Publications by authors named "Fernando Diaz Dilernia"

17 Publications

  • Page 1 of 1

Preliminary outcomes of the cementless UNITED hip system for primary total hip arthroplasty at a minimum 2-year follow-up.

Eur J Orthop Surg Traumatol 2021 Jun 12. Epub 2021 Jun 12.

Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, 4247 Potosí St., C1199ACK, Buenos Aires, Argentina.

Introduction: This study aimed to report the initial results of the cementless UNITED hip system in primary total hip arthroplasty (THA) with a minimum follow-up of 2 years.

Methods: We retrospectively studied a consecutive series of 203 cementless THAs in 180 patients operated between 2015-2017. We included 89 female and 91 male patients with a mean age of 67 (28 to 89) years. The mean follow-up was 40 (29 to 62) months. Clinical outcome scores and radiographs were measured. Survival was calculated defining failure as the need for any further femoral or acetabular revision, irrespective of the reason.

Results: No femoral component loosening was detected. One patient had a Vancouver-B1 intraoperative periprosthetic femoral fracture treated with implant retention and cerclage wires. Two acetabular components were revised for aseptic loosening. Three patients suffered an acute infection treated with debridement, antibiotics, and implant retention. The mean Merle d'Aubigné et Postel scores improved from 13 (4 to 16) points preoperatively to 17 (12 to 18) points at the latest follow-up (p < 0.001). At a mean time of 40 months of follow-up, the survival was 99% and 100% for the acetabular and the femoral components, respectively.

Conclusion: This cementless design showed excellent preliminary outcomes in terms of fixation and patient satisfaction, comparable to that of other well-known similar systems.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00590-021-03038-5DOI Listing
June 2021

Intramedullary nail for the surgical treatment of unstable fractures of the femur in previously amputated patients

Rev Fac Cien Med Univ Nac Cordoba 2021 03 12;78(1):57-63. Epub 2021 Mar 12.

Hospital Italiano de Buenos Aires.

Introduction: Femoral fractures in previously amputated patients (PAP) have been poorly reported in international literature, however it is worth mentioning that advances in the manufacture of orthotics for lower limbs have allowed these patients to remain functionally active. Surgery is then an option but difficulties may appear in positioning the patient for surgery due to the absence of the foot or ankle from where to pull and optimize the fracture reduction.

Objective: We report 3 cases of PAP with ipsilateral unstable femur fractures, treated surgically with cervicodiaphyseal endomedular nail. The surgical technique used in each case is described.

Results: Good long-term results were obtained demonstrating the effectiveness of surgical treatment and the reduction technique used.

Conclusion: Surgical treatment of unstable fractures of the proximal femur with an endomedullary nail should be considered a valid therapeutic option.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.31053/1853.0605.v78.n1.28020DOI Listing
March 2021

Are lateral view radiographs necessary to properly classify femoral neck fractures? Intra and interobserver analysis using Garden's classification system

Rev Fac Cien Med Univ Nac Cordoba 2021 03 29;78(1):41-44. Epub 2021 Mar 29.

Hospital Italiano de Buenos Aires.

Introduction: Femoral neck fractures have been historically diagnosed by anteroposterior (AP) and lateral (L) radiographic views. We analyzed the importance of the L view for management of femoral neck fractures, using the Garden's classification system.

Materials And Methods: Slides were elaborated with AP and L radiographic views of 100 patients with femoral neck fractures admitted to our emergency department. Three hip surgeons assessed independently AP views only and then AP and L views together using Garden's classification system.

Results: No statistically significant differences (Kruskal Wallis 0, p=1) were found while comparing categories among Garden's classification system, after assessing L views. There was an 81 % (p < 0.001) agreement of Garden category between AP and AP combined with L views. When analyzing patients with changing categories between displaced and non displaced after assessing L view images, we found a 5% (n=5, CI 95% 1-11%) of change. For comparing AP Garden with L view Garden, we used a quadratic weighted kappa method.

Conclusions: There is a high agreement in the Garden category when comparing AP with combined AP and L observations. Five patients would have received a different surgical treatment dependent on the hip surgeon who assessed the radiographs. This highlights the relevance of routinely L radiographs whenever a femoral neck fracture is suspected.
View Article and Find Full Text PDF

Download full-text PDF

Source
March 2021

[Isolated elbow dislocation in pediatric patients: non-operative treatment and complications associated with an infrequent pathology. Series of 4 cases].

