搜索结果：Revista espanola de cirugia ortopedica y traumatologia

The COVID-19 pandemic led to the suspension of football leagues worldwide, resulting in changes to tournament formats and player performance. While European leagues have reported injury characteristics during this period, similar analyses are lacking in South America. This study aimed to compare injury incidence, burden, and patterns between a regular season (2023) and the pandemic-affected season (2020) in Peruvian professional football. A total of 266 and 360 official matches were analyzed from the 2020 and 2023 seasons, respectively. Injury data were collected through video analysis of official broadcasts, sports media publications, and official statements from club medical departments. Injury severity was classified based on days absent until return to full competition. Injury burden was defined as total days absent per 1000h of exposure. Injury incidence rates (injuries per 1000h) and injury characteristics (type, anatomical location, mechanism, and severity) were compared between seasons. The 2020 season included 19 teams, 521 registered players, and 28 matches per team. In 2023, 20 teams and 532 players participated, with each team playing 37 matches. No significant difference was found in match injury incidence between seasons. However, injury burden in 2020 was 1.23 times higher (95% CI, p<.01) compared to 2023, with a median difference of 6 days absent per injury (U=77, p<.001). Contact injuries significantly decreased in the 2020 season (RR 0.58, 95% CI, p<.05). Although injury incidence remained similar, the 2020 pandemic season showed higher injury burden and fewer contact injuries, highlighting the need for adaptive strategies to protect athlete health during unexpected interruptions.

The most common postoperative complication relating to reverse total shoulder arthroplasty (RTSA) is instability. The risk factors for luxation include a lack of the subscapularis tendon or inadequate soft tissue tension, the prosthetic design, the bone deficiency, the obesity, and mechanical factors such as bone impingement and implant position.. To prevent this luxation, we can insert a retentive polyethylene humeral cup, The purpose of this study was to evaluate the clinical outcomes, the incidence of luxation and scapular notching between standard versus retentive polyethylene humeral cups in Delta III RTSA. 51 patients with rotator cuff insufficiency and osteoarthritis who underwent primary Delta III PIH using a standard and retentive polyethylene humeral cup were retrospectively reviewed between September 2018 and December 2023. The main indication for placing the retentive polyethylene was the complete and irreparable chronic rupture of the subscapularis tendon with impossibility of reinsertion and with muscle atrophy. The average follow-up was 42,4 months (41,6 and 44,3 months respectively) Results. 51 patients were reviewed: 35 with standard humeral cups and 16 with retentive polyethylene humeral cups. We found no prosthesis luxation in either of the two study groups and there were no differences in forward flexion, abduction or internal rotation between the two groups at the end of the follow-up. There was a lower mean for external rotation in the retentive polyethylene humeral cup group (average,36.3 &#xb1; 11,6 vs 28,7 &#xb1;10,9) but it was not statistically significant. There was no statistical difference in the postoperative Constant score at the end of the follow-up. The incidence of scapular notching was 62.8 % and 62.5 % for the standard and retentive polyethylene humeral cups, respectively. The Delta III rTSA using either a standard or retentive polyethylene humeral cups provide functional improvement and pain relief. There were no differences between the two groups in clinical mobility, forward flexion, abduction, internal rotation, external rotation, incidence of luxation and scapular notching Level of evidence: Level III; Retrospective Cohort Comparison; Treatment Study.

The posterolateral (PL) column is often the most difficult one to access and manage in tibial plateau fractures. Although multiple approaches have been described, many provide limited flexibility to address diverse fracture patterns. The Versatile Extended Anterolateral (EAL) approach with four progressive windows has been previously introduced within the Main Deformity Direction (MDD) framework. In this cadaveric study, we provide a detailed anatomical and technical description of this modified approach, characterized by an optimized skin incision and four stepwise deep windows for PL column management. The primary aim was to assess the technical feasibility of this approach. Potential reduction and fixation options associated with each window were also explored descriptively. Four fresh-frozen cadaveric specimens were used to evaluate surgical exposure and relationships with relevant anatomical structures. Based on the anatomical exposure achieved with each window, potential reduction and fixation strategies were explored descriptively. Representative clinical cases were included to illustrate fixation techniques. The skin incision allowed access to all windows, achieving safe progressive PL column exposure. The four windows (pre-fibular, supra-fibular, retro-fibular, trans-fibular) expanded reduction and fixation possibilities stepwise. The trans-fibular window enabled complete articular and metaphyseal exposure. The anterior tibial artery crossing, located at a mean of 3.5 cm from the tip of the fibular head, represented the distal anatomical limit of posterior exposure. The Versatile EAL approach is a feasible option for managing lateral and PL columns in tibial plateau fractures. Its progressive four-window strategy may allow tailored exposure and fixation according to fracture-specific requirements. IV.

