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Producción Científica, Introduction: Interest in 3D printing for orthopedic surgery has been increasing since its progressive adoption in most of the hospitals around the world. The aim of the study is to describe all the current applications of 3D printing in patients undergoing hip surgery of any type at the present time. Materials and Methods: We conducted a systematic narrative review of publications indexed in MedLine through the search engine PubMed, with the following parameters: 3D printing AND (orthopedics OR traumatology) NOT tissue engineering NOT scaffold NOT in vitro and deadline 31 July 2023. After reading the abstracts of the articles, papers were selected according to the following criteria: full text in English or Spanish and content related to hip surgery. Those publications involving experimental studies (in vitro or with anatomical specimens) or 3D printing outside of hospital facilities as well as 3D-printed commercial implants were excluded. Results are presented as a reference guide classified by disease, including the used software and the steps required for the development of the idea. Results: We found a total of 27 indications for in-house 3D printing for hip surgery, which are described in the article. Conclusions: There are many surgical applications of 3D printing in hip surgery, most of them based on CT images. Most of the publications lack evidence, and further randomized studies should be encouraged to assess the advantages of these indications.

265 p., La artrosis es una enfermedad con una prevalencia alta que va en aumento, con un alto coste sanitario en nuestro medio, asocia morbimortalidad y es moderadamente incapacitante para quien la padece. En contraposición, es una enfermedad con una patogenia poco conocida y sin un tratamiento que altere su progresión. Para esto es necesario conocer los actores y los mecanismos implicados en la fisiología y en la patogenia de la artrosis. Pero ésta y la articulación como elemento central de la artrosis, son objeto de relativamente pocos estudios si lo comparamos con otros órganos o patologías del organismo, como el cerebro o el corazón. En el presente trabajo, prospectivo observacional, analizamos 11 aminopeptidasas en líquido sinovial de pacientes con artrosis de rodilla antes y durante el tratamiento con Plasma Rico en Factores de Crecimiento. Identificamos actividad de todas ellas, algunas de las cuales describimos también actividad en fracción soluble y en fracción unida a membrana, siendo la mayor descripción realizada hasta la fecha. Se trata de un estudio novedoso ya que, a pesar de la importancia que está adquiriendo la proteomica, en su mayoría apenas si han sido descritas. Con ello planteamos que el sistema renina-angiotensina, el opioide-encefalinergico y el oxiocinergico están implicados en la fisiopatología articular. Tras la revisión bibliográfica realizada de todos los estudios previos encontrados de estas aminopeptidasas a nivel articular y de las funciones descritas en otros tejidos, proponemos que el papel de estas aminopeptidasas en la artrosis, incluirían al menos, la regulación de las vías-inmunoinflamatorias, el estrés oxidativo, las vías de la osificación endocondral, la senescencia articular y el dolor. Las diferencias obtenidas en la actividad de algunas aminopeptidasas por grado de artrosis, muestran un aumento significativo de la actividad en el grupo de pacientes con mayor artrosis, excepto para la Dipeptidil Peptidasa IV, que muestra una relaci

Background The optimal total knee arthroplasty (TKA) rotational alignment and how best to obtain and measure it are debatable. The aim was to analyse the reliability of the Berger femoral, three different tibial and four different com- bined two-dimensional computer tomography (2D-CT) TKA component rotation measurements, and to ascertain which rotational values best predict a successful clinical outcome. Methods The 2D-CT scans were obtained post-operatively on 60 patients who had TKA. We determined one femoral [Berger’s femoral angle (BFA)], three tibial [Berger’s tibial angle (BTA), anatomical tibial angle (ATA) and bimalleolar posterior tibial component angle (BM_PTCA)] and four combined [transepicondylar posterior tibial component angle (TE_PTCA), bicondylar posterior tibial component angle (BC_PTCA, transepicondylar bimalleolar angle (TE_BM) and bicondylar bimalleolar angle (BC_BM)] TKA rotation angles. We made all measures in 23 patients twice by three observers and determined inter- and intra-observer agreement using the Bland–Altman plot method. We analysed measures of 55 patients using the area under the ROC curve (AUC) analysis to ascertain the discriminative capacity of BFA, ATA, TE_PTCA and BC_PTCA for predicting a successful clinical outcome according to the Knee Society Score (KSS) threshold. Results ATA showed the smaller inter- and intra-observer average of differences (-0.1° and 1.6°, respectively) of the studied methods followed by BFA (-0.9° and 1.4°), TE_PTCA (-2.1° and 2.7°) and BC_PTCA (-0.5° and 1.8°). BFA (-4° to 2.1° and -6.1° to 8.8°) and BC_PTCA (-4.4° to 3.4° and -7.9° to 4.4°) showed the narrower inter- and intra- observer limits of agreement. A TKA device rotation (BC_PTCA) < 0.8° of external rotation (ER) predicted a KSS and KSS knee successful outcome, and < 3.8° ER for KSS functional (AUC = 0.889; 0.907 and 0.764, respectively). BFA and ATA < 0.9° ER and < 3.9° internal rotation (IR) predicted a successful KSS knee outcome (AUC = 0.7, Peer Reviewed, Postprint (published version)

