E. Ferrando Meseguer

Hospital Clínico Universitario de Valencia

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María Fe Mínguez Rey

Universitat de València

L. Pino Almero

Hospital Clínico Universitario de Valencia

A. Romano Bataller

Hospital de La Ribera

S. Roig Sánchez

Universitat de València

S. Burguet Girona

Hospital Clínico Universitario de Valencia

J.I. Maruenda Paulino

Hospital Clínico Universitario de Valencia

Damián Mifsut Miedes

Hospital Lluis Alcanyis

A. Gómez

Hospital Universitario Virgen de la Arrixaca

F L ALMEIDA HERRERO

Hospital Clínico Universitario de Valencia

M. Carmen Blasco Mollá

Universitat de València

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Hospital Clínico Universitario de Valencia

Universitat de València

INCLIVA Health Research Institute

Hospital de La Ribera

Hospital Lluis Alcanyis

Hôpital Nord

Hospital Universitario Virgen de la Arrixaca

Industrial University of Santander

Hospital Universitario de Gran Canaria Doctor Negrín

Hospital de Manises

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Estudio sobre dos técnicas quirúrgicas para el tratamiento de la braquimetatarsia congénita en adolescentes

Revista del Pie y Tobillo (2024)

L. Pino Almero Javier Navarro Muñoz E. Ferrando Meseguer M. Carmen Blasco Mollá María Fe Mínguez Rey

Antecedentes y objetivo: la braquimetatarsia es un acortamiento anormal de uno o más metatarsianos. El objetivo es analizar los resultados clínicos y radiológicos del tratamiento quirúrgico de la braquimetatarsia congénita mediante 2 técnicas quirúrgicas diferentes, el alargamiento gradual por callotasis y el alargamiento en un tiempo con injerto autólogo de peroné y fijación con placa atornillada. Material y métodos: estudio observacional, descriptivo y retrospectivo sobre una muestra de 10 metatarsianos (6 pacientes/9 pies). Para la elongación de los metatarsiano se realizaron 2 técnicas quirúrgicas: en el grupo A (5 metatarsianos) se realizó elongación mediante fijador externo y en el grupo B (5 metatarsianos), alargamiento en un solo tiempo con aporte de autoinjerto óseo. Resultados: todos los pacientes fueron mujeres y la edad media fue de 14,60 ± 1,57 años. El cuarto metatarsiano fue el más frecuentemente afectado (80%). Se trataron 5 (50%) casos mediante osteogénesis por distracción con fijador externo y 5 casos (50%) con alargamiento agudo con injerto autólogo de peroné y fijación con placa bloqueada. La ganancia media de alargamiento gradual fue de 16,82 ± 1,48 mm (38,8% ± 7,69) y de 14,16 ± 2,41 mm (29,60% ± 7,92) con el alargamiento agudo, sin que existieran diferencias estadísticamente significativas. Un 50% desarrollaron complicaciones (deformidad en flexión, fractura del regenerado óseo, pseudoartrosis asintomática con rigidez de la 4.ª articulación metatarsofalángica). Todas las pacientes estaban satisfechas con el resultado obtenido. Conclusiones: el alargamiento mediante injerto autólogo es una técnica con escasas complicaciones y segura cuando el objetivo es conseguir una longitud menor del 30% de la inicial. En cambio, la técnica de alargamiento por callotasis mediante fijador externo permite corregir mayor longitud, pero presenta una incidencia más alta de complicaciones y un periodo más largo de recuperación.

10.24129/j.rpt.3801.fs2305014

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Pseudoartrosis séptica de tibia por pseudomona aeruginosa. Tratamiento mediante transporte óseo.

Revista Española de Cirugía Osteoarticular (2020)

E. Ferrando Meseguer Francisco Segura Llopis F L ALMEIDA HERRERO A. Gómez Damián Mifsut Miedes

Septic non union has still been a challenge for orthopedic surgeons. Its resolution is complex and has hight morbility. It needs a multidisciplinary approach. Distal tibia is a common location due its poor vascularity and soft tissues. We present a patient with pseudoarthrosis of the tibia treated with resection and bone transport. Contact was achieved at the docking site at 5 months. Bone grafting and freshening of fracture ends was performed. At 12 months the frame was removed after complete consolidation. As the only complication, the patient suffered two episodes of cellulitis that were resolved with antibiotic therapy.

