HAL (Le Centre pour la Communication Scientifique Directe), 2020
Introduction: The use of the Ponseti technique continues to be the method of choice for the treat... more Introduction: The use of the Ponseti technique continues to be the method of choice for the treatment of bot foot, however, in those patients with recurrence due to poor adherence to treatment, syndronics, etc. medial postero release emerges as an alternative. Several coverage techniques are described in post-release residual defects from muscle or fasciocutaneous flaps, skin-free grafting, or open defects that close by the second intention. In recent years the relevance of the use of Human Amniotic Membrane (hAM) as a substitute for dermal matrix has been described. There are two cases of closure of bilateral post-medial post-release wound defect in the recurrence of bot foot with said membrane. Materials and Methods: Case 1: A 2-year old boy with Moebius syndrome associated with clubfeet was treated with the Ponseti method at birth. At 2 years of age, the deformity recurred in both feet and he was again treated with serial casting and posteromedial release using the Cincinnati incision. After the procedure, complete skin coverage was not possible and the large defect was treated with hAM. Case 2: A 10-year-old girl with arthrogryposis had bilateral clubfoot deformities treated with the Ponseti method at birth. Compliance with Ankle-Foot Orthoses (AFOs) was poor and subsequently, the treatment was abandoned. The posteromedial release was performed using the Cincinnati approach with good correction of the deformity; however, there was a severe soft-tissue defect that was treated with hAM. Case 3: An 8-year-old boy with arthrogryposis and clubfeet. He was treated with the Ponseti method at another institution. He had a severe equinovarus deformity that was corrected with posteromedial release using the Cincinnati approach. Postoperatively, the patient had no residual deformity, but complete skin coverage was not possible, and hAM was used. Results: All patients are currently with complete coverage, without recurrence of primary pathology. Conclusion: The use of amniotic membrane could be an option for the closure of posteromedial post-release defects of bot foot.
Revista de la Asociación Argentina de Ortopedia y Traumatología
Objetivo: Analizar la representación de la mujer a nivel societario dentro de la Asociación Argen... more Objetivo: Analizar la representación de la mujer a nivel societario dentro de la Asociación Argentina de Ortopedia y Traumatología (AAOT). Materiales y Métodos: Se realizó un estudio observacional y descriptivo analizando datos obtenidos del período entre el 1 de enero de 2015 y el 31 de diciembre de 2019. Se evaluó la proporción de mujeres que son miembros de la AAOT y su participación a nivel institucional, jerárquico y académico. Resultados: La mujer representa el 10,6% de todos los miembros de la AAOT. Doce mujeres participan activamente en los diferentes Comités de la Asociación, lo que representa un 16% del total de los integrantes. Durante el período de estudio, el 2,8% de los cargos de la Comisión Directiva fueron ocupados por mujeres. Una mujer fue Presidenta en la historia de la AAOT. En 2019, el 6,9% de los docentes que dictaron el Curso Oficial Nacional Bianual de Certificación de Ortopedia y Traumatología fueron mujeres. Conclusión: La mujer representa el 10,6% de los m...
This study examined soft-tissue coverage techniques of open tibia fractures, described softtissue... more This study examined soft-tissue coverage techniques of open tibia fractures, described softtissue treatment patterns across income groups, and determined resource accessibility and availability in Latin America. Methods: A 36-question survey was distributed to orthopaedic surgeons in Latin America through two networks: national orthopaedic societies and the Asociación de Cirujanos Traumatólogos de las Américas (ACTUAR). Demographic information was collected, and responses were stratified by income groups: highincome countries (HICs) and middle-income countries (MICs). Results: The survey was completed by 469 orthopaedic surgeons, representing 19 countries in Latin America (2 HICs and 17 MICs). Most respondents were male (89%), completed residency training (96%), and were fellowship-trained (71%). Only 44% of the respondents had received soft-tissue training. Respondents (77%) reported a strong interest in attending a soft-tissue training course. Plastic surgeons were more commonly the primary providers for Gustilo Anderson (GA) Type IIIB injuries in HICs than in MICs (100% vs. 47%, p < 0.01) and plastic surgeons were more available (< 24 h of patient presentation to the hospital) in HICs than MICs (63% vs. 26%, p = 0.05), demonstrating statistically significant differences. In addition, respondents in HICs performed free flaps more commonly than in MICs for proximal third (55% vs. 10%, p < 0.01), middle third (36% vs. 9%, p = 0.02), and distal third (55% vs. 10%, p < 0.01) lower extremity wounds. Negative Pressure Wound Therapy (NPWT or Wound VAC) was the only resource available to more than half of the respondents. Though not statistically significant, surgeons reported having more access to plastic surgeons at their institutions in HICs than MICs (91% vs. 62%, p = 0.12) and performed microsurgical flaps more commonly at their respective institutions (73% vs. 42%, p = 0.06).