Arch Argent Pediatr 2021 04;119(2):e133-e137

Hospital Italiano de Buenos Aires, Instituto de Ortopedia y Traumatología "Carlos E. Ottolenghi". Buenos Aires, Argentina.

Even though the elbow is the most often dislocated joint in children, this injury accounts for 3-6 % of elbow pathology. Dislocations without associated fractures are extremely rare. They result from a fall onto an outstretched hand. The patient is always referred with a painful joint, movement impairment and even clinical deformity. Acute treatment aims to achieve quick reduction and adequate joint stability, avoiding neurovascular injuries. We sought to analyze the functional outcomes and the complications after non-operative treatment. Our 4 patients Luxaciones puras de codo en pacientes pediátricos: tratamiento conservador y complicaciones asociadas a una patología poco prevalente. Serie de 4 casos Isolated elbow dislocation in pediatric patients: non-operative treatment and complications associated with an infrequent pathology. Series of 4 cases had excellent functional results at the latest follow-up, and one of them suffered from a median nerve palsy without further consequences. In our experience, these injuries presented excellent outcomes and we would like to highlight the importance of a quick and precise neurovascular examination with the possibility of non-surgical management of nerve injuries. A short period of immobilization with early rehabilitation should be indicated to avoid joint stiffness.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5546/aap.2021.e133DOI Listing
April 2021

Who Restores Hip Biomechanics More Effectively after a Femoral Neck Fracture? Comparison of Total Hip Arthroplasties Performed by Either Hip Surgeons or Orthopaedic Residents.

Arthroplast Today 2020 Dec 29;6(4):736-741. Epub 2020 Aug 29.

Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina.

Background: This study aims to analyze the ability to restore hip biomechanics in patients who undergo total hip arthroplasty for displaced femoral neck fractures operated by either hip surgeons (HSs) or orthopaedic residents (ORs).

Methods: We retrospectively compared 95 patients treated by HSs (group A) with 110 patients treated by ORs (group B). Leg-length discrepancy, femoral offset (FO), center of rotation (COR), acetabular inclination, and acetabular anteversion were evaluated on postoperative radiographs using the healthy contralateral hip as control.

Results: The median leg-length discrepancy was 2 mm for both groups ( = .74). The leg length was increased in 54% of the HS group and 57% of the OR group ( = .13). The median FO difference of groups A and B were 7 mm and 5.5 mm, respectively ( = .14). FO was increased in 80% of the HS group and 69% of the OR group ( = .19). Median discrepancies of the horizontal and vertical CORs were not statistically relevant, with -values of .69 and .14, respectively. The horizontal COR was slightly medialized in 58% of the HS group and 53% of the OR group ( = .003). The vertical COR was slightly proximal in 66% of the HS group and 76% of the OR group ( = .28). The median acetabular inclination angles of groups A and B were 41° and 40°, respectively ( = .62). The median anteversion angle was 19° for both groups ( = .89).

Conclusions: The horizontal COR was the only measurement with statistical significance. To conclude, ORs under supervision are as reliable as HSs to properly restore hip biomechanics in patients who undergo total hip arthroplasty for displaced femoral neck fractures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.artd.2020.07.027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7475170PMC
December 2020

Conversion total hip arthroplasty with a proximally modular, distal fixation reconstruction prosthesis following cephalomedullar nail failure.

Hip Int 2020 Sep;30(1_suppl):26-33

Orthopaedic and Traumatology Service, Hip Unit, Hospital Italiano de Buenos Aires, Buenos Aries, Argentina.

Background: The goals of intertrochanteric hip fracture (IHF) treatment are stable fixation, early mobilisation and function restoration. If the attempt to reduce, stabilise and fracture healing utilising a femoral cephalomedullar nail (CMN) fails, options for subsequent attempts are limited.

Purpose: Evaluate the clinical and radiographic outcomes of conversion total hip arthroplasty (THA) using a modular stem following a CMN failure.

Materials And Methods: We retrospectively reviewed a consecutive series of patients with an IHF between 2012 and 2014 to identify CMN patients that went on to the subsequent failure and conversion to THA utilising a modular femoral stem (MFS). In all cases, MP Reconstruction Prosthesis (Waldemar Link, Hamburg, Germany) was implanted. Primary clinical outcomes were assessed using Harris Hip Score (HSS) before conversion procedure, 3 months, 6 months and recent office visit post-conversion THA thereafter. The secondary outcome was to analyse intra and postoperative complications. Serial radiographs at each follow-up interval were assessed for clinical success or to confirm adverse events.

