Epithelioma cuniculatum of the sole of the foot mimicking an infection.

Epithelioma cuniculatum is characterized as a slow growing lesion on the sole of the foot. A diagnosis is usually delayed by a low clinical suspicion and misdirection due to its similarity to an infection. This tumor rarely metastasize but a local invasion of adjacent soft tissues is common, requiring ample surgical resection or even amputation in advanced cases. We report a case a 76-year-old patient with a 5-year-old lesion on the sole of the foot, which was originally treated as a wart without improvement while the lesion slowly evolved. The patient was referred to our center with a diagnosis of chronic osteomyelitis. An excisional biopsy revealed an invasive keratinizing squamous carcinoma. In this advanced phase of the disease the only possible treatment was a Syme amputation.

El epitelioma cuniculatum se caracteriza por una lesión de crecimiento lento en la planta del pie cuyo diagnóstico suele retrasarse por la baja sospecha clínica y por su similitud con una infección. Este tumor raramente metastatiza, pero es común que produzca una invasión local a los tejidos blandos adyacentes, requiriendo una amplia resección quirúrgica o incluso una amputación en casos avanzados. Presentamos un caso de un paciente de 76 años con una lesión de 5 años de edad en la planta del pie, que originalmente fue tratada como una verruga plantar común sin mejoría, mientras que la lesión evolucionó lentamente. El paciente fue remitido a nuestro centro con un diagnóstico de osteomielitis crónica. Una biopsia excisional reveló un carcinoma escamoso queratinizante invasivo. En esta fase avanzada de la enfermedad el único tratamiento posible fue una amputación de Syme.

[Quantitative and qualitative analysis of the influence of confinement by COVID-19 in fracture patients entered in a traumatology service at a third level hospital]. / Análisis cuantitativo y cualitativo de la influencia del confinamiento por COVID-19 en los pacientes con fractura ingresados en un servicio de traumatología en un hospital de tercer nivel.

INTRODUCTION: The COVID-19 pandemic has led to the confinement of approximately one third of the world population, causing a drastic change in the activities of daily life with many repercussions at the health, economic and social levels. OBJECTIVES: The objective of the present work is to present the epidemiological variations in the production of fractures in the period of mandatory confinement in our reference population. METHODS: Analytical retrospective comparative study of two groups of patients: Group A: patients admitted before the state of alarm that forced confinement in the period from January 13 to March 13 compared to Group B: patients admitted in the two months of confinement, until the de-escalation period began, March 13-May 13. Epidemiological variables including age, personal history, type of fracture, mechanism of injury, outpatient rate, and hospital stay were recorded. RESULTS: A total of 190 patients were included. 112 in the pre-confinement period and 78 in the confinement (30% decrease). The mean age (p = 0.007) and falls at home (p < 0.001) were higher in the confinement group. The postoperative (p = 0.006) and overall (p < 0.001) hospital stay were significantly less in the confinement group. No differences were found in the anatomical location of the lesion, sex, comorbidities, mechanism of injury, outpatient rate, or death. CONCLUSIONS: Based on the results of our study, the period of forced confinement due to the COVID-19 pandemic has produced a drastic decrease in the total number of fractures admitted to the traumatology service of a third level hospital. On the other hand, osteoporotic hip fractures have not varied in their incidence and a decrease in the average postoperative and overall stay has been observed.

Epithelioma cuniculatum of the sole of the foot mimicking an infection / Epitelioma cuniculatum de la planta del pie simulando una infección

Abstract: Epithelioma cuniculatum is characterized as a slow growing lesion on the sole of the foot. A diagnosis is usually delayed by a low clinical suspicion and misdirection due to its similarity to an infection. This tumor rarely metastasize but a local invasion of adjacent soft tissues is common, requiring ample surgical resection or even amputation in advanced cases. We report a case a 76-year-old patient with a 5-year-old lesion on the sole of the foot, which was originally treated as a wart without improvement while the lesion slowly evolved. The patient was referred to our center with a diagnosis of chronic osteomyelitis. An excisional biopsy revealed an invasive keratinizing squamous carcinoma. In this advanced phase of the disease the only possible treatment was a Syme amputation.

Resumen: El epitelioma cuniculatum se caracteriza por una lesión de crecimiento lento en la planta del pie cuyo diagnóstico suele retrasarse por la baja sospecha clínica y por su similitud con una infección. Este tumor raramente metastatiza, pero es común que produzca una invasión local a los tejidos blandos adyacentes, requiriendo una amplia resección quirúrgica o incluso una amputación en casos avanzados. Presentamos un caso de un paciente de 76 años con una lesión de 5 años de edad en la planta del pie, que originalmente fue tratada como una verruga plantar común sin mejoría, mientras que la lesión evolucionó lentamente. El paciente fue remitido a nuestro centro con un diagnóstico de osteomielitis crónica. Una biopsia excisional reveló un carcinoma escamoso queratinizante invasivo. En esta fase avanzada de la enfermedad el único tratamiento posible fue una amputación de Syme.

