Estudio de la osificación del segundo radio del pie en la edad pediátrica

Se estudia en una población madrileña del año 2000 la osificación del segundo radio del pie desde el nacimiento y a lo largo del crecimiento, con el objetivo de analizar los distintos núcleos primarios y secundarios del segundo radio del pie y la influencia que en ellos ejercen variables antropológicas como el sexo, la lateralidad, la patología del pie y las distintas fórmulas de antepié (digital, metatarsal y sus combinaciones). Se analizan 1001 radiografías dorsoplantares de pies pertenecientes a 231 pacientes pediátricos de una población madrileña entre los años 1990 y 2004. Se establece la cronología de aparición y fusión de los núcleos de osificación del segundo radio del pie (segunda cuña, epifisarios proximal y distal del segundo metatarsiano y epifisarios de las falanges del segundo dedo). Se establece la prevalencia de alteraciones radiográficas de dichos núcleos. Se aporta la existencia del núcleo secundario de osificación proximal del segundo metatarsiano, su prevalencia y características. Se comprueba la presencia de osificación an-epifisaria de la falange media del segundo dedo, su prevalencia y características. Se describe el estudio morfométrico de dichos núcleos. Se aportan modelos matemáticos a partir de indices establecidos con las mediciones de dichos núcleos, con los que estimar la edad ósea. Se describe la prevalencia de las distintas fórmulas de antepié de dicha población

Future Data Points to Implement in Adult Spinal Deformity Assessment for Artificial Intelligence Modeling Prediction: The Importance of the Biological Dimension.

Adult spinal deformity (ASD) surgery is still associated with high surgical risks. Machine learning algorithms applied to multicenter databases have been created to predict outcomes and complications, optimize patient selection, and improve overall results. However, the multiple data points currently used to create these models allow for 70% of accuracy in prediction. We need to find new variables that can capture the spectrum of probability that is escaping from our control. These proposed variables are based on patients biological dimensions, such as frailty, sarcopenia, muscle and bone (tissue) sampling, serological assessment of cellular senescence, and circulating biomarkers that can measure epigenetics, inflammaging, and -omics. Many of these variables are proven to be modifiable and could be improved with proper nutrition, toxin avoidance, endurance exercise, and even surgery. The purpose of this manuscript is to describe the different future data points that can be implemented in ASD assessment to improve modeling prediction, allow monitoring their response to prerehabilitation programs, and improve patient counseling

Luxación facetaria unilateral lumbosacra postraumática. [ Post-traumatic lumbosacral unilateral facet dislocation].

In the literature have been reported around fifty cases of lumbosacral dislocations; treated most bilateral facet dislocations. We report the case of a female 42 year old with unilateral lumbosacral facet dislocation of one month duration after accident. Circumferential instrumented fusion L5-S1 with interbody cage and pedicle screws L5-S1 was performed.   The lumbosacral dislocation is a rare injury that occurs due to the combination of a high-energy mechanism predisposing anatomical factors. Recent publications advocate the surgical reduction and stabilization with instrumentation as standard treatment

Luxación facetaria unilateral lumbosacra postraumática

In the literature have been reported around fifty cases of lumbosacral dislocations; treated most bilateral facet dislocations. We report the case of a female 42 year old with unilateral lumbosacral facet dislocation of one month duration after accident. Circumferential instrumented fusion L5-S1 with interbody cage and pedicle screws L5-S1 was performed. The lumbosacral dislocation is a rare injury that occurs due to the combination of a high-energy mechanism predisposing anatomical factors. Recent publications advocate the surgical reduction and stabilization with instrumentation as standard treatment.En la bibliografía se han reportado alrededor de medio centenar de casos de luxaciones lumbosacras; la mayor parte se tratan de luxaciones facetarias bilaterales. Presentamos el caso de una paciente mujer de 42 años con luxación facetaria unilateral lumbosacra de un mes de evolución tras accidente de tráfico. Se realiza artrodesis circunferencial L5-S1 instrumentada con caja intersomática y tornillos pediculares L5-S1. La luxación lumbosacra es una lesión poco habitual que se produce gracias a la combinación de un mecanismo de alta energía con factores anatómicos predisponentes. Recientes publicaciones defienden la reducción quirúrgica y estabilización con instrumentación como tratamiento estándar

