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

This article studies the late and unequal mechanization of the mining industry in Vizcaya from 1876 to 1936. The methods of working are described in the first part. They were labour-intensive unti1 First World War, and after 1920 the great firms purchased machinery. The second part presents a set of hypothesis about this process of mechanization, relating prices of mineral, relative prices of inputs and the prevailing patherm of small-scale ownership. The hypothesis are empirically tested in the third part of the article, which concludes relating mechanization, productivity and competitiveness of the sector.

Background: Hip fractures are associated with a significant impact on morbidity and mortality. The aim of this report was to identify the variables related to the development of complications and mortality after a hip fracture. Materials and Methods: We carried out a data analysis from the first 1000 hip fracture surveys from the Morbidity and Mortality Committee of the Asociación Argentina de Ortopedia y Traumatología. Through a bivariate analysis and a multivariate regression, the independent variables related to the presentation of complications or death were identified. Results: Complications were related to pre-operative anemia, delay in surgery, hospital stay, and red blood cell transfusions. In addition, mortality was related to pre-operative anemia, red blood cell transfusions, hospital stay, ASA score, and postoperative complications. Multiple regression analysis revealed anemia and prolonged hospitalization to be significant predictors of complications, while anemia and ASA score were recognized as predictors of mortality. Conclusion: This study highlights the predictive value of anemia, an ASA III-IV score, and hospital stay in relation to the morbidity and mortality of patients with hip fracture. Various efforts should be made to optimize the condition of these patients and the health system in order to reduce this impact on morbidity and mortality.

Introduction: Children with GMFCS IV and V spastic cerebral palsy (CP) are at risk of developing early-onset scoliosis (EOS). There is no agreement about treatment for very young children (less than 5 or 6 years old). This systematic review focuses on this problem. Materials and Methods: We conducted a search in the PubMed, Scholar Google, Cochrane Library, BVS/BIREME, LILACS, and SCIELO databases from 1/2009 to 11/2020, using the following keywords: “cerebral palsy”, “scoliosis”, “early-onset”, “treatment”. We eliminated duplicated articles, those with unrelated research, without complete text, with very few spastic CP patients or patients aged over 6, and without clear etiology or results. The variables evaluated in the selected articles were: level of evidence, average age, GMFCS level, deformity types, treatments, follow-up, outcomes, and complications. Results: From the 6770 articles retrieved, only 10 were included: 8/10 with evidence level IV, average ages 3.2 to 10 years old, scoliosis as prevalent deformity, average follow-up 1.5 to 9.8 years. Treatment: traditional growing rods (3), magnetic growing rods (1), early instrumented fusion (2), casting (1), orthotics (2), and VEPTR (1). Early instrumented fusion provides >/= 75% of Cobb correction; growing rods, orthotics, and VEPTR, between 25 and 50%, and plaster casts only prevent progression. Non-surgical treatments have a lower rate of complications (5.8%-36%) than surgical ones (21.5% - 73.1%). Surgical complications and postoperative mortality are higher in spastic than in hypotonic patients. Conclusions: Surgery is not a good initial option in very young children with spastic, GMFCS IV-V CP.

Objectives: Intertrochanteric fractures are increasingly frequent due to population aging. Osteosynthesis with cephalomedullary nail is widely used for the treatment of these fractures. The objective of this study is to analyze the rate of failure in osteosynthesis associated with cephalomedullary nail and the risk factors for this event. Materials and Methods: All cases of patients older than 75 years with intertrochanteric fractures treated in our center with cephalomedullary nails between January 2016 and December 2019 were retrospectively analyzed. The cervico-diaphyseal angle of the operated hip was determined in the immediate postoperativeperiod. We also analyzed the tip-apex distance (TAD) and the position of the lag screw in the femoral head. Results: 66 patients were included in the study. There were 8 cases of failure in osteosynthesis (12.12%). It was found that previously recognized factors in the literature (TAD>25 mm and reduction in varus) were also significant risk factors for failure in osteosynthesis in our cohort. The inadequate position of the lag screw was a risk factor that showed statistical significance in the univariate analysis, but not in the multivariate one in this study. Conclusions: When treating intertrochanteric fractures with cephalomedullary nail, a neutral or slightly valgus reduction aiming for a TAD ≤25 mm significantly reduced the risk of failure in osteosynthesis. We found evidence that a superior or posterior location of the lag screw increases the risk of fixation failure, although the location of the screw was not a significant risk factor in the multivariate analysis.  

Phosphaturic mesenchymal tumor (PMT) is an infrequent clinicopathological entity. It presents insidious bone pain and polymyalgia, accompanied by alterations in calcium and phosphorus metabolism that are difficult to resolve clinically. A multidisciplinary approach is a key to success in this pathology. We present the case of a 52-year-old female patient with a 10-year history of PMT in the right hemipelvis with ipsilateral hip extension. From the clinical point of view, she presented oncogenic osteomalacia (hypophosphatemia and hyperphosphaturia) that did not correct despite being administered the latest generation medication, burosumab, an FGF-23 inhibitor that increases renal tubular phosphate reabsorption. Resection with oncological margins was decided by a multidisciplinary committee resolving her clinical condition. Due to the rarity of this pathology, we decided to report the case

Introduction: Anterior knee pain is the most frequent cause of reoperation after intramedullary nailing of a tibial fracture. In recent years, semiextension approaches have simplified the surgical technique, but postoperative pain continues to be the most frequent complication. The aim of this study is to compare the medial parapatellar approach (PPM) vs the suprapatellar approach (SP) with respect to knee pain and postoperative function after intramedullary tibial nailing. Materials and Methods: We retrospectively formed 2 groups of patients with tibial fractures treated with intramedullary nailing through the PPM (n:33) and SP (n:17) approaches. We evaluated postoperative knee pain with the VAS and Lysholm score; and function with the SF-12. They were clinically evaluated at 1, 3, 6 and 12 months. Results: The mean age of the groups was 41.5 years (29-76) for the PPM group and 40.4 years (23-90) for the SP group. Pain and knee function were significantly better in the group of patients operated through the SP approach. Conclusion: The suprapatellar approach is associated with less knee pain and better postoperative function after intramedullary nailing of a tibial fracture. However, prospective studies should validate these results.

