32 research outputs found
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
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
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
Nuestra experiencia en el tratamiento de la escoliosis idiopática mediante la electroestimulación percutánea
Se presentan los resultados obtenidos en 40 pacientes con escoliosis tratadas
mediante estimulador externo (Spinelectron) de corriente continua y doble canal. Se valor a el
equilibrio vertebral, el valor angular de las curvas y su rotación. Los pacientes se dividieron en
2 grupos, según el valor angula r de las curvas. El primero con grados Cobb entre 20° y 29° y el
segundo entre 30° y 39°. Igualmente se analizaron los resultados según el tipo de curva .
La tas a de progresión par a curvas torácicas fue del 65.3%, mientras que par a curvas toracolumbares
y lumbares fue del 50%. En cuanto al valor angular de las curvas observamos que
el 55% de las curvas entre 20-29° aumentaron su valor angular, pasando de 24.7° a 31.5°. En
cuanto a las curvas entre 30-39° el 50% de los casos necesitó artrodesis posterior.
Los resultados de la electroestimulación no difieren de la evolución natural de la escoliosis
por lo que el tratamiento puede considerarse ineficaz.Lateral electrical Surface Stimulation using the Spinelectron ®
device was applied to 40 patients for treatment of idiopathic scoliosis.The authors
value vertebra l balance , curve measurement (Cobb method ) and rotational devia
tion .
The patients were distributed in two groups according to the angular value of the
curves; the first group between 20° an d 29° o f Cobb angle an d 30° t o 39° the second
one . The results were analyzed depending on the curve pattern .
The average of progression at the thoracic curve s was 65,3 %, an d a t th e thoraco -
lumba r an d lumba r curve s wer e 5 0 %. In th e first group , th e 5 5 % o f th e curve s showed
an increase of the Cobb angle , 24,7° at the begining of the treatment to 31,5° at the en d
(averag e values). In the second group the 5 0 % o f the patients needed surgery .
The results of the Electrical Stimulation do not modify the natural evolution of the
scoliosis, so , the treatment can consider it ineffective
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
Sleep duration in preschool age and later behavioral and cognitive outcomes:an individual participant data meta-analysis in five European cohorts
Data de publicació electrònica: 07-02-2023Short sleep duration has been linked to adverse behavioral and cognitive outcomes in schoolchildren, but few studies examined this relation in preschoolers. We aimed to investigate the association between parent-reported sleep duration at 3.5 years and behavioral and cognitive outcomes at 5 years in European children. We used harmonized data from five cohorts of the European Union Child Cohort Network: ALSPAC, SWS (UK); EDEN, ELFE (France); INMA (Spain). Associations were estimated through DataSHIELD using adjusted generalized linear regression models fitted separately for each cohort and pooled with random-effects meta-analysis. Behavior was measured with the Strengths and Difficulties Questionnaire. Language and non-verbal intelligence were assessed by the Wechsler Preschool and Primary Scale of Intelligence or the McCarthy Scales of Children's Abilities. Behavioral and cognitive analyses included 11,920 and 2981 children, respectively (34.0%/13.4% of the original sample). In meta-analysis, longer mean sleep duration per day at 3.5 years was associated with lower mean internalizing and externalizing behavior percentile scores at 5 years (adjusted mean difference: - 1.27, 95% CI [- 2.22, - 0.32] / - 2.39, 95% CI [- 3.04, - 1.75]). Sleep duration and language or non-verbal intelligence showed trends of inverse associations, however, with imprecise estimates (adjusted mean difference: - 0.28, 95% CI [- 0.83, 0.27] / - 0.42, 95% CI [- 0.99, 0.15]). This individual participant data meta-analysis suggests that longer sleep duration in preschool age may be important for children's later behavior and highlight the need for larger samples for robust analyses of cognitive outcomes. Findings could be influenced by confounding or reverse causality and require replication.Open Access funding enabled and organized by Projekt DEAL. This research (LifeCycle Project ID: ECCNLC201914) was funded by the European Union’s Horizon 2020 research and innovation programme under Grant Agreement N: 733206, LifeCycle project. Kathrin Guerlich was granted a LifeCycle Fellowship (Grant Agreement N: 733206, LifeCycle project). Berthold Koletzko is the Else Kröner Seniorprofessor of Paediatrics at LMU – University of Munich, financially supported by Else Kröner-Fresenius-Foundation, LMU Medical Faculty and LMU University Hospital. Deborah A Lawlor and Ahmed Elhakeem work in a Unit that receives support from the University of Bristol and UK Medical Research Council (MC_UU_00011/6). Deborah A Lawlor is a British Heart Foundation Chair (CH/F/20/90003) and a National Institute of Health Research Senior Investigator (NF-0616–10102). Mònica Guxens is funded by a Miguel Servet II fellowship (CPII18/00018) awarded by the Spanish Institute of Health Carlos III. Jordi Julvez holds Miguel Servet-II contract (CPII19/00015) awarded by the Instituto de Salud Carlos III (Co-funded by European Social Fund "Investing in your future"). Tim Cadman was funded a Marie Sklodowska-Curie Individual Fellowship. Funding details for each cohort are provided in Online Resource 1. No funder had any influence on the study design, data collection, statistical analyses or interpretation of findings. The views expressed in this paper are those of the authors and not necessarily of any funders
