22 research outputs found
Review of some classical gravitational superenergy tensors using computational techniques
We use computational algorithms recently developed by us to study completely
four index divergence free quadratic in Riemann tensor polynomials in GR. Some
results are new and some other reproduce and/or correct known ones. The
algorithms are part of a Mathematica package called Tools of Tensor Calculus
(TTC)[web address: http://baldufa.upc.es/ttc
Pseudoaneurismas femorales en fracturas de cadera. ¿Se puede evitar?
Aunque la aparición de un pseudoaneurisma femoral es infrecuente en el contexto del tratamiento
de fracturas pertrocantéreas, debido a su extrema gravedad y a su posible implicación en las causas de mortali
-
dad, es necesario realizar un diagnóstico temprano y un tratamiento adecuado. Presentamos 3 casos en los que
se produjo una lesión de la arteria femoral superficial, y 2 de la arteria femoral profunda, tratados los 3 casos con
stents recubiertos.
Conclusiones
. Se debe tomar en consideración, recti
fi
car la aducción y rotación interna de la
extremidad fracturada una vez colocado el implante, el uso de brocas cortas o con un tope para el momento del en
-
cerrojado distal, longitud adecuada de los tornillos, controlar el desplazamiento del trocánter menor, o una correcta
colocación de los cerclajes femorales, para poder disminuir la incidencia de este tipo de lesiones.Although the appearance of a femoral pseudoaneurysm is uncommon in the context of treatment
of trochanteric fractures, due to their extreme gravity and its possible involvement in the causes of death, it is ne
-
cessary for early diagnosis and appropriate treatment. We report 3 cases in which an injury occurred superficial
femoral artery, and 2 of the deep femoral artery, 3 cases treated with stents.
Conclusions.
It should be taken into
consideration, correct adduction and internal rotation of the fractured limb once fitted the implant, the use of short
bits or a cap on the distal locking time, proper length screws, control the displacement of the lesser trochanter , or
the correct placement of the femoral cerclage, to decrease the incidence of these injuries
Luxación anterior de cadera: presentación de un caso y revisión de la literatura.
La luxación anterior de cadera es una lesión poco frecuente y que se produce por traumatismos de
alta energía. Este tipo de luxación requiere maniobras especiales para su reducción. El tratamiento ortopédico puede
dar buenos resultados, aunque en ocasiones es necesaria la reducción abierta y el tratamiento quirúrgico de lesiones
asociadas. Presentamos el caso de un varón de 27 años que presentaba una luxación anterior de cadera derecha
debido a accidente automovilístico. Además tenía lesiones asociadas en pie derecho. Se realizó reducción cerrada y
tratamiento conservador con buenos resultados. El pronóstico de una luxación de cadera depende de la gravedad de
la lesión así como del tiempo que se tarda en realizar la reducción, que está relacionando con el riesgo de desarrollo de
necrosis avascular. La luxación anterior de cadera tiene mejor pronóstico que la luxación posterior cuando se realiza
un tratamiento temprano adecuado.The anterior hip dislocation is a little frequent injury and is produced by high energy traumatisms.
This type of dislocation requires special maneuvers for its reduction. The orthopaedic treatment can give good results,
although sometimes it is necessary the open reduction and the surgical treatment of associate injuries. We present a
case of a 27 year-old man who presented an anterior hip dislocation due to automobile accident. He had associated
injuries on right food. He was treated by closed reduction and orthopaedic treatment and he had good results. The
prognosis of a hip dislocation depends on the gravity of the injury as well as the time that takes in realizing the reduction, that it is relating to the risk of development of avascular necrosis. The anterior hip dislocation has better prognosis
than the posterior dislocation when a suitable treatment is early realized
Osteoporosis transitoria migratoria de cadera: a propósito de un caso
La osteoporosis transitoria asociada a la gestación es una condición poco usual, idiopática y auto
-
limitada. Comúnmente asociada al tercer trimestre del embarazo y al periodo postparto; cursa con dolor migra
-
torio
en
las
articulaciones
de
carga,
osteopenia
radiográfica
difusa
periarticular
y
patrón
de
edema
medular
óseo
en
la
RMN.
Presentamos
el
caso
clínico
de
una
mujer
de
28
años,
en
la
semana
34
de
gestación,
que
tras
una
leve
caída
presenta
dolor
y
limitación
funcional
en
miembro
inferior
derecho.
En
la
RMN
se
evidencia
edema
óseo
a nivel del extremo proximal de fémur derecho. Se trató de forma conservadora, mediante reposo y marcha con
andador
en
descarga,
programándose
fijación
profiláctica
en
quirófano.
Al
cabo
de
dos
semanas
de
su
ingreso,
sin
haber
sido
intervenida
aún,
inicia
dolor
en
cadera
contralateral.
Se
realiza
nueva
RMN
donde
se
observa
edema
en
cabeza
y
región
intertrocantérica
izquierda,
con
mejoría
de
los
hallazgos
previos
en
la
cadera
derecha.
Se
suspende
tratamiento
quirúrgico
y
se
indica
reposo
absoluto
con
manejo
expectante.
