Impacto de la demencia en la supervivencia de los pacientes con fractura de cadera intervenidos mediante prótesis total y parcial / Impact of dementia on the survival of patients with hip fracture after undergoing total and partial prosthesis

Objetivo: Realizar un análisis de la supervivencia comparativa de los pacientes diagnosticados de fracturas de cadera (FC) en el Servicio Vasco de Salud de 2010 a 2016 en función de que estuviesen o no diagnosticados de demencia y del tipo de artroplastia. Material y métodos: Estudio de tipo observacional (real world data) de supervivencia. Los datos fueron obtenidos de las bases de datos administrativas y clínicas del Servicio Vasco de Salud mediante el gestor Oracle Business Intelligence (OBI). Se analizaron todos los casos de fracturas de cuello de fémur desde el año 2010 al 2016 en Servicio Vasco de Salud. Se realizó un análisis descriptivo para detectar diferencias entre grupos según diagnóstico previo de demencia y tipo de prótesis. Para obtener las curvas de supervivencia se utilizó el método de Kaplan?Meier y su comparación se realizó por parejas mediante el logrank test. Mediante la regresión de Cox se analizó el riesgo de fallecimiento ajustado de cada grupo. Resultados: Se identificaron 5.867 pacientes con FC, siendo 1.131 pacientes sin demencia y prótesis total, 3.073 sin demencia y prótesis parcial, 176 con demencia y prótesis total y 1.487 con demencia y prótesis parcial. La mediana de la supervivencia fue de 9,08 años, 3,79 años, 2,55 años y 2,54 años respectivamente. La comparación de las curvas de supervivencia resultó significativa para todos los casos excepto entre los dos últimos grupos. Utilizando el primer grupo como referencia, el odds ratio de fallecimiento del resto fue 1,56, 2,27 y 2,37 respectivamente. Al analizar el riesgo de fallecimiento únicamente para los pacientes con demencia, el tipo de prótesis no resultó ser estadísticamente significativo. Conclusiones: La demencia influye en la curva de supervivencia de los pacientes que son sometidos a una artroplastia tras una fractura de cuello femoral, teniendo una mortalidad similar los que reciben una artroplastia total que los que se intervienen con una parcial. (AU)

Objetive: To carry out a comparative survival analysis of patients diagnosed with hip fractures (HF) in the Basque Health Service from 2010 to 2016 depending on whether or not they were diagnosed with dementia and the type of arthroplasty. Material and methods: Observational study (real world data) of survival. The data were obtained from the administrative and clinical databases of the Basque Health Service using the Oracle Business Intelligence (OBI) manager. All cases of femur neck fractures from 2010 to 2016 were analyzed in the Basque Health Service. A descriptive analysis was carried out to detect differences between groups according to previous diagnosis of dementia and type of prosthesis. The Kaplan-Meier method was used to obtain the survival curves and their comparison was made in pairs using the Achievement test. The adjusted risk of death for each group was analyzed with the Cox regression model. Results: 5,867 patients with CF were identified, being 1,131 patients without dementia and total prosthesis, 3,073 without dementia and partial prosthesis, 176 with dementia and total prosthesis and 1,487 with dementia and partial prosthesis. The median survival was 9.08 years, 3.79 years, 2.55 years, and 2.54 years respectively. The comparison of the survival curves was significant for all cases except between the last two groups. Using the first group as a reference, the odds ratio of death for the rest was 1.56, 2.27 and 2.37 respectively. When analyzing the risk of death only for patients with dementia, the type of prosthesis was not statistically significant. Conclusions: Dementia influences the survival curve of patients who undergo arthroplasty after a femur neck fracture, with those who undergo a total arthroplasty have a similar mortality rate as those who undergo partial arthroplasty. (AU)

The impact of hip fracture on health-related quality of life and activities of daily living: the SPARE-HIP prospective cohort study.

