Surgery of subacromial syndrome with application of plasma rich in growth factors.

BACKGROUND: Our objective was to evaluate clinical recovery of patients with subacromial syndrome, after administering them plasma rich in growth factors (PRGF) by means of the Constant, University of California Los Angeles (UCLA) and Dissabilities of Arm, Shoulder and Hand (DASH) tests. MATERIALS AND METHODS: Prospective cohort study involving two groups - group A, treated with PRGF (52 patients); and group B, without PRGF treatment (79 patients). We analyzed the clinical situation preoperatively (time 1), at 1 month (time 2) and after rehabilitation (time 3). RESULTS: We considered 131 patients (71.2% were men, with median age of 53.7 years). Different approaches were used - traditional (62.5%), mini-open (22.5%) and arthroscopic (15%), without significant differences (P= .71). We observed improvement in the Constant test results at time 2 (59.8 +/- 11.5 points in group A vs. 13.2 +/- 7.1 points in group B; P < .05) and at time 3 (79.3 +/- 11.6 points in group A vs. 59.7 +/- 20.1 points in group B; P (1/4) .05). We found improvement in the UCLA test results at time 2 (23.2 +/- 5.8 points in group A vs. 4.72 +/- 1.1 points in group B; P < .05) and at time 3 (32.1 +/- 5.3 points in group A vs. 22.1 +/- 7.35 points in group B; P < .05). We also observed improvement in the DASH test results at time 2 (45.2 +/- 17.2 points in group A vs. 118.3 +/- 7.6 points in group B, P < .05) and at time 3 (37.3 +/- 12.6 points in group A vs. 69 +/- 25.7 points in group B). Time of rehabilitation reduced significantly: 2.53 months in group A vs. 4.96 months in group B (P < .05). No significant differences were observed in surgical times: 88 minutes (group A) vs. 97 minutes (group B). CONCLUSION: In our experience, PRGF should be indicated in subacromial syndrome and cuff involvement, as shown by the improvement in our results in terms of better results of tests, reduction in rehabilitation time and no increase in operation time.

Luxaciones de tobillo sin fractura: cuatro casos / Fracture-free ankle dislocations: four cases

Objetivos. Se realiza una revisión clínico-radiológica de cuatro pacientes que presentaron luxaciones de tobillo sin fractura. Casos. Estudio descriptivo, retrospectivo, sobre 5 casos, 3 abiertos y 2 cerrados, en 4 pacientes. Se detallan las etiologías, mecanismos, relación maleolar, índice de cobertura astragalina, tiempo para iniciar la carga, balance articular final, secuelas radiográficas y evaluación final de Gay y Evrard. Resultados. La edad media fue de 23,25 años. La etiología fueron los accidentes de tráfico en un 80%. Se observó una relación maleolar y un índice de cobertura de 0,49 y 0,56, respectivamente, con desviaciones típicas de 0,40. La media de inmovilización fue de 5,60 semanas y, la carga completa en 4,2 meses. Según los criterios de Gay-Evrard se obtuvo una media de 8 puntos y una desviación típica de 2,91 puntos. Conclusiones. La luxación posteromedial conlleva un mayor riesgo de lesiones abiertas, daños colaterales, secuelas cutáneas, radiológicas y con afectación clínica. La luxación anterolateral, cerrada en nuestra serie, tiene mejor pronóstico. La actitud inmediata es fundamental en el pronóstico

Purpose. We performed a clinical-radiological review of several patients with fracture-free ankle dislocations. Cases. Descriptive retrospective study of 4 cases, 2 open and 2 closed. A description is made of the etiologies, mechanisms of injury, inter-malleolar distance, talar coverage rate, time to weight-bearing, final joint balance, radiographical sequelae and final Gay & Evrard score. Results. Mean age was 23.25 years; road accidents accounted for 80% of injuries. Mean values for inter-malleolar distance and talar coverage were 0.49 and 0.56 respectively, with standard deviations of 0.40. Mean immobilization time was 5.6 weeks and full-weight bearing was authorized at 4.2 months. The mean Gay & Evrard score was 8 points, with a Standard deviation of 2.91 points. Conclusions. Posteromedial dislocation leads to a higher risk of open trauma, collateral damage as well as cutaneous and radiological sequelae with clinical involvement. Anterolateral dislocation, closed in our series, has a better prognosis. Immediate action is fundamental for a good prognosis (AU)

