Anterior approach for pediatric supracondylar humerus fractures: A systematic review. / [Artículo traducido] Abordaje anterior para fracturas supracondíleas de húmero pediátrica: revisión sistemática.

BACKGROUND AND PURPOSE: Open reduction is rarely performed in pediatric supracondylar humerus fractures. However, clear evidence is lacking regarding the optimal open approach to achieve satisfactory results. The anterior approach provides direct visualization of the fracture and excellent exposure to neurovascular structures, although its utilization is less common. The objective of this study was to review the indications, outcomes, and complications associated with the anterior approach for open reduction of these fractures. METHODS: Our protocol was registered at PROSPERO: CRD42023446923. MEDLINE/PubMed, Embase, Web of Science, Clinicaltrials.gov, and Cochrane Library were searched from database inception to search date (December 2023) and screened in duplicate for relevant studies. Data were collected regarding patient demographics, indications for open reduction, Flynn's functional and cosmetic outcomes, and complications. Study quality was assessed using the Methodological Index for Non-Randomized Studies Criteria. RESULTS: A total of 19 studies involving 483 patients were included. One study was classified as Level 2 evidence, ten as Level 3, and eight as Level 4. The mean MINORS score was 13.05±3.47. The primary indication for open reduction was failed closed reduction, observed in 46% of patients. 97.7% and 98.6% of patients achieved Flynn's functional and cosmetic satisfactory results, respectively. The postsurgical neurovascular injury rate was 1.4%. One patient required reintervention. CONCLUSION: The anterior approach is safe and effective for managing pediatric supracondylar humerus fractures requiring open reduction. LEVEL OF EVIDENCE: Systematic review of Level 2-4 evidence studies.

Anterior approach for pediatric supracondylar humerus fractures: A systematic review.

BACKGROUND AND PURPOSE: Open reduction is rarely performed in pediatric supracondylar humerus fractures. However, clear evidence is lacking regarding the optimal open approach to achieve satisfactory results. The anterior approach provides direct visualization of the fracture and excellent exposure to neurovascular structures, although its utilization is less common. The objective of this study was to review the indications, outcomes, and complications associated with the anterior approach for open reduction of these fractures. METHODS: Our protocol was registered at PROSPERO: CRD42023446923. MEDLINE/PubMed, Embase, Web of Science, Clinicaltrials.gov, and Cochrane Library were searched from database inception to search date (December 2023) and screened in duplicate for relevant studies. Data were collected regarding patient demographics, indications for open reduction, Flynn's functional and cosmetic outcomes, and complications. Study quality was assessed using the Methodological Index for Non-Randomized Studies Criteria. RESULTS: A total of 19 studies involving 483 patients were included. One study was classified as Level 2 evidence, ten as Level 3, and eight as Level 4. The mean MINORS score was 13.05±3.47. The primary indication for open reduction was failed closed reduction, observed in 46% of patients. 97.7% and 98.6% of patients achieved Flynn's functional and cosmetic satisfactory results, respectively. The postsurgical neurovascular injury rate was 1.4%. One patient required reintervention. CONCLUSION: The anterior approach is safe and effective for managing pediatric supracondylar humerus fractures requiring open reduction. LEVEL OF EVIDENCE: Systematic review of Level 2-4 evidence studies.

Angle Evaluation of Possible Routes that Can Be Used to Reach the Foramen Ovale in the Anterior Approach / Evaluación Angular de Posibles Rutas que se Pueden Utilizar para Alcanzar el Foramen Oval en el Abordaje Anterior

SUMMARY: For the treatment of trigeminal neuralgia, the foramen ovale is reached by entering the cheek with a needle. Thermocoagulation is performed with balloon compression, administration of alcohol or radiofrequency. Apart from the classical method, it is theoretically possible to reach the foramen ovale through the mouth with the anterior approach. In our study, it was aimed to examine horizontally and vertically the angular values that must be given to the needle to reach the foramen ovale in the anterior approach. Three landmark points were determined on both right and left sides of 25 dry skulls. A rod was inserted starting from these landmark points and passing through the center of the foramen ovale. The vertical and horizontal angular values of this bar were measured. For each foramen ovale, 3 vertical angles, 3 horizontal angles and 4 distance measurements were made. There was a significant difference between the right and left sides in terms of horizontal angular values. Average values of horizontal angles (in degrees); on the right, 7.29 for H1, 12.15 for H2, 32.29 for H3; 1.26 for H1, 9.46 for H2, and 30.56 for H3 on the left side (p<0.005). The angle value was measured as 0 or negative value in 5 (20 %) of the H1 angle measurements made on the right side and 14 (56 %) on the left side. The H2 angle value was found to be smaller than the H1 angle in the skull 2 (8 %) on the right and 3 (12 %) on the left. There was no difference between the right and left sides in terms of vertical angular values. A significant difference was found between the right and left sides in the D1, D2, D4 distances (p<0.005). Six important anatomical features affecting angular values were encountered.