PURPOSE: The medical morbidity and mortality associated with neck of femur fractures is well-documented, whereas there is limited data for patient-reported outcomes. The aim of this study was to characterize the impact of neck of femur fractures on activities of daily living and patient-reported health-related quality of life. METHODS: Design and participants: Multicentric prospective cohort study. Consecutive sample patients with fragility hip fracture over 50 years old admitted in 48 hospitals in Spain. OUTCOMES: daily living activity function (Barthel Index) and health-related quality of life (EQ-5D) pre-fracture, admission to hospital and at 1- and 4-month follow-up post-fracture. STATISTICS: Barthel and EQ-5D over time are described as mean (SD) and median (interquartile range). RESULTS: A total of 997 patients were recruited at baseline with 4-month outcomes available for, and 856 patients (89.5%). Barthel Index fell from 78.77 (23.75) at baseline to 43.62 (19.86) on admission to hospital with the fracture. Scores partially recovered to 54.89 (25.40) and 64.09 (21.35) at 1- and 4-month post-fracture, respectively. EQ-5D fell from a median of 0.75 (0.47-0.91) to - 0.01 (- 0.03 to 0.51) on admission. Partial recovery was observed again to (0.51 (- 0.06 to 0.67)) and (0.60 (0.10 to 0.80)) at 1- and 4-month post-fracture, respectively. CONCLUSIONS: Hip fracture results in a large decline in the ability to perform activities of daily living and patient-reported health-related quality of life with only partial recovery amongst survivors 4-month post-fracture.

Spanish National Hip Fracture Registry (RNFC): analysis of its first annual report and international comparison with other established registries.

Hip fracture registries have helped improve quality of care and reduce variability, and several audits exist worldwide. The results of the Spanish National Hip Fracture Registry are presented and compared with 13 other national registries, highlighting similarities and differences to define areas of improvement, particularly surgical delay and early mobilization. INTRODUCTION: Hip fracture audits have been useful for monitoring current practice and defining areas in need of improvement. Most established registries are from Northern Europe. We present the results from the first annual report of the Spanish Hip Fracture Registry (RNFC) and compare them with other publically available audit reports. METHOD: Comparison of the results from Spain with the most recent reports from another ten established hip fracture registries highlights the differences in audit characteristics, casemix, management, and outcomes. RESULTS: Of the patients treated in 54 hospitals, 7.208 were included in the registry between January and October 2017. Compared with other registries, the RNFC included patients ≥ 75 years old; in general, they were older, more likely to be female, had a worse prefracture ambulation status, and were more likely to have extracapsular fractures. A larger proportion was treated with intramedullary nails than in other countries, and spinal anesthesia was most commonly used. With a mean of 75.7 h, Spain had by far the longest surgical delay, and the lowest proportion of patients mobilized on the first postoperative day (58.5%). Consequently, development of pressure ulcers was high, but length of stay, mortality, and discharge to home remained in the range of other audits. CONCLUSIONS: National hip fracture registries have proved effective in changing clinical practice and our understanding of patients with this condition. Such registries tend to be based on an internationally recognized common dataset which would make comparisons between national registries possible, but variations such as age inclusion criteria and follow-up are becoming evident across the world. This variation should be avoided if we are to maximize the comparability of registry results and help different countries learn from each other's practice. The results reported in the Spanish RNFC, compared with those of other countries, highlight the differences between countries and detect areas of improvement, particularly surgical delay and early mobilization.

Coste de la fractura de cadera osteoporótica en España por comunidad autónoma / Cost of osteoporotic hip fracture in Spain per Autonomous Region

