Search

Traditionally the curriculums of medical residencies are based on an educational process that takes place within a passive environment and they focus their effectiveness on an excessive memorization. Contrary to this, the new educational approaches intend to develop, by means of a participative view, a critical attitude that recovers the experience. Thus the student, based on reflection, can select and produce his/her own knowledge and develop his/her own position in which discernment, proper judgment and conscientiousness allow him/her to solve the daily clinical problems, all of which results in a better clinical ability. Clinical ability develops under real-life situations that challenge the student's own discernment. This paper develops an educational strategy that includes clinical cases and considers the mechanism of injury in the polytraumatized patient as a source of knowledge that allows us to assess the clinical ability. A measurement instrument was designed, with a Kidder Richardson reliability coefficient of 0.77. The educational strategy was applied to eleven Orthopedics residents of all levels. This paper reviews the results of this strategy, which show an improvement in the clinical ability; proves the usefulness of the measurement instrument, and analyzes the potential scope of this new educational approach. [ABSTRACT FROM AUTHOR]

Background: Risk factors are the endogenous or exogenous factors that may be controlled and they are responsible for disease. The objective of this paper is to describe the risk factors affecting vertebral fusion in patients with lumbar spine instability seen at our hospital and to see how they relate to nutritional factors. Material and methods: Patients undergoing vertebral fusion due to several diagnoses were analyzed. Different parameters were captured to determine the interaction among them and assess the factors affecting vertebral fusion healing. They were compared with patients with pseudoarthrosis to determine its risk factors. Patients were divided into two groups: the control group, who underwent fusion, and the cases, who had pseudoarthrosis. Results: A total of 59 patients were examined; 15 (25.4%) were cases (pseudoarthrosis) and 44 (74.6%) were controls (fusion). The demographic distribution was 27 (45.8%) females and 32 (54.2%) males; mean age was 51 ± 12 years, with a minimum age of 20 and a maximum of 85. The diagnostic-based distribution was as follows: 29 (49.1%) spondylolistheses, 21 (35.6%) fractures, 5 (8.5%) herniated discs, 3 (5.1%) infections, and one (1.7%) tumor. Mean body weight was 75.9 kg, height was 160 cm, BMI 24.5, Hb 15.2, Hct 35.9, and Alb 3.5. Various risk factors were analyzed including the following: age over 60 years, which showed a 49% higher chance of pseudoarthrosis compared with the control group, with a 95% CI, 0.12-2.27; body weight over 90 kg, which showed an 82% higher chance of pseudoarthrosis compared with the fusion group, with a 95% CI, 0.03-0.43; BMI, which showed a 25% higher chance of pseudoarthrosis, with a 95% CI, 0.18-3.18; hypoalbuminemia < 3.4 mg/100 ml, which showed a 78% higher chance of pseudoarthrosis, with a 95% CI, 0.06-0.75. Conclusions: This study found that pseudoarthrosis is caused by risk factors linked to the nutritional pro- file, i.e., obesity, and hypoalbuminemia; its chance of occurring is 1.5 greater than in individuals with normal values. For this reason it is important to assess these values and correct them early on during the preoperative period with supportive measures allowing for an appropriate metabolic control and the consequent optimum result, i.e., fusion. [ABSTRACT FROM AUTHOR]

Introduction: Many patients who present at the hospital with cervical spinal cord injury are initially treated in different ways and may have complications leading to death. It is therefore important to document them and disseminate them among surgeons so that they consider treatment alternatives and prevent complications. Material and methods: A cross-sectional descriptive retrospective study conducted from January to August 2005; case series, non-probabilistic sample. Cases were identified from the spine surgery service records by means of their clinical and radiographic files. Results: A total of 20 patients were included; with a 3:1 female-to-male ratio, mean age 39.3 years, with an ASIA motor deficit of 29.5, sensory deficit of 51, seen previously at a mean of 1.7 hospitals, and a mean injury-to-surgery time of 34 hours. Three received proper neuroprotective management, 15 patients had a mean spinal canal invasion of 42.6 %, four underwent corpectomy, two were circumferential, and 13 underwent diskectomy. Eight pneumonias, 4 STDA, one CSF fistula, and 2 deaths were reported. Conclusions: The paper provides relevant clinical evidence of patients with acute spinal cord injury. The ASIA was available for all of them; they received poor neuroprotective management, and underwent late surgery due to referral. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to present the experience of the hospital using the Ponseti method in patients with congenital adduct clubfoot. Material and methods: The study was conducted between January 2007 and December 2009. Children of both sexes were included; the Dimeglio classification was applied before surgery and their course was later assessed with the Simons scale when they resumed gait. Patients with postural clubfoot (Dimeglio I) and those with neuromuscular disease (Dimeglio IV) were excluded. Casts were placed as of 15 days of age using the Ponseti technique and then percutaneous tenotomy of the calcaneous tendon was performed in the operating room. Results: Twenty patients (9 girls, 11 boys) and 28 feet were included in the study; they were Dimeglio II (8 children) and III (12 children). Mean age at the time of surgery was 2 months, and mean age at the time of gait assessment was 2 years. Upon applying the Simons scale, 25 feet (89.3%) had satisfactory results and 3 feet (10.7%) unsatisfactory results. Two of the latter underwent percutaneous tenotomy again and in one case the cast was applied again; they evolved properly. Conclusions: We found in our series that the Ponseti technique is appropriate as definitive treatment for Dimeglio II and III congenital adduct clubfoot. [ABSTRACT FROM AUTHOR]