Vascularity

Bone grafting

10.37315/sotocav202028455131

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Opciones de tratamiento quirúrgico mínimamente invasivo en las fracturas vertebrales osteoporóticas OF4

Revista Española de Cirugía Ortopédica y Traumatología (2021)

S. Burguet Girona E. Ferrando Meseguer J.I. Maruenda Paulino

The incidence of osteoporotic vertebral fractures (OVF) is increasing. The importance of their diagnosis and treatment lies in their frequency and the morbidity they cause in patients. The classification proposed for OVFs by the German Society of Orthopaedics and Traumatology (DGOU) recommends surgical treatment for vertebral fractures classified as OF4. Most of these fractures will require anterior bracing as an adjunct to posterior fixation because of the significant loss of vertebral body structure. In elderly patients, minimally invasive surgery (MIS) allows their treatment given the lesser tissue aggression and systemic repercussions. We present the results of the treatment of OF4 vertebral fractures using minimally invasive techniques in the Spine Unit of our hospital.Retrospective study of 21 patients with OF4 osteoporotic fractures in the thoracolumbar transition treated in our centre. Six patients who underwent open posterolateral fusion or isolated vertebroplasty were excluded. The series consists of 15 cases (13 females and 2 males), with a mean age of 72.2, studied by computed tomography and magnetic resonance imaging. Clinical and analytical data were collected to decide the most appropriate surgical technique. In six cases a retropleural/retroperitoneal MIS approach was performed for partial corpectomy with expandable vertebral substitute plus long posterior percutaneous fixation (technique 1). In the remaining nine cases long posterior percutaneous fixation + vertebroplasty of the fractured vertebra (technique 2). Radiological measurements were taken pre-surgically, post-surgically, at 6 weeks and 3 months, determining the fracture angle, kyphotic deformity, compression and wedging percentage and deformation angle. To assess functional outcome, patients completed the Oswentry Disability Index before surgery and at 3 months.There were no intraoperative complications of note. In the corpectomy group the mean hospital stay was 9.4 days, with a mean operative time of 250 min, a postoperative haemoglobin loss of 3.3 g/dL and two patients were transfused. In the percutaneous fixation and vertebroplasty group the mean was 5.55 days, surgery time 71 min and loss of 1.6 g/dL haemoglobin. There was one post-surgical haematoma requiring transfusion. None of the patients had to be reoperated during follow-up. Radiological measurements showed adequate correction with both techniques which was maintained over time with minimal loss. In functional outcomes assessed with the Oswentry, patients following technique 1 suffered greater worsening (15%) than those treated with technique 2 (10%).In OWF classified as OF4, percutaneous fixation associated with vertebroplasty could be an alternative to corpectomy in older patients with comorbidities, in whom functional recovery is more important than radiological correction. The use of MIS surgery together with improvements in the prevention and treatment of osteoporosis may improve clinical outcomes in the treatment of this type of fracture.

Traumatology

Percutaneous Vertebroplasty

Vertebra

10.1016/j.recot.2021.07.009

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Pie zambo sindrómico más allá de la artrogriposis y el mielomeningocele: tratamiento ortopédico con el método de Ponseti

Revista Española de Cirugía Ortopédica y Traumatología (2021)

