Complicación vascular en abordaje posterior de cirugía lumbar. Caso clínico / Vascular complication during posterior spine surgery. Clinical case

Presentamos una lesión vascular en un varón intervenido mediante discectomía L5-S1, que volvió a consulta al año de la cirugía por una nueva lumbociatalgia con imagen de fibrosis en RMN y se le realizó una artrodesis L5-S1. Durante el tiempo de discectomía y preparación del espacio se identificó sangrado arterial. Ante el deterioro general, se procedió a efectuar una laparotomía media, encontrando un hematoma retroperitoneal y lesión arterial hipogástrica derecha por laceración. La lesión de la aorta o de sus ramas durante la discectomía es más frecuente en reintervenciones, precisando su detección y reparación inmediatas (AU)

We present a case of a male who underwent a right L5/S1 discectomy. He returned to his work after three months. A year after the patient consulted again for sciatic pain and MRI showed mild epidural fibrosis. He underwent a new surgery and during the discectomy step an arterial bleeding was identifacated. Given the general deterioration, the vascular surgeon proceeds to midline laparotomy, aortic clamping, vascular exploration with an important retroperitoneal hematoma and right hypogastric artery injury. Vascular injuries during the time of discectomy are more frequent reported in reoperations. Once this occurs, detection and immediate repair are prior (AU)

Fuentes de información de los padres respecto a la salud de sus hijos / Sources of information for parents regarding their children's health

Objetivo: Evaluar la información que los padres buscan sobre la salud de sus hijos. Material y métodos: Estudio descriptivo de la población urbana atendida en un centro de atención primaria por el servicio de pediatría. Durante un periodo de 5 meses, un total de 201 padres que acudían a nuestras consultas rellenaron un cuestionario sobre las fuentes de información que utilizan respecto a la salud de sus hijos. Resultados: El 66% de los padres consulta algún medio de comunicación sobre problemas de salud. Los medios más utilizados son Internet (85%), las revistas especializadas (36%) y la televisión (18%). El 96% de respondedores tiene acceso a la red, y de éstos el 85% tiene conexión en casa. El 67% consultó algún problema médico en Internet durante el último año, y de éstos a un 93% le resultó útil. El 84% de los padres que habían consultado Internet en el último año se informaron por este medio de algún problema de salud antes y/o después de visitar a su pediatra/enfermera. Un 45% de los padres se alarmó después de leer alguna información médica en algún medio de comunicación, y un 65% de éstos consultó a su pediatra o enfermera por este motivo. Un 98% confía más en su pediatra que en Internet. Conclusión: Una elevada proporción de padres tiene acceso a Internet y lo utiliza para obtener información sobre temas de salud de sus hijos. Frecuentemente, esta búsqueda está relacionada con las visitas realizadas al personal sanitario. Los profesionales de la salud deberíamos estar preparados para orientar a los padres en la búsqueda de información en la Red(AU)

Objective: To evaluate the information that parents are looking for about their children’s health. Material and methods: Descriptive study of the urban population attended at a primary care center by the pediatric services. During a 5-month period, a total of 201 parents came to our consultations and filled out a questionnaire about the information sources that they use regarding their children’s health. Results: 66% of the parents consulted some kind of mass media about health issues. The most widely used are Internet (85%), specialized magazines (36%) and television (18%). 96%of respondents have access to the internet; of these 85% have access at their home. 67% consulted for a medical problem on the Internet during the last year, 93% of these found it helpful. 84% of the parents who had accessed Internet got information through this source about any kind of health problem before and or after visiting the pediatrician or nurse. 45% of the parents were alarmed after reading some medical information in mass media and 65% of these, consulted their doctor or nurse about it. A 98% have more confidence in their pediatrician tha non the Internet. Conclusion: A high percentage of parents have Internet access and uses it to obtain information on health issues about their children. This search is often related to visits by health professionals. Health professionals should be prepared on guiding parents to find information on the Internet(AU)

Opening first metatarsal osteotomy and resection arthroplasty of the first MPJ in the treatment of first ray insufficiency associated with degenerative hallux valgus.