Objective To explore timing in relation to all types of adverse events (AEs), severity and preventability for patients undergoing acute and elective hip arthroplasty. Design A multicentre cohort study using retrospective record review with Global Trigger Tool methodology in combination with data from several registers. Setting 24 hospitals in 4 major regions of Sweden. Participants Patients ≥18 years, undergoing acute or elective total or hemiarthroplasty of the hip, were eligible for inclusion. Reviews of weighted samples of 1998 randomly selected patient records were carried out using Global Trigger Tool methodology. The patients were followed for readmissions up to 90 days postoperatively throughout the whole country. Results The cohort consisted of 667 acute and 1331 elective patients. Most AEs occurred perioperatively and postoperatively (n=2093, 99.1%) and after discharge (n=1142, 54.1%). The median time from the day of surgery to the occurrence of AE was 8 days. The median days for different AE types ranged from 0 to 24.5 for acute and 0 to 71 for elective patients and peaked during different time periods. 40.2% of the AEs, both major and minor, occurred within postoperative days 0-5 and 86.9% of the AEs occurred within 30 days. Most of the AEs were deemed to be of major severity (n=1370, 65.5%) or preventable (n=1591, 76%). Conclusions A wide variability was found regarding the timing of different AEs with the majority occurring within 30 days. The timing and preventability varied regarding the severity. Most of the AEs were deemed to be preventable and/or of major severity. To increase patient safety for patients undergoing hip arthroplasty surgery, a better understanding of the multifaceted nature of the timing of AEs in relation to the occurrence of differing AEs is needed. © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Objective: to describe the clinical-surgical characteristics of the management of peripheral vascular trauma (PVT) in patients attended by the Peripheral Vascular Surgery, Angiology and Lymphology Service of the Instituto Autónomo Hospital Universitario de Los Andes (IAHULA) in Merida, Venezuela 2018-2020. Methodology: quantitative approach; descriptive type, non-experimental and retrospective design, through data collection cards which recorded: personal data, admission diagnosis, symptomatology, findings reflected in the intervention notes, diagnostic studies and complications described in the in-hospital evolution of the patients' medical records. Sample of 68 patients of any age and sex with a diagnosis of vascular injury who were referred to IAHULA. Results: 79.4% men, 53% aged 26-55 years, 36.8% from the city of Merida. 83.8% were treated by emergency surgery, and 51.5% were treated after six hours of evolution. The main cause was stab wounds in 42.6%. The most injured vessels were: superficial femoral artery (13.2%) and humeral artery (13.2%); cephalic veins (11.8%) and internal jugular vein (7.4%). 67.6% did not present transoperative complications. Primary synthesis followed by end-to-end anastomosis were the most performed surgeries. Conclusion: PVT was present in less than 5% of polytraumatisms, however, it is potentially lethal. Availability of Doppler ultrasound equipment in the emergency area is suggested with the aim of making diagnoses in less than six hours, and arterial and venous vascular reconstructions are urged as the first line of action., Objetivo: describir las características clínico-quirúrgicas del manejo del trauma vascular periférico (TVP) en pacientes atendidos por el Servicio de Cirugía Vascular Periférica, Angiología y Linfología del Instituto Autónomo Hospital Universitario de Los Andes (IAHULA) en Mérida, Venezuela 2018-2020. Metodología: enfoque cuantitativo; tipo descriptivo, diseño no experimental y retrospectivo, a través de fichas de recolección de datos los cuales registraron: datos personales, diagnóstico de ingreso, sintomatología, los hallazgos plasmados en las notas de intervención, estudios diagnósticos y las complicaciones descritas en la evolución intrahospitalaria de las historias clínicas de los pacientes. Muestra de 68 pacientes de cualquier edad y sexo con diagnóstico de lesión vascular que fueron referidos al IAHULA. Resultados: 79,4% hombres, 53% con edad 26-55 años, 36,8% de la ciudad de Mérida. 83,8% fueron atendidos por cirugía de emergencia, y 51,5% atendidos luego de las seis horas de evolución. La principal causa fueron las heridas por arma blanca en un 42,6%. Los vasos más lesionados fueron: arteria femoral superficial (13,2%) y arteria humeral (13,2%); venas cefálicas (11,8%) y vena yugular interna (7,4%). 67,6% no presentaron complicaciones transoperatorias. La síntesis primaria seguida de las anastomosis término-terminales fueron las cirugías más realizadas. Conclusión: el TVP estuvo presente en menos del 5% de los politraumatismos, sin embargo, es potencialmente letal. Se sugiere disponibilidad de un equipo de ultrasonido Doppler en el área de emergencia con el propósito de realizar diagnósticos en menos de seis horas, y se exhorta la realización de reconstrucciones vasculares arteriales y venosas como primera línea de acción.

En l’actualitat, el futur de la cirurgia aposta pels quiròfans híbrids, que ja lideren un gran avenç hospitalari i tecnològic. El principal objectiu consisteix en el disseny i desenvolupament d’un pla d’equipament i d’instal·lacions per un quiròfan híbrid d’urgències de traumatologia en un hospital terciari, analitzant quines són les seves necessitats amb la finalitat d’obtenir una proposta que permeti dur a terme processos quirúrgics de forma òptima. El projecte s’enfoca en les característiques estructurals, la instal·lació contra incendis, de climatització i ventilació, de gasos medicinals, elèctrica i d’il·luminació, tenint en compte els principals components de seguretat, així com la normativa vigent per cadascuna de les instal·lacions. Es proposa un pla d’equipament a partir de l’estudi de les principals necessitats assistencials d’un quiròfan híbrid, i es procedeix a particularitzar les propostes platenjades, valorant les principals característiques tècniques oferides pels diversos equips mèdics. I es realitza un anàlisi de la localització d’aquests equips dins del quiròfan per tal de garantir un fluxe de treball eficient a l’interior de la sala., En la actualidad, el futuro de la cirugía apuesta por los quirófanos híbridos, que lideran ya un gran avance hospitalario y tecnológico. El principal objetivo consiste en el diseño y desarrollo de un plan de equipamiento y de instalaciones para un quirófano híbrido de urgencias de traumatología en un hospital terciario, analizando cuáles son sus necesidades con el fin de obtener una propuesta que permita llevar a cabo procesos quirúrgicos de forma óptima. El proyecto se enfoca en las características estructurales, la instalación contra incendios, de climatización y ventilación, de gases medicinales, eléctrica y de iluminación, teniendo en cuenta los principales componentes de seguridad, así como la normativa vigente por cada una de las instalaciones. Se propone un plan de equipamiento a partir del estudio de las principales necesidades asistenciales de un quirófano híbrido, y se procede a particularizar las propuestas planteadas, valorando las principales características técnicas ofrecidas por los diversos equipos médicos. Y se realiza un análisis de la localización de estos equipos dentro del quirófano para garantizar un flujo de trabajo eficiente en el interior de la sala., Today, the future of surgery lies in hybrid operating rooms, which are already leading a great hospital and technological advance. The main objective consists of designing and developing an equipment and facilities plan for a hybrid operating room for traumatology emergencies in a tertiary hospital, analysing its needs in order to obtain a proposal that allows surgical processes to be carried out in an optimal way. The project focuses on the structural characteristics, the fire protection, climatization and ventilation, medical gases, electrical and lighting installations, taking into account the main safety components, as well as the current regulations for each of the facilities. An equipment plan is proposed based on the study of the main healthcare needs of a hybrid operating room, and the proposals put forward are then specified, assessing the main technical characteristics offered by the different medical devices. And analysis of the location of this equipment within the operating room is carried out to guarantee an efficient workflow inside the room.

