[Pronostic factors associated with the results of subtalar arthrodesis]. / Factores pronósticos asociados a los resultados de la artrodesis subastragalina.

INTRODUCTION: Subtalar arthrodesis is a surgical stabilization procedure in the isolated pathology of the subastragaline joint that does not respond to conservative treatment, its goal is to obtain a solid fusion of the joint to eliminate or improve pain and function, normalizing the distribution of foot loads and alignment of the foot. There are studied variables that interfere with the surgical outcome of patients treated with subtalar arthrodesis such as: smoking, age, sex, osteoarthritis, BMI, rehabilitation, osteosynthesis material and surgical technique. OBJECTIVE: To know the prognostic factors associated with the results of subastragaline arthrodesis. MATERIAL AND METHODS: Retrospective, longitudinal, descriptive study with review of files and conducting descriptive statistics of treated cases of August 2012- Jan 2016 with subtalar arthrodesis to identify predictive factors affecting the outcome. RESULTS: 29 feet were analyzed, reporting a successful arthrodesis in 21 cases (72.4%), in 82.8% the surgical technique was adequate. The complication rate was 20.7% On the AOFAS scale 55.2% were reported as a very good result, 27.6% good and only 17.2% regular. The factors associated with good outcome were sex and postoperative rehabilitation. DISCUSSION: The subtalar arthrodesis provides improvement in pain and alignment, at our service this procedure presents a success rate of 72.4%, among the factors associated with statistical significance was rehabilitation and sex.

INTRODUCCIÓN: La artrodesis subastragalina o astrágalo calcánea, es un procedimiento de estabilización quirúrgica en la patología aislada de la articulación subastragalina que no responde a tratamiento conservador, su objetivo es obtener una fusión sólida de la articulación para eliminar o aminorar el dolor y mejorar la función, normalizando la distribución de cargas del pie y su alineación. Existen variables estudiadas que interfieren en el resultado quirúrgico de los pacientes tratados con artrodesis subastragalina como son: el tabaquismo, edad, sexo, artrosis, IMC, rehabilitación, material de osteosíntesis y la técnica quirúrgica. OBJETIVO: Conocer los factores pronósticos asociados a los resultados de la artrodesis subastragalina. MATERIAL Y MÉTODOS: Estudio retrospectivo, longitudinal, descriptivo con revisión de expedientes y elaboración de estadística descriptiva de casos tratados de Agosto de 2012 a Enero de 2016 con artrodesis subastragalina para identificar factores pronósticos que afecten el resultado. RESULTADOS: Se analizaron 29 pies, reportándose una artrodesis exitosa en 21 casos (72.4%), en 82.8% la técnica quirúrgica fue adecuada. La tasa de complicaciones fue de 20.7%. En la escala de la Sociedad Ortopédica Americana de Pie y Tobillo (AOFAS) 55.2% se reportaron como resultado muy bueno, 27.6% bueno y sólo 17.2% regular, se encontraron como factores asociados el sexo y la rehabilitación postoperatoria al buen resultado. DISCUSIÓN: La artrodesis subastragalina brinda alivio en cuanto al dolor y mejoría en alineación, en nuestro servicio este procedimiento presenta una tasa de éxito de 72.4%, entre los factores asociados con significancia estadística fue la rehabilitación y el sexo.

[Retrograde intramedullary nail fixation for Charcot neuroarthropathy]. / Evaluación del uso del clavo centromedular retrógrado bloqueado para artrodesis de tobillo en pacientes con neuroartropatía de Charcot.

