Person:
Marco Martínez, Fernando

First Name

Fernando

Last Name

Marco Martínez

URI

https://hdl.handle.net/20.500.14352/79599

Affiliation

Universidad Complutense de Madrid

Faculty / Institute

Medicina

Department

Cirugía

Area

Traumatología y Ortopedia

Identifiers

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Now showing 1 - 10 of 18

Project number: 240
Aprendizaje activo basado en la resolución de casos clínico-radiológicos de patología del aparato locomotor en enseñanza virtual
(2021) Crespo Rodríguez, Ana María; Archanco Olcese, Miguel; Cabrera Martín, María Nieves; Carreras Delgado, José Luis; Casado Herráez, Antonio; Corona Sánchez, Juan Antonio; Cuenca González, Concepción; Fernández Gutiérrez, Benjamín; Francés Borrego, Alberto; García Merino, Mikel; Gómez Peña, Sara; Lópiz Morales, María Yaiza; Marco Martínez, Fernando; Marquina Ospina, Gloria; Muñoz Hernando, Miriam; Nava Muñoz, Ángel
Las estrategias de enseñanza on-line basadas en Tecnologías de la Información y la Comunicación (TIC) se han utilizado con éxito para acercar la práctica clínica de Radiología a los estudiantes de Grado de Medicina durante el curso académico 2020-21. Los alumnos trabajaron por equipos con el método de Aprendizaje Basado en la Resolución de Problemas (ABRP). De esta manera, se aseguró la consecución de los objetivos formativos y se dio a conocer la forma de trabajo del médico radiólogo, el proceso de razonamiento diagnóstico, los sistemas de información de los hospitales y en particular del Picture Archiving and Communication System (PACS).
Third-generation intramedullary nailing for displaced proximal humeral fractures in the elderly: quality of life, clinical results, and complications
(Archives of Orthopaedic and Trauma Surgery, 2020) Lópiz Morales, María Yaiza; Garríguez Pérez, Daniel; Martínez Illán, Marina; García Fernández, Carlos; Marco Martínez, Fernando
Introduction: Antegrade insertion of third-generation intramedullary nail (IMN) has been shown to provide excellent results in young patients for treatment of displaced two-part surgical neck fracture. In elderly patients, osteoporosis makes internal fixation problematic and frequently contributes to failed fixation and poor clinical results. The purpose of this study was to report the health-related quality of life (HRQoL), functional results, and postoperative complications obtained with straight third-generation antegrade nailing of proximal humerus fractures (PHFs) in elderly patients. Methods: A retrospective review of 32 patients aged 80 y.o. or older presenting a two-part or three-part PHFs treated with a straight IMN with a minimum follow-up of 12 months. Results assessed included 1) radiographic measures 2) clinical data: Charlson Comorbidity Index (CCI), VAS, range of motion (ROM), Individual Relative Constant score (IRC), Simple Shoulder Test (SST) and 3) Health-related Quality of life (HRQoL) with the EQ-5D index/EQ-VAS. Results: Mean age was 82.1 (range 80-90) and mean follow-up was 45.6 months (range 16-53 months) with 91% of female patients and a mean CCI 4.6. 81% were two-part surgical neck fractures and 19% were three-part greater tuberosity fractures. The mean neck-shaft angle (NSA) at final follow-up was 132º ± 17.9º. 15.6% underwent hardware removal because of subacromial impingement and one patient (3%) was revised to RSA because of severe secondary fracture displacement. Mean IRC was 67,7 ± 30, the mean SST and VAS-Pain were 8.1 ± 3.1 and 3.2 ± 3.2, respectively, and the mean EQ-5D/EQ-VAS were 0.40 ± 0.33/64.2 ± 8.9. At last review, mean active forward flexion, abduction, and external rotation were 115º ± 35º, 100º ± 35º, and 20º ± 15º, respectively. Conclusion: Appropriate selection of fracture and proper operative technique with a third-generation nail result in good functional results and good HRQol with a low complication rate in elderly population. Elderly; Multiloc; Proximal humeral fracture; Proximal humeral nail; Quality of life.
Suprascapular nerve injury after reverse total shoulder arthroplasty. Correlation with screw out of vault penetration and functional situation. Prospective study
(Journal of Shoulder and Elbow Surgery, 2023) Lópiz Morales, María Yaiza; Rodriguez Gonzalez, Alberto; Martín Albarrán, Susana; Moreu Gamazo, Manuel; Ponz, Virginia; García Fernandez, Carlos; Marco Martínez, Fernando