E. Ferrando Meseguer S. Roig Sánchez L. Pino Almero A. Romano Bataller María Fe Mínguez Rey

El pie zambo supone una de las malformaciones congénitas del pie más frecuentes. Generalmente la etiología es idiopática. Sin embargo, pueden presentar una causa sindrómica y asociarse con afecciones musculoesqueléticas, neurológicas o del tejido conjuntivo, recibiendo en estos casos, la denominación de pie zambo sindrómico. El tratamiento de elección del pie zambo idiopático es el método Ponseti, basado en la manipulación y yesos seriados. También se ha demostrado su utilidad en pie zambo asociado con artrogriposis y mielomeningocele, pero existen pocas publicaciones sobre la eficacia en el pie zambo sindrómico. Estudio retrospectivo en seis pacientes (nueve pies) con pie zambo sindrómico tratados en un centro terciario siguiendo el método Ponseti. Tiempo de seguimiento mínimo de dos años (2-18). Los resultados fueron evaluados con la clasificación de Pirani, para valorar la severidad del pie zambo, previa y posteriormente al tratamiento. En los seis pacientes tratados, se emplearon una media de 6,5 yesos. La escala de Pirani obtuvo una valoración media de 5,2, previamente al tratamiento, con un descenso hasta 1,27 tras el tratamiento, con una mejoría media de 3,93 puntos. En más de la mitad de los casos fue necesario una tenotomía del tendón Aquileo para corregir la deformidad en equino. Se utilizó una ortesis tobillo-pie para reducir las recidivas si retraso psicomotor o dismetría severa. La deformidad residual más frecuente fue el aducto, que no requirió tratamiento quirúrgico. Un paciente recidivó en dos ocasiones. El método de Ponseti es útil en el tratamiento del pie zambo sindrómico, aunque precisa un número mayor de yesos correctores que en el pie zambo idiopático. La deformidad residual más frecuente en esta muestra fue el adductus. Talipes equinovarus or clubfoot is a congenital deformity of the foot with bone, muscle, and tendon involvement. It's one of the most frequent foot malformations in pediatric orthopedics. Although generally idiopathic, it may have a syndromic cause and be associated with musculoskeletal, neurological, or connective tissue conditions. The treatment of choice in idiopathic clubfoot is the Ponseti method based on manipulation and fixation with serial casts that seek progressive correction of the deformity. The Ponseti method effectiveness has been demonstrated in arthrogryposis and myelomeningocele clubfoot. There are few clinical studies demonstrating the efficacy of this therapeutic option in patients with syndromic clubfoot. Retrospective study with 6 patients (9 feet) with syndromic clubfoot treated in a tertiary center with the Ponseti method with a minimum follow up of two years (2-18). The results were evaluated with the Pirani classification, assessing clubfoot severity before and after treatment. Of the six patients treated were used an average of 6.5 casts. The Pirani scale obtained a mean score of 5.2 before treatment, with a decrease to 1.27 after treatment, with a mean improvement of 3.93 points. In more than half of the cases it was necessary to lengthen the Achilles tendon to correct the equine deformity. In addition, an ankle-foot orthosis was used to reduce recurrences in patients with dysmetria or psychomotor retardation. The most frequently observed residual deformity was the adduct. A patient relapsed twice. The Ponseti method obtains effective results in the correction of syndromic clubfoot, although it requires a greater number of corrective casts than other pediatric foot pathologies.

10.1016/j.recot.2020.09.005

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Syndromic clubfoot beyond arthrogryposis and myelomeningocele: Orthopedic treatment with Ponseti method

Revista Española de Cirugía Ortopédica y Traumatología (2021)

E. Ferrando Meseguer S. Roig Sánchez L. Pino Almero A. Romano Bataller María Fe Mínguez Rey

Talipes equinovarus or clubfoot is a congenital deformity of the foot with bone, muscle, and tendon involvement. It is one of the most frequent foot malformations in pediatric orthopedics. Although generally idiopathic, it may have a syndromic cause and be associated with musculoskeletal, neurological, or connective tissue conditions. The treatment of choice in idiopathic clubfoot is the Ponseti method based on manipulation and fixation with serial casts that seek progressive correction of the deformity. The Ponseti method effectiveness has been demonstrated in arthrogryposis and myelomeningocele clubfoot. There are few clinical studies demonstrating the efficacy of this therapeutic option in patients with syndromic clubfoot. Retrospective study with 6 patients (9 feet) with syndromic clubfoot treated in a tertiary center with the Ponseti method with a minimum follow up of two years (2–18). The results were evaluated with the Pirani classification, assessing clubfoot severity before and after treatment. Of the six patients treated were used an average of 6.5 casts. The Pirani scale obtained a mean score of 5.2 before treatment, with a decrease to 1.27 after treatment, with a mean improvement of 3.93 points. In more than half of the cases it was necessary to lengthen the Achilles tendon to correct the equine deformity. In addition, an ankle-foot orthosis was used to reduce recurrences in patients with dysmetria or psychomotor retardation. The most frequently observed residual deformity was the adduct. A patient relapsed twice. The Ponseti method obtains effective results in the correction of syndromic clubfoot, although it requires a greater number of corrective casts than other pediatric foot pathologies. El pie zambo supone una de las malformaciones congénitas del pie más frecuentes. Generalmente la etiología es idiopática. Sin embargo, pueden presentar una causa sindrómica y asociarse con afecciones musculoesqueléticas, neurológicas o del tejido conjuntivo, recibiendo en estos casos, la denominación de pie zambo sindrómico. El tratamiento de elección del pie zambo idiopático es el método Ponseti, basado en la manipulación y yesos seriados. También se ha demostrado su utilidad en pie zambo asociado con artrogriposis y mielomeningocele, pero existen pocas publicaciones sobre la eficacia en el pie zambo sindrómico. Estudio retrospectivo en seis pacientes (nueve pies) con pie zambo sindrómico tratados en un centro terciario siguiendo el método Ponseti. Tiempo de seguimiento mínimo de dos años (2-18). Los resultados fueron evaluados con la clasificación de Pirani, para valorar la severidad del pie zambo, previa y posteriormente al tratamiento. En los seis pacientes tratados, se emplearon una media de 6,5 yesos. La escala de Pirani obtuvo una valoración media de 5,2, previamente al tratamiento, con un descenso hasta 1,27 tras el tratamiento, con una mejoría media de 3,93 puntos. En más de la mitad de los casos fue necesario una tenotomía del tendón Aquileo para corregir la deformidad en equino. Se utilizó una ortesis tobillo-pie para reducir las recidivas si retraso psicomotor o dismetría severa. La deformidad residual más frecuente fue el aducto, que no requirió tratamiento quirúrgico. Un paciente recidivó en dos ocasiones. El método de Ponseti es útil en el tratamiento del pie zambo sindrómico, aunque precisa un número mayor de yesos correctores que en el pie zambo idiopático. La deformidad residual más frecuente en esta muestra fue el adductus.