Análisis cuantitativo y cualitativo de la influencia del confinamiento por COVID-19 en los pacientes con fractura ingresados en un servicio de traumatología en un hospital de tercer nivel / Quantitative and qualitative analysis of the influence of confinement by COVID-19 in fracture patients entered in a traumatology service at a third level hospital

INTRODUCCIÓN: La pandemia por COVID-19 ha supuesto el confinamiento de aproximadamente un tercio de la población mundial, provocando un cambio drástico en las actividades de la vida diaria con enorme impacto sanitario, económico y social. OBJETIVOS: El objetivo de este trabajo es presentar las variaciones epidemiológicas en la producción de fracturas en el período de confinamiento obligatorio en nuestra población de referencia. MATERIAL Y MÉTODOS: Estudio analítico retrospectivo comparativo de dos grupos de pacientes: Grupo A: personas ingresadas antes del estado de alarma que obligó al confinamiento en el período del 13 enero al 13 de marzo vs. Grupo B: individuos atendidos durante los dos meses de confinamiento, hasta que comenzó la desescalada, período del 13 marzo al 13 mayo. Se registraron variables epidemiológicas, incluyendo edad, antecedentes personales, tipo de fractura, mecanismo de lesión, porcentaje de ambulatorización y estancia hospitalaria. RESULTADOS: Se incluyeron un total de 190 pacientes. En el período de pre-confinamiento 112 y en el confinamiento 78 (disminución del 30%). La edad media (p = 0,007) y las caídas en domicilio (p < 0,001) fueron mayores en este último grupo. La estancia hospitalaria postoperatoria (p = 0,006) y global (p < 0,001) resultaron significativamente menores en el mismo grupo. No se encontraron diferencias en la localización anatómica de la lesión, el sexo, las comorbilidades, el mecanismo de lesión, la tasa de ambulatorización ni el éxitus. CONCLUSIONES: Con base en los resultados de nuestro estudio, el período de confinamiento forzoso por la pandemia de COVID-19 ha producido una drástica disminución del número total de fracturas ingresadas en el servicio de traumatología de un hospital de tercer nivel. Por otro lado, las fracturas osteoporóticas de cadera que requirieron tratamiento quirúrgico no variaron en número y se ha constatado un decremento de la estancia media postoperatoria y global

INTRODUCTION: The COVID-19 pandemic has led to the confinement of approximately one third of the world population, causing a drastic change in the activities of daily life with many repercussions at the health, economic and social levels. OBJECTIVES: The objective of the present work is to present the epidemiological variations in the production of fractures in the period of mandatory confinement in our reference population. METHODS: Analytical retrospective comparative study of two groups of patients: Group A: patients admitted before the state of alarm that forced confinement in the period from January 13 to March 13 compared to Group B: patients admitted in the two months of confinement, until the de-escalation period began, March 13-May 13. Epidemiological variables including age, personal history, type of fracture, mechanism of injury, outpatient rate, and hospital stay were recorded. RESULTS: A total of 190 patients were included. 112 in the pre-confinement period and 78 in the confinement (30% decrease). The mean age (p = 0.007) and falls at home (p < 0.001) were higher in the confinement group. The postoperative (p = 0.006) and overall (p < 0.001) hospital stay were significantly less in the confinement group. No differences were found in the anatomical location of the lesion, sex, comorbidities, mechanism of injury, outpatient rate, or death. CONCLUSIONS: Based on the results of our study, the period of forced confinement due to the COVID-19 pandemic has produced a drastic decrease in the total number of fractures admitted to the traumatology service of a third level hospital. On the other hand, osteoporotic hip fractures have not varied in their incidence and a decrease in the average postoperative and overall stay has been observed

Fracturas intraarticulares de calcáneo tratadas quirúrgicamente: ¿qué nos aporta la tomografía computarizada postoperatoria? / Surgically treated calcaneal joint fractures: what does postoperative computed tomography give us?