Revista de la Asociación Argentina de Ortopedia y Traumatología, 2021
Objetivo: El objetivo primario fue conocer la actual aplicación de instrumentos de evaluación de ... more Objetivo: El objetivo primario fue conocer la actual aplicación de instrumentos de evaluación de competencias quirúrgicas en las residencias acreditadas por la AAOT. Como objetivos secundarios, se describieron los tipos de herramientas utilizadas, el conocimiento de los diferentes instrumentos de evaluación y qué tipo de evaluación se utiliza para la promoción de año. Se analizó si existen diferencias en las características entre las residencias que evalúan las competencias quirúrgicas y las que no. Materiales y Métodos: Se realizó un estudio descriptivo, para lo cual se diseñó una encuesta enfocada en mostrar cuántas residencias evalúan las competencias quirúrgicas con una herramienta formal. Además, a través de ella, se logró responder a los objetivos secundarios. La encuesta se envió a los responsables docentes de las 123 residencias acreditadas por la AAOT. Resultados: Se obtuvieron 105 (85,4%) respuestas, el 59% utiliza algún tipo de herramienta para evaluar las competencias qu...
espanolEl presente trabajo compara la funcionalidad de dos tutores externos utilizados para elong... more espanolEl presente trabajo compara la funcionalidad de dos tutores externos utilizados para elongacion: el del Dr. Ilizarov y el tutor HG, desarrollado en nuestra institucion. De 131 pacientes tratados con elongacion osea en 147 huesos largos se seleccionaron al azar 25 huesos por cada aparato anteriormente mencionado. Para objetivar los resultados se registraron estadisticamente variables independientes y dependientes en sus caracteristicas subjetivas y objetivas, tales como: edad, sexo, tipo de hueso elongado, tolerancia psiquica, sensacion de confort, facilidad de higiene y control, las infecciones, las rigideces articulares por retraccion musculo tendinosa, y la deformacion osea residual. El objetivo fue comparar y establecer si el cambio en la eleccion del sistema fue ventajoso para nuestros pacientes. En el intento comparativo se enfrentaron dos variables, que a nuestro criterio eran las mas importantes para establecer diferencias: la calidad del callo del hueso sometido a elo...
Revista de la Asociación Argentina de Ortopedia y Traumatología, 2018
La cirugía ortopédica ha avanzado mucho en estos años y, con ello, el uso de la intensificación d... more La cirugía ortopédica ha avanzado mucho en estos años y, con ello, el uso de la intensificación de imágenes en el quirófano. El objetivo de este informe es revisar los principios biológicos de la radiación, el marco legal actual y hacer una breve reseña sobre la situación actual en la Argentina.
Revista de la Asociación Argentina de Ortopedia y Traumatología, 2019
Resumen La presentación de trabajos científicos a través de un informe requiere de un armado que ... more Resumen La presentación de trabajos científicos a través de un informe requiere de un armado que podemos llamar "anatomía de un informe" y una dinámica en su interior a la que consideramos "la fisiología del informe" para que tenga validez y credibilidad, pero ¿cómo se evalúan los trabajos científicos presentados en nuestros congresos? ¿Cuáles son los criterios para determinar que un trabajo sea aceptado o no? El Comité de Investigación de la AAOT elaboró las grillas de evaluación. El objetivo de publicar las grillas es poder contar con una herramienta objetiva de valoración cualitativa y cuantitativa de todos los trabajos presentados en sus diferentes géneros, que podrá ser utilizada por los evaluadores de trabajos como elemento de feedback y como elemento de evaluación objetiva, y por los autores como guía para el armado del informe de su trabajo de investigación. Palabras clave: Grillas; trabajos científicos; ortopedia; traumatología. using evaluation grids for scientific publications. A method for objectifying the evaluation process AbstRAct For validity and credibility purposes, the presentation of scientific publications in a report form requires a certain layout that we could call the "anatomy of the report" , as well as the dynamics of it, considered the "physiology of the report". But how are conference scientific publications evaluated? What are the criteria used determine whether a report is accepted or not? The Research Committee at the AAOT developed evaluation with the aim of publishing them to have an objective tool for the qualitative and quantitative evaluation of all types of publications submitted. These grids could be used by evaluators to present their feedback, as well as an objective evaluation tool. Authors could used them as a guide to prepare the report of their research work.