ZBED6, a Novel Transcription Factor Derived from a Domesticated DNA Transposon Regulates IGF2 Expression and Muscle Growth
This study identifies a previously uncharacterized protein, encoded by a domesticated DNA transposon, called ZBED6 that regulates the expression of the insulin-like growth factor 2 (IGF2) gene, and possibly numerous others, in all placental mammals including human
Gestational age at birth and body size from infancy through adolescence: An individual participant data meta-analysis on 253,810 singletons in 16 birth cohort studies
Background Preterm birth is the leading cause of perinatal morbidity and mortality and is associated with adverse developmental and long-term health outcomes, including several cardiometabolic risk factors and outcomes. However, evidence about the association of preterm birth with later body size derives mainly from studies using birth weight as a proxy of prematurity rather than an actual length of gestation. We investigated the association of gestational age (GA) at birth with body size from infancy through adolescence. Methods and findings We conducted a two-stage individual participant data (IPD) meta-analysis using data from 253,810 mother-child dyads from 16 general population-based cohort studies in Europe (Denmark, Finland, France, Italy, Norway, Portugal, Spain, the Netherlands, United Kingdom), North America (Canada), and Australasia (Australia) to estimate the association of GA with body mass index (BMI) and overweight (including obesity) adjusted for the following maternal characteristics as potential confounders: education, height, prepregnancy BMI, ethnic background, parity, smoking during pregnancy, age at child's birth, gestational diabetes and hypertension, and preeclampsia. Pregnancy and birth cohort studies from the LifeCycle and the EUCAN-Connect projects were invited and were eligible for inclusion if they had information on GA and minimum one measurement of BMI between infancy and adolescence. Using a federated analytical tool (DataSHIELD), we fitted linear and logistic regression models in each cohort separately with a complete-case approach and combined the regression estimates and standard errors through random-effects study-level meta-analysis providing an overall effect estimate at early infancy (>0.0 to 0.5 years), late infancy (>0.5 to 2.0 years), early childhood (>2.0 to 5.0 years), mid-childhood (>5.0 to 9.0 years), late childhood (>9.0 to 14.0 years), and adolescence (>14.0 to 19.0 years). GA was positively associated with BMI in the first decade of life, with the greatest increase in mean BMI z-score during early infancy (0.02, 95% confidence interval (CI): 0.00; 0.05, p < 0.05) per week of increase in GA, while in adolescence, preterm individuals reached similar levels of BMI (0.00, 95% CI: -0.01; 0.01, p 0.9) as term counterparts. The association between GA and overweight revealed a similar pattern of association with an increase in odds ratio (OR) of overweight from late infancy through mid-childhood (OR 1.01 to 1.02) per week increase in GA. By adolescence, however, GA was slightly negatively associated with the risk of overweight (OR 0.98 [95% CI: 0.97; 1.00], p 0.1) per week of increase in GA. Although based on only four cohorts (n = 32,089) that reached the age of adolescence, data suggest that individuals born very preterm may be at increased odds of overweight (OR 1.46 [95% CI: 1.03; 2.08], p < 0.05) compared with term counterparts. Findings were consistent across cohorts and sensitivity analyses despite considerable heterogeneity in cohort characteristics. However, residual confounding may be a limitation in this study, while findings may be less generalisable to settings in low- and middle-income countries. Conclusions This study based on data from infancy through adolescence from 16 cohort studies found that GA may be important for body size in infancy, but the strength of association attenuates consistently with age. By adolescence, preterm individuals have on average a similar mean BMI to peers born at term.This collaborative project received funding from the European Union's Horizon 2020 research and innovation programme (Grant Agreement No. 733206 LifeCycle, Grand Recipient VWVJ; Grant Agreement No. 824989 EUCAN-Connect, Grand Recipient AMNA). Please, see S1 Appendix for list of cohort-specific funding/support. DAL is supported by the UK Medical Research Council (MC_UU_00011/6) and British Heart Foundation (CH/F/20/90003 and AA/18/7/34219). RCW is supported by UKRI Innovation Fellowship with Health Data Research UK [MR/S003959/1]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript