Showing papers in "Revista de la Asociación Argentina de Ortopedia y Traumatologia in 2018"

Fractura por estrés del cuello del fémur en una niña hiperactiva tratada con metilfenidato. Reporte de caso. [Femoral neck stress fracture in a hyperactive child taking methylphenidate. Case report].

Abstract: Las fracturas por estres afectan, con mayor frecuencia, a personas fisicamente activas con hueso normal y son infrecuentes en los ninos con placa de crecimiento abierta. Aun mas infrecuentes son las fracturas por estres del cuello femoral en la poblacion pediatrica. Sin embargo, constituyen entidades muy importantes debido al riesgo de complicaciones graves, como la necrosis avascular. Se describe el caso de una nina de 7 anos medicada con metilfenidato que sufrio una fractura por estres del cuello del femur atipica. La paciente consulta por dolor inguinal derecho sin limitaciones en las actividades cotidianas. La radiografia muestra una fractura por estres del cuello del femur, que se confirma con tomografia. Se instaura un tratamiento conservador, y la paciente esta asintomatica a las cuatro semanas. Este caso representa una alerta sobre esta infrecuente entidad en la que podrian presentarse errores diagnosticos. Investigaciones recientes tambien sugieren la posible participacion de farmacos, como el metilfenidato, en la desmineralizacion osea, que podria constituir un posible factor de riesgo de fractura. AbstractStress fractures most commonly affect physically active individuals with normal bone, and they are rare in children with open growth plates. Even rarer are femoral neck stress fractures in pediatric age. Nevertheless, they constitute a very important entity due to the risk of severe complications, such as avascular necrosis. A seven-year-old girl, treated with methylphenidate, who suffered an atypical femoral neck stress fracture is presented. Patient complained of right inguinal pain without daily life activity limitations. The radiograph showed a stress femoral neck fracture, confirmed by CT imaging. Conservative treatment was instituted and the patient became asymptomatic after 4 weeks.This case report alerts the clinicians about this rare entity that might be misdiagnosed. Recent research also suggests a possible involvement of drugs, such as methylphenidate, in bone demineralization, which might constitute a possible risk factor for fractures.

Enclavado endomedular elástico para el tratamiento de refracturas de antebrazo en niños. [Elastic stable intramedullary nailing for the treatment of forearm refractures in children.]

Abstract: Introduccion: La diafisis del antebrazo es el sitio mas frecuente de refracturas en ninos. Estas lesiones suelen ocurrir en el tercio medio o proximal antes del ano de la fractura inicial. Hay poca informacion sobre el tratamiento de este tipo de lesiones. El objetivo de este estudio fue evaluar los resultados y las complicaciones en pacientes con refracturas de antebrazo que requirieron fijacion interna con clavos elasticos endomedulares.Materiales y Metodos: Se registro la siguiente informacion: datos demograficos, mecanismo de lesion, clasificacion, tiempo desde la consolidacion de la fractura original hasta la refractura, tipo de reduccion y tiempo de consolidacion. Los resultados fueron evaluados segun la escala propuesta por Martus y las complicaciones, con una adaptacion de la clasificacion de Clavien-Dindo.Resultados: Se evaluaron 17 pacientes (14 varones) con 17 refracturas de antebrazo (15 cerradas y 2 expuestas). La edad era de 11 anos (RIC 7, min.-max. 5-15). La lesion ocurrio a las 12 semanas de la fractura inicial (RIC 4.7, min.-max. 4-28). El 47% requirio reduccion abierta. El tiempo de consolidacion fue de 8 semanas (RIC 4, min.-max. 6-28). El seguimiento fue de 43 meses (RIC 47, min.-max. 12-103). Fue posible evaluar clinicamente a 16 pacientes (1 perdida en el seguimiento). El resultado fue excelente en 15 casos y regular en uno. Un paciente tuvo perdida del rango de movilidad (15o); uno, retraso de la consolidacion (cubito) y 3 sufrieron una segunda refractura.Conclusiones: La fijacion interna con clavos elasticos endomedulares fue una tecnica eficaz para tratar las refracturas de antebrazo en ninos. Si bien un alto porcentaje necesita reduccion abierta, el tiempo de consolidacion y la tasa de complicaciones serian similares a los de las fracturas primarias tratadas con la misma tecnica.

Tratamiento de la osteomielitis asociada a úlceras alrededor de la pelvis. [Treatment of pressure ulcer-related pelvic osteomyelitis].