Charcot arthropathy is defined as an articular degenerative, chronic, progressive disease that affects one or more peripheral joints, develops as a result of a failure in the normal sensory perception (pain and proprioception) in the innervation of joints located in the foot and ankle, is characterized by destructive bone lesions without the presence of infection. Neuropathy is directly associated with diabetes mellitus type 1 and 2. Surgery is indicated when there is severe involvement of soft tissue, foot joints are unstable, at the presence of chronic or recurrent ulcers or when the foot and ankle can not fit to a normal shoe, and had limitation to perform activities of daily living. MATERIAL AND METHODS: Charcot arthropathy is defined as an articular degenerative, chronic, progressive disease that affects one or more peripheral joints, develops as a result of a failure in the normal sensory perception (pain and proprioception) in the innervation of joints located in the foot and ankle, is characterized by destructive bone lesions without the presence of infection. Neuropathy is directly associated with diabetes mellitus type 1 and 2. Surgery is indicated when there is severe involvement of soft tissue, foot joints are unstable, at the presence of chronic or recurrent ulcers or when the foot and ankle can not fit to a normal shoe, and had limitation to perform activities of daily living. DESIGN: observational, prospective, transversal, descriptive. SAMPLE: patients diagnosed with Charcot neuropathy type 3a of Brodsky. Surgically treated by ankle arthrodesis with an intramedullary blocked nail, from January 2010 to August 2015. RESULTS: 16 patients were analyzed. Preoperative AOFAS score was 35.0 ± 5.2 points. Postoperative follow-up period of 4 years to 7 months. Postoperative AOFAS scale showed an improvement of 40 points (p = 0.0001). CONCLUSIONS: The proposed treatment allows bone stabilization, resulting in a full foot plantar support and decreases the occurrence of chronic ulcers that are difficult to treat, and is an alternative method that avoids lead to amputation.

La artropatía de Charcot se define como un padecimiento articular degenerativo, crónico y progresivo que se caracteriza por lesiones óseas destructivas sin presencia de infección. La neuropatía está asociada directamente con la diabetes mellitus tipo 1 y 2. La cirugía está indicada cuando existe compromiso de partes blandas, inestabilidad de las articulaciones del tobillo y pie, cuando se desarrollan úlceras recurrentes o no es posible adecuar el tobillo o el pie a un calzado normal o en los pacientes que presentan deformidad severa, úlceras o dolor crónico y limitación para realizar las actividades de la vida diaria. El presente es un trabajo observacional, prospectivo, transversal y descriptivo de pacientes con diagnóstico de neuroartropatía de Charcot tipo 3a de Brodsky tratados quirúrgicamente mediante artrodesis de tobillo con clavo centromedular retrógrado bloqueado, del 1o de Enero de 2010 al 31 de Agosto de 2015. Se analizaron 16 pacientes. En el preoperatorio la media de la escala de AOFAS fue de 35.0 ± 5.2 puntos. Un seguimiento postoperatorio de cuatro años con un mínimo de siete meses. En el postoperatorio la escala de AOFAS mostró un incremento de 40 puntos hacia la mejoría (p = 0.0001). La técnica revisada logra la estabilización ósea, resultando en un pie con apoyo plantígrado que disminuye la aparición de úlceras crónicas y mejora el desarrollo en las actividades de la vida cotidiana.

[Prognostic factors for post surgical complications in bone infection and pseudarthrosis]. / Factores pronósticos de complicaciones postquirúrgicas en pacientes con infecciones óseas y seudoartrosis.

Bone infection and nonunion are the main orthopedic and traumatic complications whose treatment remains a challenge because multiple factors are involved in the rate of failures when you try to correct them. Knowing these factors were the problem that caused the research through a prospective longitudinal study of 83 patients of 43.3 ± 16.1 years old. They were treated for aseptic and septic nonunion, osteomyelitis, osteitis, malunion or infected joint replacement. The cases were classified with or without postoperative complications and outcome related to systemic and local factors taken prognostic model Cierny-Mader as factors affecting immune surveillance, metabolism and local vascularization. For bivariate analysis of data Χ² it was applied or where appropriate Fishers exact test; for multivariate analysis model not conditional binary logistic regression method was applied Wald backward to select the significant prognostic factors. The alpha error was set 0.05. General complications occurred in 51.8% of cases. Local factors (lymphedema, arteritis, venous insufficiency, loss of skin) with an OR of 5.0 (95% CI 1.0-24.9, p = 0.03), septic nonunion with OR of 5.0 (95% CI 1.9-13.0, p = 0.001) and segmental fractures with an OR of 3.2 (95% CI 0.8-13.0, p = 0.07) were the prognostic factors identified in the bivariate analysis; however, the logistic regression only selected as the septic pseudoarthrosis as a significant factor. It is necessary to detect and if necessary control or eliminate those factors that can directly affect poor postoperative results.

