Pseudoartrosis de escafoides carpiano tratadas mediante la técnica de Matti-Russe: estudio retrospectivo de 36 casos

Presentamos un estudio retrospectivo de una serie de 36 pacientes con pseudoartrosis de escafoides operados mediante la técnica de Matti-Russe entre 1985 y 1991. Utilizamos injerto córtico esponjoso obtenido del radio (50%), cresta ilíaca (42%) y cúbito (8%) sin diferencias en la incorporación. La tasa de curación fue mayor en las pseudoartrosis medias y distales (80%) que en las de localización proximal (54%). El 80% de los fracasos de curación en la localización media y distal eran pseudoartrosis de más de 30 meses de evolución. Los cambios degenerativos en el carpo de las pseudoartrosis no curadas fueron significativamente mayores (p< 0,001) que en las que se obtuvo la consolidación. La localización y la antiguedad de la pseudoartrosis parecen ser dos importantes factores pronósticos. La técnica de Matti-Russe presenta limitaciones en la pseudoartrosis de localización proximal y en los carpos muy degenerados.We reported a retrospective study of 36 patients with a pseudoarthrosis of the carpal scaphoid bone treated by the Matti-Russe operation from 1985 to 1991. We used radial (50%), iliac (42%) or ulnar (8%) autogenous grafts without any difference in the rate of incorporation. The rate of healing of the pseudoarthrosis was higher in mid and distal location (80%) than in proximal location (54%). In 80% of cases, healing failures in the mid and distal location occurred in old pseudoarthrosis ( >3 0 months evolution). Carpal degenerative changes were significantly higher (p < 0,01) in patients with not healed pseudoarthrosis. The location and the age of the pseudoarthrosis appear to be important prognostic factors. The Matti-Russe technique has limitations when is performed either in proximal pseudoarthrosis or in the presence of advanced radiocarpal osteoarthritis

Fracturas de húmero complicadas con lesión arterial

Presentamos una serie de 10 pacientes afectos de una fractura de húmero asociada a una lesión arterial, tratados entre Enero de 1990 y Octubre de 1993. Dentro de la serie distinguimos tres grupos, de acuerdo con la localización de la fractura (tercio proximal, diáfisis, región supracondílea). El análisis de los resultados sugiere que el peor pronóstico corresponde a las lesiones proximales y diafisarias por su etiología, daños asociados y menor posibilidad de circulación colateral de suplencia. El manejo de estas lesiones complejas exige un tratamiento quirúrgico interdisciplinario. Señalamos la utilidad de la fijación externa como método de osteosíntesis y el uso de un «shunt» provisional para perfundir el miembro durante la cirugía ósea. Se discute la indicación de arteriografía en los traumatismos agudos del miembro superior.A serie of 10 patients with a fracture of the humerus and associated arterial injury treated from January 1990 to October 1993 is reported. The serie was divided in 3 groups acording the proximal, mid shaft or supracondylar location of the fracture. Clinical results indicate a poor prognosis of proximal and mid shaft fractures related to their etiology, associated injuries and damage of the colateral vessels. The management of these complex injuries require an interdisciplinar approach. External fixation is an usefull stabilitation method for fractures associated with vascular damage. The utility of a temporary intraluminar vascular shunt to perfuse the limb at the bone surgery and preoperative arteriography are discussed

Delayed colorectal cancer care during covid-19 pandemic (decor-19). Global perspective from an international survey

Background The widespread nature of coronavirus disease 2019 (COVID-19) has been unprecedented. We sought to analyze its global impact with a survey on colorectal cancer (CRC) care during the pandemic. Methods The impact of COVID-19 on preoperative assessment, elective surgery, and postoperative management of CRC patients was explored by a 35-item survey, which was distributed worldwide to members of surgical societies with an interest in CRC care. Respondents were divided into two comparator groups: 1) ‘delay’ group: CRC care affected by the pandemic; 2) ‘no delay’ group: unaltered CRC practice. Results A total of 1,051 respondents from 84 countries completed the survey. No substantial differences in demographics were found between the ‘delay’ (745, 70.9%) and ‘no delay’ (306, 29.1%) groups. Suspension of multidisciplinary team meetings, staff members quarantined or relocated to COVID-19 units, units fully dedicated to COVID-19 care, personal protective equipment not readily available were factors significantly associated to delays in endoscopy, radiology, surgery, histopathology and prolonged chemoradiation therapy-to-surgery intervals. In the ‘delay’ group, 48.9% of respondents reported a change in the initial surgical plan and 26.3% reported a shift from elective to urgent operations. Recovery of CRC care was associated with the status of the outbreak. Practicing in COVID-free units, no change in operative slots and staff members not relocated to COVID-19 units were statistically associated with unaltered CRC care in the ‘no delay’ group, while the geographical distribution was not. Conclusions Global changes in diagnostic and therapeutic CRC practices were evident. Changes were associated with differences in health-care delivery systems, hospital’s preparedness, resources availability, and local COVID-19 prevalence rather than geographical factors. Strategic planning is required to optimize CRC care