Calcaneal fractures are the most frequent of the tarsus (3.5% of all fractures). Young adults are... more Calcaneal fractures are the most frequent of the tarsus (3.5% of all fractures). Young adults are mainly affected, being more frequent in men (5.9:1). On the other hand, ligament injuries associated with fracture of the calcaneus are very infrequent. We describe a case of a 39 year old patient who suffered ankle trauma. He presented instability in plantar flexion and inversion. A fracture of the calcaneus was diagnosed. During surgery, a complete lesion of the lateral ligament complex was found. The reduction and osteosynthesis associated with ligament reconstruction was performed. We consider important to confirm the stability of the ankle after a calcaneus fracture. Lack of diagnosis in this type of injuries can evolve into chronic instability.
Fragestellung: Für die in der älteren Bevölkerung häufig vorkommenden intertrochantären Frakturen... more Fragestellung: Für die in der älteren Bevölkerung häufig vorkommenden intertrochantären Frakturen gibt es verschiedene operative Behandlungsmöglichkeiten, wobei die Dynamische Hüftschraube (DHS) das meistverwendete Implantat ist. Neben dem Cut-out der Zugschraube ist[for full text, please go to the a.m. URL]
Revista Española de Cirugía Ortopédica y Traumatología, Jul 31, 2021
Ankle syndesmosis injuries can be associated with a spiral mechanism on tibial shaft fractures. W... more Ankle syndesmosis injuries can be associated with a spiral mechanism on tibial shaft fractures. We are not aware if there is evidence of the incidence of ipsilateral syndesmotic lesson associated to high-energy tibial shaft fracture mechanisms. The aim of this study was to analyze the incidence of syndesmotic injuries associated with high-energy tibial shaft fractures. 233 diaphyseal tibial fractures operated between January 2007 and January 2017, the fracture patterns were analyzed, they were classified according to AO, the talocrural angle was measured, they analyzed failures and reoperations and described a novel failure method. From a total of 234 fractures that met the inclusion criteria, 159 (64.96%) suffered closed fractures and 75 (32.05%) where open fractures. According to the AO classification system: 152 (64.10%) were simple patterns 42.A; 49 (20.94%) wedge type patterns 42.B and 33 (14.10%) complex patterns 42.C. Ten patients, a 4.27% of the sample, shown an increased ta...
Revista espanola de cirugia ortopedica y traumatologia, 2021
INTRODUCTION Ankle syndesmosis injuries can be associated with a spiral mechanism on tibial shaft... more INTRODUCTION Ankle syndesmosis injuries can be associated with a spiral mechanism on tibial shaft fractures. We are not aware if there is evidence of the incidence of ipsilateral syndesmotic lesson associated to high-energy tibial shaft fracture mechanisms. The aim of this study was to analyze the incidence of syndesmotic injuries associated with high-energy tibial shaft fractures. METHODS 233 diaphyseal tibial fractures operated between January 2007 and January 2017, the fracture patterns were analyzed, they were classified according to AO, the talocrural angle was measured, they analyzed failures and reoperations and described a novel failure method. RESULTS From a total of 234 fractures that met the inclusion criteria, 159 (64.96%) suffered closed fractures and 75 (32.05%) where open fractures. According to the AO classification system: 152 (64.10%) were simple patterns 42.A; 49 (20.94%) wedge type patterns 42.B and 33 (14.10%) complex patterns 42.C. Ten patients, a 4.27% of the ...
Geriatric Orthopaedic Surgery & Rehabilitation, 2016
Background: A clinical registry encompasses a selective set of rigorously collected and stored cl... more Background: A clinical registry encompasses a selective set of rigorously collected and stored clinical data focused on a specific condition. Hip fracture is a common complication of osteoporosis in elderly patients. Hip fracture substantially increases the risk of death and major morbidity in the elderly patients. Limited data regarding hip fracture are available from Latin America and Argentina. The purpose of this project is to create an institutional registry of elderly patients with hip fracture in order to obtain data that reveal the impact of this disease in our environment, allowing us to evaluate different strategies of patient's care and clinical outcomes. Objective: To describe the implementation of an institutional registry of elderly patients with hip fracture in Argentina. Methods: In this article, we described the creation, implementation, and data management of a prospective registry of elderly patients with hip fracture. The registry contains information on baseline demographics, comorbidities, laboratory, and radiological data. Follow-up at 3 and 12 months postfracture is done by phone interview to assess physical function, readmissions, and morbi-mortality. Clinical Trials registry number NCT02279550. Conclusion: In this project, we have created a hip fracture registry. We hope that this registry will provide valuable data that can lead us to new lines of research, addressed to answer questions raised in clinical practice.
