A comparison of three techniques for the osteosynthesis after minimal invasive osteotomies for hallux valgus

PURPOSE

Third and fourth-generation minimal invasive osteotomies (MIO) for the treatment of hallux valgus (HV) have become popular procedures worldwide with promising results due to the improvement in the fixation method. The tricortical cannulated screw placement remains a complex procedure that is technically challenging and requires a long skill learning curve with high radiation exposure mainly in the form of intensifier shots (IS) required for the MIO fixation. This study aims to compare the number of X-ray IS required using three different techniques for the cannulated guide placement.

METHODS

A retrospective cross-sectional observational and comparative study was conducted to assess the number of X-rays IS required for correct cannulated screw guide placement using three different techniques: traditional perforator, the drill and joystick, and K-wire first techniques.

RESULTS

A total of 53 MIS procedures from thirty-one patients in two different hospitals were included. IS X-rays were 155.1 ± 29.7 in the traditional technique (n = 14), 143.0 ± 43.2 in the drill and joystick technique (n = 22), and 85 ± 18.7 in the K-wires first technique (n = 17), p =  < 0.001 using one-way ANOVA.

CONCLUSIONS

The K-wire first technique statistically significantly decreases X-ray IS numbers p ≤ 0.001. There were no statistically significant differences between the traditional (after osteotomy K-wire placement) and the drill and joystick techniques (p = 0.36).

Epidural administration of ropivacaine and midazolam is superior to intra-articular administration as postoperative analgesia after isolated arthroscopic anterior cruciate ligament reconstruction with hamstrings autograft: a randomized controlled clinical trial

OBJECTIVE

Reconstructive surgery of the anterior cruciate ligament (ACL) is quite common, previous studies have documented that adequate pain control in the early phases of the postoperative period translates into early mobility and a rapid start of rehabilitation. Therefore, the search for new strategies for postoperative pain control is justified. The aim of this study was to compare intra-articular to the epidural administration of ropivacaine and midazolam as postoperative analgesia after arthroscopic ACL reconstruction with hamstring autograft (HA).

MATERIAL AND METHODS

Double-blinded, prospective randomized clinical trial included 108 consecutive patients aged from 18 to 50 years that had undergone arthroscopic ACL reconstruction with HA. The patients were randomly assigned to 2 groups. The first group received intraarticular ropivacaine and midazolam. The second group received epidural ropivacaine and midazolam. The need for rescue analgesia, the postoperative pain experienced, side effects and complications of the analgesic drugs were evaluated.

RESULTS

The intra-articular group received statistically significantly higher mean doses of rescue analgesia on the first two days (2.8 ​± ​1.0 vs. 1.3 ​± ​0.6 in the epidural group; p ​= ​0.001). Visual Analogue Scale scores at flexion were statistically significantly higher in the intra-articular group over the entire study period. The intra-articular group also reported a statistically significantly lower range-of-motion 87 ​± ​15 vs. 102 ​± ​11 in the epidural group (p ​= ​0.001).

CONCLUSIONS

Epidural administration of ropivacaine combined with midazolam in patients undergoing primary ACL reconstruction with HA was clinically and significantly better relative to rescue analgesia and the intensity of pain in the first 48 postoperative hours when compared to intraarticular administration. There was no difference in terms of adverse effects and complications.

LEVEL OF EVIDENCE: 2

Clinical efficacy of botulinum toxin in lateral elbow tendinopathy: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Botulinum toxin injections for lateral elbow tendinopathy have been used as an alternative therapeutic option. However, few studies have quantitatively summarized the effect of botulinum toxin as well as its clinical significance. We aimed to evaluate the clinical efficacy (based on pain and grip strength) and adverse events of botulinum toxin on lateral elbow tendinopathy.

PATIENTS AND METHODS

The MEDLINE, EMBASE, Web of Science, and Scopus databases were searched until March 2023 for randomized controlled trials reporting the effects of botulinum toxin injections on lateral elbow tendinopathy. A random- or fixed-effects model (depending of inter-study variability) and generic inverse variance method were used to pool quantitative data from outcomes. The risk of bias was assessed with the Cochrane Risk of Bias 2.0 tool.

RESULTS

A total of 8 clinical trials recruiting 438 subjects were included for meta-analysis. Pooled analysis revealed that botulinum toxin significantly reduced pain (mean difference [MD] -0.95, 95% CI [-1.63, -0.26], p=0.007) but it was not clinically relevant. No significant effect was detected for grip strength (MD-0.62kg, 95% CI [-2.25, 1.02], p=0.46) or in the risk for adverse events (odds ratio [OR] 0.41, 95% CI [0.05, 3.56], p=0.42) between botulinum toxin injection and control interventions.

