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Las fracturas de acetábulo asociadas a traumatismos de baja energía, son una identidad frecuente hoy en día en los adultos mayores. La indicación del tratamiento quirúrgico o conservador, depende de múltiples factores como la edad y las comorbilidades del paciente, el tipo y localización de la fractura, y el medio socio-económico. Independientemente del tratamiento elegido, ninguno está exento de complicaciones. Se describe a continuación un paciente con una fractura de acetábulo cerrada, de tratamiento conservador, que derivó en artritis séptica de la articulación coxofemoral.

Femoral fractures in previously amputated patients (PAP) have been poorly reported in international literature, however it is worth mentioning that advances in the manufacture of orthotics for lower limbs have allowed these patients to remain functionally active. Surgery is then an option but difficulties may appear in positioning the patient for surgery due to the absence of the foot or ankle from where to pull and optimize the fracture reduction.We report 3 cases of PAP with ipsilateral unstable femur fractures, treated surgically with cervicodiaphyseal endomedular nail. The surgical technique used in each case is described.Good long-term results were obtained demonstrating the effectiveness of surgical treatment and the reduction technique used.Surgical treatment of unstable fractures of the proximal femur with an endomedullary nail should be considered a valid therapeutic option.Las fracturas de fémur en pacientes previamente amputados (PPA) han sido escasamente reportadas en la literatura internacional, sin embargo, cabe mencionar que los avances en la fabricación de ortesis para miembros inferiores han permitido que estos pacientes, se mantengan funcionalmente activos. La cirugía entonces es una opción, pero representa una dificultad en el posicionamiento del paciente a la hora de planificar su cirugía debido a la ausencia del pie o tobillo del cual traccionar y optimizar la reducción de la fractura.Reportamos a continuación 3 casos de PPA con fracturas inestables ipsilaterales de fémur, tratadas mediante reducción y osteosíntesis con clavo endomedular cervicodiafisario. Se describe la técnica quirúrgica utilizada en cada caso.Se obtuvieron buenos resultados a largo plazo demostrando la efectividad del tratamiento quirúrgico y la técnica de reducción utilizada.El tratamiento quirúrgico de fracturas inestables de fémur proximal con clavo endomedular, ha de ser considerado una opción terapéutica válida.

Developmental hip dysplasia (DHD) is a common entity that affects 4 out of every 1000 live births and is a recognized cause of secondary hip osteoarthritis despite routine perinatal controls. In most patients, the early diagnosis of the pathology allows an evolution without sequelae. However, in the basis that patients diagnosed late and with multiple surgeries are patients with open physis, ossification nuclei present and previous surgeries in the approach area, the late diagnosis represents a real challenge for the orthopedist. We report below the case of a patient treated in our center since birth, who evolved with complications associated with late diagnosis and surgical interventions, describing rescue surgery performed at 12 years of age and finally highlighting the importance of routine perinatals and early diagnosis of DHD.La displasia del desarrollo de la cadera (DDC) es una entidad frecuente que afecta a 4 de cada 1000 nacidos vivos y es una causa reconocida de artrosis de cadera secundaria a pesar de los controles perinatales de rutina. En la mayoría de los pacientes, el diagnóstico precoz de la patología permite una evolución sin secuelas. Sin embargo, el diagnóstico tardío con múltiples intervenciones representa un verdadero reto para el ortopedista, ya que se trata de pacientes con fisis abierta, nucleos de osificación presentes y cirugías previas en la zona de abordaje. Se reporta a continuación el caso de una paciente tratada en nuestro centro desde su nacimiento, que evolucionó con complicaciones asociadas al diagnóstico tardío y a las intervenciones quirúrgicas, describiendo la cirugía de salvataje realizada a los 12 años de edad y destacando finalmente la importancia de los controles perinatales de rutina y el diagnóstico precoz de la DDC.

