Caracterización de pacientes con fractura de cadera, intervenidos con artroplastia / Characterizing Patients with Hip Fracture, Operated with Arthroplasty

Introducción: Las lesiones traumáticas de la cadera ocupan uno de los propósitos más importantes de la cirugía traumatológica. El uso de la artroplastia como regla de oro en el tratamiento quirúrgico de las mismas, es el fundamento del trabajo. Objetivo: Caracterizar los pacientes con diagnóstico de fractura de cadera, intervenidos con artroplastia total y parcial y estudiar la mortalidad, según el tipo de prótesis utilizada. Métodos: Se realizó un estudio descriptivo de corte transversal retrospectivo en 1506 pacientes del Hospital Ortopédico Docente Fructuoso Rodríguez entre 2015 y 2019, portadores de fractura de cadera, y tratados con artroplastia. Se analizaron variables tales como edad, sexo y comorbilidades presentes. Resultados: Se colocaron prótesis totales a 427 pacientes y en 1079 se utilizó la modalidad de prótesis parcial. Predominaron las personas entre 61 y 80 años de edad. El sexo femenino prevaleció en el estudio, con una relación 3:1. Predominó el grupo de pacientes con 1 o 2 enfermedades asociadas. La mortalidad < 30 días resultó el 1,1 por ciento y ≥ 30 días el 9,2 por ciento. Conclusiones: La utilización de prótesis totales dista mucho de la media interpuesta actualmente en el mundo, donde la prótesis total se maneja como herramienta de elección. Las prótesis parciales quedan reservadas para pacientes que tienen una corta expectativa de vida y muy poco validismo(AU)

Introduction: Traumatic hip injuries occupy one of the most important purposes of trauma surgery. The use of arthroplasty as a golden rule in their surgical treatment is the foundation of the work. Objectives: To characterize patients with a diagnosis of hip fracture, who underwent total and partial arthroplasty and to study mortality, according to the type of prosthesis used. Methods: A descriptive retrospective cross-sectional study was carried out in 1506 patients from Fructuoso Rodríguez Orthopedic Teaching Hospital from 2015 to 2019, with hip fracture, and treated with arthroplasty. Variables such as age, sex, and present comorbidities were analyzed. Results: Total prostheses were placed in 427 patients and in 1079 the partial prosthesis modality was used. Persons between 61 and 80 years of age predominated. The female sex prevailed in this study, with a 3: 1 ratio. The group of patients with 1 or 2 associated diseases predominated. Mortality <30 days was 1.1 percent and ≥30 days was 9.2 percent. Conclusions: The use of total prostheses is far from the current average in the world, where the total prosthesis is used as the tool of choice. Partial prostheses are reserved for patients who have short life expectancy and very little validity(AU)

Fracturas por epilepsia en el hospital Víctor Lazarte Echegaray / Epilepsy Fractures at Víctor Lazarte Echegaray Hospital

Introducción: Las convulsiones pueden producir una tensión muscular significativa capaz de fracturar el hueso. Se halló que el aumento significativo en la incidencia de fracturas se encuentra dentro del grupo de edad entre 45 a 64 años, lo que demuestra que los epilépticos no solo son más vulnerables a las fracturas, sino que tienen un comienzo de fractura más precoz. Las medidas de prevención comprenden suplementos de calcio, vitamina D, densitometría ósea y tratamiento con bifosfonatos, que deben reforzarse en pacientes con epilepsia que tienen riesgo de osteoporosis. Objetivo: Presentar casos de fracturas extracapsular e intracapsular de la cadera por convulsiones epilépticas, atendidos en el hospital Víctor Lazarte Echegaray, Trujillo, Perú, en el periodo comprendido entre 2013 y 2019. Presentación de los casos: Se reporta dos casos de fractura de cadera por convulsiones epilépticas, uno con fractura del acetábulo e iliaco izquierdo y otro a nivel del cuello femoral y subtrocantérica. Conclusiones: Las personas con convulsiones epilépticas poseen un mayor peligro de fracturas, por consiguiente se recomienda a los médicos que maximicen su conciencia sobre las fracturas relacionadas a convulsiones, en especial a pacientes con dolor postictal, debido a que los síntomas pueden ser inespecíficos y una mala interpretación puede impedir la rehabilitación(AU)

Introduction: Seizures can produce significant muscle tension capable of fracturing the bone. The significant increase in the incidence of fractures was found to be within the age group between 45 and 64 years, which shows that epileptics are not only more vulnerable to fractures, but also have earlier fracture onset. Prevention measures include calcium supplements, vitamin D, bone densitometry, and bisphosphonate treatment that should be reinforced in patients with epilepsy who are at risk for osteoporosis. Objective: To present cases of hip fractures due to epileptic seizures, treated at Víctor Lazarte Echegaray Hospital, Trujillo, Peru, from 2013 to 2019. Case report: Cases of hip fracture due to epileptic seizures have been reported, one with fracture of the acetabulum and left iliac and another at the level of the femoral and subtrochanteric neck. Conclusions: Individuals with epileptic seizures have greater risk of fractures, it is recommended that physicians maximize their awareness of seizure-related fractures, especially in patients with postictal pain, since the symptoms can be nonspecific and misinterpretation can prevent rehabilitation(AU)

