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Objective: To determine the comorbidities associated with disability in patients with OA in Mexico (2013-2015)., Material and Methods: A cross-sectional, retrospective and multicentre IMPACTAR study (n=7703) in Mexican patients (2013-2015). Comorbidities associated with disability were identified in 4971 patients diagnosed with OA from the IMPACTAR registry (n=7073). An adjusted logistic regression analysis was carried out by demographic, economic, clinical and medical variables., Results: Mean age was 63 years; and 75% of the patients were women. Subjects with OA and presence of comorbidities are 42% more likely to develop disabilities than patients without associated comorbidity, considering age, sex, family income, OA diagnosis duration, and education level. The highest rate of people with disability (28.9%) was concentrated in Region 7, which corresponds to Mexico City. There are also significant differences between median family incomes, when the income of persons with disability is under $13 000 (IQR: 9000-16 000) Mexican pesos, compared to patients without disability. Almost half of the subjects (49.6%) reported having at least one comorbidity. Arterial hypertension was the risk factor with a statistically significant difference (32.8%) among those with disability (34.7%)., Conclusions: Programs and interventions for OA patients should take into consideration comorbidity factors, being female, family income, and the region of residence as variables that may increase the possibility of developing an OA-associated disability., (Copyright © 2020 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.)

Background: This article presents evidence and recommendations regarding the efficacy and safety of the approved and available therapies in Mexico to treat severe or established osteoporosis with the aim of developing a position regarding therapeutics in this stage of the disease, according to the descriptive cards of the National Drug Formulary of the National General Health Council of Mexico., Methods: We performed a systematic and narrative review of the evidence of teriparatide and denosumab, from their pharmacological profile, effectiveness, and safety derived from clinical trials, as well as an analysis of the general recommendations of the national and international clinical practice guidelines., Results: The evidence establishes that teriparatide and denosumab belong to different therapeutic classes, with biologically opposed mechanisms of action and indications of use, which are clearly differentiated in their respective national codes, therefore these drugs cannot be substitutable or interchangeable in severe osteoporosis therapy. Both represent the best options currently available for this stage of the disease; being similar in their efficacy in preventing new vertebral fragility fractures, with an RR of .35 (CI 95%; .22-.55) for teriparatide, and .32 (CI 95%: .26-.41) for denosumab. The absolute risk reduction is higher with teriparatide 9.3% (21 months) compared with denosumab at 4.8% (36 months)., Conclusions: Our results agree with the recommendations available in national and international clinical practice guidelines, with both therapies proposed as a sequential, but not a substitute, treatment., (Copyright © 2019 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.)

Objective: To determine the comorbidities associated with disability in patients with OA in Mexico (2013-2015)., Material and Methods: A cross-sectional, retrospective and multicentre IMPACTAR study (n=7703) in Mexican patients (2013-2015). Comorbidities associated with disability were identified in 4971 patients diagnosed with OA from the IMPACTAR registry (n=7073). An adjusted logistic regression analysis was carried out by demographic, economic, clinical and medical variables., Results: Mean age was 63 years; and 75% of the patients were women. Subjects with OA and presence of comorbidities are 42% more likely to develop disabilities than patients without associated comorbidity, considering age, sex, family income, OA diagnosis duration, and education level. The highest rate of people with disability (28.9%) was concentrated in Region 7, which corresponds to Mexico City. There are also significant differences between median family incomes, when the income of persons with disability is under $13 000 (IQR: 9000-16 000) Mexican pesos, compared to patients without disability. Almost half of the subjects (49.6%) reported having at least one comorbidity. Arterial hypertension was the risk factor with a statistically significant difference (32.8%) among those with disability (34.7%)., Conclusions: Programs and interventions for OA patients should take into consideration comorbidity factors, being female, family income, and the region of residence as variables that may increase the possibility of developing an OA-associated disability., (Copyright © 2020 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.)

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Venous thromboembolism (VTE) is a worldwide public health problem, with an annual incidence of 1-2 cases/1,000 individuals in the general population and a 1-5% associated mortality. Orthopedic surgery is a major surgical risk factor for VTE, but the problem is more important for patients with hip and knee joint replacement, multiple traumatisms, severe damage to the spine, or large fractures. Thromboprophylaxis is defined as the strategy and actions necessary to diminish the risk of VTE in high-risk orthopedic surgery. Antithrombotics may prevent VTE. At the end of this paper, we describe a proposal of thromboprophylaxis actions for patients requiring high-risk orthopedic surgery, based on the opinion of specialists in Orthopedics and Traumatology who work with high-risk orthopedic surgery patients. A search for evidence about this kind of surgery was performed and a 100-item inquiring instrument was done in order to know the opinions of the participants. Then, recommendations and considerations were built. In conclusion, this document reviews the problem of VTE in high-risk orthopedic surgery patients and describes the position of the Colegio Mexicano de Ortopedia y Traumatología related to VTE prevention in this setting.

Venous thromboembolic disease (VTED) is a public health problem worldwide. In the United States it causes 2 million annual cases. Its annual incidence is 1-2 cases per 1,000 individuals in the general population. It is a disease frequently associated with life threatening complications and its mortality rate is 1-5% of cases. Due to its high complication rate, its slow recovery, and the need for prolonged disability, it is considered as a high-cost disease. VTED may occur in both surgical and medical patients; the known associated risk factors include prolonged rest, active cancer, congestive heart failure, atrial fibrillation, and stroke, among the major medical conditions. Orthopedic surgery represents the main surgical risk factor for VTED, including mainly hip and knee replacements, as well as polytraumatized patients with severe spinal lesions, and major fractures. VTED may be prevented with the appropriate use of antithrombotics. The participants in this consensus defined thromboprophylaxis as the strategy and actions undertaken to reduce the risk of VTED in patients undergoing high risk orthopedic surgery. The position of the Mexican College of Orthopedics and Traumatology regarding the prevention of VTED in orthopedic surgery is described herein.