Objetivo: Se estimó la utilización de recursos sanitarios (URS) y costes asociados durante los 12 meses posteriores a una primera fractura de cadera osteoporótica (FCO) por comunidad autónoma (CC.AA.). Métodos: Estudio observacional, prospectivo, que incluyó pacientes ≥65años hospitalizados por una primera FCO en Andalucía, Cataluña, Comunidad Valenciana, Galicia, Madrid y País Vasco. Se registró la URS relacionada con la FCO, la calidad de vida y la autonomía del paciente, y se estimaron los costes asociados. Resultados: Participaron 487 pacientes (edad media: 83,1años, 77% mujeres), con características demográficas similares entre CC.AA. La duración media del ingreso fue más prolongada en Madrid y en Galicia (mujeres/hombres: 15,0/18,6 y 16,9/12,6 días) y menor en Andalucía y en la Comunidad Valenciana (8,2/7,2 y 8,4/9,4días). Las sesiones de rehabilitación y días de asistencia domiciliaria formal fueron más numerosos en Cataluña y en Madrid (mujeres/hombres: 16/21 y 17/29 sesiones; 19/20 y 30/27días) comparado con Andalucía y Galicia (4/1 y 3/0 sesiones; 3/1 y 1/0días). Los costes medios fueron más altos en Madrid y menores en Andalucía (mujeres/hombres: 12.321/12.297€ y 7.031/6.115€, respectivamente). Conclusiones: Las FCO implican un coste elevado para los sistemas sanitarios autonómicos, observándose diferencias notables entre CC.AA., derivadas principalmente de la duración diferencial de la primera estancia hospitalaria, así como al cuidado ambulatorio durante los meses posteriores. Estas diferencias podrían estar relacionadas con diferencias en la demora quirúrgica. Es deseable un abordaje y consenso a nivel nacional de este problema sanitario, con pautas de actuación comunes, ya que podría suponer grandes beneficios socioeconómicos y sanitarios globales

Objective: We estimated the health resource utilization (HRU) and associated costs during the 12months after a first osteoporotic hip fracture (OHF) in six Spanish Regions. Methods: Observational, prospective study including patients ≥65years-old hospitalized due to a first OHF in: Andalusia, Catalonia, Valencian Community, Galicia, Madrid and the Basque Country. HRU related to OHF, quality of life and patient autonomy were collected, and HRU-associated costs were estimated. Results: Four hundred and eighty-seven patients (mean age: 83.1years, 77% women) were included, with demographic characteristics that were similar across the Regions. Mean hospital stay was longest in Madrid and Galicia (women/men: 15.0/18.6 and 16.9/12.6days, respectively) and shortest in Andalusia and the Valencian Community (8.2/7.2 and 8.4/9.4days). There were more rehabilitation sessions and formal home care days in Catalonia and Madrid (women/men: 16/21 and 17/29 sessions; 19/20 and 30/27days) and fewer in Andalusia and Galicia (4/1 and 3/0 sessions; 3/1 and 1/0days). Mean HRU costs were higher in Madrid and lower in Andalusia (women/men: 12,321€/12,297€ and 7,031€/6,115€, respectively). Conclusions: OHF place a large burden on Spanish Regional Health Systems, including high economic costs. We found notable differences in mean costs across the Regions, mainly caused by the differential length of the first hospital stay and the outpatient care in subsequent months. These differences may be associated with differences in surgical delay. A national consensus on the management of OHF is desirable; moreover, agreeing common guidelines could have major socio-economic and healthcare benefits

Cost of osteoporotic hip fracture in Spain per Autonomous Region. / Coste de la fractura de cadera osteoporótica en España por comunidad autónoma.

OBJECTIVE: We estimated the health resource utilization (HRU) and associated costs during the 12months after a first osteoporotic hip fracture (OHF) in six Spanish Regions. METHODS: Observational, prospective study including patients ≥65years-old hospitalized due to a first OHF in: Andalusia, Catalonia, Valencian Community, Galicia, Madrid and the Basque Country. HRU related to OHF, quality of life and patient autonomy were collected, and HRU-associated costs were estimated. RESULTS: Four hundred and eighty-seven patients (mean age: 83.1years, 77% women) were included, with demographic characteristics that were similar across the Regions. Mean hospital stay was longest in Madrid and Galicia (women/men: 15.0/18.6 and 16.9/12.6days, respectively) and shortest in Andalusia and the Valencian Community (8.2/7.2 and 8.4/9.4days). There were more rehabilitation sessions and formal home care days in Catalonia and Madrid (women/men: 16/21 and 17/29 sessions; 19/20 and 30/27days) and fewer in Andalusia and Galicia (4/1 and 3/0 sessions; 3/1 and 1/0days). Mean HRU costs were higher in Madrid and lower in Andalusia (women/men: 12,321€/12,297€ and 7,031€/6,115€, respectively). CONCLUSIONS: OHF place a large burden on Spanish Regional Health Systems, including high economic costs. We found notable differences in mean costs across the Regions, mainly caused by the differential length of the first hospital stay and the outpatient care in subsequent months. These differences may be associated with differences in surgical delay. A national consensus on the management of OHF is desirable; moreover, agreeing common guidelines could have major socio-economic and healthcare benefits.