Ponseti Method

10.1016/j.recote.2020.09.012

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Citations (3)

[Translated article] Minimally invasive surgical treatment options for osteoporotic vertebral fractures OF4

Revista Española de Cirugía Ortopédica y Traumatología (2022)

S. Burguet Girona E. Ferrando Meseguer J.I. Maruenda Paulino

The incidence of osteoporotic vertebral fractures (OVFs) is increasing. The importance of their diagnosis and treatment lies in their frequency and the morbidity they cause in patients. The classification proposed for OVFs by the German Society of Orthopaedics and Traumatology (DGOU) recommends surgical treatment for vertebral fractures classified as OF4. Most of these fractures will require anterior bracing as an adjunct to posterior fixation because of the significant loss of vertebral body structure. In elderly patients, minimally invasive surgery (MIS) allows their treatment given the lesser tissue aggression and systemic repercussions. We present the results of the treatment of OF4 vertebral fractures using minimally invasive techniques in the Spine Unit of our hospital.Retrospective study of 21 patients with OF4 osteoporotic fractures in the thoracolumbar transition treated in our centre. Six patients who underwent open posterolateral fusion or isolated vertebroplasty were excluded. The series consists of 15 cases (13 females and 2 males), with a mean age of 72.2, studied by computed tomography and magnetic resonance imaging. Clinical and analytical data were collected to decide the most appropriate surgical technique. In six cases a retropleural/retroperitoneal MIS approach was performed for partial corpectomy with expandable vertebral substitute plus long posterior percutaneous fixation (technique 1). In the remaining nine cases long posterior percutaneous fixation+vertebroplasty of the fractured vertebra (technique 2). Radiological measurements were taken pre-surgically, post-surgically, at 6 weeks and 3 months, determining the fracture angle, kyphotic deformity, compression and wedging percentage and deformation angle. To assess functional outcome, patients completed the Oswentry Disability Index before surgery and at 3 months.There were no intraoperative complications of note. In the corpectomy group the mean hospital stay was 9.4 days, with a mean operative time of 250min, a postoperative haemoglobin loss of 3.3g/dL and two patients were transfused. In the percutaneous fixation and vertebroplasty group the mean was 5.55 days, surgery time 71min and loss of 1.6g/dL haemoglobin. There was one post-surgical haematoma requiring transfusion. None of the patients had to be reoperated during follow-up. Radiological measurements showed adequate correction with both techniques which was maintained over time with minimal loss. In functional outcomes assessed with the Oswentry, patients following technique 1 suffered greater worsening (15%) than those treated with technique 2 (10%).In OWF classified as OF4, percutaneous fixation associated with vertebroplasty could be an alternative to corpectomy in older patients with comorbidities, in whom functional recovery is more important than radiological correction. The use of MIS surgery together with improvements in the prevention and treatment of osteoporosis may improve clinical outcomes in the treatment of this type of fracture.

Traumatology

Percutaneous Vertebroplasty

Vertebra

10.1016/j.recot.2022.01.002

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