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BACKGROUND: Patient-Reported Outcome Measures (PROMs) are tools of increasing interest in the sports population. The purpose of this study was to perform the cross-cultural adaptation and reliability analysis of the 4 Domain Sports Patient-Reported Outcome Measure (4 DSP) into Spanish. METHODS: A six-stage cross-cultural adaptation protocol was executed to obtain the Spanish version of the 4 DSP (S-4DSP). Subsequently, the questionnaire was administered to a population of 108 postoperative athletes with ACL (Anterior Cruciate Ligament) injuries. The questionnaire was administered again after 30 days. Acceptability, floor and ceiling effects, internal consistency (Cronbach's alpha), and reproducibility (Intraclass Correlation) were evaluated. RESULTS: The S-4DSP was fully completed by 108 participants (mean age 34±10.75, 26% women), achieving 100% acceptability. No floor effect was detected. The statistical analysis yielded a global Cronbach's alpha for the questionnaire of 0.65, and domain-specific alphas of 0.88, 0.72, 0.27, and 0.68 for the first, second, third, and fourth domains, respectively. The Intraclass Correlation test reached a maximum of 0.94 and a minimum of 0.48 for the first and fifth questions, respectively. CONCLUSIONS: The S-4DSP is a reliable and useful tool for evaluating Spanish-speaking athletes after ACL reconstruction.

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BACKGROUND: Patient-Reported Outcome Measures (PROMs) are tools of increasing interest in the sports population. The purpose of this study was to perform the cross-cultural adaptation and reliability analysis of the 4 Domain Sports Patient-Reported Outcome Measure (4DSP) into Spanish. METHODS: A six-stage cross-cultural adaptation protocol was executed to obtain the Spanish version of the 4DSP (S-4DSP). Subsequently, the questionnaire was administered to a population of 108 postoperative athletes with ACL (Anterior Cruciate Ligament) injuries. The questionnaire was administered again after 30 days. Acceptability, floor and ceiling effects, internal consistency (Cronbach's alpha), and reproducibility (Intraclass Correlation) were evaluated. RESULTS: The S-4DSP was fully completed by 108 participants (mean age 34±10.75, 26% women), achieving 100% acceptability. No floor effect was detected. The statistical analysis yielded a global Cronbach's alpha for the questionnaire of 0.65, and domain-specific alphas of 0.88, 0.72, 0.27, and 0.68 for the first, second, third, and fourth domains, respectively. The Intraclass Correlation test reached a maximum of 0.94 and a minimum of 0.48 for the first and fifth questions, respectively. CONCLUSIONS: The S-4DSP is a reliable and useful tool for evaluating Spanish-speaking athletes after ACL reconstruction.

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Resumen: Introducción: La luxación tibiofibular proximal (LTFP) es una lesión poco frecuente y no diagnosticada. De no ser tratada a tiempo, puede generar una sintomatología crónica de dolor e inestabilidad. La escasa evidencia disponible no entrega un protocolo de enfrentamiento ni consenso respecto a su manejo. Con el objetivo de asistir al enfrentamiento de esta lesión, se presenta una revisión de la literatura de una LTFP con reducción espontánea. Caso clínico: Hombre de 22 años consulta por dolor intenso en su rodilla derecha, posterior a caída en cuatrimoto. Al examen físico con aumento de volumen doloroso en cara lateral de la rodilla y pierna proximal, con movilidad completa y estable. Radiografías son informadas sin alteraciones. Se mantiene la sospecha clínica de LTFP, se continúa estudio con resonancia magnética (RM), la que es sugerente de LTFP. Dentro de las 24 horas de evolución, el paciente indica haber sentido un clank espontáneo en su rodilla afectada con cese completo de sintomatología. Se sigue al paciente por tres meses con RM de control, manteniendo una rodilla asintomática; examen físico y funcionalidad normal. Conclusión: El diagnóstico de las LTFP requiere un adecuado uso de imágenes. Su manejo consiste en una reducción cerrada de urgencia y de no lograrse, una reducción abierta, reparación y fijación interna. El pronóstico de las reducciones espontáneas es incierto, por lo que deben ser seguidas de forma seriada y en caso de recidiva, manejadas quirúrgicamente según el tiempo de evolución.

Abstract: Introduction: Proximal tibiofibular joint dislocations (PTFJD) are uncommon and underdiagnosed injuries. Urgent reduction is mandatory to avoid chronic disfunction. The scarcely available literature does not present a unified management guideline. An acute PTFJD case report with spontaneous reduction and a review of the literature is presented, aiming to assist the diagnosis and management of this pathology. Case report: A 22-years old male presented to the emergency department with high intensity right knee pain after falling in a four-wheel motorcycle. The physical exam revealed a prominent painful mass on the lateral aspect of his knee and proximal leg. His range of motion and knee stability were unremarkable. X-rays were informed negative for musculoskeletal injuries. According to a sustained suspicion of PTFJD, the study was continued with a magnetic resonance imaging (MRI), which suggested PTFJD. During the following 24 hours, the patient referred he was entirely asymptomatic after feeling a loud «clank¼. He has been followed for three months with MRI, and remains asymptomatic with full functions. Conclusion: PTFJD diagnosis requires appropriate images. Urgent close reduction is mandatory; if unsuccessful, open reduction, primary repair and internal fixation are indicated. The prognosis of spontaneous reduction remains uncertain and requires a serial clinical evaluation. In the case of recurrence, the appropriate surgical management is indicated according to the elapsed time from the injury.

