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

Objetivo: Describir los resultados obtenidos en el tratamiento de las fracturas de húmero distal mediante reducción abierta y fijación interna y reflejar si el abordaje empleado tuvo impacto en el resultado funcional. Materiales y Métodos: Se llevó a cabo un estudio retrospectivo de presentación de casos. Se evaluó a 19 pacientes con diagnóstico de fractura de húmero distal compleja tratados con reducción abierta y fijación interna entre 2015 y 2021. Se realizó un control radiográfico periódico y se evaluó el resultado funcional mediante escalas internacionales, como DASH y MEPS. Luego se procedió a extrapolar las variables obtenidas utilizando un programa estadístico. Resultados: Se logró la consolidación de todas las fracturas. Se empleó el abordaje de Alonso Llames en 7 pacientes (37%) y la osteotomía de olécranon en 12 casos (63%). El puntaje DASH promedio fue de 11,31, lo que determinó discapacidades leves. El puntaje MEPS obtenido fue excelente en un paciente (5,26%), bueno en 10 (52,6%), regular en 7 (36,84%) y pobre en 1 (5,26%). Conclusiones: La reducción abierta y la fijación interna son eficaces para tratar las fracturas complejas de húmero distal, permiten lograr buenos resultados posquirúrgicos. En esta serie, el 57% de los pacientes obtuvo resultados excelentes o buenos. No se halló una diferencia estadísticamente significativa con respecto a la elección de un abordaje u otro

Introduction: One of the prophylactic techniques to reduce the incidence of periprosthetic infections is dilute povidone-iodine lavage, an agent with bactericidal action against different microorganisms. The purpose of this study was to evaluate the incidence of periprosthetic infections within the first 90 days in patients who had undergone povidone-iodine lavage after implantation of prosthetic components and before wound closure. Materials and Methods: A comparative retrospective study was performed on patients who had undergone primary total hip or knee replacement due to advanced joint osteoarthritis between October 1999 andApril 2020. We assessed the PJI rate between two cohorts: Group A, which consisted of patients who received povido ne-iodine lavage routinely, and Group B, where this solution was not applied. Results: 643 (47.60%) knee replacements and 708 (52.40%) hip replacements were performed. When comparing the incidence of periprosthetic infections between both groups, no statistically significant differences were observed (0.92% vs. 0.21%; p = 0.11). However, the risk of infection was increased in the first 90 days after surgery (OR = 4.5; 95% CI 0.56-36.19) when the solution was not used. Conclusions: The risk of developing periprosthetic infections increased 4.5 times when performing an arthroplasty without irrigation with diluted povidone-iodine. However, this could not be shown to be statistically significant.

Introduction: Early diagnosis of a periprosthetic joint infection (PJI) and identification of the pathogen are paramount. Next-generation sequencing (NGS) can identify the nucleic acids in a given germ in a short period. To our knowledge, there are no reports of its use in the management of PJI in South America. Our objective was to demonstrate the diagnostic feasibility of the NGS technique on the samples obtained from a series of patients operated on in Buenos Aires, Argentina. Materials and Methods: A prospective series of 20 patients undergoing septic and aseptic hip revision surgery from December 2019 to March 2020 was analyzed. Intraoperative samples of synovial fluid, deep tissue, and intramedullary canal were obtained and sent to the NexGen Microgen laboratory (Texas, USA) for analysis. Results: Seventeen patients were finally eligible to present a sample suitable for analysis. In 100% of the samples, NGS results were obtained within 72 hours of surgery. In one case, the NGS result reported agerm different from the one identified in the postoperative soft tissue cultures, allowing antibiotic therapy to be corrected. In another case, NGS identified Parabacteroides gordonii in aseptic revision surgery. In another patient, the NGS identified Morganella morganii, in which conventional postoperative cultures were negative in single-stage revision surgery. Conclusion: In this study, we demonstrated the diagnostic feasibility of NGS, obtaining results within 72 hours immediately after surgery for pathogenic organisms in patients with PJI and negative cultures.

Introduction: Dynamic studies of foot function are usually carried out in highly complex gait analysis laboratories. The objective of this study was to analyze functional parameters using a force platform in a series of asymptomatic patients evaluated in an outpatient clinic. Materials and Methods: Cross-sectional study, which included a consecutive series of volunteer asymptomatic patients who underwent a force platform measurement (TekScanMatScan®, Boston, MA, USA) between 2014 and 2020, in the City of Buenos Aires, Argentina. Results: 316 records were included, corresponding to 158 individuals with bilateral measurements.Most were women (66.5%), with a mean age of 47 years (SD 16.1). Fourteen variables were evaluated, corresponding to parameters of force, trajectory, and contact time. The total contact time was 0.79 seconds (SD 0.09), and the COF time according to the region of the foot was 20% in the heel, 26% in the midfoot, and 46% in the forefoot. The CPEI (Center of Pressure Excursion Index) value was 16.55% (SD 7.14). Conclusion: Foot functional parameters in asymptomatic patients are presented. The contact time of the foot on the ground, the force in the heel, midfoot, and forefoot, and the force trajectory were measured. No ionizing radiation was used. These findings could be used as reference values to detect pathological gaits. Level of Evidence: II

