[Medial discoid meniscus in a pediatric patient. Case report and review of the literature]. / Menisco discoide medial en paciente pediátrico. Presentación de un caso y revisión de la literatura.

Discoid meniscus is a congenital morphological variant of the meniscus, which tends to occur more frequently in its lateral form than in the medial form. This anomaly is characterized by central hypertrophy of the meniscus and a larger diameter than the normal meniscus, resulting in an abnormal shape and greater coverage of the tibial plateau. The clinical presentation of this condition varies depending on the stability of the meniscus. In pediatric patients, in particular, it is common to experience progressive and atraumatic symptoms, such as pain and limited mobility. Diagnosis is based on imaging studies, with magnetic resonance imaging being the preferred tool, where the "bowtie sign" is a classic finding. Surgery is recommended for symptomatic patients, with a focus on preserving the peripheral portion of the meniscus. Saucerization is the most commonly used technique, followed by stability assessment to determine if additional procedures are required. In this case, a 9-year-old patient with a medial discoid meniscus presented symptoms following trauma. Despite this atypical presentation, a successful outcome was achieved through arthroscopic surgery, underscoring the importance of accurate diagnosis and proper management of this condition in pediatric patients. Understanding the anatomical and pathophysiological characteristics of the discoid meniscus is essential for an effective therapeutic approach.

El menisco discoide es una variante morfológica congénita del menisco, que suele presentarse con mayor frecuencia en su forma lateral que en la medial. Esta anomalía se caracteriza por la hipertrofia central del menisco y un diámetro mayor que el menisco normal, lo que resulta en una forma anormal y una mayor cobertura del platillo tibial. La presentación clínica de esta condición varía según la estabilidad del menisco. En pacientes pediátricos, en particular, es común experimentar síntomas progresivos y atraumáticos, como dolor y limitación de la movilidad. El diagnóstico se basa en estudios de imagen, siendo la resonancia magnética la herramienta preferida, donde el "signo del corbatín" es un hallazgo clásico. Se recomienda la cirugía para pacientes sintomáticos, con un enfoque en preservar la porción periférica del menisco. La saucerización es la técnica más utilizada, seguida de la evaluación de la estabilidad para determinar si se requiere un procedimiento adicional. En el presente caso, se describe a un paciente de nueve años con un menisco discoide medial que manifestó síntomas después de un traumatismo. A pesar de esta presentación atípica, se logró un resultado exitoso mediante una cirugía artroscópica, lo que resalta la importancia de un diagnóstico preciso y un manejo adecuado de esta condición en pacientes pediátricos. La comprensión de las características anatómicas y patofisiológicas del menisco discoide es esencial para un enfoque terapéutico efectivo.

Bilateral mirror hand: 2-year follow-up and literature review.

INTRODUCTION: Mirror hand syndrome is a very rare congenital deformity, also called cubital dimelia, characterized by the absence of the thumb, as well as the duplication of the fingers in a symmetrical image and, in some cases, with a duplication of the bones of the forearm. METHODS: The current treatment consists of a thumb reconstruction through thumb pollicization, although there are alternatives such as rotating osteotomy, syndactylization or conservative treatment. In this article we present the case of a girl with a non-classic bilateral mirror hand, the clinical and radiological findings, the bilateral surgical technique in two surgical times with six months of difference and two years follow-up. RESULTS: Complete mobility arches, as well as a good hand holding function were achieved with metacarpophalangeal thumb flexion 0-40o, interphalangeal 5-45o and abduction-adduction 0-50o. We achieved a complete opposition of the new thumb with respect to the other fingers. The strength of the clamp between the fingers was 75.2% of the normal force for her given age, while the strength of the lateral clamp of 66.3% and that of the grip of the fist was 69.1%. CONCLUSION: The surgical technique in the present case (pollicization of the thumb) is an excellent option, achieving objectives of fine and gross motor skills, and good cosmetic results.