INTRODUCCIÓN: Actualmente existe gran controversia sobre el tratamiento ideal de las fracturas articulares de calcáneo. El objetivo de este estudio es determinar la utilidad de la tomografía computarizada (TC) postoperatoria. PACIENTES Y MÉTODOS: Estudio retrospectivo descriptivo de pacientes intervenidos en el período 2007 a 2015 en nuestro centro. Se recogieron variables epidemiológicas, datos específicos de la fractura, intervención quirúrgica, así como resultados y complicaciones. La evaluación radiológica se realizó mediante radiología simple (ángulo de Böhler) y TC coronal (congruencia de subastragalina posterior). Para los resultados funcionales utilizamos la escala AOFAS de retro pie y la escala EVA para el nivel de dolor. RESULTADOS: Incluimos 46 fracturas en 43 pacientes (tres bilaterales). Treinta y cinco eran varones y ocho mujeres, con una edad promedio de 42 años (18-79) y un seguimiento medio de 57,39 meses (33-129). LA TC preoperatoria se realizó en todos los casos, de los que 11 fueron Sanders ii, 23 tipo III y 12 tipo IV. El TC postoperatorio solo se realizó en 17 casos. La reducción de la subastragalina posterior medida por TC fue satisfactoria (escalón articular < 2 mm) en 12 casos. El ángulo de Böhler prequirúrgico promedio fue de 6,45 ± 10,21 ([-22]-25) y el posquirúrgico de 20,46 ± 7,09 (4-38). La artrosis subastragalina se desarrolló en 19 casos (sintomática en 12) y la artrosis calcáneo-cuboidea en seis (solo uno sintomático). El AOFAS fue de 74,28 ± 18,98 (27-100) y el EVA de 4,14 ± 2,98 (2-9). Resultó estadísticamente significativo un TC con escalón inferior a 2 mm con mayor resultado en la escala AOFAS (77,17 puntos de promedio), así como menor EVA de promedio (2,83) (p = 0,002). Respecto al Böhler, resultó significativa la relación de un ángulo > 20° posquirúrgico con mayor AOFAS (80,82) y menor EVA (3,18) (p = 0,001). La búsqueda bibliográfica obtuvo un total de 117 artículos que cumplieron los criterios de búsqueda, de los cuales solo 29 solicitaron TC postoperatorio. CONCLUSIONES: La TC postoperatoria es la mejor técnica para corroborar la correcta reducción de la superficie articular subastragalina, sin embargo, su indicación no está universalmente aceptada

INTRODUCTION: There is currently great controversy about the ideal treatment of intraarticular calcaneal fractures. The objective of this study is to determine the usefulness of postoperative computed tomography (CT). PATIENTS AND METHODS: We conducted a retrospective descriptive study of patients operated on in the period 2007 to 2015 in our center. Epidemiological variables, specific fracture data, surgical intervention as well as results and complications were collected. The radiological evaluation was performed using simple radiology (Böhler angle) and coronal CT (congruence of posterior subtalar joint). For the functional results we use the AOFAS hindfoot scale and the EVA scale for the level of pain. RESULTS: We included 46 fractures in 43 patients (three bilateral). Thirty-five were male and eight female, with an average age of 42 years (18-79) and an average follow-up of 57.39 months (33-129). Preoperative CT was performed in all cases, of which 11 were Sanders ii, 23 type III and 12 type IV. Postoperative CT was only performed in 17 cases. The subsequent subtalar reduction measured by CT was satisfactory (articular step < 2 mm) in 12 cases. The average presurgical Böhler angle was 6.45 ± 10.21 ([-22]-25) and the post-surgical angle of 20.46 ± 7.09 (4-38). Subtalar osteoarthritis developed in 19 cases (symptomatic in 12) and calcaneo-cuboid osteoarthritis in six cases (only one symptomatic). The AOFAS was 74.28 ± 18.98 (27-100) and the EVA was 4.14 ± 2.98 (2-9). A CT scan with a step of less than 2 mm was statistically significant, with a higher result on the AOFAS scale (77.17 average points) as well as lower EVA on average (2.83) (p = 0.002). Regarding the Böhler, it was statistically significant the relationship of an angle > 20° post-surgical with higher AOFAS (80.82) and lower VAS (3.18) (p = 0.001). The literature search obtained a total of 117 articles that met the search criteria, of which only 29 requested postoperative CT. CONCLUSIONS: The indication of postoperative CT in patients operated by intraarticular calcaneal fracture is the best technique to corroborate the correct reduction of the subtalar joint surface, although it is not universally accepted, according to the literature

Surgically treated calcaneal joint fractures: what does postoperative computed tomography give us? / Fracturas intraarticulares de calcáneo tratadas quirúrgicamente: ¿qué nos aporta la tomografía computarizada postoperatoria?

