Utilidad de la reconstrucción tridimensional con tomografía computarizada en Traumatología y Ortopedia

La reconstrucción tridimensional es una nuev a técnica diagnóstica introducida en cirugía ortopédica y traumatología. Está indicada en algunas fracturas de acetábulo, columna y pelvis porque facilita una visión desde diferente s ángulos y en determinadas lesiones congénitas donde es imprescindible una correcta evaluación preoperatoria. Presentamo s dos paciente s con fracturas acetabulares, otro con lesión me - tastásica en columna lumbar y otro con hipoplasia del arco neural de cuarta vértebra lumbar. La reconstrucción tridimensional fue útil para el definitivo diagnóstico en los cuatro pacientes.Three dimensional images is a new technique introduced in orthopaedic surgery and traumatology. It's indicated for some fractures of the acetabulum, spine or pelvic girdle becaus e supply a vision from differents angles and in determinated congenital damage s who is indispensable an accurate evaluation before the surgery. We presented two patients with acetabular fractures, other with a metastasi c tumour in lumbar spine and anothe r with a hipoplasti c neural arch in a lumbar vertebra. The thre e dimensional reconstruction was useful for the definitive diagnostic in the four patients

Fracturas epifisiolisis graves de la extremidad proximal del radio: resultado tras tratamiento quirúrgico

La fractura-epifisiolisis del cuello radial es una lesión grave que puede originar alteracione s en e l crecimiento epifisario. Presentamo s una seri e de 22 casos revisados con una antigüedad mínima de dos años. Fueron intervenidos 14 pacientes, de los que 10 estaban incluidos en el grupo III o en lesione s de Jeffery. Once enfermos fueron tratado s con cirugí a abierta. Cuando l a intervenció n consisti ó en reducció n abierta y osteosíntesis, los resultados clínicos fueron buenos en el 50%, pero cuando só- lo se practicó reducción cruenta sin asociar sistema estabilizador metálico, éstos llegaron al 100%. En cinco de los ocho paciente s del primer grupo se presentaron calcificacione s articulares y en dos, epifisiodesis. En el segundo grupo no aparecieron ninguna de éstas alteraciones. Creemos que en los casos de fracturas epifisiolisis del cuello radial en niños con gran desplazamiento, el tratamiento ideal es la cuidadosa reducción cruenta evitando fijación con aguja.The fracture epiphysiolysis of radial neck is a grave lesion which may induc e epiphysea l grown disturbances. A review of 22 case s suffering such fracture s was carried out with a mean follow-up of 2 years. Of the total, 14 cases wer e treated by surgery, 10 of thes e showing either type III or Jeffery's fractures. Eleven patients reequired open reduction. In 50% of the cases treated by open reduction and internal fixation, the clinical results wer e satisfactory. When internal fixation was not used, the satisfactory results reached 100%. Five of the 8 cases of the firt groups developed periarticular ossifications and 2 othe r showed epiphyseal closening. Thes e type of complications wer e not seen in the second group. For epiphysiolysis of the radial neck with sever e displacement. The ideal treatment seems to be a careful open reduction avoiding internal fixation

Sarcoma de Partes Blandas como Hallazgo Casual: a Propósito de Cuatro Observaciones

Se presentan en este trabajo cuatro pacientes con sarcoma s de partes blandas que fueron diagnosticados de fibrohistiocitoma maligno, osteosarcoma extraesquelético, sarcoma sinovial y sarcoma indiferenciado. En todos ellos el tumor fué un hallazgo casual apreciado en exploraciones orientadas hacia otros procesos por los que acudieron al hospital. Se insiste en el diagnóstico precoz y en el correcto tratamiento de este tipo de sarcomas y se recomienda la punción biopsia ante la presencia de tumoraciones blandas con crecimiento progresivo, aún sin otro tipo de sintomatología.Th e author s hav e colecte d fou r patients diagnose d o f Soft tissu e Sar - comas. Th e histologica l diagnosis was, malignan t fibrou s histiocytoma , extraskele - t a l osteosarcoma , synovia l sarcom a an d no-differentiate d sarcoma . Al l o f the m th e tu m o r wa s a casua l findin g durin g th e exploratio n suspectin g othe r pathology . The y emphasiz e a t th e earl y diagnosis an d correc t managemen t o f this typ e o f sarcomas, a s wel l a s th e needl e biops y (close d biopsy ) o f soft tumor s wit h progresiv e growth , even without clinical symptoms