BACKGROUND: Opening wedge proximal metatarsal osteotomy combined with first metatarsophalangeal arthroplasty can be used to correct first metatarsus primus varus with a high intermetatarsal angle and a short first metatarsal. METHODS: 147 feet in 138 patients with degenerative first metatarsophalangeal arthrosis, >or=15 degrees of metatarsus primus varus and, a short first metatarsal were included. Preoperative and postoperative clinical, radiographic, and subjective outcome measurements were taken (Scale AOFAS). RESULTS: The mean first intermetatarsal angle decrease was 7.79+/-1.43 degrees and the mean increase in first metatarsal length was 2.88+/-0.45 mm. The pre-intervention mean values were 52.6 points in the AOFAS scale, and an overall result of 92.95 obtained after surgery (P<0.001). CONCLUSIONS: The opening proximal first metatarsal osteotomy without internal fixation and with first metatarsophalangeal resection arthroplasty can correct severe hallux valgus with an intermetatarsal angle >or=15 degrees and a short first metatarsal, achieving low rate of complications.

Proximal metatarsal resection.

OBJECTIVE: The purpose of proximal tarso-metatarsal joint resection is to provide early weight-loading for biomechanical realignment and correct weight imbalance across the MTP joint. Therefore, its main indications are all those metatarsalgia in which previous orthopaedic treatment has failed. MATERIAL AND METHODS: We report our experience in metatarsalgia management with proximal metatarsal resection. This is a retrospective study between April 1997 and December 2005. 40 feet underwent this procedure (36 patients), with a total report of 86 osteotomies. Clinical results were evaluated with American Orthopaedic Foot and Ankle Society Lesser Metatarsophalangeal-Interphalangeal Scale Score (maximum score: 100 points). RESULTS: A 10-15-grade correction was achieved with a mean resection of 2mm. Assessment with AOFAS' scale disclosed previous average 35.75+/-4.2 with a final score reported of 88.4+/-6.9 (range 65-100). An overall mean increase of 52.65 points was achieved. No case had major complications that required further surgery. Pain improved in 39 patients (97.5%), and persisted in one patient. CONCLUSIONS: Proximal metatarsal resection is a simple technique that provides adequate correction of the abnormal pressure distribution across the MTP joint without internal fixation.

Pseudoartrosis de hueso grande. A propósito de un caso / Capitate bone pseudoarthrosis. A case report

Objetivos: A propósito de un caso de seudoartrosis de hueso grande, nos proponemos revisar la bibliografía sobre el tratamiento de este tipo de fracturas y de su seudoartrosis. Material y métodos: Presentamos el caso de una fractura de hueso grande desapercibida tras traumatismo en hiperextensión, que originó una seudoartrosis posterior. Resultados: Tras intervenirse quirúrgicamente mediante osteosíntesis con tornillo de Herbert-Whipple, previa cruentación del foco, se logró una curación satisfactoria. Conclusiones: La seudoartrosis de hueso grande es una causa infrecuente de dolor oculto en la muñeca. La historia clínica del dolor, la tumefacción sobre el arco carpiano distal, en ocasiones las imágenes radiográficas y, especialmente, los estudios complementarios con TAC o RMN deben confirmar el diagnóstico (AU)

Purpose: The purpose of the study is to review the literature on the treatment of capitate bone fracture and pseudoarthrosis. Materials and methods: We present the case of a capitate bone fracture that went undetected following trauma caused by forced hyperextension leading to posterior pseudoarthrosis. Results: A satisfactory result was achieved by surgery with Herbert-Whipple screw fixation preceded by fracture site refreshment. Conclusions: Hamate bone pseudoarthrosis is a rare cause of occult pain in the wrist. The pain's clinical history, numbness of the distal carpal arch, some radiographic findings and, especially, complementary CT- or MRi studies are elements that must be used to confirm an initial diagnosis (AU)

Ulnar variance and scaphoid fracture.

Between 1997 and 2006, radiographs of 66 scaphoid fractures were retrospectively reviewed to evaluate ulnar variance. Twenty-one (31.8%) patients had an 'ulna neutral' wrist, six (9.1%) had an 'ulna plus' and 39 (59.1%) had an 'ulna minus' wrist. The mean ulnar variance was -1.3 (SD 1.8) mm (range -5.5, 2.5). We observed a significant difference in the distribution of ulnar variance (P < 0.00001) and in the proportion of cases with ulna minus (OR = 5.0; 95% CI: 2.7, 9.3) compared to previous publications.

Rotura bilateral del tendón cuadricipital en paciente sano. A propósito de un caso y revisión de la literatura médica / No disponible

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