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

Introducción: La reducción abierta y fijación interna mediante el sistema absorbe-tracción es un método que ha demostrado su eficacia y logra resultados predecibles en el tratamiento de las fracturas de olécranon tipos IIA y IIIA de la Clasificación de la Clínica Mayo. Considerada por muchos cirujanos como una técnica sencilla y reproducible a la hora de restaurar la anatomía y la continuidad del aparato extensor del codo, su empleo puede asociarse con una tasa de complicaciones relativamente alta, y no es infrecuente la necesidad de retirar el cerclaje de alambre previamente colocado.El objetivo de este estudio fue determinar si reemplazar el clásico alambre de 1,6 mm por suturas de alta resistencia aporta la estabilidad suficiente para el tratamiento de las fracturas de olécranon tipos IIA y IIIA, y analizar los resultados obtenidos en una serie de casos.Materiales y Métodos: Se estudió, en forma retrospectiva, a 25 pacientes consecutivos con fracturas de olécranon tipos IIA y IIIA, tratados mediante reducción abierta y fijación interna con sistema absorbe-tracción compuesto por alambres de Kirschner de 1,6 mm y suturas de alta resistencia (polietileno trenzado de alto peso molecular), con un seguimiento mínimo de 12 meses. Se evaluaron el tiempo de consolidación radiográfica, el rango de movilidad, el puntaje MEPS, y se registraron las complicaciones.Resultados: Todas las fracturas consolidaron, en un promedio de 6.83 semanas (rango 6-10). El puntaje MEPS promedio fue de 96,6 (rango 85-100). El arco total de movilidad promedio para la flexo-extensión activa del codo fue de 139° (rango 110-150°). La extensión promedio fue de -4,8° (rango 0-20°) y la flexión, de 143,8° (rango 130-150°). Se registraron cuatro casos de migración proximal de los alambres de Kirschner y un caso de pérdida de reducción de 3 mm en la tercera semana del posoperatorio. Dos pacientes requirieron una segunda intervención para retirar los alambres de Kirschner. Ninguno refirió dolor o molestias inherentes al uso de la sutura.Conclusiones: El sistema absorbe-tracción utilizando suturas de alta resistencia es una opción a la hora de realizar la osteosíntesis de una fractura de olécranon tipos IIA y IIIA. Los resultados clínicos y radiográficos han sido satisfactorios, con una baja tasa de complicaciones. El uso de suturas ultrarresistentes simplifica el procedimiento y disminuye la necesidad de una segunda intervención para retirar el alambre.AbstractBackground: open reduction and internal fixation through the tension band system is a method which has proved to be efficient and offers predictable results in type Mayo 2A and 3A olecranon fractures. It is considered by many surgeons as a simple and reproducible technique when restoring the anatomy and continuity of the elbow’s extension mechanism is necessary. The use of this technique may be associated to a relatively high percentage of complications and the need to remove the previously collocated wire cerclage is not infrequent. The purpose of our study was to determine if replacing the classically used 1.6 metal wire by high resistance sutures could reliably hold the reduction of the olécranon fragment in the treatment of Mayo 2A and 3A olecranon fractures, and analyse the results.Materials and Methods: Twenty five consecutive patients were studied retrospectively. All of them presented Mayo 2A and 3A olecranon fractures. These patients were treated with open reduction and internal tension band system built with two 1.6 mm Kirschner wires and two high resistance sutures (ultra high molecular weight polyethylene). A minimum 12-month follow up was carried with all patients. Consolidation time, mobility range, and functional score were evaluated and complications noted.Results: All fractures healed in an average time of 6.83 weeks (6 to 10 range). The average Mayo score was of 96.6 (85 to 100 range). The average mobility range for the elbow’s active flexo extension was 139 degrees (130 to 150 range) The average extension was -4.8 degrees (0 to -20 range) and the flexion of 143.8 (130 to 150 range). Four cases of proximal migration of the Kirschner wires and one case of 3 mm reduction loss in the third post op week were registered. Two patients required a second intervention for hardware removal of the Kirschner wires. No patient referred pain or discomfort as a consequence to the use of sutures.Conclusions: The tension band system using high endurance suture is an option to consider for chirurgical treatment of type Mayo 2A and 3A olecranon fracture. The clinical and x-ray results in this series have been satisfactory and have presented a low rate of complications. The use of high resistance suture would simplify the procedure and reduce the need of a second intervention for remove hardware.

Objectives: To describe the minimally invasive locking plate approach for midshaft clavicular fractures and report our radiographic and clinical results.Methods: We retrospectively evaluated fifteen patients (12 men and 3 women, mean age: 32.4 years [range 17-51]) with clavicular fractures who underwent minimally invasive superior locking plate osteosynthesis and reduction. According to the Allman classification of clavicular fractures, 12 patients had a type I fracture, while 3 had a type II fracture.Results: The average operating time was 53 minutes (range 51-65). Union was achieved in all patients in an average of 13.3 weeks (range 12-15). Patients were satisfied with cosmetic and functional results.Conclusions: This study shows that the minimally invasive superior locking plate approach for midshaft clavicular fractures can be a reproducible procedure and an alternative to conventional surgical approaches. Clinical and radiological results were achieved without major complications or wound dysesthesia.

