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Objective: To know the surgeon’s decision making on the choice of graft in anterior cruciate ligament (ACL) reconstruction surgery according to the sport practiced by the patient. Material and method: An online survey was conducted through the Spanish Society of Sports Traumatology (SETRADE) and the European Society for Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA). A descriptive analysis of the sample was performed, and an analysis of the main reason for the choice of plasty was carried out stratifying the sample into different groups. Results: 83 surgeons responded to the survey, 71 members of SETRADE and 12 of ESSKA. The mean number of ACL reconstruction performed per year per respondent was 56 (1-220). For 86.7% of the respondents, sport influenced the decision on the type of graft to be used, the main reason being the biomechanical properties of the plasty (49.4%). The mean agreement in the type of graft to be used in each sport studied was 58.29% (71.1%-38.6%). The highest concordance in the plasty of choice occurred in cycling, with respondents using hamstrings in 71.1% of cases. The sports with the least concordance were wrestling and skiing. There were no statistically significant differences in the reason for choosing plasty. Conclusions: The survey was conducted by a significant number of surgeons with experience in ACL surgery, with biomechanical properties being the main reason for choosing which graft to use. Most of them were influenced in this decision by the type of sport practiced. The authors recommend the handling of at least 2 plasties for primary ACL reconstructions and to individualize each case considering the type of sport in the selection of the graft.

Purpose: In geriatric patients, hip fracture is considered the greatest complication of osteoporosis in terms of morbidity, mortality, and cost. The aim of this study is to assess the effects of a multidisciplinary shared care protocol (trauma services, internal medicine, emergencies, anesthesia, nursing, hematology, pharmacy, rehabilitation, home hospitalization unit, and social services) on hospital stay and in-hospital mortality in inpatients aged 65 years or older and operated for hip fracture.Methods: Retrospective cohort study between January 2011 and December 2017. The unexposed group was made up of patients who did not receive care according to the multidisciplinary protocol, while the exposed group did. We excluded patients with polytrauma, conservative treatment, bilateral hip fracture, pathological fracture, or previous fracture already included in the series. Variables analyzed were demographic data, medical comorbidities, Charlson index, hemoglobin levels, hematocrit and blood transfusion, antiplatelet drugs, length of surgical delay, length of hospital stay, in-hospital mortality, and a composite risk outcome considering in-hospital mortality and/or hospital stay of more than 10 days. We fit a multivariable logistic regression model to calculate the odds ratio (OR) of experiencing outcomes.Results: The cohort included 681 patients: 310 were unexposed and 371, exposed. Compared to the unexposed group, patients receiving protocolized multidisciplinary care showed significantly lower in-hospital mortality (3.5% versus 7.7%; p = 0.015) and were less likely to have a hospital stay of more than 10 (16.4% versus 24.2%; p = 0.012). Mean length of hospital stay was 0.7 fewer days in the exposed group. Multivariable analysis showed the composite risk outcome was 51% lower in the exposed group, after adjusting for age, sex, heart failure, days to surgery, blood transfusion after surgery, and postoperative hemoglobin levels.Conclusion: Implementing the multidisciplinary shared care protocol halved the risk of in-hospital mortality and/or a hospital admission of more than 10 days in patients over 65 years with proximal femur fracture. It also reduced mean length of hospital stay.

Los pacientes intervenidos de artroplastia de cadera a los que se implanta una prótesis con par de fricción metal-metal pueden desarrollar patologías locales o sistémicas relacionadas con la liberación de partículas de cobalto y cromo como consecuencia del roce continuo de sus superficies metálicas, fenómeno denominado metalosis. Conocer las patologías producidas por esta metalosis es fundamental para, tras su sospecha, solicitar una determinación sérica de cobalto y cromo que confirme el diagnóstico. El tratamiento de la metalosis sintomática consiste en la retirada y sustitución protésica, consiguiendo un descenso en las concentraciones sanguíneas de cobalto, y mejorando el cuadro clínico sistémico. Se presenta el caso de una mujer portadora de prótesis de cadera evaluada en Medicina Interna por presentar de forma crónica astenia, cefaleas, alteraciones sensitivas (vista, oído) e hipotiroidismo.

Objectives : This study aimed to determine the risk factors that increase the risk of in-hospital mortality and/or prolonged hospital stay in hip fracture patients aged over 65 years. Methods : We conducted a retrospective study of patients aged over 65 years who underwent hip fracture surgery in the period from January 2015 to December 2017. Our analysis included 54 variables related to medical, psychological, functional and laboratory comorbidities present at admission; treatment, complications and laboratory follow-up during the hospital stay; and functional status and destination on discharge. We performed a bivariate analysis and a multivariate analysis with a composite endpoint combining in-hospital mortality and hospital stay lasting more than 10 days. Results : We included 360 patients with an average age of 84 years. Women accounted for 75% of the sample, and 53.5% of all patients had a pertrochanteric fracture. The mean number of comorbidities per patient was 2.72, and the most common comorbidities were high blood pressure, dementia and diabetes. The rate of in-hospital mortality was 3.6% (n 13) and the mean length of hospital stay was 8.48 days, with 16.4% of patients staying in hospital for more than 10 days. Medical complications, lower hemoglobin on admission, high blood pressure, obesity and Parkinson’s disease were significantly associated with our endpoint in the multivariate analysis Conclusions : Patients who suffer medical complications during hospitalization, and those with lower hemoglobin on admission, high blood pressure, obesity or Parkinson’s disease, have an increased risk of in-hospital mortality or prolonged hospital stay

espanolObjetivo: Describir los resultados del tratamiento y complicaciones asi como establecer la relacion de lesiones asociadas y el tiempo hasta la cirugia.Metodos: Estudio retrospectivo de pacientes con fisis abiertas intervenidos mediante cirugia de reconstruccion del ligamento cruzado anterior entre Junio de 2010 y Junio de 2018. Resultados: 39 pacientes fueron incluidos. La edad media fue de 14,7 anos. El seguimiento medio fue de 42 meses. El tiempo medio hasta la cirugia fue de 10,7 meses. El aumento de este se asocio positivamente al incremento de lesiones asociadas (Test de Spearman 0,106. 1 caso sufrio un puente fisario (2,5%) con discrepancia de longitud de miembros inferiores (2,5%). La escala de Lysholm mostro 92 puntos de media al finalizar el seguimiento.Conclusiones: La tecnica transfisaria obtuvo buenos resultados funcionales con un bajo indice de complicaciones. El incremento del tiempo hasta la cirugia se asocio positivamente con el aumento de lesiones asociadas EnglishObjectives: Describing the results ofthe trans-physeal surgical technique on anterior cruciate ligament (ACL) tear and the appearance of eventual complications and setting the index of associated lesions from the initial diagnosis to surgery diagnosis.Methods: Retrospective study of patients under 18 intervened due to ACL injury with trans-physeal surgical technique between June 2010 and June 2018. Results: 39 patients were included, The average age was 14.7 years (9-17). Mean follow-up was 42 months (6-104) and average time until surgery was 10,7 months (1-48). Spearman correlation test associated positively (0.106) the increase in time to surgery and the increase in the number of associated injuries. There was 1 case of physeal bridge (2.5%) with lower limbs lenght discrepancy.Conclusion:Trans-physeal technique obtained good functional results with a low rate of complications at the end of follow-up in our serie. The increase in time to surgery was positively associated with the increase in associated injuries in the injured knee.