DISCUSSION

The use of botulinum toxin reached greater pain relief than control interventions and normal saline after a period of 12 to 24 weeks. However, changes in pain relief did not reach clinical significance. The studies that had the greatest reduction in pain used higher doses of botulinum toxin (60 U). Additionally, differences in grip strength and adverse events did not reach statistical or clinical importance. A subanalysis indicated that botulinum toxin outperformed corticosteroid injections in terms of improving grip strength. Botulinum toxin only causes local and minimal side effects such as irritation, ecchymosis, and paralysis.

LEVEL OF EVIDENCE

I.

Effect of corticosteroids over plantar fascia thickness in plantar fasciitis: a systematic review and meta-analysis

OBJECTIVES

. Corticosteroid injections have been typically used for the management of plantar fasciitis with apparently good clinical outcomes; however, there is no information of the effect of corticosteroids on the thickness of the plantar fascia which is typically altered in this pathology. We aimed determine whether treatment with corticosteroid injections induces plantar fascia thickness changes in plantar fasciitis.

METHODS

MEDLINE, Embase, Web of Science, and Scopus databases were searched for randomized controlled trials (RCT) reporting the use of corticosteroid injection to treat plantar fasciitis to July 2022. Studies must have reported plantar fascia thickness measurement. The risk of bias in all studies was assessed with the Cochrane Risk of Bias 2.0 tool. Meta-analysis was conducted using a random-effects model and the generic inverse variance method.Results. Data from 17 RCT (including 1109 subjects) were collected. The follow-up period ranged from one to six months. Most studies measured the thickness of the plantar fascia at the insertion into the calcaneus using ultrasound. Pooled analysis revealed that corticosteroid injections had no significant effect on plantar fascia thickness (weighted mean differences [WMD], 0.06 mm [95% CI: -0.17, 0.29]; p = 0.61) or pain relief (WMD, 0.12 cm [95% CI: -0.36, 0.61]; p = 0.62) above active controls.

CONCLUSION

Corticosteroid injections do not perform better than other common interventions in terms of a decrease of plantar fascia thickness and pain relief for plantar fasciitis.

Open Inferior glenohumeral joint dislocation with complete range of motion recovery: Case Report and literature review

Luxatio erecta is an inferior glenohumeral dislocation. It is an uncommon pathology with a prevalence of 0.5% of all shoulder dislocations. An open luxatio erecta presentation is rarer. After an extensive literature search, we only could find three complete case reports. From these cases, 2 out of 3 developed complications such as infections and severely limited range of motion, especially in flexion and abduction. We report the case of a 39-year-old man with an open inferior glenohumeral joint dislocation with complete rotator cuff tear and fracture of the greater tuberosity secondary to a motor vehicle accident. He was treated with open reduction, glenohumeral capsulorrhaphy, and transosseous rotator cuff repair with good clinical outcome. In conclusion, an open inferior shoulder dislocation is rare, less than 0.1% of all dislocations, with a high incidence of nerve injury. We suggest prompt surgical treatment with immediate administration of antibiotic therapy, wound debridement, irrigation, open reduction, and repair of the rotator cuff as an adequate protocol and focused rehabilitation with early mobilization of the glenohumeral joint.

Fixed-bearing unicompartmental knee arthroplasty provides a lower failure rate than mobile-bearing unicompartimental knee arthroplasty when used after a failed high tibial osteotomy: a systematic review and meta-analysis

Despite the fact that the choice of bearing design has been thought to influence the functional outcomes and longevity of unicompartimental knee arthroplasty (UKA), there is a lack of clinical evidence supporting the decision-making process in patients who have undergone high tibial osteotomy (HTO). A systematic review of studies was carried out that reported the outcomes of fixed-bearing (FB) or mobile-bearing (MB) medial UKA in patients with a previous HTO. A random effect meta-analysis using a generalized linear mixed-effects model to calculate revision rates was done. Seven retrospective cohort studies were included for this study. Regarding the fixation method, 40 were the FB-UKA and 47 were MB-UKA. For both groups, the mean post-operative follow-up was 5.8 years. The survival rates were 92% for the FB-UKA with a mean follow-up of 10 years. For the MB-UKA, it ranged from 35.7 to 93%, with a mean follow-up of 4.2 years. For the FB, the time to revision was reported as 9.3 years, while 1.2, 2.5 and 2.91 years was reported for the MB. The results of the meta-analysis showed that the revision rate for the patients receiving a FB-UKA after failed HTO was 8%, compared to 17% in those who received an MB-UKA. The results of the review suggest that the use of the FB-UKA is associated with lower revision rates and a longer survival time than the MB-UKA and have similar functional ability scores.Level of evidence: III (systematic review of level-III studies).