INTRODUCCIÓN: Mano en espejo es una deformidad congénita muy rara, en ocasiones conocida como dimelia cubital, caracterizada por la ausencia del dedo pulgar, así como la duplicación de los dedos en imagen simétrica y, de forma clásica, también de los huesos del antebrazo. MÉTODOS: El tratamiento actual consiste en una reconstrucción del pulgar mediante pulgarización, aunque existen alternativas como osteotomía rotadora, sindactilización o el tratamiento conservador. En este artículo se presenta el caso de una niña con mano en espejo no clásica bilateral, los hallazgos clínicos, radiológicos, la reconstrucción quirúrgica de ambas manos consistente en pulgarización tipo Buck-Gramcko bilateral en dos tiempos quirúrgicos con seis meses de diferencia y el seguimiento a corto plazo. RESULTADOS: Presentó arcos de movilidad completos, así como una buena función de sujeción de la mano, se lograron con la flexión del pulgar metacarpofalángica 0-40o, interfalángica 5-45o y abducción-aducción 0-50o. Logramos una oposición del nuevo pulgar con respecto a los otros dedos. La fuerza de la pinza entre los dedos fue del 75.2% de la fuerza normal para la edad, mientras que la fuerza de la pinza lateral fue de 66.3% y la de la empuñadura fue de 69.1%. CONCLUSIÓN: La técnica quirúrgica utilizada en el presente caso demuestra una excelente opción, logrando objetivos de pinza gruesa, pinza fina y agarres, así como un buen resultado cosmético.

[Clinical and functional evaluation of patellofemoral resurfacing arthroplasties]. / Evaluación clínica y funcional de las artroplastías de resuperficialización patelofemoral.

BACKGROUND: The patellofemoral articulation is a biomechanical system susceptible to accelerated wear, affecting 25% of women. Currently, the treatment of osteoarthrosis Patelofermoral has resurfaced thanks to the creation of anatomical and biomechanically appropriate systems, with precise indications, earlier stages and with a better functional result. MATERIAL AND METHODS: A cohort of 24 patients was analyzed during the period from 2010 to 2012, treated with a resurfacing prostheses HemiCap Patello Femoral Resurf (Franklin MA, USA), placed by 2 surgeons. Patients were assessed preoperatively and 2, 4, 6, 12, 18, 24 months postoperative with the Knee Society Score. RESULTS: Twenty-four patients with follow-up of 2 years on average were included. 87.5% were women, an average age of 62 years (45-80 years); an average of 29.5 of body mass index, the right laterality predominated in 54%. An improvement in KSS scale results was observed: in clinical appearance there was an improvement of 35.2% and the functional scale 41.62%. Only two patients were revised by complications of functional limitation, treated one with manipulation under anesthesia and the other with arthroscopic adhesion lysis. CONCLUSION: The patellofemoral prosthesis is an option as a treatment for isolated patellofemoral arthrosis, since the two-year survival rate is good, providing pain relief and improving knee functionality; However, more follow-up time will be required to evaluate the end result of this implant.

ANTECEDENTES: La articulación patelofemoral (PF) es un sistema biomecánico susceptible a desgaste acelerado, afecta a 25% de las mujeres. Actualmente, el tratamiento de la osteoartrosis patelofemoral (OAPF) ha resurgido gracias a la creación de sistemas anatómicos y biomecánicamente adecuados, con indicaciones precisas, estadios más tempranos y con mejor resultado funcional. MATERIAL Y MÉTODOS: Se analizó una cohorte de 24 pacientes durante el período de 2010 a 2012, tratados con prótesis de resuperficialización patelofemoral (PPF) HemiCap Patelofemoral Resurf (Franklin MA, EUA), colocadas por dos cirujanos. Se evaluaron los pacientes prequirúrgicos y a los dos, cuatro, seis, 12, 18, 24 meses postquirúrgicos con la escala Knee Society Score (KSS). RESULTADOS: Se incluyeron 24 pacientes con seguimiento de dos años en promedio. En 87.5% fueron mujeres, edad promedio de 62 años (45-80 años); una media de 29.5 de índice de masa corporal (IMC), la lateralidad derecha predominó en 54%. Se observó una mejoría en los resultados de la escala KSS: en el aspecto clínico hubo una mejoría de 35.2% y en la escala funcional de 41.62%. Sólo dos pacientes fueron reintervenidos por complicaciones de limitación funcional, uno de ellos tratado con manipulación bajo anestesia y el otro con liberación artroscópica de adherencias. CONCLUSIÓN: La PPF es una opción como tratamiento de AOPF aislada, pues la tasa de supervivencia a dos años es buena, proporciona alivio del dolor y mejoría en funcionalidad de la rodilla; sin embargo, se requerirá mayor tiempo de seguimiento para evaluar el resultado final de este implante.

