Revista Colombiana de Ortopedia y Traumatología
Esta publicación tuvo su primera etapa entre los años 1966 a 1970; cuando se editó la Revista que salió con el título de Ortopedia y Traumatología; su publicación era anual, pero por diversos motivos solo se editaron cinco números. Una vez la revista dejó de publicarse, persiste en los miembros de la Sociedad el deseo de retomar su publicación y en marzo de 1987 con el nombre que actualmente ostenta, Revista Colombiana de Ortopedia y Traumatología, se publicaron 3 ediciones anuales hasta 1997. Desde 1998 hasta el día de hoy la Revista se publica con una periodicidad trimestral: marzo, junio, septiembre y diciembre. Desde el año 1987 han sido editores; Doctor Fernán Londoño, Doctor Guillermo Alonso, Doctor Rodrigo Pesantez, Doctor Jochen Gerstner, Doctor Carlos Jaramillo, Doctor Enrique Vergara Amador, Doctor Juan Manuel Herrera y actualmente el Doctor Enrique Vergara Amador, Director Editor de la Revista Colombiana de Ortopedía y Traumatología.
Bogotá: Sociedad Colombiana de Cirugía Ortopédica y Traumatología
Bilateral compartment syndrome secondary to systemic capillary leak syndrome. A case report
Introduction: Systemic capillary leak syndrome (SCLS) is a rare life-threatening disorder of uncertain ethology characterized by increased vascular permeability, resulting in fluid leakage into the interstitial space. Compartment syndrome is a rare complication of increased interstitial volume due to SCLS. Case presentation: A 34-year-old man presented to the emergency department of a hospital in Segovia (Spain) with myalgia and paresthesias in the lower limbs with no apparent cause. Given the worsening of symptoms despite the use of anesthetics, the increase in volume in the anterior and lateral compartments of the left leg on physical examination, and the elevated hematocrit (54.1%) and creatine phosphokinase (CPK; 700U/L) levels for no obvious reason three hours after admission, he was diagnosed with compartment syndrome in both legs. Consequently, he was taken immediately to surgery (fasciotomies of the anterior and lateral compartments). Although the intensity of pain and paresthesias decreased after the procedure, the patient reported feeling the same symptoms in the right arm, being admitted to the intensive care unit 9 hours later and requiring ventilation due to suspicion of distributive shock. Two days after the first intervention, the intracompartmental pressure of the right arm was measured, confirming compartment syndrome, which prompted a new fasciotomy, achieving a progressive improvement in the patient's clinical condition to the point of being transferred to the general hospital ward without fluid therapy. Based on a new anamnesis and once other etiologies were ruled out, he was diagnosed with SCLS following type A influenza and was discharged 22 days after his admission. During follow-up, the patient did not experience prodromes or symptomatology associated with a new episode of SCLS, but he did experience decreased left hallux extension strength as a consequence of compartment syndrome. Conclusion: Continuous monitoring of compartment pressure after fluid resuscitation in patients with SCLS could contribute to the early detection of possible compartment syndrome.
Copyright (c) 2025 The Author(s). https://creativecommons.org/licenses/by/4.0/
Treatment of inveterate traumatic obturator-type anterior hip dislocation with closed reduction. Case Report
Introduction: Anterior obturator-type hip dislocation is a rare condition, accounting for approximately 5% of all hip dislocations. Timely treatment reduces the risk of short- and long-term complications such as necrosis of the femoral head. When this injury is inveterate, in other words, when it has not been reduced within the first three weeks of its occurrence, it is usually treated by open reduction. Case presentation: A 43-year-old man presented to the emergency room of a tertiary care center in Cali (Colombia) due to pain in the left hip and functional limitation secondary to high-energy trauma to the left hip 20 days prior to the visit. Physical examination showed apparent elongation of the left leg, while X-ray and computed tomography (CT) scan with three-dimensional reconstruction of the left hip on admission showed an anterior obturator dislocation (type 1B based on the modified Yaari classification). Given the imaging findings and the patient's financial situation, a closed reduction was performed (Allis maneuver with subsequent lateral skin traction in the proximal third of the thigh), achieving adequate functional outcomes. The patient, of his own volition, was discharged the following day, walking without the need for support devices or evidence of pain. Unfortunately, he did not attend follow-up appointments. Conclusions: Although the treatment of inveterate obturator-type anterior hip dislocation usually involves surgery, from the experience of the reported case it may concluded that closed reduction is a suitable treatment option to be considered in contexts of low socioeconomic resources or in patients who cannot be taken to surgery, as it implies a lower functional and, therefore, financial impact, and its use in the reported patient allowed obtaining a satisfactory outcome.
Copyright (c) 2025 The Author(s). https://creativecommons.org/licenses/by/4.0
Modified circumferential cerclage wiring for comminuted patella fracture fixation in Peru. Report of 4 cases
Introduction: Comminuted fractures account for approximately 30-35% of patella fractures and 55% of these fractures require surgery. Although open reduction and internal fixation are considered the best treatment options, their indication depends on the patient's conditions. Case presentation: This article reports the cases of four adults (three men and one woman) who were admitted to a tertiary care hospital in Lima (Peru) due to comminuted fractures of the patella. In all cases, the fracture was managed surgically using an innovative fixation technique (first described in 2019), which uses modified cerclage wiring and combines a multidirectional tension band system and a reinforcement using cerclage wires in a circular fashion. Outstanding functional outcomes were obtained in all patients (mean Oxford score of 41 points in the postoperative follow-up at 4 and/or 8 weeks). Conclusion: Based on the satisfactory outcomes reported in the four patients and given the accessibility of the required osteosynthesis material, the modified circular cerclage wiring technique for fixation of comminuted patellar fractures could be a replicable option for the treatment of these fractures in Peru.
Intraoperative use of indocyanine green fluorescence angiography to determine amputation level: A case report
Introduction: Indocyanine green (ICG) angiography has been widely adopted in several medical areas. Given that it allows real-time visualization of blood perfusion and tissue irrigation, its intraoperative utilization may be useful to determine amputation level in patients presenting with diabetic angiopathy or occlusive peripheral artery disease. Case presentation: A 70-year-old female patient with a significant medical history, including right transtibial amputation due to complications secondary to diabetic microangiopathy, was admitted to the intensive care unit (ICU) of a quaternary care center of Bogotá D.C. (Colombia) after her clinical condition was stabilized following an acute myocardial infarction without ST-segment elevation. On admission to the ICU, an ulcerated lesion with signs of necrosis was observed in the left heel, requiring computed tomography angiography (CT angiography). Based on CT angiography findings, cardiovascular involvement, and the presence of poor-quality vascular beds, the vascular surgery service concluded that she was not a candidate for endovascular treatment and, together with the prosthetics and amputee service, it was decided that transfemoral amputation was the most appropriate option. During surgery, ICG angiography showed adequate perfusion in the proximal third of the leg, so a transtibial amputation was carried out, considering that this level of amputation has benefits in terms of functional rehabilitation and general quality of life. Conclusion: The intraoperative use of ICG angiography as a complementary tool to determine amputation level made it possible to preserve the greatest amount of viable tissue in our patient. This likely contributed to reducing the risk of postoperative complications, since she did not experience any adverse events and did not require reoperation. Furthermore, this approach led to a decrease in the costs associated with the treatment. However, studies with larger samples are required to confirm its efficacy in this clinical setting.
Surgical management of foot malformations due to neurofibromatosis type 1. Case report
Introduction: Neurofibromatosis (NF) is a neurocutaneous syndrome that can affect various organs and systems. It is classified as a rare or orphan disease, and its management represents a clinical challenge. Case presentation: A 33-year-old female patient with malformations in both feet characterized by the presence of rapidly growing exophytic masses since the age of 3, who had undergone multiple surgeries for the removal of said masses, presented to the Orthopedics Department of a tertiary care hospital in Cali (Colombia) due to lesion recurrence. Based on findings from the physical examination and imaging studies, she was diagnosed with neurofibromatosis type 1 (NF1), meeting four of the National Institutes of Health diagnostic criteria. After determining that the right foot was the most affected, surgical management was initiated with four procedures performed over a period of 31 days: resection of a giant neurofibroma, resection of residual tumors, amputation of the fourth toe of the right foot along with coverage of the plantar surface using a reverse-flow fasciocutaneous flap from the superficial sural artery and skin grafts with placement of a hybrid external fixator as a protective measure for the flap and grafts, and management of small plantar areas using split-thickness skin grafts. Four months after the last intervention, adequate healing and maturation of the flaps and grafts were observed, with no evidence of lesion recurrence, so surgery was scheduled for the management of NF1-related lesions on the left foot. Conclusion: Based on the results obtained in our patient, it could be stated that accurate diagnosis and multidisciplinary management by specialists in orthopedics and trauma surgery and plastic surgery are highly important for successfully treating NF1-related lesions in the feet, resulting in satisfactory functional and aesthetic outcomes and the subsequent improvement in quality of life.
