Osificación Heterotópica Coxofemoral secundaria a Encefalitis Herpética : a propósito de un caso y revisión de la literatura

Heterotopic ossification is the abnormal formation of bone in soft tissues outside the skeleton. It is associated with nervous system injuries or after a hip replacement. It is therefore a relevant pathology against which there is a controversial diagnostic and therapeutic attitude. We report a case of a patient of 36 year who developed heterotopic ossification after herpetic encephalitis. We also review the published studies collecting the current recommendations for diagnosis, prevention and treatment

Evaluación de resultados en el tratamiento quirúrgico de las fracturas aisladas de cabeza de radio en el adulto

Presentamos una serie de 35 pacientes intervenidos en nuestro servicio por fractura aislada de cabeza de radio. El objetivo ha sido evaluar el resultado funcional del tratamiento quirúrgico de estas fracturas en el adulto, la correlación de los diferentes sistemas de evaluación de resultados y determinar los factores pronóstico. Las fracturas se clasificaron según Mason evaluando los resultados utilizando la escala de valoración del hospital par cirugía especial (HSSA) de Inglis y Pellici, el índice de clasificación funcional de Broberg y Morrey y la escala de evaluación funcional del codo de la Clínica Mayo. En más del 80% de los casos se obtuvieron resultados buenos ó excelentes, con una flexión media de 139% y un déficit de extensión de 10º. Los tres métodos de valoración mostraron un índice de concordancia estadísticamente significativo resultado por tanto ser equiparables. El retraso en la cirugía resultó ser un factor pronóstico en el resultado final (p<0.05) mientras que el tipo de fractura y de cirugía muestran tendencia a influir en el resultado final.Functional outcome after surgery for isolated radial head fractures in adults was assessed using three different outcome assessment approaches and favourable prognostic factors were determined. Thirty-five patients with radial head fractures were operated. Fractures were grouped according to the Mason classification, and the results obtained were assessed by means of the hospital for special surgery assessment (HSSA) system. Broberg and Morrey functional classification index and the Mayor Clinic elbow functional in over 80% of cases, with an average flexion of 139 degrees and an extension defect of 10 degrees. All three assessment system yielded statistically significant concordant scores, and was thus considered to be equivalent. Surgical delay proved to be a significant prognostic factor of the end result (p<0.05), while the type of fracture and surgery employed tended to influence outcome

Necrosis avascular de cabeza femoral en pacientes con enfermedad de Gaucher tipo I : tratamiento mediante artroplastia total de cadera no cementada

El 80% de los pacientes con enfermedad de Gaucher presentan manifestaciones óseas, siendo la necrosis avascular de la cabeza femoral una de las que mayor limitación produce y la primera causa de intervención quirúrgica osteoarticular. La artroplastia total de cadera cementada ha sido el tratamiento de elección en los casos con mayor deterioro de la articulación, pero sus resultados a medio y largo plazo se han visto ensombrecidos por la elevada tasa de aflojamiento. La terapia enzimática sustitutiva ha disminuido las complicaciones postoperatorias, además de permitir el uso de componentes no cementados con resultados similares a las prótesis implantadas por otros motivos. Presentamos una serie de 5 artroplastias de cadera no cementadas, con un seguimiento medio de 12.4 años (3.4-30), en 4 pacientes con enfermedad de Gaucher tipo I y osteonecrosis de la cabeza femoral. Solo se observó un caso de aflojamiento aséptico a los 18 años de la intervención

Infección periprotésica en pacientes ancianos tratados mediante hemiartroplastia de cadera tras fractura intracapsular ¿Es el uso de cemento impregnado con altas dosis de antibiótico es un factor asociado a su disminución?.

Objective: to study whether the use of cement with a high dose of antibiotics is a factor associated with a lower infection rate in hip hemiarthroplasty after femoral neck fracture.Material and methods: a retrospective cohort study of 144 consecutive patients treated surgically for a cervical hip fracture with cemented hip hemiarthroplasty between February 2015 and February 2017. In 88 (61.1%) high dose antibiotic cement was used, defined as a concentration ? 5% of the total weight (Group 1) and in 56 (38.9%) cement without antibiotics was used (Group 2). The primary outcome variable was periprosthetic infection.Results: there were 2 (1.38%) infections that were classified as deep, both in group 1. One of patients had a superficial infection in group 2. We did not find differences in the rate of infections between the two groups. Among the intra-surgical complications, we found two failures of the cement-prosthesis interface (non-adherence of the cement to the stem at the end of the setting time), both cases occurred in group 1. There was no allergic or toxic reaction. The mean survival time of all operated patients was 2.7 years (95% CI: 2.4-2.9) at the end of follow-up. We found no differences in survival when stratified by the use or not of antibiotics in cement, p = 0.874.Conclusion:In our experience, in patients undergoing hip hemiarthroplasties the use of cement with a high dose of antibiotic is not associated with lower infection rate when intravenous antibiotic prophylaxis is correct

Lipoma intraóseo, un tumor óseo benigno infrecuente : presentación de dos casos intervenidos quirúrgicamente y revisión de la literatura

Intraosseous lipomas are rare and benign tumors of unclear etiology. Most of them are asymptomatic, being accidentally diagnosed during imaging tests performed for other reasons and they usually have unspecific clinical presentations. Radiographically, they can be confused with other entities as non-ossifying fibromas or simple cysts. Methods. We report two cases, a 39-year-old and a 25-year-old Caucasian female patients, referred to our hospital with a mass in the proximal third of the right tibia and distal femur respectively with slowly progressive growth. In conventional X-ray images and computed tomography, a well-defined, expansive intraosseous lytic lesion without cortical disruption was observed in both cases. Magnetic resonance imaging demonstrated predominance of lipomatous tissue signal, being compatible with intraosseous lipoma. The patients underwent excision of the tumor, confirming the diagnosis of intraosseous lipoma after pathological study. Results. In the immediate postoperative period, swelling and pain decreased and at the 6th-month postoperative follow-up the patients are asymptomatic and without radiographic signs of recurrence. Discussion. Intraosseous lipomas are tumors that can go easily unnoticed, being difficult to diagnose on conventional X-ray images. Because of that, other imaging tests, such as CT and MRI, are necessary for diagnosis and histopathology for confirmation. Conservative treatment in asymptomatic patients and surgery in symptomatic cases is recommended. Recurrence and malignant transformation of these tumors is rare