Search

CASE REPORT: Chopart joint fracture-dislocations are rare injuries. The purpose of this report is to present the management of a high energy trans-cuboid Chopart dislocation. This fracture-dislocation dislocation was treated with closed reduction, provisional fixation, and definitively with a combination of open reduction internal fixation (ORIF) and a lateral column external fixator. Due to persistent pain and Chopart joint collapse, the patient ultimately required a double arthrodesis. CONCLUSION: While rare, Chopart joint fracture-dislocations are impactful injuries that require prompt diagnosis and specialized management. The description of this high energy trans-cuboid Chopart dislocation and the stepwise approach for its management may be useful for other surgeons who encounter similar injuries.

INTRODUCTION: Staged treatment of high-energy periarticular tibia fractures involves temporization with closed reduction and external fixation, aiming to provide early reduction and stabilization while mitigating soft-tissue complications. Various external fixator configurations exist, including those that use a multipin clamp capable of holding multiple pins but limiting pin placement to a single plane. The purpose of this study was to compare clinical and radiographic outcomes and associated costs of standard and multipin outrigger clamp constructs in tibial plateau and pilon fractures treated with temporary external fixation. We hypothesized that use of the multipin clamp may be associated with poorly aligned reductions and increased complication rates. METHODS: A retrospective review of 100 patients with periarticular tibial plateau (AO/OTA: 41B/C) or pilon (43B/C) fracture at a Level 1 trauma center from 2014 to 2023 was conducted. Patient, injury, and complication characteristics were collected. Patients were categorized based on the external fixator clamp used: multipin (MP) or standard (S). Clinical outcomes and complication rates were assessed. Radiographic alignment was evaluated by the change in anterior and lateral distal tibial angles, and sagittal plane translation for pilon fractures, and medial and posterior proximal tibial angles for plateau fractures. RESULTS: 70 patients underwent standard (25 pilon, 45 plateau) and 30 multipin (10 pilon, 20 plateau) external fixation. MP and S groups showed no notable differences in demographics or injury characteristics. Both groups demonstrated comparable complication rates and radiological alignment outcomes, with no notable differences observed. MP constructs were more costly than standard systems. CONCLUSION: In this retrospective study of 100 patients, there was no difference in radiographic or clinical outcomes between the standard frame and multipin frame groups. Typical costs for the multipin frame constructs were $635 to $1249 more than the standard frame constructs.

PURPOSE: To describe U-type sacral fracture characteristics amenable to percutaneous sacral screw fixation. METHODS: U-type sacral fractures were identified from a trauma registry at a level 1 trauma center from 2014 to 2020. Patient demographics, injury mechanism, fracture characteristics, and fixation construct were retrospectively retrieved. Associations between fracture pattern and surgical fixation were identified. RESULTS: 82 U-type sacral fractures were reviewed. Six treated with lumbopelvic fixation (LPF) and 76 were treated with percutaneous sacral screws (PSS) alone. Patients receiving LBF had greater sacral fracture displacement in coronal, sagittal, and axial planes compared to patients receiving PSS alone (P

The objective is to analyse the progress of a 2-year-olds classroom in a school in Cantabria (Spain) towards an inclusive participation project. The research, carried out over three school years, has been based on the qualitative paradigm and ethnographic approach. A variety of research strategies have been employed: participant observation; discussion groups; informal conversations; ambulation and child conferencing using image elicitation. We have analysed the transformation of the educational approach in a classroom for 2-year-olds into a pedagogy of inclusive participation. These transformation process have deployed through three practitioner enquiry cycles with different focuses: materials and proposals; curriculum as "progetazzione"; decision-making opportunities and child participation. These transformation processes have also allowed educators to move towards a critical ecology of the profession perspective. Finally, the teachers who enquired into their educational reality by listening to children, embarded on a process of transformation towards more participatory education.