Results: 28 patients were included in the study; 17 were females. The average age was 72.7 years (SD ± 10.5); the average time from the index procedure to conversion THA was 12.6 months (SD ± 3.5). At baseline, average HHS was 42.1 (SD ± 3.6), improved to 80.7 (SD ± 5.1) at 3 months, 86.0 (SD ± 3.9) at 6-months which levelled off to 86.1 (SD ± 4.0) at final follow-up. There were 4 (14%) post-conversion complications: 2 dislocations, 1 superficial wound infection, 1 patient with symptomatic abductor deficiency. All 4 cases were conservatively treated successfully, the implants were retained, and the patients progressed without further issue.

Conclusions: MFSs allow to successfully treat failed CMN and adverse variations in femoral anatomy with a device that will permit simultaneous correction of leg length, offset and version to relieve pain, restore function and create a durable prosthetic to host composite.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1120700020937952DOI Listing
September 2020

Simultaneous Bilateral Femoral Neck Fracture Due to a Tonic-Clonic Seizure and High-Dose Steroid Therapy.

Arthroplast Today 2020 Sep 14;6(3):513-516. Epub 2020 Jul 14.

Institute of Orthopaedics "Carlos E. Ottolenghi" Italian Hospital of Buenos Aires, Buenos Aires, Argentina.

Simultaneous bilateral femoral neck fractures (FNFs) are extremely rare and usually associated with an underlying condition affecting the bone quality and mineralization. Convulsions have also been described as a possible cause, mostly as a consequence of epilepsy, hyponatremia, and hypocalcemia. We present a 52-year-old female patient, with bilateral displaced FNFs due to a tonic-clonic seizure and high-dose steroid therapy related to a frontal lobe anaplastic oligodendroglioma brain tumor resection. Two days after admission, bilateral one-stage uncemented total hip arthroplasty (THA) under general anesthesia and through a posterolateral approach was performed using a metal-on-polyethylene bearing surface. Several risk factors can be identified in this unique case, such as the high-dose steroid therapy, the low-demand activity of the patient due to her functional sequelae, and finally, the convulsive episode. Surgeons should be aware of this uncommon injury to ensure early diagnosis and treatment in all patients with a previous history of seizures, chronic steroid use, severe hip pain, and inability to walk. For bone metabolic diseases, preventive measures should be indicated to avoid these complications. Bilateral one-stage uncemented THA represents an effective procedure with a low complication rate allowing early rehabilitation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.artd.2020.05.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7364048PMC
September 2020

Unusual hematogenous infection in total knee replacement treated with one-stage revision surgery.

Arthroplast Today 2019 Sep 22;5(3):296-300. Epub 2019 Jul 22.

Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina.

Septic arthritis due to (LM) is extremely rare and most infections due to this organism are seen in immunocompromised patients. We describe a patient without immunological compromise, with a late total knee arthroplasty infection caused by LM treated with one-stage revision surgery. She had an elevated erythrocyte sedimentation rate (79 mm/h) and C-reactive protein (13 mg/dL). Aspiration of the knee joint yielded purulent fluid; cultures showed LM. The patient was given 6 weeks of intravenous ampicillin, followed by trimethoprim/sulfamethoxazole, and finally amoxicillin orally for 7 months. Two years after revision surgery, radiographs showed no evidence of implant loosening. This is a single case and although one-stage approach seemed to have worked, it should not be recommended on the basis of a single report.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.artd.2019.06.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6728532PMC
September 2019

Cement leakage into the hip joint during TFN-A cement augmentation in a revision surgery of an extra-capsular hip fracture.

Trauma Case Rep 2019 Aug 20;22:100212. Epub 2019 Jun 20.

Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, 4247 Potosí St., C1199ACK Buenos Aires, Argentina.

Introduction: The intra-articular migration of the spiral lamina or screw, after close reduction and internal fixation (CRIF) with an intramedullary cervicodiaphyseal nail (cut-through), is one of the most frequent postoperative complications. We present a patient with a cut-through and cement leakage into the hip joint after TFN-A cement augmentation and spiral lamina replacement.

Methods: A 83-year-old man, suffered a cut-through after CRIF of his left extracapsular hip fracture during the third postoperative month. A revision surgery was planned, including spiral lamina replacement and cement augmentation. Cement leakage into the hip joint was confirmed in the immediate postoperative radiograph and a new intervention was indicated with the removal of the third bodies.