Utilidad de la tracción preoperatoria en la fractura de cadera / The usefulness of preoperative traction in hip fracture

La fractura de cadera es un proceso clínico grave que en la gran mayoría de los casos requiere una solución quirúrgica. En el período de tiempo que transcurre desde el ingreso hasta la intervención, que puede ser variable en función de muchos condicionantes, tradicionalmente se aplica una tracción cutánea en el miembro afectado con el fin de inmovilizar la extremidad y, en consecuencia, aliviar el dolor. Además, existe la creencia en algunos cirujanos de que esta práctica consigue mejorar la reducción de la fractura evitando la contractura muscular, lo cual podría reportar beneficios en el proceso quirúrgico. Su uso se encuentra protocolizado en el manejo de este tipo de pacientes en algunos centros hospitalarios, pese a que sea un procedimiento cuestionable y no haya ninguna evidencia que respalde tales suposiciones. Por otro lado, no es inocuo, y han sido descritas una serie de complicaciones que ponen en duda su utilización rutinaria. En este trabajo queremos revisar los principales estudios realizados con el objetivo de realizar una recomendación de manejo clínico sobre esta cuestión en base a la evidencia disponible

Hip fracture is a serious clinical event which requires surgery in the vast majority of cases. In the period of time between admission and intervention, which may vary depending on many factors, skin traction in the affected member is traditionally applied to immobilize the limb and thus relieve pain. Furthermore, some surgeons maintain that this practice better reduces fracture risk, avoiding muscular contraction, which may facilitate the surgical process. Its use is recommended in managing protocols for this patient group in some hospitals, although some question this practice as lacking evidence to support it. On the other hand, it is not harmless, with a number of reported complications which raise questions about its routine use. This paper reviews the main studies carried out, with the objective of making a recommendation for the clinical management of this issue based on available evidence

Guía SECOT-GEIOS en osteoporosis y fractura por fragilidad. Actualización / SECOT-GEIOS guidelines in osteoporosis and fragility fracture. An update

No disponible

Regional variability in changes in the incidence of hip fracture in the Spanish population (2000-2012).

UNLABELLED: The objective is to analyse the evolution of the incidence of hip fracture in the female population of Spain from 2000 to 2012 and to establish the possible changes which may have been seen over this period of time, including the trends in the different regions of the country. INTRODUCTION: Fragility-related hip fractures are considered to be the fractures of greatest significance to public health due to their high degree of morbidity and mortality. The change in their incidence, both in absolute values and when adjusted for age, is the subject of debate. The objective of this article is to describe the changes in the rates of hip fracture in Spain by autonomous community between the years 2000 and 2012. METHODS: Using the data from the Spanish Minimum Basic Data Set, in which are all the recorded cases of women with a principal diagnosis of hip fracture, the incidence rates by age group and by autonomous community were obtained. Poisson distribution or negative binomial regressions were carried out to estimate the average annual change over the time period analysed. RESULTS: There have been statistically significant changes in the trends of rates of incidence for all age groups of women over 65 years of age. The annual reduction was 2.2% for women of 65-74 years of age and less for those between 75 and 84. The rates of incidence for those over 85 increased annually by 0.58%. CONCLUSIONS: Hip fractures continue to increase in absolute numbers, although if the rates are adjusted for age, a downward trend is seen in certain age groups. These findings have various origins, although in the absence of great changes in population structure, we believe that drug treatments for osteoporosis may play a role. There is variability in the change in incidence of hip fractures in different parts of the country. Further studies are required to be able to identify the causes.