A
las
9
semanas
de
inicio
del
cuadro y 8 semanas postparto la paciente se encuentra asintomática y realiza su actividad diaria sin limitaciones.
Un alto índice de sospecha y un diagnóstico precoz son la clave para evitar una fractura como resultado de la
osteoporosis
transitoria.
La
resonancia
magnética
es
la
mejor
herramienta
no
invasiva
para
las
mujeres
embara
-
zadas con dolor en la cadera. La detección temprana puede prevenir las complicaciones y evitar cirugías mayoreTransient osteoporosis of the hip is a rare condition, idiopathic and self-limiting disease. This
malady
(complaint,
disorder)
is
more
common
in
the
third
trimester
of
pregnancy
and
postpartum.
Characterized
by
migratory
pain
in
bearing
joints,
periarticular
osteopenia
and
diffuse
radiographic
pattern
of
bone
marrow
edema
on
MR.
We
report
the
case
of
a
woman
28
years
old,
in
the
34th
week
of
her
pregnancy,
who
after
a
fall,
presents
pain
and
functional
limitation
in
her
right
leg.
The
MR
showed
bone
edema
at
the
proximal
right
femur.
She
was
treated
with
rest
and
a
walker,
and
she
was
scheduled
for
prophylactic
fixation
in
the
operating
room
in
a
few
weeks.
Two
weeks
after
hospital
admission,
left
hip
started
aching.
A
new
MR
showed
edema
in
the
head
and
intertrochanteric
region
of
the
left
hip,
with
improvement
of
previous
findings
in
the
right
hip.
Surgical
treatment
was
cancelled
and
bed
rest
was
suggested
as
expectant
management.
At
9
weeks
of
onset
of
symptoms
and
8
weeks
postpartum,
the
patient
was
asymptomatic
and
performs
daily
activities
without
limitations.
High
index
of
suspicion
and
early
diagnosis
is
the
key
to
avoid
fracture
as
a
result
of
transient
osteoporosis.
Magnetic
resonance imaging is the best non-invasive tool for pregnant women with hip pain. Early detection of the disease
can
avoid
complications
and
major
surgeries
Bifosfonatos y fracturas femorales de baja energía: la experiencia en nuestro centro
Los bifosfonatos son fármacos de uso común para la prevención de fracturas osteoporóticas. En los
últimos años ha sido relacionado su consumo prolongado con la aparición de fracturas de baja energía en fémur con
un trazo característico transverso. Para evaluar esta relación hemos analizado las fracturas de fémur de baja energía
atendidas en nuestro centro durante 2 años y relacionándolas con el consumo previo de bisfosfonatos. En fracturas
subtrocantéras no se observan diferencias significativas; en diafisarias, las fracturas trazo transverso típico se presentan
en pacientes de menor edad y significativamente asociados al consumo previo de bifosfonatos (6 de las 8 fracturas
de este tipo pensaban historia de consumo prolongado de estos fármacos). Como conclusión, aunque se han
publicado numerosos artículos en los últimos años con series de casos que relacionan este tipo de fracturas con el consumo
previo de bifosfonatos, el tamaño muestral de los estudios y las dificultades de evaluar el consumo de un fármaco
retrospectivamente hacen necesarios estudios aleatorizados y prospectivos para dejar evidencia de la posible relaciónBisphosphonates are commonly used drugs for the prevention of osteoporotic fractures. In recent years,
consumption has long been linked with the emergence of low-energy fractures of the femur with a characteristic transverse
line. To evaluate this relationship we have analyzed the femur fractures treated low energy in our center for 2
years and related to the prior use of bisphosphonates. In subtrochanteric fractures, no significant differences were
found; in diaphyseal fractures are typically transverse line is present in younger patients and significantly associated
with prior use of bisphosphonates (6 of 8 thought this type fractures history of prolonged use of these drugs). In conclusion,
although there have been numerous articles in the last years series of cases this type of fracture associated
with prior use of bisphosphonates, the sample size of studies and the difficulties of assessing a drug consumption
retrospective studies are needed prospective randomized to leave evidence of the possible association
Fijador externo como tratamiento definitivo de fractura de diáfisis femoral en Enfermedad de Paget
El tratamiento de las fracturas en la enfermedad de Paget presenta dificultades para el cirujano,
debido a las características patológicas del hueso en este tipo de pacientes. La opción terapéutica de elección
en fracturas de diáfisis femoral es el enclavado endomedular, pero a menudo encontramos en esta enfermedad
complicaciones que dificultan la técnica quirúrgica. Presentamos el caso de una paciente con fractura de diáfisis
femoral en hueso con características pagéticas, en el que por la estrechez del canal y la dureza de las corticales no
fue posible realizar en enclavado endomedular, y se optó por el fijador externo como tratamiento definitivo, con
buenos resultados radiográficos y funcionales. Tras el primer año de evolución, observamos una buena consoli
-
dación ósea en la radiografía, y la paciente deambula sin ayuda.The treatment of fractures in Paget's disease presents difficulties for the surgeon because of the
pathological features of bone in these patients. The treatment of choice for femoral shaft fractures is intrame
-
dullary nailing, but often found in this disease, complications that hinder the surgical technique. We report the
case of a patient with femoral shaft fracture in bone with pagetic characteristics, in which because of the narrow
canal and the hardness of the cortical, intamedullary nailing was not possible. We opted for the external fixator as