Artroplastia de resección de hombro como salvamento para infecciones recalcitrantes: estado actual de la técnica a propósito de dos casos / Shoulder resection arthroplasty as a salvage procedure for recalcitrant infections: current state of the art regarding two cases

INTRODUCCIÓN Y OBJETIVOS La artroplastia de resección de hombro (ARH) se presenta como una técnica obsoleta y una opción no válida en la actualidad, debido a la evolución de las técnicas quirúrgicas y de los implantes. Pero, como consecuencia del aumento exponencial del uso de artroplastias de hombro, están aumentando en paralelo el número de fracasos e infecciones, con necesidad de revisión y rescate. Es por ello que, en determinadas situaciones y pacientes, esa técnica vuelve a ser una opción necesaria como salvataje, aunque tiene un alto coste funcional. El objetivo de nuestro trabajo, es presentar dos casos de artroplastia de resección de hombro como una opción válida de tratamiento en la actualidad y la revisión de la literatura. CASOS Se presentan dos casos de ARH como tratamiento de rescate, en un caso de osteomielitis crónica de cabeza humeral y un caso de infección de hemiartroplastia de hombro. Ambos pacientes se encontraban sin dolor y libres de infección con un seguimiento de más de 30 meses. En un caso la funcionalidad fue limitada con un Constant de 45 pero el otro caso la funcionalidad fue aceptable con un Constant de 67. CONCLUSIONES La ARH sigue siendo una técnica útil tras el fracaso de procedimientos de revisión, para resolver infecciones protésicas recalcitrantes u osteomielitis. Los resultados funcionales son pobres, por lo que debe reservarse para pacientes con baja demanda funcional y como salvataje, tras agotar otras opciones.

INTRODUCTION AND OBJECTIVES shoulder resection arthroplasty (SRA) is currently considered as an outdated technique, due to the advances in surgical techniques and new prosthesis designs. However, with the exponential increase in the use of shoulder arthroplasties, the number of failures and infections is equally increasing, as well as the revisions and salvage procedures. In certain situations, SRA is therefore a necessary solution, although it grossly compromise shoulder function. The aim of our study is to present two cases who underwent SRA as a valid treatment option nowadays and a literature review. CASES We present two cases of SRA as salvatage treatment. First case in a chronic humeral head osteomyelitis and second in a partial shoulder prosthesis recalcitrant infection. Both patients had complete pain relief and infection was solved with a follow-up over 30 months. In the first case, postoperative shoulder function was limited with a Constant­Murley score of 45. In the second case, function was fairly good with a Constant of 67. CONCLUSIONS SRA remains a valuable technique after the failure of revision procedures, as a salvage for recalcitrant prosthetic infections or osteomyelitis. The functional results are poor, so it should be reserved for patients with low functional demand and as salvatage procedure, after assess other options.

Morfología glenoidea en la artrosis glenohumeral primaria: factores preoperatorios relevantes / Glenoid morphology in primary glenohumeral osteoarthritis; preoperatory relevant elements

El objetivo primario de esta revisión es realizar una actualización de los conceptos básicos relacionados a los cambios morfológicos glenoideos durante la artrosis glenohumeral primaria, métodos de medición relevantes y describir las modificaciones en la nueva clasificación de Gilles Walch. La medición de esos parámetros influyen en forma directa tanto en el acto quirúrgico dentro una prótesis de hombro como en los resultados clínicos post operatorios. Los diferentes métodos de medición descritos en la literatura han permitido evaluar la magnitud de esos fenómenos morfológicos y describir la "glenoides bicóncava", caracterizada por presentar 3 subtipos: la paleoglena, neoglena y la glena intermedia. A partir de esos conceptos, Walch en 1999 describe la clasificación de los cambios morfológicos glenoideos en artrosis primaria, la cual ha presentado una reciente modificación debido a la mala concordancia intra e interobservador de esa medición obtenida por varios investigadores, además de reconocer una carencia en la precisión para describir cada subtipo. A la fecha, diferentes autores investigan la influencia de esos factores morfológicos preoperatorios en los resultados post operatorios, y hasta que valor límite podrían guiar un tratamiento especifico. Conclusión: Enfatizamos que un análisis acabado y minucioso de la morfología glenoidea es importante para una adecuada planificación quirúrgica en artroplastia de hombro, ya que eso puede guiarnos en cuál técnica o implante puede ser el más adecuado para cada tipo de glenoides.

