¿Son las escalas de valoración de fragilidad superiores a la escala de valoración ASA en la predicción de complicaciones, estancia hospitalaria y readmisiones en prótesis total de rodilla? Un estudio comparativo entre pacientes octogenarios y septuagenarios / Are frailty scores superior to the ASA score in predicting complications, hospital stay, and readmissions in total knee replacement? A comparative study between octogenarian and septuagenarian patients

Antecedentes y objetivo: Las escalas de valoración de fragilidad no han sido estandarizadas para la evaluación prequirúrgica de pacientes sometidos a un reemplazo total de rodilla (RTR). El objetivo de este estudio fue comparar la eficacia de la escala de valoración de la Sociedad Americana de Anestesiología (ASA), el índice de comorbilidad de Charlson (ICC) y la escala simple de fragilidad (SSF) en la predicción de complicaciones, estancia hospitalaria, reingresos y mortalidad después del RTR electivo. Materiales y métodos: Estudiamos retrospectivamente a 448 pacientes que se sometieron a un RTR por artrosis en nuestra institución entre 2016 y 2019. Estos se dividieron en 2 grupos: grupo A (263 pacientes <80 años) y grupo B (185 pacientes >80 años). Todos fueron clasificados por escalas ASA, ICC y SSF. Resultados: El ICC fue mayor en el grupo B (mediana: 5 [RI: 4-6] vs. 4 [RI: 3-5]; p<0,001); sin embargo, no se asoció con un mayor número de complicaciones. Al realizar un análisis de regresión logística encontramos, para las complicaciones: OR SSF=0,67; ICC=1,11; ASA 3 y 4=0,89 y edad=1,04; mientras que para los reingresos: OR SSF=2,09; ICC=1,01; ASA 3 y 4=0,79 y edad=1. Conclusiones: Las escalas ICC y SSF demostraron no presentar diferencias a la escala ASA en la predicción de reingresos, complicaciones y estancia hospitalaria. Sin embargo, el SSF parece tener una mejor correlación en la predicción de la readmisión no planificada.(AU)

Background and objective: Frailty scores have not been standardized for the preoperative assessment of patients undergoing total knee replacement (TKR). The aim of this study was to compare the efficacy of the American Society of Anesthesiology (ASA) score, the Charlson comorbidity index (ICC) and the simple frailty score (SSF) in predicting complications, hospital stay, readmissions and mortality after elective TKR. Materials and methods: We retrospectively studied 448 patients who underwent TKR for osteoarthritis at our institution between 2016 and 2019. They were divided into two groups: Group A (263 patients, <80 years) and Group B (185 patients, >80 years).). All were classified by ASA, ICC and SSF scores. Results: The ICC was higher in Group B (median 5 [RI: 4-6] vs. 4 [RI: 3-5]; P<.001); however, it was not associated with a higher number of complications. When performing a logistic regression analysis we found, for complications: OR SSF=0.67, ICC=1.11; ASA 3 & 4=0.89 and age=1.04; while for readmissions: OR SSF=2.09; ICC=1.01; ASA 3 & 4=0.79 and age=1. Conclusions: The ICC and SSF scales showed no differences to the ASA scale in the prediction of readmissions, complications and hospital stay. However, the SSF seems to have a better correlation in predicting unplanned readmission.(AU)

[Translated article] Are frailty scores superior to the ASA score in predicting complications, hospital stay, and readmissions in total knee replacement? A comparative study between octogenarian and septuagenarian patients / ¿Son las escalas de valoración de fragilidad superiores a la escala de valoración ASA en la predicción de complicaciones, estancia hospitalaria y readmisiones en prótesis total de rodilla? Un estudio comparativo entre pacientes octogenarios y septuagenarios