Introduction: Tumoral calcinosis (TC) is a rare condition characterized by the deposition of calcium pyrophosphates in periarticular soft tissues. When TC occurs in the context of chronic kidney disease (CKD), it is known as uremic TC. Case Presentation: A 52-year-old male with a history of type II diabetes, CKD on dialysis, and secondary hyperparathyroidism (under treatment with cinacalcet for the last 6 months), attended the orthopedic outpatient service of a quaternary care hospital in Medellin (Colombia) due to a large mass in the left shoulder that appeared 3 months earlier and limited the functionality of that joint. Physical examination revealed a painless mass with no inflammatory signs. Laboratory tests on admission showed hypercalcemia, hyperphosphatemia, and elevated levels of parathyroid hormone (PTH), while imaging tests showed a multilobulated, encapsulated mass with calcifications, but no bone involvement (X-ray and ultrasound of the shoulder), as well as enlarged parathyroid glands (ultrasound). Smaller but similar lesions were also identified in the interphalangeal joints of the left hand and in the soft tissues of the left foot. Based on these findings, he was diagnosed with TC secondary to uncontrolled tertiary hyperparathyroidism, leading to subtotal parathyroidectomy to control hypercalcemia as an indirect treatment of the periarticular lesions. In a follow-up appointment 3 months after the procedure, a reduction of the shoulder mass size (at least 20%) and improvement of the ranges of motion were observed. Conclusion: This case highlights the importance of considering secondary TC as a differential diagnosis in CKD patients on dialysis who present with progressively enlarging periarticular masses. Given its frequent association with hyperparathyroidism, constant monitoring of PTH is essential for a timely diagnosis.
Giant hemophilic pseudotumor in the left thigh: A case report
Introduction: Hemophilic pseudotumor (HPT) is a rare complication affecting patients with hemophilia. It is characterized by a painless mass that, due to multiple bleeding episodes, slowly but progressively increases in size, leading to serious complications such as fractures of adjacent bones. Case presentation: A 54-year-old man with severe hemophilia A attended the emergency department of a tertiary care hospital in Bucaramanga (Colombia) due to the presence of a large mass on his left thigh, which had been growing progressively over the last 10 years, as well as pain and difficulty walking. A magnetic resonance imaging (MRI) scan performed upon admission revealed an intramuscular hematoma measuring 38.2 x 19.2 x 15.2 cm in the posterior compartment of the thigh. A diagnosis of HPT was made, and conservative treatment was initiated with the administration of human coagulation factor VIII (4000 IU). However, since an increase in the lesion was evident on the follow-up MRI one month later, percutaneous drainage of the HPT was performed. Two months after percutaneous drainage, endovascular embolization with microparticles was performed, achieving partial devascularization of the pseudotumor. One week later, a new collection was observed on ultrasound, resulting in drainage of serosanguineous fluid (3000 cc). The final treatment was complete resection of the lesion, which was performed 28 days later. However, since two seromas were identified on the medial side of the left thigh on follow-up MRI (20 days after surgery), the patient underwent further surgical drainage five days later. This multidisciplinary approach allowed obtaining good clinical and functional outcomes, since the patient was able to walk without assistive devices, his knee and hip mobility improved, and there was no evidence of HPT recurrence at the 18-month follow-up. Conclusion: This case demonstrates that an interdisciplinary approach is essential to achieve satisfactory long-term clinical and functional outcomes in patients with large HPT. Furthermore, endovascular embolization is a therapeutic alternative to be considered in cases in which HPT poses surgical challenges.
Acute carpal tunnel syndrome secondary to chronic trans-scaphoid perilunate fracture dislocation. Case report
Introduction: Perilunate injuries are rare, and their severity and frequent underdiagnosis favor the onset of complications such as carpal tunnel syndrome (CTS) or compartment syndrome (CS). Case presentation: A 53-year-old male was admitted to the emergency department of a secondary care hospital in a rural area of Antioquia (Colombia) due to a crush injury (600 kg) to his right hand. Since bone and joint injuries were ruled out during the initial assessment by means of an X-ray of the hand, he was discharged without being immobilized and with instructions to take pain medication and attend a follow-up appointment with the general medicine service. During the follow-up appointment, two weeks after the accident, the patient reported persistent pain and paresthesia in the first three fingers. In addition, a decrease in the range of motion of the wrist was observed, so a CT scan was requested and the patient was referred to the hand surgery unit, where he was evaluated two weeks later. On physical examination, a positive Tinel's sign was reported, with no findings suggestive of CS, resulting in a diagnosis of CTS. After reviewing previous imaging tests, a dorsal trans-scaphoid perilunate fracture dislocation was identified. Six weeks after the injury, open reduction with internal fixation, reconstruction of the dorsal trans-scaphoid perilunate and dorsal intercarpal ligaments, and carpal tunnel release were performed. Four weeks later, the percutaneous fixation was removed. At the 16-week postoperative follow-up, the patient reported complete resolution of pain and neuropathic symptoms and adequate reintegration to his work activities; there was also complete mobility of the fingers and wrist. Conclusion: Trans-scaphoid perilunate fracture dislocations are rare injuries that should be suspected after sustaining a high-energy trauma to the carpus, as timely diagnosis and treatment are essential to avoid severe complications such as CTS. Since surgery with open reduction and internal fixation, ligament reconstruction, and carpal tunnel release showed good outcomes in our case, it could be considered a treatment option for patients with chronic trans-scaphoid perilunate fracture dislocations with associated CTS.