The main purpose of this review is to up date the basic concepts regarding the glenoid morphological changes in primary glenohumeral osteoarthritis, relevant measuring methods, and a description of the modifications in the Gilles Walch classification. The measurement of these parameters influences both surgical indications for total shoulder arthroplasty and the post op clinical outcomes. The different measuring methods described in literature have allowed to evaluate the magnitude of these morphological phenomena describing the "biconcave glenoid", which characteristically presents 3 subtypes: paleoglenoid, neoglenoid and intermediate glenoid. Based on these concepts, Walch classified the glenoid morphological changes in primary ostheoarthritis in 1999, which has been recently modified due to the poor inter-observer and intra-observer reliability described by a vast number of researchers, and also because of an observed lack of precision when describing each sub-type. Up to date, different authors are debating the influence of these pre operative morphological factors on the post op outcomes; and the cut-off value up to which this could lead to a specific treatment. As a conclusion, we emphasize that a deep and thorough analysis of the glenoid morphology is important for an adequate surgical planning of a shoulder arthroplasty, as this can guide us to the most adequate technique and type of implant for each type of glenoid.

Active Life: a project for a safe hospital-community transition after arthroplasty / Vida Ativa: projeto para uma transição hospital-comunidade segura após artroplastia / Vida Activa: proyecto para una transición hospital-comunidad segura después de una artroplastia

ABSTRACT Objective: To define the criteria for the continuity of care to elderly people submitted to arthroplasty. Method: This is a qualitative study, inserted in the constructivist paradigm, whose methodological option fell on research-action. The participants were the health professionals of an orthopedic service and of the community care teams in the area of the hospital. Results: The different techniques allowed us to identify the difficulties in the safe transition from the hospital to the community. At this level, two categories of criteria for continuity of care emerged: criteria associated with the risk of ineffective management of the therapeutic regimen, and criteria associated with the knowledge and level of competence of the informal caregiver. Final Considerations: An elderly person undergoing arthroplasty (hip or knee) has functional alterations that affect their capacity for self-care and may lead to dependence, our findings allowed the design of an algorithm to facilitate clinical decision making and promote a safe hospital-community transition.

RESUMO Objetivo: Definir os critérios para a continuidade da assistência à pacientes idosos submetidos à artroplastia. Método: Estudo qualitativo, inserido no paradigma construtivista, utilizando a pesquisa-ação como opção metodológica. Os participantes do estudo foram os profissionais de saúde de um serviço ortopédico e das equipes de saúde comunitária na área de cobertura do hospital. Resultados: As diferentes técnicas utilizadas nos permitiram identificar as dificuldades para uma transição segura do hospital para a comunidade. Duas categorias de critérios para a continuidade da assistência surgiram: critérios associados ao risco de gestão ineficiente do regime terapêutico, e critérios associados ao conhecimento e nível de competência do cuidador informal. Considerações finais: Um idoso submetido a artroplastia (quadril ou joelho) sofre alterações funcionais que afetam a sua capacidade de autocuidado e podem levar à dependência. Nossos achados permitiram o desenvolvimento de um algoritmo para facilitar a tomada de decisão clínica e promover uma transição segura do hospital para a comunidade.

RESUMEN Objetivo: Definir los criterios para la continuidad de la atención a pacientes ancianos sometidos a la artroplastia. Método: Estudio cualitativo, fundamentado en el paradigma constructivista, utilizando la investigación-acción como opción metodológica. Los participantes del estudio fueron los profesionales de salud de un servicio ortopédico y de los equipos de salud comunitaria en el área de cobertura del hospital. Resultados: Las diferentes técnicas utilizadas permitieron identificar las dificultades para una transición segura del hospital hasta la comunidad. Dos categorías de criterios para la continuidad de la atención surgieron: criterios asociados al riesgo de gestión ineficiente del régimen terapéutico, y criterios asociados al conocimiento y nivel de competencia del cuidador informal. Consideraciones finales: Un anciano sometido a artroplastia (cadera o rodilla) sufre alteraciones funcionales que afectan su capacidad de autocuidado y pueden conducir a la dependencia. Nuestros hallazgos permitieron el desarrollo de un algoritmo para facilitar la toma de decisión clínica y promover una transición segura del hospital hasta la comunidad.

Tratamiento quirúrgico de las deformidades en Boutonniere y cuello de cisne del pulgar en la artritis reumatoidea / Traitement chirurgical des déformations du pouce en boutonnière et en col de cygne dans l'arthrite rhumatoïde / Surgical Treatment of Boutonniere and Swan-Neck Deformities in Rheumatoid Arthritis Thumb