Para el tratamiento de la neuralgia del trigémino, se alcanza el foramen oval introduciendo una aguja en la mejilla. La termocoagulación se realiza con compresión con balón, administración de alcohol o radiofrecuencia. Aparte del método clásico, en teoría es posible alcanzar el foramen oval a través de la cavidad oral mediante el abordaje anterior. En nuestro estudio se tuvo como objetivo examinar horizontal y verticalmente los valores angulares que se deben dar a la aguja para alcanzar el foramen oval en el abordaje anterior. Se determinaron tres puntos de referencia en los lados derecho e izquierdo de 25 cráneos secos. Se insertó una varilla comenzando desde estos puntos de referencia y pasando por el centro del foramen oval. Se midieron los valores angulares verticales y horizontales de esta barra. Para cada foramen oval se realizaron mediciones de 3 ángulos verticales, 3 ángulos horizontales y 4 distancias. Hubo una diferencia significativa entre los lados derecho e izquierdo en términos de valores angulares horizontales. Valores medios de ángulos horizontales (en grados); a la derecha, 7,29 para H1, 12,15 para H2, 32,29 para H3; 1,26 para H1, 9,46 para H2 y 30,56 para H3 en el lado izquierdo (p<0,005). El valor del ángulo se midió como 0 o valor negativo en 5 (20 %) de las mediciones del ángulo H1 realizadas en el lado derecho y 14 (56 %) en el lado izquierdo. Se encontró que el valor del ángulo H2 era menor que el ángulo H1 en el cráneo 2 (8 %) a la derecha y 3 (12 %) a la izquierda. No hubo diferencia entre los lados derecho e izquierdo en términos de valores angulares verticales. Se encontró diferencia significativa entre el lado derecho e izquierdo en las distancias D1, D2, D4 (p<0,005). Se encontraron seis características anatómicas importantes que afectan los valores angulares.

Comparison of early complications for primary total hip arthroplasty using modified direct anterior approach and lateral approach.

BACKGROUND: Total hip arthroplasty is a surgical procedure with reliable results, regardless of the approach used. The anterior approach has advantages by respecting muscle insertions, reflected in the lower number of complications and shorter recovery time compared to other approaches. OBJECTIVE: The goal of the study was to assess the progression of 150 total hip arthroplasty procedures in the first 90 postoperative days. 75 patients underwent a modified direct anterior approach (MDAA) using a minimally invasive technique with a special table, and 75 patients underwent a direct lateral approach (DLA). METHODS: An observational retrospective study was conducted, including 150 arthroplasties, performed by the same surgeon, using two surgical approaches. 75 cases with direct lateral approach (DLA) and 75 cases with modified direct anterior approach (MDAA), between January 2007 and December 2020. Baseline characteristics, surgical variables, and postoperative complications were compared between the two groups. RESULTS: At 90 days, both groups presented a similar percentage of minor complications (32% vs. 42%), however, there was a higher number of major complications due to DLA (40% vs. 12% p < 0.0001) overall, where motor neurological complications have a higher incidence (14 [18.6%]). No differences were found in terms of the Harris functional scale. CONCLUSION: MDAA is a safe and reliable technique with satisfactory results. It presents predictable early complications, such as other approaches. Although it allows a faster recovery, at 90 days, the evolution and satisfaction are similar between both approaches with excellent and good outcomes in > 90% of cases.

ANTECEDENTES: La artroplastia total de cadera es un procedimiento quirúrgico con buenos resultados, independientemente del abordaje empleado. El abordaje anterior presenta ventajas al respetar las inserciones musculares, lo que se refleja en un menor número de complicaciones y menos tiempo de recuperación en comparación con otros abordajes. OBJETIVO: El objetivo del estudio fue valorar la evolución de 150 reemplazos totales de cadera en los primeros 90 días comparando 75 pacientes operados por abordaje anterior directo y 75 pacientes operados por abordaje lateral. MÉTODO: Se realizó un estudio retrospectivo observacional, incluyendo 150 artroplastias realizadas entre enero de 2007 y diciembre de 2020 por el mismo cirujano empleando dos abordajes quirúrgicos: 75 casos con abordaje lateral directo y 75 casos con abordaje anterior directo modificado. Se compararon las características basales, las variables quirúrgicas y las complicaciones posoperatorias entre ambos grupos. RESULTADOS: A 90 días, ambos grupos presentaron un porcentaje similar de complicaciones menores (32 vs. 42%); sin embargo, hubo un mayor número de complicaciones mayores con el abordaje lateral directo (40 vs. 12%; p < 0.0001) de forma global, siendo las complicaciones neurológicas motoras las que presentaron mayor incidencia (14; 18.6%). No se encontraron diferencias en cuanto a la escala funcional de Harris. CONCLUSIONES: El abordaje anterior directo modificado es una técnica segura y confiable, con resultados satisfactorios. Presenta complicaciones tempranas predecibles y similares a las de otros abordajes. Aunque permite una más rápida recuperación, a 90 días la evolución y la satisfacción son similares para ambos abordajes, con desenlaces excelentes y buenos en más del 90% de los casos.

Artroplastia total de cadera por abordaje anterior directo (Hueter)

Introducción: La artroplastia de cadera se considera un tratamiento exitoso en ortopedia. El abordaje anterior directo, a través del intervalo de Hueter, evita la disección de inserciones musculares del hueso y disminuye la alteración de los tejidos blandos alrededor de la cadera. Objetivos: Presentar los resultados de artroplastias totales de cadera primarias, realizadas por abordaje anterior directo. Métodos: Se realizó un estudio descriptivo-prospectivo, tipo serie de casos, con pacientes intervenidos por artroplastia total de cadera primaria no cementada a través de abordaje anterior directo. Resultados: Predominaron el sexo femenino y los grupos etarios de 45 y 60 años. El índice de masa corporal resultó bajo y hubo escaso riesgo anestésico. El tiempo quirúrgico superó las dos horas, con escaso sangrado operatorio. La correcta colocación del componente acetabular y el femoral permitió que la deambulación iniciara en menos de tres días. Las complicaciones fueron escasas y se resolvieron con el tratamiento adecuado. Conclusiones: El empleo de abordaje anterior directo para artroplastias totales de cadera primarias ofrece resultados muy satisfactorios.