Producción Científica, The atlantoaxial joint C2 (axis) with the anterior arch of C1 (atlas) allows 50% of cervical lateral rotation. It is responsible for precise and important movements that allow us to perform precise actions, both in normal and working life. Due to low incidence in adults, this condition often goes undiagnosed, or the diagnosis is delayed and the outcome is worse. An early diagnosis and treatment are essential to ensure satisfactory neurological and functional outcomes. The aim of this review is to analyze C1-C2 rotatory subluxation in adults, given its rarity. The time between injury and reduction is key, as it is directly related to prognosis and the severity of the treatment options. Due to low incidence in adults, this condition often goes undiagnosed, or the diagnosis is delayed as a lot of cases are not related to a clear trauma, with a poor prognosis just because of the late diagnosis and the outcome is worse. The correct approach and treatment of atlantoaxial dislocation requires a careful study of the radiological findings to decide the direction and plane of the dislocation, and the search for associated skeletal anomalies.

Producción Científica, Background: Carpal Tunnel Syndrome (CTS) mainly affects adults of working age. The prevalence of severe cases is higher in elderly patients (>65 years old). Clinical guidelines recommend conservative treatment as the best option in the initial stages of CTS to avoid severe cases. Diacutaneous Fibrolysis (DF) has demonstrated to improve nerve conduction studies and mechanosensitivity. The main purpose was to quantify changes in the cross-sectional area (CSA) of the median nerve, transversal carpal ligament (TCL) thickness, numbness intensity, and the subjective assessment of clinical change after DF treatment in patients with CTS. Methods: a double-blind, randomized, placebo-controlled trial was designed. A number of 44 patients (60 wrists) with CTS were randomized to the DF group or the sham group. CSA and TCL thickness variables were registered by ultrasound. Clinical variables were assessed by the visual analogue scale and GROC scale. SPSS version 24.0 for MAC was used for statistical analysis. The group by time interaction between groups was analyzed using two-way repeated measures analysis of variance. Results: The DF group reduced CSA with a mean of 0.45 mm2 (IC 95% 0.05 to 0.86) and TCL thickness with a mean reduction of 0.4 mm (IC 95% 0.6 to 2.1) compared to the sham group (p < 0.01, p < 0,03, respectively). Additionally, the DF group decreased the numbness intensity with a mean reduction of 3.47 (IC 95% 2.50 to 4.44, p < 0.01) and showed a statistically significant improvement on the GROC scale (p < 0.01). Conclusions: DF treatment may significantly reduce CSA and TCL thickness, numbness intensity, and improved clinical perspective. DF applied in patients with mild to moderate CTS may prevent the progression of the disease as they age.

Producción Científica, Although acromioclavicular joint (ACJ) dislocation is a common injury following trauma involving the shoulder, it is rare in the absence of trauma. In this manuscript, we describe a case of ACJ in a 15-year-old girl who presented a painful dislocation with spontaneous shortening of the right acromioclavicular joint that forced her to temporarily abandon her sports career. After failure of conservative physiotherapy treatment, surgical intervention was proposed by performing an arthroscopic-assisted button slide combined with augmented hamstring allograft reconstruction. After the intervention and the subsequent recovery period, the athlete was able to return to her semi-professional training. The follow-up of the patient is 5.5 years post-surgery. The result obtained could help in planning the treatment of future cases.

The research was carried out in a health unit in Orellana -Ecuador, in the period October 2019 - February 2020 and with the purpose of evaluating the rational use of analgesics in the area of traumatology. For this, a retrospective, cross-sectional study was carried out. analyzed data from 116 medical records, information on age, gender, diagnosis, prescribed analgesics with their doses, pharmaceutical form, route of administration and duration of treatment were collected. It was considered whether the therapeutic protocol imposed by the Ministry of Public Health of Ecuador (MSP), the interactions and problems related to analgesic drugs in therapy, are complied with, categorizing it according to the Second Council of Granada. It was found that 75.86% did not comply with the MSP protocol. The most frequent cause of admissions to the traumatology area was due to fractures at the level of the lower limbs of the body with 41.38%. In analgesic therapy, 40.17% corresponds to the use of tramadol and 28.03% to ketorolac; being administered in combination or individually. The prescription of analgesics was 51.72% of rational use, so there is still a deficiency in the control of analgesics in the trauma area, A pesquisa foi realizada em uma unidade de saúde de Orellana -Equador, no período de outubro de 2019 a fevereiro de 2020 e com o objetivo de avaliar o uso racional de analgésicos na área de traumatologia. foram analisados dados de 116 prontuários, foram coletadas informações sobre idade, sexo, diagnóstico, analgésicos prescritos com suas doses, forma farmacêutica, via de administração e duração do tratamento. Foi considerado se o protocolo terapêutico imposto pelo Ministério da Saúde Pública do Equador (MSP), as interações e problemas relacionados aos medicamentos analgésicos em terapia, são cumpridos, categorizando-o de acordo com o Segundo Conselho de Granada. Constatou-se que 75,86% não cumpriram o protocolo MSP. A causa mais frequente de internações na área de traumatologia foi por fraturas ao nível dos membros inferiores do corpo com 41,38%. Na terapia analgésica, 40,17% corresponde ao uso de tramadole 28,03% ao cetorolaco; administrados em combinação ou individualmente. A prescrição de analgésicos foi de 51,72% de uso racional, portanto ainda há deficiência no controle de analgésicos na área de trauma, La investigación se realizó en una unidad de salud en Orellana -Ecuador, en el periodo octubre 2019 - febrero 2020 y con el propósito de evaluar el uso racional de analgésicos en el área de traumatología, Para ello se realizó un estudio retrospectivo, transversal y se analizaron los datos de 116 historias clínicas, se recopilo la información de edad, genero, diagnostico, analgésicos prescritos con sus dosis, forma farmacéutica, vía de administración y duración del tratamiento. Se consideró si se cumple el protocolo terapéutico impuesto por el Ministerio de Salud Pública de Ecuador (MSP), las interacciones y problemas relacionados con los medicamentos analgésicos en la terapia, categorizándolo según el Segundo Consejo de Granada. Se obtuvo que el 75,86% no cumplía con el protocolo del MSP. La causa de los ingresos al área de traumatología más frecuente se debió a las fracturas a nivel de los miembros inferiores del cuerpo con el 41,38%. En la terapia analgésica el 40,17% corresponde al uso del tramadol y el 28.03% a ketorolaco; siendo administrados de manera combinada o individualmente. La prescripción de los analgésicos fue 51,72% de uso racional por lo que todavía existe deficiencia en el control de analgésicos en el área de traumatología.

