Luxo-fractura de Chopart / Fracture-luxation de l'articulation de Chopart / Chopart luxo-fracture

La articulación de Chopart o transversa del tarso está constituida por la articulación calcaneocuboidea y la astragaloescafoidea. Las lesiones que ocurren en estas articulaciones se conocen como luxo-fractura de Chopart y son extremadamente raras. Entre las causas más frecuentes se encuentran los accidentes en motocicletas y las caídas de altura. El tratamiento es la reducción anatómica y fijación estable. La necrosis avascular del astrágalo, así como la artritis postraumática son las complicaciones más temidas. Con este trabajo se pretende describir la conducta y evolución perioperatoria de dos pacientes con luxo-fractura de Chopart, atendidos en el Servicio de Urgencias del Hospital Militar Central Dr Luis Díaz Soto. Fueron diagnosticados tempranamente y se les realizó reducción abierta más fijación interna con una recuperación en los primeros tres meses. La baja prevalencia de la luxo-fractura de Chopart requiere un diagnóstico adecuado y correcto para lograr un buen resultado clínico(AU)

The Chopart joint or transverse tarsus is constituted by the calcaneocuboid and the astragaloescafoidea joints. The injuries that occur in these joints are known as Chopart luxo-fracture and are extremely rare. Motorcycle accidents and falls from heights are among the most frequent causes of Chopart luxo-fractures. The treatment is the anatomical reduction and stable fixation. The avascular necrosis of the talus, as well as post-traumatic arthritis are the most feared complications. This paper aims to describe the behavior and perioperative evolution of two patients with Chopart luxo-fracture, treated in the Emergency Service at Dr Luis Díaz Soto Central Military Hospital. They were early diagnosed and underwent open reduction and internal fixation. They recovered in the first three months. The low prevalence of Chopart luxo-fracture requires adequate and correct diagnosis to achieve good clinical results(AU)

L'articulation de Chopart, ou médio-tarsienne, est constituée de deux articulations distinctes: l'articulation calcanéo-cuboïdienne et l'articulation astragalo-scaphoïdienne. Les lésions produites dans ces articulations sont connues comme des fractures-luxations de l'articulation de Chopart, et sont assez rares. Parmi les causes les plus fréquentes, on peut trouver les accidents du trafic (surtout, de moto) et les chutes de haut. Le traitement consiste généralement à une réduction anatomique et une fixation stable. La nécrose avasculaire de l'astragale et l'arthrite post-traumatique sont les complications les plus souvent à craindre. Le but de ce travail est de décrire le comportement et l'évolution péri-opératoire de deux patients atteints d'une fracture-luxation de l'articulation de Chopart, et traités au service d'urgence de l'hôpital militaire Dr Luis Díaz Soto. Ils sont rapidement diagnostiqués, et traités par réduction ouverte et fixation interne. Leur récupération est réussie en trois mois. La faible prévalence de la fracture-luxation de l'articulation de Chopart exige un diagnostic précis pour atteindre de bons résultats cliniques(AU)

Tratamento fisioterapêutico na síndrome complexa de dor regional tipo I: relato de caso / Physical therapy treatment for regional pain complex syndrome type I: case report

JUSTIFICATIVA E OBJETIVOS: A síndrome complexa de dor regional do tipo I (SCDR I) geralmente possui tratamento multidisciplinar,porém há uma lacuna na literatura referente ao tratamento fisioterapêutico e a conduta a ser utilizada. Sendo assim,o objetivo deste estudo foi descrever os resultados obtidos com o tratamento fisioterapêutico isoladamente em uma paciente. RELATO DO CASO: Paciente do sexo feminino, 48 anos, diagnosticada com SCDR I, após fratura do quinto metatarso devido a uma entorse de tornozelo, permanecendo com tala suropodália por 12 semanas. Submeteu-se a tratamento fisioterapêutico com mobilização articular, fortalecimento muscular, treino de carga e de controle neuromuscular. Após 13 sessões, ocorreu melhora da maioria dos sinais e sintomas iniciais. CONCLUSÃO: O tratamento fisioterapêutico isoladamente pode proporcionar melhora dos sinais e sintomas da SCDR I,porém, há a necessidade de estudos clínicos aleatórios para obter resultados mais eficazes.