Introduction: Hip arthroplasty is considered a successful treatment in Orthopedics. The direct anterior approach, through Hueter interval, avoids the dissection of muscular attachments to the bone and decreases the alteration of the soft tissues around the hip. Objectives: To report the results of primary total hip arthroplasties, performed by direct anterior approach. Methods: A descriptive-prospective case series study was carried out with patients who underwent primary uncemented total hip arthroplasty through a direct anterior approach. Results: The female sex and the age groups of 45 and 60 years predominated. The body mass index was low and there was little anesthetic risk. Surgical time exceeded two hours, with little operative bleeding. The correct placement of the acetabular and femoral components allowed ambulation to begin in less than three days. Complications were rare and resolved with appropriate treatment. Conclusions: The use of the direct anterior approach for primary total hip arthroplasties offers very satisfactory results.

Artroplastia total de cadera en dos instituciones ortopédicas de Cuba

Introducción: La artroplastia total de cadera se considera un procedimiento seguro y eficaz que alivia el dolor, y mejora la salud física y la calidad de vida en los pacientes. Objetivos: Caracterizar la artroplastia total de cadera en pacientes intervenidos en el Hospital Ortopédico Docente "Fructuoso Rodríguez" y el Complejo Científico Ortopédico "Frank País". Métodos: Estudio descriptivo retrospectivo de pacientes intervenidos con artroplastia total de cadera en el Hospital Ortopédico Docente "Fructuoso Rodríguez" y el Complejo Científico Ortopédico "Frank País", entre septiembre de 2019 y marzo de 2021. Resultados: Predominaron el sexo femenino y las edades entre 60 y 62 años, con lateralidad izquierda. El principal diagnóstico preoperatorio resultó la coxartrosis. El tamaño de la copa acetabular y la cabeza del componente femoral fueron similares. La prótesis acetabular se fijó por presión. Conclusiones: Se encontraron grandes semejanzas en cuanto a la edad, el sexo, la lateralidad, el tamaño de los componentes acetabular y cabeza femoral, el tipo de fijación del componente acetabular y la cantidad de tornillos empleados. En el diagnóstico preoperatorio prevaleció la artrosis de cadera.

Introduction: Total hip arthroplasty is considered a safe and effective procedure that relieves pain and improves physical health and quality of life in patients. Objectives: To characterize the patients who underwent total hip arthroplasty at Fructuoso Rodríguez Teaching Orthopedic Hospital and Frank País Orthopedic Scientific Complex. Methods: A retrospective descriptive study was conducted with patients who underwent total hip arthroplasty at Fructuoso Rodríguez Teaching Orthopedic Hospital and Frank País Orthopedic Scientific Complex, from September 2019 to March 2021. Results: The female sex and the ages between 60 and 62 years predominated, with left laterality. The main preoperative diagnosis was coxarthrosis. The size of the acetabular cup and the head of the femoral component were similar. The acetabular prosthesis was fixed by pressure. Conclusions: Great similarities were found in terms of age, sex, laterality, the size of the acetabular components and femoral head, the type of fixation of the acetabular component and the number of screws used. Osteoarthritis of the hip prevailed In the preoperative diagnosis.

Abordaje anterior de la cadera: historia y beneficios / Anterior Approach to the Hip: History and Benefits

La artroplastia de cadera es uno de los tratamientos quirúrgicos más exitosos en la cirugía ortopédica. Actualmente existe un mayor interés en el abordaje anterior para artroplastias de cadera determinado por la creencia de que al ser intermuscular puede provocar una disminución del dolor, una recuperación más rápida, mejor estabilidad de la cadera y menor riesgo de luxación después de la cirugía comparativamente. Es propósito de este artículo revisar la historia del abordaje anterior de la articulación de la cadera, su vía intermuscular de acceso y los principales beneficios que posee. Popularizado por Smith-Petersen en 1917, el abordaje anterior de la cadera debe su primera referencia escrita a Carl Hueter. Todos los abordajes de la cadera han demostrado ser seguros y eficaces, con ventajas y desventajas. Se requieren estudios a largo plazo de un mayor número de pacientes para demostrar un beneficio de costo y una mayor calidad en la atención médica(AU)

Hip replacement is one of the most successful surgical treatments in orthopedic surgery. There is currently greater interest in the anterior approach to hip arthroplasties determined by the belief that being intramuscular it can lead to less pain, faster recovery, better hip stability and comparatively less risk of dislocation after surgery. The purpose of this article is to review the history of the anterior approach to the hip joint, its intramuscular access route and its main benefits. Popularized by Smith-Petersen in 1917, the anterior approach to the hip owes its first written reference to Carl Hueter. All hip approaches have been shown to be safe and effective, with advantages and disadvantages. Long-term studies of larger numbers of patients are required to demonstrate cost benefit and higher quality of medical care(AU)

Comparación de resultados entre el abordaje anterior y posterior en la artroplastia total de cadera / Comparing Results between the Anterior and Posterior Approach in Total Hip Arthroplasty

Introducción: Existe una gran controversia con respecto a la existencia de un abordaje quirúrgico óptimo para artroplastia de cadera. El énfasis actual en la investigación ha sido examinar las posibles diferencias en los resultados funcionales entre el abordaje anterior y el abordaje posterior. Objetivo: Comparar las medidas de resultado informadas por los pacientes sometidos a artroplastia total de cadera, mediante abordajes anterior y posterior. Métodos: Se realiza una búsqueda sobre el tema en la base de datos PubMed entre los años 2010-2020 en inglés con los términos: comparación entre abordaje anterior y abordaje posterior de la cadera, abordaje anterior directo de la cadera, abordaje posterior de la cadera, y resultados de artroplastia de la cadera mediante abordajes anterior y posterior. Análisis y síntesis de la información: El abordaje anterior muestra una mayor mejora en la velocidad de la marcha, la longitud del paso y la simetría de la marcha, en comparación con el abordaje posterior para artroplastia de cadera al mes después de la operación. A los cuatro meses estas características de la marcha no fueron diferentes, pero los resultados de algunas pruebas funcionales fueron superiores en los pacientes intervenidos por abordaje anterior. Conclusiones: La elección del abordaje quirúrgico para artroplastia de cadera debe basarse en los factores del paciente, la preferencia del cirujano y su experiencia(AU)

Introduction: There is great controversy regarding the existence of an optimal surgical approach for hip arthroplasty. The current research emphasis has been to examine the possible differences in functional outcomes between anterior and posterior approaches. Objective: To compare the outcome measures reported by patients undergoing total hip arthroplasty, using anterior and posterior approaches. Methods: A search is carried out on the subject in the PubMed database during the years 2010-2020, in English, with the terms comparison between anterior approach and posterior approach to the hip, direct anterior approach to the hip, posterior approach to the hip, and results of hip arthroplasty using anterior and posterior approaches. Analysis and synthesis of the information: The anterior approach showed greater improvement in gait speed, stride length and gait symmetry, compared to the posterior approach for hip arthroplasty one month after the operation. At four months, these gait characteristics were not different, but the results of some functional tests were superior in patients operated on by anterior approach. Conclusions: The choice of the surgical approach for hip arthroplasty should be based on the patient´s factors, preference of the surgeons and their experience(AU)

Rotura simultánea del tendón del bíceps distal con gran retracción y del tendón de la porción larga del bíceps: revisión a propósito de un caso / Simultaneous tear of the biceps tendon distal with great retraction and tendon of the long head of the biceps: a case report

Objetivo: En el presente artículo, presentamos nuestra experiencia ante un caso clínico consistente en una rotura simultánea del tendón distal del bíceps, con gran retracción, y del tendón de la porción larga del bíceps. Material y método: Se realizó tratamiento quirúrgico para la rotura aguda del tendón del bíceps distal, haciendo un doble abordaje anterior, debido a la gran retracción que presentaba, y reinsertándolo de forma anatómica mediante un botón de fijación cortical y un tornillo interferencial. Resultados: Se obtuvo un buen resultado, con buen rango articular y sin dolor, observándose posteriormente, un bultoma en zona adyacente a pliegue flexor del codo, siendo diagnosticado mediante RM de rotura del tendón de la porción larga del bíceps, optando en este caso por un manejo conservador. Conclusión: En casos de gran retracción, tras roturas agudas del tendón del bíceps distal, un doble abordaje anterior, puede ser una buena solución para localizarlo. Además, a este caso se le añade la particularidad de una rotura, en principio, concomitante de la porción larga del bíceps.(AU)

Objective: In this article, we present our experience of a clinical case, which consists on a rupture of the distal biceps tendon with a great retraction, besides a concomitant tear of the tendon of the long head of the biceps. Material and methodsSurgical treatment was performed for the acute rupture of the distal biceps tendon. We did a double anterior approach, due to the huge retrac-tion that the tendon presented, and we reinserted it anatomically, with a cortical fixation button and an interference screw. Results: A good result was obtained, with good mobility and without pain. In the postoperative follow-up of the patient, we observed a lump in the adjacent area to the flexor fold of the elbow, diagnosing tendon rupture of the long head of the biceps by MR. We decided a conservative management in this case. Conclusions: In acute ruptures of the distal biceps tendon, when is presented a large retraction, a double an-terior approach is useful for finding the end of the torn tendon. This case has the peculiarity of a simultaneus rupture of the long head of the biceps.(AU)

Comparación de cuatro técnicas quirúrgicas para el manejo de la espondilitis tuberculosa de la columna torácica en adultos.

OBJETIVO: Comparar la eficiencia de las cuatro técnicas quirúrgicas más utilizadas para el manejo de la espondilitis tuberculosa. MÉTODO: Estudio retrospectivo en el que se incluyeron pacientes adultos con diagnóstico confirmado de espondilitis tuberculosa, afectación de dos niveles vertebrales o menos y sin deformidad vertebral grave. Se recopilaron y revisaron los expedientes médicos, los estudios de imagen y los datos demográficos de los pacientes intervenidos para analizar retrospectivamente los resultados clínicos y funcionales de cada grupo. Las variables primarias fueron la erradicación de la infección, la fusión vertebral y las complicaciones. Entre las variables secundarias se estudiaron el sangrado intraoperatorio, la estancia hospitalaria y el tiempo quirúrgico. RESULTADOS: Entre los grupos analizados no hubo diferencias significativas (p ≥ 0.05) en la mayoría de las variables analizadas, pero sí (p ≤ 0.001) respecto al sangrado, el tiempo quirúrgico, la estancia intrahospitalaria y las complicaciones, a favor del abordaje posterior único. CONCLUSIONES: El abordaje posterior único logró una eficacia clínica similar a la del resto de los abordajes en términos de erradicación de la infección y fusión vertebral; sin embargo, se asoció a menores tiempo quirúrgico, sangrado, estancia hospitalaria y complicaciones. OBJECTIVE: To compare the efficiency of the 4 most used surgical techniques for the management of tuberculous spondylitis. METHOD: Retrospective study in which adult patients with a confirmed diagnosis of tuberculous spondylitis, involvement of two vertebral levels or less, and without severe vertebral deformity were included. The medical records, imaging studies, and demographic data of the operated patients were collected and reviewed to retrospectively analyze the clinical results of each group. The primary variables were cure of infection, spinal fusion, and complications. The secondary variables included intraoperative bleeding, hospital stay, and surgical time. RESULTS: There were no significant differences (p ≥ 0.05) in most of the variables analyzed, however, there were (p ≤ 0.001) regarding bleeding, surgical time, hospital stay and complications between the groups analyzed, with a lower result in all cases for the single posterior approach. CONCLUSIONS: The single posterior approach obtained a clinical efficacy similar to the rest of the approaches in terms of eradication of the infection and vertebral fusion, however, it was associated with less surgical invasion (surgical time and bleeding), a shorter hospital stay and complications.

Fusión cervical anterior C2-C3 para espondilolistesis traumática del axis grado III / Anterior C2-C3 Cervical Fusion for Traumatic Spondylolisthesis of the Axis Grade III

RESUMEN Se trata de un paciente masculino de 85 años de edad, que sufrió una caída y fue inmovilizado y trasladado al servicio de urgencia; refería dolor cervical y rigidez del cuello. Al examen neurológico no se constata déficit neurológico, salvo la contractura de la musculatura cervical. Se le diagnosticó espondilolistesis traumática del axis grado III confirmada mediante estudios radiográficos. Se le realizó abordaje anterior retrofaríngeo extendido con fijación con láminas y tornillos C2-3. El paciente utilizó ortesis rígida externa durante 4 semanas. Su evolución fue favorable(AU)

ABSTRACT This is an 85-year-old male patient who fell and was immobilized and transferred to the emergency department. He complained of neck pain and neck stiffness. Neurological examination revealed no neurological deficit, except for the contracture of the cervical musculature. Traumatic spondylolisthesis of the axis grade III confirmed by radiographic studies was diagnosed. An extended anterior retropharyngeal approach was performed with fixation with blades and C2-3 screws. The patient wore a rigid external orthosis for 4 weeks. His evolution was favorable(AU)

Retrospective study of 16 acetabular fractures with involvement of the quadrilateral plate treated with an anterior intrapelvic modified Rives-Stoppa approach. / Estudio retrospectivo sobre 16 fracturas de acetábulo con afectación de la lámina cuadrilátera tratadas con un abordaje anterior intrapélvico de Rives-Stoppa modificado.

GOAL: To report our experience with the use of Stoppa approach for fractures of the acetabulum with quadrilateral plate involvement. MATERIAL AND METHOD: Retrospective study; level iv. All patients were operated in a third level trauma center. The surgical team was experienced in the management of pelvic fractures. Data about patients, injuries, treatment features and clinical and radiological results were collected. We performed a statistical analysis; both descriptive and analytical. RESULT: 16 patients integrated the sample. 15 suffered associated fracture patterns. Anatomical plates were used in 15. Four required extended approaches. Reduction was anatomical in 9. 7 suffered some complication, needing the additional surgical procedures in 4. The surgical site infection rate was particularly high, appearing in 3. DISCUSSION: Radiological results were within the previously reported. We had a high complication rate, particularly infection. This outcome may be influenced by the special complexity of our cases and the adaptation process to a new technique. CONCLUSSION: Using the Stoppa approach we achieved lots of good or anatomical reductions. However, is an exigent and not without complications technique.

The limited anterior approach of the elbow for open reduction and internal fixation of capitellum fractures. Surgical technique and clinical experience in 2 cases with more than 2 years follow-up. / Abordaje anterior limitado del codo para la reducción abierta y fijación interna de las fracturas del capitellum. Técnica quirúrgica y experiencia clínica en 2casos con más de 2 años de seguimiento.

OBJECTIVE: Fractures involving the capitellum can be treated surgically by excision of the fragment, or by reduction and internal fixation with screws, with or without heads. The lateral Kocher approach is the most common approach for open reduction. We believe that the limited anterior approach of the elbow, could be a valid technique for treating these fractures, as it does not involve the detachment of any muscle group or ligament, facilitating the recovery process. MATERIAL AND METHOD: A description is presented of the surgical technique, as well as of 2cases with a Bryan-Morrey type 1 fracture (Dubberley type 1A). Two different final quality of life evaluation questionnaires were completed by telephone: the EuroQol Five Dimensions Questionnaire (EQ-5D), and the patient part of the Liverpool Elbow Score (PAQ-LES) questionnaire. RESULTS: The 2patients showed favourable clinical progress at 36 and 24 months, respectively, with an extension/flexion movement arc of -5°/145° and -10°/145°, as well as a pronosupination of 85°/80° and 90°/90°. The 2patients showed radiological consolidation with no signs of osteonecrosis. The EQ-5D score was 0.857 and 0.910 (range: 0.36-1), and a PAQ-SLE of 35 and 35 (range: 17-36), respectively. CONCLUSIONS: We believe that the limited anterior approach of the elbow is a technical option to consider for the open surgical treatment of a capitellum fracture, although further studies are needed to demonstrate its superiority and clinical safety compared to the classical lateral Kocher approach.

