Controversias del empleo de plasma rico en plaquetas en cirugía ortopédica y traumatología: reparación y aplicación

La utilización de las plaquetas obtenidas por centrifugación del plasma sanguíneo se ha extendido en la práctica clínica en los últimos años. Hay suficientes evidencias de la limitación de las plaquetas como factores de crecimiento en los tejidos donde se depositan y de los efectos de estos factores en los fenómenos reparadores de los tejidos. Sin embargo, las evidencias en su uso clínico son realmente escasas. La gran variedad de técnicas empleadas en su preparación, la confusión en la terminología, una casuística poco uniforme, una valoración de métodos poco objetiva y la falta de estudios prospectivos no permiten conocer su verdadera eficacia clínica. Se analizan en este artículo los diferentes manejos de las plaquetas y la activación de los factores de crecimiento en su uso clínico.The use of platelets obtained by centrifugation of plasma to repair tissues has been extended in clinical practice during the last years. There are enough evidences on the limitation of platelets as growth factors in the tissues where they are deposited and the effects of these factors on tissue repair events. Moreover, evidences of utility in clinical settings are negligible. The variety of techniques used in their preparation, differences in the used terminology, non-uniform casuistry, biased assessment of the methodology and lack of prospective studies preclude the understanding of its real clinical utility. In this article the different managements of platelets and activation of growth factors in clinical use are discussed

Valoración del tratamiento de la tendinopatia degenerativa del manguito rotador del hombro mediante infiltraciones ecoguiadas de plasma rico en plaquetas

El objetivo del presente trabajo es determinar si existe beneficio en el tratamiento de la patología degenerativa crónica del manguito rotador del hombro mediante infiltraciones ecoguiadas de plasma rico en plaquetas. Para ello se diseñó un estudio prospectivo intervencionista de asignación secuencial paralela de 30 casos en dos subgrupos de 15 pacientes: un grupo intervención en el que se realizaron 2 infiltraciones ecoguiadas espaciadas 4 semanas de plasma rico en plaquetas, comparado con un grupo control de 15 pacientes que sólo recibieron tratamiento rehabilitador. A los pacientes se les realizó EVA, ASES, DASH y SF-36 al principio y al final del estudio. Ambos grupos de tratamiento mejoraron al final del seguimiento, sin encontrar diferencias estadísticamente significativas entre ambos grupos en ninguno de los parámetros valorados. No se evidenció que ningún parámetro radiológico fuese predictor de lesión tendinosa. Las infiltraciones de plasma rico en plaquetas no son más efectivas, desde el punto de vista clínico, que la rehabilitación aislada en el tratamiento de la tendinopatia degenerativa del manguito rotador.The aim of this study is to determine whether there is benefit in the treatment of chronic degenerative rotator cuff tendinopathy of the shoulder with ultrasound-guided injections of platelet-rich plasma. This is an interventional prospective study with parallel sequential allocation of 30 cases into two groups of 15 patients: an intervention group that received two ultrasound-guided injections of PRP in a period of four weeks, compared with a control group of 15 patients treated just with physical therapy. Patients underwent EVA, ASES, DASH and SF-36 questionnaires at the beginning and at the end of the study. Both treatment groups improved at final follow-up, no statistically significant difference was found between groups in any of the parameters evaluated. There was no evidence that any radiographic parameter was predictive of tendon injury. Ultrasound-guided platelet rich plasma injections are no more effective, from a clinical point of view, than physiotherapy alone in the treatment of the degenerative tendinopathy of the rotator cuff

Intensity of physical education classes in adolescents

Se registró la frecuencia cardiaca de 182 estudiantes (97 chicos y 85 chicas) de entre 12 y 18 años durante sus clases de Educación Física. Los resultados muestran una media del 21,62±14,33% del tiempo de clase en valores MVPA (moderate to vigorous physical activity). Respecto al género, pese a no ser significativo, los mayores valores corresponden a la chicas (23,47±14,45% vs 19,99±14,10%; p=0,106). No se ha observado efecto del tipo de sesión (deportes colectivos, deportes individuales, juegos tradicionales o bailes) sobre el tiempo en valores MVPA (p>0,05; TE0.05; ES<0.020), obtaining the highest values in team sports sessions. Results show that intensity and duration of analyzed classes do not comply with recommendations to become an adequate cardiovascular exercis

Rotura aguda completa del ligamento colateral metacarpo-falángico radial del pulgar: una lesión grave infrecuente

