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Language Revista española de cirugía osteoarticular, 2016, vol. 51, no. 265
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- Resección compartimental mediante abordaje quirúrgico modificado en sarcomas de partes blandas del deltoides(2016) López Vega, Marcos; Montaner Alonso, Daniel; Rodrigo Pérez, José Luis; Valero Fabado, H.Se describe una técnica quirúrgica para la resección radical de sarcomas de partes blandas confinados al compartimento deltoideo en tres pacientes, así como los resultados clínicos y funcionales, además de la evolución oncológica de su patología. Se realiza un abordaje en “Y” que permite la desinserción proximal y distal del deltoides, incluyendo en la pieza tumoral una isla cutánea lateral con la zona de biopsia previa, evitando la necesidad de técnicas de cobertura. No se desarrollaron complicaciones de la herida quirúrgica ni casos de recurrencias locales. Todos los pacientes presentaron un rango de movilidad mínimo de 130º de abducción y una pérdida de fuerza para la abducción y antepulsión. Concluimos que los pacientes con neoplasias malignas confinadas al compartimento deltoideo tratados con la resección radical según la técnica descrita presentan unos resultados funcionales excelentes, en ausencia de lesiones del manguito concomitantes, con un menor riesgo de recidiva local.
- Reconstrucción de rotura crónica de tendón distal del bíceps braquial: a propósito de un caso(2016) Ripalda Marín, J.; Salas García, A.; Carbonel Bueno, I.; García Martínez, B.; Cardona Malfey, R.Chronic or inveterate disruptions of the distal biceps brachii are uncommon. Treatment remains a major challenge by shrinkage and poor quality of the injured tendon and muscle, which sometimes require the use of grafts to try to restore the anatomy and improve the functional outcomes. The rate of complications in surgical treatment of chronic tears is more than the repairs of acute injuries. We report the case of a surgical reconstruction of a chronic tear three months of evolution using lyophilized Achilles allograft.
- Fractura de Maisonneuve abierta: una entidad infrecuente: a propósito de un caso y revisión de la literatura(2016) Cobo Cervantes, C.E.; Sous Sánchez, J. O.; Navarro Ortiz, R.; Marquina Ferrer, H.; Velasco Medina, J.A.Introduction. Maisonneuve fracture represents approximately 5% of all surgically treated ankle fractures. Because these fractures are usually closed, we present the case of a Maisonneuve open fracture owing to its rarity. Case report. A 63-year-old man presented to his emergency department after a right leg trauma. Physical examination revealed a skin solution of continuity above the ankle joint, with a medial tibial malleolus exposure. The radiography showed an opening of the tibiofibular mortise and a spiral fracture of the proximal third of the fibula. Fixation with two cannulated screws was performed. After 12 months of follow up, the patient has an average score of 86.8 points on the AOFAS scale. Conclusion. In the face of an open ankle dislocation, a Maisonneuve open fracture should be suspected in spite of its infrequency, being the osteosynthesis an effective therapeutic option in this type of fractures
- Cuadriceplastia de Judet : una alternativa quirúrgica para las rigideces graves en extensión de la rodilla(2016) Pérez Ortiz, S.; Gómez Barbero, Patricia; Borrás Cebrián, Juan Carlos; Ripoll Vidal, F.Introduction. Extension contracture of the knee is a complication of femoral fractures with significant soft tissue injury. The Judet quadricepsplasty is a surgical alternative to increase knee range of motion. Material and methods. We report the case of a patient with severe stiffness of knee following an open bifocal femoral fracture stabilized by osteosynthesis that was complicated by an infection and delayed healing that required several surgeries for stabilization. Judet quadricepsplasty was performed followed by intensive rehabilitation for increasing knee flexion. Results. In the postoperative care flexion and extension of 0-100º was achieved, and reduced to 95º after 3 months and remained the same at 6 months postoperatively, with a muscular strength of 4 out of 5 in quadriceps and psoas. Conclusion. The Judet quadricepsplasty is an effective technique to regain mobility in case of severe extension stiffness