Results: The patient presented good clinical evolution, without functional limitation or pain. In routinely postoperative radiographic controls, no differences were observed respect to the immediate postoperative one.

Discussion: Current literature dealing with implant revision surgery and associated cement augmentation are scarce.

Conclusion: As far as we are concerned, this is the first case in the literature of a re-revision surgery of an extracapsular hip fracture due to a three months postoperative cut-through and a posterior cement leakage into the hip joint after TFN-A cement augmentation and spiral lamina replacement with the need of a posterolateral approach for removal.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.tcr.2019.100212DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6593312PMC
August 2019

Unaddressed arterial injuries in revision total hip arthroplasty: mortality outcomes of a low-prevalence complication.

Int Orthop 2020 01 20;44(1):23-29. Epub 2019 Jun 20.

Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, ACK1199, 4247 Potosi St, Buenos Aires, Argentina.

Purpose: Peri-operative major arterial haemorrhage after revision total hip arthroplasty (RTHA) is an odd but limb- and life-threatening complication. In this retrospective analysis, we sought to determine the prevalence of such injuries requiring selective catheter embolization or bypass after RTHA and to evaluate the associated mortality rate.

Methods: Between 1995 and 2016, 2524 RTHAs were performed at a high-volume centre (1031 one-stage revisions, 1370 two-stage revisions and 123 resection arthroplasties). Throughout this period, nine patients presented with signs of persistent bleeding unaddressed during index surgery (9/2524; 0.35%), causing haemodynamic instability. All patients underwent angiographic exploration within the first 24 post-operative hours. Angiography evidenced four cases of bleeding pseudoaneurysms (three of them related to the common femoral artery and one to the medial circumflex femoral artery) and five cases of direct lacerations (one case in the inferior epigastric artery, one in the hypogastric artery, one in the external iliac artery, one in the popliteal artery and another in the superior gluteal artery).

Results: Six cases underwent selective percutaneous angiographic embolization with gelatin microspheres, obtaining immediate haemodynamic stabilization; whereas three cases required a further bypass surgery with synthetic graft. Of the former group, four patients had an uneventful evolution, while two died at a mean of 49 days after surgery due to multi-organ failure (MOF). Two cases of the bypass group died because of MOF at a mean of 22 days. Overall mortality rate was 44%.

Conclusions: The overall risk of arterial injury associated with RTHA was low. However, recognition of such a complication is imperative since it was associated with a high mortality rate.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00264-019-04358-2DOI Listing
January 2020

Impaction Bone Grafting or Uncemented Modular Stems for the Treatment of Type B3 Periprosthetic Femoral Fractures? A Complication Rate Analysis.

J Arthroplasty 2019 Sep 14;34(9):2051-2057. Epub 2019 May 14.

Hip centre "Sir John Charnley", Institute of Orthopaedics "Carlos E. Ottolenghi" Italian Hospital of Buenos Aires, Buenos Aires, Argentina.

Background: Because the gold standard for the treatment of Vancouver type-B3 periprosthetic femoral fractures (PFFs) is yet to be defined, we sought to analyze the complication rate between the impaction bone grafting (IBG) technique with a cemented stem and reconstruction with an uncemented distally-fixed modular stem (DFMS).

Methods: We retrospectively studied 54 B3 PFFs operated between 2000 and 2016, comparing the complication rate of 33 patients treated with the IBG technique (group A) with 21 patients treated with a DFMS (group B). Median follow-up of groups A and B were 75 months (interquartile range [IQR], 36-111 months) and 55 months (IQR, 32-73 months), respectively (P = .008). Median age of groups A and B were 78 years (IQR, 74-83 years) and 81 years (IQR, 74-86 years), respectively (P = .30). Median grade of Endo-Klink femoral bone defect was 3 (IQR, 3-3) for both groups (P = .11). We performed a multiple regression analysis to determine risk factors for complications including the following variables: age, initial diagnosis, and surgical technique.

Results: As for infection outcomes, 2-stage revision surgery was more frequent in group A than in group B (4 vs 0, P = .003). Group A presented more implant failures than group B (5 vs 1, P = .195). We found 4 dislocations in group B and 2 in group A (P = .192). Multiple regression analysis showed a significant association between surgical technique and complication rate (P = .01). The IBG technique presented an odds risk for complications of 4.77 (P = .016; IQR, 1.33-17.21).