PURPOSE: The retrograde femoral nailing advanced (RFNA) system (DePuy synthes) is a commonly used implant for the fixation of low distal femur and periprosthetic fractures. There is concern that the rate of distal interlock screw back-out may be higher for the RFNA compared to other nails (ON). The purpose of this study was to evaluate the incidence of interlock screw back-out and associated screw removal for RFNA versus ON, along with associated risk factors. METHODS: A retrospective comparative study of patients who underwent retrograde nailing for a distal femur fracture at an academic level one trauma center was performed. The incidence of distal interlock screw back-out and need for screw removal were compared for RFNA versus a propensity score matched cohort who received other nails. RESULTS: One hundred and ten patients underwent retrograde nailing with the RFNA for a distal femur fracture from 2015 to 2022 (average age: 66, BMI: 32, 52.7% smokers, 54.5% female, 61.8%). There was a significantly higher rate of interlock back-out in the RFNA group compared to the ON (27 patients, 24.5% vs 12 patients, 10.9%, p = 0.01), which occurred 6.3 weeks postoperatively. Screw removal rates for back-out were not significantly different for the RFNA group versus ON (8 patients, 7.3% vs 3 patients, 2.7%, p = 0.12). CONCLUSION: In this retrospective comparative study of distal femur fractures treated with retrograde nailing, the RFNA implant was associated with an increased risk of distal interlock screw back-out compared to other nails.

We describe a trifocal femur injury with intracapsular femoral neck fracture, diaphyseal fracture with bone loss, and distal complete articular (AO/OTA C type) fracture, an injury rarely described in the literature. Surgical management utilized a not-yet-reported implant combination: screw-side plate device for the intracapsular femoral neck, retrograde nail for the diaphysis, and lag screws plus mini fragment buttress plating for the distal fracture. The patient had uneventful fracture union with no changes in alignment. Given the rarity and complexity of this injury, there is little consensus on surgical technique and implant choice. This case demonstrates a modernized approach that may be useful for surgeons who encounter similar fracture patterns in their practice.

INTRODUCTION: The incidence of periprosthetic distal femur fractures (PDFF) is increasing as the number of total knee replacements becomes more common. This study compared the demographics, fracture characteristics, treatment, and outcomes of periprosthetic versus native distal femur fractures (NDFF). MATERIALS AND METHODS: This was a retrospective cohort study of patients ≥ 18 who underwent surgical fixation of NDFF or PDFF from 2012 to 2020 at a level-1 trauma center. The main variables collected included demographics, AO/OTA fracture classification, fixation construct, concomitant fractures, polytrauma rates, bone density, and reduction quality. Primary outcomes were unexpected return to the operating room (UROR), hospital length of stay, and quality of reduction. T-tests, Fishers exact tests, and multivariate analyses were used for statistical analysis. RESULTS: 209 patients were identified, including 70 PDFF and 139 NDFF. PDFF patients were elderly females (81%) with isolated (80%) and comminuted (85%) 33 A.3 (71%) fractures. NDFF patients included 53% females, were commonly middle-aged, and displayed comminuted (92%) 33 C.2 fractures. 48% of NDFF patients had concomitant fractures. Intramedullary nailing was the primary fixation for both groups, followed by nail-plate combination (37%) for PDFF and lateral locking plates (21%) for NDFF. NDFF patients experienced significantly longer hospital stays, higher UROR rates, and worse quality of reduction (p

This study aimed to compare revision ratesand associated complications in femoral shaftfractures, with and without reduction of thesebutterfly fragments.