195 p., La lesión muscular tiene una enorme incidencia en la población, tanto en el ámbito del deporte como asociada a procesos quirúrgicos. En el caso de lesiones severas, su recuperación precisa de varias semanas, y los resultados son variables, desde una regeneración completa a recuperaciones parciales contejido fibroso reemplazando a la estructura muscular previa.El Plasma Rico en Plaquetas (PRP) es un concentrado de plaquetas con valores superiores a losencontrados en sangre. Se obtiene habitualmente a partir de una muestra de sangre periférica y suposterior centrifugación para separar sus componentes. El concepto y descripción de PRP se inició en elcampo de la hematología en los años 70, empleándose como un producto de transfusión en pacientes contrombocitopenia. Posteriormente, se utilizó como fibrina en la cirugía maxilofacial, y a principios de estesiglo se comenzó a emplear infiltraciones de PRP y de suero autólogo en patologías del aparatolocomotor.El PRP representa una nueva herramienta terapéutica en el tratamiento de la lesión muscular aguda. Dadasu seguridad de uso y sus teóricos beneficios, como una regeneración tisular precoz y completa, se haincrementado notablemente su aplicación durante la última década en el ámbito del deporte. Las accionespositivas del PRP en la lesión muscular han sido demostradas en múltiples investigaciones en cienciabásica, tanto en laboratorio como en animales. Se ha observado una proliferación aumentada de las células satélite, y también en su diferenciación hacia miofibras. Sin embargo, los resultados en humanos no son concluyentes. Existen solamente 7 estudios controlados aleatorizados sobre el tratamiento de laslesiones musculares con PRP. No se encontraron diferencias significativas en la baja deportiva en 3 estudios, y si se observaron en los otros 4. Hay que tener en cuenta que la variable principal analizada, labaja deportiva o tiempo de recuperación, depende de múltiples factores, lo que puede explicar las diferencias en

Fractures in pediatric patients are important pathologies, which are a problem to be solved for the public health ofour country. The objective of the study was to determine the predisposing factors to suffer this type of pathology. Adescriptive, cross-sectional study was carried out by collecting data from clinical records in the Pediatric Unit ofthe General Hospital of Latacunga. To collect information, 1800 medical records of patients admitted to this unitwere reviewed, of which 54 presented a diagnosis of fracture. It was found that children with an age between 6 and10 years of age who resided in the urban area were the most affected, as well as the most frequent anatomical sitefor this type of injury was the upper extremities, with undisplaced fractures and his treatment was non-surgical. Thevariables analyzed belong to very determining factors for the prevention of these pathologies that must besocialized in our environment, thus avoiding an increase in morbidity and mortality rates in this age group, Las fracturas en pacientes pediátricos son patologías importantes, mismas que son un problema a solucionar para lasalud pública de nuestro país. El objetivo del estudio fue determinar los factores predisponentes para sufrir este tipode patologías. Se realizó un estudio descriptivo de corte transversal, mediante la recopilación de datos deexpedientes clínicos en la Unidad de Pediatría del Hospital General de Latacunga. Para la recolección deinformación se revisaron 1800 historias clínicas de los pacientes ingresados a esta unidad, de las cuales 54presentaron diagnóstico de fractura. Se encontró que los niños con una edad comprendida entre los 6 a los 10 añosde edad que residían en la zona urbana fueron los más afectados, así como el sitio anatómico más frecuente por estetipo de lesiones fueron las extremidades superiores, con fracturas no desplazadas y su tratamiento fue el noquirúrgico. Las variables analizadas pertenecen a factores muy determinantes para la prevención de estas patologíasque se debe socializar en nuestro medio, evitando así elevación de tasas de morbilidad y mortalidad en este grupoetario

