Revista Espanola de Cirugia Ortopedica y Traumatologia最新文献

{"title":"'À la carte' treatment algorithm for patellofemoral instability.","authors":"T Pineda, D H Dejour","doi":"10.1016/j.recot.2025.01.006","DOIUrl":"10.1016/j.recot.2025.01.006","url":null,"abstract":"<p><p>Patellar instability is a complex and multifactorial problem that poses difficulties in treatment decision-making. The treatment algorithm proposed by the Lyon School of Knee Surgery aims to guide surgeons in identifying imaging risk factors for failure and proposing a therapeutic plan focused on correcting major risk factors present in specific case.</p>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is the coronal plane alignment of the knee (CPAK) classification useful to plan individualized total knee arthroplasty surgery for the Spanish population? A critical analysis of the CPAK classification.","authors":"O Pujol, P Hinarejos, A Pons, E Famada, A Zumel, J Erquicia, J Leal-Blanquet","doi":"10.1016/j.recot.2025.01.002","DOIUrl":"10.1016/j.recot.2025.01.002","url":null,"abstract":"<p><strong>Introduction: </strong>The CPAK classification aims to categorize knee phenotypes. The original study was based on Australian and Belgian population, but significant variation in CPAK distribution exists between different geographic areas. The primary objective is to evaluate knee phenotypes of osteoarthritic Spanish population based on the CPAK system. The secondary objective is to compare the Spanish CPAK distribution with that observed in the original study to analyse if proposing modifications is necessary when applying the classification to our population. Finally, we aim to critically analyse the utility of this classification to plan individualized TKA.</p><p><strong>Methods: </strong>It is a cross-sectional observational study analysing radiological datasets from 121 patients with knee osteoarthritis treated with a Mako assisted TKA in three Spanish institutions. The preoperative lower limb CT-scan was used to measure the MPTA and LDFA of each patient. Then, the aHKA (MPTA-LDFA) and JLO (MPTA+LDFA) were calculated to categorize patients into the nine CPAK phenotypes.</p><p><strong>Results: </strong>The commonest knee phenotypes of osteoarthritic Spanish population were the distal apex JLO CPAK types (74%: II (28%), I (23%) and III (23%)). No patient presented a proximal apex type (VII, VIII and IX). The 30% of the patients had a varus alignment and 26% a valgus. No relevant differences were found between the Spanish CPAK distribution and that observed in the original study.</p><p><strong>Conclusions: </strong>No modifications to the CPAK classification should be necessary for the Spanish population. The CPAK classification can be useful to describe and categorize osteoarthritic patients. However, relevant limitations have been found to the classification, questioning its utility to plan and guide individualized TKA surgery.</p>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of lower limb lengthening with telescopic nails on functionality and quality of life in patients with achondroplasia.","authors":"M Galán-Olleros, J Alonso-Hernández, C Miranda-Gorozarri, J García-Fernández, R M Egea-Gámez, Á Palazón-Quevedo","doi":"10.1016/j.recot.2025.01.001","DOIUrl":"10.1016/j.recot.2025.01.001","url":null,"abstract":"<p><strong>Introduction: </strong>The short stature characteristic of patients with achondroplasia can negatively affect health-related quality of life (HRQoL). Lower limb lengthening reusing telescopic intramedullary nails (TIMNs) offers an alternative to external fixators, with the potential to enhance functionality, self-esteem, and HRQoL, while reducing complication risks, which this study aims to evaluate.</p><p><strong>Materials and methods: </strong>This retrospective study included nine patients with achondroplasia who underwent parallel transverse lengthening of femurs and/or tibias reusing a TIMN between 2015 and 2022. Functionality (Lower Extremity Functional Scale, LEFS), self-esteem (Rosenberg Self-Esteem Scale), and HRQoL (Short Form-12, SF-12, and EuroQol VAS) were assessed preoperatively and at least two years post-surgery. Complications (Clavien-Dindo-Sink classification) and patient satisfaction were also recorded.