Introducción: la artritis reumatoidea es una enfermedad sistémica, en la que son comunes las deformidades articulares, estas se pueden observar en el pulgar donde las de mayor frecuencia son las de Boutonniere y en cuello de cisne. Objetivo: el objetivo principal fue evaluar los resultados de la aplicación de las técnicas quirúrgicas en estas deformidades. Método: se realizó un estudio longitudinal prospectivo de intervención. Se trataron un total de 20 pacientes con este diagnóstico, atendidos en el Servicio de Miembro Superior Minifijación Externa y Microcirugía del Complejo Científico Ortopédico Internacional Frank País en el período comprendido desde enero 2011 a diciembre 2012. La evaluación de los pacientes se realizó según la escala confeccionada para este grupo particular en estudio. Resultados: se obtuvieron resultados excelentes en el 10 por ciento, buenos en el 75 por ciento y regulares en el 15 por ciento de los casos. Conclusiones: las técnicas quirúrgicas empleadas en el tratamiento de esta afección mostraron resultados alentadores(AU)

Introduction: Rheumatoid arthritis is a systemic disease, in which joint deformities are common; these deformities are observed in the thumb where the most frequent are Boutonniere and swan-neck deformities. Objective: Assess the results of the application of surgical techniques in these deformities. Method: A longitudinal prospective intervention study was conducted at Frank País International Orthopedic Scientific Complex from January 2011 to December 2012. Twenty patients with this diagnosis were treated in the Upper Limb Service for External Miniaturization and Microsurgery. The evaluation of the patients was performed according to the scale prepared for this particular study group. Results: 10 of the cases obtained excellent results, 75 percent obtained good results and 15 percent had moderate results. Conclusions: The surgical techniques used in the treatment of this condition showed encouraging results(AU)

Introduction: L'arthrite rhumatoïde est une maladie systémique caractérisée par des atteintes articulaires, surtout au niveau du pouce, telles que les déformations en boutonnière et en col de cygne. Objectif: Évaluer les résultats de l'application des techniques chirurgicales dans le traitement de ces déformations. Méthodes: Une étude longitudinale prospective interventionnelle a été réalisée. Un total de vingt patients, diagnostiqués d'arthrite rhumatoïde, ont été traités au Service d'orthopédie de membres supérieurs, mini-fixation externe et microchirurgie, au Complexe scientifique international d'orthopédie Frank Pais, dans la période comprise entre janvier 2011 et décembre 2012. Les patients de ce groupe ont été évalués selon une échelle élaborée pour cette étude. Résultats: On a obtenu des résultats excellents (10 pourcent), bons (75 pourcent), et passables (15 pourcent). Conclusions: Les techniques chirurgicales utilisées dans le traitement de cette affection ont montré des résultats encourageants(AU)

Temporomandibular Joint Ankylosis in Young Adult: A Case Report.

Temporomandibular joint (TMJ) ankylosis is a debilitating condition. It involves the mouth opening, dentofacial deformity, diet problem, and quality of life. When it occurs in a child, it can have devastating effects on the future growth and development of the jaws and teeth. Furthermore, in many cases it has a profoundly negative influence on the psychosocial development of the patient, because of the obvious facial deformity, which worsens with growth. TMJ ankylosis results in a limitation of the mouth opening. This disorder can result in an array of problems with diet, facial deformity, and poor oral hygiene. Three main surgical modalities described in the literature for its management are gap arthroplasty, interpositional arthroplasty and total joint replacement. Recurrence remains the main problem after surgery. Aggressive resection and intensive postoperative physiotherapy are recommended to prevent re-ankylosis.

Trapezoidectomía parcial y artroplastia interposicional tendinosa en el tratamiento de la rizoartrosis / Partial tendon trapezoidectomía interpositional arthroplasty in treating rizoarthrosis

INTRODUCCIÓN: la artrosis de la articulación basal del pulgar es la más común de las enfermedades degenerativas articulares de la mano. La trapezoidectomía con o sin interposición y con o sin ligamentoplastia, es una de las opciones de tratamiento quirúrgico. OBJETIVO: mostrar los resultados obtenidos con la técnica de trapezoidectomía parcial y artroplastia por interposición, así como caracterizar algunas variables que pueden estar en relación con esta enfermedad. MÉTODOS: estudio de intervención longitudinal prospectivo con pacientes diagnosticados e intervenidos por rizoartrosis de la mano, entre enero de 2009 y enero de 2013 y valorados un año después. La muestra quedó constituida por 45 pacientes, 29 mujeres y 16 hombres. RESULTADOS: existió predominio del sexo femenino y del grupo de edades entre 51 y 60 años, mayoritariamente en pacientes que desempeñaban labores de tipo manual, con estadios de degeneración avanzados y afectación de la mano derecha dominante. Ocurrieron pocas complicaciones menores y significativos cambios en la percepción del dolor, la oposición del pulgar y en el nivel de discapacidad presente antes de la intervención. CONCLUSIONES: la trapezoidectomía parcial con artroplastia interposicional tendinosa resulto altamente efectiva en el tratamiento de la artrosis carpometacarpiana del pulgar demostrado a través del índice QuickDASH.