La infección ósea y la seudoartrosis son las principales complicaciones ortopédicas en cuyo tratamiento intervienen múltiples factores en la tasa de falla al tratar de corregirlas. Conocer estos factores fue el problema que originó la investigación a través de un estudio longitudinal y prospectivo de una cohorte histórica de 83 pacientes de 43.3 ± 16.1 años de edad tratados por seudoartrosis asépticas y sépticas, osteomielitis, osteítis, consolidación viciosa o prótesis infectadas, el desenlace se relacionó con los factores pronósticos sistémicos y locales tomados del modelo de Cierny-Mader como factores que afectan la vigilancia inmunológica, el metabolismo y la vascularización local. Para el análisis bivariado se aplicó Χ² o el test exacto de Fisher; para el análisis multivariado se aplicó el modelo de regresión logística binaria no condicional con método de Wald hacia atrás para seleccionar los factores pronósticos significativos. El error alfa se fijó 0.05. Las complicaciones se presentaron en 51.8% de los casos. Los factores locales (linfedema, arteritis, insuficiencia venosa y pérdida de piel) con una OR de 5.0 (IC 95% 1.0-24.9, p = 0.03), las seudoartrosis sépticas con OR de 5.0 (IC 95% 1.9-13.0, p = 0.001) y fracturas segmentarias con OR de 3.2 (IC 95% 0.8-13.0, p = 0.07) fueron los factores pronósticos identificados en el análisis bivariado; sin embargo, la regresión logística sólo seleccionó como factor significativo a las seudoartrosis sépticas. Es necesario detectar y en su caso controlar o eliminar dichos factores que pueden incidir directamente en malos resultados postquirúrgicos.

Efectos a corto plazo del entrenamiento de la marcha en una órtesis robótica (Lokomat®) con retroalimentación auditiva en pacientes con lesión medular incompleta crónica / Short-term effects of gait training on a robotic orthosis (Lokomat®) with auditory feedback in patients with chronic incomplete spinal cord injury

Introducción. El entrenamiento de la marcha en órtesis robótica ha demostrado buenos resultados en pacientes con lesión medular incompleta (LMI) crónica; la retroalimentación auditiva puede suplir la información dada normalmente por las vías sensitivas afectadas. Objetivo. Evaluar el efecto a corto plazo del entrenamiento de la marcha en órtesis robótica con retroalimentación auditiva en pacientes con LMI crónica. Material y método. Se estudió a 31 pacientes con LMI asignados aleatoriamente a 2 grupos: uno control con entrenamiento únicamente en órtesis robótica y otro experimental con entrenamiento en órtesis robótica y retroalimentación auditiva realizada mediante un metrónomo con frecuencia igual a la de la cadencia. Se midieron las variables espacio temporales de la marcha así como el torque, la espasticidad y los arcos de movilidad en caderas y rodillas antes y después del tratamiento mediante un tapete instrumentado y la órtesis robótica, respectivamente. Se realizaron estudios de varianza, covarianza y correlaciones bivariadas para el análisis de resultados. Resultados. Se encontró mejoría estadísticamente significativa en velocidad y cadencia de la marcha, arcos de movilidad, torque y espasticidad en pacientes del grupo experimental y un cambio favorable y significativo en el uso de ayudas técnicas para la marcha. Conclusiones. El programa propuesto mejoró el patrón de marcha en pacientes con LMI crónica. Se necesita evaluar la persistencia de los cambios a largo plazo así como realizar más estudios con retroalimentación auditiva en otras enfermedades (AU)