Vertebral destruction in an 11-month-old child with spinal tuberculosis: a case report and review of literature

Background

The incidence of tuberculosis is increasing especially in endemic countries. Spinal tuberculosis represents nearly the 50% of reported cases of skeletal tuberculosis. This is the youngest case of spinal tubercular disease that has been reported. The objective of this report is to describe a spinal tuberculosis case in an infant in thoracic spine, in order to show the importance of early diagnosis in this population, to limit the progression of this highly destructive disease and reduce the severe sequelae that this disease is associated.

Case presentation

An 11-month-old infant previously healthy born in the northeast Mexico. Physical examination revealed a mass lesion in the dorsal region, fixed to deep planes, indurated. Neurological examination found Frankel C paraparesis showing muscle strength 2/5 on the Lovett scale in both lower extremities, anal reflex present, and preserved sensitivity.

In the magnetic resonance of the spine, hyperintensities in the vertebral bodies of D6-D9 were observed in the T2 with destruction of the D7 and D8 bodies. A thoracotomy was performed with total mass resection with corpectomy of vertebrae D7 and D8, medullary decompression, and placement of fibula allograft between vertebrae D6 and D9. In the histopathological sample, a chronic granulomatous inflammatory process associated with acid-fast bacilli was observed, in addition to presenting a positive result in quantitative real-time PCR GeneXpert MTB/RIF sensitive to rifampicin. Twelve months later, he presented 5/5 muscular strength, without alterations in sensitivity, in addition to presenting ambulation onset at 18 months of age.

Conclusion

The spinal tuberculosis is a disease that occurs in endemic countries. A prompt diagnosis is necessary to limit the progression of a highly destructive disease. In addition, the fact of presenting at an early age produces hard making decisions for the adequate treatment of the disease and reduces the adverse effects of these procedures.

The morphology of the femoral footprint of the anterior cruciate ligament changes with aging from a large semicircular shape to a small flat ribbon-like shape

PURPOSE

Compare the differences in the morphology of the ACL femoral footprint between the cadavers of the young and elderly in consideration of the degenerative physiological process that occurs with aging.

METHODS

The femoral footprint of the ACL was dissected in 81 knees of known gender and age (45 male/36 female). They were divided into four groups by age and gender, establishing 50 years as the cut-off point to divide patients by age. Three observers analyzed the femoral footprint dissections, and the shapes were described and classified. The area and morphometric characteristics of the femoral insertion of the ACL were determined and these were compared between genders and age groups.

RESULTS

The femoral footprint of the ACL from the cadavers of males younger than 50 years of age presented a semicircular morphology in 90% of the cases. In males aged more than 50 years, a ribbon-like morphology was found in 96% of the cases. In women less than 50 years old, the semicircular morphology was observed in 93.7% of the cases. In women aged over 50 years old, the ribbon-like morphology was found in 95% of the cases. A significant difference was observed between the prevalence rates of the morphologies, area size and measurements of the younger and older groups (p < 0.001 for both genders).

CONCLUSIONS

The femoral insertion of the ACL presents variations in its morphology, area and morphometric characteristics over time. It goes from a large semicircular shape that almost contacts the posterior articular cartilage to a smaller, flattened ribbon-like shape that moves away from the edge of the articular cartilage. It is bounded anteriorly by the lateral intercondylar ridge. These findings should be considered to avoid employing reconstruction techniques in which femoral tunnels with oval or rectangular shapes are used in patients under 50 years of age because they do not correspond to the morphology of the femoral insertion of the ACL in this age group.

Nerve gaps repaired with acellular nerve allografts recellularized with Schwann-like cells: Preclinical trial

BACKGROUND

Acellular nerve allografts (ANA) recellularized with mesenchymal stem cells (MSC) or Schwann cells (SC) are, at present, a therapeutic option for peripheral nerve injuries (PNI). This study aimed to evaluate the regenerative and functional capacity of a recellularized allograft (RA) compared with autograft nerve reconstruction in PNI.

