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

Introduction: Proximal humeral fractures (PHF) are common, particularly in the elderly. Locking plate fixation continues to provide unpredictable outcomes. Medial hinge support plays a significant role in stability. We aim to evaluate the outcomes of plate fixation with endosteal strut allograft augmentation in PHFs. Materials and Methods: We evaluated the clinical and radiological outcomes of 12 patients with PHF who were treated with plate fixation and strut allograft augmentation. The strut allograft was introduced into the humeral shaft to add support to the medial hinge. We compared the final follow-up radiographs to those taken immediately after surgery. We defined a loss of reduction if the change in Humeral Head Height or the Neck-Shaft Angle measured over 3 mm or 5°, respectively. The clinical evaluation included range of motion, Constant-Murley (CM) score, Subjective Shoulder Value (SSV), Visual Analog Scale (VAS), and return to daily activities. Results: Twelve patients completed follow-up. The patients’ average age was 62.8. Ten patients healed without loss of reduction. Average CM and SSV scores were 82.1 and 80%, respectively, and average VAS was 1.9. Anterior elevation averaged 138.3°, external rotation 49.5°, and internal rotation at L3 level. The mean differences in HHH and NSA were 2.3 mm and 4.92°, respectively. We recorded no complications associated to the procedure. Conclusion: Locking plate fixation with endosteal strut allograft augmentation is a reliable technique for the treatment of PHF. It provides support to the humeral neck and maintains reduction in fractures with disruption of the medial hinge.

Introduction: We present a case of a lateral circumflex femoral artery pseudoaneurysm associated with pertrochanteric hip fracture. Materials and Methods: We performed a systematic review considering all cases published in the last 15 years about this pathology (n=40). Results: No statistically significant associations were found between any of the variables studied. However, there seems to be some consensus in maintaining a high clinical suspicion for early intervention, thus obtaining better outcomes. Both its etiology and location are related to the morphology of the fracture, the surgical procedure, and the osteosynthesis material. Likewise, there is a greater tendency to use CT angiography for the diagnosis and localization of the pseudoaneurysm. Conclusion: Our patient is the first reported case of spontaneous resolution. Knowing this rare complication is essential to optimize therapeutic results. This review, the most recent on the subject, is very useful in listing and highlighting the most important aspects of the management and prevention of pseudoaneurysms secondary to hip fracture.

Background: Several surgical techniques have been developed to reduce nonunion rates and improve functional outcomes after displaced distal clavicle fractures, including the use of a tension band, the modified Weaver-Dunn procedure, coracoclavicular screw fixation, or locking plates. None of these techniques have been universally accepted, and each one has its own complications. NTo our knowledge, there are no previous publications describing osteolysis of the coracoid process caused by the tip of a cortical screw of a distal LCP plate. Case summary: We present the case of a 29-year-old male patient who had been treated with an anatomic pre-contoured plate for a distal clavicle fracture. Six months later, he presented to our institution with limiting shoulder pain and tenderness upon the right coracoid process. Standard radiographs of the shoulder showed that the tip of a cortical screw was eroding the coracoid process. Surgery with hardware removal was then performed. One month after surgery, the patient was painless and with a full active shoulder ROM. Conclusion: Erosion of the coracoid process with plate screw fixation has never been described before. We suggest that extreme precaution should be taken in drilling and measuring the length of screws to avoidpotential complications.

Objective: We aim to describe the lengths of hospitalization, surgery, and rehabilitation of a series of patients with floating hip. As a secondary objective, to compare the outcomes obtained in terms of return to work in patients who had suffered fractures of the pelvis or acetabulum without an associated femoral fracture. Materials and Methods: Descriptive, retrospective, and multicenter study of patients with high-energy trauma to the pelvis and acetabulum divided into two study populations according to the presence of associated ipsilateral femur fracture (floating hip) for comparison, during the period January 2014 – March 2019. Results: 102 patients with pelvis and/or acetabulum trauma were included, grouped into 2 populations according to the presence of a floating hip (Floating hip: 23 patients; Pelvis/acetabulum: 79 patients). The median days of hospitalization [floating hip: median=15.5 (range=4-193); pelvis/acetabulum: 7 (3-31); p = 0.0001] and the number of surgeries per patient [FH: median = 5 (range = 3-8); pelvis/acetabulum: 2 (1-4); p = 0.0001] were higher in patients with floating hip. Additionally, temporary work disability was higher(p = 0.00012), with no significant differences in the rate of job retraining (p = 0.11). Conclusion: Floating hip significantly increased the length of hospitalization, necessary surgical procedures, and recovery times according to temporary work disability in patients with trauma to the pelvis and/or acetabulum.