[Primary hip replacement: first year results and predictive factors of poor outcome]. / Artroplastia primaria de cadera: resultados en el primer año y factores predictores de mala evolución.

OBJECTIVE: To evaluate the results of total hip arthroplasty in patients with osteoarthritis and to identify predictors of poor functional outcome. MATERIAL AND METHODS: A prospective observational study in patients operated on in 2006 with total hip arthroplasty in 4 hospitals in Guipúzcoa, followed up for 1 year. OUTCOME VARIABLES: pain, physical function, complications, mortality, quality of life by WOMAC and SF-12 (at 0, 3, 6 and 12 months) and «Poor functional outcome¼ at one year (last quartile of the WOMAC in function area). Logistic regression was performed to examine predictors of poor functional outcome. RESULTS: A total of 166 patients were followed up. The incidence of systemic and local complications was 6.3% and 14.5%, respectively, 4.3% readmissions and no deaths related to surgery. Close to 40 points improvement in pain, stiffness and WOMAC functional limitation, mainly in the first 3 months after surgery. A similar trend was seen, but lower in the physical and mental component of the SF12 (12 and 8 points, respectively). The previous score on the WOMAC function area and the physical component of SF-12, and the existence of any complications, are predictors of poor functional recovery. DISCUSSION: The improvement experienced after the surgery is already very important before the third month. The functional and physical status before surgery and possible complications of surgery are significant determinants of the results.

Aspectos de interés para el cirujano ortopédico y traumatólogo sobre la vitamina D / Aspects of interest on vitamin D for the traumatologist and orthopaedic surgeon

La deficiencia (insuficiencia o deficiencia) de vitamina D es un problema clínico especialmente prevalente en ancianos con fracturas de baja energía, sobre todo de cadera, aunque también se ha relacionado con fracturas de estrés y de alta energía. Son muchas las evidencias que apoyan la necesidad de mantener unos niveles adecuados de vitamina D en sangre para reducir el número de fracturas por fragilidad, favorecer la consolidación de las mismas, mejorar la función neuromuscular de los pacientes, evitar las caídas, prevenir las infecciones quirúrgicas o mejorar la duración de las artroplastias. Sin embargo, no es habitual que el cirujano ortopédico y traumatólogo considere determinar los valores de vitamina D en este tipo de pacientes e instaurar el tratamiento adecuado. Se recomienda mantener niveles superiores a 30-40ng/ml (75-100nmol/l) de vitamina D y la ingesta, en casi todos los casos, de 800 a 1.000UI/día de vitamina D para alcanzar estos niveles (AU)

Vitamin D deficiency or insufficiency is a clinical problem particularly prevalent in elderly patients with low-energy fractures, particularly hip fractures, but has also been associated with stress fractures and high energy fractures. There is much evidence that supports the need to maintain adequate levels of vitamin D in the blood in order to; reduce the number of fragility fractures, furthering the consolidation of these, improve neuromuscular function of patients, prevent falls, prevent surgical infections, or improve the length of arthroplasties. However, it is rare for the orthopaedic surgeon to request the values of vitamin D in these patients and give the appropriate treatment It is recommended to maintain levels higher than 30-40ng/ml (75-100nmol/l) and increase vitamin D intake, in almost all cases, from 800 to 1,000IU/day to achieve these levels (AU)

Artroplastia primaria de cadera: resultados en el primer año y factores predictores de mala evolución / Primary hip replacement: first year results and predictive factors of poor outcome