definitive treatment, with good radiographic and functional results. After the first year of follow up, we see good
bone healing on X-ray and the patient ambulate without help
On the structure of the new electromagnetic conservation laws
New electromagnetic conservation laws have recently been proposed: in the
absence of electromagnetic currents, the trace of the Chevreton superenergy
tensor, is divergence-free in four-dimensional (a) Einstein spacetimes
for test fields, (b) Einstein-Maxwell spacetimes. Subsequently it has been
pointed out, in analogy with flat spaces, that for Einstein spacetimes the
trace of the Chevreton superenergy tensor can be rearranged in the
form of a generalised wave operator acting on the energy momentum
tensor of the test fields, i.e., . In this
letter we show, for Einstein-Maxwell spacetimes in the full non-linear theory,
that, although, the trace of the Chevreton superenergy tensor can
again be rearranged in the form of a generalised wave operator
acting on the electromagnetic energy momentum tensor, in this case the result
is also crucially dependent on Einstein's equations; hence we argue that the
divergence-free property of the tensor has
significant independent content beyond that of the divergence-free property of
The Chevreton Tensor and Einstein-Maxwell Spacetimes Conformal to Einstein Spaces
In this paper we characterize the source-free Einstein-Maxwell spacetimes
which have a trace-free Chevreton tensor. We show that this is equivalent to
the Chevreton tensor being of pure-radiation type and that it restricts the
spacetimes to Petrov types \textbf{N} or \textbf{O}. We prove that the trace of
the Chevreton tensor is related to the Bach tensor and use this to find all
Einstein-Maxwell spacetimes with a zero cosmological constant that have a
vanishing Bach tensor. Among these spacetimes we then look for those which are
conformal to Einstein spaces. We find that the electromagnetic field and the
Weyl tensor must be aligned, and in the case that the electromagnetic field is
null, the spacetime must be conformally Ricci-flat and all such solutions are
known. In the non-null case, since the general solution is not known on closed
form, we settle with giving the integrability conditions in the general case,
but we do give new explicit examples of Einstein-Maxwell spacetimes that are
conformal to Einstein spaces, and we also find examples where the vanishing of
the Bach tensor does not imply that the spacetime is conformal to a -space.
The non-aligned Einstein-Maxwell spacetimes with vanishing Bach tensor are
conformally -spaces, but none of them are conformal to Einstein spaces.Comment: 22 pages. Corrected equation (12
Experiencia con test de artrografía intraoperatoria para valorar la rotura de la sindesmosis tibioperonea
Ankle fractures frequently associate tibiofibular syndesmosis injuries, whose diagnosis allows intraoperative treatment that can prevent mid-long term complications. There are several clinical diagnostic tests and specific projections but they are difficult to interpret and standardize. The objective of the study is to evaluate a recently described intraoperative diagnostic test. We conducted the test by intraarticular contrast injection in ten patients with fractures type Weber B or C. The test was valuable in 8 cases and the result coincided with the other clinical test used. We detected a fracture in one case that had gone undetected and resulted in a change of treatment. There were no complications. Using a reproducible, cheap and safe test, we can obtain an easily interpretable image that complements the rest of clinical tests to support the surgeon in the decision to fix the sindesmosis in ankle fractures
Healthcare resource use and costs related to surgical infections of tibial fractures in a Spanish cohort
Surgical site infection constitutes a serious complication in the healing process of bone fractures and has been associated with increases in medical resource use and healthcare costs. This study evaluates the economic impact of surgical site infection in tibial fractures in a Spanish cohort. It is a retrospective, single-centre, comparative cohort study of patients with tibial fractures with longitudinal follow-up for up to 18 months post-surgery. Included patients (n = 325) were adults, with tibial fracture, either isolated or polyfracture, or polytrauma with an Injury Severity Score >15. Patients had been surgically treated within 30 days of the tibial fracture by external or internal fixation, or external followed by internal fixation. Most patients (84.9%) had an American Society of Anaesthesiology score of 1–2. 20% of the patients had one open tibial fracture, 12.3% had polytrauma, and 20% had multiple fractures. Most patients were treated with a nail (41.8%) or a plate (33.8%). 56 patients (17.2%) developed surgical site infection. Patients with infection had significantly higher hospital length of stay (34.9 vs 12.0 days; p<0.001; +191%), readmissions (1.21 vs 0.25; p<0.001; +380%) and mean operating theatre time (499 vs 219 min; p<0.001; +128%) than patients without infection. Mean length of stay in intensive care did not significantly increase with infection (2.8 vs 1.7 days; p = 0.25). Total in-hospital costs for patients with infection increased from €7,607 to €17,538 (p<0.001; +131%). Overall, infections were associated with significantly increased healthcare resource use and costs. Preventive strategies to avoid infections could lead to substantial cost savings