INTRODUCTION: There is currently great controversy about the ideal treatment of intraarticular calcaneal fractures. The objective of this study is to determine the usefulness of postoperative computed tomography (CT). PATIENTS AND METHODS: We conducted a retrospective descriptive study of patients operated on in the period 2007 to 2015 in our center. Epidemiological variables, specific fracture data, surgical intervention as well as results and complications were collected. The radiological evaluation was performed using simple radiology (Böhler angle) and coronal CT (congruence of posterior subtalar joint). For the functional results we use the AOFAS hindfoot scale and the EVA scale for the level of pain. RESULTS: We included 46 fractures in 43 patients (three bilateral). Thirty-five were male and eight female, with an average age of 42 years (18-79) and an average follow-up of 57.39 months (33-129). Preoperative CT was performed in all cases, of which 11 were Sanders ii, 23 type iii and 12 type iv. Postoperative CT was only performed in 17 cases. The subsequent subtalar reduction measured by CT was satisfactory (articular step < 2 mm) in 12 cases. The average presurgical Böhler angle was 6.45 ± 10.21 ([-22]-25) and the post-surgical angle of 20.46 ± 7.09 (4-38). Subtalar osteoarthritis developed in 19 cases (symptomatic in 12) and calcaneo-cuboid osteoarthritis in six cases (only one symptomatic). The AOFAS was 74.28 ± 18.98 (27-100) and the EVA was 4.14 ± 2.98 (2-9). A CT scan with a step of less than 2 mm was statistically significant, with a higher result on the AOFAS scale (77.17 average points) as well as lower EVA on average (2.83) (p = 0.002). Regarding the Böhler, it was statistically significant the relationship of an angle > 20° post-surgical with higher AOFAS (80.82) and lower VAS (3.18) (p = 0.001). The literature search obtained a total of 117 articles that met the search criteria, of which only 29 requested postoperative CT. CONCLUSIONS: The indication of postoperative CT in patients operated by intraarticular calcaneal fracture is the best technique to corroborate the correct reduction of the subtalar joint surface, although it is not universally accepted, according to the literature.

[Calcaneal fractures: controversies and consensus]. / Fracturas de calcáneo: controversias y consensos.

Calcaneal fractures are the most common tarsal fractures and their treatment is still debated today. We intend in this update to highlight the points of controversy and clarify the consensus, especially in the treatment of intra-articular fractures, as well as to describe the management of major complications.

Las fracturas de calcáneo son las más frecuentes del tarso y su tratamiento sigue siendo hoy en día objeto de debate. Pretendemos en esta actualización destacar los puntos de controversia, así como clarificar los consensos, especialmente en el tratamiento de las fracturas intraarticulares, así como describir el manejo de las principales complicaciones.

Experiencia con la aplicación del test de Shetty para el despistaje inicial de fracturas del pie y tobillo en el área de Urgencias / Experience using the «Shetty test» for initial foot and ankle fracture screening in the Emergency Department

Objetivo: La práctica indiscriminada de radiografías en los traumatismos de pie y tobillo no está justificada y numerosos estudios han corroborado la utilidad de los tests de despistaje clínicos como las reglas del tobillo de Ottawa. El objetivo de nuestro estudio es validar clínicamente el denominado test de Shetty. Material y método: Estudio transversal observacional mediante aplicación del test de Shetty a pacientes atendidos en el Servicio de Urgencias. Resultados: Seleccionamos a 100 pacientes con una edad media de 39,25 años (16-86). Tras efectuar el test de Shetty, la prueba fue positiva en 14 ocasiones. Realizando la radiografía posterior, se constató que en 10 casos había fractura y que 4 eran falsos positivos. Por otro lado, en los 86 pacientes restantes el test fue negativo y la radiografía confirmó la ausencia de fractura (sensibilidad del 100% y una especificidad del 95,56%, así como un valor predictivo positivo del 71,40% y un valor predictivo negativo del 100%). Conclusiones: El test de Shetty es una herramienta de despistaje clínico válida a la hora de tomar decisiones sobre la indicación de la radiografía simple en lesiones del pie y tobillo. Además, es una prueba sencilla, rápida y reproducible

Objective: The indiscriminate practice of radiographs for foot and ankle injuries is not justified and numerous studies have corroborated the usefulness of clinical screening tests such as the Ottawa Ankle Rules. The aim of our study is to clinically validate the so-called Shetty Test in our area. Material and method: A cross-sectional observational study by applying the Shetty test to patients seen in the Emergency Department. Results: We enrolled 100 patients with an average age of 39.25 (16-86). The Shetty test was positive on 14 occasions. Subsequent radiography revealed a fracture in 10 cases: 4 were false positives. The test was negative in the remaining 86 patients and radiography confirmed the absence of fracture (with sensitivity of 100% and specificity of 95.56%, positive predictive value of 71.40%, and negative predictive value of 100%). Conclusions: The Shetty test is a valid clinical screening tool to decide whether simple radiography is indicated for foot and ankle injuries. It is a simple, quick and reproducible test