[Installed Capacity Perception Survey for the Training of Residents Program in Orthopedics and Care Needs in Acute and Chronic Musculoskeletal Pathology in Mexico]. / Encuesta de Percepción en Capacidad Instalada para la Formación de Médicos Residentes en Ortopedia (Traumatología) y Necesidades de la Atención en Patología Musculoesquelética Aguda y Crónica en México. Primera Parte.

INTRODUCTION: It is essential that orthopaedic resident physicians be highly proficient in all aspects, considering the balance between supply, demand, need and context. Fundamental to identify the capacity and quality installed for their training in Mexico. MATERIAL AND METHODS: Observational Study, transverse, non-probabilistic sampling-conglomerates, in two phases. The instrument has 8 domains, 57 variables and 4,867 items. 60 graduate professors of 20 states, 50 hospital sites, 22 university programs. RESULTS: 1,038 years of experience (collective intelligence), 17 years of experience/teacher (01 to 50 years). Identified: acute pathology 30 (2 to 90%), chronic pathology 30 (5 to 96%), patients 15 years, 10 (3 to 30%), patients between 15 and 65 years, 47 (2 to 78%), patients 65 years, 20 (2 to 60%), number of beds/seat 20 (2 to 510), number of clinics 3 (1 to 48), number of surgical procedures/headquarters per year at the national level, was 960 (50 to 24,650). The national average per resident doctor is 362 surgeries/year with 1,450 surgical times/year. CONCLUSIONS: The needs and resources for the training of physicians specializing in orthopedics/traumatology are highly heterogeneous, so it should be adapted to the epidemiological needs of the region of influence, in an area of epidemiological transition. 62.2% expressed not having or have bad academic and scientific infrastructure at its headquarters, more than 50% without rotation overseas and 90% without regular scientific production.

INTRODUCCIÓN: Es fundamental que los médicos residentes de ortopedia (traumatología) sean altamente competentes en todos los aspectos, considerando el equilibrio entre la oferta, demanda, necesidad y contexto. Es primordial identificar la capacidad y calidad instalada para su formación en México. MATERIAL Y MÉTODOS: Estudio observacional, transversal, muestreo no probabilístico-conglomerados, en dos fases. El instrumento tiene ocho dominios, 57 variables y 4,867 ítems. Sesenta profesores de postgrado de 20 estados, 50 sedes hospitalarias, 22 programas universitarios. RESULTADOS: 1,038 años de experiencia (inteligencia colectiva), 17 años de experiencia/profesor (01 a 50 años). Se identificó: patología aguda 30 (2 a 90%), patología crónica 30 (5 a 96%), pacientes 15 años, 10 (3 a 30%), pacientes entre 15 y 65 años, 47 (2 a 78%), pacientes 65 años, 20 (2 a 60%), número de camas/sede 20 (2 a 510), número de consultorios 3 (1 a 48), el número de procedimientos quirúrgicos/sede al año a nivel nacional fue de 960 (50 a 24,650). La media nacional por médico residente es de 362 cirugías/año con 1,450 momentos quirúrgicos/año. CONCLUSIONES: Las necesidades y recursos para la formación de médicos especialistas en ortopedia/traumatología son en alto grado heterogéneos, por lo cual se debería adaptar a las necesidades epidemiológicas de la región de influencia, en un ámbito de transición epidemiológica. Sesenta y dos punto dos por ciento expresó no tener o tener deficiente infraestructura académica y científica en su sede, más de 50% sin rotación al extranjero y 90% sin producción científica regular.

[Doxycycline as an adjuvant in postsurgical recovery of rotator cuff injuries. One-year follow-up]. / Uso de doxiciclina como adyuvante en la recuperación postquirúrgica de las lesiones del manguito rotador. Seguimiento a un año.