Antecedentes y objetivo: Las escalas de valoración de fragilidad no han sido estandarizadas para la evaluación prequirúrgica de pacientes sometidos a un reemplazo total de rodilla (RTR). El objetivo de este estudio fue comparar la eficacia de la escala de valoración de la Sociedad Americana de Anestesiología (ASA), el índice de comorbilidad de Charlson (ICC) y la escala simple de fragilidad (SSF) en la predicción de complicaciones, estancia hospitalaria, reingresos y mortalidad después del RTR electivo. Materiales y métodos: Estudiamos retrospectivamente a 448 pacientes que se sometieron a un RTR por artrosis en nuestra institución entre 2016 y 2019. Estos se dividieron en 2 grupos: grupo A (263 pacientes <80 años) y grupo B (185 pacientes >80 años). Todos fueron clasificados por escalas ASA, ICC y SSF. Resultados: El ICC fue mayor en el grupo B (mediana: 5 [RI: 4-6] vs. 4 [RI: 3-5]; p<0,001); sin embargo, no se asoció con un mayor número de complicaciones. Al realizar un análisis de regresión logística encontramos, para las complicaciones: OR SSF=0,67; ICC=1,11; ASA 3 y 4=0,89 y edad=1,04; mientras que para los reingresos: OR SSF=2,09; ICC=1,01; ASA 3 y 4=0,79 y edad=1. Conclusiones: Las escalas ICC y SSF demostraron no presentar diferencias a la escala ASA en la predicción de reingresos, complicaciones y estancia hospitalaria. Sin embargo, el SSF parece tener una mejor correlación en la predicción de la readmisión no planificada.(AU)

Background and objective: Frailty scores have not been standardized for the preoperative assessment of patients undergoing total knee replacement (TKR). The aim of this study was to compare the efficacy of the American Society of Anesthesiology (ASA) score, the Charlson comorbidity index (ICC) and the simple frailty score (SSF) in predicting complications, hospital stay, readmissions and mortality after elective TKR. Materials and methods: We retrospectively studied 448 patients who underwent TKR for osteoarthritis at our institution between 2016 and 2019. They were divided into two groups: Group A (263 patients, <80 years) and Group B (185 patients, >80 years).). All were classified by ASA, ICC and SSF scores. Results: The ICC was higher in Group B (median 5 [RI: 4-6] vs. 4 [RI: 3-5]; P<.001); however, it was not associated with a higher number of complications. When performing a logistic regression analysis we found, for complications: OR SSF=0.67, ICC=1.11; ASA 3 & 4=0.89 and age=1.04; while for readmissions: OR SSF=2.09; ICC=1.01; ASA 3 & 4=0.79 and age=1. Conclusions: The ICC and SSF scales showed no differences to the ASA scale in the prediction of readmissions, complications and hospital stay. However, the SSF seems to have a better correlation in predicting unplanned readmission.(AU)

[Translated article] Are frailty scores superior to the ASA score in predicting complications, hospital stay, and readmissions in total knee replacement? A comparative study between octogenarian and septuagenarian patients.

BACKGROUND AND OBJECTIVE: Frailty scores have not been standardised for the preoperative assessment of patients undergoing total knee replacement (TKR). The aim of this study was to compare the efficacy of the American Society of Anesthesiology (ASA) score, the Charlson comorbidity index (ICC) and the simple frailty score (SSF) in predicting complications, hospital stay, readmissions and mortality after elective TKR. MATERIALS AND METHODS: We retrospectively studied 448 patients who underwent TKR for osteoarthritis at our institution between 2016 and 2019. They were divided into two groups: Group A (263 patients, <80 years) and Group B (185 patients, >80 years).). All were classified by ASA, ICC and SSF scores. RESULTS: The ICC was higher in Group B (median 5 [RI: 4-6] vs. 4 [RI: 3-5]; p<.001); however, it was not associated with a higher number of complications. When performing a logistic regression analysis we found, for complications: OR SSF=0.67; ICC=1.11; ASA 3 & 4=0.89 and age=1.04; while for readmissions: OR SSF=2.09; ICC=1.01; ASA 3 & 4=0.79 and age=1. CONCLUSIONS: The ICC and SSF scales showed no differences to the ASA scale in the prediction of readmissions, complications and hospital stay. However, the SSF seems to have a better correlation in predicting unplanned readmission.

Are frailty scores superior to the ASA score in predicting complications, hospital stay, and readmissions in total knee replacement? A comparative study between octogenarian and septuagenarian patients. / ¿Son las escalas de valoración de fragilidad superiores a la escala de valoración ASA en la predicción de complicaciones, estancia hospitalaria y readmisiones en prótesis total de rodilla? Un estudio comparativo entre pacientes octogenarios y septuagenarios.