- Manejo perioperatorio de fármacos anticoagulantes y antiagregantes en el paciente con fractura de cadera(2016) Blas Dobón, J.A.; Martínez González, E.; Cejalvo Andújar, María J.; Martínez Gimeno, J. L.; Aguar Carrascosa, Pablo; Rodrigo Pérez, José Luis; Carrera Hueso, José AdolfoLa fractura de cadera eleva de manera significativa en los estudios publicados la morbilidad y la mortalidad en los pacientes ancianos que la padecen. La participación en el proceso de fármacos que alteran la hemostasia se ha convertido en uno de los aspectos más importantes y controvertidos del manejo perioperatorio del paciente con fractura de cadera. La anticoagulación o antiagregación plaquetaria de estos pacientes tiene unas implicaciones tanto en la práctica anestésica como quirúrgica que hacen necesaria la búsqueda de un equilibrio entre el riesgo hemorrágico y trombótico de los mismos. Con la elaboración del presente protocolo, en línea con las últimas evidencias científicas publicadas, se sientan las bases para avanzar en el tratamiento de este grupo de pacientes. Una atención multidisciplinar especializada, una fijación precoz de la fractura antes de las 48 horas, y un efectivo programa de rehabilitación pueden disminuir las complicaciones del proceso.
- Osteosíntesis mínimamente invasiva con placa en fracturas de radio distal tipo C(2016) Mifsut Miedes, Damian; Zurriaga Carda, J.; Catalá Llosa, R.; Gomar Sancho, FranciscoIntroduction. The current trend towards the use of minimally invasive techniques (MIPO) in the treatment of fractures is justified by the reduced exposure of the fracture and dissection of the muscle planes, which facilitates early recovery. Materials and Methods. We performed a double study, a retrospective descriptive study of a series of 48 cases and a prospective longitudinal study of a series of 23 patients that underwent MIPO after intra-articular distal radius fracture. In addition to the variables: age, sex, side and injury mechanism, etc., functional outcomes, pain, range of motion and strength, through Mayo Wrist Score scale and DASH were assessed. Fractures were classified using the AO guidelines, radiological results and complications were assessed. Results. We conducted the description of surgical approach with surgical images. We analyzed a total of 71 patients, 43 women and 28 men with a mean age of 57 years. The most affected side was the left with 51 cases. According to the Mayo Wrist Score, functional outcome was 68,33 in the first study (retrospective) and 85.86 in the prospective study. A mean loss in strength, measured with a dynamometer of 5,19 Kg. (retrospective) and 2,98 Kg. (prospective), was observed when compared to the contralateral side. Radiographically no intraarticular collapse or loss reduction were observed in prospective study, and consolidation was obtained in 100% of the cases. One case of complex regional pain syndrome was observed and only one case required the removal of material because of dorsal protrusion of a screw in this study. Conclusions. It is a safe technique that allows the reduction and stabilization of fractures of the distal radius. Not only the aesthetic but also functional results are better with MIPO technique.
- Resultados de la autotransfusión postoperatoria en artroplastia total de rodilla(2016) Gómez Barbero, Patricia; Rey Vidal, P.; Blas Dobón, J.A.; López Prats, F.; Rodrigo Pérez, José LuisIntroduction. The purpose is to evaluate the use of autotransfusors drains in total knee arthroplasty primary minimizes the drop in hemoglobin in the postoperative period, and the need for allogeneic blood transfusions. Material and methods. A retrospective, analitic and observational study, have been included 100 patients undergoing knee arthroplasty between January 2014 and January 2015 at the Dr. Peset Hospital. Compare the analytical parameters of bleeding (hemoglobin and hematocrit) and the need for blood transfusion among patients and not reinfused reinfused. Results. Fifty patients with Total Knee Arthroplasty (TKA) were reinfused with a mean volume of 505 ml. The need for allogenic blood transfusions was 4%, while in patients not reinfused was 24%. The average drop in postoperative hemoglobin was 1.12 g / dl lower in the group reinfused. Conclusions. The autotransfusion drain is a safe technique which improves post-transfusional values and therefore reduces the number of allogenic blood transfusions.
