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dc.contributor.advisorMorales González, Mauricio 
dc.contributor.advisorMontoya Murillo, Diana Paola 
dc.contributor.advisorRojas Liévano, Jorge 
dc.creatorDelgadillo Arias, David 
dc.date.accessioned2020-09-22T14:09:58Z
dc.date.available2020-09-22T14:09:58Z
dc.date.created2020-08-06
dc.identifier.urihttps://repository.urosario.edu.co/handle/10336/30176
dc.descriptionAntecedentes: El hallux rigidus es degeneración de la articulación metatarsofalángica (MTF) del hallux; genera dolor, deformidad, limitación funcional y dolor neuropático. Se indica tratamiento quirúrgico ante fracaso del conservador. Se considera el estándar de cuidado, aunque existen diversos métodos de fijación con evidencia limitada de la efectividad. Objetivo: Describir efectividad (mejora del dolor y complicaciones a corto plazo) de la artrodesis MTF del hallux con método de fijación combinado (placa anatómica dorsal bloqueada y tornillo de compresión interfragmentaria) para el manejo de hallux rígido sintomático. Metodología: Se identificaron 20 casos de artrodesis MTF del hallux con un método de fijación específico en la Fundación Santa Fe de Bogotá 2012 - 2017. Se realizó caracterización demográfica, radiológica y de tratamientos pre quirúrgicos. El desenlace primario fue la mejoría del dolor postoperatorio en la articulación evaluado con escala numérica verbal de 0 a 10 seguimiento mínimo de 1 año. Se realizó prueba t de Student para muestras pareadas. Se utilizó software estadístico Stata. Los desenlaces secundarios incluyeron la tasa de unión de la artrodesis evaluada radiológicamente y tasa de complicaciones. Resultados: Se incluyeron 11 mujeres (12 casos) y 7 hombres (8 casos) de edad promedio 58 años (21-75 años). Radiológicamente, grado II de artrosis 2 casos (10%), grado III 12 casos (60%) y grado IV 6 casos (30%). Previo cirugía, el 35% había fallado a manejos conservadores, el 65% no había realizado ningún tratamiento. Todos reportaron dolor al movimiento preoperatoriamente y 7 casos (35%) dolor en reposo. Seguimiento postoperatorio promedio 58 meses (rango 26-75), hubo disminución estadísticamente significativa del dolor 6.7 ± 2.3 puntos a 0.3 ± 0.2 puntos post operatorio (p < 0.001). Ningún paciente presentó complicaciones infecciosas, de cicatrización o reintervención. Un caso (5%) reportó molestias en otras áreas (aparición de juanetillos). El 86% pudieron regresar a actividad física deportiva sin dolor. Seguimiento radiográfico a 15 casos en tiempo promedio de 14 meses (rango 5-58) identificando signos radiológicos de unión de la artrodesis sin complicaciones asociadas. Conclusión: La artrodesis MTF del hallux con placa anatómica dorsal y tornillo de compresión interfragmentaria resulto en mejoría significativa del dolor con tasas altas de unión y baja de complicaciones para pacientes con hallux rigidus sintomático. Se requieren estudios adicionales comparativos entre este y otros métodos de fijación.
dc.description.abstractBackground: Degenerative arthritis of the first metatarsophalangeal joint (MPJ) is hallux rigidus; which may be associated with pain, deformities, functional limitation and neuropathic pain. Operative treatment is indicated when patients do not improve after non-operative treatment. Currently, the first MPJ fusion is considered the standard of care for patients who require operative treatment. However, there are a variety of fixation options and the evidence on the effectiveness is limited. Aim: To describe the effectiveness, in terms of pain improvement, and short-term complications of the first MTP joint fusion fixed with a combined method which includes a dorsal locking plate and an interfragmentary compression screw for treatment of symptomatic hallux rigidus. Methodology: We retrospectively identified 20 cases of MTP joint fusion fixed with the described method performed in a tertiary hospital between 2012 and 2017. The demographic characteristics, the radiologic grade of arthrosis and treatments received before surgery were collected to characterize this group of patients. The primary outcome was the patient-reported improvement of pain at the MTP joint, measured with a numerical verbal scale from 0 to 10 at a minimum 1-year follow-up. T Student was applied, all statistical analysis was made with Stata software®. Secondary outcomes included the rate of radiological union evaluated in postoperative radiographs, and the rate of complications and reintervention. Results: The study included 11 women (12 cases) and 7 men (8 cases) with an average age of 58 years (Range 21-75 years). Radiologically, the degree of preoperative osteoarthritis was classified as grade II in 2 cases (10%), grade III in 12 cases (60%) and grade IV in 6 cases (30%). Before surgery, 35% of the cases had failed to non-surgical management, while 65% of the cases had not had any treatment. All cases reported pain with movement before surgery, while only 7 cases (35%) reported pain at rest. After an average follow-up of 58 months (range 26-75 months), there was a statistically significant decrease in pain from 6.7 ± 2.3 points preoperatively to 0.3 ± 0.2 points postoperatively (p <0.001). During the same follow-up time, no patient required reintervention, and there were no reported complications. Only one case (5%) reported discomfort in other areas of the foot due to bunionette development at the little toe. Of seven cases who reported performing sports before surgery, six (86%) returned to sports without pain after surgery. In 15 of the 20 cases, radiological follow-up was completed at an average time of 14 months (range 05-58 months). In all of these cases, radiological signs of arthrodesis union with no signs of complications were identified. Conclusion: In patients requiring first MPJ fusion for the management of symptomatic hallux rigidus, fixation with an anatomical dorsal plate and an interfragmentary compression screw is a method that results in a significant improvement in pain with a high rate of union and a low rate of complications. However, further prospective studies comparing this fixation technique with other techniques of fixation of the first MPJ fusion are required.