METHODS

Fourteen ovines were randomly included in two groups (n=7). A peroneal nerve gap 30 mm in length was excised, and nerve repair was performed by the transplantation of either an autograft or a recellularized allograft with SC-like cells. Evaluations included a histomorphological analysis of the ANA, MSC pre differentiated into SC-like cells, at one year follow-up functional limb recovery (support and gait), and nerve regeneration using neurophysiological tests and histomorphometric analysis. All evaluations were compared with the contralateral hindlimb as the control.

RESULTS

The nerve allograft was successfully decellularized and more than 70% of MSC were pre differentiated into SC-like cells. Functional assessment in both treated groups improved similarly over time (p <0.05). Neurophysiological results (latency, amplitude, and conduction velocity) also improved in both treated groups at twelve months. Histological results demonstrated a less organized arrangement of nerve fibers (p <0.05) with an active remyelination process (p <0.05) in both treated groups compared with controls at twelve months.

CONCLUSIONS

ANA recellularized with SC-like cells proved to be a successful treatment for nerve gaps. Motor recovery and nerve regeneration were satisfactorily achieved in both graft groups compared with their contralateral nontreated nerves. This approach could be useful for the clinical therapy of PNI.

Clinical Efficacy of Botulinum Toxin in the Treatment of Plantar Fasciitis: A Systematic Review and Meta-analysis of Randomized Controlled Trials

OBJECTIVE

To evaluate the efficacy of botulinum toxin A (BTX-A) for the treatment of plantar fasciitis through a meta-analysis of randomized controlled trials (RCTs) focusing on pain and functional outcomes since current literature has supported a potential benefit of BTX-A.

DATA SOURCES

The MEDLINE, EMBASE, Web of Science, and Scopus databases were searched until December 2020 for RCTs reporting the effects of BTX-A injections on plantar fasciitis. The complementary literature search included Cochrane Central Register of Controlled Trials, Clinicaltrials.gov, and greylit.org.

STUDY SELECTION

Only RCTs assessing the effect of BTX-A injections on pain, functional improvement, or plantar fascia thickness in patients with plantar fasciitis were included. Multiple researchers carried out the screening process of the 413 records.

DATA EXTRACTION

Data were extracted independently and in duplicate using a standardized data extraction format. Information was contrasted by a third observer.

DATA SYNTHESIS

BTX-A injections resulted in significant pain relief (mean difference, -2.07 [95% CI, -3.21 to -0.93]; P=.0004; I²=97%) and functional improvement (standardized mean difference, 1.15 [95% CI, 0.39-1.91]; P=.003; I²=87%). A subanalysis indicated that pain relief was sustained at 12 months while functional improvement remained significant after 0-6 months. The results were not affected by a single study after sensitivity analysis. The site of injection and the use or not of ultrasound-guided injections may account for potential sources of interstudy heterogeneity.

CONCLUSIONS

This meta-analysis suggests both a statistically significant and a clinically meaningful improvement on plantar fasciitis symptoms after BTX-A treatment.

Comparación de cuatro técnicas quirúrgicas para el manejo de la espondilitis tuberculosa de la columna torácica en adultos

OBJETIVO

Comparar la eficiencia de las cuatro técnicas quirúrgicas más utilizadas para el manejo de la espondilitis tuberculosa.

MÉTODO

Estudio retrospectivo en el que se incluyeron pacientes adultos con diagnóstico confirmado de espondilitis tuberculosa, afectación de dos niveles vertebrales o menos y sin deformidad vertebral grave. Se recopilaron y revisaron los expedientes médicos, los estudios de imagen y los datos demográficos de los pacientes intervenidos para analizar retrospectivamente los resultados clínicos y funcionales de cada grupo. Las variables primarias fueron la erradicación de la infección, la fusión vertebral y las complicaciones. Entre las variables secundarias se estudiaron el sangrado intraoperatorio, la estancia hospitalaria y el tiempo quirúrgico.

RESULTADOS

Entre los grupos analizados no hubo diferencias significativas (p ≥ 0.05) en la mayoría de las variables analizadas, pero sí (p ≤ 0.001) respecto al sangrado, el tiempo quirúrgico, la estancia intrahospitalaria y las complicaciones, a favor del abordaje posterior único.

CONCLUSIONES

El abordaje posterior único logró una eficacia clínica similar a la del resto de los abordajes en términos de erradicación de la infección y fusión vertebral; sin embargo, se asoció a menores tiempo quirúrgico, sangrado, estancia hospitalaria y complicaciones.

OBJECTIVE

To compare the efficiency of the 4 most used surgical techniques for the management of tuberculous spondylitis.

