Evaluation of the Chilean National Orthopaedic Examination Over 11 Years: Progress and Outcomes of National and International Examinees.

INTRODUCTION: The National Orthopaedics Examination (EMNOT) was initially designed for Chilean orthopaedic program graduates and is now a crucial component of the revalidation process for international orthopaedic surgeons seeking practice in Chile. This study aims to describe participation and performance of EMNOT examinees based on their origin and to analyze the difficulty and discrimination indexes during its first 11 years of implementation. METHODS: A retrospective assessment was conducted on all EMNOT results from 2009 to 2019. The study evaluated the participation and performance of examinees according to their origin and examined the difficulty and discrimination indexes of the examination. RESULTS: A total of 975 examinees were evaluated, with 41.23% from national resident programs (National Medical Graduates) and 58.77% from international examinees (International Medical Graduates). The number of participating universities increased from 4 in 2009 to 17 in 2019. National Medical Graduates examinees achieved a mean score of 66.52 ± 8.67 (0 to 100 points) while International Medical Graduates examinees scored 55.13 ± 11.42 (P < 0.001). The difficulty and discrimination indexes remained adequate throughout this period. DISCUSSION: Over the course of 11 years, the number of EMNOT examinees exhibited notable growth. The examination effectively differentiates between candidates based on their origin and maintains appropriate levels of difficulty and discrimination.

Tibial tubercle to trochlear groove and the roman arch method for tibial tubercle lateralisation are reliable and distinguish between subjects with and without major patellar instability.

PURPOSE: Patellofemoral (PF) instability recurrence depends on several factors including the relative lateralisation of tibial tubercle (TT) regarding the trochlear groove (TG). TT relative lateralisation quantification has long been a topic of debate. Multiple measuring techniques have been described including TT-trochlear groove (TT-TG), TT-posterior cruciate ligament (TT-PCL) and TT-roman arch (TT-RA), with no clear consensus regarding the most reliable index or pathologic threshold. We set out to determine the normal value range of each index and their association with age, sex and PF instability status. Also, this study aims to determine a reliable pathologic distance threshold to effectively predict patellar dislocation. METHODS: Skeletally mature patients up to 45 years of age who presented a CT Scan and an MRI of the same knee between 2014 and 2018 were included and divided into subgroups based on history of PF instability. Three indexes (TT-TG, TT-PCL and TT-RA) were assessed by two independent observers blinded to instability history. ROC curves were performed for each index to obtain the cut point that better predicts instability. Univariate and multivariate models adjusted by age, sex, instability history and type of imaging technique were performed to test the influence of these variables. RESULTS: 208 patients were included. Mean age was 27.93 â€‹± â€‹8.48 years, 67.3% were female and 71 patients (34.1%) presented major instability history. Good or excellent inter and intraobserver reliability was found for all three indexes. All indexes presented significantly different distributions between subjects with and without major instability (p â€‹< â€‹0.001), except for TT-PCL. Different cut point values differing between imaging modalities were found: 11.4 â€‹mm for MRI TT-TG, 17 â€‹mm for CT TT-TG, 15.6 â€‹mm for MRI TT-RA and 18.2 â€‹mm for CT TT-RA. CONCLUSIONS: All indexes studied had good or excellent inter and intraobserver reliability. Measurements between imaging techniques (CT and MR) are not interchangeable. Both TT-TG and TT-RA correctly distinguish between subjects with and without major instability, while TT-PCL does not, recommending caution when evaluated on its own. Specific threshold values depending on imaging technique should be considered for surgical decision-making. LEVEL OF EVIDENCE: Level IV, Diagnostic Test.

Tratamiento neuroquirúrgico de la agresividad irreductible: hipotalamotomía posteromedial estereotáxica / Stereotaxic posteromedial hypothalamotomy in the treatment of aggressive behaviour: a clinical case

Introducción: se describe el caso de un paciente de 30 años, portador de trastorno orgánico de la personalidad, que presentaba frecuentes accesos de agresividad patológica subtipo predatorio hacia otras personas. Estos episodios de descontrol fueron esporádicos en la infancia; a partir de los 15 años el síndrome fue empeorando a pesar de los tratamientos instituidos, siendo las crisis de agresividad imprevisibles cada vez más frecuentes y violentas. Se emplearon sucesivamente y en forma combinada terapéuticas farmacológicas (neurolépticos, antipsicóticos, benzodiacepinas, estabilizadores y betabloqueantes) a dosis plenas y en rango variable, electroconvulsoterapia y múltiples terapias de rehabilitación. Ante el fracaso terapéutico convencional se planteó como último recurso la neurocirugía. Procedimiento: la cirugía que se llevó a cabo fue una hipotalamotomía posteromedial bilateral estereotáxica por radiofrecuencia, bajo anestesia general, realizando la localización de los blancos a tratar con tomografía computada. No se observaron complicaciones posoperatorias. Resultados: en las semanas siguientes al posoperatorio el paciente se mantuvo en situación de mansedumbre, lo que permitió modificar el programa farmacológico, con suspensión de la megadosis de psicofármacos (haloperidol, olanzapina, lorazepam) y betabloqueantes (propranolol), y mantención del timorregulador anticomicial (valproato). En la evolución inmediata se reintegra precozmente y sin incidentes a la terapia grupal de rehabilitación y a actividades sociales con su familia. En la evolución diferida recupera paulatinamente rasgos personales y capacidades previas al comienzo de la refractariedad. La condición de mejoría clínica, respecto al objetivo del control de la agresividad patológica subtipo predatorio y la mejoría de la calidad de vida del paciente y su familia se mantienen durante el seguimiento de nueve meses, por lo que se decide publicar el reporte.

Tratamiento artroscopico del pellizcamiento femoroacetabular: tecnica quirurgica y resultados preliminares / Arthroscopic treatment of femoroacetabular impingement: surgical technique and early results

La articulacion de la cadera puede ser origen de dolor y limitacion funcional. Entre otros diagnosticos se encuentra el pellizcamiento femoroacetabular. El diagnostico de pellizcamiento de cadera se ha visto asociado a rotura del labrum y artrosis precoz. El tratamiento de esta patologia puede incluir cirugia. El procedimiento a realizar depende del tipo de pellizcamiento y lesiones asociadas. Los distintos procedimiento quirurgicos han sido reportados por via abierta. Al igual que en otras articulaciones, la via artroscopica presenta ventajas relativas haciendola una opcion atractiva por su menor indice de complicaciones. Una de las limitantes de la artroscopia es la dificultad tecnica que esta plantea. Nuestro grupo ha realizado 60 artroscopias de cadera para el tratamiento del pellizcamiento femoroacetabular con la tecnica aqui descrita. Se han obtenido buenos a excelentes resultados en 91,6 por ciento de los casos (55/60), en un seguimiento a corto plazo. A pesar de las dificultades tecnicas y complicaciones inherentes al procedimiento, la via artroscopica se presenta como una buena alternativa de tratamiento de los pellizcamientos femoroacetabulares pudiendo hacerse desinsercion del labrum, acetabuloplastia, re-insercion y bumpectomia cuando es necesario.