INTRODUCTION: Osteoarthritis of the basal joint of the thumb is the most common degenerative joint disease of the hand. Trapezoidectomy, with or without interposition and with or without ligamentoplasty, is one of the surgical treatment options. OBJECTIVE: Show the results obtained with the technique of partial trapezoidectomy and interposition arthroplasty and characterize some variables that may be related to this disease. METHODS: A prospective longitudinal intervention study was carried out with patients diagnosed and treated for hand rizoarthrosis from January 2009 to January 2013, and they were assessed a year later. The sample was composed of 45 patients: 29 women and 16 men. RESULTS: There was predominance of females, and the age group between 51 and 60 years, mostly in patients who performed manual labor with advanced stages of degeneration and disruption of the dominant right hand. A few minor complications and significant changes occurred in the perception of pain, thumb opposition and the present level of disability before surgery. CONCLUSIONS: partial tendon interpositional trapezoidectomy with arthroplasty resulted highly effective in tretaing osteoarthritis of the thumb carpometacarpal shown through QuickDASH index.

Interpositional Arthroplasty with Temporomyofascial Flap to Correct TMJ Reankylosis in Child: A Case Report.

Temporomandibular joint ankylosis (TMA) is a highly distressing condition in which the temporomandibular joint (TMJ) is replaced by scar tissue. Most frequently reported complications after surgical treatment are limited mouth opening and re-ankylosis. Reankylosis happens due to inadequate bone removal, lack of sufficient interpositional material, fibrous tissue adhesions and elongation of coronoid process and regrowth of bone in the sigmoid notch area. In gap arthroplasty treatment chances to recurrence is 53% than interpositional arthroplasy. We treated a case of right sided TMJ reankylosis by interpositional arthroplasty with temporomyofacial flap and physiotherapy was started 3 days after surgery and maintained for 6 months. In 2 years follow-up, no signs of recurrence and maximum mouth opening 45 mm were observed. The success in preventing reankylosis after TMJ interpositional arthroplasty with temporomyofacial flap is relatively better than gap arthroplasty alone.

Cervical Arthroplasty for Moderate to Severe Disc Degeneration: Clinical and Radiological Assessments after a Minimum Follow-Up of 18 Months: Pfirrmann Grade and Cervical Arthroplasty

PURPOSE: Clinical outcomes and radiologic results after cervical arthroplasty have been reported in many articles, yet relatively few studies after cervical arthroplasty have been conducted in severe degenerative cervical disc disease. MATERIALS AND METHODS: Sixty patients who underwent cervical arthroplasty (Mobi-C(R)) between April 2006 and November 2011 with a minimum follow-up of 18 months were enrolled in this study. Patients were divided into two groups according to Pfirrmann classification on preoperative cervical MR images: group A (Pfirrmann disc grade III, n=38) and group B (Pfirrmann disc grades IV or V, n=22). Visual analogue scale (VAS) scores of neck and arm pain, modified Oswestry Disability Index (mODI) score, and radiological results including cervical range of motion (ROM) were assessed before and after surgery. RESULTS: VAS and mean mODI scores decreased after surgery from 5.1 and 57.6 to 2.7 and 31.5 in group A and from 6.1 and 59.9 to 3.7 and 38.4 in group B, respectively. In both groups, VAS and mODI scores significantly improved postoperatively (p<0.001), although no significant intergroup differences were found. Also, cervical dynamic ROM was preserved or gradually improved up to 18 months after cervical arthroplasty in both groups. Global, segmental and adjacent ROM was similar for both groups during follow-up. No cases of device subsidence or extrusion were recorded. CONCLUSION: Clinical and radiological results following cervical arthroplasty in patients with severe degenerative cervical disc disease were no different from those in patients with mild degenerative cervical disc disease after 18 months of follow-up.

Tratamiento simultáneo de anquilosis temporomandibular unilateral congénita y del microlaterognatismo asociado / Simultaneously treament of congenital unilateral temporomandibular ankylosis and consecutive microlatherognathism

Este artículo tiene como objetivo reportar los resultados obtenidos a corto y largo plazo, del tratamiento con enfoque multidisciplinario de una anquilosis unilateral congénita de la articulación temporomandibular asociada a un síndrome de malformación embrionaria, en un niño de 12 años de edad, en el que se utilizó un distractor externo bidimensional con un doble propósito: como fijador para mantener el espacio logrado con la artroplastia y como distractor para elongar la rama mandibular hipotrófica, activado 5 días después de la osteotomía, con el objetivo de eliminar la anquilosis y el microlaterognatismo mandíbular consecutivo de ella, simultaneamente de manera funcional y dinámica(AU)

The paper reports the short- and long-term results obtained from the multidisciplinary treatment of a congenital unilateral ankylosis of the temporomandibular joint associated to an embryonic malformation in a 12-year-old boy, using an external bidimensional distraction device with a two-fold purpose: as fixator to maintain the space achieved by arthroplasty, and as distractor to elongate the hypotrophic mandibular branch, activated 5 days after osteotomy, with the purpose of eliminating ankylosis and consecutive mandibular microlaterognatism, both functionally and dynamically(AU)