</p><p><strong>Results: </strong>The median age was 13.5 years (IQR: 12.5-17.1), with a significant height increase of +19.9cm +19.9cm (p<0.05). Improvements were significant in functionality (LEFS, +4.6 points; p<0.05), self-esteem (Rosenberg, +3.7 points; p<0.05), and HRQoL (SF-12 physical, +8.9 points; p<0.05; EQ-VAS, +20 points; p<0.05). A total of 22 complications were reported in 32 treated bones, most classified as grade 2 or 3B, with no significant correlation to functionality, HRQoL, or self-esteem outcomes (p>0.05).</p><p><strong>Conclusions: </strong>Lower limb lengthening reusing TIMNs appears to improve functionality, HRQoL, and self-esteem in patients with achondroplasia compared to their preoperative status. High patient satisfaction and manageable complications were observed, with no negative impact on outcomes, laying the groundwork for future studies.</p>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Translated article] Reamputation prevalence after minor feet amputations in patients with diabetic foot: A cross sectional study","authors":"C.A. Sánchez Correa ,&nbsp;I. Briceño Sanín ,&nbsp;J.J. Bautista Valencia ,&nbsp;M.E. Niño ,&nbsp;J. Robledo Quijano","doi":"10.1016/j.recot.2024.11.012","DOIUrl":"10.1016/j.recot.2024.11.012","url":null,"abstract":"<div><h3>Introduction</h3><div>Reported prevalence for reamputation in diabetic foot is diverse, risk factors are not clear for minor amputations. This study aims to determine the prevalence for reamputation in diabetic foot from minor amputations and to evaluate associated factors for such outcome.</div></div><div><h3>Methods</h3><div>Cross sectional study developed in 2 hospitals. Patients hospitalized for diabetic foot ulcer requiring a minor amputation were included. A descriptive analysis of all variables is presented, as well as prevalence ratios (PR) and a multivariate logistic regression.</div></div><div><h3>Results</h3><div>The prevalence was of 48% for 15 years. Toes were the most frequent minor amputation that required reamputation and above the knee amputation was the most frequent reamputation level (45%). Variables whose PR was associated to reamputation risk were: smoking history (PR 1.32, CI 95%: 1.02–1.67, <em>p</em> <!-->=<!--> <!-->0.03), vascular occlusion in doppler (PR 1.47, CI 95%: 1.11–1.73, <em>p</em> <!-->=<!--> <!-->0.01), revascularization (PR 1.73, CI 95%: 1.31–2.14, <em>p</em> <!-->=<!--> <!-->0.00002), Wagner<!--> <!-->&gt;<!--> <!-->3 (PR 1.75, CI 95%: 1.16–1.84, <em>p</em> <!-->=<!--> <!-->0.01) and leucocytosis<!--> <!-->&gt;<!--> <!-->11,000 (PR 1.39, CI 95%: 1.07–1.68, <em>p</em> <!-->=<!--> <!-->0.01).</div><div>Leucocytosis<!--> <!-->&gt;<!--> <!-->11,000, Wagner<!--> <!-->&gt;<!--> <!-->3, vascular occlusion in doppler and revascularization were the variables that best predicted the outcome. Furthermore, leucocytosis was the best variable for predicting reamputation (OR 2.4, CI 95%: 1.1–5.6, <em>p</em> <!-->=<!--> <!-->0.04).</div></div><div><h3>Conclusions</h3><div>Reamputation prevalence was 48%. The toes were the minor amputation more frequently requiring reamputation and above the knee was the most frequent reamputation level. Risk for reamputation was associated with variables related to vascular compromise and infection.</div></div>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":"69 1","pages":"Pages T70-T76"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Translated article] Rotator cuff debridement compared with rotator cuff repair in arthroscopic treatment of calcifying tendinitis of the shoulder: A systematic review and meta-analysis","authors":"D. González-Martín ,&nbsp;M. Garrido-Miguel ,&nbsp;G. de Cabo ,&nbsp;J.M. Lomo-Garrote ,&nbsp;M. Leyes ,&nbsp;L.E. Hernández-Castillejo","doi":"10.1016/j.recot.2024.11.003","DOIUrl":"10.1016/j.recot.2024.11.003","url":null,"abstract":"<div><h3>Introduction</h3><div>Although conservative treatment of calcific tendinopathy has a high success rate, arthroscopic excision of the calcific deposit is occasionally necessary. Controversy exists as to whether the remaining rotator cuff defect can be left in situ or should be repaired to achieve better functional outcomes. This study aimed to compare the results of debridement versus debridement combined with suturing in arthroscopic surgery for calcific tendinopathy.</div></div><div><h3>Methodology</h3><div>MEDLINE, EMBASE, Cochrane Library, and Web of Science were searched from inception to February 2023 for articles on arthroscopic treatment of calcific tendinopathy. Functional outcomes (VAS, ASES, UCLA, and Constant) and the number of complications were analyzed. The effect size was calculated using Cohen's <em>d</em>-index.