Currently, most hospitals systematically request preoperative crossmatching tests for patients undergoing arthroplasty. The aim of this study is to assess whether routine preoperative crossmatch testing (CMT) is necessary for all patients undergoing primary total hip arthroplasty (THA). To this end, we evaluated the transfusion rate, associated clinical risk factors, and the economic impact of routine crossmatch testing. A retrospective study including patients undergoing primary THA for coxarthrosis from 2021 to 2023. Patients with fractures and their complications, as well as prosthetic revisions, were excluded. Epidemiological, clinical, and analytical variables, as well as the cost of routinely performing preoperative CMT were evaluated. A total of 273 patients were included (152 males), with a mean age of 66.9 years [27-89]. Tranexamic acid was administered to 207 patients (75.8%), and surgical drains were used in 133 cases (48.7%). The decision to use tranexamic acid and drains was made by the attending anaesthesiologist and surgeon, respectively. The mean length of hospital stay was 2.5 days [1.2-3.7]. All surgeries were performed using a posterolateral approach, and all prostheses implanted were uncemented Polar R3&#xae; (Smith & Nephew) components. The mean preoperative haemoglobin level was 14.3g/dL [10-19.7], and the postoperative level was 11.1g/dL [7.2-14.7]. Blood transfusion was required in 20 patients (7.3%). No urgent or intraoperative transfusions were recorded; all were prescribed postoperatively at the discretion of the attending surgeon. Female sex, the use of surgical drains, and preoperative haemoglobin<13g/dL were identified as statistically significant risk factors for transfusion (p<0.05). The estimated cost of routine PPCC was &#x20ac;21,840. The blood transfusion rate following primary THA was less than 10% (7.3%). It seems reasonable to stop routinely performing CMT for every patient undergoing primary THA and to individualise the indication for transfusion based on each specific case.

Experimental post-traumatic arthrofibrosis studies have been conducted using mostly rabbit models. However, there is great interest in developing and validating models in smaller animals, which would allow for more cost-effective research. The aim is to validate a model in rats recently described by Owen et al. MATERIALS AND METHODS: Twenty 14-weeks old Sprague-Dawley female rats were used in the study: 10 rats were used to assess biomechanical contracture, as passive extension angle at different torques (PEA-2, PEA-4, PEA-8) and at capsule disruption, and 10 rats to assess histological fibrosis (area and thickness of posterior capsule). Left knee acted as control. Index surgery was performed on the right knee (operated knee) as described by Owen at al.: intra-articular injury, disruption of posterior capsule, and immobilization with a percutaneous suture in flexion. After a 4-week immobilization period, the suture was removed, followed by another 4-week remobilization period and euthanasia. Operated knees showed lower PEA-4 (-40.6&#xb0;; p=.011), PEA-8 (-45.6&#xb0;; p=.044) and PEA at capsule disruption (-66.5&#xb0;; p=.043) than the control knees. Mean PEA-2, PEA-4 and PEA-8 from our sample were similar to those reported by Owen et al. Operated knees showed a larger posterior capsule area (1.82mm2; p=.033) and thickness (.31mm; p=.043) than the control knees. The post-traumatic arthrofibrosis model described by Owen et al. has the capacity to induce biomechanical contracture and histological fibrosis. Our biomechanical results are comparable to those of Owen, supporting the model's reproducibility.

