Valoración clínica de resultados en artrodesis trapecio-metacarpiana: placa atornillada vs agujas de Kirschner

La rizartrosis es una patología frecuente. Cuando el tratamiento conservador es insuficiente, se indica un tratamiento quirúrgico. Existen diversas técnicas, entre las más ampliamente utilizadas está la artrodesis trapeciometacarpiana. Realizamos un estudio retrospectivo 44 casos (57 intervenciones) comparando dos métodos de artrodesis, agujas de Kirschner y placas atornilladas. Se realizó una valoración radiológica, clínica y funcional de los casos para determinar las posibles ventajas de un método sobre otro. La edad media fue 56,5 5,9 años. Se utilizaron 33 agujas Kirschner, 24 placas atornilladas. Mejoría en los resultados de los cuestionarios EVA (4,8 3,4) y DASH (23,2 23,5). El 44,7% movilidad con escala de Kapandji de 10. Se analizaron estadísticamente los datos, no encontrando diferencias significativas entre los dos métodos en cuanto a la consolidación, estado funcional ni complicaciones. En la mayor parte de los casos la clínica disminuye, se mejora la función con una excelente satisfacción del paciente. No hemos encontrado diferencias en nuestro estudio en las variables observadas.Trapezio-metacarpal arthritis is common. In that cases in which has failed to respond to conservative measures we need to use surgical procedures. One of them is the trapeziometacarpal arthrodesis. Retrospectiv study 44 patients (57 arthrodeses), comparing two surgical arthrodesis procedures, K-wires versus plate and screws, to assess the efficacy of these procedures with respect to patient satisfaction, radiological and clinical outcomes. Average age was 56.5 5.9 years. 33 K-wires, 24 plate and screws. There were an improvement in quetionaires results VAS (4.8 3.4) and DASH (23.2 23.5). The 44.7 % of patients scored a 10 in Kapandji test. We found no statistical differencees between these procedures in non-union rate, functional outcome or complications. For most patients Trapeziometacarpal arthrodesis reduces pain, improves function and results in excellent patient satisfaction. We have found no differences between these procedures in our study

Cuadriceplastia de Judet : una alternativa quirúrgica para las rigideces graves en extensión de la rodilla

Introducción. La contractura en extensión de la rodilla es una complicación de las fracturas femorales con importante afectación de partes blandas. La cuadriceplastia de Judet es una alternativa quirúrgica para aumentar la movilidad. Material y métodos. Presentamos el caso de un paciente con rigidez grave de rodilla en extensión tras una fractura abierta bifocal de fémur estabilizada mediante osteosíntesis que se complicó con una infección y retardo de consolidación que requirió varias cirugías para su estabilización. Se realizó una cuadriceplastia de Judet seguida de una rehabilitación intensiva para conseguir aumentar la flexión de la rodilla. Resultados. En el postoperatorio inmediato conseguía una flexoextensión de 0-100º que se redujo a 95º a los 3 meses y se mantuvo a los 6 meses postoperatorios, con una fuerza muscular de 4 sobre 5 en cuádriceps y psoas. Conclusion. La cuadriceplastia de Judet es una técnica efectiva que permite recuperar la movilidad en caso de rigideces graves en extensión.Introduction. Extension contracture of the knee is a complication of femoral fractures with significant soft tissue injury. The Judet quadricepsplasty is a surgical alternative to increase knee range of motion. Material and methods. We report the case of a patient with severe stiffness of knee following an open bifocal femoral fracture stabilized by osteosynthesis that was complicated by an infection and delayed healing that required several surgeries for stabilization. Judet quadricepsplasty was performed followed by intensive rehabilitation for increasing knee flexion. Results. In the postoperative care flexion and extension of 0-100º was achieved, and reduced to 95º after 3 months and remained the same at 6 months postoperatively, with a muscular strength of 4 out of 5 in quadriceps and psoas. Conclusion. The Judet quadricepsplasty is an effective technique to regain mobility in case of severe extension stiffnes

Prevalencia en nuestro medio de las deformidades dinámicas posicionales del hallux como secuela de las fracturas de tercio medio y distal de tibia

Dynamic positional deformity of the hallux is a relatively new disease, precisely because of its innovative nature and dynamics may go unnoticed to clinicians. It is because of this, that the limited literature available stresses the importance of making an active search for this pathology in our daily practice. The purpose of this study is to estimate the prevalence of these deformities at the University Hospital Dr. Peset of Valencia as well as make an analysis of their management. An analytical, descriptive and retrospective study was designed in which patients admitted in our center during 2014 and 2015 with medium and distal third tibia fracture were analyzed searching for dynamics positional deformities of the hallux. We found a total of 5 compatible cases from 42 analyzed tibia fractures. This may indicate that as expected dynamic positional deformity of the hallux could be an underrated disease in our medium

