A Delphi consensus on the management of Spanish patients with osteoporosis at high risk of fracture: OSARIDELPHI study.

The OSARIDELPHI study evaluated the level of agreement between specialists in osteoporosis regarding the management of patients with high-risk fractures in Spain. The results provide expert-based recommendations for prevention, diagnosis, and treatment related to fracture risk. Therefore, the study facilitates clinical decision-making for managing this patient's profile. PURPOSE: To evaluate the level of agreement between specialists in osteoporosis regarding the management of patients with high-risk fractures in Spain. METHODS: A two-round Delphi study was performed using an online survey. In round 1, panel members rated their level of agreement with assessments on a 9-point Likert scale. Item selection was based on acceptance by ≥ 66.6% of panel experts and the agreement of the scientific committee. In round 2, the same panelists evaluated non-consensus items in round 1. RESULTS: A total of 80 panelists participated in round 1; of these, 78 completed the round 2 survey. In round 1, 122 items from 4 dimensions (definition of fracture risk: 11 items, prevention and diagnosis: 38 items, choice of treatment: 24 items, and treatment-associated quality of life: 49 items) were evaluated. The consensus was reached for 90 items (73.8%). Panelists agreed that categorizing high risk, very high risk, or imminent risk determines secondary prevention actions (97.5%). Experts agreed that treatment with bone-forming drugs should be considered in case of a very high risk of fracture, and a sequential change to antiresorptive drugs should be made after 1-2 years (97.5%). Panelists also recommended corrective action plans for non-adherent patients to improve adherence (97.5%). A total of 131 items were finally accepted after round 2. CONCLUSION: This Delphi study provides expert-based recommendations on clinical decision-making for managing patients with osteoporosis at high risk of fracture.

Spanish National Registry of Major Osteoporotic Fractures (REFRA) seen at Fracture Liaison Services (FLS): objectives and quality standards.

REFRA-FLS is a new registry in Spain aimed at identifying individuals over 50 years of age with a fragility fracture. Using this registry, we found hip fracture is the most prevalent fracture. Treatment for osteoporosis was 87.7%, with 65.3% adherence. REFRA-FLS provides fundamental data in the study of fragility fractures. PURPOSE: Fragility fractures are a growing public health concern in modern-aged societies. Fracture Liaison Services (FLS) have been shown to successfully lower rates of secondary fractures. A new registry (REFRA-FLS) has been created to monitor quality indicators of FLS units in Spain and to explore the occurrence and characteristic of fragility fractures identified by these centers. METHODS: We conducted a prospective cohort study based on fragility fractures recorded in the REFRA-FLS registry. Participants were individuals 50 years or above who suffered a low energy fragility fracture identified by the 10 participating FLS units during the study period. The type of FLS unit, the characteristics of the individuals at baseline, along with patient outcomes as quality indicators among those who completed 1 year of follow-up were analyzed. RESULTS: A total of 2965 patients and 3067 fragility fractures were identified, and the most frequent locations were hip (n = 1709, 55.7%) and spine (n = 492, 16.0%). A total of 43 refractures (4.5%) and 46 deaths (4.9%) were observed among 948 individuals in the follow-up analyses. Time from fracture to evaluation was less than 3 months in 76.7% of individuals. Osteoporosis treatment was prescribed in 87.7%, and adherence was 65.3% in Morisky-Green test. CONCLUSION: Our results provide a comprehensive picture of fragility fractures identified in FLS units from Spain. Overall, quality indicators are satisfactory although a much higher use of DXA would be desirable. As the registry grows with the incorporation of new FLS units and longer follow-up, incoming analyses will provide valuable insight.