Early Results of One-Stage Correction for Hip Instability in Cerebral Palsy

BACKGROUND: We evaluated the clinical and radiological results of one-stage correction for cerebral palsy patients. METHODS: We reviewed clinical outcomes and radiologic indices of 32 dysplastic hips in 23 children with cerebral palsy (13 males, 10 females; mean age, 8.6 years). Ten hips had dislocation, while 22 had subluxation. Preoperative Gross Motor Function Classification System (GMFCS) scores of the patients were as follows; level V (13 patients), level IV (9), and level III (1). Acetabular deficiency was anterior in 5 hips, superolateral in 7, posterior in 11 and mixed in 9, according to 3 dimensional computed tomography. The combined surgery included open reduction of the femoral head, release of contracted muscles, femoral shortening varus derotation osteotomy and the modified Dega osteotomy. Hip range of motion, GMFCS level, acetabular index, center-edge angle and migration percentage were measured before and after surgery. The mean follow-up period was 28.1 months. RESULTS: Hip abduction (median, 40degrees), sitting comfort and GMFCS level were improved after surgery, and pain was decreased. There were two cases of femoral head avascular necrosis, but no infection, nonunion, resubluxation or redislocation. All radiologic indices showed improvement after surgery. CONCLUSIONS: A single event multilevel surgery including soft tissue, pelvic and femoral side correction is effective in treating spastic dislocation of the hip in cerebral palsy.

Prótesis ellitica en fracturas de cuello femoral en mayores de 60 años / Elliptic head prosthesis in patients older than 60 years

Elliptic head prosthesis was realized in 1972 to better reproduce the anatomic femoral head shape. Many functional anatomy studies showed that this shape fills better the acetabulum during walk. We evaluated 59 patients with femoral neck fracture treated with Ellitica prosthesis, with 2 years minimal follow up. We obtained good functional outcome in the 45,6 percent and excellent results in the 29 percent of the patients operated with elliptic hemiarthroplasty in patients older than 60 with intracapsular femoral neck fractures, with no revision surgery or dislocation.

La prótesis parcial de cabeza elíptica fue diseñada en 1972 para reproducir la anatomía de la cabeza femoral. Muchos estudios anatómicos muestran cómo este diseño encaja mejor con el acetábulo durante la marcha. Evaluamos 59 pacientes con fractura de cuello femoral tratados con prótesis Ellitica, con un seguimiento mínimo de 2 años. Se obtuvieron buenos resultados funcionales en el 45,6 por ciento de los casos y excelentes en el 29 por ciento, además no existieron cambios radiológicos en el 84 por ciento de los casos; todos ellos pacientes mayores de 60 años con fractura intracapsular de cuello femoral sin aparición de luxación ni necesidad de cirugía de revisión.

Artroplastia de superfície no tratamento da osteoartrose primária e/ou secundária do ombro pelo sistema HemiCAP-Arthrosurface® / Surface arthroplasty for treating primary and/or secondary shoulder osteoarthrosis by means of the HemiCAP-Arthrosurface® system

OBJETIVO: Apresentar a técnica cirúrgica pelo sistema HemiCAP-Arthrosurface® e a avaliação dos resultados com esta técnica no tratamento da osteoartrose primária e/ou secundária do ombro. MÉTODO: Entre junho/2007 e junho/2009, 10 ombros de 10 pacientes, sendo nove com osteoartrose primária e um com necrose avascular da cabeça umeral, foram submetidos à artroplastia de superfície pelo sistema HemiCAP-Arthrosurface para correção do problema. O tempo de seguimento variou de seis a 29 meses, com média de 17 meses. A idade variou de 62 a 73 anos com média de 67,5 anos. Seis pacientes eram do sexo feminino e quatro do sexo masculino. Os pacientes foram acompanhados semanalmente no primeiro mês e a cada três meses após o procedimento cirúrgico. A avaliação clínica foi feita por meio dos critérios da University of Califórnia at Los Angeles (UCLA) e escala analógica de dor. RESULTADOS: Todos os pacientes operados encontravam-se satisfeitos com os resultados do tratamento cirúrgico, com uma média de 30 pontos e dois pontos nas escalas de avaliação da UCLA e analógica de dor, respectivamente. CONCLUSÃO: O sistema HemiCAP-Arthrosurface® utilizado na cirurgia do ombro para um grupo específico de pacientes é uma técnica cirúrgica que preserva o estoque ósseo com bons resultados funcionais e antálgicos.