BACKGROUND: The severity and progression of rotator cuff tears have forced research on new treatment pathways such as metalloprotease inhibition, which has shown a reduction in healing time and improvement in the structure of collagen fibers. OBJECTIVE: To evaluate the use of doxycycline as a healing enhancer in rotator cuff tears after surgical treatment. MATERIAL AND METHODS: 20 patients were included; they were divided into two groups, 10 with the use of doxycycline and 10 without it after arthroscopic repair with one-year follow-up. Doxycycline was given orally, 100 mg once a day for one month. Every subject in the test was diagnosed with rotator cuff tear confirmed by MRI with Patte and Goutallier scores below 2. We used the arthroscopic double row technique. Post-op follow-up was 12 months with clinical scales (UCLA, Constant and forward flexion strength). RESULTS: Both groups reported almost complete healing of rotator cuff tears after surgical treatment during the twelve months of follow-up; forward flexion strength was the only score that reported improvement in the doxycycline group during every check-up. DISCUSSION: Doxycycline use after arthroscopic cuff tear repair could improve the clinical outcome, but we do not know how yet; however larger sample and randomized trials should be developed.

ANTECEDENTES: La severidad y progresión inevitable de la lesión del manguito rotador ha llevado a experimentar con adyuvantes terapéuticos para disminuir el tiempo de recuperación postquirúrgica, así como mejorar la estructura del tendón en recuperación al inhibir la matriz de metaloproteasas. OBJETIVO: Evaluar el uso de la doxiciclina como adyuvante en la cicatrización de lesiones hueso-tendón en la reparación quirúrgica del manguito rotador. MATERIAL Y MÉTODOS: Se reclutaron 20 pacientes con lesión del manguito rotador corroborada por imagen con retracción del supraespinoso grado II (Patte) e infiltración grasa de 50% (Goutallier). Fueron divididos en dos grupos: a 10 se les administró doxiciclina, 100 mg cada 24 horas durante un mes, y el resto fueron un grupo control sin doxiciclina. Ambos fueron tratados quirúrgicamente con técnica de doble hilera vía artroscópica, con seguimiento periódico hasta 12 meses mediante escalas de UCLA, Constant y potencia de flexión anterógrada. RESULTADOS: Se encontró recuperación clínica de la lesión en ambos grupos a los 12 meses, mayor potencia de flexión anterógrada en cada uno de los intervalos de medición para el grupo donde se administró la doxiciclina. Durante la evolución del estudio, se mantuvo constante Constant y UCLA; se encontró mejoría considerable con la potencia de flexión anteró grada como valor independiente. DISCUSIÓN: El uso de doxiciclina podría mejorar de una forma considerable el pronóstico clínico de la reparación artroscópica de mango rotador con el uso de doble hilera, pero aún no sabemos cómo, aunque deberán realizarse estudios adicionales con una muestra mayor.

Uso de doxiciclina como adyuvante en la recuperación postquirúrgica de las lesiones del manguito rotador. Seguimiento a un año / Doxycycline as an adjuvant in postsurgical recovery of rotator cuff injuries. One-year follow-up

Resumen: Antecedentes: La severidad y progresión inevitable de la lesión del manguito rotador ha llevado a experimentar con adyuvantes terapéuticos para disminuir el tiempo de recuperación postquirúrgica, así como mejorar la estructura del tendón en recuperación al inhibir la matriz de metaloproteasas. Objetivo: Evaluar el uso de la doxiciclina como adyuvante en la cicatrización de lesiones hueso-tendón en la reparación quirúrgica del manguito rotador. Material y métodos: Se reclutaron 20 pacientes con lesión del manguito rotador corroborada por imagen con retracción del supraespinoso grado II (Patte) e infiltración grasa de 50% (Goutallier). Fueron divididos en dos grupos: a 10 se les administró doxiciclina, 100 mg cada 24 horas durante un mes, y el resto fueron un grupo control sin doxiciclina. Ambos fueron tratados quirúrgicamente con técnica de doble hilera vía artroscópica, con seguimiento periódico hasta 12 meses mediante escalas de UCLA, Constant y potencia de flexión anterógrada. Resultados: Se encontró recuperación clínica de la lesión en ambos grupos a los 12 meses, mayor potencia de flexión anterógrada en cada uno de los intervalos de medición para el grupo donde se administró la doxiciclina. Durante la evolución del estudio, se mantuvo constante Constant y UCLA; se encontró mejoría considerable con la potencia de flexión anterógrada como valor independiente. Discusión: El uso de doxiciclina podría mejorar de una forma considerable el pronóstico clínico de la reparación artroscópica de mango rotador con el uso de doble hilera, pero aún no sabemos cómo, aunque deberán realizarse estudios adicionales con una muestra mayor.