Importancia de la temperatura del quirófano de cirugía ortopédica y traumatología / Importance of temperature in the orthopedic operating room

La infección en la cirugía ortopédica y la trau-matología puede ser catastrófica, entre los facto-res implicados está la temperatura. Trabajar en un rango térmico óptimo es indispensable para el control de las infecciones asociadas a la asisten-cia sanitaria, el mantenimiento de las funciones vitales del paciente y la realización de un trabajo seguro y eficiente. La temperatura de los quirófanos de COT debe oscilar de los 18°C a los 24°C para reducir el riesgo de infecciones nosocomiales y, a la par, proporcionar confort al cirujano ortopédico en su trabajo, aunque ello suponga que el resto de pro-fesionales deban abrigarse. (AU)

Infection in orthopedic surgery and traumato-logy can be catastrophic, among the factors invol-ved is temperature. Working in an optimal thermal range is essential for the control of healthcare-as-sociated infections, the maintenance of vital pa-tient functions, and the performance of safe and efficient work. The temperature in the operating room of a COT should range from 18°C to 24°C to reduce the risk of nosocomial infections and, at the same time, provide comfort to the orthopedic surgeon in his work, even if this means that the other profes-sionals must wrap up warm. (AU)

Estudio epidemiológico de la fibrosis glútea en el área sanitaria norte de la provincia de Córdoba / Epidemiological study of gluteal fibrosis in the northern health area of the province of Córdoba

La fibrosis glútea es un cuadro clínico de fácil diagnóstico y de origen primario caracterizado por una limitación progresiva de los movimientos de rotación interna, flexión y abducción y/o adducción de la cadera, debida a una pérdida de la capacidad elástica muscular por una infiltración fibrosa y una atrofia de las fibras tipo 1 con hipertrofia de las 2B del músculo glúteo mayor, que puede o no acompañarse de la afectación de otros músculos. Esta facilidad diagnóstica nos lleva a plantear como objetivo establecer la prevalencia de la fibrosis glútea en la comunidad del Área Sanitaria Norte de Córdoba (ASNC) y establecer un procedimiento que permita detectar la fibrosis glútea y otros procesos musculares por profesionales de la docencia no ligados a la sanidad. Se aplicó por parte de los profesores un test de ejercicios específicos a 480 jóvenes de ambos sexos y edades comprendidas entre los 14 y los 17 años. Aquellos que no los superaron fueron estudiados por el equipo médico de nuestro hospital encontrando que la prevalencia hallada de la fibrosis glútea ha sido de 1,04% en nuestra comarca. Ninguno de los pacientes afectos de fibrosis glútea había sido diagnosticado previamente lo que prueba la eficacia del protocolo diseñado para detectar patologías musculares retráctiles de pelvis y miembros inferiores.(AU)

Gluteal fibrosis is a clinical disorder easy to diagnose, of primary origin characterized by a progressive limitation of the movements of internal rotation, flexion and abduction and/or adduction of the hip, due to a loss of muscle elastic capacity by fibrous infiltration and atrophy of the type 1 fibers with hypertrophy of the 2B fibers of the gluteus maximus muscle, which may or may not be accompanied by involvement of other muscles. This diagnostic facility leads us to propose as an objective to establish the prevalence of gluteal fibrosis in the community of the Northern Health Area of Córdoba (ASNC) and to establish a procedure that allows the detection of gluteal fibrosis and other muscular processes by teaching professionals not linked to health care. A test of specific exercises was applied by teachers to 480 young people of both sexes aged between 14 and 17 years. Those who did not pass the test were studied by the medical team of our hospital and found that the prevalence of gluteal fibrosis was 1.04% in our region. None of the patients affected by gluteal fibrosis had been previously diagnosed, which proves the efficacy of the protocol designed to detect retractile muscle pathologies of the pelvis and lower limbs.(AU)

COVID-19 y fractura por fragilidad de la cadera. Recomendaciones conjuntas de la Sociedad Española de Fracturas Osteoporóticas y la Sociedad Española de Geriatría y Gerontología / COVID-19 and fragility hip fracture. Joint recommendations of the Spanish Society of Osteoporotic Fractures and the Spanish Society of Geriatrics and Gerontology

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Eficacia clínica y coste efectividad de las plantillas ortopédicas / Clinical Efficacy and Cost-Effectiveness of foot orthoses. Critical overview of systematic reviews