</div></div><div><h3>Results</h3><div>Twenty-one studies were included, including a total of 1172 patients aged between 44.7 and 55 years. The mean follow-up time was 24.7 months. The combined ES estimates for the total score of the VAS, ASES, UCLA, and Constant scales were very strong (&gt;1.0) for both debridement and combined debridement with suture. The ES estimates for the number of total complications were 1.75 (95% CI: 0.08–3.43, <em>I</em>² <!-->=<!--> <!-->0%) for debridement and 9.07 (95% CI: −0.03 to 18.17, <em>I</em>² <!-->=<!--> <!-->50.4%) for combined debridement with suture.</div></div><div><h3>Conclusions</h3><div>Both arthroscopic procedures improve the total score significantly on the EVA, ASES, UCLA, and Constant scales. However, a higher proportion of complications was observed in the group that performed suturing. In this regard, we must consider whether it is really necessary to repair all partial tears after the calcified deposits removal.</div></div>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":"69 1","pages":"Pages T91-T103"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Colgajo fasciocutáneo tipo lengüeta medial como alternativa para el manejo de defectos de tejidos blandos en la pierna","authors":"X. Ríos Garrido ,&nbsp;A. De la Rosa ,&nbsp;L. Arzuza Ortega ,&nbsp;G. Vargas Lievano ,&nbsp;J. Molina Gándara ,&nbsp;D.A. Tellez Gamarra ,&nbsp;C. Medina Monje","doi":"10.1016/j.recot.2024.05.002","DOIUrl":"10.1016/j.recot.2024.05.002","url":null,"abstract":"<div><h3>Background</h3><div>Selecting the right technique for lower limb soft tissue reconstruction is a therapeutic challenge. Despite having several reconstruction options, it's important to choose a technique that is effective and with the least possible donor site morbidity.</div></div><div><h3>Objective</h3><div>Demonstrate the therapeutic efficacy of the medial tab flap in soft tissue reconstruction on the leg, compared to conventional flaps.</div></div><div><h3>Materials and methods</h3><div>Cohort study matched by age. 64 patients with soft tissue defects were selected and according to the intervention divided in: group 1)<!--> <!-->medial tab flap, and group 2)<!--> <!-->conventional flaps (sural, soleus, gastrocnemius) followed up to one year postoperatively. Outcome variables: surgical time in minutes, healing, healing time in days, complications.</div></div><div><h3>Results</h3><div>The patients who underwent surgery with medial tab flap and with conventional flaps healed completely. The healing time was 16.2<!--> <!-->±<!--> <!-->11.2 days in the tab flap and 16.1<!--> <!-->±<!--> <!-->11.2 days in conventional flaps, no statistically significant differences were found between the groups (<em>P</em> <!-->=<!--> <!-->.89).</div><div>The surgical time for tab flaps was 225.2<!--> <!-->±<!--> <!-->117.8<!--> <!-->minutes, and 191.3<!--> <!-->±<!--> <!-->117.2<!--> <!-->minutes for the comparison flaps (<em>P</em> <!-->=<!--> <!-->.65), there were no statistically significant differences. There were no complications in the medial tab flaps.</div></div><div><h3>Conclusion</h3><div>The findings suggest that the medial tab flap technique is as effective as the conventional flap technique, with complete flap survival and healing, and without any major complications in this studied group.</div></div>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":"69 1","pages":"Pages 17-26"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141072162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding limb necrotizing infections: A comprehensive approach","authors":"A. Garrido-Hidalgo ,&nbsp;J. García-Coiradas ,&nbsp;M. Echevarría-Marín ,&nbsp;S. Llanos ,&nbsp;J.A. Valle-Cruz ,&nbsp;F. Marco","doi":"10.1016/j.recot.2024.03.012","DOIUrl":"10.1016/j.recot.2024.03.012","url":null,"abstract":"<div><h3>Introduction</h3><div>Necrotizing soft tissue infections (NSTI) are increasing, posing a significant risk of morbidity and mortality. Due to nonspecific symptoms, a high index of suspicion is crucial. Treatment involves a multidisciplinary approach, with broad-spectrum antibiotics, early surgical debridement, and life support. This study analyzes the characteristics, demographics, complications, and treatment of NSTI in a hospital in Madrid, Spain.