Abstract: Background: The severity and progression of rotator cuff tears have forced research on new treatment pathways such as metalloprotease inhibition, which has shown a reduction in healing time and improvement in the structure of collagen fibers. Objective: To evaluate the use of doxycycline as a healing enhancer in rotator cuff tears after surgical treatment. Material and methods: 20 patients were included; they were divided into two groups, 10 with the use of doxycycline and 10 without it after arthroscopic repair with one-year follow-up. Doxycycline was given orally, 100 mg once a day for one month. Every subject in the test was diagnosed with rotator cuff tear confirmed by MRI with Patte and Goutallier scores below 2. We used the arthroscopic double row technique. Post-op follow-up was 12 months with clinical scales (UCLA, Constant and forward flexion strength). Results: Both groups reported almost complete healing of rotator cuff tears after surgical treatment during the twelve months of follow-up; forward flexion strength was the only score that reported improvement in the doxycycline group during every check-up. Discussion: Doxycycline use after arthroscopic cuff tear repair could improve the clinical outcome, but we do not know how yet; however larger sample and randomized trials should be developed.

[Functional comparison in the treatment of Weber type B ankle fractures with suture device versus screw]. / Comparación funcional en el tratamiento de las fracturas de tobillo B de Weber con implante y sutura versus tornillo situacional.

BACKGROUND: Ten percent of all ankle fractures, 20% of the fractures treated surgically, and 1-18% of all sprains involve a syndesmosis injury. The methods used for reduction are metal or bioabsorbable syndesmotic set screws, direct repair, and sutures with or without buttons. The purpose of this study was to compare the clinical function of patients who sustained Weber B ankle fractures and were treated with the TightRope system or a syndesmotic set screw. MATERIAL AND METHODS: An observational, comparative, cross-sectional study was conducted between March 2012 and March 2015. The AOFAS ankle scale was used to assess function in patients with Weber B fractures with a syndesmosis injury treated with a 3.5 mm tricortical set screw or with the TightRope system. RESULTS: Forty-three patients were included, their mean age was 47 years. The single-factor ANOVA test was used to compare the results of both groups. The latter showed that at 3, 6 and 12 months the TightRope group showed a significant improvement based on the AOFAS score, compared with the set screw group (p = 0.05). DISCUSSION: The use of the TightRope system results in better clinical function in the short term compared with the 3.5 mm tricortical set screw, according to the AOFAS scale.

ANTECEDENTES: Diez por ciento de todas las fracturas de tobillo, 20% de las fracturas tratadas quirúrgicamente y de 1 al 18% de los esguinces presentan lesión de la sindesmosis. Los métodos utilizados para su reducción son tornillos situacionales metálicos o bioabsorbibles, reparación directa y el uso de suturas con o sin botones. El objetivo de este trabajo fue comparar la función clínica de las fracturas de tobillo B de Weber tratadas con TightRope o con el uso de tornillo situacional. MATERIAL Y MÉTODOS: Se realizó un estudio observacional, comparativo, transversal en el período comprendido de Marzo del 2012 a Marzo del 2015. Se utilizó la escala de AOFAS de tobillo para valorar la función de pacientes con fracturas Weber B con lesión de sindesmosis tratados con tornillo situacional tricortical de 3.5 mm y pacientes tratados con sistema TightRope. RESULTADOS: Se estudiaron 43 pacientes con una media de 47 años de edad. Se realizó la prueba de ANOVA de un factor para comparar los resultados de ambos grupos observando que a los tres, seis y 12 meses el grupo de TightRope presentó una mejoría significativa en cuanto al puntaje de AOFAS en comparación con el grupo de tornillo situacional (p = 0.05). DISCUSIÓN: El uso del sistema TightRope presenta mejor función clínica en comparación con el tornillo situacional tricortical de 3.5 mm en el corto plazo, de acuerdo con la escala de AOFAS.