Introduction: There is a wide variety of therapeutic options for the reconstruction of segmental bone defects caused by fractures, tumors, or infections, but it continues to be a challenge in orthopedic surgery. Materials and Methods: The present work presents six (6) cases of patients with massive bone loss treated by means of what we call a “synergistic combination” of an induced membrane, to provide biological benefits, plus a trabecular titanium scaffold designed for each patient to provide stability and structure. Results: Five men and one woman with an average age of 30 years were operated on by this technique.The average follow-up was 24 months. In the immediate postoperative period, the axis, length, and sufficient mechanical stability to initiate partial weight-bearing were reestablished. Full weight-bearing according to the patients’ conditions (pain, muscle strength) required an average of 25 to 30 days. Conclusion: We propose a rare treatment option in our field with sufficient biomechanical stability to tolerate early weight-bearing, recovering the entire length of the defect in a single stage with excellent functional outcomes, understanding these as an advantage over traditional therapeutic options such as bone transport or the Masquelet technique.

Introduction: There are multiple approaches described in the literature for the treatment of fractures that involve the posterior columns of the tibial plateau. We present an anatomical intergastrocnemius approach for the treatment of all fractures involving the posterior component. It allows access with complete visualization of the entire posterior region, facilitating the reduction and placement of the osteosynthesis material necessary to achieve the most stable configuration. Surgical technique: We describe the posteromedial intergastrocnemius approach to access the tibial plateau performed by our team. Conclusion: We consider that this approach represents an option to consider when treating fractures that affect both posterior columns, some of them in isolation, or the tibial insertion of the PCL. Although the neurovascular structures require constant attention during the surgical procedure, their direct vision and their meticulous protection, performed by experienced surgeons, minimizes the risk of injury, and their manipulation is not a contraindication for using this approach.

Objetivo: Las cirugías con WALANT han ganado gran popularidad hoy en día. La ventaja principal que ofrece esta técnica es la de prescindir del torniquete y así eliminar las molestias que este genera. Nuestra hipótesis es que la descompresión del túnel carpiano con anestesia local y manguito neumático, realizada por un cirujano experimentado, en un tiempo quirúrgico corto, permite obtener similares resultados que con la cirugía con WALANT. Materiales y Métodos: Se diseñó un estudio de cohortes prospectivo comparativo clínico. Se incluyeron 23 pacientes (30 manos) con síndrome del túnel carpiano. Se asignó a los pacientes en forma aleatorizada, a 2 grupos: grupo 1, operados con anestesia local y grupo 2, operados con WALANT. Se realizó un análisis estadístico. Resultados: Todas las variables mostraron diferencias estadísticamente significativas respecto a los valores preoperatorios para los dos grupos. Respecto a la relación entre los dos grupos, los resultados funcionales de dolor y grado de satisfacción posoperatorios no mostraron diferencias con significancia estadística. Conclusiones: En nuestro estudio, la descompresión del túnel carpiano con anestesia local y torniquete y la realizada con WALANT arrojaron similares resultados. En cirujanos con experiencia posiblemente la anestesia local con torniquete sea suficiente para realizar el procedimiento, y así evitar las bajas, pero complejas complicaciones de la epinefrina.

Introduction: An aneurysmal bone cyst is an expansive, lytic, pseudotumoral lesion that consists of blood-filled spaces separated by septa. It represents 15% of primary spinal tumors. An aggressive presentation is even rarer. Different therapeutic options are described depending on its stage and recurrence rate. We present the case of a patient with neurological involvement due to the aggressive behavior of an aneurysmal bone cyst in the thoracic spine, which required surgical treatment. Conclusion: Treatment options for aneurysmal bone cysts must adapt to each case, depending on its characteristics.Level of Evidence: IV

Objective: To retrospectively evaluate the different variants of Lister’s tubercle (LT) and extensor pollicis longus (EPL) using magnetic resonance imaging (MRI) of the wrists, and based on these findings propose variables for classification. Materials and Methods: Retrospective study using images from MRI database files between 03/01/19 to 11/10/19. We included MRI of the wrist of healthy patients (axial, sagittal, and coronal slices of 1 mm thickness) who were older than 18 years, with no history of previous or current wrist or carpal fracture, excluding those who did not meet these criteria. We analyzed LT, height of the radial and ulnar peaks, the angle, tubercle length, depth of the grooves and septum height. We evaluated the EPL, analyzing the height, thickness, surface, and presence of associated inflammation. Results: We evaluated 500 MRI of the wrist, obtaining 11 different subtypes of LT. We found 411 type 1 Lister tubercles, 58 type 2, and 26 type 3. Among these, the most frequent were types 1b. 26.6% presentedasymptomatic inflammation in 3rd and 4th compartments. Conclusion: Lister’s tubercle is of importance in many procedures and serves as an anatomical landmark, meriting to know its most frequent pattern and its anatomical variants. We propose an extension of the classification, adding new types of tubercles to be known and their relationship with the EPL.