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

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Objective: To determine the demographic data of the patients in relation to age, sex, profession, affected side, single or multiple lesions, type of material used, bone healing time and possible complications of the treatment of diaphyseal fractures of the humerus treated using the MIPO technique in a series of patients from three hospital units in Ecuador, Paraguay, and Brazil. Materials and Methods: A retrospective, longitudinal, observational study of data from 133 patients collected in 3 services in Quito, Ecuador; Asunción, Paraguay; and Passo Fundo, Brazil. The distributions between different services were compared using Pearson’s chisquare test. Results: The age of the patients ranged from 17 to 76 years, with a mean of 36 years. The median time to union, which occurred in 126 of the 132 patients, was 11 weeks. Most of the patients were male (70.45%), the right side was the most affected (55.3%), most of the fractures were single (85.61%), consolidation occurred in 95.45 % of cases, complications occurred only in 9.09% of patients, 6.82% of them were severe. In relation to complications, they were divided according to the absence (87.12%) or presence of the following: post-surgical neuropraxia (0.76%), infection (3.03%), and pseudarthrosis (4.55%). Conclusion: The MIPO technique for the treatment of diaphyseal fractures of the humerus presents low rates of complications and morbidity, demonstrating good rates of consolidation.          

Introduction: Hand injuries caused by angle grinders are frequent and generally take place among young adults. In developing countries, the domestic and informal work environments are the most frequent places where this could happen. The present study is aimed at describing associated factors to these types of injuries. Lesions were quantified and classified according to the severity and anatomic region of the hand involved. Methods: An epidemiologic, retrospective study was performed between 2016 and 2020. The patients’ level of education, previous experience using the machine, use of personal protective equipment (PPE), sex, and age were analyzed. To determine the pattern of the injuries, a clinical-anatomical and a detailed and individualized radiological analysis were performed on each patient. The severity was measured using the “Hand Injury Severity Score” (HISS). Results: 928 patients were studied (920 men, 8 women, average age of 42 years [range 18-67]). Only 22.4% were wearing PPE at the time of the accident. 776 participants were performing tasks for which the tool was not intended (84.5%). The left hand was the most affected (60%). In 784 patients, the injuries involved their fingers (84.48%); the predominant pattern was the index and middle finger (55%). According to the HISS, 24.1% were minor injuries, 41.3% were moderate, 26% were serious, and 8.6% were severe. Conclusions: Injuries caused by an angle grinder can be devastating. We believe that an epidemiological update is likely to increase the need to develop preventive methods to decrease its high incidence.

Objective: Our research aims to describe the functional and radiographic outcomes and complications of percutaneous surgery in Sanders type IIC tongue-type calcaneal fractures. Materials and Methods: 9 articular displaced calcaneus fractures in 9 patients were evaluated with lateral and anteroposterior radiographs and preoperative axial computerized tomography. Non-weight-bearing foot radiographs -lateral and anteroposterior- were taken in the immediate postoperative period, and weight-bearing radiographs were taken at the sixth and twelfth weeks, and when finishing follow-up. Böhler's angle was measured, and subtalar and calcaneocuboid osteoarthritis grade was quantified. The AOFAS score, wound complications, neurological injuries, and the need for additional surgeries such as hardware removal and subtalar arthrodesis were considered. Results: 3 women and 6 men complied with follow-up during 21.1 months. The patients’ average age was 42, +-12. The preoperative Böhler angle was 7° (+-6.2°) and the final postoperative angle was 33.6° (+-4.1).(p<0.00001). Subtalar range of motion presented a minor restriction in every patient. Neither subtalar nor calcaneocuboid osteoarthritis was observed. The AOFAS score was good in 4 patients and excellent in 5 of them. 100% of the patients presented good and excellent outcomes. We did not record wound infections or complications. Conclusion: Percutaneous surgery in Sanders type IIC tongue-type calcaneal fractures allows us to reach a significant reduction with good functional outcomes and minor soft-tissue complications.

Introduction: Tibial fractures represent approximately 2% of adult fractures. Today, intramedullary nailing is the procedure of choice to treat diaphyseal fractures of the tibia; however, this technique is not exempt from complications, misalignment in the coronal plane is one of the most frequent and feared by surgeons. The aim of this study was to investigate the relationship between nail entry point and misalignment in the coronal plane after surgery. Materials and Methods: We carried out a retrospective, descriptive, observational study between January 2015 and January 2019 of patients with diaphyseal fractures of the tibia, treated with intramedullary nailing. Radiographs were obtained in the immediate postoperative period and then every two months. The eighth-month radiograph, in which clear signs of bone consolidation could be observed, was taken into account to assess tibial alignment. Results: When the nail entry point was central, there was only a 0.021 chance (or 2.1%) of any significant misalignment in the immediate postoperative period and after 8 months. In contrast, when it was medial, the chances of a valgus tendency were >0.85 (or 85%) already at the first image, i.e., post-surgery; and when it was lateral, this possibility was modified and deepened according to the time elapsed until the image achieved in the patient. Conclusion: A marked and continuous relationship was observed between the entry point of the intramedullary nail and the alignment of the tibia after bone consolidation.

