Pseudoartrosis de húmero en la enfermedad de Paget: presentación de un caso

Presentamos un paciente diagnosticado de enfermedad de Paget que sufrió una fractura patológica del húmero. El tratamiento ortopédico de la fractura deparó una pseudoartrosis. El resultado del tratamiento quirúrgico de ésta fue bueno. Se discute la incidencia de la afectación del húmero en la enfermedad de Paget y aspectos relativos a la curación de las fracturas del mismo.A patient with Paget's disease who had a pathological fracture of the humerus was presented. The fracture was orthopedically treated and developed non-union. Good result was achieved with surgical treatment. Incidence of Paget's disease on the humerus and healing in these fractures are discussed

Anomalía congénita del atlas asociada con fractura de la apófisis espinosa de C-7 : a propósito de 1 caso

Se presenta 1 paciente con un defecto congenita del arco posterior del atlas asociado con una fractura de la apólisis espinosa de C-7. La TAC, precedida de una correcta evaluación clínica, permiten diferenciar los traumatismos agudos de las anomalías congénitas en el atlas.A case of a congenital cleft of the posterior arch of the atlas associated with a fracture of the spinous process of C-7 is reported. Appropiate clinical evaluation and CT-scan study allow to differentiate acute trauma from a congenital abnormality in the atlas

Osteomielitis y tumor de Ewing: aspectos clínicos y radiográficos comunes

La osteomielitis aguda y el tumor de Ewing, dos entidades de naturaleza bien distinta, pueden mostrar semejanzas clínicas y radiográficas. Presentamos un caso de tumor de Ewing clásico y dos de osteomielitis que plantearon sendas dudas diagnósticas. Concluimos insistiendo en la importancia de un diagnóstico diferencial definitivo precoz mediante biopsia y cultivo en estas circunstancias.Acute osteomyelitis and Ewing's sarcoma are diseases of quite different natur e which may show similar clinical and radiographic characteristics. The author s present a case of classic Ewing's sarcoma ant two case s of osteomyelitis that suposed diagnosti c doubts in each case . They conclude emphasizing on the importanc e of an early, definitive differential diagnosis in thes e circunstance s by means of a biopsy and bacteriologic culture

Factores pronósticos del resultado de la quimionucleosis

Los resultados exitosos de la quimionucleosis dependen íntimamente de una estricta selección de los pacientes. En el presente trabajo se revisa la influencia de diferentes factores preoperatorios, clínicos y radiológicos, sobre el resultado de la quimionucleosis a los dos años de evolución, a través de un estudio estadístico de los casos. Los autores destacan como factores de mal pronóstico, en su casuística, las lumbalgias aisladas o prolongadas y el régimen laboral autónomo. Ni el tamaño ni la localizatción, central o lateral, de la imagen herniaria influyeron de manera estadística significativa en el resultado de la discolisis. Tampoco el número de discos explorados o inyectados, ni la presencia de signos radiológicos o tomodensitométricos asociados a la hernia discal sintomática.Successful results of chemonucleolysis depend specially on a strict patient selection. In this paper the influence of different preoperative, clinical and radiologic factors on the results two years after chemonucleolysis, is reviewed through the statistical analysis of the cases. The author s hav e observed the isolated or persistent low back pain (rather than sciatica), and being an autonomous worke r as poor prognosis factors in their environment. Size and site, either midline or lateral, of the disc herniation did not influence the results of chemonucleolysis with statistical significance; nor did the number of discs explored or injected, neither the presence of radiologic or tomodensitometric findings associated with symptomatic disc herniation

La toma de muestras intraoperatorias con hisopo para el diagnóstico precoz de una infección de prótesis total de cadera es una práctica ineficaz