Intramedullary nailing is considered the gold-standard treatment for tibial shaft fractures. The goals of treatment for these fractures are correction of axial and rotational alignment and adequate mechanical stability, allowing for optimal healing. The nail is secured in place using screws or other fasteners that are placed through the bone and into the nail itself.2  Another benefit is the ability to preserve the soft tissue around the fracture to safeguard the extraosseous blood supply and minimize soft tissue damage.3 In reference to tibial intramedullary nailing, a start point is the location where a hole is drilled in the tibia to insert the intramedullary nail. The ideal starting point for guide wire placement for the average tibia is described as 2 mm medial to the lateral tibial eminence on AP imaging and just anterior to articular surface and parallel to the anterior tibia cortex on lateral imaging.6,7 It is a critical part of the procedure because it determines the trajectory and positioning of the nail within the medullary canal.7 Having a good, ideal starting point can prevent valgus angulation and translation at the fracture site. If the start point is too far off center or at the wrong angle, the nail may be inserted incorrectly and not provide the necessary support for the bone to heal, leading to malalignment or nonunion.  It is believed that different approaches to tibial intramedullary nailing may have differing abilities to achieve an optimal start point due to associated anatomical visualization and access. These approaches include suprapatellar, parapatellar, and infrapatellar nailing. The suprapatellar approach involves making an incision above the patella and placing instruments across the patellofemoral joint, potentially damaging the joint surface. However, the nail can be inserted at the start point with the knee extended, which leads to better alignment and stability of the fractured bone. Most importantly, the main advantage of the suprapatellar approach is that it reduces anterior angulation by eliminating the extension force of the quadriceps and aids fracture reduction by preventing proximal fragment migration.4,5 The parapatellar approach, proven to be effective and reliable, involves making a smaller incision below the patella with the knee in hyperflexion. This approach is less invasive than the suprapatellar approach regarding the patellofemoral joint, but the patellar tendon needs to be circumnavigated leading to potential for higher incidence of anterior knee pain.6 Also, it can be more difficult to achieve proper alignment and increases the risk of apex anterior deformities.4 The infrapatellar approach is split into transtendinous approach and paratendinous approach where the starting point is established by splitting the patellar tendon or making an incision on either side of the knee, respectively.6 This approach provides good visualization, but it can increase the risk of damage to the patellar tendon and other soft tissue structures around the knee.

Orthopaedic trauma remains a leading cause of patient morbidity, mortality, and global health care burden. Although significant advances have been made in the diagnosis, treatment, and rehabilitation of these injuries, complications such as malunion, nonunion, infection, disuse muscle atrophy and osteopenia, and incomplete return to baseline function still occur. The significant inherent clinical variability in fracture care such as differing patient demographics, injury patterns, and treatment protocols make standardized and replicable study, especially of cellular and molecular based mechanisms, nearly impossible. Hence, the scientists dedicated to improving therapy and treatments for patients with orthopaedic trauma rely on preclinical models. Preclinical models have proven to be invaluable in understanding the timing between implant insertion and bacterial inoculation on the bioburden of infection. Posttraumatic arthritis (PTOA) can take years to develop clinically, but with a porcine pilon fracture model, posttraumatic arthritis can be reliably induced, so different surgical and therapeutic strategies can be tested in prevention. Conversely, the racehorse presents a well-accepted model of naturally occurring PTOA. With preclinical polytrauma models focusing on chest injury, abdominal injury, multiple fractures, and/or head injury, one can study how various injury patterns affect fracture healing can be systemically studied. Finally, these preclinical models serve as a translational bridge to for clinical application in human patients. With selection of the right preclinical model, studies can build a platform to decrease the risk of emerging technologies and provide foundational support for therapeutic clinical trials. In summary, orthopaedic trauma preclinical models allow scientists to simplify a complex clinical challenge, to understand the basic pathways starting with lower vertebrate models. Then, R&D efforts progress to higher vertebrate models to build in more complexity for translation of findings to the clinical practice.

INTRODUCTION: The potential capabilities of generative artificial intelligence (AI) tools have been relatively unexplored, particularly in the realm of creating personalized statements for medical students applying to residencies. This study aimed to investigate the ability of generative AI, specifically ChatGPT and Google BARD, to generate personal statements and assess whether faculty on residency selection committees could (1) evaluate differences between real and AI statements and (2) determine differences based on 13 defined and specific metrics of a personal statement. METHODS: Fifteen real personal statements were used to generate 15 unique and distinct personal statements from ChatGPT and BARD each, resulting in a total of 45 statements. Statements were then randomized, blinded, and presented to a group of faculty reviewers on residency selection committees. Reviewers assessed the statements by 14 metrics including if the personal statement was AI-generated or real. Comparison of all metrics was performed. RESULTS: Faculty correctly identified 88% (79/90) real statements, 90% (81/90) BARD, and 44% (40/90) ChatGPT statements. Accuracy of identifying real and BARD statements was 89%, but this dropped to 74% when including ChatGPT. In addition, the accuracy did not increase as faculty members reviewed more personal statements (area under the curve [AUC] 0.498, p = 0.966). BARD performed poorer than both real and ChatGPT across all metrics (p < 0.001). Comparing real with ChatGPT, there was no difference in most metrics, except for Personal Interests, Reasons for Choosing Residency, Career Goals, Compelling Nature and Originality, and all favoring the real personal statements (p = 0.001, p = 0.002, p < 0.001, p < 0.001, and p < 0.001, respectively). CONCLUSION: Faculty members accurately identified real and BARD statements, but ChatGPT deceived them 56% of the time. Although AI can craft convincing statements that are sometimes indistinguishable from real ones, replicating the humanistic experience, personal nuances, and individualistic elements found in real personal statements is difficult. Residency selection committees might want to prioritize these particular metrics while assessing personal statements, given the growing capabilities of AI in this arena. CLINICAL RELEVANCE: Residency selection committees may want to prioritize certain metrics unique to the human element such as personal interests, reasons for choosing residency, career goals, compelling nature, and originality when evaluating personal statements.

