Caso clínico: resección artroscópica de osteoma osteoide de cuello del talo / Arthoscopic excision of an osteoid osteoma at the talar neck

The case of a 17-year-old boy with osteoidosteoma of the talar neck with a 2-year history of persistent ankle pain is presented. The diagnosis was made on the basis of clinical appearance, radiography, CT scan, technetium-99m scintigraphy, and magnetic resonance imaging findings. He underwent arthroscopic excision of the lesion using a motorized trefina and radiofrequency ablation. The pathological study of the arthroscopic excision confirm the preoperative diagnosis. He ad no recurrence during a follow-up period of 24 months. We concluded that the arthroscopic excision of an osteoid osteoma on the talar neck is an appropriate surgical intervention and an excellent therapeutical choice.

Se presenta el caso de un paciente de 17 años con un osteoma osteoide del cuello del talo que presentaba una historia de dolor persistente de tobillo de 2 años de evolución. El diagnóstico se realizó en base a la historia clínica y a los hallazgos imagenológicos en radiografía, TAC, cintigrama óseo (tecnecio-99) y resonancia magnética. Se realizó un abordaje artroscópico de la lesión, siendo resecada en forma completa con trefina motorizada y ablación por radiofrecuencia en los bordes del lecho óseo. El resultado anatomopatológico confirmó el diagnóstico preoperatorio. La evolución del paciente ha sido satisfactoria a 24 meses de seguimiento. Concluimos que la resección artroscópica de un osteoma osteoide de cuello de talo es un procedimiento recomendable y una excelente alternativa terapéutica.

Valores plasmáticos de proteína C reactiva (PCR) en cirugía ortopédica electiva / Plasma C reactive protein in elective orthopedic surgery

Background: C reactive protein (CRP) is used as a marker of inflammatory, infectious and surgical processes. Aim: To measure post operative plasma CRP levels after elective orthopedic surgery. Materials and Methods: Four groups of 25 patients each were defined according to the type of surgical procedure performed. Group I corresponded to pure arthroscopic meniscectomy. Group II to arthroscopic anterior cruciate ligament reconstruction or knee osteotomy. Group III to elective primary total hip or knee arthroplasty and group IV to instrumented elective spine surgery. Plasma CRP levels were measured prospectively at the preoperative day and at the 1st, 2nd, 3rd, 7th and 15th postoperative day. Patients that had any complication were evaluated independently. Results: In all uncomplicated patients, a similar shape and distribution of plasma CRP curves were observed, with maximum postoperative levels observed between the second and third day. Patients with more complex surgical procedures had higher CRP values. In all groups, CRP levels decreased significantly at 7th and 15th day, with respect to the higher measured value. In patients with surgical complications, PCR values were higher or did not decrease significantly at the seventh postoperative day, as in patients without complications. Conclusion: Plasma CRP levels fluctuate after elective orthopedic surgical procedures, with maximum values observed between the 2nd and 3rd postoperative day followed by an ulterior decrease. This behavior changes if postoperative complication appear. Serial measurements of CRP levels may be useful in the early detection of surgical complications.