Browsing by Author "Morales, Sergio"
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- ItemConcomitant Factors Associated With Tillaux-Chaput Fractures in Adults: A Case-Control Study(2024) Massri-Pugin, Jafet; Matamoros, Gabriel; Morales, Sergio; Urrutia, Tomas; Lira, Maria Jesus; Filippi, JorgeBackground: Tillaux-Chaput fractures (TCFs) consist of fractures of the anterolateral distal tibia. They rarely occur in isolation in adults. When TCFs are missed, there is a risk of chronic pain, instability, and ankle osteoarthritis. This study aimed to identify which factors are related to the presence of TCFs in ankle injuries. Methods: A retrospective review of 1134 ankle fractures evaluated between 2013 and 2023 at a level 1 trauma center was performed. Inclusion criteria were patients aged >= 18 years, ankle radiographs and computed tomographic (CT) scan evaluation, and the presence of a TCF confirmed by CT scan. Exclusion criteria were prior ankle surgery, pilon, or distal tibial fractures. A musculoskeletal radiologist and a foot and ankle-trained orthopaedic surgeon classified the TCFs into type 1, an extraarticular avulsion; type 2, a fracture involving the incisura fibularis; and type 3, a fracture with impaction of the anterolateral tibial plafond. A matching control group of ankle fractures without TCF was created with a 1:2 ratio. The following variables were collected: sex, age (<50 vs >50 years), ankle dislocation or subluxation, Weber classification, Maisonneuve fracture, type of medial and posterior malleolar fracture, Lauge-Hansen classification, malleoli involved, and osteochondral lesion of the talus. Multivariate logistic regression was performed to detect which variables had an association with the TCF and their subtypes. P value <.05 was considered significant. Results: A total of 481 ankle fractures had radiographs and CT scans available for evaluation, of which 83 (17.3%) had a TCF. Of these, 44.6% were type 1, 44.6% type 2, and 9.6% type 3. The mean age was 52.2 years; 66.3% were women. Six patients (7.2%) had an isolated TCF. Fifty-eight (69.9%), 50 (60.2%), and 62 (74.7%) ankles had involvement of the lateral, medial, and posterior malleolus, respectively. Age >= 50 years (OR 2.73, 95% CI 1.45-5.14) and pronation external rotation injuries (OR 2.94, 95% CI 1.43-6.06) had a significant association with TCF. Moreover, ankle dislocation or subluxation (OR 3.16, 95% CI 1.11-8.96) and the absence of posterior malleolar fracture (OR 5.97, 95% CI 1.65-21.6) were significantly associated with TCF type 2 and 3. Conclusion: In this study, age >= 50 years and pronation external rotation injuries were the unique independent risk factors for TCF. Furthermore, ankle dislocation or subluxation and the absence of posterior malleolar fractures increased the odds of having a more severe TCF. This study provides insights into the factors associated with TCF and its subtypes during adulthood.