Revista de la Asociación Argentina de Ortopedia y Traumatología, 2016
Existe un riesgo tácito de fractura peri-implante de fémur en pacientes con antecedente de fractu... more Existe un riesgo tácito de fractura peri-implante de fémur en pacientes con antecedente de fractura pertrocantérica de fémur tratados con tornillos deslizantes de cadera (TDC) debido al aumento de la expectativa de vida y a las múltiples comorbilidades. Diversas opciones terapéuticas son posibles dependiendo de si se mantiene la osteosíntesis previa o no. Dada la baja prevalencia de estas fracturas, no existe consenso en la bibliografía actual sobre el tratamiento ideal. El objetivo de este trabajo es reportar un caso y describir la técnica quirúrgica de enclavado endomedular retrógrado para el tratamiento de fracturas peri-implante debajo de un TDC.
Revista de la Asociación Argentina de Ortopedia y Traumatología, 2015
Objetivo: Determinar la utilidad de la evaluación radiográfica, como único elemento, en el diagnó... more Objetivo: Determinar la utilidad de la evaluación radiográfica, como único elemento, en el diagnóstico de las fracturas asociadas a la ingestión de bifosfonatos. Materiales y Métodos: De 2006 a 2011, se evaluaron las radiografías de pacientes con fracturas subtrocantéricas y diafisarias de fémur; se excluyeron las fracturas de fémur proximal, distal, patológicas y a los pacientes pediátricos. Se obtuvieron radiografías de 167 pacientes con 169 fracturas (2 bilaterales): 109 mediodiafisarias y 60 subtrocantéricas. Veintinueve de las 169 fracturas estaban asociadas a la ingestión de bifosfonatos. La evaluación estuvo a cargo de siete traumatólogos con distintos años de experiencia: a) 3 con 3 años de formación (3. er año de residencia); b) 2 con 6 años de formación (fellowships en hombro y rodilla) y c) 2 con 15 años de formación (especialistas en pie y cadera). Los evaluadores observaron, en forma independiente y en dos oportunidades, las radiografías de los 169 casos. Durante la evaluación, se registraron los resultados en una grilla según: 1) Sí: presentaban 3 criterios; 2) No sé: presentaban 1 o 2 criterios; 3) No: no presentaban criterios. Se utilizó el índice kappa para evaluar el acuerdo intraobservador y el programa G-string para la confiabilidad interobservador. La evaluación fue realizada sobre el resultado "Sí", con la presencia de los tres criterios radiográficos. Resultados: El acuerdo intraobservador evidenció un valor de kappa de 0,2-0,5 y la confiabilidad interobservador fue del 54% en promedio. Conclusión: La evaluación radiográfica no ha demostrado ser suficiente para arribar al diagnóstico de fractura atípica por ingestión de bifosfonatos. Palabras clave: Fractura diafisaria; subtrocantérica; atípica; bifosfonatos; alendronato. Nivel de Evidencia: III Intraobserver and interobserver evaluation in the radiological diagnosis of bisphosphonate-related fractures
Resumen Las fracturas de cadera constituyen un problema de Salud Pública mundial. La morbimortali... more Resumen Las fracturas de cadera constituyen un problema de Salud Pública mundial. La morbimortalidad asociada a este evento genera "exceso de mortalidad", dependencia, internación en geriátricos y altos costos en los diferentes sistemas de salud. El tratamiento de la osteoporosis ha demostrado una disminución de la incidencia de nuevas fracturas y de la tasa de mortalidad. Un bajo porcentaje de la población con fracturas de cadera recibe tratamiento para osteoporosis. Los programas destinados al tratamiento de estos pacientes muestran mejoría en las tasas de morbimortalidad. En nuestro hospital un 27% de la población con fractura de cadera recibe tratamiento. El objetivo de este protocolo es implementar un programa multidisciplinario que integra el tratamiento de la osteoporosis, la prevención de las caídas y la seguridad en el hogar para lograr disminuir las tasas de nuevas fracturas, internaciones y mortalidad. Este artículo explicita las intervenciones durante la internación, en domicilio y en el seguimiento ambulatorio. Detalla además la participación de los distintos equipos profesionales. Palabras clave: fractura de caderas, mortalidad, disfosfonatos, osteoporosis secondaRy pRevention pRogRam foR patients with hip fRactuRe abstRact Hip fractures are a global public health problem. Morbidity and mortality associated with this event generate "excess mortality", dependency, geriatric inpatient and high costs in different health systems. Treatment of osteoporosis has shown a decrease in the incidence of new fractures and mortality rate. A small percentage of people with hip fractures are being treated for osteoporosis. Programs for the treatment of these patients show improvement in morbidity and mortality rates. In our hospital, 27% of the population with hip fracture is treated. The objective of this protocol is to implement a multidisciplinary program that integrates the treatment of osteoporosis, fall prevention and home security to achieve lower rates of new fractures, hospitalization and mortality. This paper describes the interventions during hospitalization, at home and the ambulatory setting. It also specifies the participation of different professional teams.