Experimental post-traumatic arthrofibrosis studies have been conducted using mostly rabbit models. However, there is great interest in developing and validating models in smaller animals, which would allow for more cost-effective research. The aim is to validate a model in rats recently described by Owen et al. MATERIALS AND METHODS: Twenty 14-weeks old Sprague Dawley female rats were used in the study: 10 rats were used to assess biomechanical contracture, as passive extension angle at different torques (PEA-2, PEA-4, PEA-8) and at capsule disruption, and 10 rats to assess histological fibrosis (area and thickness of posterior capsule). Left knee acted as control. Index surgery was performed on the right knee (operated knee) as described by Owen at al.: intra-articular injury, disruption of posterior capsule, and immobilization with a percutaneous suture in flexion. After a 4-week immobilization period, the suture was removed, followed by another 4-week remobilization period and euthanasia. Operated knees showed lower PEA-4 (-40.6&#xb0;; P=.011), PEA-8 (-45.6&#xb0;; P=.044) and PEA at capsule disruption (-66.5&#xb0;; P=.043) than the control knees. Mean PEA-2, PEA-4 and PEA-8 from our sample were similar to those reported by Owen et al. Operated knees showed a larger posterior capsule area (1.82mm2; P=.033) and thickness (.31mm; P=.043) than the control knees. The post-traumatic arthrofibrosis model described by Owen et al. has the capacity to induce biomechanical contracture and histological fibrosis. Our biomechanical results are comparable to those of Owen, supporting the model's reproducibility.

Early diagnosis of DDH, ultrasonography and treatment with Pavlik arnais have provided an improvent of the results. However, always appear children more than 3 months until 24 months-old with late diagnosis or failure with Pavlik treatment requiring closed reduction and spica cast treament as standard management. The authors reviewed retrospectively DDH cases treated all patients treated with spica cast in human position during 3 months. The minimum follow-up was 5 years. It was considered good result when DDH reduced, remained stable, concentric, without AVN and not required surgery for sequels. All demographics, clinical and radiological parameters were statiscally analyzed. Of a total 152 hips were treated, 24 (15.8%) required surgery. In 6 cases (4%) was observed AVN. According IHDI/T&#xf6;nnis displacement severity, types I and II were success treated in 98,9% and types III/IV in 64%. As bad prognosis factors were identified Ortolani test (+), alfa angle minor than 44&#xb0;, acetabular index higher than 44&#xb0; or IHDI/T&#xf6;nnis types III/IV and factors for a good prognosis types I/II and the early recovery of the acetabular index more than 10&#xb0; after 5 months of treatment. The age and early treatment of the patients was only important for the hips type III/IV (64 hips), the mean age of patients treated successfully was 5,1 months (64%), comparing with 8,8 months of the surgery group (36%). The incidence of AVN was 4% (6 cases) and in all cases the nucleus of ossification was not present in the x-ray pre-treatment. We cannot find relationship between AVN with previous skin traction, adductor tenotomy or severity of displacement. Conservative management of DDH with spica cast provide excellent results in almost all cases in types I and II hips (98,9%) and in 64% of Types III /IV. An improvement of the Acetabular Index more than 10&#xb0;, 5 months after the treatment is the best prognosis factor for a good result.

Early diagnosis of DDH, ultrasonography and treatment with Pavlik arnais have provided an improvement of the results. However, always appear children more than 3 months until 24-months old with late diagnosis or failure with Pavlik treatment requiring closed reduction and spica cast treatment as standard management. The authors reviewed retrospectively DDH cases treated all patients treated with spica cast in human position during 3 months. The minimum follow-up was 5 years. It was considered good result when DDH reduced, remained stable, concentric, without AVN and not required surgery for sequels. All demographics, clinical and radiological parameters were statistically analyzed. Of a total 152 hips were treated, 24 (15.8%) required surgery. In 6 cases (4%) was observed AVN. According IHDI/T&#xf6;nnis displacement severity, types I and II were success treated in 98.9% and types III/IV in 64%. As bad prognosis factors were identified Ortolani test (+), alfa angle minor than 44&#xb0;, acetabular index higher than 44&#xb0; or IHDI/T&#xf6;nnis types III/IV and factors for a good prognosis types I/II and the early recovery of the acetabular index more than 10&#xb0; after 5 months of treatment. The age and early treatment of the patients was only important for the hips type III/IV (64 hips), the mean age of patients treated successfully was 5.1 months (64%), comparing with 8.8 months of the surgery group (36%). The incidence of AVN was 4% (6 cases) and in all cases the nucleus of ossification was not present in the X-ray pre-treatment. We cannot find relationship between AVN with previous skin traction, adductor tenotomy or severity of displacement. Conservative management of DDH with spica cast provide excellent results in almost all cases in types I and II hips (98.9%) and in 64% of types III/IV. An improvement of the acetabular index more than 10&#xb0;, 5 months after the treatment is the best prognosis factor for a good result.

