A characterization of 3D steady Euler flows using commuting zero-flux homologies

We characterize, using commuting zero-flux homologies, those volume-preserving vector fields on a $3$-manifold that are steady solutions of the Euler equations for some Riemannian metric. This result extends Sullivan's homological characterization of geodesible flows in the volume-preserving case. As an application, we show that the steady Euler flows cannot be constructed using plugs (as in Wilson's or Kuperberg's constructions). Analogous results in higher dimensions are also proved

Fijación interna versus percutánea en fracturas diafisarias de metacarpianos: estudio de casos-controles

Objetivos: comparación de resultados clínicos de fijación interna versus fijación percutánea. Material y Métodos: estudio retrospectivo de casos y controles de 58 fracturas de metacarpianos (43 pacientes). Se incluyeron las fracturas diafisarias, sin afectación articular. Se excluyeron si había afectación del pulgar o de falanges, fracturas abiertas o más de 3 fracturas en la misma mano. Un total de 26 fracturas fueron tratadas con fijación interna y 32 con percutánea. Con un seguimiento medio de 2,5 años (rango, 1-4), se valoró la función mediante movilidad activa total (MAT), fuerza, DASH, EAV de dolor y resultado radiográfico. Resultados: con ambos tratamientos los resultados fueron satisfactorios. El tiempo de consolidación y alineación radiográfica fueron similares. Todas las valoraciones clínicas, objetivas y subjetivas, fueron mejores en el grupo de fijación interna, así como la tasa de retorno a las actividades previas. En el grupo de fijación interna hubo un caso de pseudoartrosis que fue reoperado y otro de déficit de movilidad. En el grupo percutáneo hubo 4 casos con déficit de movilidad. Discusión y conclusiones: ambas técnicas ofrecen resultados adecuados, pero con la fijación interna se obtuvieron mejores resultados respecto a movilidad, fuerza, mayor facilidad para realización de las actividades previas y retorno a las laborales y deportivas, a pesar de las complicaciones inherentes a la cirugía abiertaObjectives: comparison of outcomes with internal fixation versus percutaneous fixation. Material and Methods: retrospective case-control study of 58 metacarpal fractures (43 patients). Shaft fractures without joint involvement were included. Exclusion criteria were involvement of the thumb or phalange, open fracture, or more than 3 fractures in the same hand. There were 26 fractures treated with internal fixation and 32 with percutaneous fixation. With a mean follow-up of 2,5 years (range, 1-4), functional evaluation was performed by total active motion (TAM), strength grip, DASH, pain VAS, and radiographic results. Results: satisfactory outcomes were obtained with both treatments. Consolidation time and radiographic alignment were similar. All clinical objective and subjective assessments were better in the internal fixation group, as well as the rate of return to previous activities. In the internal fixation group, there was one case with nonunion, which was reoperated, and other with lack of motion. In the percutaneous group, there were 4 cases with mobility deficits. Discussion and conclusions: satisfactory results were offered by both methods, but better outcomes were obtained by internal fixation with regard to motion, strength, best facility for previous activities, and return to work and sport activities. All this was spite of the inherent complications of open surger

Fracturas supracondíleas de fémur tratadas con clavo retrógrado versus tornillo condilar dinámico