Abstract: Introduccion : El tratamiento de la osteomielitis cronica asociada a ulceras alrededor de la pelvis es complejo y multidisciplinario. Un tratamiento antibiotico, dirigido a mas de un microorganismo, sumado a la cirugia permitiria disminuir la recurrencia de la infeccion. El objetivo de este estudio fue analizar los resultados en pacientes con osteomielitis cronica asociada a ulceras por presion, con gran defecto de cobertura alrededor de la pelvis, tratados con desbridamiento del lecho y un colgajo para el defecto de cobertura. Materiales y Metodos : Se realizo un estudio descriptivo, retrospectivo, basado en los datos de las historias clinicas de pacientes que requirieron cobertura quirurgica de ulceras por presion, entre octubre de 2010 y febrero de 2017. Los pacientes fueron tratados con un procedimiento en dos tiempos quirurgicos: desbridamiento y luego colgajo de cobertura del defecto remanente. Resultados : Se trataron 27 ulceras (9 sacras, 13 isquiaticas y 5 trocantericas) en 15 pacientes (edad promedio 44. 9 anos [rango 22-81]). Tres ulceras desarrollaron un solo germen, en el resto, los cultivos fueron polimicrobianos. Se administraron antibioticos intravenosos durante un minimo de 4-6 semanas. Los valores iniciales de eritrosedimentacion y proteina C reactiva ultrasensible fueron 72 mm/h y 55 mg/l, respectivamente, y disminuyeron a 49 mm/h y 20 mg/l, respectivamente, a los 3 meses. Conclusiones : Nuestro protocolo acorta los tiempos de tratamiento, ya que no se espera a terminar la antibioticoterapia para realizar el colgajo. Consideramos que la cobertura inmediata del defecto de partes blandas permite controlar el acceso de nuevos microorganismos a la region afectada. Asi hemos obtenido buenos resultados con una baja tasa de recidiva comparada con la de otras series.

Presentación del caso.

Abstract: Hombre de 45 anos de edad, que consulta por dolor plantar del pie izquierdo y dificultad para deambular. Durante la inspeccion, en la piel, se reconoce una herida corto-punzante de unos 5 cm de extension, en la cara medial del tercio distal de la pierna izquierda, por la que recibio cobertura antibiotica. El examen fisico revela hiperalgesia a la palpacion del pie. Refiere como antecedente cardinal un accidente de moto 10 dias antes del comienzo de los sintomas plantares, con un traumatismo en la zona del tercio distal de la pierna izquierda, por el que fue sometido a un estudio radiologico rutinario. La algia plantar persistente motiva la realizacion de una resonancia magnetica (RM). Ante los hallazgos de este estudio, se decide complementar con estudio Doppler, que confirma el diagnostico.

Uso topico de acido tranexamico en el reemplazo total de rodilla primario

Abstract: Introduccion El reemplazo total de rodilla es un procedimiento que puede generar una gran perdida sanguinea durante el posoperatorio. El acido tranexamico es un agente sintetico antifbrinolitico, que en los ultimos anos, se ha estado utilizando en forma endovenosa con buenos resultados al reducir el sangrado asociado al reemplazo total de rodilla. Sin embargo, existe escasa experiencia con el uso topico del mismo. Materiales y Metodos Hemos llevado a cabo un estudio comparativo retrospectivo, analizando 117 reemplazos totales de rodilla primarios, donde comparamos los resultados obtenidos de 63 cirugias con el uso topico de acido tranexamico, con los 54 reemplazos restantes donde no se utilizo tranexamico. Se comparo la tasa de transfusion, niveles de hemoglobina y hematocrito a las 24 y 48 hs, curaciones requeridas, comorbilidades asociadas y complicaciones presentes. Resultados El grupo de uso topico de acido tranexamico mostro una reduccion de la tasa de transfusiones en un 43.9%, comparandolo con el grupo donde no se utilizo el mismo. Ademas, se registro una reduccion en la caida de la hemoglobina a las 24hs posoperatorias de 2,12 gr/dl. No se registraron complicaciones. Conclusiones El uso topico de acido tranexamico en reemplazos totales primarios de rodilla disminuye los requerimientos de transfusiones, sin incrementar el riesgo de complicaciones. Abstract Introduction : Total knee replacement is associated with extensive postoperative blood loss. Tranexamic acid is a synthetic antifibrinolytic agent that, in the last few years, has been successfully used intravenously to reduce bleeding after total knee replacement. However, topical application of tranexamic acid in total knee replacement remains largely unexplored. Methods : A retrospective study of 117 primary total knee replacements was conducted: 63 surgeries with topical tranexamic acid and 54 replacements without tranexamic acid. A comparison analysis was made, capturing results of blood transfusion rates, postoperative hemoglobin levels (24 and 48 hours), number of changed bandages, comorbidities and complications. Results : Tranexamic acid reduced blood transfusion rate by 43.9% when compared with the group without tranexamic acid. A lower decline in postoperative hemoglobin levels (24 hours) by 0.2-1.3 g/dL was also observed in this same group. There were no complications in both groups. Conclusions : Topically applied tranexamic acid was effective in reducing the need for blood transfusion following total knee replacement, without additional adverse effects.

