Revista española de cirugía osteoarticular, 2018, vol. 53, no. 275

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    Vástagos monobloque de recubrimiento completo en cirugía de revisión femoral. Resultados a largo plazo de 80 casos.
    (2019) Diranzo García, J.; Hernández Ferrando, L.; Estrems Díaz, V.; Castillo Ruiperez, L.; Zarzuela Sánchez, V.; Brú Pomer, Antonio
    Bone stock lost and anatomical changes in the proximal femur make femoral revision surgery a complex procedure where the implant chooses will be essential. With the aim of evaluating the clinical and radiological results of the fully coated monoblock stems, we retrospectively studied 80 consecutive cases of femoral revision surgery operated by our hip team. The mean follow-up was 8.6 years. The average score on the Harris Hip Score was 81,2 points. We achieved better results in patients with less bone defects (Paprosky I, II and IIIA) in contrast to those with Paprosky type IIIB defects (p=0.005), in patients with a single previous surgery (p=0.031), in patients under 65 years (p=0.009) and in those who did not suffer complications (p=0.024). The survival rate was 96.1% at 10 years if we consider as failure the removal of the stem due to aseptic loosening and 89.9% if we consider revision of the stem as a failure due to any cause. After the results obtained, we think that fully coated stems provide a solid and stable fixation in femoral revision surgery. However, worst results obtained in patients with bigger bone defects make other options to be considered.
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    Uso de impresión digital 3D con material densidad calcio para la corrección de una deformidad grave de húmero proximal.A propósito de un caso
    (2019) Vera Giménez, E.; García López, A.; Navarro Martínez, J.; Madrigal Quevedo, A.; Bailén García, A.; Gutiérrez Sánchez, L.
    The use of 3D printing technology is very useful in surgery for treating fractures and several other orthopaedic surgeries. In this case we describe the pre-surgical planning of very severe deformity of proximal humerus secondary to an epiphysiolisis in an 8 year old girl with a calcium density model. It is based on a digital printing of the bone with calcium density material, which, to the best of our knowledge, has not been dealt with so far. This has allowed us to carry out a previous radiological analysis and better planning. This surgery has resulted in successful correction and has saved surgical time. The functionality of the patient was improved and a correction of the cervical-diaphyseal angle of 72º was achieved. We believe it can be very useful for planning similar operations. We highlight the use of materials that allow radiological checking as is the case of our model used in planning.
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    Variabilidad radiológica de la artroplastia de cadera, según la dominancia del cirujano
    (2019) Menéndez Martínez, P.; Núñez Villar, J.; Canillas del Rey, F.M.; Carballo Vázquez, F.; Durán Giménez-Rico, Pablo
    El objetivo de este trabajo es analizar la relación entre la dominancia de los cirujanos ortopédicos y el correcto posicionamiento del componente acetabular en las artroplastias totales de cadera. Secundariamente, se analiza la posible relación entre esta dominancia del cirujano y la lateralidad del procedimiento quirúrgico a realizar ya sean caderas derechas o izquierdas. Para ello, se crearon 2 grupos. El grupo A correspondiente a 20 caderas intervenidas por un cirujano de dominancia diestra y el grupo B formado por 20 intervenciones realizadas por otro cirujano de dominancia zurda Las mediciones se realizaron sobre la proyección radiográfica AP de pelvis del control postquirúrgico usando el visor de rayos del hospital. Para la valoración de la anteversión se utilizó el método descrito por Widmer. Con este trabajo hemos demostrado una mayor dificultad para la correcta implantación del cotilo por parte de nuestro cirujano zurdo en el caso de intervenir caderas izquierdas.
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    Choque extraarticular de cadera secundario a consolidación viciosa tras fractura-avulsión de la espina ilíaca antero inferior : a propósito de un caso
    (2019) Matellanes Palacios, C.; Estrems Díaz, V.; Diranzo García, J.; Moratalla De Gracia, R.; Hernández Ferrando, L.; Brú Pomer, Antonio
    The anterior inferior iliac spine (AIIS) avulsion fractures are uncommon, caused by a sudden contraction of the rectus femoris muscle with hyperextension of the hip and knee flexion. We present the clinical case of a 32-year-old mansuffering from pain in his right hip for several years with a history of a AIIS avulsion fracture in his childhood. He presented pain with flexion and internal rotation of the right hip. Physical examination and imaging tests revealed an extra-articular hip impingement secondary to a malunited fracture of AIIS. The patient underwent surgery performing AIIS osteoplasty and excision of the ossification by an anterior mini-open approach. After surgery he was able to re-join sports activity. Malunited fracture of AIIS can cause an extra-articular hip impingement in young sports patients. The treatment by surgical excision of the hypertrophic spine through an anterior mini-open approach allows the correction of the deformity and an early reincorporation to sports activities.