The reliability of the Aospine thoracolumbar spine injury classification system in children : An international validation study

Publisher Copyright: © 2021, British Editorial Society of Bone and Joint Surgery. All rights reserved.Purpose To evaluate the AOSpine Thoracolumbar Spine Injury Classification System and if it is reliable and reproducible when applied to the paediatric population globally. Methods A total of 12 paediatric orthopaedic surgeons were asked to review MRI and CT imaging of 25 paediatric patients with thoracolumbar spine traumatic injuries, in order to determine the classification of the lesions observed. The evaluators classified injuries into primary categories: A, B and C. Interobserver reliability was assessed for the initial reading by Fleiss’s kappa coefficient (kF) along with 95% confidence intervals (CI). For A and B type injuries, sub-classification was conducted including A0-A4 and B1-B2 subtypes. Interobserver reliability across subclasses was assessed using Krippendorff’s alpha (αk) along with bootstrapped 95% CIs. A second round of classification was performed one-month later. Intraobserver reproducibility was assessed for the primary classifications using Fleiss’s kappa and sub-classification reproducibility was assessed by Krippendorff’s alpha (αk) along with 95% CIs. Results In total, 25 cases were read for a total of 300 initial and 300 repeated evaluations. Adjusted interobserver reliability was almost perfect (kF = 0.74; 95% CI 0.71 to 0.78) across all observers. Sub-classification reliability was substantial (αk=0.67; 95% CI 0.51 to 0.81), Adjusted intraobserver reproducibility was almost perfect (kF = 0.91; 95% CI 0.83 to 0.99) for both primary classifications and for sub-classifications (αk =0.88; 95% CI 0.83 to 0.93). Conclusion The interand intraobserver reliability for the AOSpine Thoracolumbar Spine Injury Classification System was high amongst paediatric orthopaedic surgeons. The AOSpine Thoracolumbar Spine Injury Classification System is a promising option as a uniform fracture classification in children.Peer reviewe

Surgical Site Infection a major risk factor of pseudarthrosis in adult spinal deformity surgery

BACKGROUND CONTEXT: Despite the evidence in appendicular skeletal surgery, the effect of infection on spinal fusion remains unclear, particularly after Adult Spinal Deformity (ASD) surgery. PURPOSE: The purpose of this study was to determine the impact of surgical site infection (SSI) in ASD surgery fusion rates and its association with other risks factors of pseudarthrosis. STUDY DESIGN: We conducted an international multicenter retrospective study on a prospective cohort of patients operated for spinal deformity. PATIENT SAMPLE: A total of 956 patients were included (762 females and 194 males). OUTCOME MEASURES: Patient's preoperative characteristics, pre- and postoperative spinopelvic parameters, surgical variables, post-operative complications and were recorded. Surgical site infections were asserted in case of clinical signs associated with positive surgical samples. Each case was treated with surgical reintervention for debridement and irrigation. Presence of pseudarthrosis was defined by the association of clinical symptoms and radiological signs of non-fusion (either direct evidence on CT-scan or indirect radiographic clues such as screw loosening, rod breakage, screw pull out or loss of correction). Each iterative surgical intervention was collected. METHODS: Univariate and multivariate analysis with logistic regression models were performed to evaluate the role of risk factors of pseudarthrosis. RESULTS: 956 surgical ASD patients with more than two years of follow-up were included in the study. 65 of these patients were treated for SSI (6.8%), 138 for pseudarthrosis (14.4%), and 28 patients for both SSI and pseudarthrosis. On multivariate analysis, SSI was found to be a major risk factor of pseudarthrosis (OR = 4.4; 95% CI = 2.4,7.9) as well as other known risks factors: BMI (OR = 1.1; 95% CI = 1.0,1.1), smoking (OR = 1.6; 95% CI = 1.1,2.9), performance of Smith-Petersen osteotomy (OR = 1.6; 95% CI 1.0,2.6), number of vertebrae instrumented (OR = 1.1; 95% CI = 1.1,1.2) and the caudal level of fusion, with a distal exponential increment of the risk (OR max for S1 = 6, 95% CI = 1.9,18.6). CONCLUSION: SSI significantly increases the risk of pseudarthrosis with an OR of 4.4