Aloinjerto fresco congelado en cirugía de columna lumbar. ¿Aumenta la tasa de infección? [Fresh frozen allograft in lumbar spine surgery. Does it increase the rate of infection?]

Abstract: IntroduccionLa infeccion posquirurgica en la columna lumbar es desafortunadamente comun, multifactorial y una complicacion potencialmente devastadora, que se asocia a un incremento de la morbilidad y la necesidad de futuras cirugias, y en ultima instancia, puede ser mortal. Con la intencion de disminuir la morbilidad posquirurgica, la medicacion y los dias de internacion, comenzamos a utilizar aloinjerto fresco congelado de cabeza femoral de donantes vivos, en la artrodesis lumbar corta. El objetivo de este estudio fue comparar el indice de infeccion en la artrodesis lumbar corta en pacientes con aloinjerto fresco congelado y con autoinjerto.Materiales y MetodosEstudio retrospectivo de 153 pacientes divididos en dos grupos: grupo A: 84 pacientes con autoinjerto de cresta iliaca y grupo B: 69 pacientes con aloinjerto fresco congelado, desde marzo de 2009 hasta enero 2014, sometidos cirugia instrumentada de fusion espinal lumbar posterolateral.ResultadosTres de los 153 pacientes operados se perdieron en el seguimiento (2 del grupo A y 1 del grupo B) y la muestra incluyo 150 pacientes (82 del grupo A y 68 del grupo B). Se produjeron tres infecciones por Staphylococcus aureus sensible a la meticilina, todas en el grupo A (4,5%). Ningun paciente de los dos grupos necesito transfusion.ConclusionesEl uso de aloinjerto fresco congelado en las cirugias de columna lumbar posterolateral de causa degenerativa no se asocia a un aumento en la tasa de infeccion. Consideramos que el aloinjerto fresco congelado es una excelente alternativa, porque disminuye el tiempo quirurgico y de hospitalizacion.

Indicación y resultados de la prótesis con estabilidad aumentada en la artroplastia primaria de rodilla. [Constrained prosthesis primary total knee arthroplasty.]

Abstract: Background: This paper presents the functional results and indication criteria for prostheses for total knee arthroplasty with more constraint than posterior stabilization more constraint than posterior-stabilized. Methods: Retrospective analysis of 43 TKA in 40 patients with an average follow up of 6.2 years. The preoperative diagnoses were valgus osteoarthritis in 38 cases and varus in 5. We classified the sufficiency of the collateral ligaments as sufficient, attenuated or incompetent. We developed a classification system for the valgus Osteoarthritis, which related the type of knee with the selected prosthesis. Results: Posterior-stabilized plus implants were used in 28 cases, with an average alignment of 15.9°: 26 were valgus knees, 21 of which presented sufficient and 5 attenuated ligaments. Constrained prosthesis were used in 7 patients with an average valgus alignment of 21.6°, (2 with sufficient and 5 with attenuated ligaments.) Rotating-Hinge prosthesis were used in 8 patients, 5 with an average valgus alignment of 24.6 ° (3 of them associated to recurvatum), 4 with incompetent ligaments and one with attenuated ligaments. Conclusions: We recommend using: Posterior-stabilized plus implants in deformities lower than 20°, with sufficient collateral ligaments and no bone defects; constrained prosthesis in patients with greater deformity (>20°) with collateral ligaments with some degree of sufficiency (attenuated at the most); and rotating-hinge implants in knees with collateral or multidirectional ligament insufficiency, associated with recurvatum, significant bone defects or severe deformities in rheumatoid arthritis or neuropathic origin.

Uso tópico de ácido tranexámico en el reemplazo total de rodilla primario. [Topical administration of tranexamic acid in primary total knee replacement.]

Abstract: IntroductionTotal knee replacement is associated with extensive postoperative blood loss.Tranexamic acid is synthetic antifibrinolytic agent that, in the last few years, has been successfully used intravenously to reduce bleeding after total knee replacement. However, topical application of tranexamic acid in total knee replacement remains largely unexplored.MethodsWe conducted a retrospective study of 117 total knee primary replacements, where 63 of them received topical tranexamic acid, and the remaining 54 replacements in whom no tranexamic acid was used. A comparison analysis was made, capturing results of blood transfusion rates, postoperative hemoglobin levels (24 and 48 hs), number of changed bandages, associated comorbidities and complications.ResultsTranexamic acid reduced the blood tranfusion rate by 43.9% when compared with the group without tranexamic. We also found, that the same group, resulted in a lower decline in postoperative hemoglobin levels (24 hs) by 2,12 gr/dl. There was no complications in both groups.ConclusionsTopically applied tranexamic acid was effective in reducing the need for blood transfusion following total knee replacement, without additional adverse effects.

