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

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

Prevalencia en nuestro medio de las deformidades dinámicas posicionales del hallux como secuela de las fracturas de tercio medio y distal de tibia

Dynamic positional deformity of the hallux is a relatively new disease, precisely because of its innovative nature and dynamics may go unnoticed to clinicians. It is because of this, that the limited literature available stresses the importance of making an active search for this pathology in our daily practice. The purpose of this study is to estimate the prevalence of these deformities at the University Hospital Dr. Peset of Valencia as well as make an analysis of their management. An analytical, descriptive and retrospective study was designed in which patients admitted in our center during 2014 and 2015 with medium and distal third tibia fracture were analyzed searching for dynamics positional deformities of the hallux. We found a total of 5 compatible cases from 42 analyzed tibia fractures. This may indicate that as expected dynamic positional deformity of the hallux could be an underrated disease in our medium

Utilidad de la procalcitonina sérica para la discriminación temprana entre fascitis necrosante y celulitis de las extremidades : serie de casos y revisión de la literatura

Objective: to assess the usefulness of a risk scale based on serum procalcitoninwhen compared with the LRINEC score in the early discrimination between necrotizing fasciitis (NF) and extremities cellulite.Material and method: retrospective study, between 2009 and 2017, of all patients with the confirmed diagnosis of NF in one limb (N = 10). The findings of these patients were compared with those of 23 patients who were admitted for severe cellulitis of limbs in the same period. The variables related to each group were analyzed. Using the area under the curve (AUC), the discriminationcapacity for NF diagnosis of two scales was compared, one based on procalcitonin levels and another based on the LRINEC score.Results: the area under the curve was greater for the risk categorized by procalcitonin levels. When analyzing the LRINEC score and procalcitonin levels as continuous variables, the latter also presented a larger area under the curve. The cut-off point with the greatest area under the curve was that corresponding to> 0.87 ng / ml of procalcitonin (sensitivity of 100% and specificity of 82.6%) and score 5 on the LRINEC score (sensitivity of 80% and specificity of 82.6%).Conclusion: in our sample the level of procalcitoninand the scale based on this level has been shown as a more sensitive and at least as specific tool as the LRINEC scale for early discrimination between NF and a cellulite of the extremities

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

Notodo es "cut-out" : reclasificación de las complicaciones mecánicas del tornillo cefálico del clavo intramedular.

The use of the intramedullary nail in extracapsular fractures of the proximal third of the femur is the most frequent stabilization system. In recent years, the biomechanical complications that affect this system have been increasing.A retrospective radiographic study of intertrochanteric fractures was performed followed by an analysis of the biomechanical complications in zone 1 of the cephalic screw. Of the 548 cases, 85 cases (15.5%) of complications were observed, with "back-out" being the most frequent minor complication and "cut-out" the most frequent major complication. 41% of the total fractures correspond to type 31-A2.3 AO / OTA. The basicervical fractures and 31-A2.3 have a high risk of complications.The biomechanical origin that Lenich describes is important to understand as the surgical solution varies depending on whether it is cut-out, cut-in (same origin of the biomechanical failure of the head screw) or cut-through (different origin) to, consequently, resolve them in the right manne

Estudio de la valoración del dolor articular y del grado de satisfacción,tras infiltración con plasma rico en fibrina en pacientes con artrosis de rodilla.

The definition of platelet rich plasma (PRP) is still controversial, though it can be described in general terms as ?a volumeof autologous plasma that contains a higher platelet concentration than the physiological basal concentration?. A retrospective observational analytical study was carried out in our hospital in order to assess the results and satisfaction of patients that had undergone PRF injection in knee. Between January and December of 2017, 80 gonoarthrosis patients treated with PRF injection were selected by the Orthopaedic Surgery and Rehabilitation Department, all of whom attended several medical appointments to check their recovery. Those cases that did not follow an appropriate clinical follow-up were dismissed from the study.Pain before treatment was assessed by the Numeric Rating Scale, with a mean of 8.48. A statistically significant decrease was observed after treatment (p<0.001), with a 4.87 mean and a 5.00 post-injection median. Regarding walking perimeter, most patients walked a median of 30 minutes and 55.3 minute mean, and their walking autonomy increased after treatment, doubling the median to 60 minutes, with an average of 93.15 minutes of pain-free walking. This 37.8 minute increase in the walking ability impliesa statistically significant improvement (p<0.001). A significant decrease in analgesics intake after treatment was also observed, being 81.3% patients who needed analgesia prior to treatment (n=61), and just 49.3% (n=37) after the procedure.Consequently,there is a significative improvement of pain, walking perimeter and absolute intake of analgesics that cannot be explained by any variable prior to PRF injection

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

Barriers and facilitators of physical activity in adults with severe haemophilia: A qualitative study

Background: People with haemophilia (PWH) tend to be less physically active than the general population, but there is a lack of research on the specific barriers and facilitators affecting their participation in physical activities. Objectives: This study aims to explore perceived barriers and facilitators to physical activity in severe PWH. Design: An explorative qualitative study based on focus groups. Methods: Four focus groups including 16 participants (severe haemophilia A patients) were conducted to examine the factors perceived as facilitators or barriers to haemophiliacs engaging in physical activity. One researcher conducted a thematic analysis of all data. Results: Three themes were identified: body function, personal factors, and environmental factors. Key facilitators identified were access to prophylaxis treatment to reduce the risk of bleeding(s), the enjoyability of physical activity, fitness and health motives, social interaction, support, and low cost. PWH faced additional barriers to being physically active including hurtful joints, mobility issues, haemophilic arthropathy, dislike or disinterest, lack of motivation, fear of injury, tiredness, lack of time, lack of guidance, negative social influence, restriction, and lack of coordination of prophylaxis treatment. Conclusion: This exploratory study demonstrated that participation in physical activity in PWH is influenced not only by their own abilities and attitudes, but also by external variables, including family, friends, healthcare professionals, structures, and communities. The results of this study may be used to assist caregivers and health professionals, inform programs, interventions, and policies to promote physical activity and health in severe PWH

International Consensus Document on Obstructive Sleep Apnea

El objetivo principal de este documento internacional de consenso sobre apnea obstructiva del sueno es proporcionar unas directrices que permitan a los profesionales sanitarios tomar las mejores decisiones en la asistencia de los pacientes adultos con esta enfermedad según un resumen crítico de la literatura más actualizada. El grupo de trabajo de expertos se ha constituido principalmente por 17 sociedades científicas y 56 especialistas con amplia representación geográfica (con la participación de 4 sociedades internacionales), además de un metodólogo experto y un documentalista del Centro Cochrane Iberoamer icano. El documento consta de un manuscrito principal, con las novedades más relevantes del DIC, y una serie de manuscritos online que recogen las búsquedas bibliográficas sistemáticas de cada uno de los apartados del DIC. Este documento no cubre la edad pediátrica ni el manejo del paciente en ventilación mecánica crónica no invasiva (que se publicarán en sendos documentos de consenso aparte)