Objetivo: valorar los resultados mediante tratamiento con clavo intramedular retrógrado (CIR). Material y Métodos: se revisaron 54 pacientes con fracturas supracondíleas de fémur tipos AO A y C1, con edad media de 68 años, de los que 23 fueron tratados con CIR y 31 con tornillo condilar dinámico (TCD). Seguimiento medio de 5 años (rango, 2 a 9). Se valoraron clínicamente con las escalas Knee Society y cuestionario Womac y radiográficamente. Resultados: no hubo diferencias significativas respecto a los datos perioperatorios, resultados funcionales, movilidad de rodilla, calidad de vida o tiempo medio de consolidación. En el grupo CIR no hubo pseudoartrosis y 2 pacientes tuvieron acortamiento mayor de 2 cm. En el grupo TCD hubo 2 pseudoartrosis que precisaron reintervención y otros 4 casos tuvieron consolidación con desviación angular de al menos 5º, 2 de ellos además con acortamiento mayor de 2 cm. Discusión: los resultados fueron similares en ambos grupos pero, aunque no significativamente, con el CIR hubo menor número de complicaciones de alineación y de consolidación. Conclusiones: el CIR es un método satisfactorio para las fracturas supracondíleas sin o poca afectación articular, tanto en jóvenes como en ancianos.Objective: To evaluate functional and radiographic results after retrograde intramedullary nail (RIN). Material and Methods: We reviewed 54 supracondylar femoral fractures, AO-types A and C1, in patients with mean aged of 68 years, of which 23 were treated with RIN and 31 with dynamic condylar screw (DCS). Mean follow-up of 5 years (range, 2 to 9). They were evaluated clinically by means Knee Society scores and Womac self-form, and radiographically. Results: There were no significant differences with reagard to perioperative data, functional results, knee mobility, quality of life, or mean healed time. In the RIN group, there was no nonunion, and 2 patients had shortening greater than 2cm. In the DCS group, there were 2 nonunion which required revision, and other 4 healed with angular malunion greater than 5º, 2 of which had also shortening greater than 2cm. Discussion: Outcomes were similar in both groups. Although no significantly, the RIN group had lower malunion and nonunion rates. Conclusion: RIN is a satisfactory method for supracondylar fractures with little or no joint involvement, for both young and elderly patients

Topografía de la densidad mineral osea: Método de estudio "in vivo" de la cabeza femoral humana mediante TAC

Presentamos un método, no descrito anteriormente, que permite obtener un mapa muy preciso de la distribución topográfica de la densidad mineral ósea relativa de cualquier parte del esqueleto, en el sujeto vivo, a partir de una imagen TAC convencional. El método se basa en la medición directa de los niveles de gris de la imagen TAC, los cuales guardan una relación de linealidad con las Unidades Honsfield, de manera que la densidad óptica de un punto concreto se correlaciona con la densidad ósea del mismo. En nuestro estudio lo hemos aplicado a la cabeza femoral humana, obteniendo la imagen topográfica tridimensional de sus densidades óseas.We describe a new method to obtain an accurate mapping of the bone mineral density which can be applied to any area of the human skeleton in a live subject using conventional CT scan imaging. The method involves direct measurement of grey colour intensity from the CT image. The colour intensity maintains a direct relationship with the Honsfield Units, therefore the optic density of a given area is related to the bone density. In our study this method has been applied to the human femoral head to obtain a three-dimensional topography of the bone density

Fracturas articulares de calcáneo: tratamiento incruento versus quirúrgico

Se analiza la problemática que supone el tratamiento de las fracturas articulares de calcáneo. Han sido revisadas 85 fracturas tratadas, 43 ortopédicamente, y 42 según técnica de Westhues-Ehalt. El seguimiento medio fue de 24 meses. Los resultados clínicos fueron satisfactorios en el 43,5 %, no existiendo correlación con la disminución radiográfica del ángulo de Bóhler. El tipo de tratamiento empleado no influyó significativamente en el resultado clínico final, pero sí el grado de comunicación de la fractura. Aparecieron secuelas en el 67% de los casos, siendo la principal causa de discapacidad en la artrosis subastragalina.The treatment of intraarticular fractures of the calcaneus may entail difficult problems. From 1985 to 1995, 85 patients with intraarticular fractures of the calcaneus, 43 treated with a conservative method, and 42 with surgery (Westhues-Ehalt technique) were reviewed. The average follow-up was 24 months. Clinical results were excellent- good in 43.5%. No difference in functional results between conservative and surgical treatment was found, but as the severely of the fracture increase the results deteriorate. Late complications appeared in 67% of the patients with subtalar degenerative osteoarthrosis being the principal cause of permanent disability

Fractura del cuello femoral en pacientes menores de 65 años. Análisis de las complicaciones tras fijación con tornillos canulados.

To analyze the complications after femoral neck fracture in minors of 65 years old with cannulated screws. Material and method. retrospective study of 49 cases with a minimum follow-up of 2 years, evaluating the hip function and postoperative complications, analyzing the risk factors for necrosis and hip non-union. Results. 48.9% were operated in the first 24 hours, with an average surgical delay of 2,1 days. The clinical results were satisfactory (93,9%), finding 7 cases of necrosis and 2 cases of non-union, that required reconversion to total hip arthroplasty (18,3%). In the univariate analysis, no variable was correlated with the complications or final results. Conclusions. Age, displacement of the fracture, shortening of the femoral neck and surgical delay do not influence the final functional results or the presence of necrosis or non-union after the fixation of the femoral neck fracture