To describe the application of the Wide-Awake Local Anesthesia No Tourniquet -WALANT- technique in hallux valgus surgery, highlighting its advantages in terms of patient comfort and surgical safety. A descriptive study detailing the steps for administering WALANT anesthesia during hallux valgus correction. Patient selection, local anesthetic preparation, injection technique, and surgical approach were documented. The case of a 65-year-old woman with severe hallux valgus undergoing surgery with the WALANT technique is presented. The patient tolerated the procedure well without requiring sedation or experiencing significant pain. Despite the absence of a tourniquet, the surgery was performed with adequate visibility and hemostatic control. Early mobilization was achieved, and the patient reported a high level of satisfaction. At the 2-week follow-up, wound healing progressed favorably and alignment was satisfactory, with no complications observed. WALANT appears to be a safe and effective alternative for hallux valgus surgery, minimizing the risks associated with general or regional anesthesia while improving the overall patient experience. This report outlines the anesthetic protocol routinely used in our practice, which may serve as a foundation for standardizing its application in forefoot procedures. Further comparative and prospective studies are warranted to assess its clinical and functional outcomes over the medium and long term. This is a level 4 evidence study as it focuses on the description of a surgical technique based on clinical experience.

To compare the diagnostic and classification accuracy of tibial plateau fractures on simple radiographs among three groups: knee surgeons, resident physicians, and artificial intelligence (ChatGPT-4). An observational, descriptive, cross-sectional study with a control group was conducted on a prospective cohort of patients treated for tibial plateau fractures between 2020 and 2024. Anteroposterior radiographs were blindly evaluated by three groups - three knee surgeons, three resident physicians, and ChatGPT-4 - with fractures classified according to the Schatzker system. The reference standard was computed tomography (CT). The interobserver agreement was assessed using the Kappa statistic for fracture detection and the Ciccetti-weighted Kappa for fracture classification, with a 95% confidence interval. A significance level of p<0.01 was established. A total of 387 radiographs were included, of which 129 showed tibial plateau fractures (classified according to Schatzker as follows: 7 type I, 28 type II, 5 type III, 16 type IV, 21 type V, and 52 type VI) and 258 were without fracture. The AI demonstrated the highest accuracy in fracture detection, achieving an absolute agreement of 99.5% and a Kappa of 0.98 (95% CI: 0.97-1.00, p<0.001), compared to 97% (&#x3ba;=0.93, 95% CI: 0.91-0.95, p<0.001) for knee surgeons and 93% (&#x3ba;=0.848, 95% CI: 0.81-0.88, p<0.001) for residents. In terms of interobserver variability for fracture diagnosis, the AI showed greater consistency than the human evaluators; however, for fracture classification, knee surgeons achieved a higher weighted Kappa (0.616, 95% CI: 0.554-0.679, p<0.001) compared to the AI (0.612, 95% CI: 0.502-0.722, p<0.001) and residents (0.572, 95% CI: 0.510-0.635, p<0.001). Artificial intelligence demonstrated notable accuracy in the detection of tibial plateau fractures, outperforming both residents and attending physicians in this specific task. However, in the classification of fractures using the Schatzker system, attending physicians achieved higher accuracy. These findings suggest that AI may serve as a valuable support tool in the diagnostic process, particularly in its early stages, complementing - but not replacing - the clinical judgment and experience of healthcare professionals. Level III. Cross-sectional descriptive study with control group.