Introduction: Amniotic band syndrome (ABS) is an uncommon congenital anomaly characterized by mul... more Introduction: Amniotic band syndrome (ABS) is an uncommon congenital anomaly characterized by multiple incapacitating manifestations. It may affect the bone, muscle, nerves, and vascular bundles according to the depth of the constriction band. Material and methods: Here we present a 2-month-old infant patient with active ABS in the lower limb at risk for amputation, in which the constriction bands were released surgically using the extensive approach. A two-step surgery was performed. In the first step, a Z-plasty of the anterior portion of the proximal constriction band was performed. In a second step, the bag on the foot was removed and subsequently the posterior part of the constrictive band was resected. Result: A follow-up of five years after surgery, respectively, revealed fully functional foot and restoration of blood supply. Conclusion: This procedure allowed to establish normal circulation in the limb with active ABS after birth. Removal of the constriction band improves the distal tissue and avoids progressive deformity. Surgery of the SBA may be performed in one or two steps.
Background: Residual acetabular dysplasia is one of the main complications of developmental dyspl... more Background: Residual acetabular dysplasia is one of the main complications of developmental dysplasia of the hip (DDH). Without treatment, over time degenerative osteoarthritis of the joint will develop, inexorably leading to the need for joint replacement. Acetabular and/or femoral osteotomies do not avoid the appearance of osteoarthritis in a significant number of patients. The purpose of this study was to assess the possibility of provoking changes in the morphology of the acetabulum through selective epiphysiodesis of the extra-articular portion of the ilioischial arm of the triradiate cartilage, using a percutaneous cannulated screw with the guidance of an imaging intensifier in an experimental model in rabbits. Methods: In a pilot study, 3-week-old New Zealand rabbits (n = 20) were submitted to unilateral surgery of the hip while the contralateral hip of the same group was used as a control. Posterior epiphysiodesis to the triradiate cartilage of the acetabulum was performed by placement of a cannulated screw. The rabbits were followed-up until 18 weeks of life. Radiographic measurements of the hips were performed immediately postoperatively and at 12 weeks of life and before the rabbits were sacrificed at week 18. Three-dimensional computed tomography (3D-CT) scans were performed. Non-parametric tests for paired samples and the Wilcoxon test were used to compare the differences between group 1 and group 2. A p < 0.05 was considered significant. Results: The non-intervened hips showed that, when the rabbit matured, the acetabulum lost concavity and depth. When comparing the median differences of the angles evaluated at 12 weeks between groups, a statistically significant difference was found in all radiographic measurements: an increase in Wiberg's angle but a decrease in acetabular index, acetabular angle of Sharp, acetabular depth index, and acetabular anteversion. Evaluating the operated hips at 12 and 18 weeks (three months after having removed the screw) using 3D-CT, we observed a rebound effect in the correction confirming that the effect obtained through selective B. Dello Russo 241 epiphysiodesis did not cause the definitive closure of the cartilage. Conclusions: Selective growth arrest of the ilioischial arm of the triradiate cartilage (posterior epiphysiodesis) can alter growth and change the shape of the acetabulum in rabbits. A rebound effect was observed when the screw was removed, confirming that the technique did not provoke definitive closure of the physis. Level of evidence: Level-2, therapeutic study.
The three major bones of the pelvis are joined together in a ringed shape. When one part of the r... more The three major bones of the pelvis are joined together in a ringed shape. When one part of the ring is broken there will be a fracture or a Summary Purpose: Pelvic fractures are uncommon in children. They rank second to those of the skull in terms of complication. The present study retrospectively evaluates 200 multi-trauma patients. Mode of injury, type of fracture, associated lesions, morbidity and mortality were assessed. Methods: Fractures were classified according to the tile pelvic fractures classification and injury severity was classified according to the Modified Injury Severity Scale (MISS) and Pediatric Trauma Score (PTS). The type of fracture correlated with injury severity and complications. The greatest morbidity and mortality was found in patients with completely unstable pelvic fractures. Results: In the pre-hospital stage at the site of the accident, the PTS demonstrated to be a very useful tool to assess injury severity of the patient, to decide on the first treatment measures, and to evaluate the degree of complexity of care the patient needs. The MISS showed to have good predictive value for injury assessment during the in-hospital stage Conclusions: Pelvic fractures are rare in children. Early stabilization with external fixation is the gold standard for the management of patients with fractures of the pelvic ring. In the pre-hospital stage at the site of the accident, the PTS demonstrated to be a very useful tool to assess injury severity of the patient, to decide on the first treatment measures, and to evaluate the degree of complexity of care the patient needs. The MISS showed to have good predictive value for injury assessment during the inhospital stage and is, together with the tile classification, useful for the staging of associated injury and the degree of morbidity and mortality. Adequate treatment of this type of fracture allows to minimize sequelae in the growing skeleton. Correct orthopedic treatment is important in the majority of these lesions.