Introduction: Clavicle fractures represent 2.6% of all fractures and 35% of all shoulder injuries in the adult population. Multiple surgical techniques are available to treat these fractures, including superior and anteroinferior plating.Objective: To determine the most effective and safest surgical technique for treating middle-third clavicle fractures: superior plating or anteroinferior plating.Materials and methods: Analytical observational cohort study carried out on 96 patients with middle-third clavicle fractures treated by one of these two surgical techniques in a secondary care hospital in Huila, Colombia. Different outcomes of interest were measured for each technique. The degree of satisfaction and functional outcome were assessed by means of the DASH and the Constant Score questionnaires, respectively. Univariate, bivariate, and multivariate analyses were performed to characterize the relationship between the outcomes measured.Results: The superior plating technique was used in 52 patients, while the anteroinferior plating technique was used in 44. The outcomes of interest that were measured behaved as a protective factor for the anteroinferior plating method: intraoperative bleeding (RR 0.60), surgical time (RR 0.53), consolidation time (RR 0.56), irritation caused by osteosynthesis materials (RR 0.12) and removal of the material (RR 0.25). Differences regarding functional outcomes and degree of satisfaction were also statistically significant (Constant score, p=0.000; DASH, p=0.000, respectively).Conclusion: The anteroinferior plating technique proved to be safer and more effective for the treatment of these fractures, achieving both a better functional outcome and a better degree of satisfaction. Consequently, its use is recommended for treating patients with middle-third clavicle fractures., Introducción. En población adulta, las fracturas de clavícula constituyen el 2.6% de todas las fracturas y el 35% de todas las lesiones del hombro. Existen varias técnicas quirúrgicas para el tratamiento de estas fracturas, entre ellas la fijación con placa antero-inferior y con placa superior.Objetivo. Determinar cuál es la técnica quirúrgica más efectiva y segura para el tratamiento de fracturas del tercio medio de la clavícula: fijación con placa superior o con placa antero-inferior.Materiales y métodos. Estudio observacional analítico de cohorte realizado en 96 pacientes con fracturas del tercio medio de la clavícula tratadas mediante una de estas dos técnicas quirúrgicas en un hospital de segundo nivel de Huila, Colombia. Se midieron distintos desenlaces de interés para cada técnica. El grado de satisfacción y el resultado funcional fueron evaluados mediante los cuestionarios DASH y Constant Score, respectivamente. Además, se realizó un análisis univariado, uno bivariado, y uno multivariado para caracterizar la relación entre los desenlaces medidos.Resultados. la técnica de fijación de placa superior se utilizó en 52 pacientes, y la de placa antero-inferior, en 44. Los desenlaces de interés medidos se comportaron como factor protector para el método de placa antero-inferior: sangrado intraoperatorio (RR 0.60), tiempo quirúrgico (RR 0.53), tiempo de consolidación (RR 0.56, irritación del material de osteosíntesis (RR 0.12) y retiro del material (RR 0.25). Las diferencias respecto a resultados funcionales y grado de satisfacción también fueron estadísticamente significativas (Constant Score, p=0.000; DASH, p=0.000, respectivamente).Conclusión. La técnica de fijación con placa antero-inferior demostró ser más segura y efectiva para el tratamiento de estas fracturas, logrando un mejor resultado funcional y grado de satisfacción, por lo que se recomienda su uso en estos pacientes.

Trauma är den vanligaste dödsorsaken bland unga människor i Sverige. Omhändertagandet vid trauma präglas av effektivitet och tiden är dyrbar för att snabbt identifiera patientens skador och behov av fortsatta medicinska- och omvårdnadsåtgärder. Patienten som drabbas av trauma är i ett utsatt läge och sjuksköterskan får inte glömma bort dennes omvårdnadsbehov i en komplex situation. Hur patienten själv ser på omhändertagande vid trauma lägger grunden för bemötandet. Syftet var att beskriva traumapatienters upplevelser av bemötande och omhändertagande på akutmottagningen.Den metod som användes var en allmän litteraturöversikt för att svara på studiens syfte. Sökningar utfördes i databaserna PubMed, CINAHL, samt manuella sökningar. I översikten inkluderades 17 vetenskapliga originalartiklar efter kvalitetsgranskning, dessa var publicerade 2010–2020. En integrerad analys användes för att analysera och syntetisera de artiklar som inkluderades.I resultatet uppkom fyra huvudkategorier; patientens upplevelse av traumateamets omhändertagande, kommunikationens betydelse för patienten, att vara patient i en utsatt situation och patientens upplevelse av vårdpersonalens bemötande. Under huvudkategorierna framkom flera underkategorier. Avseende traumateamets omhändertagande handlade det både om tillfredsställelse och missnöje med insatsen. Betydelsen av kommunikationen för patienten kunde delas in i god kommunikation, icke verbal kommunikation och bristande kommunikation. Att vara patient i en utsatt situation handlade om patientens upplevelse i en skrämmande situation på akutmottagningen och hur patienten upplevde undersökningar och procedurer. I huvudkategorin patientens upplevelse av vårdpersonalens bemötande handlade det om personalens kompetens, patientens upplevelse av att bli respekterad och sedd samt att patienten ej kände förtroende för personalen. Slutsatsen av litteraturstudien var att kommunikationen har en särskild betydelse vid traumaomhändertagande på akutmottagnin, Trauma is the most common cause of death among young people in Sweden. Care in the event of trauma is characterized by efficiency and time is precious to quickly identify patients´injuries and the need for medical treatment and nursing care. The patient who suffers from trauma is in a vulnerable situation and the nurses must not forget his or her needs for nursing care in a complex situation. How the patient himself views care in the event of trauma lays the foundation for the treatment. The purpose was to describe trauma patients’ experience of treatment and care in the emergency department.The method used to respond to the purpose of the study was a general literature review. Article searches were performed in the database PubMed, CINAHL and through manual searches. Seventeen empirical original articles were included in the literature review after a quality review, the articles were published between 2010-2020. An integrated analysis was used to analyze and synthesize the included articles. In the result, four main categories emerged; the patient's experience of the trauma team's care, the importance of communication to the patient, being a patient in a vulnerable situation and the patient's experience of the healthcare professionals treatment. Under the main categories, several subcategories emerged. Regarding the trauma team's care, it was both about satisfaction and dissatisfaction with the effort. The meaning of communication could be divided into good communication, non-verbal communication and lack of communication. Being a patient in a vulnerable situation was about the patient's feelings in a frightening situation in the emergency department and how the patient experienced examinations and procedures. In the main category, the patient's experience with healthcare professionals' reply, they talked about the staff's competence, the patient's experience of being respected and seen and that the patient felt confidence in healthcare professionals. In conclusion

Patients with diffuse idiopathic skeletal hyperostosis (DISH) are at high risk for unstable vertebral fracture, which can be frequently missed. An 80-year-old man with pre-existing muscle lower limb weakness due to frailty was referred from another hospital, presenting with progressive urinary retention and its related symptoms, which had been treated as a urinary tract infection at previous hospital. One week prior to our visit, he had fallen. On arrival, he appeared lethargic and unable to follow commands. He denied any back pain. Computed tomography identified a T10 fracture and dislocation associated with DISH. Although immediate surgical fixation was performed, the patient did not recover from the neurological deficits. Diagnostic delay of DISH-associated vertebral fracture can occur due to both patients' and clinicians' delayed action. We believe this case report can help clinicians recognize this potentially devastating condition.