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    Resultados clínicos a 6 años de 40 pacientes con fascitis plantar crónica tratados con 2 infiltraciones de prp vs 2 infiltraciones de corticoides.
    (2019) Jiménez Pérez, Adriana Elena; Saldaña Díaz, Andrés; González-Arabio Sandoval, Daniel; Álvarez Castro, Alfredo; Maderuelo Fernández, J. A.; Ramos Pascua, Luis R.
    Introduction. Chronic plantar fasciitis is the most frequent cause of plantar talalgia. The treatment in cases refractory to conservative measures is controversial. Objectives. To demonstrate clinical efficacy of a protocol of 2 infiltrations with platelet-rich plasma (PRP) in chronic talalgias in plantar fasciitis compared to another one of 2 infiltrations with corticosteroids. Material and methods. We conducted a quasi-experimental, non-randomized, controlled, non-blinded, analytical study that evaluated the effectiveness of 2 infiltrations of PRP in chronic plantar fasciitis refractory to conservative treatment. Clinical results were assessed by EVA, AOFAS, SF12 questionnaire and Roles and Maudsley scale after 6 years of treatment. Results. There were no complications derived from the treatment in any patient. In the group treated with PRP the clinical results were clearly better and more lasting: the punctuation of the scale AOFAS improved from 47,05 to 92,1 after 6 months; and the EVA improved from 8,25 to 2,25 after 77,7 months. In the group treated with corticoides the scale AOFAS improved from 50,85 to 49,75 points after 6 months; and the EVA improved from 7,97 to 6,77 after 77,7 months.Conclusions. Percutaneous infiltrations of PRP are an effective and safe therapeutic option in the treatment of chronic plantar fasciitis, maintaining its long-term results.
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    Utilización del manguito de isquemia en artroplastia total de rodilla. Práctica habitual en la Comunidad Valenciana y revisión bibliográfica
    (2019) Gargallo, E.; Mifsut Miedes, Damian; Gilabert, E.; Climent Peris, Vicente; Álvarez Llanas, A.; Martínez Algarra, J.C; Ferraro Esparza, L.; Fargueta Roig, I.; Strauch, M.; Baeza Oliete, J.; Valero Queralt, M.A.; Grupo de Estudio Sobre Artroplastia Total de Rodilla de la Comunidad Valenciana
    The aim of this study is to know which is the routine clinical practice related to the use of ischemic tourniquet in total knee arthroplasty (TKA) in hospitals of Comunidad Valenciana and to make a Literature review. We performed a retrospective, descriptive, observational study based on questioner surveys of specialists in Orthopedic Surgery and Traumatology in 9 public Hospitals of Comunidad Valenciana 96, 9% of surgeons preferred the use of ischemic tourniquet in protheses implantation, versus 3,1% who did not. Among those who used Ischemic tourniquet, 57,8% preferred to inflate it before establishing a sterile field versus 39,1% who inflated the tourniquet once the sterile field was established. As for the tourniquet withdrawal, 29,7% of respondents preferred to perform it before the end of intervention in order to assess the blood flow and coagulate bleeding vessels before wound closure, while 70,3% kept the tourniquet until the compression bandage was applied. There is not enough evidence in literature to recommend or not the use of ischemia tourniquet.
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    Bloqueo IPACK asociado a bloqueo del canal de los aductores frente a bloqueo femoral, calidad analgésica y uso de rescate tras artroplastia total de rodilla.
    (2019) Díaz Martínez, Jose Vicente; Pérez Navarro, G.I; Sánchez Alepuz, Eduardo; Miranda, I.; Peregrín Nevado, I.; Collado Sánchez, A.
    Total knee arthroplasty and its postoperative period can be very painful. Usually patients undergoing locoregional or general anesthetic techniques to which peripheral nerve blocks are associated for postoperative analgesia, within which femoral nerve block is the most widespread an adequate analgesic quality of the anterior compartment of the knee. It is widely described in the literature that blockage of the adductor canal or Hunter confers an analgesic quality similar to that achieved with the femoral block without objectifying that motor block that can limit its use for rapid rehabilitation. Recently also described in the literature, the blockade that is defined as IPACK (Infiltration between Popliteal Artery and Capsule Knee) or SPANK (Posterior Articular Sensory Nerves of the Knee) achieves an adequate analgesia of the posterior compartment of the knee. We believe that the combination of these two peripheral nerve blocks associated with the usual anesthetic technique may result in better analgesic quality in our patients and a lower consumption of opioids in the form of rescue.