Revista de la Asociación Argentina de Ortopedia y Traumatología
Introducción: El 11 de marzo de 2020, la OMS declaró la pandemia global por COVID-19 que afectó l... more Introducción: El 11 de marzo de 2020, la OMS declaró la pandemia global por COVID-19 que afectó la práctica ortopédica en el mundo. Para analizar la influencia de la COVID-19 sobre la situación laboral de los socios de la Asociación Argentina de Ortopedia y Traumatología, hemos realizado tres encuestas desde el inicio (marzo 2020) hasta la etapa posvacunación (julio 2021). Los objetivos fueron determinar diferencias en la reducción relativa del trabajo (consultorios, cirugías) durante las tres fases de la pandemia: prepico, pico y etapa de vacunación, y diferenciar entre la población estudiada, cuidados de protección, actividad, testeos, infección, aislamientos, vacunación. Materiales y Métodos: Encuesta prospectiva, en tres etapas, a los socios en general, autorizada por la Comisión Directiva, desde el inicio del aislamiento social obligatorio (Ro de 2,8), en el pico y posvacunación. Resultados: Se observó un bajo grado de adherencia que fue disminuyendo progresivamente entre las f...
Journal of Clinical & Experimental Orthopaedics, 2016
Background: A good fracture classification should provide information about fracture stability an... more Background: A good fracture classification should provide information about fracture stability and fracture mechanism, and should be a guide for treatment selection with a high degree of reproducibility. The purpose of this study was to analyze the degree of reliability of the two most widely used classification systems for pediatric ankle fractures: The AO classification and the Dias-Tachdjian Classification. Methods: We studied 53 patients, 34 male and 19 female, with ankle fractures. Two classifications, the AO classification and the Dias-Tachdjian classification, were used. Two groups of assessors, one consisting of experienced surgeons and the other of fellows, were asked to classify the fractures. The Cohen Kappa index was used to measure interobserver reliability and to determine interobserver agreement, the Kappa value was deduced using the Fleiss method. Interobserver agreement was measured using the Fleiss kappa coefficient, and intraobserver reliability was measured using the Cohen's kappa coefficient. Results: The intraobserver and interobserver agreement was not significantly different between the different groups of assessors. Conclusions: In the pediatric age different types of fractures and different mechanisms within an isolated fracture can be found. We found that many of these fracture patterns do not fit in any of the two classifications, which are thus unproductive for surgical planning.
As trauma is the leading cause of mortality in pati ents under the age of 35 years optimizing bot... more As trauma is the leading cause of mortality in pati ents under the age of 35 years optimizing both pre- hospital and initial in-hospital care is of utmost importance . Many different scores have been proposed. The aim of the present retrospective study was to c ompare the predictive value of two pediatric trauma scores: the pediatric trauma score (PTS) and the mo dified injury severity scale (MISS). The study population consisted of 84 patients (64 boys and 20 girls) admitted to the intensive care unit of the Garrahan Hospital between November 11, 1987 and Aug ust 1, 1991 with a diagnosis of polytrauma. For each score the level of severity of injury of the c hildren in the study population was determined. The predictive abilities of the scores were analyzed as to final outcome (survival-death), sensitivity, specificity, and positive and negative predictive v alue of the PTS with a cut-off point of 3 or less a nd of the MISS with a cut-off point of 25 or more. PTS wi th a cut-off poi...
Introduction: The use of the Ponseti technique continues to be the method of choice for the treat... more Introduction: The use of the Ponseti technique continues to be the method of choice for the treatment of bot foot, however, in those patients with recurrence due to poor adherence to treatment, syndronics, etc. medial postero release emerges as an alternative. Several coverage techniques are described in post-release residual defects from muscle or fasciocutaneous flaps, skin-free grafting, or open defects that close by the second intention. In recent years the relevance of the use of Human Amniotic Membrane (hAM) as a substitute for dermal matrix has been described. There are two cases of closure of bilateral post-medial post-release wound defect in the recurrence of bot foot with said membrane. Materials and Methods: Case 1: A 2-year old boy with Moebius syndrome associated with clubfeet was treated with the Ponseti method at birth. At 2 years of age, the deformity recurred in both feet and he was again treated with serial casting and posteromedial release using the Cincinnati inc...
Informe sobre radio exposición en el personal quirúrgico de Ortopedia y traumatología, 2018
La cirugía ortopédica ha avanzado mucho en estos años y, con ello, el uso de la intensificación d... more La cirugía ortopédica ha avanzado mucho en estos años y, con ello, el uso de la intensificación de imágenes en el quirófano. El objetivo de este informe es revisar los principios biológicos de la radiación, el marco legal actual y hacer una breve reseña sobre la situación actual en la Argentina. Palabras clave: Radiación; cirugía ortopédica. Report on the radiation exposure in the Orthopedic and Traumatology surgical staff.
HAL (Le Centre pour la Communication Scientifique Directe), 2020
Introduction: The use of the Ponseti technique continues to be the method of choice for the treat... more Introduction: The use of the Ponseti technique continues to be the method of choice for the treatment of bot foot, however, in those patients with recurrence due to poor adherence to treatment, syndronics, etc. medial postero release emerges as an alternative. Several coverage techniques are described in post-release residual defects from muscle or fasciocutaneous flaps, skin-free grafting, or open defects that close by the second intention. In recent years the relevance of the use of Human Amniotic Membrane (hAM) as a substitute for dermal matrix has been described. There are two cases of closure of bilateral post-medial post-release wound defect in the recurrence of bot foot with said membrane. Materials and Methods: Case 1: A 2-year old boy with Moebius syndrome associated with clubfeet was treated with the Ponseti method at birth. At 2 years of age, the deformity recurred in both feet and he was again treated with serial casting and posteromedial release using the Cincinnati incision. After the procedure, complete skin coverage was not possible and the large defect was treated with hAM. Case 2: A 10-year-old girl with arthrogryposis had bilateral clubfoot deformities treated with the Ponseti method at birth. Compliance with Ankle-Foot Orthoses (AFOs) was poor and subsequently, the treatment was abandoned. The posteromedial release was performed using the Cincinnati approach with good correction of the deformity; however, there was a severe soft-tissue defect that was treated with hAM. Case 3: An 8-year-old boy with arthrogryposis and clubfeet. He was treated with the Ponseti method at another institution. He had a severe equinovarus deformity that was corrected with posteromedial release using the Cincinnati approach. Postoperatively, the patient had no residual deformity, but complete skin coverage was not possible, and hAM was used. Results: All patients are currently with complete coverage, without recurrence of primary pathology. Conclusion: The use of amniotic membrane could be an option for the closure of posteromedial post-release defects of bot foot.
Revista de la Asociación Argentina de Ortopedia y Traumatología
Objetivo: Analizar la representación de la mujer a nivel societario dentro de la Asociación Argen... more Objetivo: Analizar la representación de la mujer a nivel societario dentro de la Asociación Argentina de Ortopedia y Traumatología (AAOT). Materiales y Métodos: Se realizó un estudio observacional y descriptivo analizando datos obtenidos del período entre el 1 de enero de 2015 y el 31 de diciembre de 2019. Se evaluó la proporción de mujeres que son miembros de la AAOT y su participación a nivel institucional, jerárquico y académico. Resultados: La mujer representa el 10,6% de todos los miembros de la AAOT. Doce mujeres participan activamente en los diferentes Comités de la Asociación, lo que representa un 16% del total de los integrantes. Durante el período de estudio, el 2,8% de los cargos de la Comisión Directiva fueron ocupados por mujeres. Una mujer fue Presidenta en la historia de la AAOT. En 2019, el 6,9% de los docentes que dictaron el Curso Oficial Nacional Bianual de Certificación de Ortopedia y Traumatología fueron mujeres. Conclusión: La mujer representa el 10,6% de los m...
This study examined soft-tissue coverage techniques of open tibia fractures, described softtissue... more This study examined soft-tissue coverage techniques of open tibia fractures, described softtissue treatment patterns across income groups, and determined resource accessibility and availability in Latin America. Methods: A 36-question survey was distributed to orthopaedic surgeons in Latin America through two networks: national orthopaedic societies and the Asociación de Cirujanos Traumatólogos de las Américas (ACTUAR). Demographic information was collected, and responses were stratified by income groups: highincome countries (HICs) and middle-income countries (MICs). Results: The survey was completed by 469 orthopaedic surgeons, representing 19 countries in Latin America (2 HICs and 17 MICs). Most respondents were male (89%), completed residency training (96%), and were fellowship-trained (71%). Only 44% of the respondents had received soft-tissue training. Respondents (77%) reported a strong interest in attending a soft-tissue training course. Plastic surgeons were more commonly the primary providers for Gustilo Anderson (GA) Type IIIB injuries in HICs than in MICs (100% vs. 47%, p < 0.01) and plastic surgeons were more available (< 24 h of patient presentation to the hospital) in HICs than MICs (63% vs. 26%, p = 0.05), demonstrating statistically significant differences. In addition, respondents in HICs performed free flaps more commonly than in MICs for proximal third (55% vs. 10%, p < 0.01), middle third (36% vs. 9%, p = 0.02), and distal third (55% vs. 10%, p < 0.01) lower extremity wounds. Negative Pressure Wound Therapy (NPWT or Wound VAC) was the only resource available to more than half of the respondents. Though not statistically significant, surgeons reported having more access to plastic surgeons at their institutions in HICs than MICs (91% vs. 62%, p = 0.12) and performed microsurgical flaps more commonly at their respective institutions (73% vs. 42%, p = 0.06).
Revista de la Asociación Argentina de Ortopedia y Traumatología, 2021
Objetivo: El objetivo primario fue conocer la actual aplicación de instrumentos de evaluación de ... more Objetivo: El objetivo primario fue conocer la actual aplicación de instrumentos de evaluación de competencias quirúrgicas en las residencias acreditadas por la AAOT. Como objetivos secundarios, se describieron los tipos de herramientas utilizadas, el conocimiento de los diferentes instrumentos de evaluación y qué tipo de evaluación se utiliza para la promoción de año. Se analizó si existen diferencias en las características entre las residencias que evalúan las competencias quirúrgicas y las que no. Materiales y Métodos: Se realizó un estudio descriptivo, para lo cual se diseñó una encuesta enfocada en mostrar cuántas residencias evalúan las competencias quirúrgicas con una herramienta formal. Además, a través de ella, se logró responder a los objetivos secundarios. La encuesta se envió a los responsables docentes de las 123 residencias acreditadas por la AAOT. Resultados: Se obtuvieron 105 (85,4%) respuestas, el 59% utiliza algún tipo de herramienta para evaluar las competencias qu...
espanolEl presente trabajo compara la funcionalidad de dos tutores externos utilizados para elong... more espanolEl presente trabajo compara la funcionalidad de dos tutores externos utilizados para elongacion: el del Dr. Ilizarov y el tutor HG, desarrollado en nuestra institucion. De 131 pacientes tratados con elongacion osea en 147 huesos largos se seleccionaron al azar 25 huesos por cada aparato anteriormente mencionado. Para objetivar los resultados se registraron estadisticamente variables independientes y dependientes en sus caracteristicas subjetivas y objetivas, tales como: edad, sexo, tipo de hueso elongado, tolerancia psiquica, sensacion de confort, facilidad de higiene y control, las infecciones, las rigideces articulares por retraccion musculo tendinosa, y la deformacion osea residual. El objetivo fue comparar y establecer si el cambio en la eleccion del sistema fue ventajoso para nuestros pacientes. En el intento comparativo se enfrentaron dos variables, que a nuestro criterio eran las mas importantes para establecer diferencias: la calidad del callo del hueso sometido a elo...
Revista de la Asociación Argentina de Ortopedia y Traumatología, 2018
La cirugía ortopédica ha avanzado mucho en estos años y, con ello, el uso de la intensificación d... more La cirugía ortopédica ha avanzado mucho en estos años y, con ello, el uso de la intensificación de imágenes en el quirófano. El objetivo de este informe es revisar los principios biológicos de la radiación, el marco legal actual y hacer una breve reseña sobre la situación actual en la Argentina.
Revista de la Asociación Argentina de Ortopedia y Traumatología, 2019
Resumen La presentación de trabajos científicos a través de un informe requiere de un armado que ... more Resumen La presentación de trabajos científicos a través de un informe requiere de un armado que podemos llamar "anatomía de un informe" y una dinámica en su interior a la que consideramos "la fisiología del informe" para que tenga validez y credibilidad, pero ¿cómo se evalúan los trabajos científicos presentados en nuestros congresos? ¿Cuáles son los criterios para determinar que un trabajo sea aceptado o no? El Comité de Investigación de la AAOT elaboró las grillas de evaluación. El objetivo de publicar las grillas es poder contar con una herramienta objetiva de valoración cualitativa y cuantitativa de todos los trabajos presentados en sus diferentes géneros, que podrá ser utilizada por los evaluadores de trabajos como elemento de feedback y como elemento de evaluación objetiva, y por los autores como guía para el armado del informe de su trabajo de investigación. Palabras clave: Grillas; trabajos científicos; ortopedia; traumatología. using evaluation grids for scientific publications. A method for objectifying the evaluation process AbstRAct For validity and credibility purposes, the presentation of scientific publications in a report form requires a certain layout that we could call the "anatomy of the report" , as well as the dynamics of it, considered the "physiology of the report". But how are conference scientific publications evaluated? What are the criteria used determine whether a report is accepted or not? The Research Committee at the AAOT developed evaluation with the aim of publishing them to have an objective tool for the qualitative and quantitative evaluation of all types of publications submitted. These grids could be used by evaluators to present their feedback, as well as an objective evaluation tool. Authors could used them as a guide to prepare the report of their research work.
