Estudio anatómico del abductor accesorio de la mano y su correlación clínico-ecográfica

Al primer compartimento extensor, siempre se le ha dado gran importancia por sus variaciones anatómicas y su repercusión en la enfermedad de De Quervain. Existen variaciones anatómicas no solo en la longitud del compartimento y la presencia de tabiques en su interior, sino también en su contenido. Las variaciones en el número de tendones de los músculos extensor corto y del abductor largo del pulgar, así como en la gran variabilidad de inserciones distales son debidas a alteraciones en el desarrollo filogenético de estas estructuras. El tendón del abductor largo del pulgar, puede situarse en el interior del primer compartimento en número variable de 1 a 7 tendones, pudiendo diferir este número de una mano a la contralateral. El número de tendones del músculo extensor corto del pulgar, varía entre 1 y 4, siendo lo más frecuente encontrar un único tendón (85%). El número de tendones suele ser similar en ambas extremidades en un 83.3·%. Se considera que existe un verdadero tabique (septo) en el interior del primer compartimento extensor, cuando este se extiende a lo largo de al menos un 50% del compartimento y forma un túnel fibroso circunferencial; la tabicación de este compartimento ha sido descrita por diversos autores estableciéndose hasta siete tipos diferentes. El abductor largo del pulgar puede presentar un vientre muscular con una porción superficial y una profunda; la parte más proximal y profunda daría lugar distalmente al tendón abductor accesorio (AALP), mientras que la parte distal y superficial dará lugar al abductor largo del pulgar (ALP) propiamente dicho..

Surgical site infection in hip arthroplasty in a 10-year follow-up prospective study: Risk and factors associated.

The increased demand for hip arthroplasty means a growing number of postsurgical complications. This study aims to assess the risk of surgical site infection (SSI) in a teaching hospital; develop regional, national and international external comparisons; and evaluate SSI-related risk factors, particularly according to the timing of surgery (urgent/unplanned or elective). Prospective cohort study from January 2008 to December 2018. Patients were followed up to 90 days after surgery. Primary endpoint was SSI incidence according to the Centers for Disease Control and Prevention criteria. Multivariate analysis was conducted to find independently associated SSI risk factors. The association between risk factors and SSI incidence was assessed by reference to odds ratio (OR). Analyses were also performed among urgent/unplanned and elective patients to identify whether SSI risk factors differed between groups. The study population (n = 1,808) has an overall SSI rate of 3.0% (95% confidence interval [CI]: 2.4-3.9). Timing of surgery caused an effect modification, so surgery duration> 75th percentile (OR: 3.8; 95% CI: 1.5-9.8) and inadequate preparation (OR: 3.3; 95% CI: 1.1-10.0) were independent risk factors in the urgent/unplanned group; National Healthcare Safety Network risk index≥ 2 (OR: 6.3; 95% CI: 0.1-19.2) and transfusion (OR: 3.6; 95% CI: 1.1-11.9) in the elective group. Hospital infection surveillance systems allow identifying risk factors susceptible to change. Characterization of factors that caused an effect modification is key to identify areas of quality improvement, including reducing operating times, preventing perioperative blood transfusion, or improving patient preparation before surgery.The authors thank the European Regional Development Fund (ERDF) and the Health Research Fund (Fondo de Investigación Sanitaria/FIS) supporting the research projects PI11/01272 and PI14/01136 which enabled the completion of this study.The study was approved by the center Ethics Committee and Research Board.S

Cost-effectiveness evaluation of manual physical therapy versus surgery for carpal tunnel syndrome: Evidence from a randomized clinical trial

U BACKGROUND: Carpal tunnel syndrome (CTS) results in substantial societal costs and can be treated either by nonsurgical or surgical approaches. U OBJECTIVE: To evaluate differences in cost-effectiveness of manual physical therapy versus surgery in women with CTS. U METHODS: In this randomized clinical trial, 120 women with a clinical and an electromyo-graphic diagnosis of CTS were randomized through concealed allocation to either manual physical therapy or surgery. Interventions consisted of 3 sessions of manual physical therapy, including desensitization maneuvers of the central nervous system, or decompression/release of the carpal tunnel. Societal costs and health-related quality of life (estimated by the European Quality of Life-5 Dimensions [EQ-5D] scale) over 1 year were used to generate incremental cost per quality-adjusted life year ratios for each treatment. U RESULTS: The analysis was possible for 118 patients (98%). Incremental quality-adjusted life years showed greater cost-effectiveness in favor of manual physical therapy (difference, 0.135; 95% confidence interval: 0.134, 0.136). Manual therapy was significantly less costly than surgery (mean difference in cost per patient, €2576; P\u3c.001). Patients in the surgical group received a greater number of other treatments and made more visits to medical doctors than those receiving manual physical therapy (P = .02). Absenteeism from paid work was significantly higher in the surgery group (P\u3c.001). The major contributors to societal costs were the treatment protocol (surgery versus manual therapy mean difference, €106 980) and absenteeism from paid work (surgery versus manual physical therapy mean difference, €42 224). U CONCLUSION: Manual physical therapy, including desensitization maneuvers of the central nervous system, has been found to be equally effective but less costly (ie, more cost-effective) than surgery for women with CTS. From a cost-benefit perspective, the proposed CTS manual physical therapy intervention can be considered