Browsing by Author "Besa Vial, Pablo José"

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    An Independent Validation of the Brighton Spondylodiscitis Score and a Proposal to Modify the Score
    (2020) Urrutia Escobar, Julio Octavio; Besa Vial, Pablo José; Meissner-Haecker, A.; Delgado, B.
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    An Isolated Transosseous Flexible Suture Frame in the Treatment of Patellar Tendon Rupture Provides Adequate Mechanical Resistance
    (2021) Besa Vial, Pablo José; Telias, Alberto; Orrego, Francisca; Guzmán-Venegas, Rodrigo; Cariola, Martín; Amenábar, Diego; Palma, Felipe H.; Irarrázaval Domínguez, Sebastián; Orrego Luzoro, Mario Santiago
    Introduction: Acute patellar tendon ruptures are frequently observed in patients with metabolic comorbidities, and the benchmark treatment is surgical repair. It is desirable not to harm an already fragile biologic environment with sutures and hardware. We aimed to compare the mechanical requirements of an isolated, flexible, high-strength nonabsorbable transosseous suture frame with that of the Krackow suture technique. Methods: A total of 12 cadaveric pieces were randomized into two groups: the isolated flexible frame group (n = 6) and the standard Krackow fixation group (n = 6). A traumatic rupture of the patellar tendon was performed, and a transosseous displacement sensor was installed on a validated biomechanical system. Gap formation was measured during 50 cycles of flexion and extension with traction on the quadriceps (250 N). Subsequently, specimens underwent progressive loading in a fixed flexion position until failure occurred. The data were analyzed using nonparametric statistical tools with a significance level of 5%. Results: The isolated frame group had a smaller gap formation (1.7 mm) than the Krackow group (3.4 mm; P = 0.01). No significant difference existed in the median failure end points of the two groups (676 and 530 N, respectively; P = 0.11). Discussion: Patellar tendon repair using an isolated, transosseous, flexible, suture frame outperformed using the traditional Krakow repair technique in gap formation. Further studies are needed to determine if this will result in better functional outcomes or fewer clinical failures. Level of evidence: Level IV, experimental case series.
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    An online training and feedback module enhances the musculoskeletal examination performance of medical interns
    (2024) Arteaga, Matías; Vidal Olate, Catalina Victoria; Ruz, Cristián; Zilleruelo Cañas, Raúl Andrés; Pino Piemonte, Ernesto Arnaldo; Dauvergne Ogaz, Javier Alejandro; Besa Vial, Pablo José; Irarrázaval, Sebastián
    Background: Pathologies of the locomotor system are frequent and can cause disability and impact the quality of life of the people affected. In recent years, online training and feedback have emerged as learning tools in many fields of medicine. Objective: This study aims to evaluate medical interns’ musculoskeletal examination performance after completing an online training and feedback module. Methods: This study employed a quasi-experimental design. Medical interns were invited to complete a 4-week musculoskeletal physical examination training and feedback module via an e-learning platform. The course included written and audiovisual content pertaining to medical history, physical examination, and specific tests for the diagnosis of the most common knee, spine, shoulder, ankle, and foot conditions. Before and after completing the module, their ability to perform the physical examination was evaluated using an objective structured clinical examination (OSCE) with simulated patients that took place face-to-face. A control group of experts was assessed using the OSCE, and their performance was compared to that of the interns before and after the training. At the end of the module feedback on the OSCE was provided to participants through the platform asynchronously and two evaluation questions about the user experience were conducted at the end of the study. Results: A total of 35 subjects were assessed using the OSCE, including 29 interns and 6 experts. At the beginning of the training module, the group of interns obtained an average score of 50.6±15.1. At the end of the module, 18 interns retook the OSCE, and their performance increased significantly to an average of 76.6±12.8 (p<0.01). Prior to the training, the experts performed significantly better than the interns (71.2 vs. 50.6; p=0.01). After the interns received the training and feedback, there were no significant differences between the two groups (71.2 vs. 76.6; p=0.43). Two evaluation questions were conducted at the end of the study, revealing that 93% of the participants affirm that the training module will be useful in their clinical practice, and 100% of the participants would recommend the training module to a colleague. Conclusión: The online training and feedback module enhances the musculoskeletal examination performance of medical interns.