BackgroundProvisional stabilization of high-energy tibia fractures using temporary plate fixation (TPF) or external fixation (ex-fix) prior to definitive medullary nailing (MN) is a strategy common in damage control orthopaedics. There is a lack of comprehensive data evaluating outcomes between these methods. This study compares outcomes of patients stabilized with either TPF or ex-fix, and with early definitive MN only, assessing complications including nonunion and deep infection.MethodsA retrospective review was performed on adult patients with tibia fractures treated with MN followed until fracture union (≥3 months) at a single level-1 trauma center from 2014 to 2022. Medical records were evaluated for nonunion and deep infection. Demographics, injury characteristics, and fixation methods were recorded. Significance between patients who underwent TPF and ex-fix was compared with a matched cohort of early MN using Pearsons exact tests, independent t-tests, and one-way ANOVA, depending on the appropriate variable.Results81 patients were included; 27 were temporized with TPF (n = 12) or ex-fix (n = 15). 54 early MN cases defined the matched cohort. All groups had similar patient and fracture characteristics. The difference in rates of nonunion between groups was significant, with TPF, ex-fix, and early MN groups at 17, 40, and 11% respectively (p = 0.027). Early MN had lower rates of nonunion (11% vs. 40%, p = 0.017) and deep infection (13% vs. 40%, p = 0.028) compared to ex-fix.ConclusionTemporary ex-fix followed by staged MN was associated with higher rates of nonunion and deep infection. There was no difference in complication rates between TPF and early definitive MN. These data suggest that ex-fix followed by MN of tibia fractures should be avoided in favor of early definitive MN when possible. If temporization is needed, TPF may be a better option than ex-fix. Level of Evidence: IV.

PURPOSE: Emerging evidence suggests that osteosarcoma stem cells (OSCs) may be responsible for tumor initiation propagation, recurrence, and resistance to therapy. We set out to evaluate the relationship between the abundance of ALDH1A1 and CD44-positive cells in biopsy and resection samples on disease recurrence and overall survival. METHODS: A retrospective review of 20 patients, including biopsy and resection samples, was performed at a comprehensive cancer center. Additionally, we queried the publicly available TARGET dataset of osteosarcoma patients. RESULTS: Neither the percentages of ALDH1A1-positive cells nor CD44-positive cells were significantly associated with overall mortality or disease recurrence in either biopsy or resection samples. Unlike our institutional data, overall survival was significantly correlated to higher ALDH1A1 expression in the TARGET dataset both in univariate and age-adjusted analyses. CONCLUSIONS: ADLH1 and CD44, potential markers of OSCs, were not found to be reliable clinical immunohistochemical prognostic markers for osteosarcoma patient survival, specifically disease-free survival. Osteosarcoma patients with high ALDH1A1 RNA expression showed improved overall survival in examining a national genomic database of osteosarcoma patients but again no association with disease-free survival. The potential of CD44 and ALDH1A1 as cellular-specific prognostic markers of survival, and as possible molecular targets, may be limited in osteosarcoma.