BACKGROUND AND OBJECTIVE: Frailty scores have not been standardized for the preoperative assessment of patients undergoing total knee replacement (TKR). The aim of this study was to compare the efficacy of the American Society of Anesthesiology (ASA) score, the Charlson comorbidity index (ICC) and the simple frailty score (SSF) in predicting complications, hospital stay, readmissions and mortality after elective TKR. MATERIALS AND METHODS: We retrospectively studied 448 patients who underwent TKR for osteoarthritis at our institution between 2016 and 2019. They were divided into two groups: Group A (263 patients, <80 years) and Group B (185 patients, >80 years).). All were classified by ASA, ICC and SSF scores. RESULTS: The ICC was higher in Group B (median 5 [RI: 4-6] vs. 4 [RI: 3-5]; P<.001); however, it was not associated with a higher number of complications. When performing a logistic regression analysis we found, for complications: OR SSF=0.67, ICC=1.11; ASA 3 & 4=0.89 and age=1.04; while for readmissions: OR SSF=2.09; ICC=1.01; ASA 3 & 4=0.79 and age=1. CONCLUSIONS: The ICC and SSF scales showed no differences to the ASA scale in the prediction of readmissions, complications and hospital stay. However, the SSF seems to have a better correlation in predicting unplanned readmission.

Independent inter and intra-observer agreement of the Schizas's classification of degenerative lumbar stenosis: Comparison among three levels of surgical training / Acuerdo inter e intraobservador independiente de la clasificación de Schizas de estenosis lumbar degenerativa. Comparación entre tres niveles de entrenamiento quirúrgico

Introduction and objectives: Lumbar spinal stenosis is a common age-related condition that affects the quality of life. Multiple classifications have been developed to quantify the severity of stenosis affecting comparison between studies and homogenous communication among surgeons and researchers. Even though this classification has not shown a direct clinical correlation, Schizas's classification appears to be a simple method to assess stenosis. Our objective was to evaluate the inter and intraobserver independent agreement of the Schizas's classification to assess stenosis severity. Additionally, we aimed to compare agreement among three levels of training in spine surgery. Materials and methods: An independent inter and intra observer agreement was conducted among junior, senior orthopedic residents and attending spine surgeons. Ninety lumbar levels from 30 patients were evaluated by 16 observers. Weighted kappa agreement was used. Results: Overall interobserver and intraobserver agreement was of 0.57 (95% CI=0.52–0.63) and 0.69 (0.55–0.79), respectively. Interobserver agreement according to level of training yielded values of 0.53 (0.46–0.60) for junior residents, 0.61 (0.54–0.67) for senior residents and 0.67 (0.59–0.74) for attendings. Intraobserver agreement was of 0.54 (0.48–0.60) for junior, 0.60 (0.55–0.66) for senior and 0.66 (0.60–0.72) for attendings. Conclusion: The Schizas's classification showed moderate interobserver and substantial intraobserver agreement. Among attending surgeons, substantial inter and intraobserver agreement was observed. The classification allowed acceptable communication among trained spine surgeons.(AU)

Introducción y objetivos: La estenosis espinal lumbar es una condición frecuente relacionada con la edad que afecta la calidad de vida. Se han desarrollado múltiples clasificaciones para cuantificar la gravedad de la estenosis que afectan la comparación entre estudios y la comunicación homogénea entre cirujanos e investigadores. A pesar de que esta clasificación no ha mostrado una correlación directa con la clínica, la clasificación de Schizas parece ser un método simple para evaluar la estenosis. Nuestro objetivo fue evaluar el acuerdo independiente inter e intraobservador de la clasificación de Schizas en la severidad de la estenosis. Además, comparamos la concordancia entre tres niveles de formación en cirugía de columna. Materiales y métodos: Se llevó a cabo un acuerdo independiente inter e intraobservador entre los residentes ortopédicos principiantes, avanzados y los cirujanos de columna; 90 niveles lumbares de 30 pacientes fueron evaluados por 16 observadores. Se utilizó concordancia a través del kappa ponderado. Resultados: La concordancia global interobservador e intraobservador fue de 0,57 (IC 95%=0,52-0,63) y 0,69 (0,55-0,79), respectivamente. La concordancia interobservador según el nivel de formación arroja valores de 0,53 (0,46-0,60) para los residentes menores, 0,61 (0,54-0,67) para los residentes mayores y 0,67 (0,59-0,74) para los asistentes. La concordancia intraobservador fue de 0,54 (0,48-0,60) para principiantes, 0,60 (0,55-0,66) para avanzados y 0,66 (0,60-0,72) para cirujanos de columna. Conclusión: La clasificación de Schizas mostró concordancia interobservador moderada y concordancia intraobservador sustancial. Entre los cirujanos de columna, se observó un acuerdo sustancial inter e intraobservador. La clasificación permitió una comunicación aceptable entre los cirujanos de columna entrenados.(AU)

