Browsing by Author "Ledermann, Gerardo"

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    Do Patients Older Than 60 Years With Inflammatory Bowel Disease Have More Vertebral Fractures Than Age-matched Controls? A Study Using Abdominal and Pelvic CT Scans With Sagittal Reformatting as Screening Tool.
    (2020) Besa Vial, Pablo José; Meissner, Arturo; Ledermann, Gerardo; Pérez Valenzuela, Javier; Vergara López, María; Álvarez Lobos, Manuel; Urrutia Escobar, Julio Octavio
    Introduction: Inflammatory bowel disease (IBD) has been associated with metabolic bone disease and increased fractures. This association is directly influenced by the disease and indirectly influenced by treatment. Therefore, patients with IBD could develop an elevated risk of osteoporotic fractures, particularly vertebral compression fractures (VCFs); however, symptomatic VCFs have not been shown to be more common in these patients. Our study evaluated the prevalence of VCF, independent of the presence of spinal symptoms, in IBD patients. Methods: We assessed IBD patients previously enrolled in a prospective cohort. All patients from that cohort who underwent computed tomography (CT) scans for nonspinal conditions were evaluated to detect the presence of VCFs. VCFs were classified using the Genant scheme. We evaluated whether patients with or without VCF differed in demographic data, type of IBD, treatment received and time from diagnosis. We used logistic regression to assess the independent effect of each variable. Results: In total, 6.5% of these patients had at least one VCF. Most fractures were Genant I (77%) and mostly at the thoracolumbar junction (T11 to L2, 65%). Bivariate and logistic regression analyses showed that age was the only variable independently associated with VCF (OR 1.12, 1.05 to 1.19). Conclusion: VCFs are not unusual in OBD patients. Radiologists and clinicians should specifically look for the presence of VCFs in patients with IBD, particularly the elderly, by using abdominal and pelvic CT scans.
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    Tibial Cut Accuracy in Mechanically Aligned Total Knee Arthroplasty Using Extensor Hallucis Longus Tendon to Determine Extramedullary Tibial Guide Position
    (2022) Besa, Pablo; Vega, Rafael; Ledermann, Gerardo; Calvo, Claudio; Angulo, Manuela; Lira, Maria Jesus; Vidal, Catalina; Orrego, Mario; Irribarra, Luis; Espinosa, Julio; Vial, Raimundo; Irarrazaval, Sebastian
    This study aimed to determine the tibial cut (TC) accuracy using extensor hallucis longus (EHL) tendon as an anatomical landmark to position the total knee arthroplasty (TKA) extramedullary tibial guide (EMTG), and its impact on the TKA mechanical alignment (MA). We retrospectively studied 96 TKA, performed by a single surgeon, using a femoral tailored intramedullary guide technique. Seventeen were prior to the use of the EHL and 79 used the EHL tendon to position the EMTG. We analyzed preoperative and postoperative standing total lower extremity radiographs to determine the tibial component angle (TCA) and the correction in MA, comparing pre-EHL use and post-EHL technique incorporation. Mean TCA was 88.89 degrees and postoperative MA was neutral in 81% of patients. Pre- and postoperative MAs were not correlated. As a conclusion of this study, using the EHL provides a safe and easy way to determine the position of EMTG.
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    Training Program for Orthopedic Residents in Forefoot Osteotomy Skills Transference From a Simulator to a Cadaveric Surgical Scenario
    (2023) Ledermann, Gerardo; Kuroiwa, Aron; Gonzalez, Nicolas; Silva, Isadora; Villa, Andres
    IntroductionAn effective simulation program allows both the acquisition of surgical skills on the simulated model and the transfer of these skills to a surgical scenario. We designed a forefoot osteotomy training program and sought to determine the transferability to a cadaveric surgical scenario.MethodsEleven orthopedic residents and 2 foot and ankle surgeons were included. A foot simulator was used. All residents were instructed on the surgical techniques of Chevron, Akin, and triple Weil osteotomies. Eight junior residents (trainees) were enrolled in a supervised simulation program. Baseline assessment was performed on the simulator with the Objective Structured Assessment of Technical Skills (OSATS) and the Imperial College Surgical Assessment Device (ICSAD). After baseline, trainees completed a training program and had a final evaluation of proficiency on the simulator and on cadaveric specimens. Three senior residents with no simulated training (controls) and experts were assessed for comparison.ResultsAll trainees improved from a baseline OSATS score of 11 points (9-20) to a final score of 35 points (33-35) in the simulator and 34 points (32-34) in the cadaveric specimen (P < 0.01). Compared with baseline, the ICSAD results improved in path length (391 [205-544] to 131 [73-278] meters, P < 0.01) and number of movements (2756 [1258-3338] to 992 [478-1908], P < 0.01). The final OSATS and ICSAD scores did not differ from experts (P = 0.1) and were significantly different from untrained residents (P = 0.02).ConclusionsSimulated training of Chevron, Akin, and triple Weil osteotomies in orthopedic residents improved procedural proficiency, enabling successful skill transfer to a surgical scenario in cadavers.