Abstract Objective This study aims to investigate the interrelationship of risk factors for suicidal behaviour and their influence on attempt severity in a sample of adolescents who have recently attempted suicide. For it a network analyse was performed. Method Data from a sample of adolescents from 12 to 17 years of age with documented suicide attempts were collected and analysed in the context of a larger study conducted in Spain called SURVIVE. Several factors were examined including age, sex, depression, trauma, impulsivity, and substance abuse. Graph analysis was performed to identify relationships and centrality measures among these factors. Results A total of 267 participants were enrolled: 233 females and 34 males with a mean age of 15.00 years (SD = 1.52). The results indicate that age and sex do not have a notable relationship with attempt severity in adolescents. Emotional and behavioural difficulties, measured by the Strengths and Difficulties Questionnaire (SDQ), have the greatest influence on other variables. Depression and childhood trauma show varying degrees of association with suicidal behaviour, as does motor impulsivity. Substance use does not appear to be strongly related to suicide attempt severity. The number of suicide attempts is strongly correlated with emotional and behavioural difficulties, depression, and childhood trauma. Lethality of suicide attempts and intensity of suicidal ideation do not show significant associations with the other variables. Conclusion This study identifies significant risk factors for adolescent suicide. Emotional and behavioural symptoms, depression, and childhood trauma are strongly linked to suicidal behaviour. However, age, sex, and substance abuse show minimal correlation. Assessing emotional difficulties and depressive symptoms using specific questionnaires could be crucial in evaluating suicidal behaviour in adolescents.

Nenhum.

This paper develops an actionable interdisciplinary model that quantifies and assesses uncertainties in water resource allocation under climate change. To achieve this objective, we develop an innovative socio-ecological grand ensemble that combines climate, hydrological, and microeconomic ensemble experiments with a widely used decision support system for water resource planning and management. Each system is populated with multiple models (multi-model), which we use to evaluate the impacts of multiple climate scenarios and policies (multi-scenario, multi-forcing) across systems so as to identify plausible futures where water management policies meet or miss their objectives and to explore potential tipping points. The application of the methods is exemplified by a study conducted in the Douro River basin (DRB), an agricultural basin located in central Spain. Our results show how marginal climate changes can trigger non-linear water allocation changes in the decision support systems (DSSs) and/or non-linear adaptive responses of irrigators to water shortages. For example, while some irrigators barely experience economic losses (average profit and employment fall by < 0.5 %) under mild water allocation reductions of 5 % or lower, profit and employment fall by up to 12 % (∼ 24 ×) when water allocation is reduced by 10 % or less (∼ 2×). This substantiates the relevance of informing the potential natural and socio-economic impacts of adaptation strategies and related uncertainties for identifying robust decisions.

This paper analyses a research developed at the University of Cantabria (Spain) committed to inclusive education, as it proposes a process of collaborative enquiry into relevant educational concepts related to attention to diversity. The work carried out by the university students (preservice teachers) resulted in the production of a dictionary constructed from several voices (informants). The study is qualitative and involves 4 university professors (they are also the researchers) and 70 students of the Education Degree. Here we present the results of the enquiry process into the concept of the 'yellow vest'. This project has been led by three preservice teachers with the participation of five six-year-old students, three tutors and two support specialists as informants. This enquiry project functions as the epitome of the training process and demonstrates how inclusion is a socially anchored process. The results highlight a number of factors that contribute to making teacher education inclusive: the agency of university students in their training process; recognition of the value of diverse voices in order to build legitimate knowledge; deliberative dialogue in inclusive education; the use of heterogeneous communicative languages.

The Self-Determination Theory argues that individuals are optimally motivated when their three Basic Psychological Needs (BPNs) are satisfied, which can be influenced by the learning environment created by the teachers. Student-centered frameworks are permeating worldwide. Thus, the study aimed to evaluate the effects of pedagogical models-based interventions in the promotion of students' BPNs. Four databases were searched, and twenty-five articles were retrieved. It was found that most programs had a positive impact on the students' BPNs, but they also uncovered interventions with no effects and a few with mixed results. The present review provides information not only to understand the effects of pedagogical models on the students' BPNs, but also to recognize the elements that could increase the success of future intervention programs.