Objective: To evaluate the results of different nerve transfers used for elbow flexion in patients with traumatic brachial plexus injury. Materials and Methods: Between April 2012 and January 2019, 13 patients (12 men) with traumatic brachial plexus injury underwent surgery. 5 patients had total paralysis and did not recover, 4 had total paralysis and partially recovered the lower trunk, and 4 had high paralysis. The nerve transfers performed for elbow flexion were: 3 intercostal nerves with a sural graft to the musculocutaneous nerve or its motor branch(es) (4 patients), 3 intercostal nerves to the musculocutaneous nerve without graft (3 patients), the accessory spinal nerve to motor branches of the musculocutaneous nerve with sural graft (2 patients), fascicles of the ulnarnerve to the motor branch of the biceps (3 patients) and fascicles of the ulnar nerve and fascicles of the median nerve to the motor branches of the biceps and anterior brachialis (3 patients). We assessed elbow flexion strength (M0-M5), pain on the visual analog scale, and DASH score. The average follow-up was 50 months. Results: Elbow flexion strength was M5 (1 patient), M4 (7 patients), M3 (1 patient), M2 (1 patient), and M1 (2 patients). The mean DASH score was 54.1 before surgery and 29.5 postoperatively. The preoperative pain score was 7 and 0.9 postoperatively. There were no complications. Conclusions: Nerve transfers achieved satisfactory outcomes for active elbow flexion reconstruction in patients with brachial plexus injury.

Introduction: Minimally invasive techniques are preferred to treat acute Achilles tendon ruptures. They represent an option to avoid integumentary complications, and sural nerve injury is one of its main problems. This study aims to verify the usefulness of ultrasound in preventing sural nerve injury during Achilles repair with percutaneous techniques. Materials and Methods: Study in 12 cadaveric pieces. We recreated an injury at the level of the Achilles tendon, 5 cm proximally to its distal insertion. In one of the cadaver limbs, the sural nerve and/or its satellite vein were identified by ultrasonography. We repaired the sural nerve percutaneously with two needles at the proximal level and two needles at the distal level of the lesion and represented the path of the sural nerve. In the contralateral limb, the sural nerve was not identified by ultrasound. We performed the percutaneous repair of the injuries using the Ma & Griffith technique. Results: In the ultrasound group, no sural nerve injuries were identified. In the control group, two sural nerve injuries were observed (p=0.6). In all cases, the identification of the sural nerve by ultrasound was correct. Conclusion: Ultrasound assistance in the percutaneous treatment of Achilles tendon injuries is an effective and reliable method to prevent sural nerve injuries.  

Introduction: The use of double osteosynthesis for the treatment of fractures of the distal femur with metaphyseal comminution (AO 33C2, C3) and periprosthetic fractures (Vancouver C) provides greater stability. The use of helical plates has increased in order to avoid vascular damage related to the approach. Materials and Methods: Between 2017 and 2021, six patients were treated by double plate osteosynthesis (helical plate by medial approach). The series consisted of four females and two males, 66% (4 patients) had distal femoral fractures, and the rest (33%, 2 patients) were diagnosed with Vancouver C periprosthetic fractures. Results: In all cases, radiographic consolidation was observed 6 months after surgery, with a normal return to activities of daily living. None of them presented an associated neurovascular injury. Conclusion: The helical plate is a great option in distal femur fractures and Vancouver C periprosthetic femoral fractures. By applying the basic principles of osteosynthesis, sophisticated materials can be supplied, obtaining good clinical, functional, and radiographic outcomes.

Fractures of the distal femur, especially open fractures, occur in association with high-energy trauma. The presence of associated injuries around the knee is common; however, the association with a complete quadricipital tendon injury has been poorly documented. Early diagnosis and adequate treatment of both injuries is essential to achieve good postoperative outcomes. We present two cases of exposed intra-articular distal femoral fractures associated with complete quadricipital tendon injuries. The repair of the associated tendon injury with transosseous tunnels after fracture fixation allows an early rehabilitation protocol, essential to obtain good functional outcomes.