Trasplante osteocondral autólogo para tratar lesiones osteocondrales de la rodilla: evaluación de 62 pacientes con un seguimiento promedio de ocho años. [Osteochondral autograft transplantation for the treatment of osteochondral injuries of the knee: evaluation of 62 patients with an average follow-up of 8 years.]

Abstract: There are several surgical options described for osteochondral defects of the knee. The aim of our study was to analyze a series of patients treated with mosaicplasty with an average of 8 years follow-up. Sixty-two patients with osteochondral defects of the knee who underwent mosaicplasties between 2001 and 2014 were included in the study with minimum follow-up of 2 years. Patients were evaluated using the Lysholm score, International Knee Documentation Committee Score (IKDC) and Kellgren-Lawrence radiographic scale. Forty-five were men and seventeen women with an average age of 36 years old. Mosaicplasties were 45 in the medial condyle, 12 lateral condyle, 12 trochlea and 3 combined. Forty-two patients had isolated mosaicplasties and 20 patients presented associated surgical procedures (osteotomy, ACL reconstruction, meniscectomy). The mean results of the Lysholm score were 80.1 and IKDC was 66.7. There were no significant differences among the Lysholm and IKDC scores between these two groups. In 30 patients evaluated with radiography a satisfactory inclusion of the bony block was observed. We believe that mosaicplasty is a procedure with a high degree of satisfaction with good functional results in patients with focal lesions of articular cartilage that may or may not be associated to other surgical procedures.

Descompresión ósea metafisaria del radio distal para estadios tempranos de la enfermedad de Kienböck. Seguimiento mínimo de 10 años. [Metaphyseal bone decompression of distal radius for early stages of Kienböck's disease. Minimum follow-up of 10 years.]

Abstract: Background The purpose of this study is to analyze the long-term clinical and radiological results of a series of patients with early stages of the Kienbock disease treated with radius core decompression. Methods This retrospective study included 23 patients with Kienbock’s disease (Lichtman stage II and IIIA) who underwent distal radius metaphyseal core decompression that were followed-up for at least 10 years. At the last follow-up, the patients were evaluated for wrist range of motion and grip strength. The overall results were evaluated by the modified Mayo wrist score and visual analogue scale pain score. We also compared the radiological changes between the preoperative and final follow-up in their Lichtman classification and the modified carpal height ratio. Results The mean follow-up period was 13 years (range 10-18). Based on the modified Mayo Wrist Score, clinical results were excellent in 9 patients, good in 11 patients, fair in 2 and poor in one patient. The mean preoperative pain according to VAS was 7 (range 6-10) and was 1.1 (range 0-6) at the final follow-up. Compared with the opposite side, the average flexion/extension arc was 78% and the grip strength was 81%. Radiographic disease progression according to the Lichtman classification occurred in four wrists. Conclusion This long-term follow-up study shows that radius core decompression is a valid alternative for the treatment of the early stages of the kienbock disease.

Fracturas de falange tratadas con placas de osteosíntesis. Resultados a corto plazo. [Phalangeal fractures treated with osteosynthesis plates. Short -term results].

Abstract: Introduction A prospective cohort study was carried out to evaluate functional results in workers with phalangeal fractures treated with plates and to establish poor prognostic factors. Methods From May 2012 to May 2014, 55 workers with phalangeal fractures were operated on consecutively by reduction and fixation with plate and screws. Forty-two patients (39 men; average age 30.76 years) were evaluated, with 68 operated phalanges (first phalanx 15, second phalanx 53). Twenty-eight percent of fractures were open, 38.24% comminuted and 11.76% had joint involvement. Average follow-up: 3.38 months. Results Bone union was achieved in all fractures in 1.8 months. Gingrass score for the thumb was good in two cases and regular in one. In the remaining fingers, Belsky score was excellent (35%), good (55%), and poor (9%). Average DASH score was 18.53. Worst results were observed in the first phalanx fractures with respect to the second and in older patients than in the younger, both with statistical significance. No relationship was observed between the outcome and other variables studied. Four patients had complications (9.5%). Conclusions Comparing our study with others, the rate of complications was small, and similar results were obtained, but unlike other authors, we are not used to remove hardware with tenolysis or arthrolysis. Bone union was achieved in all cases and results were satisfactory in 90% of patients.