OBJECTIVE: To present the surgical technique for the HemiCAP-Arthrosurface® system and evaluate our results from this technique for treating primary and/or secondary shoulder osteoarthrosis. METHOD: Between June 2007 and June 2009, 10 shoulders of 10 patients (nine with primary osteoarthrosis and one with avascular necrosis of the humeral head) underwent surface arthroplasty using the HemiCAP-Arthrosurface® system to correct the problem. The follow-up time ranged from six to 29 months (mean of 17 months). The patients' ages ranged from 62 to 73 years (mean of 67.5 years). Six patients were female and four patients were male. The patients were followed up weekly for the first month after the surgical procedure and every three months thereafter. The clinic evaluation was done using the criteria of the University of California at Los Angeles (UCLA) and a visual analogue pain scale. RESULTS: All the patients said that they were satisfied with the results from the surgical treatment, with a mean UCLA score of 30 points and a mean analogue pain score of two points. CONCLUSION: The HemiCAP-Arthrosurface® system for shoulder surgery for a specific group of patients is a technique that preserves the bone stock with good functional and antalgic results.

Evolución clínica de pacientes sometidos a artroplastia de cadera en el HEODRA, departamento de ortopedia y traumatología en el período comprendido entre 2007-2009, León, Nicaragua

La fractura de cadera es una grave lesión habitual que ocurre principalmente en personas ancianas, por lo que se deseaba conocer ¿Cuál es la evolución clínica post quirúrgica en pacientes sometidos a artroplastía de cadera HEODRA 2007 - 2009? yobtener el resultado de la evolución clínica post-quirúrgica de dichos pacientes, por lo que se llevó a cabo el presente estudio para conocer la situación socio-demográfica,complicaciones, material utilizado y su evolución posterior. La artroplastía de cadera es un procedimiento ortopédico capaz de aliviar el dolor, restablecer la función y mejorar la calidad de vida de los pacientes que presentan dolor en la articulación de la cadera de diferente etiología. Se estima que cada añose realizan más de 500.000 artroplastias de cadera en todo el mundo por diferentes causas. En el presente estudio se revisaron un total de 36 pacientes, a los cuales se lesrealizó cirugías a 28, ya que el restante abandonaron por falta de dinero paracomprar el material en el periodo comprendido de 2007 - 2009. Las características socio-demográficas de los pacientes que se sometieron aartroplastia predominaron las del sexo femenino, mayores de 60 años y con unpromedio de edad de 75 años y procedieron de la zona urbana.Los resultados funcionales de los pacientes sometidos al procedimiento quirúrgico fueron evaluados mediante la escala funcional de Harris, obteniendo resultados satisfactorios funcionales en 82.1 %, lo que indica que este procedimiento es una muy buena opción...

Pedicle screw-based dynamic stabilization of the lumbar spine

Although spinal fusion has been the definitive surgical management of symptomatic lumbar degenerative conditions, continued reports of adjacent level degeneration and suboptimal patient outcomes have prompted the advancement of motion-preserving technology. Posterior dynamic stabilization [PDS] devices are designed to maintain native motion while providing indirect foraminal decompression and off-loading of the facets and posterior anulus. Posterior dynamic stabilization systems relying on pedicle screws as vertebral anchors have the advantage of surgeon familiarity with screw placement technique and instrumentation. Interconnections between the screws serve as a tension band to resist posterior distractive forces during flexion and maintain foraminal height in extension. Short-term results of pedicle screw-based PDS systems show comparable pain relief to traditional fusion with the added advantage of retained motion and potential reduction of fusion-related morbidity and of the incidence of adjacent segment degeneration. As with most new technology, pedicle screw based PDS systems require further evaluation to determine their long-term clinical benefit

Tratamiento de las fracturas proximales del fémur provocadas por metástasis de carcinomas / Treatment of proximal femur fracture caused by metastatics of carcinomas

Fueron evaluados 25 pacientes que acudieron a la Unidad de Tumores Óseos y Partes Blandas (UTO-PB) del Hospital "Manuel Núñez Tovar" entre enero de 2002 a enero de 2008, con fracturas de la región proximal del fémur, provocadas por lesiones metastásicas de carcinomas, predomino en el estudio el sexo masculino, las edades de los pacientes estuvieron por encima de los 40 años, con mayor numero en la década de los 50, el cáncer mas importante en el hombre fue el de próstata y en la mujer el de cuello uterino. En todos los procedimientos se seleccionó pacientes con expectativa de vida superior a 4 semanas y se persiguió como objetivo fundamental mejorar calidad de vida, aliviar dolor y reincorporar al paciente a su estilo de vida previo a sufrir la fractura. Se realizó artroplastia para lesiones cervicales y osteosíntesis con clavos intramedulares y sistemas de placas con tornillos deslizantes para la región subtrocantérica e intertrocantérica, obteniéndose mejores resultados funcionales con las artroplastias y menor índice de complicaciones con respecto al uso de clavos intramedulares y a los DCS, DHS.

We evaluated 25 patients who came to the Unit of Bone and soft tissue tumors (UTOPB) Hospital "Manuel Núñez Tovar" between january 2002 and january 2008, with fractures of the proximal femur, lessions caused by metastic carcinoma, predominance in the study males, ages of the patients were above age 40, with the highest number in the 50s, the most important cancer in men was prostate cancer and women in the cervical. All procedures were selected patients with life expectancy greater than 4 weeks and was pursued as a key objective to improve quality of life, alleviate pain and return patients to their lifestyle prior to suffering the fracture. Arthroplasty was performed for cervical lesions and osteosynthesis with intramedullary nails and screws systems with sliding plates for the region subtrocanterica and intertrocanterica, obtained better functional results with arthroplasties and lower complication rate with respect to the use of intramedullary nails and DCS, DHS.

