Search

Background This paper's purpose was to analyze clinical results obtained with trapeziometacarpal arthrodesis and complications comparing different osteosynthesis systems. Methods Thirty-seven trapeziometacarpal arthrodesis were performed in our center in a 7-year period, with a mean age of 52 years and 34 months of follow-up. The implants were distributed homogenously into three groups, using bone grafts in 12.5% of them. Results A 75% achieved complete consolidation with a mean postsurgical Visual Analog Scale (VAS) of 2.4, Kapandji Opposition Score (KOS) of 8.1, lateral pinch strength of 12.1 kg, tripod pinch strength of 3.6 kg, and tip-to-tip strength of 1.5 kg. Consolidation was not achieved in nine patients, of which five were asymptomatic, three reoperated on trapeziectomy and tenosuspension, and one rearthrodesis. No statistical association was found between the implant used and pseudoarthrosis (p = 0.17), VAS (p = 0.06), or KOS (p = 0.45). Conclusions Trapeziometacarpal arthrodesis reduces pain for well-chosen patients. Nonunion has low clinical significance in most cases and does not seem to depend on the use of allograft or the type of implant but on an appropriate surgical technique.

Cement removal during hip or knee arthroplasty revision surgery is technically demanding and prone to severe complications such as periprosthetic fractures, incomplete cement removal, or perforations. Several alternative techniques have been developed to enable complete, accurate, and safe removal of cement from bone, including osteotomies and cortical windows, endoscopic instruments, ultrasound devices, lithotripsy, and laser-assisted removal. We describe a cement-on-cement technique with a sterile, single-use tool for cement removal. The cement is removed piece by piece using a specifically designed device, without osteotomies or cortical windows.

Purpose:SARS-CoV-2 new scenario has forced health systems to work under extreme stress urging to perform a complete reorganization of the way our means and activities were organized. Orthopedic and trauma have rescheduled their activities to help SARS-CoV-2 units, but trauma patients require also treatment, and no standardized protocols have been established.Methods: Single-center cross-sectional study was performed in a tertiary hospital. Two different periods of time were analyzed: a two-week period time in March 2019 (pre-SARS-CoV-2) and the same period of March 2020 (SARS-CoV-2 pandemic time). Outpatient’s data, emergency activity, surgical procedures and admissions were evaluated. Surgeons and patient´s opinion was also evaluated using a survey.Results:A total of ~16k (15.953) patients were evaluated. Scheduled clinical appointments decreased by ~22%. Urgent consultations and discharge from clinics also descended (~37% and ~20% respectively). Telemedicine was used in 90% of outpatient clinical evaluations. No elective surgical procedures during SARS-CoV-2 time were scheduled, and subtracting the effect of elective surgeries, a reduction of inpatient surgeries, from ~85% to ~59%. Patients delayed trauma assistance more than 48 hours in 13 cases (35%). Preoperative admission for hip fractures decreased in 10 hours on average. Finally surveys stated that patients were more in favor than surgeons to this new way to evaluate orthopedic and trauma patients based strongly on telemedicine.ConclusionDetailed protocols should be standardized for surgical departments during the pandemic. This paper offers a general view in how this virus affects an orthopedic unit and could serve as a protocol and example for orthopedic and trauma units. Even in the worst scenario, an orthopedic and Trauma unit could offer an effective, efficient and quality service. SARS-CoV-2 will set up a new paradigm for health care in orthopedics and trauma.