This article highlights the importance of historical knowledge in current medical training and practice, particularly in specialties such as Traumatology and Orthopedic Surgery. It criticizes the increasing technologization of medicine and its growing disconnection from the humanities. The study argues that the historical study of diseases -especially so-called "crippling" diseases, like poliomyelitis and musculoskeletal tuberculosis- provides a deeper understanding of current clinical processes, enhances medical empathy, and promotes a more comprehensive and critical education. A historiographic study was conducted on 138 medical records from the San Juan de Dios Sanatorium in Seville, spanning the years 1943 to 1950. Thirty-two cases related to poliomyelitis and musculoskeletal tuberculosis were analyzed in depth, 9 of which underwent surgical intervention. Two cases involving subtalar arthrorisis were highlighted as examples to reinterpret past treatments using current orthopedic knowledge. Patients with poliomyelitis treated in the past underwent aggressive surgical procedures that, although well-intentioned, often resulted in severe deforming sequelae. Many of these patients now present with osteoarthritis, chronic pain, or deformities. Techniques such as rib arch grafting (Grice's technique) were precursors to modern methods like the calcaneal stop screw. While some procedures had long-term functional success (over 90% positive outcomes), many failed to consider the emotional and psychosocial impact on the patient. This study demonstrates that understanding the historical context of disease is essential for providing more humane, effective, and empathetic care. It advocates for the integration of the History of Medicine into the curricula of medical specialties, to avoid simplistic judgments of past practices and to recognize that medical treatments are also cultural products of their time. Historical training allows physicians to develop critical, humanistic thinking and a respectful approach to the patient's experience.

This article highlights the importance of historical knowledge in current medical training and practice, particularly in specialties such as Traumatology and Orthopedic Surgery. It criticises the increasing technologization of medicine and its growing disconnection from the humanities. The study argues that the historical study of diseases-especially so-called "crippling" diseases, like poliomyelitis and musculoskeletal tuberculosis-provides a deeper understanding of current clinical processes, enhances medical empathy, and promotes a more comprehensive and critical education. A historiographic study was conducted on 138 medical records from the San Juan de Dios Sanatorium in Seville, spanning the years 1943-1950. Thirty-two cases related to poliomyelitis and musculoskeletal tuberculosis were analysed in depth, 9 of which underwent surgical intervention. Two cases involving subtalar arthrorisis were highlighted as examples to reinterpret past treatments using current orthopaedic knowledge. Patients with poliomyelitis treated in the past underwent aggressive surgical procedures that, although well-intentioned, often resulted in severe deforming sequelae. Many of these patients now present with osteoarthritis, chronic pain, or deformities. Techniques such as rib arch grafting (Grice's technique) were precursors to modern methods like the calcaneal stop screw. While some procedures had long-term functional success (over 90% positive outcomes), many failed to consider the emotional and psychosocial impact on the patient. This study demonstrates that understanding the historical context of disease is essential for providing more humane, effective, and empathetic care. It advocates for the integration of the History of Medicine into the curricula of medical specialties, to avoid simplistic judgments of past practices and to recognise that medical treatments are also cultural products of their time. Historical training allows physicians to develop critical, humanistic thinking and a respectful approach to the patient's experience.

Diabetic foot (DF) is a common and serious complication of diabetes mellitus (DM), especially in patients with chronic kidney disease (CKD) undergoing renal replacement therapy (RRT). This study aimed to assess the prevalence of DF and associated conditions in DM patients receiving RRT at a tertiary care hospital in Argentina. We conducted a cross-sectional observational study between December 2022 and September 2024. A total of 54 patients with type 1 or type 2 DM undergoing either hemodialysis (HD) or peritoneal dialysis (PD) were included. History of DF, active or pre-ulcerative lesions, neuropathy, peripheral vascular disease, and associated risk factors were evaluated through physical examination and medical record review. DF was present in 40.7% of patients, with a higher proportion in HD (48.6%) compared to PD (26.3%). Pre-ulcerative lesions were found in 61.1%, and active ulcers in 9.3%. A history of amputation was reported in 31.4% of cases. Diabetic neuropathy (87%) and peripheral vascular disease (81.5%), both closely related to DF development, were key findings. Significant differences were observed in smoking (42.1% PD vs. 11.4% HD, p=0.016), which may impair microcirculation, and obesity (63.2% PD vs. 25.7% HD, p=0.016), which increases plantar pressure and contributes to foot deformities. DM patients on RRT have a high prevalence of DF and related risk factors. Early detection and multidisciplinary follow-up are essential to prevent complications such as ulcers and amputations.