Objective: The objective of this study was to evaluate if discectomy with placement of an interspinous silicon DIAM spacer is associated with a different rate of clinical and radiographic ipsilateral disc herniation recurrence than discectomy alone.Methods: A prospective, observational,randomized study was performed from May 2009 to May 2013 at XXXXX. Of the 123 patients included in the study, 3 were lost to follow-up, leaving 120 patients for data analysis. All patients were operated on by the same surgical team. Patients received one of two types of treatment. Group A consisted of 30 patients (16 women and 14 ment) who underwent discectomy with placement of an interspinous silicone DIAM spacer. Group B was composed of 90 patients (53 women and 37 men) who received discectomy alone.Results: Discectomy at L4-L5 was the most common level, occurring in 90% (27) Group A patients and 80% (72) Group B patients. Group A demonstrated clinical and radiographic disc herniation recurrence in 6/30 (20%) of patients. Disc herniation recurrence developed in 4/90 (4.4%) Group B patients. One patient underwent reoperation (1.1%). Both recurrence and reoperation was significantly higher in Group A (p = 0.007 and p = 0.019, respectively).Conclusions: The benefits of interespinosos devices for the treatment of the lumbar spinal stenosis secondary to herniated disc while they are controversial in the present study showed significant difference according to the Group. In this study, patients that underwent discectomy and interspinous spaceer placement had higher reoperation and recurrence rates than discectomy patients that did not receive an interspinous spacer. Interspinous spacers may increase the rate of disc herniation by maintaining movement at the level of prior disc herniation and changing the physiologic load. More studies are needed to corroborate and evaluate these trends.   

Large head metal on metal hip arthroplasty revision has a significant complication rate, mainly related to the removal of the acetabular component, as well as to the friction pair used. In some cases, an isolated femoral revision can be made, sparing the acetabular cup and, thus, decreasing surgical morbidity.This paper discusses a case successfully treated with a dual mobility acetabular cup in a patient with a resurfacing hip replacement and a pseudotumor that caused pain and instability.Mastering this surgical approach allows hip surgeons to solve complex problems in a simple and safe manner, and with a low complication rate.

Objetivo: Reportar la tasa de consolidación y los resultados de una serie de 22 pacientes con seudoartrosis del polo proximal del escafoides tratados con un bloqueo óseo metafisario asociado a un tornillo autocompresivo anterógrado.Materiales y Métodos: Serie prospectiva de pacientes con seudoartrosis del polo proximal del escafoides en quienes se constató un sangrado intraoperatorio en ambos fragmentos. Se excluyó a los pacientes con desplazamiento, cambios degenerativos, fragmentación del polo proximal, cavitación del foco, pérdida de altura, necrosis y aquellos con inestabilidad carpiana. Se tomaron radiografías e imágenes por tomografía computarizada para evaluar su consolidación; se registraron la movilidad y la fuerza de puño, y los pacientes completaron una escala analógica visual para dolor en reposo, dolor en actividad, estado subjetivo funcional y el cuestionario DASH.Resultados: La serie incluyó 18 pacientes. Diecisiete presentaron consolidación. El seguimiento promedio fue de 22 meses y la movilidad final promedio fue: flexión 87%, extensión 84%, desviación radial 78%, desviación cubital 84% y fuerza de puño 85%. El puntaje promedio de la escala analógica visual fue 0 para dolor en reposo; 2, para dolor en actividad y 9 para función, en tanto que el puntaje DASH promedio fue de 8.Conclusiones: Con esta técnica confiable y sencilla, obtuvimos una tasa de consolidación del 95% y un muy buen resultado funcional. El bloqueo óseo metafisario asociado a un tornillo anterógrado constituye una alternativa válida y eficaz para tratar la seudoartrosis del polo proximal del escafoides, vital en pacientes cuidadosamente seleccionados. ABSTRACTObjective: To report the consolidation rate and the outcomes of a series of 22 patientswith proximal pole scaphoid nonunion treated with a metaphyseal core decompressionand an anterograde self-compressing screw.Methods: We present a prospective series of patients with proximal pole scaphoidnonunion and confirmation of intraoperative bleeding in both fragments. Patientspresenting with displacement, degenerative changes, proximal pole fragmentation,cavitation at the fracture site, reduced bone length, and necrosis, as well as those withcarpal instability, were excluded. X-rays and computed tomography scans wereperformed to assess consolidation; range of motion and grip strength were recorded, andpatients completed a visual analogue scale for pain at rest, pain during activity, andsubjective functional status, as well as a DASH (Disabilities of the Arm, Shoulder andHand) questionnaire.Results: Eighteen patients were included. Union was observed in 17 patients. Theaverage follow-up time was 22 months, and the average final range of motion was asfollows: 87% for flexion, 84% for extension, 78% for radial deviation, 84% for ulnardeviation, and 85% for grip strength. The average score on the visual analogue scalewas 0 for pain at rest, 2 for pain during activity, and 9 for function, while the averageDASH score was 8.Conclusions: Using this simple and reliable technique, we obtained a 95% union andvery good functional results. Metaphyseal core decompression with an antegrade screwis a valid and effective alternative for treatment of proximal pole scaphoid nonunion incarefully selected patients.