[Artículo traducido] Acuerdo inter-e intraobservador independiente de la clasificación de Schizas de estenosis lumbar degenerativa. Comparación entre tres niveles de entrenamiento quirúrgico / Independent inter and intra-observer agreement of the Schizas's classification of degenerative lumbar stenosis: Comparison among three levels of surgical training

Introduction and objectives: Lumbar spinal stenosis is a common age-related condition that affects the quality of life. Multiple classifications have been developed to quantify the severity of stenosis affecting comparison between studies and homogenous communication among surgeons and researchers. Even though this classification has not shown a direct clinical correlation, Schizas's classification appears to be a simple method to assess stenosis. Our objective was to evaluate the inter and intraobserver independent agreement of the Schizas's classification to assess stenosis severity. Additionally, we aimed to compare agreement among three levels of training in spine surgery. Materials and methods: An independent inter and intra observer agreement was conducted among junior, senior orthopedic residents and attending spine surgeons. Ninety lumbar levels from 30 patients were evaluated by 16 observers. Weighted kappa agreement was used. Results: Overall interobserver and intraobserver agreement was of 0.57 (95% CI=0.52–0.63) and 0.69 (0.55–0.79), respectively. Interobserver agreement according to level of training yielded values of 0.53 (0.46–0.60) for junior residents, 0.61 (0.54–0.67) for senior residents and 0.67 (0.59–0.74) for attendings. Intraobserver agreement was of 0.54 (0.48–0.60) for junior, 0.60 (0.55–0.66) for senior and 0.66 (0.60–0.72) for attendings. Conclusion: The Schizas's classification showed moderate interobserver and substantial intraobserver agreement. Among attending surgeons, substantial inter and intraobserver agreement was observed. The classification allowed acceptable communication among trained spine surgeons.(AU)

Introducción y objetivos: La estenosis espinal lumbar es una condición frecuente relacionada con la edad que afecta la calidad de vida. Se han desarrollado múltiples clasificaciones para cuantificar la gravedad de la estenosis que afectan la comparación entre estudios y la comunicación homogénea entre cirujanos e investigadores. A pesar de que esta clasificación no ha mostrado una correlación directa con la clínica, la clasificación de Schizas parece ser un método simple para evaluar la estenosis. Nuestro objetivo fue evaluar el acuerdo independiente inter e intraobservador de la clasificación de Schizas en la severidad de la estenosis. Además, comparamos la concordancia entre tres niveles de formación en cirugía de columna. Materiales y métodos: Se llevó a cabo un acuerdo independiente inter e intraobservador entre los residentes ortopédicos principiantes, avanzados y los cirujanos de columna; 90 niveles lumbares de 30 pacientes fueron evaluados por 16 observadores. Se utilizó concordancia a través del kappa ponderado. Resultados: La concordancia global interobservador e intraobservador fue de 0,57 (IC 95%=0,52-0,63) y 0,69 (0,55-0,79), respectivamente. La concordancia interobservador según el nivel de formación arroja valores de 0,53 (0,46-0,60) para los residentes menores, 0,61 (0,54-0,67) para los residentes mayores y 0,67 (0,59-0,74) para los asistentes. La concordancia intraobservador fue de 0,54 (0,48-0,60) para principiantes, 0,60 (0,55-0,66) para avanzados y 0,66 (0,60-0,72) para cirujanos de columna. Conclusión: La clasificación de Schizas mostró concordancia interobservador moderada y concordancia intraobservador sustancial. Entre los cirujanos de columna, se observó un acuerdo sustancial inter e intraobservador. La clasificación permitió una comunicación aceptable entre los cirujanos de columna entrenados.(AU)

Independent inter and intra-observer agreement of the Schizas's classification of degenerative lumbar stenosis: Comparison among three levels of surgical training. / [Artículo traducido] Acuerdo inter- e intraobservador independiente de la clasificación de Schizas de estenosis lumbar degenerativa. Comparación entre tres niveles de entrenamiento quirúrgico.

