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Language Revista española de cirugía osteoarticular, 2019, vol. 54, no. 280
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- Tratamiento artroscópico de las fracturas de tercio distal de clavícula tipo 2 de Neer con sistema ZipTight(2019) Cañete San Pastor, PPURPOSE.Neer type II fractures of the external third of the clavicle are fractures with a high rate of nonunion or malunion(up to 30%). Multiple surgical techniques have been describe their treatment.Also, several arthroscopic techniques.METHODS.We have retrospectively reviewed 29 cases with Neer type II distal third clavicle fractures treated with coracoclavicular fixationwith a suspension system. RESULTS.All fractures except 1 have undergone complete consolidation in 3 months,without the disadvantages of other systems such as KW,screws or plates. The rate of consolidation has been 96.5% (all but 1 patient).The mobility obtained was very satisfactory: flexion of 176º, abduction of 145º, an external rotation of 80º, an internal rotation with the hand until T11 and horizontal adduction of 132º.The functional results obtained have been excellent in most patients: obtaining 96 points on the Constant scale and excellent UCLA in 26 cases.This is one of the studies with more patients treated with this type of technique. All patients have been followed until the clinical and radiographic consolidation of the fractures.We also contribute some technical modifications to the initial technique that we have been obtaining with the experience to improve the clinical and radiological result of the patients.CONCLUSION.The arthroscopic assisted treatment of Neer type II distal third clavicle fractures with a Ziptight system is a reproducible technique that allows us to reduce and stabilize the fracture and also to diagnose and treat possible glenohumeral o rotator cuff injuries, obtaining excellent clinical and radiological results.
- Notodo es "cut-out" : reclasificación de las complicaciones mecánicas del tornillo cefálico del clavo intramedular.(2019) Wadhwani, Jayant; Gil Monzó, Eva; Pérez Correa, J.I.; García Álvarez, J; Blas Dobón, J.A.; Rodrigo Pérez, José LuisThe 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 manner
- Ángulo de pendiente tibial posterior ?Slope? en prótesis total de rodilla. Diferencias entre alineación Intra o Extramedular y su repercusión sobre el rango de movilidad postoperatorio(2019) Cruzado Navarro, B; Mifsut Miedes, Damian; Silvestre Muñoz, AntonioIntroduction: The aim of this work was to compare the posterior tibial slope of the tibial component after performing a total knee arthroplasty, as an intramedullary or extramedullary guide was used during the surgical technique, as well as comparing the range of mobility obtained according to the Instrumentation used.Material and methods: We conducted a descriptive, retrospective, observational study of a series of 57 patients operated in our Center during 2012 and 2013, with the same model of total knee arthroplasty (Sigma PS® DePuy), divided into two homogeneous groups in terms of age, sex, degree of osteoarthritis evolution, the first with patients operated by extramedullary guidance and the second by intramedullary guidance. A radiographic study was performed, measuring the posterior slope angle in the sagittal plane. The range of mobility achieved after arthroplasty and implant survival was studied.Results: Together, in both groups, measurements of the posterior slope angle were made, which was 4.35º preoperative average. In groups, the mean postoperative posterior fall angle was 4.04 ° in the patients who underwent an EM guide, while those who underwent an IM guide the mean was 1.76 °; the differences being statistically significant. The range of mobility in the ATRs operated by intramedullary guidance was 102.7º on average (range 80-125º), while in the group where the extramedullary guide was used, it was 104.3º (range 80-130º) no these differences being statistically significant. Regarding the survival of the implant, during the study period two cases of patients undergoing surgery for the replacement of prostheses were found, both of which belonged to the ?Extramedullary guide? group.Conclusion: The posterior drop angle, for the same PS prosthesis model, was statistically different according to the guide used, being within the 3-7º range in the group where the extramedullary guide was used; but despite these differences, no impact on the range of mobility was observed.Currently, it is recommended to restore the patient's posterior tibial slope, and in cases with a slope greater than 10º use a PS ATR.
- 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(2019) Salazar, J; Novoa, C.; Wadhwani, Jayant; Montaner Alonso, Daniel; Rodrigo Pérez, José LuisObjective: 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.
- Factores pronósticos del resultado clínico de las prótesis de cabeza de radio(2019) Sevil de la Torre, J.; Aguilella, L.; Soler Peiro, M.Introduction. Overlengthening of a radial head implant has been associated with less than optimal clinical outcomes and capitellar erosions. The purpose of this study was to identify which factors, both clinical and radiological, have influenced the clinical results in our series. Material and methods. Analytical study of a sample of 31 patients between 2005 and 2017 with an average follow-up of 5 years.Analysis of qualitative variables of age, sex, type of lesion and type of treatment used and analysis of the lenght of the implant by means of radiological measurements (implant and proximal margin of the lesser sigmoid notch/ lateral ulnohumeral angle) by independent evaluators with the updated results on scales of MEPS and DASH assessment and mobility ranges explored to the patient. Results. No significant differences depending on the type of lesion nor on the type of treatment were found. Implant length was aligned with the proximal margin of the lesser sigmoid notch in 16 cases, was higher in 12 (mean 3 mm, SD 1.5) and inferior in 3 (mean 3.4 mm, SD 1.7). The lateral ulnohumeral joint opening angle was increased an average range of 2,2º and this has shown to have a significant correlation with a reduction in the range of mobility for flexion and supination (p<0,05). Conclusions. An overlengthening or shortening up to 3 mm has not shown to alter the clinical results in our series, while an excessive lateral ulnohumeral joint opening has a negative effect on flexion and supination mobility.
- Resultados en la cirugía por rotura del ligamento cruzado anterior en pacientes con edad pediátrica(2019) Salvador Marín, Jorge; Miranda Gorozarri, C.; Barceló Bañuls, J. M.; Alonso Hernández, Javier; Palazón Quevedo, Ángel; Martínez López, J.F.Objectives: Describing the results ofthe trans-physeal surgical technique on anterior cruciate ligament (ACL) tear and the appearance of eventual complications and setting the index of associated lesions from the initial diagnosis to surgery diagnosis.Methods: Retrospective study of patients under 18 intervened due to ACL injury with trans-physeal surgical technique between June 2010 and June 2018. Results: 39 patients were included, The average age was 14.7 years (9-17). Mean follow-up was 42 months (6-104) and average time until surgery was 10,7 months (1-48). Spearman correlation test associated positively (0.106) the increase in time to surgery and the increase in the number of associated injuries. There was 1 case of physeal bridge (2.5%) with lower limbs lenght discrepancy.Conclusion:Trans-physeal technique obtained good functional results with a low rate of complications at the end of follow-up in our serie. The increase in time to surgery was positively associated with the increase in associated injuries in the injured knee.