Versatilidad del colgajo libre anterolateral de muslo en la reconstrucción de defectos de cobertura en los miembros superiores e inferiores. [Versatility of the anterolateral thigh free flap in upper and lower extremities defects coverage reconstruction.]

Abstract: Introduction The anterolateral thigh free flap is currently one of the most useful reconstructive options. A long pedicle with suitable vessel diameter, reliable anatomy and the availability of different tissues with large amounts of skin make this flap versatile. The purpose of this study was to evaluate the flap versatility in a series of patients with coverage defects in both, the upper and lower limbs. Methods A retrospective study was performed. Inclusion criteria were patients with defects in the extremities to whom this flap was made as a reconstructive treatment. Preoperative, intraoperative and postoperative variables were analyzed. Results Twelve patients (7 men and 5 women) with an average age of 44 years were included. Defects were caused by oncological resection (9 patients) and trauma (3 cases). In 4 cases the defect was in the upper extremity and in 8 cases in the lower extremity. The average time between the defect and the reconstructive surgery was 8 days. The survival rate of the flap was 92%, with only one failure. Donor site presented no complications and primary closure was performed in all cases, except for two requiring closure with skin graft. Conclusions Anterolateral thigh free flap is a valid and very useful resource for coverage of defect of different etiologies in the upper and lower limbs since its versatility allows its successful adaptation in defects of varied location and size.

Informe sobre la radio-exposición en el personal quirúrgico de Ortopedia y Traumatología.Principios, marco legal y análisis situacional en la Argentina.

Abstract: Orthopedic surgery has significantly advanced in the past years along with image intensifier fluoroscopy in the operating room. The purpose of this report is to review biological principles of radiation, as well as the current legal framework and to outline the present situation in Argentina.

Uso de copas de tantalio trabecular para la reconstrucción acetabular compleja. Resultados de una serie de 42 casos y un seguimiento promedio de tres años.[Trabecular metal cup outcomes in complex acetabular reconstruction. Review of 42 cases with a 3-year follow-up].

Abstract: Introduction The aim of this study is to assess our clinical-radiographic results with the use of trabecular tantalum cups for the reconstruction of complex acetabulums, both in primary surgeries and revisions, and compare them with other authors’ similar series. Materials and Methods We carried out a retrospective revision of a series of 42 surgeries (29 revisions and 13 primary arthroplasties) in 40 patients between March 2010 and March 2016. The series included 20 females and 20 males who averaged 60 years of age (ranging from 27 to 93). The patients’ average follow-up was of 37 months (ranging from 12 to 84). All the patients were treated with the same type of trabecular metal. Results At average 37-month follow-up survival rates in the acetabular component were of 97.6%. One patient was treated with resection arthroplasty due to persistent infection. Global complication rates were of 12% and the average postoperative Harris Hip Score was of 81.54 (63.25-92.75). Conclusions Although a longer follow-up is required, the use of trabecular metal cups gets promising results in the treatment of complex acetabulums.

Tumor de células gigantes espinal en niños. Reporte de dos casos. [Spinal giant cell tumor in children. Report of two cases].

Abstract: El tumor de celulas gigantes espinal es una neoplasia de estirpe benigna y comportamiento local agresivo, de presentacion rara en la poblacion pediatrica. El dolor asociado al compromiso neurologico es la presentacion tipica en ninos. La reseccion amplia del tumor y la descompresion de los elementos neurales asociada a fusion instrumentada permiten obtener una columna estable, preservar o restaurar la funcion neural y evitar la recidiva tumoral. Se presentan dos pacientes con tumor de celulas gigantes espinal en esqueleto inmaduro, sometidos a reseccion y estabilizacion mediante artrodesis instrumentada, sin recidiva en el posoperatorio alejado. La presentacion clinica, la edad de los pacientes y los resultados quirurgicos a largo plazo hacen de extremo valor el reporte de estos casos en esqueletos inmaduros.

Estudio histopatológico en rotura aguda del ligamento cruzado anterior de rodilla. [Histopathological study in acute rupture of the anterior cruciate ligament of the knee].

Abstract: IntroductionThe histological structure of the ligaments, including the ACL, is composed of collagen and elastin wrapped in a matrix of water and proteoglycans. Collagen is the main component of tendons and ligaments, accounting for 65-75% of its dry weight. The aim of the present study is performing a histopathological evaluation of the ruptured ACL fragments taken at the time of the surgical procedure by arthroscopy.Material and methodsA prospective observational study of 50 cases with ACL rupture. LCA samples were taken in an arthroscopic procedure and the histopathology of the ligament was evaluated.ResultsThe results are mentioned based on results of pathological anatomy and post-operative evolution.ConclusionDegenerative changes were evidenced in the histopathology that can not be demonstrated if these changes are previous or posterior to the ligament rupture.