Background: Multiple vertebral fractures (MVF) are the result of high-energy trauma. These can be contiguous (CMVF) when there is a fracture of two or more vertebral bodies in an adjacent way and non-contiguous (NCMVF) when there are lesions of various levels separated by at least one vertebra without injury. Objective: To evaluate clinical features and kinematics, establish distribution, evaluate association with extra-vertebral injuries, detail complications. Materials and Methods: A multicenter, prospective, and observational study. Patients with MVF. Results: Sixty-six patients presented 196 vertebral lesions, without neurological deficit in 55; 26 were women and 40 were men, with an average age of 39 years old. Kinematics: 32 car accidents, 27 falls from height, 5 direct traumas and 2 sports traumas. Topography: 2 C0-C3, 4 C3-C7, 8 C7TT1, 61 T1-T10, 91 T10-L2, 28 L2-L5 and 1 sacrum. Combination: 21 thoracolumbar-thoracolumbar and 8 thoracic-thoracic. There were 32 contiguous injuries, 19 non-contiguous injuries, and 15 mixed-pattern injuries. Twenty-six patients presented 47 extra-verterbral injuries (20 multiple trauma, 12 thoracic trauma). 36 patients received non-surgical treatment and 30 patients underwent surgery. Conclusion: The presence of MVF in spinal cord trauma is frequent, most do not show neurological involvement and are consequences of motor vehicle accidents. The most affected sector was between T2 to L5, the most frequent combination was thoracolumbar-thoracolumbar, followed by thoracic-thoracic; the most frequent were extra-vertebral injuries, mainly head and chest trauma. Complications: one patient hadincreased kyphosis; one, surgical site infection; and one patient died.

Background: The aim of this retrospective study was to assess whether open reduction with cerclage wire affected the union and/or complication rate in subtrochanteric hip fractures treated with cephalomedullary nails. Materials and Methods: We analyzed all patients who had undergone surgery in our center between January 2010 and December 2017. We comparatively analyzed those treated with (Group A) and without (Group B) cerclage wire in terms of fracture type, hospital stay, surgical time, blood transfusions, malalignment, union, and complications (infection rates, non-union, and reoperations). Results: Fifty-eight patients were included. Group A consisted of 20 patients and Group B of 38. The most frequent type of fracture was 3A (p 0.0004). The mean hospital stay was similar (9 vs 10.6 days p 0.81), the surgical time and transfusions were higher in group A (p<0.0001 and p 0.58 respectively). The union rate was similar (90 vs 92.1%;p 0.09, respectively). Malalignment was only observed in group B (5 - 13.5%; p 0.01). Thecomplication (15 vs 18.4%) and reoperation (15 vs 15.8%) rates were similar (p 0.99). Conclusions: The use of cerclage wire in subtrochanteric hip fractures treated with cephalomedullary nails generated a significant increase in surgical time and a lower rate of malalignment. It allowed a lower rate of re-operation, although it was not significant.

Arterial thrombosis after total knee replacement (TKR) is a rare complication; however, it can lead to disastrous consequences. We describe a case of an arterial occlusion after TKR in an 85-year-old female patient. Initially, the clinical presentation made us consider Raynaud (she had a history of CREST) and complex regional pain syndrome, which delayed the diagnosis for 2 weeks. Diagnosis and treatment were accomplished with angiography and the patient achieved a full recovery. The low frequency of this injury may make diagnosis a challenge for the surgeon. In this case, partial occlusion of the arteries avoided more serious complications.  

Introduction: On March 11, 2020, the WHO declared a global pandemic due to COVID-19 that affected orthopedic practice worldwide. To analyze the influence of COVID-19 on the employment situation of the members of the Argentine Association of Orthopedics and Traumatology (AAOT), we have conducted 3 surveys from the beginning of March 2020 to the post-vaccination stage in July 2021. The objectives were to determine differences between the relative reduction of work (outpatient clinics, surgeries) during the three phases of the pandemic: pre-peak, peak, and vaccination stage and to differentiate between the studied population, protective care, activity, tests, infection, isolation, and vaccination. Materials and Methods: Prospective survey, in three stages, to members in general, authorized by the Board of Directors, from the beginning of compulsory social isolation (R0 2.8), through the peak and post-vaccination stages. Results: We observed a low degree of participation that progressively decreased between phases. In the first survey, 6.99% had been tested; in the second, 25.29%; and after 6 months, 88.2%. The reduction of habitual activities and the incorporation of telemedicine as a new way of doctor-patient exchange was the novelty in the second part of the survey. Conclusion: Protection systems have given an acceptable percentage of reliability with a high vaccination rate among specialists. Despite the risk and fears of contagion, telemedicine has not managed to be an alternative accepted by both professionals and patients.