Luxación periastragalina medial pura: reporte de casos y revisión bibliográfica

Las luxaciones subastragalinas (periastragalinas) sin fractura asociada son un cuadro poco frecuente. Representan solo el 1% de las luxaciones en el ser humano. Presentamos tres casos de luxaciones mediales puras en pacientes que sufrieron un traumatismo de alta energía. En todos los casos, el tratamiento consistió en la reducción cerrada bajo anestesia y posterior inmovilización; la evolución fue satisfactoria. Las luxaciones subastragalinas requieren de un diagnóstico temprano y una rápida resolución. Con estos casos se quiere demostrar la importancia de la sospecha diagnóstica y el beneficio de un tratamiento precoz y acertado. Nivel de Evidencia: I

Are complications after repairing acute Achilles tendon ruptures related to the surgical approach or the patient’s comorbidities?*

Objective: Analyze the postoperative complications after repairing acute Achilles tendon rupture and compare them according to the surgical approach (open surgery (OS) or minimally invasive surgery (MIS)) and the patient’s comorbidities. Methods: A retrospective analytical study including 154 consecutive patients with an acute Achilles tendon rupture submitted to surgery and divided into OS and MIS cohorts. The following relevant comorbidities were analyzed: obesity, diabetes mellitus, smoking, dyslipidemia, gout, chronic corticosteroid use, connective tissue pathologies, transplant history, cancer treatment patients, and postoperative complications. Results: Seventy-eight patients (50.6%) were treated surgically with an OS technique and 76 (49.4%) with an MIS approach. Twenty patients (13%) had postoperative complications between the two cohorts (OS 11.5%; MIS 14.5%; p = 0.588). No statistically significant difference was found in the logistic regression of the risk of the surgical approaches and complications. Obesity had a significant statistical difference when complications and comorbidities were compared. Conclusions: Patients with obesity have a higher risk of developing postoperative complications with both OS and MIS techniques. No relationship was found between the type of surgical approach and a higher percentage of postoperative complications in treating acute Achilles tendon rupture

Incidencia de dedo flotante en la osteotomía metatarsiana distal percutánea con osteosíntesis para el tratamiento de la metatarsalgia con dedo en martillo rígido

Introducción: La metatarsalgia central es una causa frecuente de dolor de antepié. La osteotomía de Weil es el tratamiento quirúrgico más popular y la osteotomía metatarsiana distal percutánea (OMDP) es la técnica percutánea más utilizada. La principal desventaja de estas técnicas es la aparición de dedo flotante que es aún mayor cuando se la asocia a artrodesis interfalángica proximal (AIFP). En esta serie de casos, se combinó la OMDP y la osteosíntesis con clavija de Kirschner para elevar el centro de rotación de la cabeza del metatarsiano con el objetivo de disminuir la presencia de dedos flotantes. Nuestra principal hipótesis fue que esta técnica generará menos dedos flotantes en los pacientes con diagnóstico de metatarsalgia mecánica y dedo en martillo rígido, comparada con la osteotomía de Weil. Materiales y Métodos: Se realizó un estudio retrospectivo en pacientes adultos con diagnóstico de metatarsalgia mecánica y dedo en martillo rígido. Se los sometió a una OMDP más fijación con clavija de Kirschner en combinación con AIFP. Finalmente, se comparó la presencia de dedos flotantes con un grupo de pacientes operados con la técnica de Weil y AIFP. Resultados: Se realizaron 39 OMDP más AIFP. La tasa de dedos flotantes fue del 31%. No hubo una diferencia estadísticamente significativa comparada con la técnica de Weil (36%, p = 0,634). Conclusión: La OMDP con elevación del centro de rotación asociada con AIFP no proporcionó una menor incidencia de dedos flotantes en comparación con la osteotomía de Weil

Endoscopic Calcaneoplasty in Haglund's Disease: Surgical Technique, Clinical and Subjective Outcomes