Aim: to compare the occurrence of femur fractures treated in a secondary and in a tertiary hospitals.Method: the sample of this study consisted of all patients who had fractures of the proximal femur treated at two hospital services, from 2015 to 2017, and the medical records were evaluated.Results: a greater number of surgeries has been performed at the tertiary hospital, although the secondary hospital patients had the highest number of complications, resulted probably by longer waiting times for the procedure, including surgeries that needed to be scheduled. It is also likely that this fact implied in a longer hospital stay and the need for referral to the Intensive Unit Care in the immediate postoperative period, also observed in secondary hospitals.Conclusion: these results call attention to the need to reformulate the protocols for the care of patients with proximal fracture of the femur, to solve the problems presented here., Objetivo: comparar a ocorrência de fraturas de fêmur proximal atendidas em um hospital secundário e em um terciário.Método: a amostra deste estudo foi composta por todos os pacientes que apresentaram fratura de fêmur proximal atendidos em dois serviços hospitalares, no período de 2015 a 2017, sendo realizada a avaliação dos prontuários.Resultados: embora um maior número de cirurgias tenha sido realizado no hospital terciário, os pacientes atendidos no hospital secundário apresentaram maior número de complicações, provavelmente em decorrência de mais tempo de espera pelo procedimento, incluindo as cirurgias que precisaram ser remarcadas. É provável, também, que esse fato tenha implicado em maior tempo de internação e necessidade de encaminhamento para UTI no período pós-operatório imediato, fenômenos também observados no hospital secundário.Conclusão: estes resultados chamam atenção para a necessidade de reformulação dos protocolos de atendimento a pacientes com fratura proximal de fêmur, visando sanar os problemas aqui apresentados.

Introduction Refugees and asylum seekers are vulnerable to common mental disorders, including post-traumatic stress disorder (PTSD). Using a network meta-analysis (NMA) approach, the present systematic review compared and ranked psychosocial interventions for the treatment of PTSD in adult refugees and asylum seekers. Methods Randomised studies of psychosocial interventions for adult refugees and asylum seekers with PTSD were systematically identified. PTSD symptoms at postintervention was the primary outcome. Standardised mean differences (SMDs) and ORs were pooled using pairwise and NMA. Study quality was assessed with the Cochrane Risk of Bias (RoB) tool, and certainty of evidence was assessed through the Confidence in Network Meta-Analysis application. Results A total of 23 studies with 2308 participants were included. Sixteen studies were conducted in high-income countries, and seven in low-income or middle-income countries. Most studies were at low risk of bias according to the Cochrane RoB tool. NMA on PTSD symptoms showed that cognitive behavioural therapy (CBT) (SMD=-1.41; 95% CI -2.43 to -0.38) and eye movement desensitisation and reprocessing (EMDR) (SMD=-1.30; 95% CI -2.40 to -0.20) were significantly more effective than waitlist (WL). CBT was also associated with a higher decrease in PTSD symptoms than treatment as usual (TAU) (SMD -1.51; 95% CI -2.67 to -0.36). For all other interventions, the difference with WL and TAU was not significant. CBT and EMDR ranked best according to the mean surface under the cumulative ranking. Regarding acceptability, no intervention had less dropouts than inactive interventions. Conclusion CBT and EMDR appeared to have the greatest effects in reducing PTSD symptoms in asylum seekers and refugees. This evidence should be considered in guidelines and implementation packages to facilitate dissemination and uptake in refugee settings.

Ayurveda focussed mainly on the preventive aspect rather than curative in comparison to other systems  of medicine. The concept of Marma in the Ayurveda is pioneer in science of traumatology, which has  explored the vulnerable areas of human body. Marma play very important role in surgical procedure  by avoiding injury to the adjacent vital point. Every individual must know about the vital parts of our  body so that they prevent them from any type of injury. Marma defined as sites where there is  conglomeration of Mamsa, Sira, Snayu, Asthi and Sandhi, Prana(life) resides naturally. In between  Amashaya and Pakvashaya root of Sira is Nabhi Marma, which is responsible for Sadyahpranahara on trauma. It is Sira Marma. It is Svapanitala in Pramana or Caturangula. Nabhi marma extends from  the superior mesenteric vessels appearing between the neck of the pancreas and the third part of the  duodenum crossing its anterior surface in median plane (L3 vertebra) to the formation of inferior vena  cava from common iliac veins (L5). This includes abdominal aorta as well as inferior vena cava.&nbsp