The primary objective is to evaluate the clinical and functional outcomes of tape reinforcement in anterior cruciate ligament (ACL) reconstructions, recording complications, as well as the rate of reinterventions and graft failure. Retrospective analysis of ACL reconstructions with hamstring (HS) autograft that were reinforced with high-strength tape. We included patients in whom we obtained a graft of HS <8mm or &#x2265;8mm of poor quality. Age, sex, body mass index (BMI), and previous activity were recorded. Clinical and functional evaluation were made and postoperative range of motion (ROM), pain, and Lysholm functional scale were recorded. Complication rate, graft failure rate, and reintervention rate were analyzed. A total of 160 patients were included, with a mean age of 29.19 years. Of these, 98 were male and 62 female, with a mean BMI of 23.5. The mean follow-up period was 31.7 months. The average ROM was 137.2&#xb0;, the mean pain level was 0.8, and the average Lysholm score was 95.1. The complication rate was 11%, with 5% requiring reoperation. The graft failure rate was 1.3%. A graft diameter <8mm was associated with females with Fisher's exact test of p<.0001. In the other parameters, no statistically significant differences were found between patients with grafts <8mm and those with grafts &#x2265;8mm. This study demonstrates that tape reinforcement in ACL reconstruction is a safe procedure, offering excellent clinical and functional outcomes with low reinterventions and graft failure rates.

The primary objective is to evaluate the clinical and functional outcomes of tape reinforcement in anterior cruciate ligament (ACL) reconstructions, recording complications, as well as the rate of reinterventions and graft failure. Retrospective analysis of ACL reconstructions with hamstring (HS) autograft that were reinforced with high-strength tape. We included patients in whom we obtained a graft of HS <8mm or &#x2265;8mm of poor quality. Age, sex, body mass index (BMI), and previous activity were recorded. Clinical and functional evaluation were made and postoperative range of motion (ROM), pain, and Lysholm functional scale were recorded. Complication rate, graft failure rate, and reintervention rate were analyzed. A total of 160 patients were included, with a mean age of 29.19 years. Of these, 98 were male and 62 female, with a mean BMI of 23.5. The mean follow-up period was 31.7 months. The average ROM was 137.2&#xb0;, the mean pain level was 0.8, and the average Lysholm score was 95.1. The complication rate was 11%, with 5% requiring reoperation. The graft failure rate was 1.3%. A graft diameter <8mm was associated with females with Fisher's exact test of P<.0001. In the other parameters, no statistically significant differences were found between patients with grafts <8mm and those with grafts &#x2265;8mm. This study demonstrates that tape reinforcement in ACL reconstruction is a safe procedure, offering excellent clinical and functional outcomes with low reinterventions and graft failure rates.

Non-surgical management of intracapsular hip fractures is rare and reserved for fragile patients with co-morbidities that contraindicate surgery. The aim of the study is to determine the mortality rate in intracapsular hip fractures managed non-surgically. Retrospective series of patients who received non-surgical management between January 2004 and December 2023 included, minimum follow-up 1 year. Periprosthetics or secondary-to-tumor fractures, polytraumatized and surgically treated intracapsular hip fractures were excluded. Mortality was recorded during admission, at 30 days, 6 months and one year. Non-surgical management was indicated in 54 patients (frequency 7.56%), the most common reason was low functionality (Barthel index <20 points) associated with non-ambulation and/or neurological disease/dementia. Two patients were excluded due to loss of follow-up. During admission, 3 patients died (5.8%), at 30 days 8 patients (15.4%), at 6 months 23 patients had died (44.2%) and in the first year 30 patients (57. 7%). It was observed that the deceased patients were older (mean age 89.7 years versus 83 years); and association between mortality at one year and Barthel index (p: 0.019) and mobility 30 days after the fracture (p: 0.006). We present a high one-year mortality (57.7%), higher than published for surgery, so we believe that in fragile patients we must either improve multidisciplinary outpatient follow-up or consider other palliative care, without reaching harsh therapeutic treatment.