Concomitant peroneal tendon dislocation and medial malleolus fracture. A case report
Introduction: The concomitant occurrence of peroneal tendon dislocation (PTD) and medial malleolus fracture (MMF) is rare. Its timely identification is important to prevent long-term complications. Case presentation: A 21-year-old male was admitted to the emergency department of a tertiary care hospital in Medellín (Colombia) after suffering a motorcycle accident (as a passenger). Physical examination revealed left hip internally rotated and painful; complete functional limitation and severe pain in the left leg; wound on the medial aspect of the left knee without bone exposure; and edema, pain, functional limitation, and ecchymosis in the left ankle. Admission imaging tests (X-rays of the pelvis and ankle and CT scan of the pelvis) showed posterior hip dislocation with fracture of the posterior rim of the left acetabulum and MMF with slight displacement of the bone fragment. Hip dislocation was initially treated with closed reduction, but given its instability, open reduction and acetabular osteosynthesis were performed. However, during routine preoperative assessment (physical and radiological assessment) of the MMF, concomitant PTD was identified, so open reduction and medial malleolus osteosynthesis and repair of the superior peroneal retinaculum with anchor suture were performed. At 6 months of follow-up, functionality and mobility had been completely restored, and adequate bone consolidation of the medial malleolus was observed. Conclusion: The concomitant occurrence of PTD and MMF is rare and may go unnoticed on initial assessment, so patients with MMF should undergo careful and routine clinical evaluation of ligament stability and ankle ligament complexes.
Rare presentation of primary Rosai-Dorfman disease of the bone: single lesion in the proximal humerus with no clinically evident lymphadenopathy. A case report
Introduction: Rosai-Dorfman disease (RDD) is a rare non-neoplastic histiocytic proliferative disease of non-Langerhans cells. Secondary extranodal involvement occurs in approximately 40% of cases, with bone involvement accounting for less than 10% of these cases. Primary extranodal presentation in bones (i.e., without evident lymph node involvement) is even rarer and usually multifocal, but on some occasions, it can appear as a solitary lesion. Case presentation: A 22-year-old woman, with pain in her right shoulder without a history of trauma and refractory to pharmacological therapy, presented with functional loss of the limb after two months. X-ray and magnetic resonance scans revealed a well-defined lytic lesion in the greater tuberosity of the right humerus and surrounding bone edema extending to the proximal diaphysis, involving the rotator cuff. Given the size of the lesion (26 mm) and the suspicion of chondroblastoma, an excisional biopsy was performed. Furthermore, considering the severity of the edema, after repairing the rotator cuff, a total synovectomy was performed using a cortico-cancellous particulate allograft to correct the residual defect. Histopathological analysis showed abundant emperipolesis and positivity for CD68 and S100 biomarkers in histiocytes, leading to a diagnosis of RDD. Eleven months after surgery, the patient experienced shoulder pain and functional disability again, and clinical and imaging findings suggested tumor recurrence. Therefore, she underwent a revision surgery (resection of the lesion and local augmentation with an autologous graft). Histopathological analysis ruled out tumor recurrence and concluded that the lesion was caused by bone graft resorption. At the most recent follow-up (30 months after index surgery), the patient showed adequate functionality and mobility of the right shoulder and reported that pain was imperceptible. Conclusions: Primary RDD of bone should be considered as a differential diagnosis when an atypical lytic bone lesion is found, particularly in a young person. Also, a timely diagnosis requires a multidisciplinary approach.