INTRODUCCIÓN: Históricamente, el diagnóstico de una fractura medial de cadera requiere de una radiografía anteroposterior (AP) y de perfil (P). Nos propusimos analizar la importancia de la radiografía de perfil en la evaluación y planificación del tratamiento de las fracturas mediales de cadera, utilizando la clasificación de Garden. MATERIALES Y MÉTODOS: Se prepararon diapositivas con radiografías AP y de P de 100 pacientes con fracturas mediales de cadera admitidos en nuestra central de emergencias. Tres cirujanos de cadera evaluaron de forma independiente las incidencias AP únicamente y luego las vistas AP y P, utilizando la clasificación de Garden. RESULTADOS: Se utilizó el método de Kruskal Wallis para comparar los rangos en la clasificación de Garden después de ver la proyección de P y no se encontraron diferencias estadísticamente significativas (Kruskal Wallis 0, p=1). El acuerdo ponderado entre AP y el AP combinado con el P del Garden promedio fue de 81 % (p < 0.001). Se analizó el porcentaje de pacientes recategorizados entre fracturas no desplazadas y desplazadas, tras observar el perfil: 5% (n=5, IC 95% 1-11%). Para comparar el Garden AP con el Garden P, se utilizó el método kappa ponderado cuadrático. CONCLUSIONES: Existe una alta concordancia en la clasificación de Garden al comparar las observaciones de las radiografías AP, con las observaciones AP y P juntas. Cinco pacientes hubiesen recibido un tratamiento quirúrgico diferente dependiendo del especialista que interpretaba las radiografías. Esto permite destacar la importancia de solicitar la incidencia de perfil de rutina en pacientes con sospecha de fractura medial de cadera. INTRODUCTION: Femoral neck fractures have been historically diagnosed by anteroposterior (AP) and lateral (L) radiographic views. We analyzed the importance of the L view for management of femoral neck fractures, using the Garden's classification system. MATERIALS AND METHODS: Slides were elaborated with AP and L radiographic views of 100 patients with femoral neck fractures admitted to our emergency department. Three hip surgeons assessed independently AP views only and then AP and L views together using Garden's classification system. RESULTS: No statistically significant differences (Kruskal Wallis 0, p=1) were found while comparing categories among Garden's classification system, after assessing L views. There was an 81 % (p < 0.001) agreement of Garden category between AP and AP combined with L views. When analyzing patients with changing categories between displaced and non displaced after assessing L view images, we found a 5% (n=5, CI 95% 1-11%) of change. For comparing AP Garden with L view Garden, we used a quadratic weighted kappa method. CONCLUSIONS: There is a high agreement in the Garden category when comparing AP with combined AP and L observations. Five patients would have received a different surgical treatment dependent on the hip surgeon who assessed the radiographs. This highlights the relevance of routinely L radiographs whenever a femoral neck fracture is suspected. INTRODUÇÃO: Historicamente, o diagnóstico de uma fratura medial de quadril requer uma radiografia ântero-posterior (AP) e de perfil (P). Propusemo-nos a analisar a importância da radiografia de perfil na avaliação e planejamento do tratamento das fraturas mediais do quadril, utilizando a classificação de Garden. MATERIAIS E MÉTODOS: As lâminas foram preparadas com radiografias AP e P de 100 pacientes com fratura medial do quadril admitidos em nosso centro de emergência. Três cirurgiões de quadril avaliaram independentemente apenas os eventos AP e, em seguida, as visualizações AP e P, usando a classificação de Garden. RESULTADOS: O método de Kruskal Wallis foi usado para comparar as classificações na classificação de Garden após a visualização da projeção P e não foram encontradas diferenças estatisticamente significativas (Kruskal Wallis 0, p = 1). A concordância ponderada entre AP e AP combinada com a média do Garden P foi de 81% (p

Background: In high-risk patients, common prophylaxis may be insufficient to prevent thromboembolic events after orthopaedic procedures. In this scenario, a retrievable vena cava filter (VCF) could be considered as an alternative, although it's use remains controversial. Therefore, we asked: (1) what is the overall mechanical complication rate associated with the use of retrievable VCFs in orthopaedic surgery?, (2) what is the association with thromboembolic disease (TED) recurrence, post-thrombotic syndrome and/or major bleeding according to different surgical characteristics?, (3) What is the overall mortality rate attributed to VCF use?Methods: We retrospectively analyzed a cohort of 68 patients who underwent orthopaedic surgery with a previous diagnosis of TED, in whom a retrievable VCF was placed. Permanent filters were excluded. We studied the filter’s mechanical complications and considered as possible outcomes death and 3 hematologic complications: TED recurrence, post-thrombotic syndrome and major bleeding. To estimate association with risk factors, we subclassified surgeries into 5 groups: 1, arthroplasty/non-arthroplasty; 2, primary/revision; 3, elective/urgent; 4, oncologic/non-oncologic; 5, preoperative/postoperative filter.Results: Mechanical complications were 16% and required a filter revision. Sixty-four percent of the revised VCFs developed a mechanical failure and could not be retrieved. Overall prevalence of TED recurrence, post-thrombotic syndrome and hemorrhage was 33%, 15% and 4.5%, respectively. Spinal surgeries were a risk factor for developing TED recurrences. Only 4% of patients died of a TED recurrence.Conclusions: Orthopaedic procedures had a high risk of mechanical and hematologic complications after using a retrievable VCF. However, mortality was low due to these complications.