Objetivo. Evaluar los resultados del primer año en la artroplastia total de cadera de pacientes con osteoartritis e identificar los factores predictores de mala evolución funcional. Material y método. Estudio observacional, prospectivo en pacientes intervenidos en 2006 con artroplastia total de cadera en 4 hospitales de Guipúzcoa, seguidos durante un año. Variables de resultado: dolor, función física, complicaciones, mortalidad, calidad de vida mediante WOMAC y SF-12 (a 0, 3, 6 y 12 meses) y «mal resultado funcional» al año (último cuartil del WOMAC en área de función). Mediante regresión logística se estudiaron los factores predictores de mal resultado funcional. Resultados. Se incluyeron 166 pacientes. La incidencia de complicaciones sistémicas y locales fue de 6,3 y 14,5%, respectivamente, con 4,3% de reingresos y sin fallecimientos relacionados con la cirugía. Mejoría cercana a 40 puntos en dolor, rigidez y limitación funcional del WOMAC, principalmente en los primeros tres meses postintervención. Evolución similar, pero inferior en el componente físico y mental del SF12 (12 y 8 puntos respectivamente). La puntuación previa en el área de función de WOMAC y en el componente físico del SF-12, así como la existencia de alguna complicación, son factores predictores de la mala recuperación funcional. Discusión. La mejoría experimentada tras la intervención es ya muy relevante antes del tercer mes. La situación funcional y física previa a la intervención y las posibles complicaciones de la cirugía son factores determinantes de los resultados (AU)

Objective. To evaluate the results of total hip arthroplasty in patients with osteoarthritis and to identify predictors of poor functional outcome. Material and methods. A prospective observational study in patients operated on in 2006 with total hip arthroplasty in 4 hospitals in Guipúzcoa, followed up for 1 year. Outcome variables: pain, physical function, complications, mortality, quality of life by WOMAC and SF-12 (at 0, 3, 6 and 12 months) and «Poor functional outcome» at one year (last quartile of the WOMAC in function area). Logistic regression was performed to examine predictors of poor functional outcome. Results. A total of 166 patients were followed up. The incidence of systemic and local complications was 6.3% and 14.5%, respectively, 4.3% readmissions and no deaths related to surgery. Close to 40 points improvement in pain, stiffness and WOMAC functional limitation, mainly in the first 3 months after surgery. A similar trend was seen, but lower in the physical and mental component of the SF12 (12 and 8 points, respectively). The previous score on the WOMAC function area and the physical component of SF-12, and the existence of any complications, are predictors of poor functional recovery. Discussion. The improvement experienced after the surgery is already very important before the third month. The functional and physical status before surgery and possible complications of surgery are significant determinants of the results (AU)

[Aspects of interest on vitamin D for the traumatologist and orthopaedic surgeon]. / Aspectos de interés para el cirujano ortopédico y traumatólogo sobre la vitamina D.

Vitamin D deficiency or insufficiency is a clinical problem particularly prevalent in elderly patients with low-energy fractures, particularly hip fractures, but has also been associated with stress fractures and high energy fractures. There is much evidence that supports the need to maintain adequate levels of vitamin D in the blood in order to; reduce the number of fragility fractures, furthering the consolidation of these, improve neuromuscular function of patients, prevent falls, prevent surgical infections, or improve the length of arthroplasties. However, it is rare for the orthopaedic surgeon to request the values of vitamin D in these patients and give the appropriate treatment It is recommended to maintain levels higher than 30-40ng/ml (75-100nmol/l) and increase vitamin D intake, in almost all cases, from 800 to 1,000IU/day to achieve these levels.

Fracturas atípicas relacionadas con el uso prolongado de bifosfonatos. Estado de la situación / Atypical fractures associated with the long term use of bisphosphonates. The current situation

Los bifosfonatos son considerados actualmente un tratamiento de primera elección de la enfermedad osteoporótica. Su reconocida eficacia antifractura en todos los tipos de osteoporosis y su presencia en el mercado desde hace varios años, hacen que sean los fármacos de uso más extendido para el tratamiento de la enfermedad. En la última década han aparecido una serie de efectos adversos relacionados con esta medicación que han encendido la voz de alarma sobre la conveniencia o no de mantener el tratamiento continuado con estos fármacos durante un largo período de tiempo. Entre estos efectos se encuentra la aparición de una serie de fracturas consideradas atípicas por su localización y apariencia radiológica que se manifiestan en pacientes tratados de forma crónica con bifosfonatos. Estas fracturas que comparten una serie de características clínicas comunes, no cumplen el clásico perfil de la fractura por fragilidad osteoporótica. La prolongada inhibición del remodelado óseo podría ser el sustento fisiopatológico para su explicación, aunque todavía no está claramente establecida esta relación causal. El objetivo del presente trabajo es doble, por un lado presentar cuatro casos clínicos propios de fracturas atípicas relacionadas con la administración de estos fármacos y, por otro, realizar en base a ellos una revisión bibliográfica de esta entidad patológica, para intentar esclarecer cuál es la situación real del problema y determinar si es necesario establecer algún tipo de recomendaciones terapéuticas, tanto quirúrgicas como no quirúrgicas, ante este tipo de fracturas (AU)

