Prevalencia en nuestro medio de las deformidades dinámicas posicionales del hallux como secuela de las fracturas de tercio medio y distal de tibia

Dynamic positional deformity of the hallux is a relatively new disease, precisely because of its innovative nature and dynamics may go unnoticed to clinicians. It is because of this, that the limited literature available stresses the importance of making an active search for this pathology in our daily practice. The purpose of this study is to estimate the prevalence of these deformities at the University Hospital Dr. Peset of Valencia as well as make an analysis of their management. An analytical, descriptive and retrospective study was designed in which patients admitted in our center during 2014 and 2015 with medium and distal third tibia fracture were analyzed searching for dynamics positional deformities of the hallux. We found a total of 5 compatible cases from 42 analyzed tibia fractures. This may indicate that as expected dynamic positional deformity of the hallux could be an underrated disease in our medium

Notodo es "cut-out" : reclasificación de las complicaciones mecánicas del tornillo cefálico del clavo intramedular.

The use of the intramedullary nail in extracapsular fractures of the proximal third of the femur is the most frequent stabilization system. In recent years, the biomechanical complications that affect this system have been increasing.A retrospective radiographic study of intertrochanteric fractures was performed followed by an analysis of the biomechanical complications in zone 1 of the cephalic screw. Of the 548 cases, 85 cases (15.5%) of complications were observed, with "back-out" being the most frequent minor complication and "cut-out" the most frequent major complication. 41% of the total fractures correspond to type 31-A2.3 AO / OTA. The basicervical fractures and 31-A2.3 have a high risk of complications.The biomechanical origin that Lenich describes is important to understand as the surgical solution varies depending on whether it is cut-out, cut-in (same origin of the biomechanical failure of the head screw) or cut-through (different origin) to, consequently, resolve them in the right manne

Review of Classification Systems for Adult Acquired Flatfoot Deformity/Progressive Collapsing Foot Deformity and the Novel Development of the Triple Classification Delinking Instability/Deformity/Reactivity and Foot Type

Background: Classifications of AAFD/PCFD have evolved with an increased understanding of the pathology involved. A review of classification systems helps identify deficiencies and respective contributions to the evolution in understanding the classification of AAFD/PCFD. Methods: Using multiple electronic database searches (Medline, PubMed) and Google search, original papers classifying AAFD/PCFD were identified. Nine original papers were identified that met the inclusion criteria. Results: Johnson’s original classification and multiple variants provided a significant leap in understanding and communicating the pathology but remained tibialis posterior tendon-focused. Drawbacks of these classifications include the implication of causality, linearity of progression through stages, an oversimplification of stage 2 deformity, and a failure to understand that multiple tendons react, not just tibialis posterior. Later classifications, such as the PCFD classification, are deformity-centric. Early ligament laxity/instability in normal attitude feet and all stages of cavus feet can present with pain and instability with minor/no deformity. These may not be captured in deformity-based classifications. The authors developed the ‘Triple Classification’ (TC) understanding that primary pathology is a progressive ligament failure/laxity that presents as tendon reactivity, deformity, and painful impingement, variably manifested depending on starting foot morphology. In this classification, starting foot morphology is typed, ligament laxities are staged, and deformity is zoned. Conclusions: This review has used identified deficiencies within classification systems for AAFD/PCFD to delink ligament laxity, deformity, and foot type and develop the ‘Triple classification’. Advantages of the TC may include representing foot types with no deformity, defining complex secondary instabilities, delinking foot types, tendon reactivity/ligament instability, and deformity to represent these independently in a new classification system. Level of Evidence: Level V

Review of Classification Systems for Adult Acquired Flatfoot Deformity/Progressive Collapsing Foot Deformity and the Novel Development of the Triple Classification Delinking Instability/Deformity/Reactivity and Foot Type

Peer reviewed: TruePublication status: PublishedBackground: Classifications of AAFD/PCFD have evolved with an increased understanding of the pathology involved. A review of classification systems helps identify deficiencies and respective contributions to the evolution in understanding the classification of AAFD/PCFD. Methods: Using multiple electronic database searches (Medline, PubMed) and Google search, original papers classifying AAFD/PCFD were identified. Nine original papers were identified that met the inclusion criteria. Results: Johnson’s original classification and multiple variants provided a significant leap in understanding and communicating the pathology but remained tibialis posterior tendon-focused. Drawbacks of these classifications include the implication of causality, linearity of progression through stages, an oversimplification of stage 2 deformity, and a failure to understand that multiple tendons react, not just tibialis posterior. Later classifications, such as the PCFD classification, are deformity-centric. Early ligament laxity/instability in normal attitude feet and all stages of cavus feet can present with pain and instability with minor/no deformity. These may not be captured in deformity-based classifications. The authors developed the ‘Triple Classification’ (TC) understanding that primary pathology is a progressive ligament failure/laxity that presents as tendon reactivity, deformity, and painful impingement, variably manifested depending on starting foot morphology. In this classification, starting foot morphology is typed, ligament laxities are staged, and deformity is zoned. Conclusions: This review has used identified deficiencies within classification systems for AAFD/PCFD to delink ligament laxity, deformity, and foot type and develop the ‘Triple classification’. Advantages of the TC may include representing foot types with no deformity, defining complex secondary instabilities, delinking foot types, tendon reactivity/ligament instability, and deformity to represent these independently in a new classification system. Level of Evidence: Level V