Category: Arthroscopy; Ankle Introduction/Purpose: During the last decade, arthroscopic procedures have been replacing open techniques in Haglund's disease treatment due to their considerable advantages. Endoscopic calcaneoplasty is a technique that allows resection of posterosuperior calcaneal exostosis and retrocalcaneal bursitis. The objective of this article is to describe this technique and report its clinical and subjective outcome. Methods: A retrospective cohort study was carried out in patients who underwent endoscopic surgery between July 2014 and March 2020. The patients were clinically and radiologically evaluated. All cases included were studied prior to the intervention and postoperative. All patients who did not show any clinical improvement after 6 months of conservative treatment were surgically treated with endoscopic treatment in the prone position through two posterior arthroscopic portals. Results: In this study, 14 endoscopic calcaneoplasties were performed in 14 patients, with an average follow-up of 40 months. The visual analog scale improved from a preoperative average value of 9.07 to 1.79 after surgery (p> 0.0001). The AOFAS scale rose from 38.71 before surgery to 94.57 postoperative (p> 0.0001). Good subjective results were observed in twelve patients ( 85.71%) and all of them would have surgery again. There were no wound complications or infections. No patient required reoperation. Conclusion: Endoscopic treatment is a useful technique, with good clinical and subjective results and few complications, being a good alternative to open techniques

Osteotomías supramaleolares en pacientes con artrosis de tobillo: resultados clínicos y radiográficos

Introducción: Las osteotomías supramaleolares son una opción terapéutica para la artrosis asimétrica de tobillo. El objetivo de este artículo es describir los resultados clínicos, radiográficos y subjetivos obtenidos en pacientes con artrosis de tobillo sometidos a una osteotomía supramaleolar. Materiales y Métodos: Estudio observacional descriptivo retrospectivo de pacientes sometidos a una osteotomía supramaleolar por artrosis de tobillo entre enero de 2010 y julio de 2017. Se analizaron las historias clínicas para recabar datos clínicos y radiográficos preoperatorios y posoperatorios. Resultados: Se incluyó a 13 pacientes: 8 con una desalineación del tobillo y retropié en valgo (61,5%) y 5 (38,5%) en varo. El puntaje medio posoperatorio de la escala analógica visual del grupo con deformidad en varo disminuyó de 9 ± 0,45 a 3 ± 1 (p <0,05) y de una media de 7,88 ± 0,35 a 2,15 ± 1,64 (p <0,05) en aquellos con deformidad en valgo. El puntaje medio de la escala de la AOFAS se modificó de 32,8 ± 16,2 antes de la cirugía a 82,1 ± 13,6 en el posoperatorio, en el grupo con deformidad en varo (p <0,05) y de 31 ± 17,3 a 93,1 ± 6,20, respectivamente, en aquellos con deformidad en valgo (p <0,05). Se constató la consolidación radiográfica en 12 pacientes (92,3%), en un promedio de 10.4 semanas. Conclusión: La osteotomía supramaleolar como tratamiento de la artrosis asimétrica de tobillo es una técnica predecible, con muy buenos resultados clínicos y radiográficos a corto y mediano plazo

Percutaneous surgery for overlapping fifth toe

Category: Lesser Toes Introduction/Purpose: Overlapping fifth toe is an unusual disease in which the fifth toe is adducted, rotated, and hyperextended. This pathology is often asymptomatic, however pain may occur with footwear. Although there are many surgical techniques available, there is yet no gold standard. While old techniques were aggressive and cosmetically inappropriate, newest techniques involve large surgical incisions and risk of neurovascular damage. Percutaneous surgery is a novel approach which avoids the disadvantages that old and new techniques present. It was originally described by De Prado but no case series have been reported in adults up to date. The aim of this study is to describe a percutaneous corrective technique of the overlapping fifth toe and to evaluate its functional results and patient satisfaction. Methods: We performed a retrospective review of 12 feet in 10 adult patients who were surgically treated between 2008 and 2016. The percutaneous surgical technique consisted in a dorsal capsulotomy and extensor tenotomy followed by an osteotomy of the proximal phalanx (as described by De Prado). We added to his procedure the use of a K-wire to stabilize the osteotomies. In 6 of these feet a percutaneous oblique osteotomy of the fifth metatarsal was also performed. This osteotomy was stabilized using the same K-wire, which was removed 1 month after surgery. All patients were clinically rated prior to surgery and at the final follow-up visit using the AOFAS Score for lesser toes. In addition, patients were asked to provide a subjective qualification of the results (pain/cosmetic) as “excellent”, “good”, “regular” and “poor” and to state if they would recommend the surgical procedure to one of their peers. Results: The average follow up was 48 months (104 - 9). Osteotomy consolidation was completely achieved in all patients. There were no infections or wound complications. Mean preoperative AOFAS score was 38 (20-55) and postoperative score was 84 (62-95). Patient subjective qualification after surgery was: excellent for 7 feet, good for 3 and regular and poor for the remaining 2 feet. Nine of the ten patients stated that they would recommend the procedure. Conclusion: Percutaneous treatment of the overlapping fifth toe is a reproducible surgical technique with good functional results, low postoperative complications and good cosmetic acceptance by the patients