Técnica modificada de Burton y Pellegrini en la rizartrosis / Modified technique of Burton and Pellegrini at the rhizarthosir

Estudio prospectivo en pacientes con osteoartrosis de la articulación trapezimetacarpiana a los cuales se le realizó una modificación de la técnica de artroplastia por interposición de Burton y Pellegrini. Se evaluaron 14 pacientes y se realizaron 16 artroplastias, obteniendo excelentes resultados en un 93,75% y buenos en 6,25%.

Treatment of temporomandibular joint ankylosis with gap arthroplasty and temporal muscle/fascia graft: a case report with five-year follow-up / Tratamento de anquilose da articulação temporomandibular com artroplastia e enxerto de músculo temporal: Relato de caso com cinco anos de acompanhamento

Purpose: Temporomandibular joint ankylosis (TMA) is a highly distressing condition in which the Temporomandibular Joint (TMJ) is replaced by scar tissue. The most commonly surgical approach used to restore normal joint functioning is a gap arthroplasty associated with the temporal muscle flap (TMF) as interpositional material. This paper aimed to present a modification of the conventional vascularized temporal muscle flap, and describe an alternative procedure using a muscle/fascia temporal graft as interpositional tissue for the gap arthroplasty. Case description: We report a case of TMA treated using a gap arthroplasty and a variation of the TMF technique as interpositional material, performing a temporal muscle/fascia graft. The technique described is associated with adequate bone removal and excellent intraoperative joint mobilization. Physiotherapy was started 2 days after surgery and maintained for 4 months. During the five years of follow-up, no signs of ankylosis recurrence were observed; maximum mouth opening is currently 35 millimeters. Conclusion: The success in preventing reankylosis after TMJ gap arthroplasty is related primarily to the early postoperative physiotherapy, maintained long-term. A free graft harvested from temporal muscle and used as interpositional material is easy to obtain, reliable, and effective. Another advantage is minimal damage to the temporal muscle and low morbidity.

Objetivo: A anquilose da articulação temporomandibular (AATM) é uma condição altamente angustiante aonde a articulação é substituída por tecido cicatricial. A técnica cirúrgica mais comumente usada é a artroplastia associada a um retalho de músculo temporal como um material de interposição entre côndilo/fossa glenóide. Este manuscrito relata um caso de anquilose da articulação temporomandibular tratada pela técnica da artroplastia com uma variação da técnica do retalho do músculo temporal como material interposicional. Descrição do caso: Relatou-se um caso de AATM que foi tratada usando artroplastia com enxerto livre do músculo temporal e fáscia como material interposicional. A técnica descrita está associada a adequada remoção de osso e excelente imobilização articular transoperatória. A fisioterapia foi iniciada 2 dias após a cirurgia e mantida por 4 meses. Durante os 5 anos de controle não houve sinais de recidiva de anquilose; a abertura máxima bucal atualmente é de 35 mm. Conclusão: O sucesso na prevenção da recidiva de anquilose após artroplastia da ATM está primariamente relacionado com fisioterapia pós-operatória precoce, mantida por longo período. Um enxerto livre do músculo temporal usado como material interposicional é fácil de ser obtido, confiável e efetivo. Outra vantagem é dano mínimo ao músculo temporal e baixa morbidade.

Debridement Arthroplasty for Post-traumatic Stiff Elbow: Intraoperative Factors Affecting the Clinical Results of Surgical Treatment

BACKGROUND: This study evaluated the outcomes of debridement arthroplasty for stiff elbows, as well as the factors affecting clinical outcomes after surgical treatment. METHODS: Eighteen patients with post-traumatic stiff elbows were treated with debridement arthroplasty using a posterior approach. The mean patient age was 33 years (range, 16 to 59 years), and the average follow-up period was 59 months (range, 24 to 141 months). The patient's ability to perform activities of daily living, including combing their hair, feeding themselves, performing hygiene, and putting on shirt and shoes, were evaluated using the Mayo Elbow Performance Score. RESULTS: At the last follow-up, 16 elbows had painless motion. Two patients continued to complain of mild intermittent pain. The flexion and extension improved to 121degrees and 10degrees after surgery, respectively, indicating an average 34degrees increase in elbow flexion range and an average 25degrees increase in elbow extension range (p < 0.001, p < 0.001). The Mayo Elbow Performance Score at the last follow-up was excellent in nine elbows (50%) and good in nine elbows (50%). CONCLUSIONS: Debridement arthroplasty is a predictable procedure for the treatment of intractable stiff elbow, provided that the elbow is stable and congruous.