Genistein effect on cognition in prodromal Alzheimer's disease patients. The GENIAL clinical trial

Background: Delaying the transition from minimal cognitive impairment to Alzheimer’s dementia is a major concern in Alzheimer’s disease (AD) therapeutics. Pathological signs of AD occur years before the onset of clinical dementia. Thus, long-term therapeutic approaches, with safe, minimally invasive, and yet efective substances are recommended. There is a need to develop new drugs to delay Alzheimer’s dementia. We have taken a nutritional supplement approach with genistein, a chemically defned polyphenol that acts by multimodal specifc mechanisms. Our group previously showed that genistein supplementation is efective to treat the double transgenic (APP/PS1) AD animal model. Methods: In this double-blind, placebo-controlled, bicentric clinical trial, we evaluated the efect of daily oral supplementation with 120 mg of genistein for 12 months on 24 prodromal Alzheimer’s disease patients. The amyloidbeta deposition was analyzed using 18F-futemetamol uptake. We used a battery of validated neurocognitive tests: Mini-Mental State Exam (MMSE), Memory Alteration Test (M@T), Clock Drawing Test, Complutense Verbal Learning Test (TAVEC), Barcelona Test-Revised (TBR), and Rey Complex Figure Test. Results: We report that genistein treatment results in a signifcant improvement in two of the tests used (dichotomized direct TAVEC, p=0.031; dichotomized delayed Centil REY copy p=0.002 and a tendency to improve in all the rest of them. The amyloid-beta deposition analysis showed that genistein-treated patients did not increase their uptake in the anterior cingulate gyrus after treatment (p=0.878), while placebo-treated did increase it (p=0.036). We did not observe signifcant changes in other brain areas studied. Conclusions: This study shows that genistein may have a role in therapeutics to delay the onset of Alzheimer’s dementia in patients with prodromal Alzheimer’s disease. These encouraging results indicate that this should be followed up by a new study with more patients to further validate the conclusion that arises from this study.This work was supported by the following grants: CB16/10/00435 (CIBERFES) from Instituto de Salud Carlos III, (PID2019-110906RB-I00/ AEI/10.13039/501100011033) and RED2018-102576-T from the Spanish Ministry of Innovation and Science, PROMETEO/2019/097 from “Consellería de Innovación, Universidades, Ciencia y Sociedad Digital de la Generalitat Valen ciana” and EU Funded H2020- DIABFRAIL-LATAM (Ref: 825546), European Joint Programming Initiative “A Healthy Diet for a Healthy Life” (JPI HDHL) and of the ERA-NET Cofund ERA-HDHL (GA N° 696295 of the EU Horizon 2020 Research and Innovation Programme) and Fundación Ramón Areces y Fundación Soria Melguizo. to J.V. and Grant PID2020-113839RB-I00 funded by MCIN/ AEI/10.13039/501100011033, PCIN-2017-117 of the Ministry of Economy and Competitiveness, and the EU Joint Programming Initiative ‘A Healthy Diet for a Healthy Life’ (JPI HDHL INTIMIC-085) to CB. We also acknowledge funding from the Spanish Ministry of Science, Innovation, and Universities (RTI2018099200-B-I00), the Generalitat of Catalonia, Agency for management of University and Research Grants (2017SGR696) and the Department of Health (SLT002/16/00250) to RP. Part of the equipment employed in this work has been funded by Generalitat Valenciana and co-fnanced with ERDF funds (OP ERDF of Comunitat Valenciana 2014-2020). M.J. is a “Serra Hunter” Fellow

Genistein effect on cognition in prodromal Alzheimer's disease patients : the GENIAL clinical trial

Delaying the transition from minimal cognitive impairment to Alzheimer's dementia is a major concern in Alzheimer's disease (AD) therapeutics. Pathological signs of AD occur years before the onset of clinical dementia. Thus, long-term therapeutic approaches, with safe, minimally invasive, and yet effective substances are recommended. There is a need to develop new drugs to delay Alzheimer's dementia. We have taken a nutritional supplement approach with genistein, a chemically defined polyphenol that acts by multimodal specific mechanisms. Our group previously showed that genistein supplementation is effective to treat the double transgenic (APP/PS1) AD animal model