Conclusion: Femoral reconstruction with the IBG technique evidenced an ostensibly higher complication rate than that of DFMS for the treatment of B3 PFF.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.arth.2019.04.047DOI Listing
September 2019

Are there any risk factors for developing complications with the use of retrievable vena cava filters in orthopaedic surgery?

Rev Fac Cien Med Univ Nac Cordoba 2018 06 11;75(2):119-127. Epub 2018 Jun 11.

.

Background: In high-risk patients, common prophylaxis may be insufficient to prevent thromboembolic events after orthopaedic procedures. In this scenario, a retrievable vena cava filter (VCF) could be considered as an alternative, although it's use remains controversial. Therefore, we asked: (1) what is the overall mechanical complication rate associated with the use of retrievable VCFs in orthopaedic surgery?, (2) what is the association with thromboembolic disease (TED) recurrence, post-thrombotic syndrome and/or major bleeding according to different surgical characteristics?, (3) What is the overall mortality rate attributed to VCF use?

Methods: We retrospectively analyzed a cohort of 68 patients who underwent orthopaedic surgery with a previous diagnosis of TED, in whom a retrievable VCF was placed. Permanent filters were excluded. We studied the filter's mechanical complications and considered as possible outcomes death and 3 hematologic complications: TED recurrence, post-thrombotic syndrome and major bleeding. To estimate association with risk factors, we subclassified surgeries into 5 groups: 1, arthroplasty/non-arthroplasty; 2, primary/revision; 3, elective/urgent; 4, oncologic/non-oncologic; 5, preoperative/postoperative filter.

Results: Mechanical complications were 16% and required a filter revision. Sixty-four percent of the revised VCFs developed a mechanical failure and could not be retrieved. Overall prevalence of TED recurrence, post-thrombotic syndrome and hemorrhage was 33%, 15% and 4.5%, respectively. Spinal surgeries were a risk factor for developing TED recurrences.  Only 4% of patients died of a TED recurrence.

Conclusions: Orthopaedic procedures had a high risk of mechanical and hematologic complications after using a retrievable VCF. However, mortality was low due to these complications.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.31053/1853.0605.v75.n2.17746DOI Listing
June 2018

THA conversion rate comparing decompression alone, with autologous bone graft or stem cells in osteonecrosis.

Hip Int 2018 03 10;28(2):189-193. Epub 2017 Sep 10.

"Sir John Charnley" Hip centre, "Carlos E. Ottolenghi" Orthopaedic and Traumatology Institute, Italian Hospital of Buenos Aires, Buenos Aires - Argentina.

Introduction: Core decompression (CD) with or without the addition of autologous bone graft (CDBG) is currently the most widely accepted treatment for hip osteonecrosis in stages of pre-collapse. The use of bone marrow mesenchymal stem cells (CDSC) is emerging as a promising biological alternative. We sought to determine the total hip arthroplasty (THA) conversion rate for patients treated with CD, CDBG or CDSC.

Material And Methods: Between 1996 and 2012, 97 cases were evaluated in 72 patients: 47 CD cases, 34 CDGB cases and 16 CDSC cases. The mean age was 39 (20-63) years, 25 bilateral, 19 female and 53 male, 14 Ficat 1 and 83 Ficat 2. Bilateral cases with asymmetric stage and equal treatment were excluded.

Results: Conversion rate to THA was 44% for the CD group (21/47) at an average of 77 (24-324) months; 50% for the CDBG group (17/34) at an average of 34 (24-240) months and 50% for the CDSC group (8/16) at an average of 48 (24-72) months (p = 0.619). Log Rank test for survivorship analysis was not significant (p = 0.2011). Immunodeficiency or corticosteroid treatment history was associated with 16/47 of the CD group, 7/34 in the CDBG group and 1/16 in the CDSC group. Trauma was associated with 2/47 of the CD group, 5/34 of the CDBG group and none of the CDSC group. Hazard ratio considering risk factors was not significant (p = 0.252).

Conclusions: In these series of cases including patients with pre-collapse osteonecrosis, we observed non-significant results regarding rate of conversion to THA with CD, CDBG or CDSC at an average of 5.5 years.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5301/hipint.5000552DOI Listing
March 2018

Return to Sports and Recurrences After Arthroscopic Anterior Shoulder Stabilization in Martial Arts Athletes.

Orthop J Sports Med 2017 09 13;5(9):2325967117725031. Epub 2017 Sep 13.

Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi Institute, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.