INTRODUCTION AND OBJECTIVES: Lumbar spinal stenosis is a common age-related condition that affects the quality of life. Multiple classifications have been developed to quantify the severity of stenosis affecting comparison between studies and homogenous communication among surgeons and researchers. Even though this classification has not shown a direct clinical correlation, Schizas's classification appears to be a simple method to assess stenosis. Our objective was to evaluate the inter and intraobserver independent agreement of the Schizas's classification to assess stenosis severity. Additionally, we aimed to compare agreement among three levels of training in spine surgery. MATERIALS AND METHODS: An independent inter and intra observer agreement was conducted among junior, senior orthopedic residents and attending spine surgeons. Ninety lumbar levels from 30 patients were evaluated by 16 observers. Weighted kappa agreement was used. RESULTS: Overall interobserver and intraobserver agreement was of 0.57 (95% CI=0.52-0.63) and 0.69 (0.55-0.79), respectively. Interobserver agreement according to level of training yielded values of 0.53 (0.46-0.60) for junior residents, 0.61 (0.54-0.67) for senior residents and 0.67 (0.59-0.74) for attendings. Intraobserver agreement was of 0.54 (0.48-0.60) for junior, 0.60 (0.55-0.66) for senior and 0.66 (0.60-0.72) for attendings. CONCLUSION: The Schizas's classification showed moderate interobserver and substantial intraobserver agreement. Among attending surgeons, substantial inter and intraobserver agreement was observed. The classification allowed acceptable communication among trained spine surgeons.

Independent inter and intra-observer agreement of the Schizas's classification of degenerative lumbar stenosis: Comparison among three levels of surgical training.

INTRODUCTION AND OBJECTIVES: Lumbar spinal stenosis is a common age-related condition that affects the quality of life. Multiple classifications have been developed to quantify the severity of stenosis affecting comparison between studies and homogenous communication among surgeons and researchers. Even though this classification has not shown a direct clinical correlation, Schizas's classification appears to be a simple method to assess stenosis. Our objective was to evaluate the inter and intraobserver independent agreement of the Schizas's classification to assess stenosis severity. Additionally, we aimed to compare agreement among three levels of training in spine surgery. MATERIALS AND METHODS: An independent inter and intra observer agreement was conducted among junior, senior orthopedic residents and attending spine surgeons. Ninety lumbar levels from 30 patients were evaluated by 16 observers. Weighted kappa agreement was used. RESULTS: Overall interobserver and intraobserver agreement was of 0.57 (95% CI=0.52-0.63) and 0.69 (0.55-0.79), respectively. Interobserver agreement according to level of training yielded values of 0.53 (0.46-0.60) for junior residents, 0.61 (0.54-0.67) for senior residents and 0.67 (0.59-0.74) for attendings. Intraobserver agreement was of 0.54 (0.48-0.60) for junior, 0.60 (0.55-0.66) for senior and 0.66 (0.60-0.72) for attendings. CONCLUSION: The Schizas's classification showed moderate interobserver and substantial intraobserver agreement. Among attending surgeons, substantial inter and intraobserver agreement was observed. The classification allowed acceptable communication among trained spine surgeons.

