Fascitis necrotizante de extremidad superior: a propósito de un caso

Los autores presentan un caso de fascitis necrotizante en miembro superior causada por la combinación de bacterias estreptococo microaerofílico y estafilococo aureus. El paciente ha sobrevivido con una pérdida orgánica mínima (amputación del quinto dedo) y una recuperación funcional completa. Se destaca el papel de la antibioterapia precoz.The authors report a case of necrotizing fascitis of the upper limb, produced by a microaerophilic streptococcus and staphilococcus aureus. The only organic sequelae for the patient was amputation of the little finger with a complete recovery of the functional capacity. The role of the early institution of high dose antibiotic therapy is emphasized

Fractura triplana epifisaria distal de tibia: a propósito de un caso con interposición de periostio

Se presenta un caso de fractura triplana en 2 fragmentos en un paciente varón de 13 años tratado quirúrgicamente, observando la interposición perióstica en el plano axial a nivel del fragmento antero-externo, que impedía la reducción anatómica de la zona epifisaria articular. Se analiza la anatomía quirúrgica de las fracturas triplanas considerando que esta lesión puede ser más frecuente de lo que se ha informado, y sólo valorada en los casos en que se emplee un abordaje antero-externo.The case of a 13-year-old boy with a two-fragment triplane fracture of the distal epiphysis of the tibia is presented. At surgery, an interposition of the periosteum in the axial plane behind the antero-lateral fragment, preventing the anatomical reduction of the epiphyseal joint surface was found. The surgical anatomy of triplane fractures is review taking into account that this lesion can be more frequent that it has been reported. The true incidence should be evaluated at surgery by antero-lateral approach

Fracturas del macizo trocantéreo. Estudio comparativo Ender-DHS: revision de 114 casos

Se presenta un estudio retrospectivo de 114 fracturas pertrocantéreas tratadas con enclavado elástico de Ender (71) y tornillo placa deslizante, DHS (43). Se efectuó un estudio estadístico descriptivo-comparativo entre los 2 grupos de pacientes según la técnica quirúrgica empleada. Se constató un mayor índice de estabilidad usando el DHS (81%), frente al 6 1 % del otro grupo. La tasa de complicaciones fue del 16% y 55% respectivamente. Los resultados clínicos fueron mejores en los enfermos tratados con DHS, fundamentalmente en cuanto a la deambulación que se consiguió en el 98% (Ender 75%), ausencia de dolor y movilidad conservada. Los autores piensan que la estabilidad preoperatoria no influye en la solidez del montaje usando el DHS, pero con la técnica de Ender ésta disminuye en las fracturas inestables; por ello, la técnica de Ender estaría solamente indicada en el tratamiento de fracturas estables en pacientes de edad avanzada o con mal estado general, aunque en clara competencia con el DHS.A retrospective study of 114 intertrochanteric fractures operated on either with Ender's rods (71) or dynamic hip screws, DHS (43) is presented. A statistical descriptive-comparative study between the 2 groups was attempted. There was a greater index of stability using the DHS (82%) than Ender's rods (61%). The rate of complications was 16% and 55% respectively. The clinical outcome was better in cases treated with DHS, specially for walking ability, which was regained in the 98% of cases (Ender 75%), painless and preserved mobility. The authors think that the stability before operation do not influence the solidity of the assembly using the DHS device. On the contrary, with the Ender's technique the fixation is no satisfactory in unstables fractures. Ender's rods would only be suitable for treatment of stable fractures in older patient or with serious associated diseases, although in clear competition with the DHS

Protesis de Monk. Revisión. Resultados del tratamiento de las fracturas subcapitales con artroplastia parcial de Monk

A review of the subcapital fracture of the hip treated with partial prothesis (Monk's prothesis) from 1979 to 1983 is reported. A clinical evaluation, using the Merle-D' Aubigne's and Harris' methods and carrying out radiographic study after the surgery and during the follow-up is analised. The best results were obtained in: - Patients older than 70 years of age. - Prothesis with longstem and metallic cup with adequate size. - Good support at the calcar. - Voss' + effect

Tratamiento profiláctico por anaerobios con oxígeno hiperbárico

The authors report their experience in the use of hyperbaric camera in the management of anaerobic infections after important traumatisms throughout the period of time 1984-1985. A double blind study is carried out. The first group includes those patients under treatment with hyperbaric oxygen, once the anaerobic infection has been detected. The second group is formed by patients who received, during the 24 hours after the accident, profilactic treatment in the hyperbaric camera. The results obtained in the first group were 84'3% good, whilst in the second group there were no cases of anaerobic infection. Therefore, these results Jed authors believe that the use of hyperbaric oxygen must be applied in a profilactic way during the first 24 hours after the traumatism, in conjunction with an antibiotherapy and a good surgical procedure. Key Words

Dibuix I: apunts, programa i exercicis

2010/201

Dibuix I: apunts, programa i exercicis

2010/201