Funcionalidad y calidad de vida luego de la cirugía de escoliosis neuromuscular. [Functionality and quality of life after neuromuscular scoliosis surgery.]

Abstract: Objective The objective of our study is to study the complications of surgical in scoliosis operated in our center, as well as the functionality and quality of life of patients after surgical treatment. Methods A retrospective study was carried out, with a series of cases. We reviewed the medical history and interviewed the patient and primary caregiver. Results after surgery were assessed for complications, function, quality of life and degree of satisfaction of caregivers. Results We obtained 26.7% of complications, due to infection and hemodynamic alterations. As for the functional and quality of life of these patients, we obtained positive results, being more significant in terms of the ability to be seated and activities of daily living. Conclusions The surgery of patients with neuromuscular scoliosis improves the capacity and balance of sitting, favoring with this the digestive, respiratory and social life capacity of the patient. Although it is about surgeries with high rates of complications, it shows high indices of satisfaction on the part of the caregivers.

Roturas del tendón de Aquiles operadas con técnica percutánea: resultados quirúrgicos y complicaciones posoperatorias. [Achilles tendon ruptures operated on with percutaneous technique: surgical results and post-operative complications.]

Abstract: Introduction Achilles tendon ruptures have increased considerably in recent years. The treatment of these injuries can be either conservative or surgical. Despite extensive literature, no gold standard has been probed. Surgical options include open surgery, mini-open and percutaneous technique. The objective of this work is to characterize the clinical presentation and show surgical results and complications in patients with ruptured Achilles tendon treated surgically with percutaneous technique. Materials and methods A retrospective descriptive study was carried out. Adult patients treated at the University Clinic of Puerto Montt were included and clinical and epidemiological data were obtained. All patients were operated with percutaneous technique using the Dresden Instrument. Results 60 patients enrolled. All presented pain, associated with Thompson's sign and palpable gap in 92%. Complementary images were requested in 7 patients (12%). The average time until surgery was 4.28 days. 7 patients presented minor post-operative complications. No mayor complications were observed. Discussion Achilles tendon ruptures are increasing due to older active population and weekend athletes. The diagnosis is mostly clinical, however, some patients may require complementary images for diagnosis. Strong evidence in the literature suggests that surgical treatment is superior to the classic conservative treatment. In comparison with open surgery, the percutaneous technique has shown better aesthetic results and fewer complications.

Fracturas atípicas de fémur proximal asociadas al uso prolongado de bifosfonatos.

Abstract: IntroduccionLos bifosfonatos constituyen el tratamiento de primera eleccion de la enfermedad osteoporotica. Algunos efectos adversos ponen en duda su uso prolongado, como las fracturas atipicas de femur proximal. Los objetivos de este estudio fueron determinar la relacion entre consumo de bifosfonatos y fracturas atipicas de femur, mostrar la incidencia en nuestra institucion y el tiempo de consumo.Materiales y MetodosEstudio retrospectivo, observacional, analisis de caso-control no pareado. Se incluyeron pacientes >55 anos, con fractura de femur que ingresaron entre el 1 de enero de 2009 y el 31 de mayo de 2015. Las variables consideradas fueron: sexo, edad, tipo de fractura; uso, tipo y tiempo de consumo de bifosfonatos. Las fracturas se distribuyeron en tipicas: pertrocantericas, y cuello femoral, y atipicas: subtrocantericas y diafisarias. Se consideraron como casos las fracturas atipicas y como controles, las pertrocantericas.Resultados Se incluyo a 517 pacientes que cumplieron los criterios de inclusion. Cuarenta y dos fracturas eran atipicas y 236, tipicas. Hubo predominio de sexo femenino (81,4% en los casos y 83% en los controles). La edad promedio fue de 76 y 80 anos, respectivamente. La asociacion con bifosfonatos fue del 44,2% en los casos y 15,3% en los controles (11,6% y 0,8% en las fracturas pertrocantericas, respectivamente).ConclusionesEl alendronato se asocio significativamente con fracturas atipicas de femur. No se hallo relacion con el tiempo de consumo; sin embargo, la incidencia fue mas alta luego de 4.5-5 anos de consumo.

Anastomosis entre vasos ilíacos y obturadores en la región retropúbica: estudio en cadáveres. [Anastomosis among iliac vessels and obturators in the retropubic region: Study in cadavers].

