Sistema Regional de Información
en línea para Revistas Científicas de América Latina,
el Caribe, España y Portugal

Introduction: Brachymetatarsia is a shortening of any metatarsal bone, mainly due to premature growth arrest of the growth plate. It is more frequent in women, the fourth and the first metatarsal being the most affected bones. The aim of this study was to evaluate the outcomes of progressive bone lengthening with external mini-fixator. Methods: This was a retrospective, descriptive, case series study in which we analyzed the outcomes of all patients operated on with this technique in our Center. Six cases were evaluated, two of which presented bilateral brachymetatarsia. All patients were women and had brachymetatarsia of the 4th metatarsal. The average age was 14 years. The following aspects were evaluated: lengthening in millimeters and presence of complications, such as delayed consolidation, infection, metatarsophalangeal joint dislocation, metatarsophalangeal joint flexion, and patient satisfaction. Results: On average, an increase of 15 mm was achieved. Two cases presented superficial infection at the needle insertion site. One patient progressed to metatarsophalangeal joint dislocation, and another one to metatarsophalangeal joint flexion. No neurovascular complications were observed. Conclusions: Bone lengthening with external fixator is a safe and effective treatment. A greater length in millimeters can be achieved in comparison to one-stage lengthening, as well as an improved soft-tissue and neurovascular stretching. All complications resolved smoothly and did not affect final treatment results. Complications are similar to those described in the international literature.            

Introduction: Infected segmental bone defects are challenging conditions, with complex treatment. Masquelet technique represents an alternative for these cases. The aim of this retrospective, multicenter study was to show clinical and radiological outcomes with the use of this reconstruction technique in infected segmental bone defects of femur and tibia, to characterize the defects treated and to describe different aspects of surgical technique.Methods: We analyzed 24 patients (14 men and 10 women; average age 36.16 years [range 18-67]) treated with Masquelet technique between 2011 and 2016. Average follow-up was 16.5 months (range 12-27) from the second surgical stage. Affected bone, defect length (cm), consolidation time and infectious process control were analyzed.Results: Length of treated bone defect was on average 5.7 cm (range 3-12), it was higher than 4 cm in 50% of the cases. The largest segmental bone defect measured 12 cm at the tibia and 10 cm at the femur. Bone consolidation was achieved in all cases, on average, in 4.5 months. One patient presented a recurrence of the infectious process 12 months after the successful consolidation.Conclusions: Masquelet technique or induced membrane technique offers a reasonable and simple alternative to a highly challenging problem, such as infected segmental bone defects, presenting a consolidation rate greater than 90% even in complex cases. 

Osteopetrosis (also known as Albers-Schönberg disease) is a syndrome that includes four classic types and is characterized by bone dysplasia and lack of bone resorption due to abnormal osteoclastic activity and consequent development of brittle and hard bone that is prone to fractures that are difficult to treat surgically. Herein we present two cases of osteopetrosis with diaphyseal fractures of the humerus, both managed with non-surgical treatment. The objectives of our manuscript are to document our experience in the management of these cases and review the literature. The non-invasive treatment provides the best outcome for dyaphyseal fractures on the humerus in patients with osteopetrosis, given that the quality of the bone in these patients impairs the implementation of osteosynthesis. In addition, the placement of implants can lead to complications such as infections, delayed consolidation and pseudoarthrosis, among others. Surgical treatment should reserved for certain patients such as those with delayed consolidation, pseudoarthrosis, a history of repeated fractures, pre-existing deformity and those who are at risk for the development of disabling deformities or do not respond to non-surgical treatment

Chronic exertional compartment syndrome (CECS) of the forearm is uncommon and has been described in association with sport and work-related activities. We describe the uncommon presentation of a patient with CECS of the forearm who was treated through a min-invasive fasciotomy. CECS of the forearm must be suspected in patients with compartmental pain even if they do not practice risk activities. Mini-invasive fasciotomy is an effective option for the treatment of this pathology.

Introduction: Arthroscopy has become an important tool to treat various conditions of the ankle. The use of anterior and posterior portals, with or without mechanical distraction, allows for a complete exploration of this joint. Like all surgical techniques, it is not without complications.Objectives: To evaluate the early complications of anterior ankle arthroscopy with or without joint distraction, and to compare them with those described in the international literature.Materials and Methods: A retrospective study that evaluated 198 patients undergoing anterior ankle arthroscopy for various pathologies. All were operated on by a single surgeon, in two health centers, during a period of 6 years, with a postoperative follow-up of at least 12 months. Patients were evaluated by AOFAS score and early and postoperative complications were recorded.Results: 34 women and 164 men were evaluated (average age 37.5 years). There were 23 complications (11.61%): local cellulitis (6 cases), transient paresthesia of the superficial peroneal nerve (4 cases), permanent paresthesia of the superficial peroneal nerve (1 case), residual pain in the portals (4 cases), septic arthritis (2 cases) and one case of other complications.Conclusions: Most complications can be avoided by a precise knowledge of the anatomy and the aseptic techniques, as well as an adequate surgical approach and intra-operative management of the instrumentation. Anterior ankle arthroscopy without joint distraction through standard antero-lateral and antero-medial portals is a safe technique, having a low rate of complications and a very low morbidity for the patient.