Causas no traumáticas de necrosis avascular bilateral de la cabeza femoral: relación hepatitis C-interferón pegilado / Nontraumatic causes of bilateral avascular necrosis of the femoral head: link between hepatitis C and pegylated interferon

Antecedentes: La necrosis avascular de la cabeza femoral es una patología frecuente en pacientes con antecedentes de trauma, encontrándose como causas patologías vasculares, oncológicas, estados hipercoagulantes, tratamientos esteroideos prolongados, asociándose en algunos casos en pacientes con antecedente de hepatitis C con manejo con interferón pegilado + ribavirin. Seef, Foster y Poynard encontraron al estudiar el comportamiento del virus de la hepatitis, un estado de hipercoagulabilidad, que crea interrupción del flujo vascular retinacular en la cabeza femoral, sin incrementar la incidencia de osteonecrosis en este grupo de pacientes. Lauer expone que dichas infecciones virales llevan un proceso autoinmune, las cuales podrían producir vasculitis transitorias. Giampaolo en 2005 reporta la relación entre el uso de interferón en mieloma múltiple y otros padecimientos oncológicos relacionándose con necrosis avascular femoral. Material y métodos: Se valoraron los casos de diagnóstico de osteonecrosis bilateral de la cabeza femoral bilateral. Resultados: Se revisaron 5 pacientes, 4 mujeres y 1 hombre, con el diagnóstico de osteonecrosis bilateral de la cabeza femoral bilateral. Todos con antecedentes de hepatitis C con manejo con interferón pegilado, corroborándose diagnóstico definitivo por patología posterior a artroplastías, realizándose revisión bibliográfica de la relación de esta patología con el uso de interferón en pacientes con hepatitis C. Conclusiones: Al conocer la relación que existe en enfermedades virales como la hepatitis B y C con la presencia de estados de hipercoagulabilidad, procesos autoinmunes que conllevan a vasculitis transitorias y el uso de interferón pegilado 2B, relacionándose a necrosis avascular de las cabezas femorales, conoceremos nuevas causas asociadas no traumáticas a este padecimiento.

Background: Avascular necrosis of the femoral head is a frequent condition in patients with a history of trauma. The major pathologic causes include vascular diseases, malignancies, hypercoagulability states, long-term steroid treatment, and some patients have a history of hepatitis C infection treated with pegylated interferon and ribavirin. Upon studying the behavior of the hepatitis C virus, Seef, Foster and Poynard found a hypercoagulability state that causes interruption of retinacular blood flow to the femoral head, without an increased incidence of osteonecrosis in this patient group. Lauer states that such viral infections involve an autoimmune process and may result in transient vasculitides. Giampaolo, in 2005, reported the relationship between interferon use for multiple myeloma and other cancers and femoral avascular necrosis. Material and methods: Cases with a diagnosis of bilateral osteonecrosis of the femoral head were assessed. Results: Five patients were included, 4 females and one male, with a diagnosis of bilateral osteonecrosis of the femoral head. All of them had history of hepatitis C infection treated with pegylated interferon. The final diagnosis was proven by pathology after arthroplasty. A literature review was made of articles on the relationship between this condition and interferon use in patients with hepatitis C infection. Conclusions: Finding out the relationship between viral diseases such as hepatitis B and C infection and hypercoagulability states, autoimmune processes leading to transient vasculitides and the use of pegylated interferon 2B, will help us discover new nontraumatic causes associated with this condition.

Fracturas de húmero proximal: valoración clínica y resultado funcional en pacientes con osteonecrosis de la cabeza humeral / Proximal humerus fractures: clinical assessment and functional outcome in patients with osteonecrosis of the humeral head

Introducción: Las fracturas de húmero proximal de tres o más fragmentos presentan riesgo elevado de necrosis, siendo éste el segundo sitio más frecuente sólo después del fémur, presentándose causas traumáticas y no traumáticas, siendo las traumáticas las más comunes, presentando una incidencia de 13 a 34% en fracturas de más de cuatro fragmentos. El propósito de este estudio es valorar el resultado funcional de pacientes con antecedente de fractura humeral proximal y osteonecrosis con manejo conservador. Material y métodos: Se presenta un estudio descriptivo, retrospectivo, observacional con seguimiento de 6 a 12 meses de pacientes mayores de 60 años con diagnóstico de fractura de húmero proximal con manejo conservador, en el período comprendido de Enero de 2004 a Noviembre de 2009, se seleccionaron 122 pacientes que cumplían los criterios de inclusión, perdiendo el seguimiento de 12 de ellos, con edad promedio de 71.02 años con rango de 60 a 92 años, 41 hombres y 69 mujeres, realizándose escalas de DASH y CONSTANT. Resultados: Posterior a la realización de las escalas de valoración funcional se realiza la validación de dichos resultados obteniendo un coeficiente de correlación de 0.80 siendo estadísticamente significativo. Conclusión: El tratamiento conservador debe ser reservado sólo en pacientes que cumplan con las características necesarias. Dependiendo del tipo de fractura y las características del individuo, el tratamiento siempre está enfocado a la estabilización y a la movilización temprana y en la obtención de la recuperación funcional precoz. Encontrando en este estudio que las fracturas tratadas de forma conservadora, desarrollan algún estadio de osteonecrosis de la cabeza pero con adecuada función casi similar a la extremidad sana.