Introduction: There is no single criterion to select a posterior stabilization system for an arthroplasty; the ultracongruent system may avoid the complications observed with the drawer and the post., Objective: To assess the clinical and functional status of total knee arthroplasty with the ultracongruent system and compare the results with those published in the international literature., Material and Methods: A retrospective study was carried out with a descriptive and comparative analysis of the total knee arthroplasties in which the Consensus system was used, to determine the operative time, the range of motion, pain, the Western Ontario and McMaster Universities Osteoarthritis Scale (WOMAC), and the level of satisfaction., Results: Sixty-six arthroplasties were performed; mean age was 70.58 years; 45.5% were right and 54.5% left; the operative time was 76.84 minutes, the VAS pain score was 2.02, the WOMAC score was 17.11, and the range of motion was 96.5 +/- 14.04. Ninety-two percent of the patients are satisfied with the surgical procedure., Conclusions: The prosthesis with the ultracongruent insert is an effective option to relieve pain in patients with knee pathology. The clinical and functional results were similar to those reported with other stabilization systems. The system is well accepted by the patients. It is recommended as an alternative to prevent the possible complications that occur with the drawer and post system.

Purpose: To show how open treatment of the elbow stiffness offers an improvement in the range of motion, pain control, and patient's satisfaction., Methods: We present a case series analysis of patients who suffer elbow stiffness and were treated with open surgery. We analyzed the range of motion (ROM), visual analogue scale (VAS) for pain and satisfaction, and the Mayo Score. Statistical analysis was performed using Student's t-test, Fisher's exact and Pearson correlation coefficient., Results: 33 patients were included mean, age was 30.3 +/- 13.4. Twenty patients were male and 13 female, 32 patients had an articular fracture of the elbow and 1 with ectopic ossification. In 90.9% the column procedure was the option and in 9.1% open reduction and internal fixation was made. Compared with preoperative ROM was 58.8 degrees +/- 28.6 degrees, postoperative 96.10 +/- 25.5 (p < 0.001). Pain versus registered 5.06 points in the Preoperative 1.7 points in the postoperative period (p = 0.001). 75% of the patients were satisfied. Preoperative Mayo score was 47.2 +/- 17.8 versus 89.2 +/- 13.4 in the postoperative (p < 0.0001)., Conclusion: The open treatment of the stiff elbow offers the patient pain relief; increased motion and most patients report final results as satisfactory.

Objective: Our aim was to determine the disability impact on quality of life (QOL) in Mexican adults with juvenile idiopathic arthritis polyarticular course (JIAPA) and juvenile ankylosing spondylitis (JAS)., Methods: A cross-sectional study was performed on 32 adult patients with juvenile idiopathic arthritis. Functional outcome was evaluated using Global Functional Status (GFS) according to American College of Rheumatology (ACR) and Spanish Health Assessment Questionnaire-Disability Index (HAQ-DI) arthritis-specific measurements for functional disability in patients with polyarticular course and Bath Ankylosing Spondylitis Functional Index (BASFI) for those who developed JAS. Quality of life (QOL) was assessed using SF-36 and EuroQol 5D (EQ-5D). Descriptive statistics and associations among clinical, functional, and QOL measurements were examined using Spearman's correlation test. Multiple regression analysis was used to estimate predictor factors for impaired QOL. Differences between groups were evaluated by Fisher exact and Mann-Whitney U tests, and p values of <0.05 were considered statistically significant., Results: JIAPA and JAS had GFS III/IV in 65 and 50%, respectively. A HAQ-DI score of > 1.5 was found in 35% of JIAPA, and a BASFI score of > 5 in 92% of JAS. Patients with JIAPA and JAS reported lower scores for all physical domains and for mental domains (physical role, social functioning, and emotional role) compared with Mexican population scores (p < 0.005). Health status between both groups studied does not show significant differences (p > 0.05). EQ-5D showed impairment in all five dimensions for both groups studied. Multiple regression analysis showed that GFS was the only variable that affects QOL assessed by SF36., Conclusions: In our study population, JIAPA and JAS exhibited a great disability impact on QOL and poor functional outcome during the patients' adult life. GFS has a significant impact on quality of life.

Introduction: Tibial shaft fractures are common since they account for 9% of all fractures. Intramedullary nailing is described in the literature as the gold standard for their treatment and the most recent research emphasizes minimum exposure., Objective: To present the clinical and radiological course of closed, unreamed intramedullary fixation for tibial shaft fractures in a group of patients seen at Medica Sur Hospital., Material and Methods: Twenty-two male patients with a diagnosis of tibial shaft fracture were analyzed retrospectively; mean age was 28 years. In all of them the Orthofix nail was inserted through the patellar tendon, with a closed approach and without reaming the medullary cavity., Results: Twenty patients had closed fractures (90.90%) and 2 patients had open fractures (9.09%). The mean time to starting ambulation with protected weight bearing was two weeks in 18 patients (81.81%); with full weight bearing, six weeks in 13 patients (91%). The mean time to full weight bearing without crutches was 10 weeks in 21 patients (95.45%). Mean radiographic grade III-IV healing time was 16 weeks. Complications were: delayed union in two patients (9.09%), compartmental syndrome, in one patient (4.45%)., Conclusion: The Orthofix interlocking intramedullary nail placed with a closed approach provides immediate stability due to the proximal and distal locking. Patient rehabilitation is quicker, with total mobility, providing an early stimulation for callus formation and the added benefit of sparing the endosteal blood supply.