Revista española de cirugía osteoarticular, 2018, vol. 53, no. 276

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    Estrategias de ahorro de sangre en Artroplastia Total de Rodilla Primaria aplicadas en nuestra Comunidad
    (2018) Mifsut Miedes, Damian; Climent Peris, Vicente; Baeza Oliete, J.; Gargallo, E.; Strauch, M.; Álvarez Llanas, A.; Martínez Algarra, J.C; Valero Queralt, M.A.; Ferraro Esparza, L.; Gilabert, E.
    Antecedentes. El objetivo del presente estudio fue realizar una actualización sobre las diferentes estrategias en el ahorro de sangre en cirugía protésica de rodilla pri-maria, a través de una revisión bibliográfica; así como, conocer qué estrategias se siguen en diferentes centros hospitalarios de nuestro ámbito, mediante un estudio multicéntrico. Métodos. Se realizó un estudio observacional transversal descriptivo basado en una encuesta realizada a 64 cirujanos y una búsqueda bibliográfica sobre los distintos aspectos incluidos en la encuesta. Resultados. Los cirujanos refieren que cuentan con protocolos de ahorro sanguíneo prequirúrgicos implantados en su Hospital en un 48,4% (31/64). La utilización del ácido tranexámico es bastante generalizada 71,9% de los encuestados (46/64). Este se administra vía endovenosa previa a la cirugía en un 26,6% (17/64) de los casos, de manera intraarticular en un 21,9% (14/64) y en una combinación de ambas en un 23,4% (15/64). El momento preferido para la colocación de la isquemia por los cirujanos es en un 57,8% (37/64) previo a pintar el campo, mientras que un 39,1% (25/64) prefiere colocarla en estéril. Un 3,1% (2/64) de cirujanos afirma implantar las prótesis sin utilizar isquemia en la cirugía. Conclusiones. En los últimos años se está imponiendo la utilización de ATX como principal estrategia de ahorro de sangre en ATR, aunque no existe consenso en cuanto a la dosis óptima ni a su vía de administración. La eficacia del ATX está influyendo en la eliminación de los drenajes postquirúrgicos y en la implementación de programas de rehabilitación precoz
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    Artroplastia total de codo tras fractura de húmero distal en ancianos. Revisión de casos.
    (2018) Huerta López, Olga M.; García López, A.; Sáez Picó, J.J.; Arlandis Villarroya, Santiago; Ruíz Piñana, E.
    Osteosynthesis is the gold standard in most distal humerus fractures but in elderly patients, arthroplasty may be a better option. The aim of the study was to assess our results with total elbow arthroplasty after acute distal humerus fracture in the elderly. Retrospective study to evaluate clinical and functional results plus complications of all patients from our hospital with a total elbow arthroplasty performed for acute distal humeral fracture. 18 patients were included with a mean age of 77 years (63-87). The mean postoperative range of motion was 89º and the average MEPS and DASH score 80 and 26 respectively. There were 4 complications (22%) and no reoperations. Total elbow arthroplasty can be a good choice for distal humerus fracture, as long as they are indicated in patients with complex fractures, difficult to synthesize due to osteoporotic or severe comminution and with a low functional demand.
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    Osteoporosis en alcoholismo crónico : un problema infravalorado. Incidencia y complicaciones de las fracturas en el paciente alcohólico
    (2018) Guillén Botaya, E.; Blasco Mollá, M. Carmen; Navarro Muñoz, J.; Silvestre Muñoz, Antonio
    Main goal. To estimate the incidence of pathologic fractures and associated complications in patients in follow-up for moderate to severe chronic alcoholism by the Unidad de Conductas Adictivas (UCA) of our health area. To highlight the importance of recognizing osteoporosis in patients with chronic alcoholism in order to establish strategies for prevention of both primary and secondary fractures. Material and methods. Retrospective analysis of patients in follow-up for chronic alcoholism by the UCA between 2014 and 2018 that required assessment by the Orthopedics Unit for fractures during that period, excluding fractures in the context of politraumatism. In addition, the complications derived from these fractures were collected and it was determined whether bone densitometry (BMD) was indicated following the main osteoporosis guidelines. Results. The incidence rate of fractures due to low-energy trauma in the selected population during the follow-up period was 7.2 for every 1,000 patients / year. 41% of the 44 study patients suffered new fractures during this period. 33% of the patients with fractures that required surgical treatment suffered major complications. 100% of the patients fulfilled criteria for BMD after the first traumatic event, despite only 20% of them being ultimately performed. Conclusions. The prevalence of fractures and associated complications in alcoholic patients is significantly higher than in the general population. It is necessary to stress the importance of both primary and secondary prevention of pathologic fractures in alcoholic patients, and if they occur, osteosynthesis techniques adapted to an osteoporotic bone should be applied.
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    Complicaciones del aloinjerto meniscal : luxación del trasplante meniscal. A propósito de un caso.
    (2018) Villanueva Dolcet, C.; Martínez Algarra, J.C; Picazo Gabaldón, Benito R.; Gracia Ochoa, M.; Capó Soliveres, Irina
    Early osteoarthritis is one of the great enemies after meniscal surgery, especially in young patients. When meniscal repair is not possible, there are few therapeutic alternatives in order to prevent this complication in the medium and long term. In this situation we can consider the possibility of carrying out techniques such as implants with substitute materials or meniscal transplants with allografts. This article describes the evolution of a 25-year-old patient who underwent one of these meniscal transplants.
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    Comparación de los requerimientos de sangre y estancia hospitalaria tras la implantación del protocolo fast track en prótesis total de rodilla.
    (2018) Segarra Muñoz, B.; Soler Peiro, M.; Sevil de la Torre, J.; Cortés Tronch, V.; Ruiz Mil, M.; Ribes Iborra, J.
    Objectives. To analyse the differences in blood requirements and length of stay in patients undergoing total knee arthroplasty during the period before and after the implementation of the fast track protocol. Material and methods. Retrospective observational follow-up study or cohorts. The variables under study were: initial and minimum haemoglobin, number of patients and units transfused and days of hospital stay. For the comparisons, the chi-square and U-Mann Whitney statistics were calculated. Values of p?0.05 were considered significant. Results. A sample of 189 patients was studied. The pre- and post-implementation values for the variables under study were: minimum haemoglobin 10.2 vs. 11.2 (p = 0.0), percentage of patients who required blood transfusion 20.8 vs. 4.5% (p = 0.001), rate of anaemia 3.4 vs. 2.9 (p = 0.002) and lengths of hospital stay 5.9 vs. 3.8 days (p = 0.017). Conclusions. The fast track protocol significantly improved haemoglobin values and decreased the need for transfusion and length of stay