Introduction: Fractures of the proximal humerus resulting in three or more fragments represent a high risk of necrosis. The former is the second most frequent site of necrosis, only after the femur, due to either traumatic or nontraumatic causes. The former are the most common, with an incidence rate of necrosis of 13-34% in fractures with more than four fragments. The purpose of this study is to assess the functional outcome of patients with a history of fracture of the proximal humerus and osteonecrosis treated conservatively. Material and methods: This is a descriptive, retrospective, observational study with a 6-12 month follow-up of patients older than 60 years of age with a diagnosis of fracture of the proximal humerus managed conservatively between January 2004 and November 2009. One hundred and twenty-two patients met the inclusion criteria and 12 were lost to follow-up. Mean age was 71.02 years with a range between 60 and 92 years; 41 males and 69 females. The DASH and CONSTANT scales were applied. Results: After applying the functional assessment scales and validating the results, the correlation coefficient obtained was 0.80, and it was statistically significant. Conclusion: Conservative treatment should be used only in patients who meet the necessary criteria. Depending on the type of fracture and the patient's characteristics, treatment should always be aimed at stabilization, early mobilization, and early functional recovery. This study found that fractures treated conservatively eventually develop some degree of osteonecrosis of the head, but they have proper function, similar to that of a healthy limb.

[Nontraumatic causes of bilateral avascular necrosis of the femoral head: link between hepatitis C and pegylated interferon]. / Causas no traumáticas de necrosis avascular bilateral de la cabeza femoral: relación hepatitis C-interferón pegilado.

BACKGROUND: Avascular necrosis of the femoral head is a frequent condition in patients with a history of trauma. The major pathologic causes include vascular diseases, malignancies, hypercoagulability states, long-term steroid treatment, and some patients have a history of hepatitis C infection treated with pegylated interferon and ribavirin. Upon studying the behavior of the hepatitis C virus, Seef, Foster and Poynard found a hypercoagulability state that causes interruption of retinacular blood flow to the femoral head, without an increased incidence of osteonecrosis in this patient group. Lauer states that such viral infections involve an autoimmune process and may result in transient vasculitides. Giampaolo, in 2005, reported the relationship between interferon use for multiple myeloma and other cancers and femoral avascular necrosis. MATERIAL AND METHODS: Cases with a diagnosis of bilateral osteonecrosis of the femoral head were assessed. RESULTS: Five patients were included, 4 females and one male, with a diagnosis of bilateral osteonecrosis of the femoral head. All of them had history of hepatitis C infection treated with pegylated interferon. The final diagnosis was proven by pathology after arthroplasty. A literature review was made of articles on the relationship between this condition and interferon use in patients with hepatitis C infection. CONCLUSIONS: Finding out the relationship between viral diseases such as hepatitis B and C infection and hypercoagulability states, autoimmune processes leading to transient vasculitides and the use of pegylated interferon 2B, will help us discover new nontraumatic causes associated with this condition.

[Proximal humerus fractures: clinical assessment and functional outcome in patients with osteonecrosis of the humeral head]. / Fracturas de húmero proximal: valoración clínica y resultado funcional en pacientes con osteonecrosis de la cabeza humeral.

INTRODUCTION: Fractures of the proximal humerus resulting in three or more fragments represent a high risk of necrosis. The former is the second most frequent site of necrosis, only after the femur, due to either traumatic or nontraumatic causes. The former are the most common, with an incidence rate of necrosis of 13-34% in fractures with more than four fragments. The purpose of this study is to assess the functional outcome of patients with a history of fracture of the proximal humerus and osteonecrosis treated conservatively. MATERIAL AND METHODS: This is a descriptive, retrospective, observational study with a 6-12 month follow-up of patients older than 60 years of age with a diagnosis of fracture of the proximal humerus managed conservatively between January 2004 and November 2009. One hundred and twenty-two patients met the inclusion criteria and 12 were lost to follow-up. Mean age was 71.02 years with a range between 60 and 92 years; 41 males and 69 females. The DASH and CONSTANT scales were applied. RESULTS: After applying the functional assessment scales and validating the results, the correlation coefficient obtained was 0.80, and it was statistically significant. CONCLUSION: Conservative treatment should be used only in patients who meet the necessary criteria. Depending on the type of fracture and the patient's characteristics, treatment should always be aimed at stabilization, early mobilization, and early functional recovery. This study found that fractures treated conservatively eventually develop some degree of osteonecrosis of the head, but they have proper function, similar to that of a healthy limb.

