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ResumenIntroducciónEl tratamiento de la patología del pie por su frecuencia y extensión es en muchos casos objeto de demanda por mala praxis ante los tribunales de justicia, tanto en la vía penal como en la civil y contencioso administrativa.Material y métodosEn este trabajo se analizan 303 sentencias en segunda instancia o superior de la Escuela de Medicina legal de Madrid, de las cuales: 50 corresponden a procedimientos sobre el pie, para establecer las causas que han motivado la demanda, los condicionantes que han producido una sentencia condenatoria, y su cuantía.ResultadosLa jurisdicción civil ha sido la más empleada.Las reclamaciones las formularon mayoritariamente mujeres.El ámbito asistencial privado fue el más reclamado.El 87,5% de las reclamaciones por procesos ortopédicos fueron por patología del antepié.Se condenó al traumatólogo en el 44% de los casosEn el 68,1% de las condenas el tratamiento realizado había sido quirúrgico.El 100% de las condenas en los casos de tratamiento quirúrgico fue por patología del antepié.En los casos con defecto del consentimiento informado existió condena en el 83,3%.ConclusionesUn resultado insatisfactorio en cirugía del antepié, junto con una deficiente información al paciente, generan sentencias condenatorias en una mayoría de casos especialmente en el ámbito de la sanidad privada.Se establece un modelo de paciente y procedimiento tipo con un riesgo especialmente alto de demanda judicial con resultado condenatorioAbstractIntroductionAs surgical treatment of foot pathology is very common and extensive, it is frequently exposed to malpractice claims.Material and methodsIn this paper, we analyze 303 sentences in superior instance from Madrid Legal Medicine School. 50 of these sentences refer to foot procedures, to look for lawsuit causes, conditions that led to an unfavourable sentence and the economical impact of it.ResultsThe civil jurisdiction has been the most used.Complaints are mostly made by women.The private health care setting was the most claimed.87.5% of claims were for orthopedic procedures forefoot pathology.He was sentenced to trauma in 44% of casesIn 68.1% of convictions treatment performed was surgical.100% of convictions in cases of surgical treatment was for forefoot pathology.In cases of default of informed consent existed sentence in 83.3%.ConclusionsA poor result in forefoot surgery, combined with unclear and deficient information given to the patient, have a high probability of resulting in an unfavorable sentence for the surgeon. Most lawsuits occur in the private sector.We establish a standard patient and procedure with high risk of lawsuit resulting in unfavorable sentence for the surgeon.

Introduction: Koutsogiannis’ osteotomy has been widely described to treat adult-acquired flatfoot. However, few articles describe its midterm follow-up. Our aim was to study clinical and radiological outcomes at least one year after surgery and to analyze whether a combined procedure on the medial soft tissue affected these outcomes. Methods: We performed a retrospective study of 30 feet of patients who underwent a Koutsogiannis’ osteotomy due to adult-acquired flatfoot stage II and “early stage III”: a stage III acquired flatfoot without any important structural deformities. The parameters studied were additional medial soft tissue procedures, clinical outcome through the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and midfoot score as well as complications and radiological measurements. Results: Sixteen cases were “early stage III” and 14 stage II. Thirteen patients underwent an associated posterior tibial tendon (PTT) revision: in three cases an end-to-end suture was possible, seven cases needed a FDL transposition, and three underwent synovectomy. Statistically significant improvement was found in the AOFAS score although no significant changes were seen radiologically. No additional benefit was found with the revision of the posterior tibial tendon. As to clinical and radiological results, no differences were found between stage II and “early stage III”. Five cases presented a mild dysesthesia but only one patient needed neurolysis. Conclusions: We consider the Koutsogiannis’ osteotomy to be a safe and effective procedure to reduce pain in patients with stage II and “early stage III” adult-acquired flatfoot.

Background To describe the frequent association of metatarsus adductus and hallux valgus in the adult foot as a cause of insufficient correction after application of common surgical techniques. Method and material A retrospective review was made of 16 cases in 15 patients with clinical and radiological metatarsus adductus operated by Hallux valgus from 2006 to 2008. In all cases, a correction of the deformity lower than 10° was observed. Results The mean postoperative correction was 9°. The mean inclination of first cuneummetatarsal joint was 65°. We did not find any relationship between Metatarsus adductus magnitude and postoperative Hallux valgus correction. The best results were observed with Scarf Osteotomy. Discussion There is controversy on the Metatarsus adductus and Hallux valgus relationship. Although poor application of the surgical techniques is the most important cause of correction failure, the limited literature references and the comparison with similar results, may show this association as a cause of the difficulty in the application of conventional surgical techniques. Poor performance of these techniques is an important cause of correction failure and must be evaluated. Conclusion Metatarsus adductus in the adult foot with Hallux valgus to be operated must be detected and seen as a deformity that is difficult to correct. Preoperative planning and choice of surgical technique must assess these angular deformities to avoid a poor result for the patient.