INTRODUCCIÓN: La demanda mundial de plantillas ha aumentado dramáticamente en los últimos años, pero, ¿realmente son efectivas las plantillas en todas las indicaciones en que se prescriben?, ¿todas las plantillas son coste efectivas?. MÉTODO: Metarevisión basada en una búsqueda bibliográfica exhaustiva de estudios con un nivel 1 de evidencia y un grado A de recomendación. Se buscó en la base de datos electrónicas Medline, Pubmed, Cochrane y Agencia de Evaluación de Tecnologías Sanitarias. RESULTADOS: El uso terapéutico de plantillas no es costo efectivo en una gran parte de los procesos nosológicos en los que se continúan indicando en la actualidad. Las plantillas personalizadas o hechas a medida han demostrado mayor eficacia funcional que las plantillas prefabricadas. Salvo en contadas ocasiones no hay diferencias de rentabilidad entre las plantillas prefabricadas y las personalizadas

INTRODUCTION: The global demands for foot orthoses has increased dramatically in recent years, but are insoles really effective in all indications that they are prescribed? Are all insoles cost effective?. METHOD: Meta-review based on a comprehensive bibliographic of studies with a level 1 evidence and a grade A recommendation. The search was carried using the electronic database Medline, Pubmed, Cochrane and the Health Technology Assessment Agency. CONCLUSIONS: The therapeutic use of insoles is not cost effective in many of the nosological processes in which they continue to be prescribed. Custom or custom-made foot orthoses have been more functional than prefabricated insoles. Except on rare occasions, there are no cost-effectiveness differences between pre-made and custom insoles

Resultados de la técnica de reconstrucción con injerto tendinoso y plastia espiral modificada para el tratamiento de la lesión de Stener crónica / Results of the reconstruction technique with tendinous graft and modified spiral plastia for the treatment of chronic Stener lesión

OBJETIVOS: Evaluar los resultados postoperatorios en pacientes intervenidos con la técnica de reconstrucción del ligamento colateral cubital (LCC) de la metacarpofalángica (MCF) del pulgar con injerto tendinoso en pacientes con lesión crónica del mismo. MATERIAL Y MÉTODO: Estudio longitudinal retrospectivo donde se han revisado 13 pacientes operados con una técnica de reconstrucción con injerto tendinoso. Se evaluaron variables demográficas generales y variables subjetivas y objetivas. RESULTADOS: El 54% de los pacientes fueron varones, con una media de 45 años. El injerto tendinoso utilizado fue el palmaris longus (PL) en 10 casos. El tiempo medio transcurrido desde la lesión hasta la intervención fue de 24 semanas y el seguimiento postoperatorio de 35 semanas. Todos los pacientes lograron una articulación estable. El DASH, la fuerza de pinza frontal, lateral, de puño y la movilidad también mejoraron. Se obtuvieron complicaciones menores, principalmente algún grado de rigidez de la MCF. Un 15% de los pacientes fueron reintervenidos para lograr una mejoría de la movilidad articular. CONCLUSIONES: La técnica utilizada creó una articulación estable en todos los pacientes y proporcionó buenos resultados a medio plazo en cuanto a DASH, dolor, fuerza y movilidad

OBJECTIVES: To evaluate the postoperative results in patients operated with the technique of reconstruction of the ulnar collateral ligament of the thumb metacarpophalangeal joint with tendon graft in patients with a chronic lesion. METHOD: Retrospective longitudinal study where 13 patients operated with a tendon graft reconstruction technique have been reviewed. General demographic variables and subjective and objective variables were evaluated RESULTS: 54% of the patients were male, with an average of 45 years. The tendon graft used was palmaris longus in 10 cases. The average time elapsed from the injury to the procedure was 24 weeks and the average postoperative follow-up time was 35 weeks. All patients achieved a stable joint. DASH, frontal and lateral pinch strength, grip strenght and motion also improved. Minor complications were obtained, mainly some degree of metacarpophalangeal stiffness.15% of patients were reoperated to achieve an improvement in joint mobility. CONCLUSIONS: This technique produced a stable joint in all patients and provided good results in the medium term regarding DASH, pain, strength and motion

Registro Andaluz de Artroplastias / Andalusian arthroplasty registry

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Burden of First Osteoporotic Hip Fracture in Spain: A Prospective, 12-Month, Observational Study.