[Use of ischemia in total knee arthroplasty. Is there a difference?]. / Uso de isquemia en la artroplastía total de rodilla. ¿Existe diferencia?

In Mexico, aging has become the daily routine of millions. Total Knee Arthroplasty is a procedure that is doing more and more with satisfactory results and survival of the implant up to 20 years in 90%. The tourniquet is a useful tool to the orthopedic surgeons to minimize blood loss and make the placement of implants easier, because it enhances the vision of the surgical field. We report the results of 75 total knee arthroplasties performed in January 2007 to January 2010, in terms of bleeding, duration of procedure and Haemoglobin levels with and without tourniquet, the patients were distributed in 3 different groups, In group 1 the tourniquet was kept inflated until the placement of the femoral and tibial components, in group 2 the tourniquet was kept inflated until the wound dressing and finally in group 3 we did not use tourniquet. We performed hematic biometry 24 hours after surgery and if the patient's hemoglobin was less than 9.0 g/dl or the patient had low cardiac output symptoms, regardless of hemoglobin level, blood transfusion was indicated. The results demonstrate that there significant differences between the amount of blood loss among the 3 groups (1:1.157 ml, 2:709 ml, 3:1.493 ml) and surgical time (1:100, 2:110, 3:135). So that demonstrates that tourniquet use has a direct relation to blood loss and surgical time.

[Infection prevention during the perioperative period of primary hip and knee arthroplasty]. / Prevención de infecciones en el perioperatorio de la artroplastía primaria de cadera y rodilla.

All surgical wounds are at risk of contamination by pathogens that may get in through the incision. The pre-surgical bath with a skin antiseptic agent 24 hours prior to the surgery, the timing of administration of prophylactic antibiotics, the choice and postoperative duration of the latter, the number of individuals within the OR and the movement inside it, the choice of chlorhexidine gluconate for its long duration against gram-positive and gram-negative organisms, and the use of a hair remover or an electric razor, all of the former concepts, some new and others not so new, led to performing an extensive bibliographic review with the idea of starting a standardization process that could change the way in which institutions operate when performing primary joint replacement, trying to reduce the annual infection rate and upgrade the quality of life of patients.

[Periprosthetic femur fractures. Experience at hospital Español de México with a 2-year follow-up]. / Fracturas periprotésicas del fémur. Experiencia en el hospital Español de México a 2 años de seguimiento.

UNLABELLED: Periprosthetic fractures have had an increasing incidence in the past decades; their resolution is a difficult challenge even for the most experienced orthopedist surgeons. The Vancouver classification has contributed to a great extent to their better characterization and therapeutic guidance. The purpose of this paper is to make a review of the most recent advances on the topic and present our experience in the treatment of these fractures. MATERIAL AND METHODS: We describe the characteristics of a sample of 20 patients with periprosthetic femur fractures treated at our hospital from March 2008 to March 2010 and typed according to the Vancouver classification. RESULTS: Mean age was 74.5 years with a range of 65-87 years. Females were predominant (70%). Five cases were type A in the classification, 10 cases type B, and 5 cases type C. Nineteen underwent surgical treatment. The mean total length of stay was 7 days, with a range of 5-12. The mean healing time for types B and C was 4 months (range 3-6 months). Four patients had complications. The resolution was assessed as excellent in 5 cases (25%), good in 11 cases (55%), and poor in 4 cases (20%). CONCLUSIONS: A thorough individual assessment based on the Vancouver classification, age and the patient's functional requirements are the major parameters for treatment success.

An acrylic Judet hip prosthesis in a shoulder hemiarthroplasty for thirty-nine years--a case report.

We describe a hemiarthroplasty of the shoulder with an acrylic Judet hip prosthesis, inserted after the excision of a giant cell tumour of the head of the humerus, which functioned well for 39 years.