Introduction: Baseplate screws have been suggested as a possible cause of suprascapular neuropathy after reverse total shoulder arthroplasty (RTSA). This study aims to investigate the association between screw penetration out of the vault, electromyographic study and the clinical outcomes. Methods: 31 patients who underwent RTSA for cuff tear arthropathy were prospectively enrolled. They were followed up for a minimum of 24 months. All underwent computed tomography 6 months postoperatively in order to determine the extraosseous position of the screws (perforation of the second bone cortex and protrusion into the supra or infraspinatus fossa). Electrodiagnostic evaluation was performed preoperatively and postoperatively to stablish any relation between cortex perforation of the screw and SSN injury. Clinical outcomes pre and postoperatively (Constant score, ranges of motion, and VAS) of patients with and without documented injury were recorded. Results: 14 patients (45.2%) had abnormal preoperative SSN electrodiagnostic study (chronic or disuse injuries) and 6 patients (19.4%) abnormal postoperative study (acute injury. Of these last 6 patients: 2 cases appeared over the pre-existing lesion and 4 appeared over an intact preoperative nerve, all of them affecting the infraspinatus branch of the SSN. Perforation of the second cortex was detected for 60% of superior screws and 40% of posterior screws. The mean lengths of the superior and posterior screws were 30 and 18.2 mm, respectively. Patients with screw perforation of the second cortex were assessed as having a high risk of nerve injury (40% vs. 9.5%). Conclusions: Preoperative SSN injuries do not have a significant clinical impact and do not predispose to an acute postoperative SSN lesion. The Constant Score and VAS scale for patients with acute SSN injuries were not statistically different than those without SSN injury. Extraosseous position of the screw increases the probability of a SSN injury to 31%. This risk is higher with the posterior screw, which leads us to question whether it is really necessary to use it.
Neuropathy of the suprascapular and axillary nerves in rotator cuf arthropathy: a prospective electrodiagnostic study
(International Orthopaedics, 2024) Lópiz Morales, María Yaiza; Rodríguez González, Alberto; Martín Albarrán, Susana; Herzog, Raul; García Fernández, Carlos; Marco Martínez, Fernando
Purpose: Prevalence of axillary (AN) and/or suprascapular (SSN) neuropathy in rotator cuff tear arthropathy (RCTA) is unknown. We aimed to prospectively evaluate for preoperative neurodiagnostic abnormalities in order to determine their prevalence, location, and influence on reverse shoulder arthroplasty (RSA) outcomes. Methods: Patients who underwent RSA for RCTA were prospectively included. An electromyography and nerve conduction study were performed pre and post-surgery. Clinical situation: VAS, Relative Constant-Murley Score (rCMS) and ROM over a minimum of two years follow-up. Results: Forty patients met the inclusion criteria; mean follow-up was 28.4 months (SD 4.4). Injuries in RCTA were present in 83.9% (77.4% in AN and 45.2% in SSN). There were no differences on preoperative VAS, ROM, and rCMS between patients with and without preoperative nerve injuries. Four acute postoperative neurological injuries were registered under chronic preoperative injuries. Six months after RSA, 69% of preoperative neuropathies had improved (82.14% chronic injuries and 77.7% disuse injuries). No differences in improvement between disuse and chronic injuries were found, but patients with preoperative neuropathy that had not improved at the postoperative electromyographic study at six months, scored worse on the VAS (1.44 vs 2.66; p .14) and rCMS (91.6 vs 89.04; p .27). Conclusions: The frequency of axillary and suprascapular neuropathies in RCTA is much higher than expected. Most of these injuries improve after surgery, with almost complete neurophysiological recovery and little functional impact on RSA. However, those patients with preoperative neuropathies and absence of neurophysiological improvement six months after surgery have lower functional results.
Do the humeral radiographic changes at 5-year follow-up affect the clinical outcomes of press-fit humeral stems in primary reverse shoulder arthroplasties?
(European Journal of Orthopaedic Surgery & Traumatology, 2024) García Fernández, Carlos; Lópiz Morales, María Yaiza; Garríguez Pérez, Daniel; Arvinius, Camilla; Ponz, Virginia; Echevarria, Marta; Garrido, Ana; Marco Martínez, Fernando
Introduction: The purposes of this study were to analyze and compare the functional outcomes and radiological changes around the press-fit humeral components in two contemporary medialized reverse total shoulder arthroplasty (RTSA) systems at a minimum of 5-year follow-up. Materials and methods: Between December 2003 and December 2015, 249 consecutive RTSAs were performed at our hospital. Of these, 68 primary uncemented RTSA met our inclusion criteria. The Constant-Murley score (CMS), the modified Constant score, a visual analog scale (VAS) and active shoulder range of motion (ROM) were measured pre- and postoperatively. Radiological assessment was performed by plain radiographs at a minimum of 5 years postoperatively. Results: At a mean follow-up of 80.2 months, there was no significant difference (p = .59) between the postoperative functional scores and range of motion of the two groups (Delta Xtend and Lima SMR). Radiological data of stress-shielding were observed in 38 patients (55.9%) being slightly more frequent in the Lima SMR group (21 patients) than in the Delta Xtend group (17 patients) (p = .62). Conclusions: Our study shows that the good functional results are similar between the two uncemented RTSA systems used and that they do not depend on the presence of radiological changes (stress-shielding) in the humeral stem at a minimum 5-year follow-up.