El diagnóstico de infección articular periprotésica es motivo de reuniones y consensos internacionales. Sin embargo, no hay consenso sobre cuál es la prueba más adecuada para identificar de manera profiláctica el o los microorganismos responsables. En este trabajo se realiza un estudio retrospectivo de 1.022 pacientes a los que se les implantaron 1.045 prótesis totales de cadera entre los años 2009-2013, ambos inclusive. Se analizan los resultados del cultivo de muestras tomadas intraoperatoriamente identificándose los microorganismos aislados y su correlación con la clínica de infección. Se calcularon la sensibilidad, especificidad, valores predictivos positivos y negativos de la prueba. Se identificaron los pacientes con complicaciones infecciosas, la clasificación de los mismos según criterios de Tsukayama y el tratamiento realizado. Concluimos que la toma rutinaria de muestras intraoperatorias en la artroplastia primaria de cadera para intentar adelantar el diagnóstico de una infección periprotésica es una práctica ineficaz e ineficiente y, por ello, hay que abandonarla.There are many international meetings and consensus about the diagnosis of periprosthetic joint infection. However, there aren´t consensus about the most appropriate test to identify the prophylactically microorganisms responsible of infection. This paper is a retrospective study of 1.022 patients with 1.045 total hip replacements between 2009-2013. We analyzed the results of intraoperative culture samples, identified the microorganisms and the patients with clinical infection. We calculated the sensitivity, specificity, positive and negative predictive values of the test. The patients with infectious were identified and classified according to criteria Tsukayama and treatment performed. We conclude that intraoperative culture samples in primary hip arthroplasty to try to advance the diagnosis of periprosthetic infection are an ineffective and inefficient practice and we have to stop doing it

Long-term outcomes of distal locking in extracapsular fractures treated with trochanteric Gamma3 nails

[EN]Background: Few publications have assessed long-term results of distal locking of short endomedullary nails for extracapsular hip fracture. Virtually all of them focus on immediate differences. Criteria for the use of static or dynamic locking are unclear in most nailing systems, and use is advised in unstable fracture patterns or with risk of bell-clapper effect, but often influenced by the “orthopaedic school”. Materials and methods: This is a historical cohort study on patients diagnosed and operated in 2014 and followed up until endpoint, considered as consolidation or major complication, plus evaluation of overall long-term survival. They were categorised as static distal locking (ST) or dynamic distal locking (DN). Both are comparable, except for all stable pre-operative classifications, Fracture Mobility Score (FMS) at discharge, and immediate post-operative loading,all of which were in favour of DN. Results: Consolidation took place in > 95% of patients, with a non-statistically significant delay trend in ST. Less than 6% in both ST and DN had major complications, with no differences. Most cases suffered early cut-out. Significant fracture collapse was the most frequent minor complication. There were more statistically significant minor and total complications in ST. Infection, without differences, can precede cut-out. Lateral thigh pain was similar and could be related to back-out. In DN, 21.1% of cases were truly dynamised. We did not find differences in mobility or in longterm survival. Conclusions: Any type of distal locking seems to be safe for consolidation, despite a slightly longer consolidation time in static locking. Early cut-out was the main complication, while others were very infrequent, which is an advantage over helical blade devices. There was a higher rate of minor and overall mechanical complications in ST, but infection and lateral thigh pain were similar. Most non-traumatic mechanical complications occurred around 5–6 weeks. About one in five of the DN truly dynamised, with all cases occurring before 8 weeks. Mobility until endpoint and overall long-term survival were not influenced by the locking mode used. Level of evidence: Therapeutic study, level 2b

Biomechanical study of autograft anatomic reconstruction in lateral ankle instability

Introduction: The purpose of this work is perform a biomechanical comparison of anatomic reconstruction of the anterior talofibular ligament (ATFL) with the intact ATFL. Materials and methods: We studied 18 fresh cadaveric ankles with intact ATFL. Each specimen was clinically assessed with the anterior drawer (AD) and varus tilt (VT) tests and the angular movement in the three spatial planes (axial, coronal and sagittal) was measured with an arthrometer using a sensor located in the talus. Results: Statistically significant differences were found in the axial plane, between the intact ATFL versus the sectioned ATFL for AD test with p = 0.012, and for VT test with p = 0.013. Regarding the coronal plane, we also observed a statistically significant difference for VT test with p = 0.016. In the sagittal plane, there are no statistically significant differences in both maneuvers. No statistically significant differences were found when comparing the biomechanics of anatomic ligament reconstruction versus the intact ATFL. Conclusion: Autograft anatomic reconstruction of the ATFL showed biomechanical properties similar to those of the native ATFL, at the zero moment in a cadaveric model.publishersversionpublishe