Introduction: Given the increase in hip arthroplasties in the last century, serious acetabular defects are increasingly frequent events. Their treatment represents a real challenge, due to the bone deficit and poor bone quality that these patients usually present. Materials and Methods: Six patients treated between 2016 and 2021 are presented. Five cases of pelvic discontinuity due to failed revisions, classified as Paprosky type IIIB, and one transverse fracture of the acetabulum, a possible treatment option in cases of osteoporotic patients. Results: The patients treated with this multidisciplinary technique were followed up for an average of 20 months, and none of them presented postoperative complications. The results evaluated by analogous scales are promising and invite us to establish this procedure as the gold standard. Conclusions: Strict evaluation is necessary for acetabular defects. The inclusion of medical IT makes it possible to study the need to use bank grafting and to manufacture custom-made multiporous trabecular titanium/tantalum implants, which is ideal for achieving osseointegration, added to the possibility of planning the direction and length of the screws to the remaining bone, according to its quality. The cementation of a dual mobility cup inside the customized implant reduces the risk of dislocation and overload of the latter, by eliminating metal-metal friction.

Osteosarcoma

An 8-year-old male consulted for a tumor on his right leg. He reported that the pain had started approximately 2 months earlier, that it was continuous, occurred in the evening, and had increased over the days. At the time of consultation, the pain was constant, of variable intensity, and increased with weight-bearing and activity. It did not wake him up at night, he had not had a fever, sweats, or concomitant systemic symptoms.

Introduction: To our knowledge, there is no published literature on the outcomes of short-stem total hip arthroplasty (THA) in patients under 20 years old. This study aimed to analyze clinical, radiological, and functional outcomes in patients under 20 years of age undergoing THA with a short uncemented 2B femoral stem. Materials and Methods: We carried out a retrospective study of 13 patients (16 THAs) treated between January 2006 and January 2021. The mean age and BMI were 16.5±2.5 years and 22.74±4.06 kg/m2, respectively. The mean follow-up was 43.3 months (range 12-128, SD ± 33.45). Surgical indications, as wellas functional and radiologic outcomes, were analyzed. Implant survival was calculated with the Kaplan-Meier estimate. Results: The predominant indication was avascular necrosis (9/16 hips [56%]), of which 66% were associated with prolonged use of corticosteroids. Eight (50%) of the cases had undergone surgeries before the THA. The Harris hip score improved significantly from 33±16.5 to 94±5.6 (p<0.001). Ten (76%) patients required assistive devices to walk preoperatively, and no patient required them at the end of follow-up. Radiolucency was evident in one acetabular component, without clinical implications. There were no signs of femoral component loosening. The implant survival was 100% at the last follow-up. Conclusions: Short stems in primary THAs in patients under 20 years of age with advanced hip osteoarthritis showed clinical, functional, and radiological outcomes comparable to those previously reported in the literature for conventional stems, with the particularity of being less invasive and sparing femoral bone stock.

Introduction: Total hip replacement (THR) is the most successful arthroplasty to date, not exempt from complications, such as prosthetic instability. Double mobility (DM) cups are a treatment option in the resolution of THR with recurrent dislocations due to instability. The objective of the study was to evaluate the results of cementing a DM component in a previous, stable uncemented cup, in a patient with recurrent dislocation, undergoing revision THR. A patient with uncemented THR with distal fixation after failedosteosynthesis, who presented episodes of recurrent dislocations, was treated by revision with a cemented DM implant inside a fixed uncemented primary cup and a proximal femoral module with extended offset, preserving tension, length and reducibility of the prosthesis. Resolution of the prosthetic instability was achieved and the patient did not present any episodes of dislocation, obtaining good outcomes in the short term. The hip Harris score went from 4/80 preoperatively to 61/80, 73/80, and 76/80 evaluated at 3, 6, and 9 months postoperatively, respectively. Conclusion: Cementation of a DM cup in a previously well-fixed cup appears to be a viable option to treat and prevent instability after revision THR.  

An adequate level of job satisfaction of the members of a health team is essential to guarantee the quality of the services provided, generate personal commitment, stimulate the desire to update, and promote retention within the system. We have not found any publication that specifically addresses this issue in the field of Orthopedics and Traumatology in our setting. The objective of this study is to know how the specialists who belong to the Argentine Association of Shoulder and Elbow Surgery perceive their working conditions, what their remuneration is and their degree of satisfaction, and to compare them with equivalents from other IberoAmerican countries. The results of the survey showed low average levels of satisfaction in the Argentine professionals surveyed. There are statistically significant differences with professionals from other Ibero-American countries both in terms of remuneration and wellbeing indices. If there are no profound changes in the healthcare system, the remuneration and the working conditions, sooner or later consequences will appear that will affect not only professionals but also patients and the system in general.