Neuropatías del Nervio Cubital a Nivel del codo: factores pronósticos

En el presente trabajo se estudian los factores pronósticos invocados como influyentes en el resultado quirúrgico de las neuropatías del nervio cubital a nivel del codo. Desde 1970 los autores han intervenido 37 lesiones cubitales, que han clasificado según APFELBERG y LARSON. El grupo más frecuente de esta serie ha sido la Parálisis Cubital Tardía (14 casos), siguiéndole en importancia numérica el Síndrome Idiopático del Túnel Cubital (9 casos). La liberación con epineurotomía y transposición subcutánea, ha sido la técnica quirúrgica más veces utilizada (17 veces). En la valoración objetiva de resultados, han utilizado la usada por ADELAAR y colaboradores. Tras el análisis y discusión de los resultados, concluyen que son factores pronósticos negativos en el preoperatorio: la amiotrofía interna; la ausencia de potenciales de fibrilación y la ausencia de potenciales sensitivos evocados. Los resultados globales de la serie han sido satisfactorios, ya que pasamos de un valor medio preoperatorio de lesión moderada de 4 puntos a un valor medio final de 6,5 puntos.The authors have studied the forecast factor called on as influential at the surgical results of neuropathie s of ulnar nerve in the elbow joint. Since 1970, the authors have operated on 37 patients affected by ulnar neuropathies, classified according to APFELBERG and LARSON. 14 cases had a tardy ulnar nerve palsy, 9 case s of cubital tunne l syndrome. The surgical technique more frequent used was epineurotomy and anterior subcutaneous transposition of ulnar nerve (17 cases). They have employed the method of ADELAAR et al. to evaluate the results and they conclude that the factors of bad prognosis are intense amyotrophy, absence of fibrilation potentials and absenc e of evoked sensitive potentials. The results of this group wer e satisfactory, of the average value preoperatory of moderate lession was 4 points, after surgery this was 6,5 points at last

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

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

Half hip fracture patients are reportedly ‘worse’ than dead as based on health-related quality of life at the time of admission, with partial recovery at 1 and 4-months follow-up: the spare-hip prospective cohort

Objective: To estimate the impact of hip fracture on health-related quality of life (HRQoL) up to 4 months post-fracture

Bone mineral density and body composition among athletes: Lightweight versus heavyweight sports

Objectives: Energy restriction and weight loss techniques are associated with adverse effects on bone mineral density (BMD) whilst participation in sports is known to be beneficial for skeletal health. However, it is not entirely clear the skeletal health status in lightweight sports where participants often use weight management techniques to attain relatively low mass. Therefore, the aim of this study is to evaluate the differences in BMD and body composition among athletes engaged in weight restricted and non-weight restricted sports.Published versio

In-hospital care, complications, and 4-month mortality following a hip or proximal femur fracture: the Spanish registry of osteoporotic femur fractures prospective cohort study

Summary We have characterised 997 hip fracture patients from a representative 45 Spanish hospitals, and followed them up prospectively for up to 4 months. Despite suboptimal surgical delays (average 59.1 hours), in-hospital mortality was lower than in Northern European cohorts. The secondary fracture prevention gap is unacceptably high at 85%. Purpose To characterise inpatient care, complications, and 4-month mortality following a hip or proximal femur fracture in Spain. Methods Design: prospective cohort study. Consecutive sample of patients ≥ 50 years old admitted in a representative 45 hospitals for a hip or proximal femur fragility fracture, from June 2014 to June 2016 and followed up for 4 months post-fracture. Patient characteristics, site of fracture, in-patient care (including secondary fracture prevention) and complications, and 4-month mortality are described. Results A total of 997 subjects (765 women) of mean (standard deviation) age 83.6 (8.4) years were included. Previous history of fracture/s (36.9%) and falls (43%) were common, and 10-year FRAX-estimated major and hip fracture risks were 15.2% (9.0%) and 8.5% (7.6%) respectively. Inter-trochanteric (44.6%) and displaced intra-capsular (28.0%) were the most common fracture sites, and fixation with short intramedullary nail (38.6%) with spinal anaesthesia (75.5%) the most common procedures. Surgery and rehabilitation were initiated within a mean 59.1 (56.7) and 61.9 (55.1) hours respectively, and average length of stay was 11.5 (9.3) days. Antithrombotic and antibiotic prophylaxis were given to 99.8% and 98.2% respectively, whilst only 12.4% received secondary fracture prevention at discharge. Common complications included delirium (36.1 %) and kidney failure (14.1%), with in-hospital and 4-month mortality of 2.1% and 11% respectively. Conclusions Despite suboptimal surgical delay, post-hip fracture mortality is low in Spanish hospitals. The secondary fracture prevention gap is unacceptably high at > 85%, in spite of virtually universal anti-thrombotic and antibiotic prophylaxis

In-hospital care, complications, and 4-month mortality following a hip or proximal femur fracture: the Spanish registry of osteoporotic femur fractures prospective cohort study

We have characterised 997 hip fracture patients from a representative 45 Spanish hospitals, and followed them up prospectively for up to 4 months. Despite suboptimal surgical delays (average 59.1 hours), in-hospital mortality was lower than in Northern European cohorts. The secondary fracture prevention gap is unacceptably high at 85%. PURPOSE: To characterise inpatient care, complications, and 4-month mortality following a hip or proximal femur fracture in Spain. METHODS: Design: prospective cohort study. Consecutive sample of patients ≥ 50 years old admitted in a representative 45 hospitals for a hip or proximal femur fragility fracture, from June 2014 to June 2016 and followed up for 4 months post-fracture. Patient characteristics, site of fracture, in-patient care (including secondary fracture prevention) and complications, and 4-month mortality are described. RESULTS: A total of 997 subjects (765 women) of mean (standard deviation) age 83.6 (8.4) years were included. Previous history of fracture/s (36.9%) and falls (43%) were common, and 10-year FRAX-estimated major and hip fracture risks were 15.2% (9.0%) and 8.5% (7.6%) respectively. Inter-trochanteric (44.6%) and displaced intra-capsular (28.0%) were the most common fracture sites, and fixation with short intramedullary nail (38.6%) with spinal anaesthesia (75.5%) the most common procedures. Surgery and rehabilitation were initiated within a mean 59.1 (56.7) and 61.9 (55.1) hours respectively, and average length of stay was 11.5 (9.3) days. Antithrombotic and antibiotic prophylaxis were given to 99.8% and 98.2% respectively, whilst only 12.4% received secondary fracture prevention at discharge. Common complications included delirium (36.1 %) and kidney failure (14.1%), with in-hospital and 4-month mortality of 2.1% and 11% respectively. CONCLUSIONS: Despite suboptimal surgical delay, post-hip fracture mortality is low in Spanish hospitals. The secondary fracture prevention gap is unacceptably high at > 85%, in spite of virtually universal anti-thrombotic and antibiotic prophylaxis