[Rationale and complications of the anterior-lateral extrapleural retroperitoneal approach for unstable thoracolumbar fractures: Experience in 86 consecutive patients]. / Fundamentos y complicaciones del abordaje anterolateral extrapleural-retroperitoneal en fracturas inestables toracolumbares: experiencia en 86 pacientes consecutivos.

OBJECTIVES: To describe the rationale, pros and cons, and complications of the anterior-lateral extrapleural retroperitoneal approach for unstable (TLICS>4) thoracolumbar fractures. PATIENTS AND METHODS: Clinical and radiological data and outcomes from a cohort treated surgically via said approach were retrospectively reviewed. All patients were operated on exclusively by 5 neurosurgeons trained in spine surgery. RESULTS: Between June 1999 and December 2015, 86 patients underwent surgery (median age 42years, most common level: L1). Approximately 32.5% presented with a preoperative neurological defect. After surgery (mean duration: 275minutes), 75.6% presented with no neurological sequelae and only one-third required blood transfusion. Median postoperative stay was 7days. Correction of kyphosis was considered adequate and suboptimal but acceptable in 91% and 9% of the patients, respectively. Complications occurred in 36 patients, the majority being transient. We observed failure of the construct in 2 cases (collapse of an expandable cage and extrusion of a locking screw). No infections, vascular or visceral lesions, permanent neurological worsening or mortality occurred during hospitalisation. One patient ultimately needed additional posterior fixation due to persistence of pain. Median follow-up was 252days (27.9% was lost to follow-up). CONCLUSIONS: The extrapleural extraperitoneal approach provides solid anterior reconstruction, allows wide decompression of the spinal canal, and permits adequate and long-lasting correction of kyphosis. The rates of infection, construct failure, need for reoperation and vascular or visceral lesions are minimal.

Quiste aracnoidal cervical anterior en edad pediátrica / Anterior cervical arachnoid cyst in pediatric age

Los quistes aracnoidales espinales son lesiones poco comunes en la población pediátrica. La mayor parte de ellos, se ubican en los segmentos dorsales y la posición anterior respecto a la médula es rara en todos los casos. Si bien su patogenia no está aclarada, se han asociado a defectos del tubo neural y traumas previos. Clínicamente, pueden presentarse con síndrome medular que en ocasiones pueden empeorar con cambios posturales. El tratamiento, puede ser conservador o quirúrgico, el que está indicado en presencia de síntomas neurológicos secundarios a compresión medular, siendo el abordaje posterior el más frecuentemente utilizado. El propósito de la cirugía es la resección total o en su defecto, la fenestración del quiste para comunicarlo al espacio subaracnoídeo. Una potencial complicación de la vía posterior, es la herniación medular durante la durotomía, secundaria al efecto compresivo del quiste, la cual podría aumentar la morbilidad neurológica en el período postoperatorio. Se presentan 2 casos consecutivos en edad pediátrica con quistes intradurales espinales anteriores, el primero en la región cervico-dorsal cuya cirugía se vio dificultada por la presencia de herniación medular transdural y un segundo caso con un quiste exclusivamente cervical, en que mediante una punción lateral del quiste guiada por ecografía previo a la durotomía, se logró resecar la lesión sin esta complicación.

Spinal arachnoid cysts are rare lesions in pediatric population. Most of them are located posteriorly in dorsal segments ananterior position is rare. Although its pathogenesis has not been elucidated, they have been associated with neural tube defects and the presence of previous spinal traumas. Clinically, they present with a spinal cord syndrome which can sometimes worsen with postural changes. Treatment may be conservative or surgical, the latter indicated by the presence of neurological symptoms secondary to spinal cord compression, with the posterior approach being the most frequently used. The purpose of surgery is total or partial resection, or fenestration of the cyst to subarachnoid space. A potential intra-surgical complication of posterior approach in anterior cyst is spinal cord herniation during durotomy, secondary to the compressive effect of the cyst, which could increase neurological morbidity in the postoperative period (1 case with mortality is described in the literature). We present 2 consecutive cases in pediatric patients with previous spinal intradural cysts. The first in the cervico-dorsal region whose surgery was hampered by the presence of medullary transdural herniation and second case with an exclusively cervical cyst that through a side puncture cyst guided by ultrasound prior to durotomy, it was possible to resect the lesion without this complication.

[Anterior and anterolateral approach in the treatment of thoracic and lumbar vertebral metastasis causing spinal cord compression]. / Abordaje anterior y anterolateral en el tratamiento de la compresión medular metastásica a nivel torácico y lumbar.