El ligamento colateral radial es el principal estabilizador articular contra las fuerzas de estrés en aducción de la articulación metacarpofalángica del pulgar. Esta lesión infrecuente, pasa a menudo desapercibida, desarrollándose una inestabilidad articular sintomática y, posteriormente, una artrosis secundaria. Aunque tradicionalmente se ha recomendado el tratamiento conservador de estas lesiones, estudios recientes han documentado mejores resultados funcionales cuando se realiza su reparación quirúrgica, especialmente en las lesiones completas.The radial collateral ligament is the primary stabilizer against stress forces in adduction of the metacarpophalangeal joint of the thumb. This uncommon injury may go unnoticed, resulting in symptomatic joint instability and secondary osteoarthritis. Although traditionally it has been recommended conservative treatment of these lesions, recently studies have documented better functional outcomes with surgical repair of complete ruptures

Toracoplastia expansiva en el tratamiento de la escoliosis congénita torácica con malformaciones vertebrales asociadas a fusión costal

Se presenta el caso clínico de un paciente varón de 3 años de edad con escoliosis congénita torácica en el contexto de un síndrome de VACTERL, que presentaba defectos múltiples de segmentación vertebral con fusión costal asociada, en el que se realizó una toracoplastia expansiva mediante un sistema protésico vertical expandible de titanio de distracción costal, consiguiéndose una corrección indirecta de la escoliosis, favoreciendo el desarrollo torácico y pulmonar en la concavidad de la curva, y retrasando la instrumentación con fusión vertebral.This paper reports on a 3-year-old patient with congenital thoracic scoliosis in the context of a VACTERL's syndrome, who had many spinal segmental defects with ribs fusion associated, in which an expansion thoracoplasty was made by means of a vertical expandable prosthetic titanium rib. An indirect correction of the scoliosis was achieved allowing the thoracic and respiratory development in the concavity of the curve and, thus, postposing the instrumentation with spinal fusion

Luxación esternoclavicular posterior: a propósito de un caso y revisión de la literatura

La luxación esternoclavicular posterior es una patología poco frecuente. Se presenta sobre todo en varones jóvenes asociada a traumatismos de alta energía. Puede presentar complicaciones potencialmente letales por compresión de estructuras mediastínicas, por lo que es necesario su reducción urgente. El diagnóstico radiográfico puede ser difícil debido a la superposición de estructuras, siendo de gran utilidad la TC para determinar el tipo y grado de desplazamiento, así como la relación anatómica con las estructuras mediastínicas. Se presenta el caso de un paciente varón, de 23 años de edad, que presentó una luxación esternoclavicular posterior traumática aguda tras accidente de tráfico en el que se consiguió la reducción cerrada mediante manipulación bajo anestesia general y posterior inmovilización antiálgica durante 3 semanas, sin objetivarse inestabilidad esternoclavicular posterior que obligase a más procedimientos. Se realiza una revisión de la literatura médica al respecto de esta patología.Posterior sternoclavicular dislocation is a rare disease. It occurs mainly in young men associated with high-energy trauma. It can be life-threatening due to compression of mediastinal structures, so its reduction is urgently needed. The radiographic diagnosis can be difficult because of overlapping structures, CT is very helpful to determine the type and degree of displacement and the anatomic relationship with the mediastinal structures. We present the case of a male patient, aged 23, with an acute traumatic posterior sternoclavicular dislocation after accident, in which closed reduction was achieved by manipulation under general anesthesia, followed by analgesic immobilization for 3 weeks resulting in sternoclavicular healing without instability, so no more procedures were needed. A literature review is presented regarding to this case

Physical Education in English. A proposal for working postural hygiene in Primary Education

In recent years, European Union has increased the demand for bilingual education as a tool to prepare young people in school and at work. This need has been reflected in the educational legislation of its member countries In Spain, since 2006 there is a basic competency related to foreign language learning. The Physical Education area has become an ideal means to facilitate the learning of English through play and movement. In order to facilitate the work of future teachers in the area, this article examines the teaching of Physical Education in the bilingual English. The current legislation that governs the implementation of bilingualism in schools will be presented, along with the most important methodological considerations for teaching our subject in English. Finally, in the section about practical applications, we present a circuit of activities to work postural hygiene in Primary Education. Each activity has its description in Spanish and English, along with the «teacher speech», with specific instructions to carry out in each of the exercise