METHOD

Retrospective study in which adult patients with a confirmed diagnosis of tuberculous spondylitis, involvement of two vertebral levels or less, and without severe vertebral deformity were included. The medical records, imaging studies, and demographic data of the operated patients were collected and reviewed to retrospectively analyze the clinical results of each group. The primary variables were cure of infection, spinal fusion, and complications. The secondary variables included intraoperative bleeding, hospital stay, and surgical time.

RESULTS

There were no significant differences (p ≥ 0.05) in most of the variables analyzed, however, there were (p ≤ 0.001) regarding bleeding, surgical time, hospital stay and complications between the groups analyzed, with a lower result in all cases for the single posterior approach.

CONCLUSIONS

The single posterior approach obtained a clinical efficacy similar to the rest of the approaches in terms of eradication of the infection and vertebral fusion, however, it was associated with less surgical invasion (surgical time and bleeding), a shorter hospital stay and complications.

First Comparative Study of the Effectiveness of the Use of Tranexamic Acid against ε-Aminocapróic Acid via the Oral Route for the Reduction of Postoperative Bleeding in TKA: A Clinical Trial

Total primary knee replacement results in significant postoperative bleeding. There are reports that 20 to 50% of the patients require a blood transfusion, which has been related to many complications, resulting in the search for strategies to reduce bleeding. The use of oral antifibrinolytics is becoming a low cost and safe way of achieving this goal. The hypothesis of this study was that the use of oral aminocaproic acid could provide similar results to the use of oral tranexamic acid (TXA). The purpose was to compare the effects of oral aminocaproic acid as a hemostatic agent versus the use of oral TXA administered in multiple doses pre and postsurgery in patients undergoing total primary knee replacement. We enrolled 92 patients that were randomly divided into two groups: received three doses of aminocaproic acid (2,000 mg per dose) or three doses of oral TXA (1,300 mg per dose). The drugs were administered according to the following schedule: 2 hours before surgery and 6 and 12 hours after surgery. The variables that were analyzed to compare the effectiveness of the hemostatic agents were total blood loss; hidden blood loss; external blood loss; transfusion rate; intraoperative blood loss; decreases in hemoglobin and hematocrit values; surgical drainage output; visual analogue scale; and surgical complications. There were no significant differences between any of the study variables for the group receiving oral aminocaproic acid and the group receiving oral TXA (p > 0.05), with the exception of patients who received TXA, who presented with more adverse events (p = 0.04). Our study showed that the use of oral aminocaproic acid was similar to its counterpart TXA regarding the evaluated parameters. Although patients who received TXA presented an average of 140 mL less blood loss than patients in the ε-ACA group, the difference did not appear to be clinically important, the transfusion rate was very low, and there were no between-group differences in postoperative complications.

Prevalence of Morphological Variations Associated With Femoroacetabular Impingement According to Age and Sex: A Study of 1878 Asymptomatic Hips in Nonprofessional Athletes

Background:

Radiographic findings related to the cam and pincer variants of femoroacetabular impingement (FAI) include measurements of the alpha angle and lateral center-edge angle (LCEA). The function of these radiographic findings has been put into question because of high heterogeneity in reported studies.

Purpose:

The aim of this study was 3-fold: (1) to determine the prevalence of cam and pincer variants according to sex and age on anteroposterior (AP) pelvic radiographs from an asymptomatic nonathletic population, (2) to identify the most common radiographic signs of cam- and pincer-type variants, and (3) to determine if there are variations in the prevalence of these radiographic signs according to sex and age.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

There were 3 independent observers who retrospectively analyzed the 939 AP pelvic radiographs (1878 hips) of patients aged 18 to 50 years who did not have hip symptoms and who were not professional athletes. The prevalence of the cam and pincer variants according to the alpha angle and LCEA, respectively, and the presence of other radiographic signs commonly associated with these variables were determined in the overall population and by subgroup according to sex and age group (18-30, 31-40, and 41-50 years). Descriptive and inferential statistics were used to analyze the study sample.

Results:

The mean age of the included population was 31.0 ± 9.2 years, and 68.2% were male. The prevalence of the cam-type variant was 29.7% (558/1878), and that of the pincer-type variant was 24.3% (456/1878). The radiographic signs that were most associated with the cam and pincer variants were a pistol-grip deformity and the crossover sign, respectively. Significant differences (P < .001) in the prevalence of these variants were identified between men and women in both variants. No differences were observed in the alpha angle or LCEA according to sex or age.

Conclusion:

Radiographic findings suggestive of FAI had significant variations with respect to sex and age in this study sample. This study provides information to determine the prevalence of these anatomic variants in the general population.