234 p., El dolor de muñeca secundario a traumatismo o caída es uno de los principales motivos de consulta en Servicios de Urgencias Pediátricas (SUP). En un 25-30% de los casos se identifica fractura del tercio distal del antebrazo. A día de hoy, no existen criterios clínicos suficientemente sensibles que permitan diferenciar los pacientes con fractura; de modo que, para su diagnóstico se suele recurrir a pruebas complementarias como la radiografía (Rx). La Rx se basa en la emisión de radiación ionizante, lo que se ha relacionado con diversos efectos adversos, siendo el paciente pediátrico especialmente sensible a dicha radiación. La ecografía clínica (EC) es aquella que se realiza a pie de cama del paciente por un médico no especializado en radiodiagnóstico, teniendo como objetivo ampliar la exploración física convencional. Según publicaciones, se trata de una técnica de fácil aprendizaje y de alta sensibilidad diagnóstica.Se realiza un estudio observacional prospectivo por parte de dos investigadores con diferente formación en EC. El objetivo es analizar la utilidad y la precisión de la EC, comparado con la Rx, para el diagnóstico de las fracturas del tercio distal de antebrazo en SUP. Se incluyen 180 pacientes con sospecha de fractura del tercio distal del antebrazo y se identifican 100 fracturas óseas mediante EC. La EC presenta una sensibilidad 93.9% (IC95%:87.3-97.7) y una especificidad 97.3% (IC95%: 94.6-98.9) comparado con la Rx. Los resultados obtenidos por los investigadores son equiparables, a pesar de las diferencias de formación en EC existentes previas al estudio. Se concluye que la EC resulta una herramienta clínica útil y de fácil aprendizaje para el diagnóstico de fracturas del tercio distal de antebrazo en SUP.

Doctor of Philosophy in Clinical Psychology (PhD), Living in urban settings can create an increased risk for traumatic exposures. This continues to be true for people who work within these urban settings in community development roles. Workplace motivation has been found to be an important area within motivation research, finding that people are often motivated both by reasons related to themselves and reasons that arise from their larger worldview. Additionally, traumatic experiences and their comingled sequelae, including their impact on motivations, have long been a topic of study. Both childhood adversities and adult traumatic experiences have pervasive repercussions throughout an individual’s life. The current study enters into this discussion, making use of regression equations to investigate the moderating role of spiritually oriented workplace motivation on the impact of traumatic experiences as compared to more self-oriented workplace motivation in a sample of urban community development workers. Although direct relationships

Objective: To describe the writing and implementing process of a contingency plan for a public healthcare Department of Ortho-pedics and Traumatology in the setting of the COVID-19 pandemic. materials and methods: Descriptive study of the writing and implementing process of a COVID-19 contingency plan at a Department of Orthopedics and Traumatology of the Buenos Aires City Public Healthcare System, during the period between March 12 and April 20, 2020, when the public health emergency and yellow alert was declared in our environment amid the imminent possibility of a potentially exponential increase of COVID-19 cases. Under the Pandemic Committee of Orthopedics and Traumatology supervision, the process was divided into 3 instances: planning, implementation, and control. Results: Data source: federal regulations, 17 international articles, 13 scientific association guidelines, and 17 articles of recommendations from the World Health Organization (WHO) and the United States Center for Di-sease Control and Prevention (CDC). Seven sectors were defined: 1) Hospitalization room; 2) Operating room; 3) Outpatient clinic; 4) Emergency Department; 5) Supplies; 6) Healthcare personnel control; 7) Education and research. Conclusion: We provide a writing and implementing process for the development of a contingency plan in the setting of the COVID-19 pandemic. Organizing, training and protecting yourselves as a team constitutes the plan fundamental pillars., Objetivo: Describir el proceso para la formulación e implementación de una estrategia de contingencia de un servicio público de Ortopedia y Traumatología frente a la pandemia de COVID-19. materiales y métodos: Estudio descriptivo del proceso para la formulación e implementación de una estrategia de contingencia de la pandemia de COVID-19 en un Servicio de Ortopedia y Traumatología del sistema público de salud de la Ciudad Autónoma de Buenos Aires, entre el 12 de marzo y el 20 de abril de 2020, período en el cual fue declarada la emergencia sanitaria y el alerta amarilla en nuestro medio frente a la posibilidad inminente de un potencial aumento exponencial de casos de COVID-19. A cargo de un Comité de Pandemia de Ortopedia y Traumatología, el proceso fue dividido en tres instancias: planificación, implementación y control. Resultados: Basados en la normativa nacional, 17 artículos internacionales, 13 guías de sociedades científicas y 17 artículos de recomendaciones de la Organización Mundial de la Salud y los Centros para el Control y la Prevención de Enfermedades de los Estados Unidos. Definimos 7 áreas de trabajo: 1) Sala de internación, 2) Quirófano, 3) Consultorios externos, 4) Servicio de Urgencias, 5) Insumos, 6) Cuidado del personal de salud, 7) Docencia e investigación. Conclusión: Nuestro trabajo aporta una propuesta para el proceso de desarrollo de una estrategia de contingencia frente a la pandemia de COVID-19. Organizarse, capacitarse y protegerse como equipo son sus pilares fundamentales

[spa] La luxación completa y cerrada del astrágalo, es una lesión extremadamente rara que se caracteriza por una disrupción completa de las articulaciones del tobillo, subtalar y talonavicular, que requiere un tratamiento de urgencia para la reducción total de las mismas sin dilación. Presentamos el caso de una paciente de 60 años, que sufrió una caída de altura, entorsis del pie y tobillo derechos, con una deformidad cerrada extrema. Se realizan radiografías y TAC. Evidencian una luxación completa lateral del astrágalo con integridad ósea de la mortaja maleolar. Se practica la reducción abierta a la brevedad, con la evidencia de una rotura completa de los complejos ligamentosos de las tres articulaciones. Recolocación ósea y osteosíntesis con tornillos canulados. La revisión final a los 4 años, nos ofrece la estabilización y revascularización evidentes del talus. Sufrió una algodistrofia (DSR) de Südeck moderada que se resolvió. La funcionalidad y marcha se han restablecido prope integrum., [eng] Lateral and complete enucleating dislocation of the talus, is a extremely rare, and a urgent serious injury. In this case, present a complete disruption of the ankle joint, subtalar and talus-navicular ligaments complex. In fact, high energy trauma is required to produce this injury. Talus is a bone that doesn´t have muscular insertions, only ligaments, and practically all of it is covered by cartilage; a very poor blood circulation for that, have a very high rate of avascular necrosis over 90%. We present the case of a 60 years old woman, who suffered a height drop with endorses of the right ankle. Presenting a serious varus deformity of the foot and several pain. Initial attempts at closed reduction failed, was open urgent reduction. In the anterolateral approach, we found a complete rupture of the ligaments complex of the ankle, subtalar and also the talus-navicular joints. The complete enucleating, dislocation of the talus its present twisted in hand. A Thin sagittal dissected fracture of 13 mm in a medial face, like a arrow, we found. Cannulated screws on a top pulley fracture, tibio-fibularis, talus-fibularis, talus-naviculare, and also was precise micro sutures. Revision at 4 years follow-up, no talus necrosis, only ONC in roof corner, moderated osteodystrophy restored, also the normal function and walk incredible life, until today