Copyright (c) 2025 The Authors. https://creativecommons.org/licenses/by/4.0
Technical considerations for revision shoulder arthroplasty
In recent decades, the frequency of shoulder arthroplasty has increased markedly. Despite advances in surgical techniques, revision rates remain between 3.9% and 9.9% and continue to pose a significant technical challenge due to bone loss and soft tissue deficiency. In this context, the objective of this article is to present the technical considerations relevant to revision shoulder arthroplasty, with particular emphasis on surgical steps that may improve outcomes and reduce complications. Strategies for exposure and removal of humeral and glenoid components are described, along with approaches to the management of humeral and glenoid bone defects, taking into account variations in approach based on defect classification and the use of bone grafts or augmented prostheses. The recommendations provided herein are supported by the available literature and the authors’ clinical experience.
Anatomic anterior cruciate ligament reconstruction scoring checklist: Spanish language validation
Introduction: An ideal arthroscopic anterior cruciate ligament (ACL) reconstruction aims to restore the anatomy and function of the knee to its original state. The Anatomic ACL Reconstruction Score Checklist (AARSC) has been validated and used to assess reconstruction techniques described in the literature. Objectives: To validate the Colombian Spanish version of the AARSC in terms of inter-rater reliability, construct validity, and internal consistency as a tool for assessing ACL reconstruction surgical techniques described in the literature. Methodology: Study to validate the AARSC in Colombian Spanish developed in two phases: 1) translation and adaptation to Colombian Spanish, and 2) validation. The validation process followed the methodology used by the creators of the checklist. Eighteen articles describing ACL reconstruction (ACRL) techniques were selected and reviewed by 4 senior knee surgeons without any pre-established criteria and by 6 orthopedists using the AARSC (54 evaluations; 3 per article; all with experience in ACRL). Internal consistency, inter-rater reliability, and construct validity were determined by calculating Cronbach's alpha, intraclass correlation coefficient (ICC), and Spearman's correlation coefficient (rho), respectively. Cohen's Kappa coefficient was also calculated to assess agreement between senior orthopedists’ assessments. Results: The internal consistency of the list was poor (Cronbach’s alpha= 0.591). The agreement between the evaluations made by experts based on their own opinion was moderate or poor (Cohen’s Kappa: 0.48, 0.31, and 0.36). The ICC was 0.613 for consistency and 0.610 for absolute agreement, which shows a substantial correlation between the evaluations made using the AARSC. However, there was no correlation between assessments performed by senior orthopedists and those performed using the checklist in most cases (rho= 0.014 -0.433). Conclusions: Although it was not possible to establish the validity of the Colombian Spanish version in our study, some elements of the AARSC might be useful to evaluate the anatomic nature of a reconstruction in the ACRL techniques described in the literature.
Outcomes at one-year follow-up of surgical treatment for distal radius fractures in a university hospital in Bogotá, Colombia
Introduction: Distal radius fractures are the most common type of fractures found in adults. Although there is still a debate about the most appropriate treatment, surgery has been increasingly used in recent years. Objective: To describe the sociodemographic, clinical, and radiological characteristics of patients with distal radius fractures who underwent surgery in a university hospital in Bogotá (Colombia), to analyze the outcomes of treatment at 6 and 12 months of follow-up, and to determine the variables associated with functional outcomes. Methodology: Longitudinal cohort study. Patients over 18 years of age with distal radius fractures who underwent surgery at a university hospital in Bogotá between May 2020 and June 2021 were included. Sociodemographic, clinical, and radiological variables were collected at the first postoperative follow-up and at 6- and 12-month follow-ups. A bivariate analysis was performed to explore associations between the variables considered and functional outcomes using the QuickDASH score. Results: A total of 78 patients were included, of whom 37.2% had 2R3A fractures, 24.4% had 2R3B fractures, and 38.5% had 2R3C fractures as per the AO classification. Stabilization was achieved by means of a palmar plate in 81% of the cases and via percutaneous pinning in 9% of the cases. Significant improvement was observed in total active motion (TAM) of the fractured wrist and in the functional outcomes measured with the PRWE and QuickDASH scores when comparing the results at 6 and 12 months (p<0.05). Patients with dominant side fracture and TAM <160º showed significant differences in the QuickDASH score at 6 months follow-up; however, the differences were not significant at 12 months. No significant differences were observed in the remaining variables analyzed. The incidence of complications was low. There was a positive correlation between the scores obtained in the QuickDASH and PRWE scores both at 6 (R=0.818, p<0.001) and 12 months (R=0.856, p<0.001). Conclusions: Significant improvement in terms of functionality and arcs of motion was observed during follow-up. Dominant side involvement and decreased TAM were identified as variables affecting functional outcomes during the first six months. The complication rate was low.