[Tropical pyomyositis of the iliacus, obturator internus, piriformis and psoas major muscles in an immunocompetent patient with claudication]

INTRODUCTION

Pyomyositis is a term that denotes pyogenic infection usually primary skeletal muscle, associated with hematogenous dispersion due to transient bacteremia, or penetrating trauma, usually forming abscesses. Classically described frequently in tropical areas and predominantly affecting the lower limb musculature, however, in recent decades it has increasingly been associated with areas of temperate climates and relatively more frequently in immunosuppressed patients, being the patients under 30 years the most affected.

CLINICAL CASE

Male of 15 years without relevant medical history. The patient had no history of trauma, falls, surgical interventions, infections or any other systemic condition. He came because of a clinical picture of 7 days of evolution characterized by pain referred to the groin and left iliac crest area associated with claudication and hyperthermia not quantified, which yielded partially to NSAIDs and paracetamol, but without achieving improvement so it is taken emergency by relatives.

CONCLUSIONS

It is necessary to bear in mind this pathology when performing the differential diagnostic approach of a patient presenting with pain and functional limitation of some joint associated with data suggestive of an infectious or inflammatory process.

Tibial tuberosity avulsion-fracture associated with complete distal rupture of the patellar tendon: A case report and review of literature

BACKGROUND

Few cases of avulsion fractures of the tibial tuberosity with simultaneous rupture of the patellar tendon have been reported in the literature. Therefore, its mechanism and incidence have not been determined conclusively. This type of fracture is considered a serious injury that requires prompt diagnosis and early surgical repair. There is no therapeutic algorithm or standard method of treatment due to the infrequency of the injury. In this case report, we conducted an exhaustive review and synthesis of the existing literature including all previously reported cases.

CASE SUMMARY

We present a 16-year-old male soccer player with a case of a tibial tuberosity fracture with distal avulsion of the patellar tendon 5 d prior to surgical treatment. The patient presented with a loss of the extensor mechanism of the knee, edema, the inability to walk, and pain. X-rays showed a high patella and a 180-degree avulsion of the tibial tuberosity. The diagnosis was confirmed by magnetic resonance imaging and computed tomography. The patient underwent open reduction and internal fixation of the fracture with a cannulated screw and washer as well as patellar tendon repair with two metallic anchors. The rehabilitation protocol consisted of initial immobilization in extension followed by passive mobility and muscle strengthening exercises. The patient demonstrated excellent postoperative outcomes and returned to regular activity without complications.

CONCLUSION

This case presentation and literature review comprise the most relevant clinical, radiographic, and treatment details described in the international literature to date, providing the reader with an overview of this rare condition.

Treatment of lateral ankle sprain with platelet-rich plasma: A randomized clinical study

BACKGROUND

We aimed to clinically evaluate the effect of platelet-rich plasma (PRP) therapy in patients with acute lateral ankle sprain treated with rigid immobilization.

METHODS

Patients with first-time grade II lateral ankle sprain clinically diagnosed were evaluated (n=21). A rigid immobilization was placed in all patients for ten days; previously, an application of PRP over the anterior talofibular ligament was performed in patients from the experimental group. The Visual Analogue Scale, the American Orthopedic Foot and Ankle Score, and the Foot and Ankle Disability Index were applied at 3, 5, 8 and 24 weeks of follow-up period.

RESULTS

The experimental group presented the highest reduction in pain and better functional scores than the control group at 8 weeks. At the end of follow-up period the results of both groups were similar.

CONCLUSIONS

A similar evolution was observed in patients treated with rigid immobilization with or without PRP after 24 weeks.

TRIAL REGISTRATION

Clinical Trials.gov with ID NCT02609308.

[External fixation with reconstruction rail system as a treatment for pseudoarthrosis of the distal femur]

Distal femur pseudoarthrosis also called «distal femur non-union» (DFNU) represents a rare complication associated with a fracture caused by high-energy trauma; its treatment is controversial, as there is a wide variety of surgical techniques that can be implemented, from open reduction plus internal fixation with plates, to the use of fixed angle plates combined with bone autograft. We expose the case of a 24-year-old man who shows up for consultation with the history of having presented a left femoral supracondylar fracture with a year of evolution, treated by osteosynthesis of the distal femur with dynamic condylar screws (DCS plate); developed a torpid evolution with severe pain in the distal third of the left thigh and functional limitation, developed a progressive varus deformity of the left thigh that caused a shortening of 3.8 cm of the limb. A focus of pseudoarthrosis was identified, which was surgically removed, the intramedullary canal was recanalized, and a lateral closed wedge osteotomy was performed to correct the angulation and allow reduction. 5.5 mm (three proximal and three distal) hydroxyapatite screws and an external fixator were placed. In addition, a review of the literature focused on the use of external fixation was carried out as a treatment for the pseudoarthrosis of the distal femur.