[ES] Introducción: La fractura de cadera del anciano es de los diagnósticos más prevalentes en los servicios de Traumatología, con gran impacto en términos clínicos, económicos y sociales. Nuestro objetivo es analizar el impacto clínico de un modelo de comanejo entre Traumatología y Medicina Interna para pacientes ancianos ingresados por fractura de cadera en un hospital de tercer nivel. Material y métodos: Cohortes retrospectivas de pacientes mayores de 65 años ingresados por fractura de cadera entre enero de 2005 y agosto de 2006 (cohorte HIST) sin modelo de comanejo, y entre enero de 2008 y agosto de 2010 (cohorte COFRAC) con dicho modelo. Se analizaron características demográficas, clínicas y quirúrgicas, incidencia de complicaciones, mortalidad y reingreso a los 30 días. Resultados: Se incluyó a 701 pacientes (471 HIST, 230 COFRAC). No hubo diferencias en edad, género, demora quirúrgica, tiempo y tipo de cirugía e intervención, estancia, deambulación al alta, consulta en urgencias ni reingreso o mortalidad a 30 días. Hubo diferencias en identificación de pluripatológicos (16,8 vs. 24,4%; p = 0,02), osteoporosis (3,9 vs. 7,6%; p = 0,03) o déficit motor (3,5 vs. 8,8%; p = 0,03), fármacos del tratamiento (3,7 ± 2,5 vs. 4,3 ± 3,2; p < 0,01), aparición de delirium (15,6 vs. 20,9%, p = 0,048) e hipomotilidad intestinal (80,3 vs. 74,7%; p < 0,001), seguimiento de anemia (83,3 vs. 97,1%; p > 0,01) y de función renal (44,5 vs. 97,3%; p < 0,01) y mortalidad intrahospitalaria (4,6 vs. 1,3%; p = 0,02). Conclusiones: El comanejo de pacientes ancianos ingresados por fractura de cadera permite mejorar la documentación de los problemas crónicos previos y el control de complicaciones hospitalarias y disminuye la mortalidad intrahospitalaria., [EN] Introduction: Hip fracture in the elderly is one of the most prevalent diagnoses in Orthopedic Surgery Departments. It has a great impact in medical, economic and social terms. Our objective is to analyze clinical impact of a co-management care model between orthopedic surgery and internal medicine departments for elderly patients admitted with hip fracture in a tertiary referral hospital. Material and methods: Retrospective cohort study of patients older than 65 years old admitted with hip fracture between January 2005-August 2006 (HIST cohort) without a co-management care model, and between January 2008-August 2010 (COFRAC cohort) with a co-manEdadment care model. Analysis of demographic, clinical and surgery characteristics, complications incidence and mortality and re-admissions at 30 days was made. Results: A total of 701 patients were included (471 HIST, 230 COFRAC). There were no differences in sex, gender, time to surgery, type of anesthesia and surgery, length of stay, ambulation at discharge and 30-days emergency room consultation, readmissions or mortality at 30 days. There were differences in identification of polypatological patients (16.8 vs. 24.4%, P = 0.02), presence of osteoporosis (3.9 vs. 7.6%, P = 0.03), motor deficit (3.5 vs. 8.8%, P = 0.03), number of chronic drugs (3.7 ± 2.5 vs. 4.3 ± 3.2, P < 0.01), diagnosis of delirium (15.6 vs. 20.9%, P = 0.048), constipation (80.3 vs. 74.7%, p < 0.001), monitoring of anemia (83.3 vs. 97.1%, P > 0.01) and renal failure at discharge (44.5 vs. 97.3%, P < 0.01) and hospital mortality (4.6 vs. 1.3%, P = 0.02). Conclusions: Co-management for elderly patients admitted with hip fracture provides a better information about previously chronic conditions, a higher control of hospital complications and decreases hospital mortality.

Bakalářská práce se věnuje tématu diagnostické metody v traumatologii páteře. Práce je zaměřena na stručný popis anatomie páteře, na traumatologii páteře, klasifikaci zlomenin a diagnostické zobrazovací metody používané při vyšetření páteře. Zabývá se použitím konkrétních zobrazovacích metod při podezření na trauma páteře. Porovnává počet použití zobrazovacích metod v kontextu sledovaných diagnóz a dalších kritérií., The subject of this bachelor's thesis deals with imaging techniques used in spinal-related traumas. The thesis addresses topics such as the anatomy of the spine itself, classification of fractures and imaging techniques and diagnostic methods used for spinal examination. In this thesis there were described methods used in case of spinal cord injury possibility. A comparison was made how many times various imaging techniques were used when diagnosing an injury with other criteria in mind., Fakulta zdravotnických studií, Hodnocení vedoucího: velmi dobře mínus Hodnocení oponenta: výborně Doplňující otázky k obhajobě: 1. V diskuzi uvádíte, že výsledky analýzy vzorku dat z krajské nemocnice Pardubice se neshodují s tvrzením v odborné literatuře a to, že v případě polytraumatu s poškozením v horním krčním úseku páteře je nejčastější diagnostickou metodou CT. Čím si tento rozpor vysvětlujete? 2. Dále v diskuzi uvádíte, že se Vám nepodařilo najít odbornou literaturu, která by srovnávala použití zobrazovacích metod u jednotlivých diagnóz. V jakých databázích jste pátrala? Obhajoba bakalářské práce s prezentací velmi dobrá minus., Dokončená práce s úspěšnou obhajobou