ntroduction. Gait training on a robotic orthosis has shown good results in patients with chronic incomplete spinal cord injury (SCI). Auditory feedback in these patients can replace the information normally given by the sensory pathways. Objective. To evaluate the effects of gait training on a robotic orthosis with auditory feedback in patients with chronic SCI. Material and methods. We studied 31 patients with chronic incomplete SCI, who were randomized to 2 groups. Control group was trained on a robotic orthosis and experimental group received auditory feedback added to robotic orthosis training. Auditory feedback consisted on a metronome whose frequency was equal to gait cadence. The variables measured were spatiotemporal gait (by an instrumented mat), torque, spasticity, and range of motion in the hips and knees (by a robotic orthosis) before and after the assigned treatment. Calculation of variance, covariance and bivariate correlation were conducted for the analysis of results. Results. We found a statistically significant improvement in gait speed and cadence, range of motion, torque and spasticity in the experimental group and a positive and significant change in the use of assistive devices for walking. Conclusions. The proposed program improved gait pattern in patients with chronic SCI. Further studies are needed to assess the persistence of these changes in the long-term, as well as the use of auditory feedback in other disorders (AU)

Association of strength, muscle balance, and atrophy with pain and function in patients with degenerative spondylolisthesis.

PURPOSE: To analyze the relationship of strength, muscular balance, and atrophy with pain and function in patients with degenerative spondylolisthesis. STUDY DESIGN: Transversal, descriptive, and observational. PATIENTS AND METHODS: Institutional review board approval was obtained for this study. Twenty six patients ages 50 years and older, with degenerative spondylolisthesis at L4-L5. Measurements included Pain Visual Analogue Scale scores (VAS), Oswestry Disability Index scores (ODI), and isokinetic trunk testing; assessment of multifidus atrophy and spinal stenosis was performed by Magnetic Resonance Imaging (MRI). STATISTICS: Statistical analysis was performed using SPSS version 17.0 software for Windows. Pearson's correlation was used to ascertain the correlation between variables. ANOVA with analysis of covariance was used to determine the correlation between the remainder variables. Significance was set at p < 0.05. RESULTS: Of the 26 patients studied, with an average age of 60.23 ± 7.6 years, 20 had grade I spondylolisthesis and 6 were grade II. Correlation between the ODI scores and spondylolisthesis grading was significant (r=0.576, p=0.005); correlation between agonist/antagonist ratio in the isokinetic test (predominant extensor muscles over flexors) with the ODI scores was also significant (r=0.446, p=0.02), regardless of spinal stenosis. No correlation was found between functionality and pain with strength or multifidus atrophy. CONCLUSION: Muscle trunk imbalance with predominance of extensor over flexor muscles is associated with functional disability. Rehabilitation programs should be designed to improve muscle balance rather than muscle strength alone.

[Treatment and reconstruction of bone tumors of the with a RIMAG unconventional prosthesis]. / Tratamiento y reconstrucción en tumores óseos del húmero con prótesis no convencional tipo RIMAG.

INTRODUCTION: Conservative surgery and reconstruction with an unconventional prosthesis are indicated for tumors of the humerus without neurovascular compromise, as they help preserve shoulder, elbow and hand function. The humerus is the third most frequent site of benign, aggressive, malignant and metastatic tumors that cause functional limitation or limb loss. MATERIAL: Patients with a bone tumor of the humerus without neurovascular involvement that met the inclusion criteria. Unconventional, uncemented RIMAG prosthesis with diaphyseal fit and locking bolts. METHODS: 39 patients with intraarticular type I tumors according to the Malawer and Enneking classification were treated with tumor resection and reconstruction with an unconventional prosthesis and soft tissues. RESULTS: Patients enrolled included 18 females and 21 males ages 12-72 years with tumors such as: giant cell tumors (14), osteosarcomas (7), metastasis (7), chondrosarcomas (6), Ewing's sarcomas (2), chondroblastoma (2) and aneurysmatic bone cyst (1). Twelve patients died due to systemic disease and the remaining patients survived. Surgical margins were broad, with humeral resection between 100 and 230 mm. Functional results were assessed according to the Muscoloskeletal Tumor Society score as 13 excellent, 16 good, 5 failures and 5 poor. DISCUSSION: The resection level does not restrict the placement of this prosthesis, which permits future revisions. An appropriate result depends on the resection size and the preserved shoulder musculature and it is not limited by the size of resection, thus improving patients' disability.