Rotura de la sindesmosis asociada a fracturas diafisarias de tibia de alta energía: serie de casos de una lesión habitualmente inadvertida / Syndesmosis injury associated with high-energy tibial shaft fractures: Case series of a misdiagnosis rupture

Introducción: Las fracturas diafisarias espiroideas de tibia pueden asociarse a lesiones sindesmales del tobillo. No tenemos conocimiento de que exista evidencia sobre la incidencia de lesiones sindesmales ipsilaterales asociadas a los mecanismos de fractura de tibia de alta energía con patrones oblicuos y transversos. Nuestro objetivo fue analizar retrospectivamente una serie de pacientes que presentaron rotura de la sindesmosis asociada a fracturas diafisarias de tibia con patrones oblicuos y transversos y evaluar la incidencia en nuestro medio. Métodos: Del total de 233 fracturas diafisarias de tibia operadas entre enero de 2007 y enero de 2017, se analizaron los patrones de fractura, se clasificaron según AO, se midió el ángulo talocrural, se analizaron los fracasos y reoperaciones y se describe un método poco conocido de fracaso. Resultados: De 234 fracturas que cumplieron los criterios de inclusión, 159 (64,96%) sufrieron fracturas cerradas y 75 (32,05%) expuestas. Según el sistema AO: 152 (64,10%) fueron patrones simples 42.A; 49 (20,94%) patrones tipo cuña 42.B, y 33 (14,10%) en patrones complejos 42.C. Diez pacientes presentaron acortamiento del peroné, evidenciado por el aumento del ángulo talocrural en las radiografías postoperatorias, suponiendo un 4,27% de la muestra. Nueve pacientes requirieron cirugía; el paciente restante se perdió en el seguimiento. Todos los pacientes presentaron restauración del ángulo talocrural normal. Conclusión: La incidencia de lesiones sindesmales inadvertidas asociadas a fracturas diafisarias de tibia oblicuas y transversas llega al 4,27% en nuestra serie. Consideramos necesaria la evaluación del tobillo y la sindesmosis en todas las fracturas diafisarias de tibia, aun con patrones de alta energía y no solo en patrones espiroideos, a fin de lograr mejores resultados y evitar secuelas e intervenciones futuras.(AU)

Introduction: Ankle syndesmosis injuries can be associated with a spiral mechanism on tibial shaft fractures. We are not aware if there is evidence of the incidence of ipsilateral syndesmotic lesson associated to high-energy tibial shaft fracture mechanisms. The aim of this study was to analyze the incidence of syndesmotic injuries associated with high-energy tibial shaft fractures. Methods: 233 diaphyseal tibial fractures operated between January 2007 and January 2017, the fracture patterns were analyzed, they were classified according to AO, the talocrural angle was measured, they analyzed failures and reoperations and described a novel failure method. Results: From a total of 234 fractures that met the inclusion criteria, 159 (64.96%) suffered closed fractures and 75 (32.05%) where open fractures. According to the AO classification system: 152 (64.10%) were simple patterns 42.A; 49 (20.94%) wedge type patterns 42.B and 33 (14.10%) complex patterns 42.C. Ten patients, a 4.27% of the sample, shown an increased talocrural angle in the postoperative radiographs, evidencing shortening of the fibula. Nine patients underwent surgery, the remaining patient was lost to follow-up. All the treated patients presented restoration of the normal talocrural angle. Conclusion: The incidence of syndesmotic injuries associated with high-energy tibial shaft fractures reaches 4.27%. We think that is necessary to evaluate the ankle and syndesmosis in all tibial shaft fractures, even with high-energy patterns, not only in spiral patterns.(AU)

Syndesmosis injury associated with high-energy tibial shaft fractures: Case series of a misdiagnosis rupture / Ruptura de la sindesmosis asociada a fracturas diafisarias de tibia de alta energía: serie de casos de una lesión habitualmente inadvertida

Introduction: Ankle syndesmosis injuries can be associated with a spiral mechanism on tibial shaft fractures. We are not aware if there is evidence of the incidence of ipsilateral syndesmotic lesson associated to high-energy tibial shaft fracture mechanisms. The aim of this study was to analyze the incidence of syndesmotic injuries associated with high-energy tibial shaft fractures. Methods: 233 diaphyseal tibial fractures operated between January 2007 and January 2017, the fracture patterns were analyzed, they were classified according to AO, the talocrural angle was measured, they analyzed failures and reoperations and described a novel failure method. Results: From a total of 234 fractures that met the inclusion criteria, 159 (64.96%) suffered closed fractures and 75 (32.05%) where open fractures. According to the AO classification system: 152 (64.10%) were simple patterns 42.A; 49 (20.94%) wedge type patterns 42.B and 33 (14.10%) complex patterns 42.C. Ten patients, a 4.27% of the sample, shown an increased talocrural angle in the postoperative radiographs, evidencing shortening of the fibula. Nine patients underwent surgery, the remaining patient was lost to follow-up. All the treated patients presented restoration of the normal talocrural angle. Conclusion: The incidence of syndesmotic injuries associated with high-energy tibial shaft fractures reaches 4.27%. We think that is necessary to evaluate the ankle and syndesmosis in all tibial shaft fractures, even with high-energy patterns, not only in spiral patterns.(AU)