Resumen Objetivo Senalar la frecuente asociacion de metatarso adductus y Hallux valgus en el adulto como causa de correccion insuficiente de este tras la aplicacion de tecnicas quirurgicas comunes. Material y metodo Se han revisado retrospectivamente 16 casos en 15 pacientes operados de Hallux valgus entre los anos 2006 y 2008, presentaban metatarso adductus clinico y radiologico y en los que se observaba una correccion de la deformidad inferior a 10°. Resultados La correccion media presentada fue de 9°. La oblicuidad media de la primera articulacion cuneometatarsiana fue de 65°. No aparecio relacion entre grado de metatarso adductus y correccion observada. Las mejores correcciones se obtuvieron con la osteotomia en Scarf. Discusion Existe controversia en cuanto a la relacion entre metatarso adductus y Hallux valgus . Aunque una inadecuada aplicacion de las tecnicas quirurgicas es la causa mas importante de fracaso en la correccion, la poca bibliografia existente y la comparacion con resultados propios, nos pueden senalar esta asociacion como una causa de dificultad en la aplicacion de tecnicas quirurgicas convencionales. Conclusion La presencia de metatarso adductus en un paciente adulto que va a ser operado de Hallux valgus debe ser detectada y consignada como una causa que dificulta la correccion. La planificacion y la eleccion de la tecnica deben tener en cuenta estos defectos angulares para evitar un resultado decepcionante para el paciente.

Trimalleolar ankle fractures can be difficult to manage and convey a high risk of long-term morbidity. The question of whether internal fixation of the posterior malleolar fragment is warranted remains open. We conducted a retrospective cohort study involving 45 patients who underwent surgical repair of a trimalleolar fracture. Our goal was to study the effect of the size of the posterior fragment on outcomes. We defined small posterior malleolar fragments as being ≤ 25% of the distal tibial articular surface as viewed on the lateral radiograph. Outcome measures included the radiographic appearance of the reduction, as well as Olerud and Molander (O&M) scores and AOFAS scores. Overall better outcomes were obtained in patients whose fractures involved ≤ 25% of the articular surface, and the difference in outcomes was statistically significant in regard to the AOFAS scores (P = .05), although not statistically significant in regard to Olerud and Molander scores and the radiographic appearance of the reduction (P = .14 and P = .45, respectively). Anatomic reduction was achieved in 73.3% of patients, but they did not have better clinical results than nonanatomic reduction patients: AOFAS (P = .14), O&M (P = .38), radiographic appearance (P = .74).

La prótesis es la principal alternativa a la artrodesis en las patologías graves de tobillo y se están publicando buenos resultados a medio plazo, comparables a los de rodilla o cadera.Se presenta una revisión retrospectiva de los primeros 16 casos en 15 pacientes con la prótesis de tobillo Ramsés.El seguimiento medio ha sido de 40 meses. Se retiró un implante de los 16, por lo que la supervivencia es del 93%. La puntuación de la escala AOFAS (American Orthopaedic Foot and Ankle Score) pasó de 38 a 60. La movilidad plantar fue de 15°, sin mejoría en la dorsal.Radiológicamente, se observó radiotransparencia precoz en el componente tibial, sin progresión significativa. No hubo hundimientos del componente astragalino. Los ejes no sufrieron grandes cambios. Dos casos presentan signos de desimplantación completa.No ha habido complicaciones relevantes. Un 80% de los pacientes se ha mostrado satisfecho con el procedimiento.ConclusiónLos resultados de estos primeros casos de prótesis de tobillo Ramsés pueden considerarse aceptables desde el punto de vista clínico y funcional, con pocas complicaciones relevantes.Los resultados radiológicos plantean interrogantes sobre la supervivencia de los implantes a largo plazo.Total ankle replacement is the main option versus ankle fusion in severe ankle pathologies and there are many publications showing good results in the medium term, with implant survival rates similar to knee or hip prosthesis.We present a retrospective review about our first 16 cases in 15 patients with a Ramses total ankle replacement.Medium follow-up was 40 months. Only one implant has been removed; therefore survival rate is 93%. AOFAS average score raised from 38 to 60. Medium plantar flexion was 15° with no improvement in dorsal flexion.With X-ray we register early radiolucent lines in tibial component with no progression signs. No talar component subsidence was registered. No changes in axial alignement. Two cases present severe loosening.We had no severe complications. 80% of patients declared to be satisfied with the procedure.ConclusionClinical and functional results of these first Ramses total ankle replacements are satisfactory and without outstanding complications. Radiological results make us question how will the implant survival rates be in the long term.