Vitamin D and adolescent idiopathic scoliosis, should we stop the hype? A cross-sectional observational prospective study based on a geometric morphometrics approach

[Purpose]: There is strong evidence supporting the presence of fluctuating asymmetry (FA) in Adolescents with Idiopathic Scoliosis (AIS). Additionally, recent research investigating the relationship between vitamin D and AIS found a relation between them. We hypothesize a negative correlation between FA and vitamin D.[Methods]: We performed a surface scan of the torso of 53 AIS patients, a blood test to measure vitamin D and the radiographic Cobb angle. A correlation analysis between vitamin D and FA was carried out to test our hypothesis, and a regression of vitamin D on 3D shape was performed to observe shape differences between the vitamin D deficiency and insufficiency groups.[Results]: There was no correlation between vitamin D and FA. We found a strong negative correlation between vitamin D and the Cobb angle only in the premenarche group (n = 7; r = - 0.92). Differences in shape were observed between the deficiency and insufficiency groups, and that differences were related to the width of the torso, but not the rotation or lateral flexion.[Conclusions]: Our results do not support the massive screening of vitamin D in AIS. Shape analysis revealed differences between the shape of the deficiency and insufficiency groups related to robustness. However, this finding had no relation with the scoliosis characteristics, it just reflected different body composition, and its importance should be explored in future.Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature. Research was funded by grant number PID2020-115854GB-I00 to Markus Bastir, José María González Ruiz, and Carlos A. Palancar, by MCIN/AEI/10.13039/501100011033 of the Spanish Ministry of Science and Innovation and the European Union.Peer reviewe

Obeid-Coronal Malalignment Classification Is Age Related and Independently Associated to Personal Reported Outcome Measurement Scores in the Nonfused Spine

Objective To evaluate Obeid-coronal malalignment (O-CM) modifiers according to age, sagittal alignment, and patient-reported outcome measures (PROMs), in the mobile spine. Methods Retrospective review of a prospective multicenter adult spinal deformity (ASD) database with 1,243 (402 nonoperative, 841 operative) patients with no prior fusion surgery. Patients were included if they were aged over 18 years and were affected by spinal deformity defined by one of: Cobb angle ≥ 20°, pelvic tilt ≥ 25°, sagittal vertical axis ≥ 5 cm, thoracic kyphosis ≥ 60°. Patients were classified according to the O-CM classification and compared to coronally aligned patients. Multivariate analysis was performed on the relationship between PROMs and age, global tilt (GT) and coronal malalignment (CM). Results Four hundred forty-three patients had CM of more than 2 cm compared to 800 who did not. The distribution of these modifiers was correlated to age. After multivariate analysis, using age and GT as confounding factors, we found that before the age of 50 years, 2A1 patients had worse sex life and greater satisfaction than patients without CM. After 50 years of age, patients with CM (1A1, 1A2) had worse self-image and those with 2A2, 2B had worse self-image, satisfaction, and 36-item Short Form Health Survey physical function. Self-image was the consistent determinant of patients opting for surgery for all ages. Conclusion CM distribution according to O-CM modifiers is age dependent. A clear correlation between the coronal malalignment and PROMs exists when using the O-CM classification and in the mobile spine, this typically affects self-image and satisfaction. Thus, CM classified according to O-CM modifiers is correlated to PROMs and should be considered in ASD