Factors associated with prolonged hospital stay following hip fracture surgery in adults: a multicenter study in Trujillo, Peru
Introduction: Hip fracture (HF) is a highly prevalent health problem with a high morbidity and mortality rate. Most HFs occur in older adults, so hospital stays are often long due to the presence of comorbidities and the increased risk of complications in this age group. To date, there are no studies on the factors associated with this outcome in the Peruvian population. Objective: To identify the factors associated with prolonged hospital stay following HF surgery in the Peruvian population. Methodology: A multicenter retrospective case-control study was conducted using data from 1 120 patients who underwent HF surgery in four hospitals in Trujillo (Peru) between 2018 and 2023, with a case-control ratio of 1:1 (140 controls and 140 cases per hospital). Cases were defined as patients with a hospital stay ≥14 days, and the controls as patients with a hospital stay <14 days. Bivariate analyses (chi-square and Mann-Whitney U tests) were performed to evaluate differences between groups (overall and per hospital). A multivariate analysis (bivariate and multivariate binary logistic regression) was performed to identify factors independently associated with prolonged hospital stay. Results: The factors independently associated with prolonged hospital stay were diabetes mellitus (aOR: 3.058; 95%CI: 2.357 – 3.967; p<0.001), chronic kidney disease (aOR: 3.513; 95%CI: 1.915 – 6.444; p<0.001), preoperative ASA score ≥III (aOR: 1.615; 95%CI: 1.112 - 2.346; p=0.012), and preoperative severe functional dependency (aOR: 6.073; 95%CI: 1.324 – 27.851 p=0.020). Conclusion: Factors independently associated with prolonged hospital stay following HF surgery in the adult population of northern Peru were diabetes mellitus, chronic kidney disease, preoperative ASA score ≥III, and preoperative severe functional dependency.
Sociodemographic and clinical characteristics of pediatric patients (≤16 years) with hip fractures treated between 2011 and 2022 at a hospital in Medellín, Colombia
Introduction: Hip fractures in children are rare and require timely diagnosis and treatment to reduce the risk of long-term complications. Avascular necrosis of the femoral head is the most common and most feared complication due to the resulting functional impairment. Information on this type of fracture in the Colombian pediatric population is scarce. Objective: To describe the sociodemographic and clinical characteristics of pediatric patients (≤16 years old) with hip fractures treated at a quaternary care hospital in Medellín, Colombia. Methodology: Observational, descriptive, and retrospective study of 71 pediatric patients (≤16 years old) with hip fractures treated at the Hospital Universitario San Vicente Fundación in Medellín between 2011 and 2022. Data on sociodemographic and clinical variables were collected. The Delbet classification was used. Results: The mean age of the patients was 6.56 years (SD=4.47), 57.75% were male, 67.61% underwent surgery, and 61.97% had a fracture of the left hip. Falls from height were the most common cause of fracture (57.75%), and the most frequent fracture type was Delbet IV (60.56%). Only two patients developed complications: avascular necrosis of the femoral head (1.41%) and failure of fracture fixation (1.41%). Conclusions: A preference for surgical treatment and a slight predominance of males were observed. Fractures were mainly caused by falls from height, and most of them were classified as Delbet type IV. The complication rate was very low.
Vitamin D deficiency in patients with fragility hip fractures treated at a quaternary care hospital in Medellín, Colombia
Introduction: Vitamin D deficiency is associated with lower bone density, increased frequency of falls, and greater risk of fragility fractures. Objective: To describe the clinical and sociodemographic characteristics of older adults with fragility hip fractures treated at a hospital in Medellín (Colombia) and to establish the frequency of vitamin D deficiency in these patients. Methodology: Retrospective descriptive study. A total of 440 patients >60 years of age with fragility hip fractures treated at a quaternary hospital in Medellín (Colombia) between 2021 and 2023 were included. Data were collected based on the review of their medical records. The level of 25-hydroxy vitamin D assessed within 72 hours after the fall was considered. Results: The mean age of the patients was 81.55 years (±8.89), and 70.23% (n=309) were women. The most common risk factors for fragility fractures were smoking (39.09%; n=172), history of fragility fracture (13.64%; n=60), and having osteoporosis/osteopenia (10.91%; n=48). Moreover, 88.63% (n=390) had at least one comorbidity, the most frequent being hypertension (72.27%; n=318). Meanwhile, 78.18% (n=344) had an extracapsular fracture, 91.81% (n=404) underwent surgery, 37.73% (n=166) developed at least one complication, and 30-day mortality was 12.27% (n=57). Finally, 78.86% (n=347) had low vitamin D levels (deficiency: 6.82%; insufficiency: 72.05%). Conclusions: Most patients with fragility hip fractures were elderly, female, and had at least one comorbidity. Furthermore, extracapsular fractures and surgery were predominant, with a high complication rate being observed. Lastly, more than three-thirds of patients had low vitamin D levels, mainly 25-OH vitamin D insufficiency.