[Efficacy of the RIMAG unconventional hip prosthesis in patients with primary bone tumors, metastasis and non-tumor osteoarticular losses]. / Eficacia de la prótesis no convencional para la cadera tipo RIMAG en pacientes con tumores óseos primarios, metástasis y pérdidas osteoarticulares no tumorales.

OBJECTIVE: To assess the functional efficacy of the RIMAG unconventional hip prosthesis in cancer and non-cancer patients. MATERIAL AND METHODS: Functional analysis of 38 patients with RIMAG arthroplasty, using the Musculoskeletal Tumor Society Scoring System and including the following: functionality versus histologic diagnosis (5 malignancies, 3 metastases, 14 giant cell tumors (GCT), 8 with other benign tumors, and 8 had no tumor), age (40.4 +/- 19.1 years), sex (24 females, 14 males), postoperative follow-up (34.7 +/- 31.3 months). Analysis of intraoperative, immediate and late complications, time to weight bearing, gait and work or social reintegration were also assessed. RESULTS: Global mean of ideal functionality was 65.6 +/- 23.2%. Age was negatively correlated with the functionality rate (r = -0.507, p = 0.001); significant difference with the histologic diagnosis: malignant tumors 54.8, metastasis 58.6, giant cell tumor 25.6, other benign tumors 34.2, non-tumor causes 56.6 (p = 0.001). When functionality means were adjusted for age with a covariance analysis, better percentages were found for benign tumors (79.2 +/- 6.8%) and giant cell tumors (76.4 +/- 6.3%), less functionality for non-tumor causes (45.7 +/- 7.6%), and intermediate percentages for malignant tumors and metastasis (p = 0.03). Intraoperative complications occurred in 4 cases (28.6%), immediate in 3 (7.8%), late in 15 (39.4%); 62.5% of patients started immediate weight bearing, 92.1% resumed their usual activities after surgery. CONCLUSIONS: The reconstruction of the proximal femur with RIMAG is a safe and reliable treatment option, with complication rates below the ones reported in the literature. Satisfactory results were obtained, with high functional rates for benign tumors, and low rates in older patients, malignant tumors and metastasis.

Utilidad de la tizanidina. Seguimiento de un año en el tratamiento de la espasticidad en la parálisis cerebral infantil / The usefulness of tizanidine. A one-year follow-up of the treatment of spasticity in infantile cerebral palsy

Introducción. La parálisis cerebral infantil ocupa el primerlugar de discapacidad (tipo espástico, 88%). La tizanidina es unimidazólico de acción central y agonista que actúa como α2-adrenérgico.Objetivo. Demostrar clínicamente la efectividad de la tizanidinaen la disminución de la espasticidad. Pacientes y métodos.Por asignación aleatoria en estudio doble ciego, se trataron durante6 meses 10 niños con tizanidina (0,05 mg/kg/día) y 30 con placebo,los cuales posteriormente se unificaron en el grupo de la tizanidina.Las variables dependientes fueron la espasticidad, la escalade Ashworth, la escala del tono postural, los reflejos y las pruebasde funcionamiento hepático. Resultados. La espasticidad y los reflejosfueron sistemáticamente menores en el grupo de la tizanidina, demanera que la espasticidad se redujo en un 78,85% frente al 7,64 %con el placebo (p = 0,0001); en el seguimiento de seis meses de los35 pacientes se redujo un 78,2% (p = 0,0001). La duración de laefectividad de la tizanidina en cuatro pacientes fue de dos meses yéstos nunca regresaron a su valoración basal. No se observaron efectosadversos ni la elevación de enzimas hepáticas. Conclusiones. Latizanidina produce una reducción significativa de la espasticidad enniños, sin efectos adversos y con un alto porcentaje de aceptaciónen las dosis prescritas