The purpose of this study was to estimate the burden of osteoporotic fractures beyond the hospitalization period covering up to the first year after the fracture. This was a prospective, 12-month, observational study including patients aged ≥65 years hospitalized due to a first low-trauma hip fracture, in six Spanish regions. Health resource utilization (HRU), quality of life (QoL) and autonomy were collected and total costs calculated. Four hundred and eighty seven patients (mean ± SD age 83 ± 7 years, 77 % women) were included. Twenty-two percent of patients reported a prior non-hip low-trauma fracture, 16 % were receiving osteoporotic treatment at baseline, and 3 % had densitometry performed (1.8 % T-score ≤-2.5). Sixteen percent of patients died (women 14 %; men 25 %; p = 0.0011) during the first year. Mean hospital stay was 11.8 ± 7.9 days and 95.1 % of patients underwent surgery. Other relevant HRUs were: outpatient visits in 78 % of patients (mean 9.2 ± 9.7); walking aids, 58.7 %; rehabilitation facilities, 35.5 % (28.7 ± 41.2 sessions); and formal and informal home care, 22.2 % (49.6 ± 72.2 days) and 53.4 % (77.1 ± 101.0 h), respectively. Mean direct cost was €9690 (95 % confidence interval: 9184-10,197) in women and €9019 (8079-9958) in men. Main cost drivers were: first hospitalization episode (women €7067 [73 %]; men €7196 [80 %]); outpatient visits (€1323 [14 %]; €997 [11 %]); and home care (€905 [9 %]; €767 [9 %]). QoL and autonomy showed a marked decrease during hospitalization, not entirely recovered at 12 months (p < 0.05 vs. baseline for EQ-5D, Harris hip score and modified Barthel index). In a Spanish setting, osteoporotic hip fractures incur a high societal and economic cost, mainly due to the first hospitalization HRU, but also due to subsequent outpatient visits and home care.

Resolución del conflicto intimidad de los pacientes y formación de médicos y especialistas / No disponible

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Tratamiento farmacológico para la Osteoporosis y su influencia en el proceso de consolidación de las fracturas / Pharmacologic treatment for osteoporosis and its influence on fracture healing

Las fracturas por fragilidad o secundarias a la osteoporosis se pueden considerar como un importante problema de Salud Pública por las consecuencias en términos de mortalidad y morbilidad que generan. Y las previsiones para el futuro, teniendo en cuenta el progresivo envejecimiento de la población y el aumento de la esperanza de vida, no son nada optimistas. Suponen y supondrán un importante consumo de recursos. Una de las estrategias que ha demostrado eficacia para su prevención, es el tratamiento farmacológico. Pero este tratamiento puede afectar de una manera u otra al proceso de consolidación, uno de los objetivos primarios fundamentales en su manejo. En este trabajo de revisión queremos establecer, en base a la evidencia actual, cómo afectan todos y cada uno de los fármacos indicados para el tratamiento de la osteoporosis al proceso de consolidación de las fracturas por fragilidad, una cuestión que genera dudas e incertidumbres en el traumatólogo, cuya responsabilidad y papel en el escenario de la prevención, es fundamental

Osteoporotic fragility fractures can be seen as a major public health problem because their consequences in terms of mortality and morbidity. Taking into account the progressive ageing of the population and the increase in life expectancy, the expectative in the next future are not optimistic. They are and will be an important focus of health resources consumption. One of the strategies that have proven be effective for fracture prevention, is the antiosteoporotic pharmacological treatment. This type of treatments can affect bone healing process in one way or another. In this review, based on the current scientific evidence, we want to establish how each one of the drugs prescribed for the osteoporosis treatment affects the bone healing process of fragility fractures, an issue that generates doubts and uncertainties in the orthopaedic surgeon, whom responsibility and role in fracture prevention is essential

Revisión del tratamiento del pie plano adquirido del adulto en el estadio II / Treatment of adult acquired flatfoot stage II: a literature review