Effectiveness of surgical and conservative treatment of middle third clavicle fractures in Peruvian adolescents
Introduction: Clavicle fractures are quite frequent (2.6-10% of all fractures), occur predominantly in men (mainly during sports), and the diaphysis or midshaft is the most commonly fractured segment (69-90%); moreover, they are the most common type of fracture in adolescents. Although conservative management is used in most cases, given its effectiveness, surgery has increased in this age group, despite a higher risk of complications. Objective: To determine the effectiveness of conservative and surgical management in Peruvian adolescents with displaced midshaft clavicle fracture. Methodology: Single-center retrospective cohort study conducted in 36 adolescents with midshaft clavicle fracture treated in a trauma service in Trujillo (Peru) between 2018 and 2022: 18 patients underwent surgery and 18 received conservative management. Effectiveness was measured in terms of functional outcomes using the QuickDASH scale. Satisfaction with cosmetic outcomes was also assessed using a 5-point Likert scale. Both measurements were performed 3 months after the end of treatment. Differences between groups were assessed using Chi-square and Mann-Whitney U tests Results: Functional outcomes were satisfactory in both groups, with no significant differences in the QuickDASH score (p=0.784). Complications were observed only in the surgery group, in which 4 patients (22.2 %) required a second surgery after fracture healing for implant removal due to protrusion and pain (p=0.034). Finally, the proportion of patients satisfied with the cosmetic outcomes of the treatment was significantly higher in those treated conservatively (77.8 % vs. 11.1%; p=0.001). Conclusions: Both therapeutic approaches provide satisfactory functional outcomes. However, conservative management is significantly superior to surgery in terms of lower morbidity and higher satisfaction with cosmetic outcomes.
Efficacy of photobiomodulation for reducing pain in patients who have sustained fractures. A systematic review
Introduction: Fractures are painful and disabling injuries that can be caused by trauma. In recent years, photobiomodulation has been suggested to reduce pain in these patients. Objective: To perform a systematic literature review on the efficacy of photobiomodulation to reduce pain in patients who have sustained fractures. Methodology: A systematic search was performed in PubMed, Cinahl, PsycINFO, SPORTDiscus, Academic Search Complete, Lilacs, IBECS, CENTRAL, SciELO, and WOS. Randomized clinical trials (RCTs) evaluating the efficacy of photobiomodulation in reducing pain in patients with fractures published in English and Spanish within the last 5 years were included. Results: Five RCTs were included (182 patients in total) and all compared photobiomodulation with sham photobiomodulation or placebo. Fracture localization varied between studies: zygomaticomaxillary complex, distal radius, mandible, tibia and/or ankle, and various sites in lower limbs). The duration of therapy ranged from 4 to 8 weeks and all studies found it to be a safe intervention, with no major side effects. Pain was assessed directly using the Visual Analog Scale or the McGill scale. Moreover, some studies measured pain indirectly by analyzing the use of analgesics. Conclusions: Based on the retrieved evidence, it can be stated that photobiomodulation is effective in reducing pain in patients who have sustained fractures.
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An up-to-date overview of bone metastases management: A systematic review
Introduction: Bone metastases (BM) are a major complication in patients with advanced cancer, resulting in pain, fractures, and other skeletal-related events (SREs) that greatly affect quality of life. Objective: To provide an updated overview of the current management strategies for BM. Methodology: This systematic review adhered to the PRISMA 2020 guidelines and was registered in PROSPERO (CRD42024586182). A comprehensive literature search was performed in July 2024 across PubMed, ScienceDirect, and Scopus, using terms related to BM and Boolean operators (OR, AND, and NOT). The search strategy was refined to only include studies published since January 2020. Randomized controlled trials (RCTs), clinical trials (CTs), and cohort and case-control studies published in English or Spanish assessing various management strategies for BM, such as surgery, radiotherapy, systemic therapies, and supportive care, and reporting data on the outcomes of interest were included. The Newcastle-Ottawa Scale was used for quality assessment. Results: A total of 131 records were retrieved from the searches. After duplicate removal and title and abstract and full-text screening, 27 studies were included in the review: 13 RCTs, 7 CTs, 6 cohort studies, and 1 case-control study with an aggregate sample of 14 672 patients. Radiotherapy, particularly multifractionated regimens and stereotactic body radiotherapy, was shown to improve pain relief and bone stability. Systemic therapies, including immune checkpoint inhibitors and bone-targeted agents, demonstrated efficacy in reducing skeletal-related events. Emerging techniques such as percutaneous vertebroplasty combined with ablative methods demonstrate potential in minimizing complications and improving quality of life. Conclusion: The management of BM continues to evolve, with personalized, multimodal approaches being essential for achieving optimal outcomes. Further research should focus on enhancing predictive models, exploring novel therapies, and integrating bone-targeted agents to reduce complications and improve both survival and quality of life in patients with bone metastases.