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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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    Does 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
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    Evaluation of the Chilean National Orthopaedic Examination Over 11 Years: Progress and Outcomes of National and International Examinees
    (LIPPINCOTT WILLIAMS & WILKINS, 2024) Lira Salas, María Jesús; Besa Vial, Pablo José; Irarrázaval Dominguez, Sebastián; Ruz Laurent, Cristian Andrés; Walbaum, Garcia Cristóbal; Montecinos, Carla; Amenabar, Diego; Orrego Luzoro, Mario Santiago
    Introduction: The National Orthopaedics Examination (EMNOT) was initially designed for Chilean orthopaedic program graduates and is now a crucial component of the revalidation process for international orthopaedic surgeons seeking practice in Chile. This study aims to describe participation and performance of EMNOT examinees based on their origin and to analyze the difficulty and discrimination indexes during its first 11 years of implementation. Methods: A retrospective assessment was conducted on all EMNOT results from 2009 to 2019. The study evaluated the participation and performance of examinees according to their origin and examined the difficulty and discrimination indexes of the examination.Results: A total of 975 examinees were evaluated, with 41.23% from national resident programs (National Medical Graduates) and 58.77% from international examinees (International Medical Graduates). The number of participating universities increased from 4 in 2009 to 17 in 2019. National Medical Graduates examinees achieved a mean score of 66.52 +/- 8.67 (0 to 100 points) while International Medical Graduates examinees scored 55.13 +/- 11.42 (P , 0.001). The difficulty and discrimination indexes remained adequate throughout this period. Discussion: Over the course of 11 years, the number of EMNOT examinees exhibited notable growth. The examination effectively differentiates between candidates based on their origin and maintains appropriate levels of difficulty and discrimination.
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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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    Mid and lower thoracic kyphosis changes during adulthood: the influence of age, sex and thoracic coronal curvature
    (2021) Urrutia Escobar, Julio Octavio; Besa Vial, Pablo José; Narvaez, Felipe; Meissner-Haecker, Arturo; Rios, Clemente; Piza, Cristobal
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    Orthopaedic Residents' Transfer of Knee Arthroscopic Abilities from the Simulator to the Operating Room
    (2020) Ledermann, G.; Rodrigo, A.; Besa Vial, Pablo José; Irarrázaval Delpiano, Sebastián
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    Scheuermann's disease in patients 15-40 years old: a study to determine its prevalence and its relationship with age and sex using chest radiographs as screening tool
    (2019) Urrutia Escobar, Julio Octavio; Narvaez, F.; Besa Vial, Pablo José; Meissner Haecker, A.; Ríos, C.; Piza, C.
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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.
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    The distance between the fibular collateral ligament tunnel and the common peroneal nerve allows a posterolateral corner reconstruction without neurolysis
    (Institute for Ionics, 2023) Vial Irarrazabal, Raimundo; Orrego Luzoro, Mario Santiago; Espinosa Fuenzalida, Julio Andrés; Besa Vial, Pablo José; Irarrazaval Domínguez, Sebastián
    © 2023, The Author(s) under exclusive licence to SICOT aisbl.Purpose: The most popular knee posterolateral corner (PLC) reconstruction techniques describe that a common peroneal nerve (CPN) neurolysis must be done to safely address the posterolateral aspect of the knee. The purpose of this study was to measure the distance between the CPN and the fibular insertion of the FCL in different degrees of knee flexion in cadaveric specimens, to identify if tunnel drilling could be done anatomically and safely without a CPN neurolysis. Methods: Ex vivo experimental analytical study. Ten fresh frozen human knees were dissected leaving FCL and CPN in situ. Shortest distance from the centre of the FCL distal tunnel and CPN was measured (antero-posterior and proximal-distal wire-nerve distances) at 90°, 60°, 30°, and 0° of knee flexion. Measurements between different flexion angles were compared and correlation between knee flexion angle and distance was identified. Results: The mean distance between the FCL tunnel and the CPN at 90° were 21.15 ± 6.74 mm posteriorly (95% CI: 16.33–25.97) and 13.01 ± 3.55 mm distally (95% CI: 10.47–15.55). The minimum values were 9.8 mm posteriorly and 8.9 mm, respectively. These distances were smaller at 0° (p ≤ 0.017). At 90° of knee flexion, the mean distance from the fibular tip to the CPN distally was 23.46 ± 4.13 mm (20.51–26.41). Conclusion: Anatomic localization and orientation of fibular tunnels can be done safely while avoiding nerve neurolysis. Further studies should aim to in vivo measurements and results.
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    The new AO classification system for intertrochanteric fractures allows better agreement than the original AO classification. An inter- and intra-observer agreement evaluation
    (2020) Klaber Rosenberg, Ianiv; Besa Vial, Pablo José; Sandoval, F.; Lobos, D.; Zamora Helo, Tomás; Schweitzer Fernández, Daniel; Urrutia Escobar, Julio Octavio
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    Tibial tubercle to trochlear groove and the roman arch method for tibial tubercle lateralisation are reliable and distinguish between subjects with and without major patellar instability
    (2024) Irarrázaval Domínguez, Sebastián; Besa Vial, Pablo José; Fernández, Tomás; Fernandez Schlein, Francisco Andrés; Aguirre Donoso, Rodrigo; Tuca De Diego, María Jesús; Lira Salas, María Jesús; Orrego Luzoro, Mario Santiago