Amhaz Escanlar S.

By Alberto Jorge-Mora, Samer Amhaz-Escanlar, Iván Couto González, Cristina López-Del Teso, Rodolfo Gómez, Teresa Jorge-Mora, José Ramón Caeiro-Rey and Jesús Pino-Mínguez

Open fractures are common and their prevalence is increasing in elderly people. The burden of open fractures is high because of economic and social costs. Most open fractures occur in lower limbs. The use of validated protocols, will optimize our outcomes when treating open fractures. The first step began with the proper identification of the fracture characteristics and the hidden soft tissue injury. The use of an adequate and early antibiotic prophylaxis is mandatory and then, we have to perform adequate irrigation and debridement. Finally, we have to decide to temporally fix the fracture or proceed with the definitive fixation method. Recently, the creation of dedicated “orthoplastic” units has increased the outcomes in high-energy tibial fractures. These fractures should be managed in adequate trauma centers that should be used to face all the complications that will appear during the reconstruction procedure because complications can be as high as 50% in high-energy open fractures.

Part of the book: Trauma Surgery

By Amhaz Escanlar S., Jorge Mora A. and Pino Miguez J.

Rotator cuff tears are a common cause of pain and disability among adults. Partial tears are usually treated conservatively. Complete tears might be treated conservatively in some cases; however, surgical repair is often performed in selected cases and situations where conservative treatment fails to restore function and pain relief. In addition, some patients with acute tears might be good candidates for acute surgical repair, as will be studied in this chapter. A plethora of techniques is available to repair rotator cuff tears. Among these, the surgeon faces the dilemma to choose the best treatment for the patient. Open techniques were the gold standard in the 1990s. However, the advent of arthroscopy has led the shoulder and sports surgeon community towards these. Arthroscopic rotator cuff repair has become the gold standard nowadays despite the lack of proper evidence to support this change. Furthermore, simple single-row repairs had been discarded favouring double-row techniques, yet new evidence supports the use of the former due to similar results, simplicity and cost-effectiveness. This chapter examines current evidence to help the surgeon decide between open and minimally invasive techniques and select suitable repair configurations.

Part of the book: Shoulder Surgery for RC Pathology, Arthropathy and Tumors

By Raquel Guitián-Montes, Samer Amhaz-Escanlar, Alberto Jorge-Mora and Ana Carolina Presas-Presas

Throughout this chapter, we will discuss the treatment of greater tuberosity fractures of the proximal humerus. Greater tuberosity fractures are common, and an increase is expected due to population aging. We can address these fractures in different ways to restore the anatomy and function of the patient, but surgery is usually selected for displaced fractures. The surgical approach remains unclear, and few data can guide surgeons in choosing one technique or another. We will discuss open versus less invasive and arthroscopic repair techniques for fractures of the greater tuberosity of the humerus, and we will try to underline the advantages and cons of each method and describe the evidence around each surgical technique. We will also include some tips and tricks that may be helpful to orthopedic surgeons to achieve an optimal outcome.

Part of the book: Shoulder Surgery