be related to BMD or any bone marker or other parameters related to Ca and P metabolism in these ... more be related to BMD or any bone marker or other parameters related to Ca and P metabolism in these patients. Methods: DNA was isolated from blood samples from 65 TS patients (15 ± 7 y.o.) and 68 healthy individuals (17 ± 8 y.o.). Amplification by PCR and digestion with Bsm I, Apa I and Taq I restriction enzymes were employed. BMD and serum Ca, P, PTH, osteocalcin and β-crosslaps were determined. Results: Genotype distribution corresponding to Bsm I and Taq I sites was similar in b oth TS patients and controls, whereas Apa I genotypes were differently distributed within the two groups (TS: AA 15%, Aa 63,3% vs controls: AA 41,1 %, Aa 37,5%; p < 0,01). Bsm I bb genotype was associated with lower BMD (p = 0,001) whereas the other genotypes did not show any association with BMD. Bone markers and biochemical parameters were similar for all the groups. Seventeen different haplotypes were detected, being the BbAaTt the most frequent. Conclusion: bb genotype is associated with lower BMD in TS patients. Enlarging the number of patients might allow to identify some haplotypes valuable as predictors of bone deterioration.
Calcaneal fractures are the most frequent of the tarsus (3.5% of all fractures). Young adults are... more Calcaneal fractures are the most frequent of the tarsus (3.5% of all fractures). Young adults are mainly affected, being more frequent in men (5.9:1). On the other hand, ligament injuries associated with fracture of the calcaneus are very infrequent. We describe a case of a 39 year old patient who suffered ankle trauma. He presented instability in plantar flexion and inversion. A fracture of the calcaneus was diagnosed. During surgery, a complete lesion of the lateral ligament complex was found. The reduction and osteosynthesis associated with ligament reconstruction was performed. We consider important to confirm the stability of the ankle after a calcaneus fracture. Lack of diagnosis in this type of injuries can evolve into chronic instability.
Fragestellung: Für die in der älteren Bevölkerung häufig vorkommenden intertrochantären Frakturen... more Fragestellung: Für die in der älteren Bevölkerung häufig vorkommenden intertrochantären Frakturen gibt es verschiedene operative Behandlungsmöglichkeiten, wobei die Dynamische Hüftschraube (DHS) das meistverwendete Implantat ist. Neben dem Cut-out der Zugschraube ist[for full text, please go to the a.m. URL]
Revista Española de Cirugía Ortopédica y Traumatología, Jul 31, 2021
Ankle syndesmosis injuries can be associated with a spiral mechanism on tibial shaft fractures. W... more Ankle syndesmosis injuries can be associated with a spiral mechanism on tibial shaft fractures. We are not aware if there is evidence of the incidence of ipsilateral syndesmotic lesson associated to high-energy tibial shaft fracture mechanisms. The aim of this study was to analyze the incidence of syndesmotic injuries associated with high-energy tibial shaft fractures. 233 diaphyseal tibial fractures operated between January 2007 and January 2017, the fracture patterns were analyzed, they were classified according to AO, the talocrural angle was measured, they analyzed failures and reoperations and described a novel failure method. From a total of 234 fractures that met the inclusion criteria, 159 (64.96%) suffered closed fractures and 75 (32.05%) where open fractures. According to the AO classification system: 152 (64.10%) were simple patterns 42.A; 49 (20.94%) wedge type patterns 42.B and 33 (14.10%) complex patterns 42.C. Ten patients, a 4.27% of the sample, shown an increased ta...