</div></div><div><h3>Methods</h3><div>A retrospective observational study was conducted, including all surgically treated NSTI patients at our center from January 2016 to December 2022, examining epidemiological and clinical data. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) was prospectively calculated for all patients.</div></div><div><h3>Results</h3><div>Twenty-two patients (16 men, 6 women, mean age 54.8) were included. Median time from symptom onset to emergency room visit was 3.5 days. All reported severe treatment-resistant pain; sixteen had fever exceeding 37.8<!--> <!-->°C (72.7%). Skin lesions occurred in twelve (54.5%), and thirteen had hypotension and tachycardia (59.1%).</div><div>Treatment involved resuscitative support, antibiotherapy, and radical debridement. Median time to surgery was 8.25<!--> <!-->h. Intraoperative cultures were positive in twenty patients: twelve <em>Streptococcus pyogenes</em>, four <em>Staphylococcus aureus</em>, one <em>Escherichia coli</em>, and four polymicrobial infection. In-hospital mortality rate was 22.73%.</div></div><div><h3>Conclusions</h3><div>We examined the correlation between our results, amputation rates and mortality with LRINEC score and time to surgery. However, we found no significant relationship unlike some other studies. Nevertheless, a multidisciplinary approach with radical debridement and antibiotic therapy remains the treatment cornerstone. Our hospital stays, outcomes and mortality rates align with our literature review, confirming high morbimortality despite early and appropriate intervention.</div></div>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":"69 1","pages":"Pages 9-16"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140768641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Análisis de modelos algorítmicos de aprendizaje automático para la predicción del estado vital a los seis meses tras fractura de cadera en pacientes mayores de 74 años","authors":"I. Calvo Lorenzo,&nbsp;I. Uriarte Llano,&nbsp;M.R. Mateo Citores,&nbsp;Y. Rojo Maza,&nbsp;U. Agirregoitia Enzunza","doi":"10.1016/j.recot.2024.05.005","DOIUrl":"10.1016/j.recot.2024.05.005","url":null,"abstract":"<div><h3>Background and objective</h3><div>The objective is to develop a model that predicts vital status six months after fracture as accurately as possible. For this purpose we will use five different data sources obtained through the National Hip Fracture Registry, the Health Management Unit and the Economic Management Department.</div></div><div><h3>Material and methods</h3><div>The study population is a cohort of patients over 74 years of age who suffered a hip fracture between May 2020 and December 2022. A warehouse is created from five different data sources with the necessary variables. An analysis of missing values and outliers as well as unbalanced classes of the target variable («vital status») is performed. Fourteen different algorithmic models are trained with the training. The model with the best performance is selected and a fine tuning is performed. Finally, the performance of the selected model is analyzed with test data.</div></div><div><h3>Results</h3><div>A data warehouse is created with 502 patients and 144 variables. The best performing model is Linear Regression. Sixteen of the 24 cases of deceased patients are classified as live, and 14 live patients are classified as deceased. A sensitivity of 31%, an accuracy of 34% and an area under the curve of 0.65 is achieved.</div></div><div><h3>Conclusions</h3><div>We have not been able to generate a model for the prediction of six-month survival in the current cohort. However, we believe that the method used for the generation of algorithms based on machine learning can serve as a reference for future works.</div></div>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":"69 1","pages":"Pages 47-54"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141159015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Translated article] Medial tab-type fasciocutaneous flap as an alternative for the management of soft tissue defects of the leg","authors":"X. Ríos Garrido ,&nbsp;A. De la Rosa ,&nbsp;L. Arzuza Ortega ,&nbsp;G. Vargas Lievano ,&nbsp;J. Molina Gándara ,&nbsp;D.A. Tellez Gamarra ,&nbsp;C. Medina Monje","doi":"10.1016/j.recot.2024.11.007","DOIUrl":"10.1016/j.recot.2024.11.007","url":null,"abstract":"<div><h3>Background</h3><div>Selecting the right technique for lower limb soft tissue reconstruction is a therapeutic challenge. Despite having several reconstruction options, it's important to choose a technique that is effective and with the least possible donor site morbidity.</div></div><div><h3>Objective</h3><div>Demonstrate the therapeutic efficacy of the medial tab flap in soft tissue reconstruction on the leg, compared to conventional flaps.</div></div><div><h3>Materials and methods</h3><div>Cohort study matched by age. 64 patients with soft tissue defects were selected and according to the intervention divided in: group (1) medial tab flap, and group (2) conventional flaps (sural, soleus, gastrocnemius) followed up to one year postoperatively. Outcome variables: surgical time in minutes, healing, healing time in days, complications.</div></div><div><h3>Results</h3><div>The patients who underwent surgery with medial tab flap and with conventional flaps healed completely. The healing time was 16.2<!--> <!-->±<!--> <!-->11.2 days in the tab flap and 16.1<!--> <!-->±<!--> <!-->11.2 days in conventional flaps, no statistically significant differences were found between the groups (<em>p</em> <!-->=<!--> <!-->.89).</div><div>The surgical time for tab flaps was 225.2<!--> <!-->±<!--> <!-->117.8<!--> <!-->min, and 191.3<!--> <!-->±<!--> <!-->117.2<!--> <!-->min for the comparison flaps (<em>p</em> <!-->=<!--> <!-->.65), there were no statistically significant differences. There were no complications in the medial tab flaps.</div></div><div><h3>Conclusion</h3><div>The findings suggest that the medial tab flap technique is as effective as the conventional flap technique, with complete flap survival and healing, and without any major complications in this studied group.</div></div>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":"69 1","pages":"Pages T17-T26"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Artículo traducido] Infecciones necrosantes de partes blandas: aproximación diagnóstico-terapéutica","authors":"A. Garrido-Hidalgo ,&nbsp;J. García-Coiradas ,&nbsp;M. Echevarría-Marín ,&nbsp;S. Llanos ,&nbsp;J.A. Valle-Cruz ,&nbsp;F. Marco","doi":"10.1016/j.recot.2024.11.002","DOIUrl":"10.1016/j.recot.2024.11.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Necrotizing soft tissue infections (NSTI) are increasing, posing a significant risk of morbidity and mortality. Due to nonspecific symptoms, a high index of suspicion is crucial. Treatment involves a multidisciplinary approach, with broad-spectrum antibiotics, early surgical debridement, and life support. This study analyzes the characteristics, demographics, complications, and treatment of NSTI in a hospital in Madrid, Spain.</div></div><div><h3>Methods</h3><div>A retrospective observational study was conducted, including all surgically treated NSTI patients at our center from January 2016 to December 2022, examining epidemiological and clinical data. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) was prospectively calculated for all patients.</div></div><div><h3>Results</h3><div>Twenty-two patients (16 men, 6 women, mean age 54.8) were included. Median time from symptom onset to emergency room visit was 3.5 days. All reported severe treatment-resistant pain; sixteen had fever exceeding 37.8<!--> <!-->°C (72.7%). Skin lesions occurred in twelve (54.5%), and thirteen had hypotension and tachycardia (59.1%). Treatment involved resuscitative support, antibiotherapy, and radical debridement. Median time to surgery was 8.25<!--> <!-->h. Intraoperative cultures were positive in twenty patients: twelve <em>Streptococcus pyogenes</em>, four <em>Staphylococcus aureus</em>, one <em>Escherichia coli</em>, and four polymicrobial infection. In-hospital mortality rate was 22.73%.</div></div><div><h3>Conclusions</h3><div>We examined the correlation between our results, amputation rates and mortality with LRINEC score and time to surgery. However, we found no significant relationship unlike some other studies. Nevertheless, a multidisciplinary approach with radical debridement and antibiotic therapy remains the treatment cornerstone. Our hospital stays, outcomes and mortality rates align with our literature review, confirming high morbimortality despite early and appropriate intervention.</div></div>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":"69 1","pages":"Pages T9-T16"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}