Dislocation after reverse total shoulder arthroplasty using contemporary medialized modular systems. Can we still consider it such a frequent complication?
(European Journal of Orthopaedic Surgery and Traumatology, 2021) Garcia Fernandez, Carlos; Lópiz Morales, María Yaiza; Arvinius, Camilla; Ponz, Virginia; Alcobía Diaz, Borja; Checa, Pablo;; Galán Olleros, Maria; Marco Martínez, Fernando
Introduction: Improvement in reverse total shoulder arthroplasty (RTSA) prosthesis and technique has reduced the initially high complication and revision rates associated with this implant. However, instability continues to be a leading cause of reoperation after RTSA, being related in previous studies with medialized designs. The aim of this study was to determine the dislocation rate with the employment of two medialized modular systems of RTSA in our institution. Materials and methods: A retrospective review of two different modular systems of RTSA (SMR Modular Shoulder System and Delta XTEND Reverse Shoulder) was performed between 2009 and 2017 with a minimum 3-year follow-up. Baseline demographic, clinical (Constant, ASES and ROM), and radiographic data were collected. Characteristics of postoperative instability cases were also evaluated. Results: 237 primary RTSA (41% SMR/59% Delta) and 34 revision RTSA (44% SMR/56% Delta) with a mean follow-up of 75.6 ± 5.2 months (79.2 SMR/86.3 Delta, p = .586) were included in the present study. Indications for primary RTSA were osteoarthritis, rotator cuff tear arthropathy and massive irreparable rotator cuff tear (64%), acute fracture (32%), and fracture sequelae (4%). Subscapularis tendon was always repaired in degenerative pathology and tuberosities reattached in traumatic cases. The mean age of the global series was 76.5 ± 5.3 years (75.8 SMR/78.6 Delta, p = .104) with a mean Constant/ASES score at final follow-up of 68.5 ± 4.3/72.9 ± 20.3 (71/68 SMR and 69/74 Delta, p = .653 and .642). Only 2 patients (one acute fracture and one fracture sequelae) suffered an early postoperative anterior dislocation (before 3 months) which represents a rate of .84% in primary cases and .73% including revision surgery. Closed reduction manoeuvres were not successful, and both patients required revision surgery. At the end follow-up, both were stable and had no further dislocations. Conclusion: The dislocation rate after RTSA with the employment of two contemporary modular systems with a medialized centre of rotation is extremely low, especially when compared with the previously published series with the original Grammont design. Acute fracture and fracture sequelae were the main diagnoses associated with this instability. The reasons for the low dislocation rate are multifactorial, but the improvement in the baseplate position according to the more recent standards of "ideal position" and technical aspects such as subscapularis repair or tuberosity reattachment in fractures probably play an important role in this aspect.
Functional results of Circumferential Capsular Release in adhesive shoulder capsulitis. Comparative study of patients over and under fift years of age
(Archives of Orthopaedic and Trauma Surgery, 2023) Gómez Muñoz, Eduardo; Sánchez Ibáñez, Ivan; Garríguez Pérez, Daniel; García Fernández, Carlos; Marco Martínez, Fernando; Lópiz Morales, María Yaiza
Introduction: The aim of our study is to evaluate the functional and mobility outcomes in patients who have undergone arthroscopic circumferential arthrolysis of the shoulder and to find out if there are differences in the results in relation to the patient's age. Materials and methods: This is a retrospective case series of patients with idiopathic adhesive capsulitis treated by arthroscopic 360º circumferential capsulotomy in lateral position and followed for a minimum of 2 years. Range of motion (ROM), functional outcomes using the Constant Score (CS), health-related quality of life outcomes with the EuroQol Five Dimensions tool (EQ-5D), pain using the Visual Analogue Scale (VAS). Results: A total of 26 shoulders were included, 10 men (41.7%) and 14 women (58.3%), with 2 patients being bilateral. The mean age was 48.64 ± 7.5 years, and the mean follow-up was 50.2 months. Postoperative ROM improved significantly compared to preoperative ROM (p < 0.05). Shoulder forward flexion improved by 38.6° (95%CI 22.3-54.9, p < 0.01), abduction by 35.2° (95%CI 17.6-52.8, p < 0.01) and external rotation by 21.9° (95%CI 12.8-30.9, p < 0.01 p < 0.01). Median internal rotation improved from buttock to T12 (p < 0.01). The mean improvement in CS was 54.3 ± 24.4 points (p < 0.01). The EQ-5D and VAS scores at the end of follow-up were 0.73 ± 0.23 and 2.73 ± 2.55, respectively. There were no statistical differences between young patients and patients aged 50 years or older in ROM or functional results. Conclusions: Patient age did not affect outcomes significantly, with patients older than 50 years showing similar results to younger patients.