El pie plano adquirido del adulto es una patología compleja resultado de la insuficiencia del tendón tibial posterior y del fallo de las estructuras capsulares y ligamentosas del pié. En el estadio II existe una gran controversia respecto al tratamiento a elegir. Se ha realizado una revisión bibliográfica narrativa mediante el motor de búsqueda de Pubmed. La búsqueda se ha acotado a las publicaciones realizadas durante los últimos cinco años. Se han seleccionado 30 artículos que incluyen el pie plano adquirido en su conjunto y el estadio II. Los autores coinciden que el tratamiento conservador debe ser siempre la primera opción. En caso de cirugía debemos de valorar de manera independiente la corrección del valgo del retropié, siendo la osteotomía de medialización de calcáneo el tratamiento más extendido; el alargamiento de la columna externa; la inestabilidad de la columna medial; la supinación del antepié; y la presencia de equinismo. Cada paciente presenta una deformidad característica por lo que el tratamiento debe ser individualizado

Adult acquired flatfoot deformity is a complex pathology consisting both of posterior tibial tendon insufficiency and failure of the capsular and ligamentous structures of the foot. In stage II there is much controversy when it comes to treatment. We performed a narrative literature review using the PubMed search engine. The search was limited to publications over the past five years. We have selected 30 articles including acquired flatfoot a whole and stage II. The authors agree that conservative treatment should always be the first choice. When we decide surgical treatment independently assess the correction of the hindfoot valgus, medializing calcaneal osteotomy is the most accepted treatment; lengthening the lateral column; the instability of the medial column; supination of the forefoot; and the presence of equinus. Each patient has a characteristic deformity so the treatment must be individualized

En 2010, la Consejería de Salud de Andalucía... [editorial] / No disponible

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Renovación de la revista: adaptándonos al siglo XXI / Renovation of the journal: Adapting to the XXI century

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Evaluation of the treatment of hallux rigidus by percutaneous surgery.

This longitudinal prospective study of 22 patients (26 feet) aimed to evaluate the effectiveness of percutaneous surgery in the treatment of hallux rigidus, and to assess patient satisfaction with the result of this surgical approach. Pain levels (VAS), quality of life (SF-12) and clinical stage (AOFAS) were scored prior to surgery and 18 months after surgery. Pain relief was noted in all cases, with mean pain scores falling from 7.44 before surgery to 1.69. Perception of quality of life also improved, while AOFAS scores rose from 58.45 to 92.36. These results suggest that percutaneous treatment of hallux rigidus, consisting in capsular release, resection of bony spurs and dorsal wedge osteotomy of the first metatarsophalangeal joint, is effective in terms of both clinical outcome and patient satisfaction, as the scores for both measures were noted to be higher than reported using conventional techniques.

Predictors for blood transfusion following total knee arthroplasty: a prospective randomised study.

A prospective randomised study was conducted on 121 patients undergoing total knee arthroplasty, to identify factors predicting the need for postoperative transfusion. Patients were additionally distributed into two groups, one of which received local adrenaline into the surgical field before wound closure, while the other served as control. A statistically significant correlation was noted between preoperative haemoglobin level, haematocrit and erythrocyte count and the need for transfusion; haemoglobin level emerged as the main predictor. No correlation was observed with patients' age, sex, body mass index, blood pressure or number of comorbidities. Local administration of adrenaline into the surgical field did not result in any reduction in blood loss, nor did it modify transfusion requirements.

Lesiones del tendón de Aquiles en corredores de larga distancia / Achilles tendon injuries in long distance runners

Las lesiones del tendón de Aquiles son muy frecuentes entre los deportistas, sobre todo en los corredores de larga distancia. Los autores realizaron un estudio a 23 pacientes, hombres y mujeres, en edades comprendidas entre 25 y 45 años, que habían sufrido este tipo de lesión y que de forma habitual practicaban la carrera de fondo. Exponen su criterio en cuanto al motivo de su frecuencia, los factores predisponentes, cómo pueden prevenirse o disminuir su incidencia, principalmente con la colaboración estrecha entre el personal de salud y los entrenadores(AU)