Pedagogical models have been described as suitable for promoting positive outcomes in the physical domain of learning. Is this enough in the battle against sedentary lifestyles? To answer this question, a systematic search of four scientific literature databases was conducted. The articles were included if they met the following criteria: (1) interventions using the four most widely implemented pedagogical models (and their hybridizations), (2) analyzed physical activity (PA) and/or intention to be physically active (IPA), and (3) indexed in the Journal Citation Reports. As a result, twenty-eight articles were included. Some studies showed positive outcomes (in both PA and IPA); others showed ambiguous results (increases in one and no effects in the other) and, finally, some showed no effects. Most studies that assessed individuals' IPA produced positive effects. IPA can lead to goals, and through goals, individuals shape their life. Thus, pedagogical models can become a major input in terms of health for future adults.

This systematic review synthesized current literature regarding the effect of physical activity (PA) interventions on brain structure (BS) and brain function (BF) in healthy children. This review followed the Preferred Reporting Items for Systematic Reviews protocols and used the Rayyan web for data extraction. Eleven experimental studies were included. Specifically, six studies conducted chronic PA interventions, and the others applied acute PA interventions. Evidence from five articles (45.45%) confirmed that PA interventions had beneficial effects on brain structure and function in healthy children, including enhancing brain activation and microstructural plasticity. These articles shared a study protocol and were conducted in school settings, indicating homogeneity. Due to the technical complexity and limitations involved, there are few studies on brain health and development. Future research is necessary to validate and evaluate the effectiveness of PA interventions on brain structure and function in healthy children.

Introduction Genetic variations impact drug response, driving the need for personalised medicine through pre-emptive pharmacogenetic testing. However, the adoption of pre-emptive pharmacogenetic testing for commonly prescribed drugs, such as statins, outside of tertiary hospitals is limited due to a lack of pharmacoeconomic evidence to support widespread implementation by healthcare policy-makers. The Spanish Consortium for the Implementation of Pharmacogenetics (iPHARMGx Consortium) addresses this by developing a clinical trial master protocol that will govern multiple nested adaptive clinical trials that compare genotype-guided treatments to standard care in specific drug–gene–population triads, asses their cost-efficacy and identify novel biomarkers through advanced sequencing techniques. The first of these studies aims to assess whether a pre-emptive statin therapy genotyping scheme reduces the incidence of statin-associated muscle symptoms (SAMS) in a population at risk of cardiovascular disease susceptible of receiving high-intensity or moderate-intensity doses of statins: The PREVESTATGx trial.Methods and analysis the PREVESTATGX trial is a multicentre, adaptive randomised controlled pragmatic phase IV clinical trial nested to the iPHARMGx master protocol with two parallel arms, aiming for superiority. Randomisation will be conducted on an individual basis with a centralised approach and stratification by centre. After inclusion in the trial and genotyping has been performed, subjects will be randomly allocated to experimental group (pharmacogenetic genotype-guided statin prescription) or standard-of-care statin prescription (as deemed by attending physician). The main objective is to assess the efficacy of a statin pre-emptive genotyping strategy in reducing the incidence of SAMS. A total of 225 subjects will be recruited among the 10 participating centres if no futility/efficacy boundary is reached in the prespecified interim analyses. Recruitment will be carried out during a 12-month period and subjects will be followed for a 9-month period.Ethics and dissemination The PREVESTATGx trial received ethical approval on 24 April 2024. Results will be disseminated via publication in peer-reviewed journals as well as presentation at international conferences. Trial results will be submitted for publication in an open-access peer-reviewed medical speciality-specific publication.Trial registration number EU CT number: 2023-509418-12-00/Clinical trial Identifier (ClinicalTrials.gov): NCT06262685. Protocol version 1.2 12 April 2024 (includes non-substantial modification number 14 June 2024). Trial registration of this study can be located at both the EU Clinical Trials Register available from https:// euclinicaltrials.eu/search-for-clinical-trials/?lang=en and https://clinicaltrials.gov. Registration on both websites was done before the enrolment of the first patient complying with European regulations. EU Clinical Trials Register is a primary registry according to the WHO.