OBJECTIVES: To analyse the results of the anterior and anterolateral approaches in the treatment of thoracic and lumbar spine metastasis. MATERIALS AND METHODS: Patients who underwent surgery between 2003 and 2012 in our institution using an anterior or an anterolateral approach for the treatment of thoracic or lumbar spine metastasis were retrospectively reviewed. RESULTS: Twenty-two patients with median age of 49.5 years (26-73 years) and median follow-up of 9.5 months (0-96 months) were analysed. The most common primary malignancies were renal cell carcinomas and breast adenocarcinomas. Before the intervention, 12 (54.5%) patients were able to walk (Frankel D and E). Preoperative arteriography was performed in 14 (63.6%) patients, and 7 (31.8%) of them underwent tumour embolisation. Medical complications occurred in 5 (22.7%) patients during the immediate postoperative period, 2 (9.1%) of whom died. At the end of follow-up, 16 (72%) of the remaining 20 patients were able to walk (Frankel D and E). Ninety percent of the patients could reduce at least 50% of their analgesic drug requirements. During follow-up 16 patients died, with a median survival of 10 months (range 0-48 months). CONCLUSIONS: Resection of thoracolumbar vertebral metastases by an anterior/anterolateral approach, despite its considerable risk of morbidity and mortality, offers the possibility of significant improvement in the quality of life of the patient; and it does so not only by preserving or restoring their ability to walk but also by ameliorating pain. Preoperative angiography, considering the embolisation of the lesion, is an important tool.

[Surgical treatment of distal biceps tendon ruptures with bone anchors using a single anterior approach]. / Tratamiento quirúrgico de las roturas del tendón distal del bíceps con anclajes óseos por abordaje anterior único.

PURPOSE: To evaluate the clinical results of reinsertion of the distal biceps tendon with anterior bone anchors. MATERIAL AND METHODS: A retrospective study was conducted on 79 patients who underwent reinsertion of the distal biceps tendon with anterior bone anchors. The mean age was 46 years (range, 32-64). Two anchors were used in 57% of cases, and one anchor in 43%. The same postoperative protocol was performed in all patients. Functional assessment was made using a Motor evoked potentials (MEPS) functional scale. The mean of follow-up time was 20 months (range, 12 -28 months). RESULTS: The final mean of MEPS score was 95.2 points (SD 6.8). Almost all (94%) patients had excellent and good results, and 6% a bad result. No differences were observed when comparing functional outcome among patients in whom one anchor was used (96 points) with those in whom two anchors were used (95 points), p=0.5. The mean time off work was 14 weeks (range, 5-56) and 100% of patients were able to return to work. The incidence of complications was 13%. The most frequent was neuropraxia of the lateral antebrachial cutaneous nerve. CONCLUSION: The anatomic re-attachment of the distal biceps tendon with bone anchors using a single anterior approach is a safe technique that offers excellent and good functional results in the medium term.

Cifosis de unión proximal en curvas Lenke 5C. Comparación entre cirugía anterior y cirugía posterior / Proximal junctional kyphosis in lenke c5 curves. A comparison between anterior and posterior surgery

Introducción: El balance sagital es crítico para los resultados a largo plazo en el manejo quirúrgico de la escoliosis idiopática del adolescente. La cifosis de unión se podría definir como un hallazgo radiológico en la transición de la columna fusionada y la columna móvil en pacientes asintomáticos. El objetivo de este trabajo fue comparar la cifosis de unión proximal posoperatoria en curvas Lenke 5C con dos técnicas quirúrgicas distintas: la instrumentación anterior y la instrumentación posterior. Materiales y Métodos: Estudio retrospectivo, controlado no aleatorizado, de 37 pacientes con escoliosis idiopática del adolescente, curvas Lenke 5C con fusión corta, de vértebra límite a vértebra límite. Grupo 1: 18 pacientes con artrodesis anterior instrumentada y Grupo 2: 19 pacientes con artrodesis posterior instrumentada. Los parámetros sagitales radiológicos medidos fueron: 1) línea de plomada de C7, 2) cifosis de unión, 3) cifosis torácica, 4) lordosis lumbar, con un seguimiento mínimo de 2 años. Resultados: Grupo 1: aumento de la cifosis de unión entre el preoperatorio y el seguimiento a los 2 años de 6,27° (p = 0,0002). La incidencia de cifosis de unión patológica fue del 17 por ciento. Grupo 2: aumento de la cifosis de unión entre el preoperatorio y el seguimiento de 4,63° (p = 0,0004). La incidencia de cifosis de unión patológica fue del 16 por ciento. Conclusión: No hubo diferencias significativas entre ambos grupos en la incidencia de cifosis de unión patológica.

Background: Sagittal balance is critical for long-term results in the surgical handling of adolescent idiopathic scoliosis. Proximal junctional kyphosis could be defined as a radiographic findings in the fused and mobile spine transition in asymptomatic patients. Objective: To compare post-surgical proximal junctional kyphosis in Lenke C5 curves with two different surgical techniques: anterior and posterior instrumentation. Methods: Retrospective, controlled, non-randomized study of 37 patients with Lenke C5 adolescent idiopathic scoliosis, with short fusion from end-vertebra to end-vertebra. Group 1: 18 patients with anterior instrumented arthrodesis, and Group 2: 19 patients with posterior instrumented arthrodesis. The radiographic sagittal parameters measured were: 1) plumbline from the C7, 2) junctional kyphosis, 3) thoracic kyphosis, and 4) lumbar lordosis; with a minimum follow-up of two years. Results: Group 1: increase of junctional kyphosis between the preoperative period and a two-year follow-up, 6.27° (p = 0.0002). The incidence of pathologic junctional kyphosis was 17%. Group 2: increase of junctional kyphosis between the preoperative period and the follow- up, 4.63° (p = 0.0004). The incidence of pathologic junctional kyphosis was 16%. Conclusion: There were no significant differences between groups in the incidence of pathologic junctional kyphosis.