Estudio de los efectos de las lesiones del labrum acetabular en la cadera en un modelo experimental lagomorfo adulto

Objetivo: El cartílago labral es una estructura cartilaginosa que recubre el acetábulo de la cadera. Su lesión es controvertida en cuanto a sus implicaciones debido a que no se conoce bien si es una causa de degeneración articular o sólo un cambio degenerativo más. Hemos diseñado un modelo animal en conejo para estudiar esta lesión. Material y metodología: Se utilizaron tres grupos de 13 animales a los que se lesionó una cadera dejando la otra como control y se les mantuvo estabulados al primer grupo 12 semanas, al segundo 18 y al tercero 30. Posteriormente se les realizó un estudio radiológico, otro por resonancia magnética y, tras su sacrificio, un estudio histológico. Resultados: No encontramos relación en nuestro modelo entre la lesión labral y los cambios degenerativos posteriores en los plazos citados. Tampoco encontramos daños labrales sin cicatrizar en el momento del sacrificio. Conclusión: En el modelo animal lagomorfo, la lesión labral no produce cambios degenerativos artrósicos y el cartílago labral podría presentar cierta capacidad de regeneración

Denosumab treatment for giant-cell tumor of bone: a systematic review of the literature

Denosumab is a human monoclonal antibody (mAb) that specifically inhibits tumor-associated bone lysis through the RANKL pathway and has been used as neoadjuvant therapy for giant-cell tumor of bone (GCTB) in surgical as well as non-surgical cases. The purpose of this systematic review of the literature, therefore, is to investigate: (1) demographic characteristics of patients affected by GCTBs treated with denosumab and the clinical impact, as well as, possible complications associated with its use (2) oncological outcomes in terms of local recurrence rate (LRR) and development of lung metastasis, and (3) characteristics of its treatment effect in terms of clinical, radiological, and histological response.A systematic review of the literature was conducted using PubMed, EMBASE, and COCHRANE search including the following terms and Boolean operators: “Denosumab” AND “primary bone tumor”, “denosumab” AND “giant cell tumor”, “denosumab” AND “treatment”, and finally, “denosumab” AND “giant cell tumor” AND “treatment” since 2000. After applying inclusion and exclusion criteria, a total of 19 articles were included. The quality of the included studies was assessed using STROBE for the assessment of observational studies.A total of 1095 patients were included across all 19 studies. Across all the studies included, there were 615 females and 480 males. The mean patient age was 33.7 ± 8.3 years when starting the denosumab treatment. The pooled weighted local recurrence rate was 9% (95% CI 6–12%) and the pooled weighted metastases rate was 3% (95% CI 1–7%). The most common adverse event was fatigue and muscular pain. Radiologic response was estimated to occur in 66–100% of the patients. A significant reduction in pain under denosumab treatment was reported in seven studies and additional improvement in function and mobility was reported by several authors. Only two studies reported musculoskeletal tumor society (MSTS) scores which were better after denosumab treatment.The use of denosumab as an adjuvant treatment of GCTB has shown a positive but variable histological response with consistent radiological changes and several types of adverse effects. There is a positive clinical response in terms of pain relief with decrease on the morbidity of surgical procedures to be performed. Finally, oncological outcomes are disparate with neither effect on metastatic disease nor local recurrence rates.IV

Epidemiología de las fracturas diafisarias de tibia.: a propósito de 275 casos

Los autores revisan los factores epidemiológicos más importantes que inciden en una serie de 275 pacientes con fractura diafisaria de tibia. Los accidentes de tráfico fueron el mecanismo causal más frecuente en esta patología, seguidos a escasa distancia de los casuales, habitualmente en individuos varones en su periodo de máxima actividad físico-laboral. Se analizan las características anatomopatológicas de las fracturas y su clasificación, en relación a las enunciadas por JOIINER y cols. y por NICOLL.In this report, the authors review the most important epidemiologic factors in a series or 275 patients with fracture of tibial shaft. Traffic accident were the most frequent ethiology, followed closely by casual accldents, and most of patients were male in their period of major physical-laboral activity. Anatomo-patologic characters and classification of the fractures are analysed, in relation to those stated by JOHNER et al. and NICOLL