Revision anterior cruciate ligament reconstruction and outcomes with different autografts in a population with kneeling customs.

OBJECTIVES: This study was designed to evaluate, compare the mid-term functional outcome of revision anterior cruciate ligament reconstruction (ACLR) using different autografts and assess the cause of failure of primary ACLR in an Omani population with kneeling customs. MATERIALS AND METHODS: Patients with failed primary ACLR who underwent revision ACLR using autografts were included in this retrospective study. The cause of primary ACLR failure and the functional outcome was assessed using the Tegner-Lyholm knee score and compared among bone patella tendon-bone (BPTB), quadriceps tendon (QT), semitendinosus gracilis (STG) autografts used. RESULTS: One hundred two patients (102 male) were included in the study with a minimum follow-up of 2 years. Thirty-one patients underwent revision with BPTB, 34 with STG and 19 with QT autografts. Majority of the patients (70.23%) achieved good-to-excellent functional outcome based on their Tegner-Lysholm scores. The functional outcome of different autografts was comparable to each other based on Kruskal-Wallis test. The causes of primary ACLR failure were failure due to trauma in 58.33% of patients, technical failure in 22.61% of patients, and nontraumatic failure in 19.04% of patients. CONCLUSIONS: The functional outcome of revision ACLR in this Middle Eastern Asian Omani population was good-to-excellent, with the patients experiencing no difficulty in performing activities of daily living, including kneeling activities. The outcome of different autografts, BTPB, QT, STSG is similar in high knee flexion patients with no autograft found to be superior. The findings of this study add to the literature on functional outcomes after primary and revision ACLR in a customary kneeling population.

Management of maternal pulse and blood pressure abnormalities during labour and childbirth: evidence-based algorithms for intrapartum care decision support.

AIMS: To develop evidence-based clinical algorithms for assessment and management of abnormal maternal pulse and blood pressure during the intrapartum period. POPULATION: Low risk singleton, term, pregnant women in labour. SETTING: Institutional births in low- and middle-income countries. SEARCH STRATEGY: A review of the literature was performed to retrieve evidence-based guidelines, systematic reviews, and papers on maternal pulse and blood pressure during labour. We searched a number of international clinical guidelines and PubMed using the corresponding key terms in November 2018 and updated the search in May 2020. CASE SCENARIOS: Four common intrapartum case scenarios of abnormal pulse and blood pressure were identified for which algorithms were developed: hypertension, hypotension, tachycardia and bradycardia. Algorithms were constructed after reviewing guidelines and relevant papers, with input from a panel of experts. Thresholds for upper and lower limits of normal maternal pulse and blood pressure measurements are defined, evidence-based interventions for the initial management of abnormal parameters are described (resuscitation and monitoring) and guidance is provided on exploration of the potential causes for each case scenario, with links to pathways for their management. CONCLUSIONS: Evidence-based algorithms to support the identification, and management of deviations in pulse and blood pressure during intrapartum care have been developed for hypertension, hypotension, tachycardia and bradycardia. The algorithms focus on initial resuscitation and monitoring, with an exploration of causes and early identification of underlying maternal conditions. These algorithms will help provide a standardised approach to investigation and management of these abnormal parameters to guide clinical practice. TWEETABLE ABSTRACT: Algorithms for abnormal maternal pulse and blood pressure during labour allow standardised approach to early identification and management of complications.

Native valve endocarditis complicated by abscess formation caused by Rothia mucilaginosa.

Rothia mucilaginosa is increasingly recognized as an emerging pathogen associated with endocarditis. It has mostly been reported a causative agent for prosthetic valve endocarditis. The previously reported cases of native valve endocarditis caused by this organism only required medical treatment with no surgical intervention. We report a case of R. mucilaginosa native valve endocarditis complicated by abscess formation requiring surgical intervention and review the literature of native valve endocarditis caused by this organism.

[Professional profiles and representations of staff members in Burundi health centers: Socio-professional groups with compartmentalizes knowledge]. / Profils et représentations professionnelles des agents en centre de santé au Burundi : des groupes socio-professionnels aux savoirs cloisonnés.

BACKGROUND: The professional identities, profiles and representations of Burundian health workers remain insufficiently explored. Our twofold objective is to identify the different socio-professional profiles of first-line caregivers and to explore their respective representations of health workers and work. METHODS: The first study describes the overall population of the 1047 staff members employed in 2014-2015 in 62 health centers. The second is a cross-sectional survey conducted in April 2014. Using IRAMUTEQ© software, we conducted textology analysis of the structure and contents of 911 respondents' representations via 3 free associations with regard to 6 questions on the "good worker" and the "what renders one capable of doing good work". RESULTS: At the normative level, among all categories of staff, a relational role is a foundation of professional identity, while technical or administrative functions remain marginal. At the positional level, responses differed according to initial qualification level but not as a function of their role with patients or their professional experience. Three socio-professional categories emerged. The most qualified category (one-quarter of the population) consists primarily of male caregivers, with a high turnover rate (4 years) associated with prospects for further training and career development. These persons present the most professionalized representations of the worker and work. The second quarter has an average level of qualification and turnover (10 years), and is mainly composed of female caregivers with limited professional perspectives. This group's representations are less technical and more patient-centered. Finally, the remaining half consists of relatively low-skilled staff members in charge of technical and logistical support, who are likely to spend their entire career in the same center (>20 years). Largely disregarded by the health care system and its funders, they have few opportunities for training or advancement and despite their long experience, maintain profane representations of workers and work. CONCLUSION: Our results shed light on the predicament of unskilled staff members whose expectations are rarely taken into consideration, even though they represent a significant proportion of the workforce, perform tasks essential to quality of care, and serve as bearers of the memory of their hospital center. These results also highlight the compartmentalization of practices and knowledge between categories of workers and underscore the failure of continuous training strategies targeting the unskilled.

