Pinzamiento femoroacetabular: Conceptos básicos en una nueva causa de dolor inguinal: [revisión] / Femoroacetabular impingement as a cause of inguinal pain: [review]

Femoro-acetabular impingement is an anatomical disturbance of the hip, caused by a deformity of the acetabulum, femur or both that causes an abnormal contact between both structures during certain movements. Its prevalence is 10 to 15 percent and causes chronic inguinal pain. It can be confused with several other causes of inguinal pain such as hernias, facet syndromes, a renal colic, etc. Patients with this condition are usually young individuals with inguinal pain that may appear after a minor trauma. During examination, pain may be elicited by infernal rotation and abduction movements of hip, flexed in 90°. Plain hip X ray is the most commonly used diagnostic method. Non-steroidal anti-inflammatory drugs and physical therapy can be used to alleviate pain, but the definitive treatment is surgical.

Eficacia del ácido tranexámico en la reducción del sangrado post operatorio en artroplastía total de rodilla / Efficacy of the tranexamic acid in the reduction of the postoperative bleeding in total knee replacement

We investigated the effect of the tranexamic acid in the reduction of the post operative bleeding in patients undergoing a total knee replacement. A prospective study was performed, 20 patients made up the study group, these individuals received an intravenous dose of 15 mg/kg weight just before the surgery and a second dose equal to the first one, before the release of the pneumatic tourniquet. The control group included 20 patients who underwent a total knee replacement and did not receive any kind of antifibrinolytic therapy. Patients who received the tranexamic acid had a mean postoperative bleeding of 383 mls +/- 236 versus the control group who had a mean of 1.025 mls +/- 281 of bleeding. The difference between both groups was statistically relevant according to the Mann Whitney test. There were no cases of clinical deep vein thrombosis (DVT), neither pulmonary thromboembolism. Based on the results reported in the literature and obtained in our study, we recommend the routinary use of the tranexamic acid in patients undergoing a total knee replacement.

Investigamos el efecto del ácido tranexámico en el sangrado post operatorio de pacientes sometidos a artroplastía total de rodilla. Este es un estudio prospectivo que contó con un grupo de 20 casos en los que se administró una dosis de 15 mgs/kg peso justo antes del inicio de la cirugía y se repitió antes de la deflación del torniquete neumático. Los pacientes que recibieron ácido tranexámico presentaron un sangrado postoperatorio promedio medido en el receptáculo del drenaje de 383 mls +/- 236 versus el grupo control que tuvo un sangrado promedio de 1.025 mls +/- 281. La diferencia fue estadísticamente significativa entre ambos grupos de acuerdo al test de Mann Whitney. No se registraron casos de trombosis venosa profunda clínica, ni de tromboembolismo pulmonar. Recomendamos el uso de este fármaco de manera rutinaria en este tipo de procedimientos dados los beneficios reportados en la literatura y comprobados en nuestro estudio.

Proyección de Rosenberg en la evaluación radiológica de la osteoartrosis de rodilla / Rosenberg projection for the radiological diagnosis of knee osteoarthritis

Background: Knee osteoarthritis is highly prevalent in our country. An early diagnosis is very important to provide an accurate and early treatment, and eventually delay its progression. Aim: To compare the diagnostic yield for osteoarthritis of two projections in knee Xray examination. Material and Methods: We evaluated 44 knees with conventional (AP weight-bearing, in full extension) and Rosenberg (PA weight-bearing in 45 degrees of flexion) X ray projections in 32 patients (24 women and 8 men), aged 26 to 78 years. All patients were symptomatic at the time of evaluation, with a suspicion of knee osteoarthritis. Both projections were analyzed and compared. Results: Joint space in the lateral compartment with conventional AP weight-bearing and Rosenberg projections were 8.6±11.5 mm and 7.8±10.9 mm, respectively (NS). The joint space for the medial compartment were 8.2±10.9 mm and 6.7±8.6 mm, respectively (p <0.05). Conclusions: Rosenberg projection is more sensitive to detect knee joint space narrowing as compared with conventional AP weight-bearing prqjection, at least in the medial compartment ofthe knee. Therefore, Rosenberg prqjection should be included in the initial study of any patient with suspicion ofknee osteoarthritis.

Radiografia con carga en flexion para la deteccion precoz de artrosis de rodilla: mejorando el screening / Flexion weight bearing X ray for early detection of knee osteoarthritis: improving the screening

La osteoartrosis de rodilla es una patología con una elevada prevalencia en nuestro medio cuyo diagnóstico precoz es fundamental para un adecuado y oportuno tratamiento, y eventualmente, retrasar su progresión. En población deportista de la vida media, su detección precoz puede ser muy importante para el consejo médico de una práctica deportiva que no agrave su progresión. Evaluamos las radiografías de 44 rodillas en 32 pacientes (24 mujeres y 8 hombres), entre 26 y 78 años. Todos los pacientes eran sintomáticos y con un diagnóstico presuntivo de gonartrosis. Las proyecciones radiológicas empleadas fueron: convencional (anteroposterior (AP) en extensión, con carga) y Rosenberg (posteroanterior (PA) con carga y flexión de 45 grados). Al analizar y comparar ambas proyecciones se encontró una mayor capacidad de la proyección de Rosenberg para detectar la disminución del espacio articular en la articulación femorotibial, comparado con las proyecciones convencionales AP. Dicha diferencia fue estadísticamente significativa en nuestro estudio. Se concluye que la proyección de Rosenberg debería ser la proyección de elección en el estudio radiológico inicial de todo paciente con sospecha de gonartrosis.