Efficacy and safety of avocado-soybean unsaponifiables for the treatment of hip and knee osteoarthritis: A systematic review and meta-analysis of randomized placebo-controlled trials

OBJECTIVE

We performed a systematic review and meta-analysis from randomized controlled trials to examine the efficacy and safety of avocado-soybean unsaponifiables (ASU) in patients with hip or knee osteoarthritis (OA).

DATA SOURCES

Medline, SCOPUS, Web of Science, and Google Scholar databases were searched for randomized placebo-controlled trials.

STUDY SELECTION

Original studies were randomized placebo-controlled trials evaluating the effect of orally administered ASU on knee or hip OA symptoms using the Lequesne index, visual analog scale (VAS) and/or joint space width (JSW).

DATA EXTRACTION

Meta-analysis was conducted using a random-effects model and generic inverse variance method. Heterogeneity was tested using the I² statistic index.

DATA SYNTHESIS

Avocado-soybean unsaponifiables therapy had a significant reduction on pain by VAS assessment (weighted mean difference [WMD]: -9.64 mm, 95% CI: -17.43, -1.84; P = .02; I²  = 92%). A subanalysis according to the type of OA showed that ASU significantly decreased both VAS and Lequesne index in knee OA (WMD: -17.36, 95% CI: -25.91, -8.82; P < .0001; I²  = 87% and WMD: -2.33, 95% CI: -2.88, -1.78; P < .00001; I²  = 18%, respectively) but not in hip OA. Finally, ASU supplementation showed no significant differences for adverse events compared to placebo (relative risk: 1.02, 95% CI: 0.83, 1.25; P = .88; I²  = 0%).

CONCLUSION

Results of this meta-analysis suggest a beneficial effect of ASU treatment in symptomatic knee OA but not in hip OA. Additionally, adverse events were similar in patients receiving ASU therapy or placebo.

[Installed Capacity Perception Survey for the Training of Residents Program in Orthopedics and Care Needs in Acute and Chronic Musculoskeletal Pathology in Mexico]

INTRODUCTION

It is essential that orthopaedic resident physicians be highly proficient in all aspects, considering the balance between supply, demand, need and context. Fundamental to identify the capacity and quality installed for their training in Mexico.

MATERIAL AND METHODS

Observational Study, transverse, non-probabilistic sampling-conglomerates, in two phases. The instrument has 8 domains, 57 variables and 4,867 items. 60 graduate professors of 20 states, 50 hospital sites, 22 university programs.

RESULTS

1,038 years of experience (collective intelligence), 17 years of experience/teacher (01 to 50 years). Identified: acute pathology 30 (2 to 90%), chronic pathology 30 (5 to 96%), patients 15 years, 10 (3 to 30%), patients between 15 and 65 years, 47 (2 to 78%), patients 65 years, 20 (2 to 60%), number of beds/seat 20 (2 to 510), number of clinics 3 (1 to 48), number of surgical procedures/headquarters per year at the national level, was 960 (50 to 24,650). The national average per resident doctor is 362 surgeries/year with 1,450 surgical times/year.

CONCLUSIONS

The needs and resources for the training of physicians specializing in orthopedics/traumatology are highly heterogeneous, so it should be adapted to the epidemiological needs of the region of influence, in an area of epidemiological transition. 62.2% expressed not having or have bad academic and scientific infrastructure at its headquarters, more than 50% without rotation overseas and 90% without regular scientific production.

[Uso de etamsilato para reducir el sangrado posoperatorio y el índice de transfusión en la artroplastia total de cadera. Ensayo clínico controlado]

Antecedentes

El sangrado secundario es una de las principales causas de morbilidad después de la cirugía. El etamsilato se ha utilizado con buenos resultados para disminuir el sangrado en diversas patologías, como metrorragias, sangrado intraventricular, prostatectomías, cirugías de catarata y amigdalectomías. El objetivo de este estudio fue evaluar la efectividad del etamsilato para disminuir el sangrado en la cirugía de reemplazo total de cadera.

Método

La población se dividió en dos grupos. En el grupo control se realizó la hemostasia de manera convencional; en el grupo experimental se administró etamsilato.