Introducción: Las fracturas diafisarias espiroideas de tibia pueden asociarse a lesiones sindesmales del tobillo. No tenemos conocimiento de que exista evidencia sobre la incidencia de lesiones sindesmales ipsilaterales asociadas a los mecanismos de fractura de tibia de alta energía con patrones oblicuos y transversos. Nuestro objetivo fue analizar retrospectivamente una serie de pacientes que presentaron rotura de la sindesmosis asociada a fracturas diafisarias de tibia con patrones oblicuos y transversos y evaluar la incidencia en nuestro medio. Métodos: Del total de 233 fracturas diafisarias de tibia operadas entre enero de 2007 y enero de 2017, se analizaron los patrones de fractura, se clasificaron según AO, se midió el ángulo talocrural, se analizaron los fracasos y reoperaciones y se describe un método poco conocido de fracaso. Resultados: De 234 fracturas que cumplieron los criterios de inclusión, 159 (64,96%) sufrieron fracturas cerradas y 75 (32,05%) expuestas. Según el sistema AO: 152 (64,10%) fueron patrones simples 42.A; 49 (20,94%) patrones tipo cuña 42.B, y 33 (14,10%) en patrones complejos 42.C. Diez pacientes presentaron acortamiento del peroné, evidenciado por el aumento del ángulo talocrural en las radiografías postoperatorias, suponiendo un 4,27% de la muestra. Nueve pacientes requirieron cirugía; el paciente restante se perdió en el seguimiento. Todos los pacientes presentaron restauración del ángulo talocrural normal. Conclusión: La incidencia de lesiones sindesmales inadvertidas asociadas a fracturas diafisarias de tibia oblicuas y transversas llega al 4,27% en nuestra serie. Consideramos necesaria la evaluación del tobillo y la sindesmosis en todas las fracturas diafisarias de tibia, aun con patrones de alta energía y no solo en patrones espiroideos, a fin de lograr mejores resultados y evitar secuelas e intervenciones futuras.(AU)

Syndesmosis injury associated with high-energy tibial shaft fractures: Case series of a misdiagnosis rupture. / Rotura de la sindesmosis asociada a fracturas diafisarias de tibia de alta energía: serie de casos de una lesión habitualmente inadvertida.

INTRODUCTION: Ankle syndesmosis injuries can be associated with a spiral mechanism on tibial shaft fractures. We are not aware if there is evidence of the incidence of ipsilateral syndesmotic lesson associated to high-energy tibial shaft fracture mechanisms. The aim of this study was to analyze the incidence of syndesmotic injuries associated with high-energy tibial shaft fractures. METHODS: 233 diaphyseal tibial fractures operated between January 2007 and January 2017, the fracture patterns were analyzed, they were classified according to AO, the talocrural angle was measured, they analyzed failures and reoperations and described a novel failure method. RESULTS: From a total of 234 fractures that met the inclusion criteria, 159 (64.96%) suffered closed fractures and 75 (32.05%) where open fractures. According to the AO classification system: 152 (64.10%) were simple patterns 42.A; 49 (20.94%) wedge type patterns 42.B and 33 (14.10%) complex patterns 42.C. Ten patients, a 4.27% of the sample, shown an increased talocrural angle in the postoperative radiographs, evidencing shortening of the fibula. Nine patients underwent surgery, the remaining patient was lost to follow-up. All the treated patients presented restoration of the normal talocrural angle. CONCLUSION: The incidence of syndesmotic injuries associated with high-energy tibial shaft fractures reaches 4.27%. We think that is necessary to evaluate the ankle and syndesmosis in all tibial shaft fractures, even with high-energy patterns, not only in spiral patterns.