Restablecimiento de una nueva normalidad biomecánica en las graves deformidades de la rodilla

En las graves alteraciones morfo-estructurales de la rodilla, con inestabilidad en varusvalgus, las prótesis vinculadas a bisagra simple, tendían a fallar. El presente trabajo se propone evidenciar que, en tales situaciones, la prótesis vinculada a rotación representa la solución más idónea para el restablecimiento de una nueva normalidad. 18 pacientes (13 mujeres y 5 hombres) con edad media de 68 años han sido sometidos a intervención para colocar prótesis de rodilla. Ha sido utilizado el implante Endo-Model® de Waldemar Link®, prótesis vinculada a rotación. El follow-up medio es de 19 meses con controles a 2, 3, 6 y 12 meses y después anuales. Los resultados han sido: óptimo para 17 pacientes y bueno para 1 paciente, en el cual se ha verificado la ruptura post-operatoria del tendón cuadricipital. Nuestra casuística muestra resultados comparables a los de otros autores. No hemos tenido movilizaciones asépticas o sépticas, ni complicaciones médicas intraoperatorias y post-operatorias. Consideramos que, en presencia de la correcta indicación clínica, la utilización de la prótesis vinculada a rotación es preferible a la de deslizamiento porque disminuye el riesgo de una movilización precoz del implante y del desgaste anormal de los componentes protésicos, restableciendo una nueva normalidad biomecánica.Peer Reviewe

Calcaneal osteomyelitis presenting with acute tarsal tunnel syndrome: a case report

<p>Abstract</p> <p>Introduction</p> <p>Cases of acute tarsal tunnel syndrome are rare. To the best of our knowledge, we describe the only reported case of acute posterior tibial nerve compression resulting from adjacent haemotogenous pyogenic calcaneal osteomyelitis.</p> <p>Case presentation</p> <p>A previously healthy 38-year-old Caucasian woman developed symptoms of acute tarsal tunnel syndrome in her right foot over a six-day period. No antecedent trauma or systemic symptoms were noted. Magnetic resonance imaging and bone scan imaging, followed by surgical decompression and bone biopsy confirmed a diagnosis of <it>Staphylococcus aureus </it>calcaneal osteomyelitis. Her pain and paraesthesia disappeared after the operation, while her inflammatory markers normalised during a 12-week course of antibiotics. After four years she has remained asymptomatic without any indication of recurrence.</p> <p>Conclusion</p> <p>This case is not just unique in describing osteomyelitis as a cause of tarsal tunnel syndrome, because haemotogenous calcaneal osteomyelitis is in itself a rare pathology. We recommend considering infection as a differential diagnosis in patients presenting with acute tarsal tunnel syndrome.</p

Volar locking plates versus K-wire/pin fixation for the treatment of distal radial fractures: a systematic review and quantitative synthesis.

INTRODUCTION: Volar locking plate and Kirschner wire/pin fixations are the most commonly used methods for surgical fixation of distal radius fractures. SOURCES OF DATA: A literature search was performed using PubMed, CINAHL, Cochrane Central and Embase Biomedical databases, selecting studies comparing two or more different surgical treatments including Kirschner wire fixation and volar locking-plate fixation. This systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Methodological quality of all selected articles was assessed. AREAS OF AGREEMENT: A total of 14 publications (1306 patients) were included in this review, 10 of which were prospectively designed (8 randomized controlled trial). A total of 659 (50.5%) patients underwent volar locking plating (VLP group), while 647 of 1306 (49.5%) were treated with Kirschner wire/pin fixation (KW group). No differences were recorded in terms of ROM, grip strength, radiographic variables and total rate of complications. There is no clear superiority of either fixation method for the surgical management of distal radius fractures. AREAS OF CONTROVERSY: At a pooled analysis, VLP obtained statistically significant better DASH value compared to KW (18.1 ± 7.8 vs. 12.8 ± 6.4%, P = 0.026). Costs and surgical times were significantly higher for plate fixation. GROWING POINTS: Both techniques provide excellent clinical and radiographic results, without a clear superiority of either fixation method for the surgical management of distal radius fractures. RESEARCH: There is a need for more randomized trials performing standardized measurements at fixed follow-up, with results divided by subtypes of distal radius fractures

Allergy to components of total hip arthroplasty before and after surgery

Sensitivity to a series of haptens was studied in two groups of patients by means of patch tests. The first group was made up of 66 patients with total hip replacements, 12 of whom had aseptic loosening of the implant. The second group, which was used as a control, consisted of 41 patients scheduled to undergo total hip replacement. Ten patients (15.1%) in the first group tested positive; one of these had aseptic loosening. In the control group, two patients (4.8%) tested positive. The theory that an allergy may be the cause of loosening has a biologic foundation, but it can only be used to explain a few cases. However, since considerable vanadium sensitivity was found, we suggest that this material be used as little as possible in the manufacturing of prosthetic components