Background: The high demands to the glenohumeral joint and the violent shoulder blows experienced during martial arts (MA) could compromise return to sports and increase the recurrence rate after arthroscopic stabilization for anterior shoulder instability in these athletes.

Purpose: To report the functional outcomes, return to sports, and recurrences in a series of MA athletes with anterior shoulder instability treated with arthroscopic stabilization with suture anchors.

Study Design: Case series; Level of evidence, 4.

Methods: A total of 20 consecutive MA athletes were treated for anterior shoulder instability at a single institution between January 2008 and December 2013. Range of motion (ROM), the Rowe score, a visual analog scale (VAS), and the Athletic Shoulder Outcome Scoring System (ASOSS) were used to assess functional outcomes. Return-to-sport and recurrence rates were also evaluated.

Results: The mean age at the time of surgery was 25.4 years (range, 18-35 years), and the mean follow-up was 71 months (range, 36-96 months). No significant difference in preoperative and postoperative shoulder ROM was found. The Rowe, VAS, and ASOSS scores showed statistical improvement after surgery ( < .001). In all, 19 athletes (95%) returned to sports. However, only 60% achieved ≥90% recovery after surgery. The recurrence rate was 20%.

Conclusion: In this retrospective study of a consecutive cohort of MA athletes, arthroscopic anterior shoulder stabilization significantly improved functional scores. However, only 60% of the athletes achieved the same level of competition, and there was a 20% recurrence rate.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2325967117725031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5600303PMC
September 2017

Outcomes of nondisplaced intracapsular femoral neck fractures with internal screw fixation in elderly patients: a systematic review.

Hip Int 2018 01;28(1):18-28

3 Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires - Argentina.

Introduction: Although the preferred treatment for displaced femoral neck fractures in the elderly is hip arthroplasty, the treatment for impacted or undisplaced femoral neck fractures (UFNF) is still a subject of controversy. Our purpose was to systematically review studies of elderly patients with UFNF treated with internal fixation using screws: (i) what is the reported mortality; (ii) what is the reoperation rate; (iii) what are the clinical and radiological outcomes; and (iv) what is the methodological quality of the included studies?

Methods: This systematic review was performed through a search of PubMed and the Cochrane database using a structured search algorithm including studies enrolling patients older than 60 years old, with UFNF treated with internal fixation using screws. Our literature search returned 950 studies and 11 were selected for final abstraction.

Results: 6 studies reported mortality rate. At 1-year follow-up mortality was reported by 3 studies: 18.8%; 22%, and 19%. At 5 years, 1 study reported mortality rate of 42%. Overall reoperation rate was reported by 9 studies and ranged from 8%-19%, while conversion to hip arthroplasty was performed in the range between 8% and 16% according to 6 studies.

Conclusions: Internal fixation with cannulated screws for UFNF in the elderly is a valuable option, although it has substantial reoperation and mortality rates. Further prospective high-quality, randomised controlled trials are required to establish the optimal approach for the treatment of UFNF.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5301/hipint.5000532DOI Listing
January 2018

Gluteal Compartment Syndrome Secondary to Pelvic Trauma.

Case Rep Orthop 2016 8;2016:2780295. Epub 2016 Aug 8.

Institute of Orthopaedics "Carlos E. Ottolenghi" Italian Hospital of Buenos Aires, C1199ACK Buenos Aires, Argentina.

Gluteal compartment syndrome (GCS) is extremely rare when compared to compartment syndrome in other anatomical regions, such as the forearm or the lower leg. It usually occurs in drug users following prolonged immobilization due to loss of consciousness. Another possible cause is trauma, which is rare and has only few reports in the literature. Physical examination may show tense and swollen buttocks and severe pain caused by passive range of motion. We present the case of a 70-year-old man who developed GCS after prolonged anterior-posterior pelvis compression. The physical examination revealed swelling, scrotal hematoma, and left ankle extension weakness. An unstable pelvic ring injury was diagnosed and the patient was taken to surgery. Measurement of the intracompartmental pressure was measured in the operating room, thereby confirming the diagnosis. Emergent fasciotomy was performed to decompress the three affected compartments. Trauma surgeons must be aware of the possibility of gluteal compartment syndrome in patients who have an acute pelvic trauma with buttock swelling and excessive pain of the gluteal region. Any delay in diagnosis or treatment can be devastating, causing permanent disability, irreversible loss of gluteal muscles, sciatic nerve palsy, kidney failure, or even death.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2016/2780295DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4992797PMC
August 2016