Revista espanola de cirugia ortopedica y traumatologia, 2021
INTRODUCTION Ankle syndesmosis injuries can be associated with a spiral mechanism on tibial shaft... more INTRODUCTION Ankle syndesmosis injuries can be associated with a spiral mechanism on tibial shaft fractures. We are not aware if there is evidence of the incidence of ipsilateral syndesmotic lesson associated to high-energy tibial shaft fracture mechanisms. The aim of this study was to analyze the incidence of syndesmotic injuries associated with high-energy tibial shaft fractures. METHODS 233 diaphyseal tibial fractures operated between January 2007 and January 2017, the fracture patterns were analyzed, they were classified according to AO, the talocrural angle was measured, they analyzed failures and reoperations and described a novel failure method. RESULTS From a total of 234 fractures that met the inclusion criteria, 159 (64.96%) suffered closed fractures and 75 (32.05%) where open fractures. According to the AO classification system: 152 (64.10%) were simple patterns 42.A; 49 (20.94%) wedge type patterns 42.B and 33 (14.10%) complex patterns 42.C. Ten patients, a 4.27% of the ...
Geriatric Orthopaedic Surgery & Rehabilitation, 2016
Background: A clinical registry encompasses a selective set of rigorously collected and stored cl... more Background: A clinical registry encompasses a selective set of rigorously collected and stored clinical data focused on a specific condition. Hip fracture is a common complication of osteoporosis in elderly patients. Hip fracture substantially increases the risk of death and major morbidity in the elderly patients. Limited data regarding hip fracture are available from Latin America and Argentina. The purpose of this project is to create an institutional registry of elderly patients with hip fracture in order to obtain data that reveal the impact of this disease in our environment, allowing us to evaluate different strategies of patient's care and clinical outcomes. Objective: To describe the implementation of an institutional registry of elderly patients with hip fracture in Argentina. Methods: In this article, we described the creation, implementation, and data management of a prospective registry of elderly patients with hip fracture. The registry contains information on baseline demographics, comorbidities, laboratory, and radiological data. Follow-up at 3 and 12 months postfracture is done by phone interview to assess physical function, readmissions, and morbi-mortality. Clinical Trials registry number NCT02279550. Conclusion: In this project, we have created a hip fracture registry. We hope that this registry will provide valuable data that can lead us to new lines of research, addressed to answer questions raised in clinical practice.
Revista de la Asociación Argentina de Ortopedia y Traumatología, 2016
Existe un riesgo tácito de fractura peri-implante de fémur en pacientes con antecedente de fractu... more Existe un riesgo tácito de fractura peri-implante de fémur en pacientes con antecedente de fractura pertrocantérica de fémur tratados con tornillos deslizantes de cadera (TDC) debido al aumento de la expectativa de vida y a las múltiples comorbilidades. Diversas opciones terapéuticas son posibles dependiendo de si se mantiene la osteosíntesis previa o no. Dada la baja prevalencia de estas fracturas, no existe consenso en la bibliografía actual sobre el tratamiento ideal. El objetivo de este trabajo es reportar un caso y describir la técnica quirúrgica de enclavado endomedular retrógrado para el tratamiento de fracturas peri-implante debajo de un TDC.