Introduction: Amniotic band syndrome (ABS) is an uncommon congenital anomaly characterized by mul... more Introduction: Amniotic band syndrome (ABS) is an uncommon congenital anomaly characterized by multiple incapacitating manifestations. It may affect the bone, muscle, nerves, and vascular bundles according to the depth of the constriction band. Material and methods: Here we present a 2-month-old infant patient with active ABS in the lower limb at risk for amputation, in which the constriction bands were released surgically using the extensive approach. A two-step surgery was performed. In the first step, a Z-plasty of the anterior portion of the proximal constriction band was performed. In a second step, the bag on the foot was removed and subsequently the posterior part of the constrictive band was resected. Result: A follow-up of five years after surgery, respectively, revealed fully functional foot and restoration of blood supply. Conclusion: This procedure allowed to establish normal circulation in the limb with active ABS after birth. Removal of the constriction band improves the distal tissue and avoids progressive deformity. Surgery of the SBA may be performed in one or two steps.
Background: Residual acetabular dysplasia is one of the main complications of developmental dyspl... more Background: Residual acetabular dysplasia is one of the main complications of developmental dysplasia of the hip (DDH). Without treatment, over time degenerative osteoarthritis of the joint will develop, inexorably leading to the need for joint replacement. Acetabular and/or femoral osteotomies do not avoid the appearance of osteoarthritis in a significant number of patients. The purpose of this study was to assess the possibility of provoking changes in the morphology of the acetabulum through selective epiphysiodesis of the extra-articular portion of the ilioischial arm of the triradiate cartilage, using a percutaneous cannulated screw with the guidance of an imaging intensifier in an experimental model in rabbits. Methods: In a pilot study, 3-week-old New Zealand rabbits (n = 20) were submitted to unilateral surgery of the hip while the contralateral hip of the same group was used as a control. Posterior epiphysiodesis to the triradiate cartilage of the acetabulum was performed by placement of a cannulated screw. The rabbits were followed-up until 18 weeks of life. Radiographic measurements of the hips were performed immediately postoperatively and at 12 weeks of life and before the rabbits were sacrificed at week 18. Three-dimensional computed tomography (3D-CT) scans were performed. Non-parametric tests for paired samples and the Wilcoxon test were used to compare the differences between group 1 and group 2. A p < 0.05 was considered significant. Results: The non-intervened hips showed that, when the rabbit matured, the acetabulum lost concavity and depth. When comparing the median differences of the angles evaluated at 12 weeks between groups, a statistically significant difference was found in all radiographic measurements: an increase in Wiberg's angle but a decrease in acetabular index, acetabular angle of Sharp, acetabular depth index, and acetabular anteversion. Evaluating the operated hips at 12 and 18 weeks (three months after having removed the screw) using 3D-CT, we observed a rebound effect in the correction confirming that the effect obtained through selective B. Dello Russo 241 epiphysiodesis did not cause the definitive closure of the cartilage. Conclusions: Selective growth arrest of the ilioischial arm of the triradiate cartilage (posterior epiphysiodesis) can alter growth and change the shape of the acetabulum in rabbits. A rebound effect was observed when the screw was removed, confirming that the technique did not provoke definitive closure of the physis. Level of evidence: Level-2, therapeutic study.
The three major bones of the pelvis are joined together in a ringed shape. When one part of the r... more The three major bones of the pelvis are joined together in a ringed shape. When one part of the ring is broken there will be a fracture or a Summary Purpose: Pelvic fractures are uncommon in children. They rank second to those of the skull in terms of complication. The present study retrospectively evaluates 200 multi-trauma patients. Mode of injury, type of fracture, associated lesions, morbidity and mortality were assessed. Methods: Fractures were classified according to the tile pelvic fractures classification and injury severity was classified according to the Modified Injury Severity Scale (MISS) and Pediatric Trauma Score (PTS). The type of fracture correlated with injury severity and complications. The greatest morbidity and mortality was found in patients with completely unstable pelvic fractures. Results: In the pre-hospital stage at the site of the accident, the PTS demonstrated to be a very useful tool to assess injury severity of the patient, to decide on the first treatment measures, and to evaluate the degree of complexity of care the patient needs. The MISS showed to have good predictive value for injury assessment during the in-hospital stage Conclusions: Pelvic fractures are rare in children. Early stabilization with external fixation is the gold standard for the management of patients with fractures of the pelvic ring. In the pre-hospital stage at the site of the accident, the PTS demonstrated to be a very useful tool to assess injury severity of the patient, to decide on the first treatment measures, and to evaluate the degree of complexity of care the patient needs. The MISS showed to have good predictive value for injury assessment during the inhospital stage and is, together with the tile classification, useful for the staging of associated injury and the degree of morbidity and mortality. Adequate treatment of this type of fracture allows to minimize sequelae in the growing skeleton. Correct orthopedic treatment is important in the majority of these lesions.