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INTRODUCTION: Proximal tibiofibular joint dislocations (PTFJD) are uncommon and underdiagnosed injuries. Urgent reduction is mandatory to avoid chronic disfunction. The scarcely available literature does not present a unified management guideline. An acute PTFJD case report with spontaneous reduction and a review of the literature is presented, aiming to assist the diagnosis and management of this pathology. CASE REPORT: A 22-years old male presented to the emergency department with high intensity right knee pain after falling in a four-wheel motorcycle. The physical exam revealed a prominent painful mass on the lateral aspect of his knee and proximal leg. His range of motion and knee stability were unremarkable. X-rays were informed negative for musculoskeletal injuries. According to a sustained suspicion of PTFJD, the study was continued with a magnetic resonance imaging (MRI), which suggested PTFJD. During the following 24 hours, the patient referred he was entirely asymptomatic after feeling a loud "clank". He has been followed for three months with MRI, and remains asymptomatic with full functions. CONCLUSION: PTFJD diagnosis requires appropriate images. Urgent close reduction is mandatory; if unsuccessful, open reduction, primary repair and internal fixation are indicated. The prognosis of spontaneous reduction remains uncertain and requires a serial clinical evaluation. In the case of recurrence, the appropriate surgical management is indicated according to the elapsed time from the injury.

INTRODUCCIÓN: La luxación tibiofibular proximal (LTFP) es una lesión poco frecuente y no diagnosticada. De no ser tratada a tiempo, puede generar una sintomatología crónica de dolor e inestabilidad. La escasa evidencia disponible no entrega un protocolo de enfrentamiento ni consenso respecto a su manejo. Con el objetivo de asistir al enfrentamiento de esta lesión, se presenta una revisión de la literatura de una LTFP con reducción espontánea. CASO CLÍNICO: Hombre de 22 años consulta por dolor intenso en su rodilla derecha, posterior a caída en cuatrimoto. Al examen físico con aumento de volumen doloroso en cara lateral de la rodilla y pierna proximal, con movilidad completa y estable. Radiografías son informadas sin alteraciones. Se mantiene la sospecha clínica de LTFP, se continúa estudio con resonancia magnética (RM), la que es sugerente de LTFP. Dentro de las 24 horas de evolución, el paciente indica haber sentido un clank espontáneo en su rodilla afectada con cese completo de sintomatología. Se sigue al paciente por tres meses con RM de control, manteniendo una rodilla asintomática; examen físico y funcionalidad normal. CONCLUSIÓN: El diagnóstico de las LTFP requiere un adecuado uso de imágenes. Su manejo consiste en una reducción cerrada de urgencia y de no lograrse, una reducción abierta, reparación y fijación interna. El pronóstico de las reducciones espontáneas es incierto, por lo que deben ser seguidas de forma seriada y en caso de recidiva, manejadas quirúrgicamente según el tiempo de evolución.

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OBJECTIVE: To study the incidence of MS in Chile by examining the hospitalizations across all geographical regions of the country and to examine whether there is a correlation between these rates and the latitude or ultraviolet radiation. METHODS: This is a descriptive study examining the national registry of hospitalizations because of MS (code G35 in ICD-10) from January 1, 2001, to December 31, 2006. Incidence rates were calculated by gender and geographical region and standardized to the world population estimated for 2010. RESULTS: A total of 6857 hospitalizations were analyzed. There were 935 individuals; 63.9% were women. The mean incidence rate for 2002-2006 period was 0,90 (95% CI: 0.75-1.05). The annualized incidence rates for regions from North to South were as follows: I Tarapaca 0.54 (95% CI: 0.0-1.21), II Antofagasta 0,93 (0.10-1.75), III Atacama 1.07 (0.0-2.31), IV Coquimbo 0.63 (0.01-1.24), V Valparaiso 0.83 (0.38-1.27), VI O'Higgins 0.72 (0.14-1.30), VII Maule 0.52 (0.06-0.98), VIII BIO BIO 0.81 (0.41-1.21), IX Araucanía 0.43 (0.0-0.86), X Los Lagos 0.91 (0.35-1.46), XI Aysen 0.99 (0.0-2.98), XII Magallanes 3.54 (0.57-6.51), and XIII Metropolitana 1.10 (0.84-1.36). There were no significant correlations between hospitalization rates and latitude, except for region XII. UV radiation levels showed significant differences only for region XII. CONCLUSION: There is a moderate risk of MS in Chile. The southernmost region showed significantly higher incidence rates than those in the rest of the country (a cluster zone). We did not find any correlation between incidence rates and latitude or UV radiation.

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We report a 20-year-old woman with continuous abnormal muscle activity syndrome in which pharmacological blockade of different sites of the motor unit demonstrates a peripheral nerve origin for the abnormal muscle activity. The case showed no markers of autoimmune disease. A rapid recovery after high dose i.v. methylprednisolone was observed supporting the hypothesis of an autoimmune pathogenesis.

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