Revista de la Asociación Argentina de Ortopedia y Traumatología, 2015
Objetivo: Determinar la utilidad de la evaluación radiográfica, como único elemento, en el diagnó... more Objetivo: Determinar la utilidad de la evaluación radiográfica, como único elemento, en el diagnóstico de las fracturas asociadas a la ingestión de bifosfonatos. Materiales y Métodos: De 2006 a 2011, se evaluaron las radiografías de pacientes con fracturas subtrocantéricas y diafisarias de fémur; se excluyeron las fracturas de fémur proximal, distal, patológicas y a los pacientes pediátricos. Se obtuvieron radiografías de 167 pacientes con 169 fracturas (2 bilaterales): 109 mediodiafisarias y 60 subtrocantéricas. Veintinueve de las 169 fracturas estaban asociadas a la ingestión de bifosfonatos. La evaluación estuvo a cargo de siete traumatólogos con distintos años de experiencia: a) 3 con 3 años de formación (3. er año de residencia); b) 2 con 6 años de formación (fellowships en hombro y rodilla) y c) 2 con 15 años de formación (especialistas en pie y cadera). Los evaluadores observaron, en forma independiente y en dos oportunidades, las radiografías de los 169 casos. Durante la evaluación, se registraron los resultados en una grilla según: 1) Sí: presentaban 3 criterios; 2) No sé: presentaban 1 o 2 criterios; 3) No: no presentaban criterios. Se utilizó el índice kappa para evaluar el acuerdo intraobservador y el programa G-string para la confiabilidad interobservador. La evaluación fue realizada sobre el resultado "Sí", con la presencia de los tres criterios radiográficos. Resultados: El acuerdo intraobservador evidenció un valor de kappa de 0,2-0,5 y la confiabilidad interobservador fue del 54% en promedio. Conclusión: La evaluación radiográfica no ha demostrado ser suficiente para arribar al diagnóstico de fractura atípica por ingestión de bifosfonatos. Palabras clave: Fractura diafisaria; subtrocantérica; atípica; bifosfonatos; alendronato. Nivel de Evidencia: III Intraobserver and interobserver evaluation in the radiological diagnosis of bisphosphonate-related fractures
Resumen Las fracturas de cadera constituyen un problema de Salud Pública mundial. La morbimortali... more Resumen Las fracturas de cadera constituyen un problema de Salud Pública mundial. La morbimortalidad asociada a este evento genera "exceso de mortalidad", dependencia, internación en geriátricos y altos costos en los diferentes sistemas de salud. El tratamiento de la osteoporosis ha demostrado una disminución de la incidencia de nuevas fracturas y de la tasa de mortalidad. Un bajo porcentaje de la población con fracturas de cadera recibe tratamiento para osteoporosis. Los programas destinados al tratamiento de estos pacientes muestran mejoría en las tasas de morbimortalidad. En nuestro hospital un 27% de la población con fractura de cadera recibe tratamiento. El objetivo de este protocolo es implementar un programa multidisciplinario que integra el tratamiento de la osteoporosis, la prevención de las caídas y la seguridad en el hogar para lograr disminuir las tasas de nuevas fracturas, internaciones y mortalidad. Este artículo explicita las intervenciones durante la internación, en domicilio y en el seguimiento ambulatorio. Detalla además la participación de los distintos equipos profesionales. Palabras clave: fractura de caderas, mortalidad, disfosfonatos, osteoporosis secondaRy pRevention pRogRam foR patients with hip fRactuRe abstRact Hip fractures are a global public health problem. Morbidity and mortality associated with this event generate "excess mortality", dependency, geriatric inpatient and high costs in different health systems. Treatment of osteoporosis has shown a decrease in the incidence of new fractures and mortality rate. A small percentage of people with hip fractures are being treated for osteoporosis. Programs for the treatment of these patients show improvement in morbidity and mortality rates. In our hospital, 27% of the population with hip fracture is treated. The objective of this protocol is to implement a multidisciplinary program that integrates the treatment of osteoporosis, fall prevention and home security to achieve lower rates of new fractures, hospitalization and mortality. This paper describes the interventions during hospitalization, at home and the ambulatory setting. It also specifies the participation of different professional teams.
be related to BMD or any bone marker or other parameters related to Ca and P metabolism in these ... more be related to BMD or any bone marker or other parameters related to Ca and P metabolism in these patients. Methods: DNA was isolated from blood samples from 65 TS patients (15 ± 7 y.o.) and 68 healthy individuals (17 ± 8 y.o.). Amplification by PCR and digestion with Bsm I, Apa I and Taq I restriction enzymes were employed. BMD and serum Ca, P, PTH, osteocalcin and β-crosslaps were determined. Results: Genotype distribution corresponding to Bsm I and Taq I sites was similar in b oth TS patients and controls, whereas Apa I genotypes were differently distributed within the two groups (TS: AA 15%, Aa 63,3% vs controls: AA 41,1 %, Aa 37,5%; p < 0,01). Bsm I bb genotype was associated with lower BMD (p = 0,001) whereas the other genotypes did not show any association with BMD. Bone markers and biochemical parameters were similar for all the groups. Seventeen different haplotypes were detected, being the BbAaTt the most frequent. Conclusion: bb genotype is associated with lower BMD in TS patients. Enlarging the number of patients might allow to identify some haplotypes valuable as predictors of bone deterioration.
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