Fascitis necrotizante fulminante tras inyección intramuscular glútea

La fascitis necrotizante es una infección grave que afecta a la fascia y al tejido celular circundante, de diagnóstico complejo y que asocia una mortalidad elevada. Se han descrito múltiples factores de riesgo, siendo controvertida su asociación con la administración intramuscular de antiinflamatorios no esteroideos. Se presenta una serie de 3 casos clínicos documentados en nuestro departamento de fascitis necrotizante glútea tras inyección intramuscular, adjuntando una revisión de literatura.Necrotizing fasciitis is a serious infection that affects the fascia and the surrounding soft tissues, its diagnosis is complex and it associates with a high mortality. Despite being described many risk factors, the as - sociation with non-steroidal anti-inflammatory drugs remains controversial. We report a serie of 3 clinical cases of necrotizing fasciitis after muscle gluteal injection registered in our department. A medical literature review is presented as well

Bayesian network method for decision-making about the social sustainability of infrastructure projects

[EN] Nowadays, sustainability assessment tends to focus on the biophysical and economic aspects of the built environment. The social aspects are generally overestimated during an infrastructure evaluation. This study proposes a method to optimize infrastructure projects by assessing their social contribution. This proposal takes into account the infrastructure¿s interactions with the local environment in terms of its potential contribution in the short and long term. The method is structured in three stages: (1) preparation of a decision-making model, (2) formulation of the model, and (3) implementation of the model through optimization of infrastructure projects from the social sustainability viewpoint. The theory of Bayesian reasoning and a harmony search optimization algorithm are used to carry out the research. The paper presents the application to a case study of a set of alternatives for road infrastructure projects in El Salvador. This approach creates a model of participative decision-making. The results show that the method can distinguish socially efficient alternatives from the short and long-term contributions. In addition, the results suggest that some variables are less sensitive to the short and long-term maximization, while others vary their values to improve one objective or the other. The findings are directly applied to a real case. The method can be employed in the infrastructure formulation and prioritization phases and complemented with economic and environmental sustainability assessments.This research was funded by the Government of Chile under the Doctoral Fellowship Abroad Program (grant CONICYT-2015/72160059) and the Spanish Ministry of Economy and Competitiveness along with FEDER funding (project BIA2014-56574-R). The authors are grateful to both the United Nations Development Programme and the Ministry of Public Works, Transportation, Housing and Urban Development of El Salvador for their participation in the implementation of the proposed method (Project 00074250).Sierra-Varela, LA.; Yepes, V.; García-Segura, T.; Pellicer, E. (2018). Bayesian network method for decision-making about the social sustainability of infrastructure projects. Journal of Cleaner Production. 176:521-534. https://doi.org/10.1016/j.jclepro.2017.12.140S52153417

Pseudosubluxación C2-C3: un hallazgo radiológico frecuente en la infancia

Objetivo: Mostrar un hallazgo radiológico fisiológico de la columna cervical infantil que tiende a ser malinterpretado como patológico: la pseudosubluxación C2-C3. Se presenta un caso de una niña de 14 meses de edad remitida a nuestro centro bajo sospecha de subluxación C2-C3. Se aporta una metodología para el diagnóstico diferencial entre pseudosubluxación C2-C3 y subluxación C2-C3 verdadera. Una anamnesis detallada así como una exploración clínica y radiográfica minuciosas, permiten establecer el diagnóstico en la mayoría de los casos. La normal movilidad en flexión de C2 sobre C3 en la columna cervical infantil puede ser tan pronunciada que llegue a confundirse con una lesión. La interpretación adecuada de las radiografías simples de la columna cervical en los niños requiere el conocimiento de las peculiaridades de este segmento en la edad pediátrica.Objective: To report on a physiological radiographic finding of the cervical spine in childhood that trends to be misjudged as pathologic: C2-C3 pseudosubluxation. We presented a girl, aged 14 months, who was remitted to our Center for clinical suspect of C2-C3 subluxation. A diagnostic methodology is offered to distinguish between C2-C3 pseudosubluxation and a true C2-C3 subluxation. A detailed anamnesis as well as a meticulous radiological and clinical exploration, allow to establish the right diagnosis in most cases, without any other complementary probe. The normal mobility of C2 on C3 in flexion could be so pronounced as to be mistaken for a pathological finding. The suitable radiographic interpretation of the cervical spine in children requires the knowledge of the peculiarities of this segment in the pediatric age