Abstract: Introduction During surgical interventions, section or rupture of the anastomosis may cause severe difficult-to-controlbleeding. The aim of this study was to verify the presence or absence of arterial or venous anastomosis among iliac and obturator vessels in retropubic region Methods Thirty cadavers (14 male/16 female; 60% white and 40% non-white). After dissection, the presence of anastomosis and its distance from the pubic symphysis were verified. Results The 13.3% presented no communication and 86.6% presented some type of anastomosis (p 0.05). The anastomosis was observed in 72% of whites and 67% of non-whites. Conclusions Presence of anastomosis is more frequent than its absence, and there is no significant difference regarding side. It is located at 5.7 cm from the pubic symphysis and venous is significantly more frequent. Anastomosis is significantly more frequent in females. There is no statistically significant difference between white and non-white.

Rotura traumática del extensor propio del hallux en la inserción distal. Reporte de un caso. [Traumatic rupture of the extensor hallucis longus at the level of the distal insertion. Case report]

Abstract: The rupture of the extensor hallucis longus is infrequent, even more in spontaneous lesions and in those caused by indirect trauma. It can occur in any part of the tendon, but the most frequent lesions are those caused by cutting injury. There is no specific surgical technique described for the distal reinsertion of the tendon. The aim of this article is to present a thirty-five years old patient who due to indirect traumatism suffered the rupture of the extensor hallucis longus at the level of its distal insertion. We describe the surgical technique we used, and the patient’s rehabilitation and preoperative and postoperative results in the AOFAS scale.

Artroplastia de cadera luego de una osteosíntesis fallida en fracturas laterales de cadera. [Hip arthroplasty for failed internal fixation of intertrochanteric fractures.]

Abstract: Introduction The purpose of this retrospective study was to asses the clinical and radiographics outcomes, complications as well technicals problems of hip arthroplasty following failure of dynamic screw fixation of the intertrochanterics fractures. Methods 38 hip arthroplasty in 38 patients were reviewed. There were 31 females and 7 males. The mean age was 75,59 (67-90) years and average follow – up was 45,5 (16-128) months. The prosthesis types included 30 total hip arthoplasties, 7 bipolar hip arthroplasties and one resection tumoral prothesis. Nine large femoral stems were used. Eleven uncemented cups and 20 cemented were used. We evaluated the presence of pain and objectively the Harris hip score (HSS) was used. Radiologically cementing quality, the appearance of a radiolucent line at the cement-stem interfase, the presence of loosening, nonunion of the greater trochanter and its complications was analyzed. Results A verage Harris Hip Score was 79 (70-88) points. 30 of 35 cemented femoral stems were rated as Barrack A, 4 as B and 1 as C. There were no revisions for aseptic loosening. There were 5 nonunion of greater trochanter, 3 acutes infections, and 3 dislocations, one of them need reoperation. Conclusion H ip arthroplasty as salvage procedure after failed dynamic screw fixation is a satisfactory procedure with aceptable clinical outcomes and resumption of ambulation. This procedure is technically challenges with hight complications rate.

Colgajo paraescapular en pérdidas postraumáticas de tejidos blandos de las extremidades. [Parascapular flap in post-traumatic soft-tissue loss at the limbs.]

Abstract: IntroductionThe aim of this study is to present the results after the use of paraescapular free flaps to cover severe soft tissue defects at the extremities.MethodsA retrospective, descriptive study of 20 patients who underwent parascapular free flaps to cover massive combined soft tissue lesions at the extremities as a salvage procedure from 2006 to 2017 was performed. Patients age averaged 30 years (18 men, 2 women). Sites of lesions were: ten at the forearm and wrist, one at the inguinal region, seven at the leg and two at the ankle/foot.ResultsFollow-up averaged 3.6 years. Successful coverage was achieved in 17 cases. Flap size averaged 24.8 x 10.7 cm. There were six cases with neurovascular lesions that needed grafting, six cases had associated bone loss, eleven patients needed skin graft and four required tendon reconstructions. Donor area closed primarily without functional limitations in all patients. In three cases the flap was combined with a scapular flap and in three cases with a latissimus dorsi flap. Two flaps failed and the injured limb was amputated; one patient died due to massive embolism seven days after surgery.ConclusionsParascapular free flaps allowed salvage and reconstruction of 17 out of 20 severely injured limbs, without morbidity for the donor area. But its use is not free of complications, and a multidisciplinary approach is necessary to reduce this morbidity.

Tratamiento de las fracturas complejas de platillo tibial con compromiso de la tuberosidad anterior de la tibia.[Treatment of complex tibial plateau fracture associated with anterior tibial tubercle involvement].