Epidemiología de las fracturas de la extremidad proximal del fémur en asturias

Hemos realizado un estudio epidemiológico de las fracturas de fémur proximal en personas mayores de 50 años, atendidas en nuestro Hospital durante los años 1990-92. Se valoraron un total de 355 casos. En el período estudiado se observó que las fracturas más numerosas fueron la cervicales, no encontrando diferencias significativas en los ingresos según el período estacional. La edad media de presentación fue de 81 años. La tasa de incidencia fue muy semejante a las otras provincias españolas y menor que la encontrada en los países del Norte de Europa, Inglaterra y Estados Unidos.We have performed an epidemiologic study on the incidence of proximal femoral fractures in patients older than 50 years, all reviewed in our Hospital from 1990 to 1992. We included 355 patients. Femoral neek fractures were the most frequent lesions. No significant differences in the hospital admissions were found during all the year's seasons. The mean age of presentation was 81 years. The incidence rate was similar to the rest of Spain, and less than in North Europe, England and United States

Multi-messenger observations of a binary neutron star merger

On 2017 August 17 a binary neutron star coalescence candidate (later designated GW170817) with merger time 12:41:04 UTC was observed through gravitational waves by the Advanced LIGO and Advanced Virgo detectors. The Fermi Gamma-ray Burst Monitor independently detected a gamma-ray burst (GRB 170817A) with a time delay of ~1.7 s with respect to the merger time. From the gravitational-wave signal, the source was initially localized to a sky region of 31 deg2 at a luminosity distance of 40+8-8 Mpc and with component masses consistent with neutron stars. The component masses were later measured to be in the range 0.86 to 2.26 Mo. An extensive observing campaign was launched across the electromagnetic spectrum leading to the discovery of a bright optical transient (SSS17a, now with the IAU identification of AT 2017gfo) in NGC 4993 (at ~40 Mpc) less than 11 hours after the merger by the One- Meter, Two Hemisphere (1M2H) team using the 1 m Swope Telescope. The optical transient was independently detected by multiple teams within an hour. Subsequent observations targeted the object and its environment. Early ultraviolet observations revealed a blue transient that faded within 48 hours. Optical and infrared observations showed a redward evolution over ~10 days. Following early non-detections, X-ray and radio emission were discovered at the transient’s position ~9 and ~16 days, respectively, after the merger. Both the X-ray and radio emission likely arise from a physical process that is distinct from the one that generates the UV/optical/near-infrared emission. No ultra-high-energy gamma-rays and no neutrino candidates consistent with the source were found in follow-up searches. These observations support the hypothesis that GW170817 was produced by the merger of two neutron stars in NGC4993 followed by a short gamma-ray burst (GRB 170817A) and a kilonova/macronova powered by the radioactive decay of r-process nuclei synthesized in the ejecta

Multi-messenger Observations of a Binary Neutron Star Merger

On 2017 August 17 a binary neutron star coalescence candidate (later designated GW170817) with merger time 12:41:04 UTC was observed through gravitational waves by the Advanced LIGO and Advanced Virgo detectors. The Fermi Gamma-ray Burst Monitor independently detected a gamma-ray burst (GRB 170817A) with a time delay of ∼ 1.7 {{s}} with respect to the merger time. From the gravitational-wave signal, the source was initially localized to a sky region of 31 deg2 at a luminosity distance of {40}-8+8 Mpc and with component masses consistent with neutron stars. The component masses were later measured to be in the range 0.86 to 2.26 {M}ȯ . An extensive observing campaign was launched across the electromagnetic spectrum leading to the discovery of a bright optical transient (SSS17a, now with the IAU identification of AT 2017gfo) in NGC 4993 (at ∼ 40 {{Mpc}}) less than 11 hours after the merger by the One-Meter, Two Hemisphere (1M2H) team using the 1 m Swope Telescope. The optical transient was independently detected by multiple teams within an hour. Subsequent observations targeted the object and its environment. Early ultraviolet observations revealed a blue transient that faded within 48 hours. Optical and infrared observations showed a redward evolution over ∼10 days. Following early non-detections, X-ray and radio emission were discovered at the transient’s position ∼ 9 and ∼ 16 days, respectively, after the merger. Both the X-ray and radio emission likely arise from a physical process that is distinct from the one that generates the UV/optical/near-infrared emission. No ultra-high-energy gamma-rays and no neutrino candidates consistent with the source were found in follow-up searches. These observations support the hypothesis that GW170817 was produced by the merger of two neutron stars in NGC 4993 followed by a short gamma-ray burst (GRB 170817A) and a kilonova/macronova powered by the radioactive decay of r-process nuclei synthesized in the ejecta.</p