To evaluate the effect of prosthetic lateralization on tuberosity healing following reverse shoulder arthroplasty (RSA) for proximal humerus fractures (PHFs) in older adults. This single-center retrospective study included patients aged >&#x2009;65&#x2009;years with displaced Neer 3- or 4-part PHFs treated with RSA within four weeks of injury. Patients were allocated according to the global lateralization of the prosthesis: Very Highly Lateralized (VHL; 21.4&#x2009;mm, Arrow&#xae;, n&#x2009;=&#x2009;53) and Lateralized (L; 14.7&#x2009;mm, Unique&#xae;, n&#x2009;=&#x2009;20). Tuberosity healing was assessed radiographically and classified as anatomic, non-anatomic, or failed consolidation. Statistical analysis was performed using Student's t-test or Mann-Whitney U test for continuous variables, and Chi-square or Fisher's exact test for categorical variables. The final cohort consisted of 73 patients (62 women, 11 men) with a mean age of 76.2&#x2009;&#xb1;&#x2009;6.9&#x2009;years. Overall tuberosity healing occurred in 60 patients (82.2%), while 13 (17.8%) demonstrated failed consolidation. The L group showed a significantly higher overall healing rate (100%) compared with the VHL group (75.5%; P&#x2009;=&#x2009;.020). Anatomic healing was achieved in 55% of the L group and 28% of the VHL group (P&#x2009;=&#x2009;.020). All failures occurred exclusively in the VHL cohort (24.5%). The overall complication rate was 6.8%, with no significant differences between groups. Very high prosthetic lateralization (>&#x2009;20&#x2009;mm) is associated with reduced rates of anatomic tuberosity healing and a higher incidence of failed consolidation, likely due to increased mechanical tension that compromises osteointegration in osteoporotic bone.

Non-surgical management of intracapsular hip fractures is rare and reserved for fragile patients with comorbidities that contraindicate surgery. The aim of the study is to determine the mortality rate in intracapsular hip fractures managed non-surgically. Retrospective series of patients who received non-surgical management between January 2004 and December 2023 included, minimum follow-up 1 year. Periprosthetics or secondary-to-tumor fractures, polytraumatized and surgically treated intracapsular hip fractures were excluded. Mortality was recorded during admission, at 30 days, 6 months and one year. Non-surgical management was indicated in 54 patients (frequency 7.56%), the most common reason was low functionality (Barthel Index <20 points) associated with non-ambulation and/or neurological disease/dementia. Two patients were excluded due to loss of follow-up. During admission, 3 patients died (5.8%), at 30 days 8 patients (15.4%), at 6 months 23 patients had died (44.2%) and in the first year 30 patients (57. 7%). It was observed that the deceased patients were older (mean age 89.7 years versus 83 years); and association between mortality at one year and Barthel Index (p=0.019) and mobility 30 days after the fracture (p=0.006). We present a high one-year mortality (57.7%), higher than published for surgery, so we believe that in fragile patients we must either improve multidisciplinary outpatient follow-up or consider other palliative care, without reaching harsh therapeutic treatment.

To evaluate the clinical effectiveness, safety, and impact on quality of life of vertebral distraction techniques in patients with early-onset scoliosis (EOS) through a systematic review and meta-analysis. The techniques evaluated were conventional growing rods (CGR), magnetically controlled growing rods (MCGR), and the VEPTR device. A systematic review was conducted following PRISMA guidelines. Comparative studies, systematic reviews, and economic evaluations published between 2012 and 2023 were included. The analyzed outcomes were Cobb angle, T1-S1 length, quality of life, and complications. Certainty of the evidence was assessed using the GRADE approach. Meta-analyses were performed using fixed- or random-effects models according to heterogeneity. A total of 29 primary comparative studies were included in the meta-analyses of effectiveness and safety. MCGR showed greater Cobb angle correction compared with VEPTR (MD = -22.07&#xb0;; 95% CI: -31.52 to -12.62) and a lower proportion of patients with at least one complication compared with CGR (RR = 0.54; 95% CI: 0.38 to 0.78). No clinically relevant differences in radiographic correction were observed between CGR and MCGR. CGR were associated with a significant improvement in the psychosocial dimension of quality of life. The certainty of evidence was rated as low or very low for most outcomes. No clinically relevant differences were observed in the correction of large deformities between CGR and MCGR, although MCGR tend to be associated with a lower proportion of patients with complications. The VEPTR device maintains a specific role in patients with thoracic insufficiency syndrome. The available evidence is limited and of low or very low certainty; therefore, higher-quality studies are required to establish robust clinical recommendations.