Objectives: To evaluate potential differences in clinical and radiological outcomes after surgical versus conservative management of ulnar styloid fractures associated with unstable distal radius fractures treated by locked volar plating. Materials and Methods: This was a multicenter, retrospective and descriptive study including surgical patients treated at four different institutions between 2009 and 2012 for ulnar styloid fractures associated with unstable distal radius fractures. Ulnar styloid fractures were treated conservatively in group I and surgically in group II. Results: The average follow-up was 56 months. The study included 57 patients divided into two groups (group I [29 cases] and group II [28 cases]). Patients in group II had 2.76 times (95% CI: 1.086; 8.80) more chances of achieving bone union than those in group I. DASH and pain scores, both at rest and during activity, did not show significant differences between the two groups (p = 0.276 and p = 0.877). Group I presented milder ulnar deviation and better strength (p = 0.0194 and p = 0.024). Conclusions: Although patients who underwent surgery for ulnar styloid fractures had 2.76 more chances of achieving bone union than those who received conservative management, there were no significant differences between both groups in subjective evaluations (DASH and pain scores) or when considering the degree of ulnar styloid involvement. However, the parameters of strength and ulnar deviation were better in the conservative management group.

AbstractBackground: Intraoperative radiographic control (IRC) is an increasingly common practice, but it causes certain adverse events for healthcare providers.Objectives: To measure the use of fluoroscopy in spinal surgery, recognize control measures, evaluate assimilation of protection elements by surgeons, and analyze adverse events for spinal surgeons.Materials and Methods: A survey of 17 multiple-choice questions was e-mailed to spinal surgeons.Results: 55 surveys were answered. More than 60% of surgeons were spinal surgeons. The C-arm is the most widely used machine for final control by pulsating X-rays. Real-time controls are carried out in 31% of cases. One-piece leaded aprons are the most commonly used method, but it is unknown when they should be replaced. Half of the respondents uses more than one protection element. There were seven cases of vision changes, 5 of thyroid disorders, 3 of dermatitis, and 2 of infertility. Three surgeons required surgery for thyroid nodules, cataracts or neoplasm.Conclusions: IRC is a common practice in spinal surgery. One-piece leaded aprons are the most commonly used method and they are often combined with other elements, but it is not known when aprons must be replaced. One in 3 surgeons suffered from the studied conditions, and there were 3 related surgeries. Lack of adequate protection and control is a reality for specialist surgeons, together with a lack of protocols, making this an unregulated issue.

Spontaneous spinal epidural hematoma is an uncommon condition and a neurological emergency. The clinical presentation of this type of hematoma is very variable, ranging from a backache up to a quadriplegia, according to the severity and the site of compression. Here, we discuss the clinical case of a 71-year-old patient with heart problems, under previous treatment with acenocumarol, that suffered a spontaneous epidural hematoma. The patient, previously asymptomatic, presented, sudden cervical pain when he bent over, followed by weakness in the lower and the upper limbs. Due to the clinical suspicion, an emergency MRI was performed, showing an epidural hematoma extending from C4 to T8. Early diagnosis and decompressive treatment are mandatory to minimize permanent neurological damage.

Introduction: The World Health Organization defines elderly person as anyone who is between 75 and 90 years of age and those who surpass this age are called old people. The objective of this study was to analyze postoperative results of ankle fractures treated with MIPO and ORIF techniques, achieving a functional and biological reduction in patients older than 75 years. Methods: Between 2013 and 2017, 13 patients beyond the age of 75 with unstable ankle fractures were evaluated. Six were treated with MIPO technique and 7 with ORIF. All patients were evaluated at 90 days and at 18 month postoperatively using the AOFAS score. Results: Mean age was 79.7 years (range 75-95). Overall postoperative AOFAS score was 97 at day 90 and 96 at 18 months. No losses of reduction or shaft defects were observed. Conclusion: Our study indicates that biological and functional reduction in patients older than 75 years is the ideal treatment for ankle fractures.

Introduction: Bisphosphonates evolved as the mainstay for the treatment of osteoporosis, reducing the incidence of fractures. Recently, several publications described the occurrence of low-energy atypical femur fractures associated with the use of bisphosphonates. The objective of this work was to study the average time of consolidation of the atypical femoral fractures caused by the consumption of bisphosphonates compared with a control group.Materials and Methods: We retrospectively evaluated 34 patients with atypical femoral fractures of which 16 patients had undergone treatment with bisphosphonates for at least 5 years, treated between 2006 and 2017, and stabilized with a cephalomedullary nail, and were compared with a control group of similar characteristics.Results: All the patients were female. The average age was 74 years. 22 presented subtrochanteric fractures while 12 were diaphyseal. 14% of the subjects who took bisphosphonates and received surgical treatment, required a revision versus 5.5% of the control group. The average time of consolidation was higher in those treated with bisphosphonates (8.5 months vs. 6 months), this being statistically significant (p <0.001).Conclusions: The benefit of treatment with bisphosphonates in the prevention of fractures is greater than the risk of atypical fractures. However, it is important to evaluate the risk-benefit in each patient at the beginning and the duration of the treatment, taking into account that despite this, the healing time is longer.