Browsing by Author "Vial Irarrázabal, Raimundo"

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    Medial opening wedge high tibial osteotomy: more than ten years of experience with Puddu plate technique supports its indication
    (2022) Orrego Luzoro, Mario Santiago; Besa Vial, Pablo José; Orrego, Francisca; Amenábar, Diego; Vega Mayer, Jorge Rafael; Irribarra Trivelli, Luis Alfonso; Espinosa, J.; Vial Irarrázabal, Raimundo; Phillips, V.; Irarrázaval Domínguez, Sebastián
    Purpose: To describe the short-term and long-term results of patients who underwent a medial opening wedge high tibial osteotomy (MOW-HTO) for unicompartmental medial knee joint osteoarthritis. Methods: A retrospective review was conducted of patients with MOW-HTO using a Puddu plate®, with more than ten year follow-up. The degree of correction, initial chondral damage, number of meniscal lesions, preoperative and 1-year postoperative functional scale scores (IKDC and Lysholm), and arthroplasty conversion rates at the ten year follow-up were registered. We assumed early indication when patients underwent the operation before they were 40 years old and delayed ≥ 40. Functional outcomes were analyzed by adjusting for pre-operative values. Fisher’s exact test was used to study the association between the arthroplasty conversion rates and the timing of indication. Results: Fifty-five patients were included, 37 of whom were male (67%). Twenty-nine patients had early indications for surgery (53%). All patients completed ten year follow-up. All patients improved IKDC (p < 0.01) and Lysholm (p < 0.01) scores compared to their presurgical scores at the one year post-operative evaluation. We had six minor complications, none requiring revision surgery. We had three conversions to arthroplasty, all in the late indication group, not statistically significant different. Linear regression showed that early indication was associated with a higher IKDC score when adjusting for the Outerbridge chondral damage score, the number of meniscal lesions, and sex (p < 0.01). Conclusion: All patients improved functional scores one year after surgery. Early indication (i.e., younger than 40 years of age) was independently associated with better functional outcomes than late indication at one year follow-up.
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    The AO classification system for tibial plateau fractures: An independent inter and intraobserver agreement study
    (2023) Besa Vial, Pablo José; Angulo, Manuela; Vial Irarrázabal, Raimundo; Vega Mayer, Jorge Rafael; Irribarra Trivelli, Luis Alfonso; Lobos Tallard, Daniel Alejandro; Sandoval Gallardo, Felipe Sebastián
    Purpose: Classifying tibial plateau fractures is paramount in determining treatment regimens and systemizing decision making. The original AO classification described by Müller in 1996 and the Schatzker classification of 1970 are the most cited classifications for tibial plateau fractures, demonstrating substantial to almost perfect agreement. The main problem with these classifications schemes is that they lack the detail required to convey the variety of fracture patterns encountered. In 2018, the AO foundation published a new classification system for proximal tibia fractures, highlighting a more complete and detailed number of categories and subcategories. We sought to independently determine inter and intraobserver agreement of the AO classification system, compared to the previous systems described by Müller and Schatzker. Methods: One hundred seven consecutive tibial plateau fractures were screened, and a representative data set of 69 was created. Six independent evaluators (three knee surgeons, three senior orthopedic residents) classified the fractures using the original AO, the Schatzker and the new AO classifications. After six weeks, the 69 cases were randomized and reclassified by all evaluators. The Kappa coefficient (k) was calculated for inter- and intraobserver correlation and is expressed with 95% confidence intervals. Results: interobserver agreement was moderate for all three classifications. k = 0.464 (0.383–0.560) for the original AO; k = 0.404 (0.337–0.489) for Schatzker; and k = 0.457 (0.371–0.545) for the base categories of the new AO classification. The inclusion of subcategories and letter modifiers to the new classification worsened agreement to k = 0.358 (0.302–0.423) and k = 0.174 (0.134–0.222), respectively. There were no significant differences between knee surgeons and residents for the new classification. Intra-observer correlation was also moderate for each of the scores: k = 0.630 (0.578–0.682) for the original AO; k = 0.623 (0.569–0.674) for Schatzker; and k = 0.621 (0.566–0.678) for the new AO base categories; without differences between knee surgeons or residents. Conclusions: This study demonstrated an adequate inter and intra-observer agreement for the new AO tibial plateau fractures classification system for its base categories, but not at the subcategory or letter modifier levels.