Introduction: Postoperative complications (PCs) constitute any deviation from the normal postoperative course. Reporting of PCs remains a challenge, multiple classification systems have been proposed, however these have not been validated across surgical specialties. Clavien and Dindo (DCCS) developed a system for General Surgery and has been adopted in different fields. Nonetheless, this classification has not been adapted to Orthopedics. The objective of this study was to adapt the Clavien-Dindo classification to orthopedic scenarios and to determine the intra and interobserver reliability. Methods: The designer team adapted the Clavien Dindo classification to orthopedic scenarios. Ten orthopedic observers with different degrees of training and experience were selected to evaluate the classification. 48 simulated clinical scenarios of complications and another negative outcomes such as failure to cure and sequelae were sent by electronic format independently. A second round of scoring was performed 30 days later to assess the intraobserver concordance. Results: We found a high interobserver and intraobserver reliability for both the first and second evaluation (Kappa 0.88 and 0.91, respectively). In addition, the intraobserver analysis showed a very good correlation (Kappa 0.93). Discussion: The DCCS classification has been developed for general surgery and has been widely applied in the different surgical subspecialties. In Orthopedics, this classification was validated to hip and pediatric surgery. Therefore, our study involved an adaptation of the classification to general and specific orthopedic scenarios of the different orthopedic subspecialties. This classification may be a useful tool for documenting complications in orthopedic surgery. Keywords: postoperative complications; orthopedics; health systems

Introduction: Registration of adverse events following orthopedic surgery has a critical role in patient safety and has received increasing attention. The purpose of this study was to determine the prevalence and severity of postoperative complications in the department of orthopedic unit in a tertiary hospital.Methods: A retrospective review from the postoperative complication registry of a cohort of consecutive patients operated in the department of orthopedic surgery from May 2015 to June 2016 was performed. Short-term complications (3 months after surgery), age gender, types of surgery (elective, scheduled urgency, non-scheduled urgency, and emergency), operative time, surgical start time (morning, afternoon or evening), American Society of Anesthesiologists score and surgeon's experience were assessed. Complications were classified based on their severity according to Dindo-Clavien system: Grade I complications do not require alterations in the postoperative course or additional treatment; Grade II complications require pharmacological treatment; Grade III require surgical, endoscopic, or radiological interventions without (IIIa) or with (IIIb) general anesthesia; Grade IV are life-threatening with single (IVa) or multi-organ (IVb) dysfunction(s), and require ICU management; and Grade V result in death of the patient. Complications were further classified in minor (Dindo I, II, IIIa) and major (Dindo IIIb, IVa, IVb and V), according to clinical severity.Results: 1960 surgeries were performed. The overall 90-day complication rate was 12.7% (249/1960). Twenty-three complications (9.2 %) were type I, 159 (63.8%) type II, 9 (3.6%) type IIIa, 42 (16.8%) type IIIb, 7 (2.8%) type IVa and 9 (3.6%) were grade V according to Dindo-Clavien classification (DCC). The most frequent complication was anemia that required blood transfusion (27%) followed by wound infection (15.6%) and urinary tract infection (6%).Discussion: The overall complication rate after orthopedic surgery in our department was 12.7%. The implementation of the DCC following orthopedic surgery was an important tool to measure the standard of care.

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Introducción: La afección articular que lleva a la necesidad de una artrodesis tibio-calcánea puede estar acompañada de una segunda lesión en el mismo segmento óseo, y los clavos de diseño para artrodesis no tienen la longitud adecuada para cubrir ambas lesiones. No hallamos opciones terapéuticas para este tipo de lesiones en la bibliografía. Objetivo: Presentar una serie de casos en los que se utilizó un único clavo de tibia (de colocación anterógrada) de forma retrógrada, con el doble objetivo de efectuar una artrodesis tibio-talo-calcánea, sumada al tratamiento de una lesión asociada en un mismo tiempo quirúrgico. Materiales y Métodos: Se evaluó, en forma retrospectiva, desde septiembre de 2009 hasta junio de 2019, a un grupo de 12 pacientes que requirió una artrodesis tibio-talo-calcánea sumada a la necesidad de resolver simultáneamente un defecto secundario local. La edad promedio fue de 43.7 años, y el seguimiento global fue de 43.9 meses. Resultados: Todos los pacientes lograron una artrodesis tibio-calcánea constatada en radiografías de frente y de perfil, y el 83,3% recuperó el stock óseo de manera completa. Conclusión: Ante la ausencia en el mercado de osteosíntesis para resolver las patologías asociadas en un mismo paciente, proponemos el uso del clavo endomedular largo de tibia colocado de manera retrógrada como una opción de tratamiento, porque se ha demostrado que es eficaz para lograr la artrodesis tibio-calcánea. Además, se lo pudo utilizar como guía en el alargamiento y el transporte óseo, y como estabilización para tratar lesiones simultáneas.      

Las lesiones por avulsión isquiática o rotura tendinosa en la inserción proximal de los isquiotibiales son infrecuentes. El abordaje terapéutico es diferente del de los desgarros. Se ha comprobado ampliamente un mayor beneficio con el tratamiento quirúrgico y, dada la baja frecuencia de este tipo de lesiones, son pocos los cirujanos ortopédicos habituados tanto al diagnóstico como al procedimiento quirúrgico. El objetivo de este estudio es reportar cuatro casos de pacientes con rotura insercional de isquiotibiales y describir la técnica quirúrgica utilizada. Asimismo, se detallan las variantes quirúrgicas y sus resultados.