Resumen: Introducción: La fascitis plantar supone la principal causa de dolor en el talón en pacientes de mediana edad. En los casos crónicos, la dorsiflexión limitada del tobillo producida por contractura aislada del gastrocnemio se considera el principal factor de riesgo de padecerla. Por lo que en los últimos años se ha incrementado el número de pacientes intervenidos mediante fasciotomía proximal de gemelo medial (FPGM) para tratar la fascitis plantar crónica. Material y métodos: Revisión sistemática siguiendo las guías PRISM. Hemos realizado una búsqueda bibliográfica en las bases de datos PubMed, Science Direct, Cochrane Library y Web of Science. Se encontraron 184 artículos. La extracción de datos fue realizada utilizando el software Covidence, y se realizó un análisis de calidad y riesgo de sesgo de los artículos incluidos, basada en Cochrane risk of bias Tool 2.0. Resultados: Fueron incluidos tres artículos en la revisión, dos ensayos clínicos aleatorizados y un estudio de cohortes con un total de 138 pacientes. En los estudios analizados los pacientes tras la FPGM presentaban mejorías significativas en la valoración del dolor y en la escala de la American Orthopaedic Foot & Ankle Society (AOFAS), con niveles altos de satisfacción de los pacientes. Se encontraron aumentos en el ángulo de dorsiflexión del tobillo tras 12 meses de seguimiento, sin pérdidas de fuerza del gastrocnemio. La tasa de complicaciones fue baja y menores con la FPGM que con la fasciotomía plantar (FP). Conclusión: La fasciotomía proximal de gastrocnemio medial aporta beneficio clínico en los pacientes con fascitis plantar crónica, con baja probabilidad de complicaciones y con una satisfacción alta de los pacientes. Abstract: Introduction: Plantar fasciitis is the main cause of heel pain in middle-aged patients. In chronic cases, limited ankle dorsiflexion caused by isolated gastrocnemius contracture is considered the main risk factor for suffering it. Therefore, in recent years the number of patients operated on by proximal fasciotomy of the medial gastrocnemius (FPGM) has increased to treat chronic plantar fasciitis. Material and methods: Systematic review following the PRISMA guidelines. We have carried out a bibliographic search in Pubmed, Science Direct, Cochrane Library and Web of Science databases. One hundred and eighty-four articles were found. Data extraction was performed using the Covidence software, and a quality and risk of bias analysis of the included articles was performed based on the Cochrane risk of bias Tool 2.0. Results: Three articles were included in the review: two randomized clinical trials and one cohort study with a total of 138 patients. In the analyzed studies, patients after proximal fasciotomy of the medial gastrocnemius showed significant improvements in pain and in the AOFAS score with high levels of patient satisfaction. Increases in ankle dorsiflexion angle were found after 12 months of follow-up, with no loss of gastrocnemius strength. The complication rate was low and fewer occurred in the proximal fasciotomy compared to plantar fasciotomy. Conclusion: Proximal fasciotomy of the medial gastrocnemius provides clinical benefit in patients with chronic plantar fasciitis, with a low probability of complications and high patient satisfaction.

In this manuscript, we study some algebraic and differential properties of matrix orthogonal polynomials with respect to the Laguerre-Sobolev right sesquilinear form defined by ⟨p,q⟩S≔∫0∞p*(x)WLA(x)q(x)dx+M∫0∞(p′(x))*W(x)q′(x)dx,{\langle p,q\rangle }_{{\bf{S}}}:= \underset{0}{\overset{\infty }{\int }}{p}^{* }\left(x){{\bf{W}}}_{{\bf{L}}}^{{\bf{A}}}\left(x)q\left(x){\rm{d}}x+{\bf{M}}\underset{0}{\overset{\infty }{\int }}{(p^{\prime} \left(x))}^{* }{\bf{W}}\left(x)q^{\prime} \left(x){\rm{d}}x, where WLA(x)=e−λxxA{{\bf{W}}}_{{\bf{L}}}^{{\bf{A}}}\left(x)={e}^{-\lambda x}{x}^{{\bf{A}}} is the Laguerre matrix weight, W{\bf{W}} is some matrix weight, pp and qq are the matrix polynomials, M{\bf{M}} and A{\bf{A}} are the matrices such that M{\bf{M}} is non-singular and A{\bf{A}} satisfies a spectral condition, and λ\lambda is a complex number with positive real part.