Análisis de las complicaciones y mortalidad en pacientes mayores de 95 años con fractura de cuello femoral tratada mediante hemiartroplastia de cadera cementada.

to analyze postoperative complications and mortality, as well as evaluate the functional results of patients older than 95 years with a femoral neck fracture treated by cemented hip hemiarthroplasty. Material and method. Retrospective study of 33 cases, analyzing complications and mortality, identifying risk factors, and evaluating cognitive status, functionality and level of ambulation after surgery. Results. eight patients (24,2%) presented postsurgical medical complications, finding blood transfusion and bilateral hemiarthroplasty as predictive factors, and 11 died in the first year (33,3%), finding the previous functional status and the taking of antiaggregants or anti-coagulants as risk factors. All worsened functionally after the fracture. Conclusions. we consider fundamental, in order to optimize the treatment, the precise preoperative evaluation of the patient given the limited life expectancy and the high mortality rate in the first year after hip surgery

Intravenous single dose of tranexamic acid safely reduces blood loss and the need for transfusion in elderly patients with hip fracture. A randomized double-blinded controlled trial at 1-year follow-up

Background: A hip fracture usually presents significant blood loss in the perioperative period, with a transfusion rate of 20-60%. In order to reduce the complications associated with this procedure, the administration of Tranexamic Acid (TXA) has been implemented in the treatment of perioperative anemia. The objectives were to evaluate the effectiveness and safety of a single dose of intravenous Tranexamic Acid (TXA) in reducing perioperative blood loss and the requirement for transfusion in elderly patients undergoing hip fracture surgery within one postoperative year. Methods: A double-blind randomized controlled trial was conducted on 129 patients with hip fractures. After randomization, at the start of the surgery, 65 patients received a single dose of 1 gram of intravenous TXA (TXA group), and 64 received a placebo (placebo group). The primary effectiveness outcomes were the total blood loss and transfusion rate. The primary safety outcome was the rate of thromboembolic events. Data on surgical or medical infection, readmission and death were also collected. Results: The TXA group had a significant decrease in blood loss (p = 0.006) and requirement for transfusion (p < 0.001) compared with the placebo group. Likewise, there were no thromboembolic events in the TXA group and seven in the placebo group (p = 0.006). Mortality within 1-year postoperatively was not significantly different (p = 0.115). Conclusion: Using a single dose of intravenous TXA at the start of the surgery significantly reduces blood loss and the requirement for transfusion without increasing the risk of thromboembolic events or mortality within 1-year postoperatively in patients with hip fracture undergoing surgery. Registration number: NCT03211286. https://clinicaltrials.gov/ct2/show/NCT03211286. Level of evidence: I

Change in 1-year mortality after hip fracture surgery over the last decade in a European population

Objective: There are scarce data on the mortality after hip fracture surgery for patients treated in the most recent years. The objective of this study was to analyze whether the overall initiatives introduced over the last decade for elderly patients with hip fractures had a positive impact on the 1-year mortality. Methods: Patients treated during 2010–2012 were compared with patients treated during 2018–2020 for all-cause 1-year mortality. Variables influencing mortality were collected based on the literature, including demographic, comorbidity, cognitive status, and preinjury physical function. Crude mortalities were compared between periods, as well as with the expected mortality in the general population adjusted for age, gender, and year of surgery using the standardized mortality ratio (SMR). A multivariate model was used to identify mortality risk factors. Results: 591 patients older than 65 years were treated during 2010–2012 and 642 patients during 2018–2020. The mean age increased significantly between periods (78.9 vs. 82.6 years, respectively, p = 0.001) in both genders, together with an increase in comorbidity (p = 0.014). The in-hospital mortality risk had no significant difference between periods (2.5 vs. 2.0%, p = 0.339), but the 30-day mortality risk (8.3 vs. 5.5%, p = 0.031) and 1-year mortality risk (16.1 vs. 11.9%, p = 0.023) declined significantly. However, 1-year mortality in 2020 had an excess of 1.33 in SMR. Age older than 80 years, male gender, and Charlson comorbidity index > 2 were significant predictors of 1-year mortality. Conclusion: The important evolution achieved in the last decade for the management of patients with hip fracture surgery has led to a significant decline in 1-year mortality, but the 1-year mortality remains significantly higher compared to the general population of similar age and gender.Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature