Introducción El objetivo del estudio fue analizar las residencias ortopedia y traumatología en Argentina y determinar: 1) La proporción de mujeres; 2) Diferencias sociales y demográficas entre géneros: 3) Los factores que influyen positiva o negativamente en las mujeres al elegir ortopedia. Métodos Se realizó un estudio observacional y descriptivo en dos fases. Primera fase: se analizó la base de datos de la “Asociación Argentina de Ortopedia y Traumatología¨ durante el período 2016-2017. Segunda fase: se desarrolló una encuesta, enfocada en cuestiones demográficas, sociales y laborales, y se envió a todos los residentes de ortopedia. Resultados y conclusión Se incluyeron 933 residentes,121 (13%) eran mujeres y 812 (87%) eran hombres. Recibimos 259 (28%) respuestas de la encuesta. En las características demográficas encontramos diferencias estadísticamente significativas en términos de matrimonio o convivencia: mujeres (16%) vs hombres (42%) (p <0,001); paternidad (23.3%) vs maternidad (4.5%) (p <0.001). Observamos que las mujeres prefieren principalmente ortopedia infantil, pie y el tobillo y mano, mientras que la elección primaria de los hombres es la artroplastia y la artroscopia. Focalizándonos en las mujeres, las tres razones principales para elegir esta residencia fueron: gusto por el trabajo manual (59%), deseo personal (56%) y experiencia positiva en ortopedia durante la universidad (56%). Dentro de los factores disuasivos se relacionan principalmente con la idea de la gran demanda física y un ambiente de trabajo predominantemente masculino. En Argentina, las mujeres representan solo el 13% de todos los residentes de ortopedia y este número es similar a otros informes internacionales.
Category: Hindfoot Introduction/Purpose: The tarsal tunnel syndrome is a compressive neuropathy that affects either the posterior tibial nerve, within the tarsal tunnel, or one of its terminal branches. It can be caused by extrinsic or intrinsic factors. Even though the tarsal tunnel syndrome has been reported as a complication of lateralizing calcaneal osteotomy, we have not identified in the literature reports of this syndrome associated to medializing calcaneal osteotomy. We report the case of a 60-year-old female who developed a tarsal tunnel syndrome, on the third postoperative week, following a medializing calcaneal osteotomy for flatfoot correction with stage IIB posterior tibial tendon dysfunction. Methods: We reviewed and obtained the information from the medical records of this patient: clinical examination, radiographs, computed tomography, magnetic resonance imaging, and outcome. Pain was assessed with visual analog scale (VAS). Results: The patient is a 60-year-old female with left stage II posterior tibial tendon dysfunction who failed to respond to conservative treatment. Medializing and lengthening (Evans) osteotomies of the calcaneus were performed, together with posterior tibial tendon repair and spring ligament reconstruction. In the postoperative, after a cast replacement into a more plantigrade position, the patient developed symptoms that suggested a compressive neuropathy of posterior tibial nerve within the tarsal tunnel associated to calcaneal medializing osteotomy. Initial conservative treatment failed and the posterior tibial nerve was explored under loupe magnification and the tarsal tunnel was released. Figure 1. An immediate improvement in pain was observed postoperatively and almost full recovery occurred within 6 months. Conclusion: In our case report, the tarsal tunnel syndrome was a consequence of the osteotomy fragment displacement that generated a reduction of the tarsal tunnel volume. It has been described that the tarsal tunnel syndrome symptoms become more evident with ankle dorsiflexion and eversion, in our patient this can be associated with the symptom exacerbation presented when the cast was placed into plantigrade position. We conclude that even though in the literature the tarsal tunnel syndrome has been mainly associated to lateralizing osteotomies, it is important to take this complication into account when performing a medializing osteotomy.
Objective: There is a renewed interest in Syme amputation (SA) as it is considered a “lower limb salvage” procedure. The aim of this study was to describe the characteristics and evolution of diabetic patients who underwent SA to search for factors that would affect the outcome by comparing a group of patients who had a successful amputation against those who required a major amputation. Methods: Seventeen diabetic patients submitted to non-traumatic SA between 2008 and 2016 were analyzed retrospectively. Results: Eight patients required a higher level of amputation. In this group, six patients continued with the posterior tibial artery (PTA) occluded despite the revascularization, and seven were on dialysis. When assessing the permeability of PTA and dialysis as predictors of failure, they multiplied the risk by 20 (cOR of 24 and 21, respectively). However, after adjusting for both factors, there was only clinical significance. Conclusion: SA in diabetic patients may be an alternative in those with a preserved heel pad tissue vascularization and permeable posterior tibial artery at the time of surgery. Patients on dialysis are likely to fail with this level of amputation. Level of Evidence IV; Therapeutic Studies; Retrospective Cohort Study.
Category: Diabetes; Bunion; Midfoot/Forefoot Introduction/Purpose: Diabetes mellitus (DM) is a chronic disease with a high worldwide prevalence. People with DM are more likely to develop complications compared to non-diabetic patients undergoing foot and ankle surgery. Currently, orthopedic surgery tends to use minimally invasive surgery (MIS), this resource is used to successfully solve forefoot deformities such as Hallux Valgus (HV). So far there is no evidence enough on this type of surgery and its complications in people with DM. The objective of this study is to determine the types and rates of early complications of elective MIS procedure for hallux valgus in a population of diabetic patients (DBT) compared to a control group of non-diabetic patients (NDBT). Methods: This retrospective study was carried out at our institution between October 2017 and August 2020. During the study period, 874 feet were operated on with MIS technique. All diabetic adults with a diagnosis of HV who underwent percutaneous correction surgery with distal metaphyseal osteotomy and a minimum follow-up of 6 months were included. All diabetic patients who underwent surgery had controlled diabetes with glycosylated hemoglobin less than 7%.For each DBT patient, we randomly selected two aged-matched patients +-1 year without DM as controls. In bilateral surgery, only the first operated foot was taken into account. Patients with previous foot surgery, open lesions or history of previous ulceration, Charcot's neuropathy, metatarsophalangeal osteoarthritis, peripheral vascular disease, and incomplete clinical history were excluded. Complications were recorded and defined as any deviation from the normal postoperative course. Results: A total of 75 patients were analyzed, 25 DBT and 50 NDBT. The follow-up was 10.8 months (6-48). There were no significant differences in demographic characteristics except for the body mass index and the Charlson comorbidity index, both of them were higher in the DBT group (p = <0.001). The complication rate was 18% (n = 9) in NDBT and 24% (n = 6) in DBT patients (p=0.553). There were also no significant differences in the different types of complications. Table 1. It is important to highlight that 7 of 9 complications of the NDBT group required a new surgical intervention (5 osteosynthesis extractions, 1 pseudarthrosis treatment and 1 toilette). In the DBT group, superficial infections were successfully treated with oral antibiotics. Conclusion: This would be the first study that specifically evaluates complications in diabetes patients with elective hallux valgus MIS correction. In our results, diabetic patients have not been associated with a higher rate of complications compared to non- diabetic patients.
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