Introducción: La enfermedad tromboembólica es una de las complicaciones serias en la cirugía ortopédica. La tromboprofilaxis para las cirugías de tobillo y pie no está estandarizada, porque la incidencia es baja, según la bibliografía. El objetivo de este estudio es aportar un algoritmo de prevención para la trombosis venosa profunda y una revisión de la bibliografía.Materiales y Métodos: Se llevó a cabo una revisión de las historias clínicas de los pacientes operados entre 2011 y 2017. La muestra estaba integrada por 696 hombres (28,98%) y 1706 mujeres (71,02%), con un promedio de edad de 51 años (rango 20-82). Se realizaron 2402 procedimientos, 575 (23,94%) fueron por patologías traumáticas y 1827 (76,06%), por patologías ortopédicas.Resultados: Nueve pacientes (0,37%) presentaron trombosis venosa profunda y solo dos, tromboembolismo pulmonar (0,08%). Los procedimientos en los que ocurrieron fueron: artroscopia, reparación aguda del tendón de Aquiles, hallux valgus y fractura del 5.° metatarsiano.Conclusiones: Se recomienda un enfoque multimodal para la profilaxis de la trombosis venosa profunda. Esto incluye abordar los factores de riesgo modificables, mediante la profilaxis mecánica, la movilización temprana y la profilaxis química. La heparina de bajo peso molecular es eficaz para reducir la tasa de trombosis venosa profunda y tromboembolismo pulmonar. AbstractIntroduction: Deep vein thrombosis (DVT) is a major complication in orthopedic surgery. According to the literature, thromboprophylaxis in foot and ankle surgery is not a standardized practice due to the low incidence of DVT.Materials and Methods: We reviewed the medical records of surgical patients. Between 2011 and 2017, 1591 surgeries were performed, 6 of them due to symptomatic DVT.Results: The incidence of DVT in major orthopedic surgeries, such as knee and hip, is well documented, but there are only a few reports about its incidence in foot and ankle surgery. It is considered a relatively rare complication in many published studies; thus, preventive drug therapy is not routine practice.Conclusions: A multimodal approach to DVT prophylaxis for high-risk patients is recommended. All risk factors should be addressed, such as mechanical prophylaxis, early mobilization, and the use of chemoprophylaxis. Low molecular weight heparin is effective in reducing the rate of clinically significant DVT and is also likely to reduce the rate of pulmonary embolism.

El osteosarcoma “tipo osteoblastoma”, una variante menos agresiva del osteosarcoma, es una enfermedad poco frecuente y representa un desafío diagnóstico tanto clínico como histopatológico. Se han publicado escasos reportes de casos de este tumor.Presentamos a un paciente de 16 años con un osteosarcoma “tipo osteoblastoma” localizado en la columna cervical. La biopsia ósea bajo tomografía reveló una lesión con un patrón de crecimiento permeativo, con sospecha de osteosarcoma “tipo osteoblastoma”. Se realizó una espondilectomía total en bloque mediante un doble abordaje. Se describen el caso clínico, la secuencia diagnóstica, la técnica quirúrgica y el seguimiento a 10 años. ABSTRACT Osteoblastoma-like osteosarcoma; a less aggressive variant of osteosarcoma;is a rare entity and represents a clinical and histopathological diagnostic challenge. We have found few reports of cases of this tumor in the literature. In this case we describe an osteoblastoma-like osteosarcoma located in the cervical spine in a 16-year-old patient. Tomography guided bone biopsy showed a lesion with a permeative growth pattern with suspicion of an osteoblastoma-like osteosarcoma. A total block spondylikectomy wasperformed through a double approach. We present the clinical case, the diagnostic sequence, the surgical technique and 10-year follow-up.

Patellar tendon-lateral femoral condyle friction syndrome is discussed, a condition that has received little attention in orthopedic literature. In many cases, it is an incidental finding on MRI when there is no clinical suspicion or even confirmation of Hoffa fat pad impingement (FPI) syndrome. Identification of pathognomonic findings on imaging studies is key, both for selecting the adequate treatment option and to distinguish this condition from other causes of anterior knee pain. Although there is currently no definitive etiology for the syndrome, its identification is important for both diagnosis and treatment.