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

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

[Intra-articular fracture of the calcaneus associated with injury to lateral collateral ligaments of the ankle]. / Fractura intraarticular de calcáneo asociada a lesión de ligamentos colaterales laterales del tobillo.

Calcaneal fractures are the most frequent of the tarsus (3.5% of all fractures). Young adults are mainly affected, being more frequent in men (5.9:1). On the other hand, ligament injuries associated with fracture of the calcaneus are very infrequent. We describe a case of a 39 year old patient who suffered ankle trauma. He presented instability in plantar flexion and inversion. A fracture of the calcaneus was diagnosed. During surgery, a complete lesion of the lateral ligament complex was found. The reduction and osteosynthesis associated with ligament reconstruction was performed. We consider important to confirm the stability of the ankle after a calcaneus fracture. Lack of diagnosis in this type of injuries can evolve into chronic instability.

Las fracturas de calcáneo son las más frecuentes del tarso (3.5% de todas las fracturas). Afectan a adultos jóvenes, siendo más frecuentes en hombres (5.9:1). Por otro lado, las lesiones ligamentarias asociadas a fractura de calcáneo no son muy frecuentes. Presentamos un caso de un paciente de 39 años que sufrió entorsis de tobillo. Mostraba inestabilidad en flexión plantar e inversión. Radiografías mostraron una fractura de calcáneo. Durante la cirugía se evidenció una lesión completa del complejo ligamentario lateral. Se realizó la reducción y osteosíntesis asociada a la reconstrucción ligamentaria. Ante fracturas de calcáneo es importante corroborar la estabilidad del tobillo. La falta de diagnóstico en este tipo de lesiones puede generar inestabilidades crónicas.

[Effect of nutritional status on mortality and functional recovery in older adults with hip fracture]. / Efecto del estado nutricional en la mortalidad y recuperación funcional en adultos mayores con fractura de cadera.

INTRODUCTION: Malnutrition is a common problem in the elderly population but has not been fully studied in elderly people with hip fractures. The goal is to estimate annual mortality based on nutrition in the elderly with hip fracture and compare motor functionality. MATERIAL AND METHODS: Retrospective cohort of patients over 65 years of age with hip fracture included in the Institutional Register of The Elderly with Hip Fracture of a University Hospital, between July 2014 and July 2018. Nutritional status with Mini Nutritional Assessment Short-Form (MNA-SF) was assessed at hospital admission. Motor functional capacity was evaluated with Parker Scale (PS) basal, at three and 12 months. RESULTS: 1,253 patients were included. 49.92% (CI95% 47.12-52.72) were malnourished. The annual mortality of the well-nourished (WN) was 9.45% (CI95% 7.23-12.30) against 21.52% (CI95% 18.12-25.45; p 0.001) of the malnourished (MN). The risk of death was associated with malnutrition HR 2.45 (CI95% 1.75-3.43; p 0.001). After adjusting it by age, sex, fragility, AVD, Charlson comorbility index and dementia, the risk remained HR 1.71 (CI95% 17-2.49; p = 0.005). With respect to functionality, the basal Parker Scale median (EP) for the WN group was 9 (RIC6-9) and for MN was 5 (RIC3-9) p 0.001, 6 months (RIC3-6) and 4 (RIC2-6) p 0.001 and 12 months 6 (RIC4-7) and 3 (RIC2-6) p 0.001. CONCLUSIONS: There is an association between the malnutrition of the elderly with hip fracture and its mortality with a year of evaluation; we also find a difference in motor functionality.

INTRODUCCIÓN: La malnutrición es una problemática frecuente en la población anciana, pero no ha sido completamente estudiado en ancianos con fractura de cadera. El objetivo es estimar mortalidad anual según nutrición en ancianos con fractura de cadera y comparar la funcionalidad motora. MATERIAL Y MÉTODOS: Cohorte retrospectiva de pacientes mayores de 65 años con fractura de cadera incluidos en el Registro Institucional de Ancianos con Fractura de Cadera de un Hospital Universitario, entre Julio de 2014 y Julio de 2018. Se evaluó el estado nutricional con Mini Nutritional Assessment Short-Form (MNA-SF) al ingreso hospitalario. La capacidad funcional motora fue evaluada con escala de Parker (EP) basal, a los tres y 12 meses. RESULTADOS: Se incluyeron 1,253 pacientes. 49.92% (IC95% 47.12-52.72) estaba malnutrido. La mortalidad anual de los bien nutridos (BN) fue de 9.45% (IC95% 7.23-12.30) contra 21.52% (IC95% 18.12-25.45; p 0.001) de los malnutridos (MN). El riesgo de muerte se asoció a la malnutrición HR 2.45 (IC95% 1.75-3.43; p 0.001). Luego de ajustarlo por edad, sexo, fragilidad, AVD, índice de comorbilidades de Charlson y demencia, el riesgo se mantuvo HR 1.71 (IC95% 17-2.49; p = 0.005). Con respecto a la funcionalidad, la mediana de la escala de Parker (EP) basal para el grupo BN fue 9 (RIC6-9) y para MN fue 5 (RIC3-9) p 0.001, a los tres meses 6 (RIC3-6) y 4 (RIC2-6) p 0.001 y a los 12 meses 6 (RIC4-7) y 3 (RIC2-6) p 0.001. CONCLUSIONES: Existe asociación entre la malnutrición del anciano con fractura de cadera y su mortalidad al año, asimismo una diferencia en la funcionalidad motora.

Survival and functionality in the elderly over 85 years of age with hip fracture. / Supervivencia y funcionalidad en ancianos mayores de 85 años con fractura de cadera.

BACKGROUND: There is a tendency for the aging population to fracture their hips. Our aim was to compare survival and functionality at one year, among elderly and very elderly patients with hip fracture. MATERIAL AND METHODS: A prospective cohort of patients included in the Institutional Registry of Elderly Patients with Hip Fracture between 2014 and 2017. We classified patients as elderly patients (EP) <65 and <85 years and very elderly patients (VEP) ≥85 years. RESULTS: We included 952 patients, 43% were EP and 57% were VEP. The proportion of women was 84% and 86% (P=.33) and with 2 or more points in the Charlson comorbidities index (28 and 31%, P= .36), respectively. The VEP were more dependent according to the Barthel score (34% and 62%, P<.01) and frailer according to the Edmonton score (30% and 61%, P<.01). One-year survival was 91% (95% CI 86-93) in the EP and 76% (95% CI 70-89) in the VEP. In-hospital complications were more frequent in the VEP 12% (7% in the EP, P<.01). Age is an independent risk factor for one-year survival (HR 2.11; 95% CI 1.36-3.29, P<.001). CONCLUSIONS: Age is a risk factor for the VEP group survival despite fragility and comorbidities. Because of their vulnerability, an appropriate care plan should be considered for VEP.

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

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

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

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

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

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