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dc.language.isospa
dc.rightsAtribución-NoComercial-SinDerivadas 2.5 Colombia
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/2.5/co/
dc.sourcereponame:Repositorio Institucional EdocUR
dc.sourceinstname:Universidad del Rosario
dc.subjectHallux rigidus
dc.subjectArtrosis
dc.subjectArtrodesis
dc.subjectArticulación metatarsofalángica del dedo gordo del pie
dc.subject.ddcIncidencia & prevención de la enfermedad 
dc.titleArtrodesis Metatarsofalángica del Hallux con placa anatómica y tornillo interfragmentario como tratamiento del Hallux Rigidus. Serie de casos
dc.typemasterThesis
dc.publisherUniversidad del Rosario
dc.creator.degreeEspecialista en Ortopedia y Traumatología FSFB
dc.publisher.programEspecialización en Ortopedia y Traumatología FSFB
dc.publisher.departmentFacultad de Medicina
dc.subject.keywordHallux rigidus
dc.subject.keywordOsteoarthritis
dc.subject.keywordArthrodesis
dc.subject.keywordMetatarsophalangeal joint of the big toe
dc.rights.accesRightsinfo:eu-repo/semantics/openAccess
dc.type.spaTrabajo de grado
dc.rights.accesoAbierto (Texto Completo)
dc.type.hasVersioninfo:eu-repo/semantics/acceptedVersion
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dc.rights.licenciaEL AUTOR, manifiesta que la obra objeto de la presente autorización es original y la realizó sin violar o usurpar derechos de autor de terceros, por lo tanto la obra es de exclusiva autoría y tiene la titularidad sobre la misma. PARGRAFO: En caso de presentarse cualquier reclamación o acción por parte de un tercero en cuanto a los derechos de autor sobre la obra en cuestión, EL AUTOR, asumirá toda la responsabilidad, y saldrá en defensa de los derechos aquí autorizados; para todos los efectos la universidad actúa como un tercero de buena fe. EL AUTOR, autoriza a LA UNIVERSIDAD DEL ROSARIO, para que en los términos establecidos en la Ley 23 de 1982, Ley 44 de 1993, Decisión andina 351 de 1993, Decreto 460 de 1995 y demás normas generales sobre la materia, utilice y use la obra objeto de la presente autorización. -------------------------------------- POLITICA DE TRATAMIENTO DE DATOS PERSONALES. Declaro que autorizo previa y de forma informada el tratamiento de mis datos personales por parte de LA UNIVERSIDAD DEL ROSARIO para fines académicos y en aplicación de convenios con terceros o servicios conexos con actividades propias de la academia, con estricto cumplimiento de los principios de ley. Para el correcto ejercicio de mi derecho de habeas data cuento con la cuenta de correo habeasdata@urosario.edu.co, donde previa identificación podré solicitar la consulta, corrección y supresión de mis datos.
dc.type.documentDescriptivo observacional retrospectivo
dc.creator.degreetypeFull time
dc.title.TranslatedTitleMetatarsophalangeal arthrodesis of the Hallux with an anatomical plate and interfragmentary screw as a treatment for Hallux Rigidus. Number of cases


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Atribución-NoComercial-SinDerivadas 2.5 Colombia
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