Fracturas de calcáneo: controversias y consensos / Calcaneal fractures: controversies and consensus

Resumen: Las fracturas de calcáneo son las más frecuentes del tarso y su tratamiento sigue siendo hoy en día objeto de debate. Pretendemos en esta actualización destacar los puntos de controversia, así como clarificar los consensos, especialmente en el tratamiento de las fracturas intraarticulares, así como describir el manejo de las principales complicaciones.

Abstract: Calcaneal fractures are the most common tarsal fractures and their treatment is still debated today. We intend in this update to highlight the points of controversy and clarify the consensus, especially in the treatment of intra-articular fractures, as well as to describe the management of major complications.

Experience using the «Shetty test¼ for initial foot and ankle fracture screening in the Emergency Department. / Experiencia con la aplicación del test de Shetty para el despistaje inicial de fracturas del pie y tobillo en el área de Urgencias.

OBJECTIVE: The indiscriminate practice of radiographs for foot and ankle injuries is not justified and numerous studies have corroborated the usefulness of clinical screening tests such as the Ottawa Ankle Rules. The aim of our study is to clinically validate the so-called Shetty Test in our area. MATERIAL AND METHOD: A cross-sectional observational study by applying the Shetty test to patients seen in the Emergency Department. RESULTS: We enrolled 100 patients with an average age of 39.25 (16-86). The Shetty test was positive on 14 occasions. Subsequent radiography revealed a fracture in 10 cases: 4 were false positives. The test was negative in the remaining 86 patients and radiography confirmed the absence of fracture (with sensitivity of 100% and specificity of 95.56%, positive predictive value of 71.40%, and negative predictive value of 100%). CONCLUSIONS: The Shetty test is a valid clinical screening tool to decide whether simple radiography is indicated for foot and ankle injuries. It is a simple, quick and reproducible test.

Artrodesis tibiotalocalcánea con clavo retrógrado cementado con antibiótico en rescate de osteosíntesis infectada de tobillo / Tibiotalocalcaneal fusion with a cemented coated retrograde nail as a salvage procedure for infected ORIF of the ankle

La artrodesis tibiotalocalcánea es un procedimiento de rescate efectivo en casos de artrosis combinada de tobillo y subastragalina así como en deformidades severas multiplanares y graves destrucciones articulares del retropié. Mención especial merece la indicación de este procedimiento en casos de pérdida ósea, especialmente astragalina, secundaria a cirugías previas fallidas o como secuela de infección ósea, constituyendo muchas veces la única forma de conseguir un pie plantígrado y un tobillo estable e indoloro. Presentamos un caso de fractura de tobillo en paciente con morbilidad asociada y múltiples complicaciones tras la osteosíntesis, en el que la artrodesis tibiotalocalcánea con clavo retrógrado cementado con antibiótico ha conseguido un resultado final satisfactorio (AU)

Tibiotalocalcaneal arthrodesis is an effective salvage procedure in cases of combined ankle and subtalar osteoarthritis as well as severe multiplanar deformities and severe joint destruction of the hindfoot. Special mention should be made of this procedure in cases of bone loss, especially from the talus, secondary to failed previous surgeries or bone infection, often being the only way to achieve a stable and painless foot and ankle. We present a case of ankle fracture in a patient with associated morbidity and multiple complications following osteosynthesis, in which tibiotalocalcaneal arthrodesis with cemented with antibiotic coated retrograde nail has achieved a satisfactory final result (AU)

Tibiotalocalcaneal fusion with a cemented coated retrograde nail as a salvage procedure for infected ORIF of the ankle. / Artrodesis tibiotalocalcánea con clavo retrógrado cementado con antibiótico en rescate de osteosíntesis infectada de tobillo.

Tibiotalocalcaneal arthrodesis is an effective salvage procedure in cases of combined ankle and subtalar osteoarthritis as well as severe multiplanar deformities and severe joint destruction of the hindfoot. Special mention should be made of this procedure in cases of bone loss, especially from the talus, secondary to failed previous surgeries or bone infection, often being the only way to achieve a stable and painless foot and ankle. We present a case of ankle fracture in a patient with associated morbidity and multiple complications following osteosynthesis, in which tibiotalocalcaneal arthrodesis with cemented with antibiotic coated retrograde nail has achieved a satisfactory final result.