Cifosis de unión proximal en curvas Lenke 5C. Comparación entre cirugía anterior y cirugía posterior / Proximal junctional kyphosis in lenke c5 curves. A comparison between anterior and posterior surgery

Introducción: El balance sagital es crítico para los resultados a largo plazo en el manejo quirúrgico de la escoliosis idiopática del adolescente. La cifosis de unión se podría definir como un hallazgo radiológico en la transición de la columna fusionada y la columna móvil en pacientes asintomáticos. El objetivo de este trabajo fue comparar la cifosis de unión proximal posoperatoria en curvas Lenke 5C con dos técnicas quirúrgicas distintas: la instrumentación anterior y la instrumentación posterior. Materiales y Métodos: Estudio retrospectivo, controlado no aleatorizado, de 37 pacientes con escoliosis idiopática del adolescente, curvas Lenke 5C con fusión corta, de vértebra límite a vértebra límite. Grupo 1: 18 pacientes con artrodesis anterior instrumentada y Grupo 2: 19 pacientes con artrodesis posterior instrumentada. Los parámetros sagitales radiológicos medidos fueron: 1) línea de plomada de C7, 2) cifosis de unión, 3) cifosis torácica, 4) lordosis lumbar, con un seguimiento mínimo de 2 años. Resultados: Grupo 1: aumento de la cifosis de unión entre el preoperatorio y el seguimiento a los 2 años de 6,27° (p = 0,0002). La incidencia de cifosis de unión patológica fue del 17 por ciento. Grupo 2: aumento de la cifosis de unión entre el preoperatorio y el seguimiento de 4,63° (p = 0,0004). La incidencia de cifosis de unión patológica fue del 16 por ciento. Conclusión: No hubo diferencias significativas entre ambos grupos en la incidencia de cifosis de unión patológica. (AU)

Background: Sagittal balance is critical for long-term results in the surgical handling of adolescent idiopathic scoliosis. Proximal junctional kyphosis could be defined as a radiographic findings in the fused and mobile spine transition in asymptomatic patients. Objective: To compare post-surgical proximal junctional kyphosis in Lenke C5 curves with two different surgical techniques: anterior and posterior instrumentation. Methods: Retrospective, controlled, non-randomized study of 37 patients with Lenke C5 adolescent idiopathic scoliosis, with short fusion from end-vertebra to end-vertebra. Group 1: 18 patients with anterior instrumented arthrodesis, and Group 2: 19 patients with posterior instrumented arthrodesis. The radiographic sagittal parameters measured were: 1) plumbline from the C7, 2) junctional kyphosis, 3) thoracic kyphosis, and 4) lumbar lordosis; with a minimum follow-up of two years. Results: Group 1: increase of junctional kyphosis between the preoperative period and a two-year follow-up, 6.27° (p = 0.0002). The incidence of pathologic junctional kyphosis was 17%. Group 2: increase of junctional kyphosis between the preoperative period and the follow- up, 4.63° (p = 0.0004). The incidence of pathologic junctional kyphosis was 16%. Conclusion: There were no significant differences between groups in the incidence of pathologic junctional kyphosis. (AU)

Abordaje combinado en columna toracolumbar para los tumores / Approach combined in thoracolumbar spine for tumors

Introducción: el progreso de la imaginología, la supervivencia del paciente oncológico y el desarrollo de instrumentaciones cortas, aumentó el interés por el uso de abordajes combinados. Objetivo: exponer la experiencia del servicio de ortopedia del Hospital Clínico Quirúrgico Hermanos Ameijeiras en abordaje combinado de columna toracolumbar. Descripción: se presentaron 5 casos con procesos tumorales del segmento toracolumbar en los que se empleó abordaje combinado, operados en el servicio de ortopedia desde febrero de 2007 hasta mayo de 2011; se reflejó edad, sexo, tipo de tumor. Se evaluó el dolor (por la escala Denis) y el estado neurológico (por la escala Frankel) preoperatorio y posoperatorio, así como las complicaciones. Resultados: en los pacientes menores de 50 años predominó el sexo femenino y los tumores primarios; 4 pacientes tenían en el preoperatorio un estado Frankel C y en todos se logró pasar a E. En cuanto al dolor por la escala Denis que era entre 3 y 4, pasaron a 0 y 1. Como complicaciones se presentó una luxación del injerto con sepsis profunda, así como 2 desgarros del saco dural. Conclusiones: el abordaje combinado se presenta como opción ventajosa y recomendable de tratamiento quirúrgico en los tumores espinales(AU)

Introduction: the progress of imaging, the survival of oncology patient and the development of short instrumentations increased the interest by the use of combined approaches. Objective: to expose the experience of the Orthopedics service of Hermanos Ameijeiras Clinical Surgical Hospital in the combined approach of thoracolumbar spine. Description: authors present 5 cases presenting with tumoral processes of thoracolumbar segment using a combined approach, operated on above mentioned service from February, 2007 to May, 2011. Following variables were included: age, sex, and type of tumor. Pain was assessed (Denis) and the preoperative and postoperative neurologic status (Frankel), as well as the complications. Results: in patients aged under 50 there was predominance of female sex and of primary tumors: in preoperative period 4 patients had a C Frankel and in all of them it was possible to move to E. As regards the Denis pain between 3 and 4 moving to 0 and 1. Complications included graft luxation with a deep sepsis, as well as two dural sac tears. Conclusions: the combined approach is an advantageous and recommendable option for surgical treatment in spinal tumors(AU)