Browsing by Author "Vidal, Catalina"

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    Post-operative complications affect survival in surgically treated metastatic spinal cord compression
    (2024) González-Kusjanovic, Nicolás; Delgado Ochoa, Byron; Vidal, Catalina; Campos, Mauricio
    Purpose: The prevalence of metastatic epidural spinal cord compression (MESCC) is increasing globally due to advancements in cancer diagnosis and treatment. Whilst surgery can benefit specific patients, the complication rate can reach up to 34%, with limited reporting on their impact in the literature. This study aims to analyse the influence of major complications on the survival of surgically treated MESCC patients.Methods: Consecutive MESCC patients undergoing surgery and meeting inclusion criteria were selected. Survival duration from decompressive surgery to death was recorded. Perioperative factors influencing survival were documented and analysed. Kaplan–Meier survival analysis at one year compared these factors. Univariate and multivariate Cox proportional hazard regression analyses were performed. Additionally, univariate analysis compared complicated and uncomplicated groups.Results: Seventy-five patients were analysed. Median survival for this cohort was 229 days (95% CI 174–365). Surgical complications, low patient performance, and rapid primary tumour growth were significant perioperative variables for survival in multivariate analyses (p < 0.001, p = 0.003, and p = 0.02, respectively) with a hazard ratio of 3.2, 3.6, and 2.1, respectively. Univariate analysis showed no variables associated with complication occurrence.Conclusion: In this cohort, major surgical complications, patient performance, and primary tumour growth rate were found to be independent factors affecting one year survival. Thus, prioritizing complication prevention and appropriate patient selection is crucial for optimizing survival in this population.
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    Role of Lateral Ankle Ligaments in Vertical Stability of the Fibula: A Cadaveric Model
    (2023) Filippi, Jorge; Gutierrez, Paulina; Quezada, Jose; Massri-Pugin, Jafet; Bastias, Gonzalo F.; Melo, Rodrigo; Vidal, Catalina; Silvestre, Rony
    Background: In unstable ankle fractures, the role of the deltoid and syndesmosis ligaments has been widely studied. However, it is uncertain what the importance of the lateral ankle ligament complex (LALC) is in the vertical stability of the fibula. Given its anatomical position, it should prevent the proximal translation of the fibula. This study aims to evaluate the role of the LALC in stabilizing the fibula in the vertical plane.
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    Safety 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.
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    The Reliability of Acromioclavicular Joint Dislocation Classification Systems: A Comparison Between the Rockwood and Kraus Classifications
    (2023) Velasquez Garcia, Ausberto; Liendo, Rodrigo; Ekdahl, Max; Calvo, Cristobal; Vidal, Catalina
    Background:The Rockwood system for the classification of acute acromioclavicular (AC) joint dislocations has been associated with a lack of reliability. A novel system has been proposed (Kraus classification) that is based on dynamic posterior translation of these injuries. Purpose:To assess the interobserver and intraobserver reliability of the Rockwood and Kraus classification systems and also to examine the impact of surgeon experience on the assessments. Study Design:Cohort study (diagnosis); Level of evidence, 3. Methods:Included were 45 patients with acute AC joint injuries who underwent a radiographic examination using standard bilateral AP and modified Alexander views. For interobserver reliability, 6 shoulder surgeons (expert group) and 6 orthopaedic residents (novice group) reviewed the radiographs to classify injuries according to the Rockwood and Kraus classifications; for each categorization, the participants chose between nonoperative management and surgical treatment. The evaluation was repeated 6 weeks later to determine intraobserver reliability. Kappa (kappa) coefficients and their 95% CIs were used to compare interobserver and intraobserver reliability for each classification system according to assessor experience. Statistical differences were considered significant when the upper and lower boundaries of the 95% CI did not overlap. Results:The overall interobserver agreement for diagnosis (both novice and expert groups) was moderate (kappa = 0.52 [95% CI, 0.51-0.54]) for the Rockwood classification and substantial (kappa = 0.62 [95% CI, 0.53-0.65]) for the Kraus classification; however, no significant differences were observed between the kappa values. The overall interobserver agreement for treatment selection was substantial when using both the Rockwood (kappa = 0.78 [95% CI, 0.72-0.81]) and Kraus (kappa = 0.77 [95% CI, 0.66-0.87]) classifications. The overall intraobserver agreement for diagnosis was substantial using both the Rockwood (kappa = 0.65 [95% CI, 0.61-0.67]) and Kraus (kappa = 0.73 [95% CI, 0.69-0.75]) classifications. There were no significant differences between the novice and expert groups on any of the evaluations. Conclusion:The Kraus system was slightly more reliable than the Rockwood system for classifying AC joint injuries both between assessor groups and overall. The level of surgeon experience had no impact on the evaluations.
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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.