Revista española de cirugía osteoarticular, 2019, vol. 54, no. 277

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    Osificación Heterotópica de Cadera : revisión bibliográfica y presentación de un caso.
    (2019) Zurriaga Carda, J.; Argüelles Linares, Francisco; Mifsut Miedes, Damian; Silvestre Muñoz, Antonio
    Heterotopic ossification is a bone-developing disease whose etiology remains unknown, and whose risk factors include both fractures and luxations, traumatic brain injuries and long periods of immobilisation. Its treatment mainly consists of preventive measures, and may be done by either NSAIDs or radiotherapy. Once established, the elective treatment is surgical. We present a case of bilateral severe heterotopic ossification, as well as a review of the existing literature and therapeutic guidelines.
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    Eficacia de la infiltración local analgésica en la artroplastia total de rodilla primaria. Revisión de casos
    (2019) Llácer Ferrandis, M.J.; Mifsut Miedes, Damian; Silvestre Muñoz, Antonio
    Postoperative pain is an important determinant of rehabilitation and functional outcomes after total knee arthroplasty (TKA). In an effort to decrease the need for postoperative opioids, there has been an increasing interest in analgesic techniques, such as local infiltration analgesia (LIA). Objective. The aim is to evaluate the effectiveness of LIA in reducing postoperative pain and opioid medication, improving functional results and decreasing the length of hospital stay, as well as to reassess its safety and analyse its advantages compared to other analgesic alternatives and / or the combination of the same. Material and methods. An observational descriptive study of a series of cases was conducted on patients undergoing TKA who received LIA for postoperative pain control. Pain was recorded in Visual Analogue Scale (VAS) at 12, 24 and 48 h postoperatively. Therefore, the study includes a systematic review using PubMed. Results. The majority of patients included in the analysis were women, and the mean age was 69.92 years. The number of right-sided TKA was higher than left-sided, and posterior stabilized prosthesis was the most used. The mean pain levels assessed by the EVA scale at 12, 24 and 48 hours were 3.85, 4.56 and 4.38 respectively, increasing the percentage of patients who presented higher pain intensity at 48 hours. Statistical association was observed between age and pain levels at 12 hours after the intervention. Other parameters studied (sex, degree of osteoarthritis, hospital stay, depression and rheumatoid arthritis) were not statistically significant. Conclusion. The LIA technique offers a safe and effective analgesia, reduces the consumption of analgesic medication, improves subjective parameters, and supports early mobilization after TKA.
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    Análisis de las complicaciones y mortalidad en pacientes mayores de 95 años con fractura de cuello femoral tratada mediante hemiartroplastia de cadera cementada.
    (2019) Miralles Muñoz, F. A.; Rubio Morales, M.; Lizaur Utrilla, Alejandro
    to analyze postoperative complications and mortality, as well as evaluate the functional results of patients older than 95 years with a femoral neck fracture treated by cemented hip hemiarthroplasty. Material and method. Retrospective study of 33 cases, analyzing complications and mortality, identifying risk factors, and evaluating cognitive status, functionality and level of ambulation after surgery. Results. eight patients (24,2%) presented postsurgical medical complications, finding blood transfusion and bilateral hemiarthroplasty as predictive factors, and 11 died in the first year (33,3%), finding the previous functional status and the taking of antiaggregants or anti-coagulants as risk factors. All worsened functionally after the fracture. Conclusions. we consider fundamental, in order to optimize the treatment, the precise preoperative evaluation of the patient given the limited life expectancy and the high mortality rate in the first year after hip surgery.
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    Artrodesis subtalar primaria como tratamiento de fracturas conminutas de calcáneo Sanders tipo IV
    (2019) Hortelano Marco, S.; Sánchez González, M.; Navarrete Faubel, Francisco Enrique; Vicent Carsí, V.
    Las fracturas conminutas Sanders IV de calcáneo dan lugar, en la mayoría de los casos, a una artrosis subtalar postraumática dolorosa e incapacitante, que en muchas ocasiones, requiere una artrodesis subtalar secundaria. Esta artrodesis puede ser técnicamente compleja, ya que no se trata de una fijación in situ, sino que requiere la realización de osteotomías de corrección a nivel del cuerpo del calcáneo en la misma cirugía.Material y métodos. Presentamos 4 pacientes con fracturas conminutas de calcáneo Sanders tipo IV que fueron tratadas mediante una artrodesis subtalar primaria con reconstrucción concomitante del cuerpo del calcáneo. El seguimiento medio fue de 15 meses. Resultados. Obtuvimos la consolidación ósea, tanto de la artrodesis como de la fractura, alrededor de los 4 meses, sin existir signos de artrosis en otras articulaciones. No hubo ninguna complicación de herida quirúrgica, ni aparecieron otras complicaciones típicas de estas lesiones, como impingement de peroneos, problemas con el calzado o bloqueo o degeneración de la articulación tibio talar durante el seguimiento. La puntuación AOFAS media a los 12 meses fue de 78. Conclusiones. La artrodesis subtalar primaria con la corrección inicial de las deformidades asociadas en el cuerpo del calcáneo (acortamiento, ensanchamiento y varo) evita complicaciones posteriores y obtiene buenos resultados.
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    Fractura del cuello femoral en pacientes menores de 65 años. Análisis de las complicaciones tras fijación con tornillos canulados.
    (2019) Miralles Muñoz, F. A.; Mahiques Segura, G.; Lizaur Utrilla, Alejandro
    To analyze the complications after femoral neck fracture in minors of 65 years old with cannulated screws. Material and method. retrospective study of 49 cases with a minimum follow-up of 2 years, evaluating the hip function and postoperative complications, analyzing the risk factors for necrosis and hip non-union. Results. 48.9% were operated in the first 24 hours, with an average surgical delay of 2,1 days. The clinical results were satisfactory (93,9%), finding 7 cases of necrosis and 2 cases of non-union, that required reconversion to total hip arthroplasty (18,3%). In the univariate analysis, no variable was correlated with the complications or final results. Conclusions. Age, displacement of the fracture, shortening of the femoral neck and surgical delay do not influence the final functional results or the presence of necrosis or non-union after the fixation of the femoral neck fracture.