Abstract: Introduction Fractures in both tibial plateaus occur following high-energy traumatisms. Sometimes, fracture can compromise the tibial tubercle. Neither the Schatzker nor the AO/OTA classifications take this fragment into account. The aim of this study was to describe incidence and surgical management in these types of fractures. Materials and Methods We carried out a retrospective study between 2009 and 2017 which included 48 fractures in both tibial plateaus treated with reduction and osteosynthesis; 10 of them showed a fragment of the tibial tubercle associated. Seven patients were males, whereas 3 of them were females. Patients averaged 33.5 years old. Nine of them received initial stabilization by external fixator. The fragment of the tibial tubercle was fixed using 2 3.5-mm screws (9 cases) and 1/3 tubular plate (one case). One patient had suffered an open fracture. Minimal follow-up was 12 months. Results We got bone healing in all the cases. There were no infections. Knee ROM was 10o-extension (0o-20o) and 120oflexion (90o-140o). In one case it was necessary to remove the osteosynthesis material. One patient required arthroscopy to treat a meniscal injury. Conclusions In our series, 20.8% of all fractures in both tibial plateaus showed one fragment from the tibial tubercle. The fixation of this fragment with 3.5-mm screws or a 1/3 tubular plate is an effective technique to get adequate stabilization for the fragment.

Colgajo de recto anterior del abdomen para el tratamiento de los defectos de cobertura lumbosacros. [Rectus abdominis flap for the treatment of lumbosacral coverage defects.]

Abstract: Introduction: Treatment of soft tissue lumbosacral defects is based on dead space management and defect coverage. The aim of this study is to describe the surgical technique, results and complications of patients who underwent rectus abdominis flap for lumbosacral defects coverage.Methods: A six-year retrospective review was performed. Demographic characteristics are analyzed. Surgical technique and intra-operative complications are described. Postoperative variables, such as donor site complications, recipient site complications, and flap survival were also reported. Results: Five patients met the inclusion criteria (average age, 50 years). Four patients presented sacral tumor diagnosis and one patient had lumbosacral osteomyelitis. Mean follow-up was 20 months. Flap average size was 8 x 13 cm. Intraoperative complications were one pedicle injury (microsurgical repair) and the death of a patient. Regarding postoperative complications, one wound dehiscence was reported. None of the flaps suffered vascular complications and all remained vital throughout follow-up.Conclusion: Rectus abdominis flap should be considered a valid option in the management of large soft tissue lumbosacral defects. This flap provides sufficient skin volume and muscular tissue. Surgical technique is relatively simple with no need for microsurgical procedure.

Injerto óseo vascularizado pediculado del radio distal para tratar la seudoartrosis recalcitrante del cúbito. [Vascularized bone graft of the distal radius for recalcitrant ulnar pseudoarthrosis.]

Abstract: IntroductionThe purpose of this study was to analyze the clinical and radiological outcomes of a series of patients treated with the pedicled distal radius vascularized bone graft (VBG) for recalcitrant ulnar nonunions.MethodsA retrospective study was perfomed. The inclusion criteria were patients with diaphyseal or proximal ulnar nonunions with bone defects smaller than 6 centimeters, at least three previous surgeries and a minimum follow-up of 2 years treated with pedicled VBG of the distal radius. The number of previous surgeries was recorded. The elbow and wrist range of motion, the comparative grip strength, the Visual Analogue Scale (VAS) for pain, the QuickDASH questionnaire and the Mayo Score for elbow were evaluated. ResultsSeven patients were included. The mean age was 42 years (range 26-64). The average number of previous surgeries was 4 (3-7). The mean follow-up was 21 months (range 24-36). All pseudoarthrosis consolidated. The Mayo score was good in 4 patients, excellent in 2 patients and moderate in one patient. The mean postoperative QuickDASH was 13 (0-29). The flexion-extension arch of the wrist was 81% of the contralateral. The elbow range of motion was > 100° in 5 patients and 50°- 100° in 2 patients.ConclusionThe pedicled vascularized bone graft of the distal radius is an effective alternative for the treatment of recalcitrant ulnar nonunions.

Análisis de la displasia epifisaria hemimélica (enfermedad de Trevor) de tobillo

Abstract: Dysplasia epiphysealis hemimelica or Trevor’s disease is an osteocartilaginous deformity in the bone epiphyseal area. It is an uncommon condition prevailing in males. It develops in childhood, with growth plates still open, and it affects mainly patients’ ankles and knees. It is a condition of unknown origin. We present three cases with different degrees of severity, and also the therapeutic alternatives for each. There is only one case subject to surgical treatment due to irreducible equinus deformity. We provide details about surgical techniques, postoperative management and results in histologic analyses. We recommend operating on only those patients with some functional limitation or severe deformity due to the high recurrence rates they are associated with.