Resultados

Se incluyeron 34 pacientes, de los cuales 17 fueron aleatorizados al grupo de etamsilato y 17 al grupo control. No hubo diferencias en las características de la población entre los dos grupos. Al comparar los valores de hemoglobina preoperatoria y a las 24, 48 y 72 horas posquirúrgicas entre ambos grupos, no se encontraron diferencias estadísticamente significativas. Tampoco hubo diferencia en el hematocrito ni en la cuantificación del gasto por drenaje a las 24 y 48 horas. Hubo tres pacientes transfundidos en el grupo de etamsilato y siete en el grupo de control, lo cual no difirió significativamente (p = 0.62).

Conclusión

En este estudio no se demostró un efecto sobre la reducción de la hemorragia en pacientes sometidos a reemplazo total de cadera con el uso de etamsilato.

Background

Secondary bleeding is one of the leading causes of morbidity after the surgery. Ethamsylate has been used with good results to decrease bleeding in various pathologies such as metrorrhagia, intraventricular bleeding, prostatectomies, cataract surgeries and tonsillectomies. The objective of this study was to evaluate the effectiveness of the hemostatic agent ethamsylate to decrease bleeding in total hip replacement surgery.

Method

The population were divided into two groups, in the control group was performed the hemostasis conventionally; in the experimental group ethamsylate was administered.

Results

A total of 34 patients were included, of whom 17 were randomized to the group of ethamsylate and 17 randomized to the control group. There were no differences in the characteristics of the population between the two groups. Comparing preoperative hemoglobin levels and at 24, 48 and 72 postsurgical hours between the control group and ethamsylate group there was no statistically significant difference. There was also no difference in the levels of hematocrit. In the quantification of expenditure by the drainage there was no difference between the groups at 24 and 48 hours. There were three patients transfused in the ethamsylate group and seven in the control group, which did not differ significantly (p = 0.62).

Conclusion

An effect on the reduction of bleeding in patients undergoing total hip replacement with the use of hemostatic agent ethamsylate was not demonstrated in this study.

Human amniotic membrane intra-articular injection prevents cartilage damage in an osteoarthritis model

Osteoarthritis (OA) is a degenerative joint disease that affects the soft tissues and bones of involved articulations as a result of deregulation between synthesis and extracellular matrix degradation in articular cartilage. The present study evaluated the effect of intra-articular injection of human amniotic membrane (AM) as a treatment in an OA animal model in the knee. Chemical OA was developed in the knees of New Zealand rabbits. Once OA was established, the right knees only were treated with an intra-articular injection of human AM, with the left knees considered as a negative control group. The evaluation was performed at 3 and 6 weeks post-treatment. At 3 weeks post-injection, the cartilage exhibited fibrillation, erosion, cracks and cell clusters in the negative control group, but not in the treated group (P=0.028). At 6 weeks post-injection, the left knees exhibited hypertrophy, cracks, cell clusters, decreased matrix staining and structure loss. However, the right knees exhibited cell clusters without evidence of disruption in cartilage integrity (P=0.015). These results suggested that the intra-articular injection of human AM delays histological changes of cartilage in OA.

Effect of glucosamine and chondroitin sulfate in symptomatic knee osteoarthritis: a systematic review and meta-analysis of randomized placebo-controlled trials

Although glucosamine and chondroitin sulfate have showed beneficial effects on joint tissues in osteoarthritis (OA), their therapeutic use in the clinical setting is still debatable. Hence, a systematic review and meta-analysis of randomized placebo-controlled trials was conducted to investigate the efficacy of glucosamine and chondroitin sulfate on knee OA symptoms. Medline, SCOPUS, Web of Science, and Google Scholar databases were searched for randomized placebo-controlled trials evaluating the effect of orally administered glucosamine and/or chondroitin sulfate on OA symptoms using the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) and/or the Visual Analog Scale (VAS). Meta-analysis was conducted using a random-effects model and generic inverse-variance method. Heterogeneity was tested using the I2 statistic index. Treatments with glucosamine and chondroitin were found to significantly reduce pain in VAS [weighted mean difference (WMD) - 7.41 mm, 95% CI - 14.31, - 0.51, p = 0.04 and WMD - 8.35 mm, 95% CI - 11.84, - 4.85, p < 0.00001, respectively]. Their combination did not show this behavior (WMD - 0.28 mm, 95% CI - 8.87, 8.32, p = 0.95). None of the glucosamine, chondroitin or their combination had a significant positive effect on the total WOMAC index and its subscores. Oral supplementation with glucosamine or chondroitin sulfate reduces pain in knee OA. However, there is no additional effect using both therapeutic agents in combination for the management of symptomatic knee OA.