BACKGROUND AND OBJECTIVES: The complex regional pain syndrome type I (CRPS I) has generally multidisciplinary treatment; however there is a gap in the literature related to physioterapy and the approach used. Therefore, the objective is to describe the results obtained with physical therapy treatment alone in one patient. CASE REPORT: Female patient, 48 years, diagnosed with CRPS I after fracture of the fifth metatarsal because of an ankle sprain, staying with short leg splint for 12 weeks. The same was referred to physical therapy, which used joint mobilization, muscles trengthening, weight-bearing and neuromuscular control.After 13 sessions, there was improvement in most of the initial signs and symptoms. CONCLUSION: The physical therapy alone can provide improvement of the signs and symptoms of CRPS I, however, there is a need for randomized clinical trials to obtain more effective results.

Repair of sheep metatarsus defects by using tissue-engineering technique / 华中科技大学学报（医学）（英德文版）

Tissue-engineering bone with porous ,betatricalcium phosphate (3-TCP) ceramic and autologous bone marrow mesenchymal stem cells (MSC) was constructed and the effect of this composite on healing of segmental bone defects was investigated. 10-15 ml bone marrow aspirates were harvested from the iliac crest of sheep, and enriched for MSC by density gradient centrifugation over a Percoll cushion (1. 073 g/ml). After cultured and proliferated, tissue-engineering bones were constructed with these,cellS seeded onto porous f-TCP, and then the constructs were implanted in 8 sheep left metatarsus defect (25 mm in length) as experimental group. Porous ,-TCP only were implanted to bridge same size and position defects in 8 sheep as control group, and 25 mm segmental bone defects of left metatarsus were left empty in 4 sheep as blank group. Sheep were sacrificed on the 6th, 12th, and 24th week postoperatively and the implants samples were examined by radiograph, histology, and biomechanical test. The 4 sheep in blank group were sacrificed on the 24th week postoperatively. The results showed that new bone tissues were observed either radiographic or histologically at the defects of experimental group as early as 6th week postoperatively, but not in control group, and osteoid tissue, woven bone and lamellar bone occurred earlier than in control group in which the bone defects were repaired in "creep substitution" way, because of the new bone formed in direct manner without progression through a cartilaginous intermediate. At the 24th week, radiographs and biomechanical test revealed an almost complete repair of the defect of experimental group, only partly in control group. The bone defects in blank group were non-healing at the 24th week. It was concluded that engineering bones constructed with porous -TCP and autologous MSC were capable of repairing segmental bone defects in sheep metatarsus beyond "creep substitution" way and making it healed earlier. Porous ,-TCP being constituted with autologous MSC may be a good option in healing critical segmental bone defects in clinical practice and provide insight for future clinical repair of segmental defect.

Fractura por estrés en artritis reumatoide / Stress fracture in rheumatoid artritis

Objetivo. Describir las características clínicas y radiográficas de siete pacientes con artritis reumatoide (AR) que presentaron ocho fracturas por estrés (FE). Método. En un lapso de 10 años se reunieron retrospectivamente siete casos de pacientes con AR, que estaban bajo tratamiento y control médico. La información se obtuvo de los expedientes clínicos y estudios radiográficos. Resultados. Todas las pacientes fueron mujeres con edad promedio de 51.2 años, duración promedio de la enfermedad, 13.2 años y factor reumatoide seropositivo. Como parte de su esquema de tratamineto, todas recibían antiinflamatorio no esteroideo e inductores de remisión. Las siete pacientes estaban recibiendo dosis bajas de corticoesteroides por vía oral. Previo a la FE se enocntraban en clase funcional I-II y sin causa aparente cursaron con datos de inflamación peri o paraarticular. La radiografía inicial no fue concluyente en todos los casos, pero 3 y 4 semanas después se hizo evidente el trazo de fractura. Todas las fracturas ocurrieron en extremidad pélvica (4 en metatarsianos, 2 en el peroné y una doble en iliopubis e isquiopubis). En todos los casos se hizo un manejo conservador, con respuesta satisfactoria. Conclusiones. El dolor, la inflamación y la limitación de la función, con topografía peri o paraarticular cuando ocurre en pacientes con AR deben orientar a la posibilidad de fracturas por estrés. El seguimiento radiológico permite confirmar o descartar dicha posibilidad