Artificial intelligence in the context of the surgical treatment of scoliosis in adults, with an emphasis on applications, outcomes, and ethical implications: A systematic review
Introduction: Artificial intelligence (AI) and machine learning (ML) are being increasingly implemented in the surgical treatment of scoliosis in adults in an effort to enhance precision, optimize outcomes, and support clinical decision-making. Despite significant progress, their use in the clinical setting raises ethical concerns regarding data governance, transparency, and algorithmic bias. Objective: To systematically review the current evidence on the use of AI in the context of surgical treatment of scoliosis in adults, focusing on its clinical applications, reported outcomes, and associated ethical considerations. Methodology: This systematic review was conducted in accordance with the PRISMA 2020 guidelines and registered in PROSPERO (CRD42024585554). A comprehensive search was performed in June 2024 across PubMed, ScienceDirect, Scopus, and Google Scholar. Studies addressing the use of AI or ML in the surgical treatment of scoliosis in adults (≥18 years) and reporting clinical applications, surgical outcomes, or ethical implications were included. Quality assessment was performed using the Newcastle-Ottawa Scale. Results: A total of 304 records were retrieved from the searches. After removing duplicates and screening titles, abstracts, and full-text, 16 studies were included in the review. All studies were published between 2020 and 2024; 8 were observational studies, 1 was a systematic review, and 7 were literature reviews. The combined sample size of observational studies was 43 320 patients (141-39 254). Artificial Neural Networks (ANN), Convolutional Neural Networks (CNN), and Support Vector Machines (SVM) were predominant. Clinical applications encompassed predictive modeling of surgical outcomes, assessment of complication risks, and decision support for surgical planning. AI-enhanced systems showed potential to reduce complications and improve alignment outcomes. However, external validation was limited, and no study included prospective clinical trials. Ethical concerns such as transparency and data bias were acknowledged in only a minority of studies. Conclusion: AI holds a considerable potential in scoliosis surgery for adults but it is still in early stages of clinical integration. Future research must focus on validation, explainability, and equitable implementation to fully realize its potential in spine surgery.
Surgical treatment of SLAP tears: labrum repair versus biceps tenodesis. A systematic review
Introduction: In the past, biceps tenodesis was the go-to technique for treating SLAP lesions in older patients with lower functional demands, while arthroscopic labrum repair was preferred in young, active individuals. However, there is still debate about which technique to select. Objective: To compare the efficacy and safety of biceps tenodesis and labrum repair in the treatment of SLAP tears. Methodology: This systematic review and meta-analysis adhered to the PRISMA 2020 guidelines. Systematic searches were conducted in December 2024 in Medline (PubMed), Web of Science, and Cochrane to find clinical trials and observational studies published in the last 10 years that compared both treatments in terms of efficacy and safety. The meta-analysis was performed in RevMan using a fixed-effect model when heterogeneity was <50% and a random-effects model if it was >50%. A statistical significance level of p<0.05 was considered. Results: Ten retrospective observational (cohort) studies were included. The mean age in both groups was <40 years in six studies and ≥40 years in three. In the remaining study, the mean age was <40 years in the tenodesis group and ≥40 years in the labrum repair group. Postoperative pain (VAS score) was significantly lower in patients who underwent tenodesis [mean difference (MD): -0.29, 95%CI: -0.50 to -0.07, p=0.010]. No differences were found between groups in the ASES score (MD: 0.72, 95%CI: -1.61 to 3.05, p=0.54), the rate of return to sports (RR: 1.08, 95%CI: 0.97 to 1.21, p=0.15), or the reoperation rate (RR: 0.41, 95%CI: 0.17 to 1.01, p=0.05). Conclusions: Regardless of age, there are no significant differences between biceps tenodesis and labrum repair for the treatment of SLAP tears in terms of the patient’s subjective perception on functional scales, rate of return to sports activity, and reoperation rate. Postoperative pain was significantly lower in the biceps tenodesis group.
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