Resultados radiológicos y funcionales en fracturas de platillo tibial de alta energía / Radiological and functional results in high-energy tibial plate fractures

Resumen: Introducción: Las fracturas de platillo tibial por mecanismos de alta energía son lesiones graves que ocurren sobre una articulación de carga. Son difíciles de abordar, ya que además de afectar la estructura ósea de la pierna suelen tener lesiones de partes blandas asociadas. Objetivo: Evaluar los resultados radiológicos y funcionales de las fracturas de platillo tibial de alta energía con un mínimo seguimiento de un año. Material y métodos: Estudio retrospectivo, observacional y multicéntrico. Análisis de los resultados radiológicos y funcionales en el tratamiento de fracturas de platillo tibial de alta energía tratadas mediante reducción abierta y fijación interna (RAFI) entre 2014 y 2019. Resultados: 54 fracturas tratadas mediante RAFI. Seguimiento un año, 98.1% de consolidación en 13 semanas de promedio, 83.4% sin alteraciones del eje en plano coronal, 74% sin ensanchamiento articular postoperatorio. Escalas funcionales: Lysholm 82.1 puntos promedio y Oxford Knee Score (OKS) 39.5 puntos promedio. Conclusión: El rango de movilidad articular se redujo luego de una fractura de platillos tibiales de alta energía, pero con buenos resultados funcionales. Cuanto menor deseje y menor ensanchamiento radiográfico postoperatorio, se obtienen mejores resultados.

Abstract: Introduction: The tibial plateau fractures due to high-energy mechanisms are serious injuries that occur on a load bearing joint. These are difficult to approach because, also affect the bone structure of the leg, they usually have associated soft tissue injuries. Objective: To evaluate the radiological and functional results of high-energy tibial plateau fractures with a minimum follow-up of one year. Material and methods: Retrospective, observational and multicenter study. Analysis of radiological and functional outcomes in the treatment of high-energy tibial plateau fractures, treated by open reduction and internal fixation (ORIF) between 2014 and 2019. Results: 54 fractures treated by ORIF. Follow-up one year. 98.1% consolidation in 13 weeks on average. 83.4% without alterations of the axis in the coronal plane. 74% without postoperative joint widening. Functional scores: Lysholm 82.1 average points and Oxford Knee Score (OKS) 39.5 average points. Conclusion: The joint range of motion was reduced after a high-energy tibial plateau fracture, but with good functional results. The less off axis and less post-operative radiographic widening, the better results are obtained.

Current and Future Trends in the Clinical Diagnosis of Rickettsioses Sensu Lato.

Aims: The aim of this review is to present Rickettsioses sensu lato, with emphasis on their current and future clinical diagnosis. The review presents the conditions, the agents that cause them, and the current gold standards on their diagnosis in national and international reference centres. Additionally, this review covers the various emerging technologies available in the diagnosis of Rickettsioses and discusses their potential for future use as gold standards in the diagnosis of these diseases. Introduction: The introduction presents Rickettsioses sensu lato and gives a broad overview of the conditions they cause, the issues associated with their current diagnosis and the need for their improved, earlier and more accurate diagnosis, in order to prevent current issues with false negatives, misdiagnosis or delay in the diagnosis associated with these conditions, which often renders them grave or lethal. Main Body: The main body of the review presents in independent sections Rickettsias, Ehrlichia, Anaplasma, Bartonella and Coxiella and the conditions associated with each of these bacteria. Spotted fever, endemic typhus, human granulocytic anaplasmosis, human monocytic ehrlichioses, bartonellosis and Q-fever are some of the conditions associated with this group of proteobacteria. The emphasis is on the clinical diagnosis of these conditions and an overview of the current practice, gold standards in reference laboratories and improvements in these methodologies is presented. The last part of the review focuses on novel technologies in bacterial detection and their application specifically on Rickettsioses sensu lato, demonstrating how these technologies are being applied in this field and how they could improve current standards and resolve issues associated with the clinical diagnosis of rickettsioses. Conclusion: Rickettsioses sensu lato are conditions associated with proteobacteria historically included in the Rickettsiaceae family, able to cause a number of conditions, often grave or lethal. One of the major issues associated with poor clinical outcome is the lack of early and accurate differential diagnostic methodologies. Current methods, including serological and molecular biology techniques have various advantages and disadvantages, which new technologies available or currently in development may be in a position to resolve and the issues associated with the institution of such technologies.

Trombosis venosa cerebral secundaria a síndrome antifosfolípido y déficit de antitrombina III / Cerebral venous thrombosis secondary to antiphospholipid syndrome and dificit of antithrombin III

La trombosis venosa cerebral es menos frecuente que la arterial como causa de stroke, sin embargo aún continua subdiagnosticada. Fisiopatológicamente se caracteriza por un desequilibrio entre factores trombogénicos y fibrinolíticos. Los desórdenes hematológicos tienen un rol protagónico importante, destacándose entre ellos el sindrome antifosfolipídico, el cual debe particularmente sospecharse cuando el accidente cerebrovascular ocurre en individuos jóvenes