Bisphosphonates are currently considered first choice treatment of osteoporotic disease. Its proven anti-fracture effect in all types of osteoporosis and its presence on the market for many years, make them the most widely used drugs for the treatment of this disease. A number of adverse effects associated with this medication have appeared over the past 10 years or so have caused concern on whether or not to maintain a continued treatment with these drugs over a long period of time. These side effects include a series of fractures, considered atypical because of their location and radiological appearance, which occur in patients treated long-term with bisphosphonates. These fractures, that share a number of common clinical features, do not meet the classic profile of osteoporotic fragility fractures. Prolonged inhibition of bone remodelling could be the pathophysiological basis for his explanation, although this causal relationship is not yet clearly established. The objective of this paper is two-fold, on the one hand to present four clinical cases of atypical fractures related with long-term administration of these drugs and, on the other, to perform a literature review of this pathological entity, in an attempt to clarify what is the real status of this problem and whether it is necessary to establish both surgical and non-surgical therapeutic recommendations for these types of fractures (AU)

Asociación de difosfonatos y vitamina D. ¿Avance terapéutico o argucia comercial? / No disponible

No disponible

Sintomatología neurológica secundaria a la migración de una bala intrarraquídea / Neurological symptoms secondary to the intraspinal migration of a bullet

Introducción. Presentamos un caso singular de la migración de una bala dentro del canal raquídeo tras una herida dorsolumbar por arma de fuego, los hallazgos radiológicos y los distintos sucesos ocurridos durante la intervención quirúrgica. Caso clínico. Varón de 28 años que dos semanas antes había sufrido una herida por arma de fuego en zona dorsolumbar. Presentó radiculopatía tardía tras la migración del proyectil desde L5-S1 a S1-S2. El paciente fue colocado en posición antitrendelenburg para poder realizar la extracción de la bala. Seis meses después de la intervención el paciente se encontraba asintomático sin evidencia de trastornos neurológicos. Discusión. La movilización de la bala en el espacio subaracnoideo, libre en el líquido cefalorraquídeo, generalmente está limitada a los segmentos entre T10 y S1 por cuestión del tamaño del canal medular. Los proyectiles pueden migrar por efecto de la gravedad según la posición del paciente. Nosotros consideramos la necesidad de extraer un proyectil intracanal, aun sin déficit neurológico, si se objetiva movilización en diferentes estudios radiográficos o tras la instauración de clínica radicular compresiva, tratándose de una cirugía urgente

Introduction. This is a very rare case of a bullet wondering into the spinal canal after a dorsolumbar firearm wound; we present the radiological findings and the problems faced at the time of surgery. Case report. The patient is a 28 year old man who had sustained a firearm wound in the dorsolumbar region two weeks before. He presented with deferred radicular symptoms after the bullet migrated from L5-S1 to S1-S2. The patient was placed in the reverse Trendelemburg position in order to extract the foreign body. Six months after the operation the patient made a full recovery with no signs of neurological damage. Discussion. The relevant literature of this uncommon condition is reviewed. Given the size of the femoral canal, the transit of the bullet in the subarachnoid space is generally limited to the movement between levels T-10 and S-1, following the laws of gravity depending on the position of the patient. We recommend extraction of a bullet present in the spinal canal, even if no neurological damage is present, if after taking sequential x-rays, the bullet is seen to migrate progressively and the patient starts reporting some radicular symptoms

Infecciones osteoarticulares en niños por Kingella Kingae / Osteoarticular infections in children for Kingella Kingae