Acromioclavicular joint dislocation associated with a coracoid process fracture: report of 2 cases
(JSES International, 2020) Galán Olleros, María; Lópiz Morales, María Yaiza; Arvinius, Camila; García Fernández, Carlos; Marco Martínez, Fernando
Shoulder problems after percutaneous antegrade intramedullary nailing in humeral diaphyseal fractures using contemporary straight third-generation nail
(J Shoulder Elbow Surg, 2023) Garriguez Pérez, Daniel; Roman Gómez, Julia; Scarano Pereira, Juan Pablo; Ponz Lueza, Virginia; García-Fernández, Carlos; Lópiz Morales, María Yaiza; Marco Martínez, Fernando
Background: Antegrade intramedullary nailing in humeral shaft fracture has been abandoned by certain orthopedic surgeons because of rotator cuff injury caused by first- and second-generation intramedullary nails (IMNs). However, only a few studies have specifically addressed the results of antegrade nailing for the treatment of humeral shaft fractures with a straight third-generation IMN; thus, complications need to be re-evaluated. We hypothesized that fixation of displaced humeral shaft fractures with a straight third-generation antegrade IMN with the percutaneous technique avoid shoulder problems (stiffness and pain) incurred by first- and second-generation IMNs. Methods: This was a retrospective, single-center, nonrandomized study of 110 patients with a displaced humeral shaft fracture between 2012 and 2019 treated surgically with a long third-generation straight IMN. Mean follow-up was 35.6 months (range, 15-44 months). Results: There were 73 women and 37 men with a mean age of 64.7 ± 19 years. All fractures were closed (37.3% 12A1, 13.6% 12B2, and 13.6% 12B3 AO/OTA classification). Mean Constant score was 82 ± 19, Mayo Elbow Performance Score 96 ± 11 and the mean EQ-5D visual analog scale score was 69.7 ± 21.5. Mean forward elevation 150° ± 40°, abduction 148° ± 45°, and external rotation 38° ± 15°. Symptoms associated with rotator cuff disease were present in 6.4%. Evidence of radiographic fracture healing was detected in all but 1 case. One postoperative nerve injury and 1 adhesive capsulitis were present. Overall, 6.3% underwent second surgeries (4.5% were minor surgeries like hardware removal). Conclusion: Percutaneous antegrade intramedullary nailing of humeral shaft fractures with a straight third-generation nail considerably reduced complications related to shoulder problems and achieved good functional results.
Does fluoroscopy improve baseplate position compared to conventional technique in reverse shoulder arthroplasty? A preliminary study
(Shoulder and Elbow, 2021) Galán Olleros, María; Lópiz Morales, María Yaiza; Ciller, Gabriel; Alcobía Díaz, Borja; García Fernández, Carlos; Marco Martínez, Fernando
Background: Accurate placement of glenoid component in reverse shoulder arthroplasty remains a challenge for surgeons of all levels of expertise; however, no studies have evaluated the utility of fluoroscopy as a surgical assistance method. Methods: Prospective comparative study of 33 patients undergoing primary reverse shoulder arthroplasty during a 12-month period. Fifteen patients had a baseplate placed using the conventional "free hand" technique (control group), and 18 patients using intraoperative fluoroscopy assistance group, in a case-control design. Postoperative glenoid position was evaluated on postoperative Computed Tomography (CT) scan. Results: The mean deviation of version and inclination for fluoroscopy assistance vs. control group was 1.75° (0.675-3.125) vs. 4.2° (1.975-10.45) (p = .015), and 3.85° (0-7.225) vs. 10.35° (4.35-18.75) (p = .009). The distance from the central peg midpoint to the inferior glenoid rim (fluoroscopy assistance 14.61 mm/control 4.75 mm, p = .581) and the surgical time (fluoroscopy assistance 1.93 ± 0.57/control 2.18 ± 0.44 h, p = .400) showed no differences, with an average radiation dose of 0.45 mGy and fluoroscopy time of 14 s. Conclusions: Accurate axial and coronal scapular plane positioning of glenoid component is improved with intraoperative fluoroscopy at the cost of a greater radiation dose and without differences in surgical time. Comparative studies are needed to determine whether their use in relation to more expensive surgical assistance systems result in similar effectiveness.L evel of evidence : Level III, therapeutic study.