Introduction. The cerebral palsy has the first place of physical handicap in children (type spastic, 88%). Tizanidineimidazole derivative is centrally acting as a α2-adrenergic agonist. Aim. To demonstrate clinically the effectiveness oftizanidine in the decrease of the spasticity. Patients and methods. We assigned randomly in a double blind study 10 childrentreated with tizanidine (0.05 mg/kg/day) and 30 with placebo for a 6-month period, after which they were unified in the groupof tizanidine. The dependent variables were spasticity, Ashworth scale, posture tone scale, reflex scale and liver function test.Results. The spasticity and the reflex decreased in the group of tizanidine an 78.85% in comparison with a 7.64% in the groupof placebo (p = 0.0001); in the monitoring of 6 months 35 patients reduced this to 78.2% (p= 0.0001). The duration ofeffectiveness of tizanidine in four patients was two months and they never returned to their appraisal basal. Without reportedadverse effects, the liver function test remains normal. Conclusion. Tizanidine produces a significant reduction of thespasticity in children without adverse effects, having a high percentage of acceptance to the prescribe dose

[The usefulness of tizanidine. A one-year follow-up of the treatment of spasticity in infantile cerebral palsy]. / Utilidad de la tizanidina. Seguimiento de un ano en el tratamiento de la espasticidad en la paralisis cerebral infantil.

INTRODUCTION: The cerebral palsy has the first place of physical handicap in children (type spastic, 88%). Tizanidine imidazole derivative is centrally acting as a a2-adrenergic agonist. AIM: To demonstrate clinically the effectiveness of tizanidine in the decrease of the spasticity. PATIENTS AND METHODS: We assigned randomly in a double blind study 10 children treated with tizanidine (0.05 mg/kg/day) and 30 with placebo for a 6-month period, after which they were unified in the group of tizanidine. The dependent variables were spasticity, Ashworth scale, posture tone scale, reflex scale and liver function test. RESULTS: The spasticity and the reflex decreased in the group of tizanidine an 78.85% in comparison with a 7.64% in the group of placebo (p = 0.0001); in the monitoring of 6 months 35 patients reduced this to 78.2% (p= 0.0001). The duration of effectiveness of tizanidine in four patients was two months and they never returned to their appraisal basal. Without reported adverse effects, the liver function test remains normal. CONCLUSION: Tizanidine produces a significant reduction of the spasticity in children without adverse effects, having a high percentage of acceptance to the prescribe dose.

[Patellar complications in total arthroplasty of the knee: a meta-analytic study]. / Complicaciones patelares en la artroplastia total de rodilla: un estudio de metanálisis.

Patellar complications during total knee arthroplasty (TKA) with and without prosthesis has been reported with great variability in the rates of patellar complications and has been noted by different authors. We decided to perform a meta-analysis study to find possible differences among them by measuring the effects of magnitude (EM), the rate risks (RR), and the number of patients (NP) who require this treatment. We found that in studies that include small samples, the aleatory errors are greater than those with larger samples, so the first would not be considered to estimate the effect of magnitude against control groups (without patellar prosthesis). When we carried out correct comparisons between these groups, the percentage of complications in the patellar group were reduced. We also see that the differences in patellar complications reported by different authors with a similar large number of samples are due to different levels of expertise in the surgical procedure employed. We conclude that a meta-analysis study will be necessary in Orthopedics.