Kingella Kingae es un bacilo Gram negativo, colonizador habitual del tracto nasofaríngeo en niños y que en ocasiones puede originar infecciones sistémicas, con especial afinidad por el sistema osteoarticular. Su baja expresividad clínica, la discreta alteración de parámetros analíticos y sus dificultades de aislamiento hacen que, a menudo, pueda ser infradiagnosticada. Realizamos una revisión actualizada de un tema que ha suscitado un interés creciente en los últimos años y que se debe tener presente, ya que en el momento actual se considera uno de los patógenos más frecuentemente implicados en el desarrollo de infecciones osteoarticulares en niños

Kingella Kingae is a Gram-negative bacillus that colonizes the upper respiratory tract in children and occasionally causes invasive infections, particularly of the bones and joints. The infection could be usually undiagnosed because the clinical presentation is often subtle, the laboratory tests are normal or slightly elevated, and the germ isolation is difficult. We carry out a review that stirs up a growing interest in recent years, because at this moment, Kingella Kingae appears to be one of the most common cause of osteoarticular infections in children

Dolor agudo de rodilla en paciente añoso / Acute knee pain in elderly patient

La osteonecrosis de rodilla es un cuadro relativamente frecuente que puede originarse de una manera espontánea sin una etiología claramente demostrable o de una forma secundaria con unos factores de riesgo asociados identificables. Presentamos un caso de osteonecrosis de rodilla en una paciente que consulta por dolor en la misma de instauración aguda. Se describen las características clínicas de esta entidad junto con sus opciones diagnósticas y terapéuticas

Osteonecrosis of the knee is a relatively frequent picture that may arise spontaneously without a clearly demonstrable etiology or secondarily with some identifiable associated risk factors. We present a case of osteonecrosis of the knee in a patient who consulted due to acute onset knee pain. The clinical characteristics of this entity together with its diagnostic and therapeutic options are described

Lipoma simple intraarticular de rodilla / Simple intra-articular lipoma of the knee

Introducción. El lipoma simple intraarticular de rodilla es una rara patología. Se han documentado muy pocos casos de un lipoma intraarticular simple en la rodilla. Caso clínico. Varón de 47 años que presenta una tumoración de partes blandas en la cara anterointerna de su rodilla izquierda. La imagen en la resonancia magnética nuclear revela un lipoma intraarticular, que fue resecado mediante miniartrotomía. Discusión. Se realiza una revisión bibliográfica del lipoma intraarticular localizado en la rodilla. Debe hacerse el diagnóstico diferencial con el lipoma arborescente, que es una proliferación lipomatosa difusa, de etiología desconocida y que habitualmente va asociada a procesos crónicos de la articulación. El lipoma simple es una masa grasa ovoidea, contenida en una cápsula fibrosa y que aparece de novo. Es importante distinguir histológica y clínicamente ambas entidades, ya que el tratamiento es diferente. Conclusión. Es una patología sumamente rara. La resonancia magnética es necesaria para realizar un correcto diagnóstico. Tras la revisión bibliográfica llevada a cabo, recomendamos su escisión por tratamiento artroscópico

Introduction. Intra-articular lipoma of the knee is extremely rare, with few documented cases published. Case report. A 47-year-old man presented with a soft-tissue mass on the anteromedial aspect of the left knee. Magnetic resonance imaging revealed an intra-articular lipoma, which was resected by miniarthrotomy. Discussion. We reviewed the literature on intra-articular lipoma and the knee location. The differential diagnosis is made with lipoma aborescens, a diffuse lipomatous proliferation of the synovial membrane of unknown origin that is commonly associated with chronic joint disease. Simple lipoma is a solitary ovoid mass of mature adipose tissue covered by a fibrous capsule that occurs de novo. Lipoma aborescens and simple lipoma must be differentiated clearly by histology and clinical presentation because each receives a different treatment. Conclusion. This tumor is rare. Magnetic resonance imaging is necessary for correct diagnosis and we recommend arthroscopic resection based on our review of the literature