La acromioplastia con reparación del manguito rotador y sus efectos en el test de Constant tras la aplicación de plasma rico en factores de crecimiento (PRGF) / Acromioplasty with rotator cuff repair and its effects in Constant test after application of plasma rich in growth factors (PRGF)

Introducción y objetivos: Nuestro objetivo fue valorar la recuperación clínica en pacientes diagnosticados de síndrome subacromial tras administrarles plasma rico en factores de crecimiento (PRGF). Pacientes y métodos: se efectuó un estudio comparativo de cohortes, en dos grupos de pacientes diagnosticados e intervenidos de síndrome subacromial, grupo A, prospectivo y tratado con PRGF (47 pacientes) y grupo B, histórico, sin PRGF (71 pacientes). El 74,6% eran hombres y el 25,4% de mujeres; con una edad media de 51 años. Se realizó la valoración clínica con el test de Constant en el preoperatorio, al mes y después de terminar la rehabilitación; también se valoraron la RNM pre y postoperatoria. Resultados: En la cirugía se siguió el abordaje tradicional (69,5%), miniopen (24,6%) y artroscópico (5,9%). La mejoría en el al mes de la cirugía fue de 60,47 puntos (grupo A) y 13,75 puntos (gripo B) (p<0,05). Después de la rehabilitación los resultados fueron 77,28 puntos (grupo A) y 63,68 puntos (grupo B) (p<0,05). Conclusión: el PRGF debería indicarse en síndromes subacromiales y afectación del manguito, pues mejora el test de Constant (AU)

Introduction and objectives: Our objective was to evaluate the clinical recovery of patients with subacromial syndrome after surgical plasma rich in growth factors (PRGF) administration. Patients and methods: Comparative cohort study involving two groups; prospective cohort, group A, treated with PRGF (47 patients) and historical cohort, group B without PRGF treatment (71 patients). The gender distribution was 74.6% of men and 25.4% of women; with an average age of 51 years. Preoperative analysis, one month after surgery and after rehabilitation with the Constant test was made. Also pre- and postoperative MRI was taken. Resultus: the surgical approach was traditional incision (69.5%), mini-open (24.6%) and arthroscopic (5.9%). We observed improvement in the Constant test one month after surgery, 60.47 points (group A) and 13.75 points (group B) (p<0.05); iafter rehabilitation results was 77.28 points in group A and 63.68 points in group B (p<0.05). Conclusion: PRGF should be indicated in subacromial syndromes and cuff surgery due to the improvement in the Constant test (AU)

Peripheral osteoarticular tuberculosis in children: tumor-like bone lesions.

Osteoarticular tuberculosis in children is rare in developed countries. We report three patients who were monitored between 3 1/2 years and 8 years. The primary focus was located in the distal epiphysis of the femur, distal epiphysis of the tibia, and the calcaneus. The lesions were initially radiolucent and ill defined, appearing afterward surrounded by a sclerosis halo; these features may disguise them as other infectious lesions or pseudotumoral processes. A poorly defined set of symptoms and a lack of specific signs may delay their diagnosis and treatment. Histopathological examination and culture identification are in the most accurate methods to reach a definitive diagnosis. Lesion scrapping and chemotherapy during sat least 9 months was effective in two patients.

[Bone lengthening in congenital malformations of the lower limbs]. / Alargamiento óseo en malformaciones congénitas de miembros inferiores.

The authors analyse 21 patients with congenital inequaliti of the lower limbs that had been included on a lengthening programme. The shortening aetiology was: global hipoplasy (8p), congenital deficiency of the fibula isolated (5p) or associated to proximal femoral focal deficiency (PFFD) (3p), congenital short femur (3p) and congenital abscense of the tibia (2p) The authors evaluate the anticipated discrepancy at the end of growth, the lengthening that was obtained and the complications that had been arised. On the femur and tibia hipoplasy the authors equalize the length of the lower limbs in the 75% of the patients, at only one time of lengthening. On the aplasya of the fibula the authors require two periods of lengthening and the achievement of complementary orthopaedic surgery. The authors conclude that the decision to initiate a limb lengthening programme must include not only the leg inequality evaluation, but also anothers factors like the associated anomalies, joint inestability, axial disturbance, foot condition, joint and muscle balance and the patient and family collaboration.