- ItemDoes the META score evaluating osteoporotic and metastatic vertebral fractures have enough agreement to be used by orthopaedic surgeons with different levels of training?(2018) Urrutia Escobar, Julio Octavio; Besa Vial, Pablo José; Morales, Sergio; Parlange, Antonio; Flores, Sebastián; Campos Daziano, Mauricio Andrés; Mobarec Katunaric, Sebastián Ignacio
- ItemPercutaneous Fixation of Posterior Malleolar Fractures: A Contemporary Review(2024) Massri-Pugin, Jafet; Morales, Sergio; Serrano, Javier; Mery, Pablo; Filippi, Jorge; Villa, Andrés
- ItemResponse to “Letter Regarding: Percutaneous Fixation of Posterior Malleolar Fractures: A Contemporary Review”(2024) Massri Pugin, Jafet Esteban; Morales, Sergio; Serrano Vargas, Javier Alonso; Mery Ponce, Pablo Agustín; Jorge Filippi; Villa, Andrés
- ItemRole of the CT Scan in Preoperative Planning for Tillaux-Chaput Fractures in Adults(2025) Massri Pugin, Jafet Esteban; Matamoro Rueda, Gabriel; Morales, Sergio; Mery, Pablo; Lira, María Jesús; Filippi, JorgeBackground: Tillaux-Chaput fractures (TCFs) occur in the anterolateral rim of the distal tibia. TCFs are often overlooked on radiographic review, increasing the risk of chronic pain, instability, and ankle osteoarthritis. This study evaluated the effect of the computed tomography (CT) scan on preoperative planning for TCFs in adults.Methods: A retrospective review of ankle fractures evaluated from 2013 to 2023 at a university hospital was conducted. The inclusion criteria were patients ≥18 years of age who underwent radiographic and CT evaluation and had a TCF that was confirmed by CT. The exclusion criteria included pilon and distal tibial fractures and prior ankle surgery. Three orthopaedic surgeons assessed radiographs, classified TCFs using the Rammelt classification, formulated a treatment plan (conservative versus surgical), and, if a surgical treatment was indicated, determined the patient positioning, fixation type, and approach for the TCF. After evaluating CT images, changes in treatment strategy were recorded. Forward stepwise regression was utilized to analyze variables associated with modifications in preoperative planning.Results: A total of 481 fractures had ankle radiographs and CT scans; of these, 83 (17.3%) had a TCF. After the CT evaluation, the Rammelt classification and the surgical decision changed by 69.1% and 12.5%, respectively. Changes in patient positioning, the type of fixation, and the surgical approach for a TCF (when surgery was indicated) occurred in 32.1%, 43.8%, and 35.3% of all cases, respectively. Multivariable analysis showed that the detection of a TCF on CT predicted changes in the surgical decision and fixation type, while changes in the TCF classification predicted modifications in the fixation type and surgical approach. Posterior malleolar fractures were the unique predictor of changes in the patient positioning.Conclusions: CT evaluation modified the surgical decision, type of fixation, and surgical approach for a TCF in 12.5%, 43.8%, and 35.3% of cases, respectively. Moreover, the detection of a TCF and a change in the classification after CT evaluation were predictors of a change in treatment strategy. These findings underscore the importance of the CT scan in the preoperative planning for TCFs in adults. Therefore, we strongly recommend conducting a CT scan when a TCF is suspected in adult patients.Level of Evidence: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
- ItemSafety and exposure area in three different posteromedial surgical approaches for the treatment of ankle fractures. A cadaveric study(Elsevier Ltd, 2024) Urrutia, Tomás; Morales, Sergio; Mendez, Magdalena; Filippi, Jorge; Vidal, Catalina; Palma, Joaquín© 2024 European Foot and Ankle SocietyIntroduction: This study aimed to compare the degree of posterior malleolar exposure, the tension of the flap containing the posteromedial neurovascular bundle (NVB), and the distance between the surgical incision and the NVB using three different posteromedial ankle approaches. Methods: Three approaches were compared: medial posteromedial (MePM) modified posteromedial (MoPM) and posteromedial (PM). We measured the minimal tension of the flap containing the NVB that allowed proper exposure. In the second stage, an axial cut was performed, and we measured the degree of posterior malleolar exposure and the distance between the incision and the NVB Results: There were significant differences between the three approaches examined regarding the degree of posterior malleolar exposure and distance from the incision to the NBV,favoring the PM approach (71,00% ± 1.83 and 25.50 mm ± 4.20). The PM approach provided a significantly lower tension to the flap containing the posteromedial NVB (6.18 N ± 1.28) compared to the other two approaches Conclusion: The PM approach achieved the highest degree of posterior malleolar exposure, the lowest tension to the posteromedial NVB, and the greatest distance between the incision and the NBV. Thus, we believe it should be considered the approach of choicefor large fractures of the posteromedial aspect of the PM.