Revista de la Asociación Argentina de Ortopedia y Traumatología
Introducción: El 11 de marzo de 2020, la OMS declaró la pandemia global por COVID-19 que afectó l... more Introducción: El 11 de marzo de 2020, la OMS declaró la pandemia global por COVID-19 que afectó la práctica ortopédica en el mundo. Para analizar la influencia de la COVID-19 sobre la situación laboral de los socios de la Asociación Argentina de Ortopedia y Traumatología, hemos realizado tres encuestas desde el inicio (marzo 2020) hasta la etapa posvacunación (julio 2021). Los objetivos fueron determinar diferencias en la reducción relativa del trabajo (consultorios, cirugías) durante las tres fases de la pandemia: prepico, pico y etapa de vacunación, y diferenciar entre la población estudiada, cuidados de protección, actividad, testeos, infección, aislamientos, vacunación. Materiales y Métodos: Encuesta prospectiva, en tres etapas, a los socios en general, autorizada por la Comisión Directiva, desde el inicio del aislamiento social obligatorio (Ro de 2,8), en el pico y posvacunación. Resultados: Se observó un bajo grado de adherencia que fue disminuyendo progresivamente entre las f...
Journal of Clinical & Experimental Orthopaedics, 2016
Background: A good fracture classification should provide information about fracture stability an... more Background: A good fracture classification should provide information about fracture stability and fracture mechanism, and should be a guide for treatment selection with a high degree of reproducibility. The purpose of this study was to analyze the degree of reliability of the two most widely used classification systems for pediatric ankle fractures: The AO classification and the Dias-Tachdjian Classification. Methods: We studied 53 patients, 34 male and 19 female, with ankle fractures. Two classifications, the AO classification and the Dias-Tachdjian classification, were used. Two groups of assessors, one consisting of experienced surgeons and the other of fellows, were asked to classify the fractures. The Cohen Kappa index was used to measure interobserver reliability and to determine interobserver agreement, the Kappa value was deduced using the Fleiss method. Interobserver agreement was measured using the Fleiss kappa coefficient, and intraobserver reliability was measured using the Cohen's kappa coefficient. Results: The intraobserver and interobserver agreement was not significantly different between the different groups of assessors. Conclusions: In the pediatric age different types of fractures and different mechanisms within an isolated fracture can be found. We found that many of these fracture patterns do not fit in any of the two classifications, which are thus unproductive for surgical planning.
As trauma is the leading cause of mortality in pati ents under the age of 35 years optimizing bot... more As trauma is the leading cause of mortality in pati ents under the age of 35 years optimizing both pre- hospital and initial in-hospital care is of utmost importance . Many different scores have been proposed. The aim of the present retrospective study was to c ompare the predictive value of two pediatric trauma scores: the pediatric trauma score (PTS) and the mo dified injury severity scale (MISS). The study population consisted of 84 patients (64 boys and 20 girls) admitted to the intensive care unit of the Garrahan Hospital between November 11, 1987 and Aug ust 1, 1991 with a diagnosis of polytrauma. For each score the level of severity of injury of the c hildren in the study population was determined. The predictive abilities of the scores were analyzed as to final outcome (survival-death), sensitivity, specificity, and positive and negative predictive v alue of the PTS with a cut-off point of 3 or less a nd of the MISS with a cut-off point of 25 or more. PTS wi th a cut-off poi...
Introduction: The use of the Ponseti technique continues to be the method of choice for the treat... more Introduction: The use of the Ponseti technique continues to be the method of choice for the treatment of bot foot, however, in those patients with recurrence due to poor adherence to treatment, syndronics, etc. medial postero release emerges as an alternative. Several coverage techniques are described in post-release residual defects from muscle or fasciocutaneous flaps, skin-free grafting, or open defects that close by the second intention. In recent years the relevance of the use of Human Amniotic Membrane (hAM) as a substitute for dermal matrix has been described. There are two cases of closure of bilateral post-medial post-release wound defect in the recurrence of bot foot with said membrane. Materials and Methods: Case 1: A 2-year old boy with Moebius syndrome associated with clubfeet was treated with the Ponseti method at birth. At 2 years of age, the deformity recurred in both feet and he was again treated with serial casting and posteromedial release using the Cincinnati inc...
Informe sobre radio exposición en el personal quirúrgico de Ortopedia y traumatología, 2018
La cirugía ortopédica ha avanzado mucho en estos años y, con ello, el uso de la intensificación d... more La cirugía ortopédica ha avanzado mucho en estos años y, con ello, el uso de la intensificación de imágenes en el quirófano. El objetivo de este informe es revisar los principios biológicos de la radiación, el marco legal actual y hacer una breve reseña sobre la situación actual en la Argentina. Palabras clave: Radiación; cirugía ortopédica. Report on the radiation exposure in the Orthopedic and Traumatology surgical staff.
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