Eye of the Tiger Sign in Pantothenate Kinase-Associated Neurodegeneration.

Pantothenate kinase-associated neurodegeneration (PKAN) is a rare disorder associated with brain iron accumulation caused by a recessive mutation in pantothenate kinase 2 gene (PANK2). We present a case of an 11 year-old boy presenting extrapyramidal signs and developmental regression. T2-weighted images showed the classic eye of the tiger sign seen in pantothenate kinase-associated neurodegeneration.

A Robust Handwritten Numeral Recognition Using Hybrid Orthogonal Polynomials and Moments.

Numeral recognition is considered an essential preliminary step for optical character recognition, document understanding, and others. Although several handwritten numeral recognition algorithms have been proposed so far, achieving adequate recognition accuracy and execution time remain challenging to date. In particular, recognition accuracy depends on the features extraction mechanism. As such, a fast and robust numeral recognition method is essential, which meets the desired accuracy by extracting the features efficiently while maintaining fast implementation time. Furthermore, to date most of the existing studies are focused on evaluating their methods based on clean environments, thus limiting understanding of their potential application in more realistic noise environments. Therefore, finding a feasible and accurate handwritten numeral recognition method that is accurate in the more practical noisy environment is crucial. To this end, this paper proposes a new scheme for handwritten numeral recognition using Hybrid orthogonal polynomials. Gradient and smoothed features are extracted using the hybrid orthogonal polynomial. To reduce the complexity of feature extraction, the embedded image kernel technique has been adopted. In addition, support vector machine is used to classify the extracted features for the different numerals. The proposed scheme is evaluated under three different numeral recognition datasets: Roman, Arabic, and Devanagari. We compare the accuracy of the proposed numeral recognition method with the accuracy achieved by the state-of-the-art recognition methods. In addition, we compare the proposed method with the most updated method of a convolutional neural network. The results show that the proposed method achieves almost the highest recognition accuracy in comparison with the existing recognition methods in all the scenarios considered. Importantly, the results demonstrate that the proposed method is robust against the noise distortion and outperforms the convolutional neural network considerably, which signifies the feasibility and the effectiveness of the proposed approach in comparison to the state-of-the-art recognition methods under both clean noise and more realistic noise environments.

An overview of the literature on emerging pollutants: Chlorinated derivatives of Bisphenol A (ClxBPA).

CONTEXT: Bisphenol A (BPA) is a ubiquitous contaminant with endocrine-disrupting effects in mammals. During chlorination treatment of drinking water, aqueous BPA can react with chlorine to form chlorinated derivatives of BPA (mono, di, tri and tetra-chlorinated derivatives) or ClxBPA. OBJECTIVE: The aim of this study is to summarize and present the state of knowledge on human toxicological risk assessment of ClxBPA. MATERIALS AND METHODS: A search on ClxBPA in the PubMed database was performed based on studies published between 2002 and 2021. Forty-nine studies on chlorinated derivatives of BPA were found. Available information on their sources and levels of exposure, their effects, their possible mechanisms of action and their toxicokinetics data was extracted and presented. RESULTS: ClxBPA have been essentially detected in environmental aqueous media. There is evidence in toxicological and epidemiological studies that ClxBPA also have endocrine-disrupting capabilities. These emerging pollutants have been found in human urine, serum, breast milk, adipose and placental tissue and can constitute a risk to human health. However, in vitro and in vivo toxicokinetic data on ClxBPA are scarce and do not allow characterization of the disposition kinetics of these compounds. CONCLUSION: More research to assess their health risks, specifically in vulnerable populations, is needed. Some water chlorination processes are particularly hazardous, and it is important to evaluate their chlorination by-products from a public health perspective.

Encephalopathy and seizure activity in a COVID-19 well controlled HIV patient.

A 41-year-old male with a history of well controlled HIV presented with confusion and was found to have COVID-19. Lumbar puncture was negative. He had worsening encephalopathy with tonic-clonic seizure requiring intubation. He was treated with hydroxychloroquine and azithromycin with improvement in mental status back to baseline after 6 days.

Skin Color and Severe Maternal Outcomes: Evidence from the Brazilian Network for Surveillance of Severe Maternal Morbidity.

Background: Taking into account the probable role that race/skin color may have for determining outcomes in maternal health, the objective of this study was to assess whether maternal race/skin color is a predictor of severe maternal morbidity. Methods: This is a secondary analysis of the Brazilian Network for Surveillance of Severe Maternal Morbidity, a national multicenter cross-sectional study of 27 Brazilian referral maternity hospitals. A prospective surveillance was performed to identify cases of maternal death (MD), maternal near miss (MNM) events, and potentially life-threatening conditions (PLTC), according to standard WHO definition and criteria. Among 9,555 women with severe maternal morbidity, data on race/skin color was available for 7,139 women, who were further divided into two groups: 4,108 nonwhite women (2,253 black and 1,855 from other races/skin color) and 3,031 white women. Indicators of severe maternal morbidity according to WHO definition are shown by skin color group. Adjusted Prevalence Ratios (PRadj - 95%CI) for Severe Maternal Outcome (SMO=MNM+MD) were estimated according to sociodemographic/obstetric characteristics, pregnancy outcomes, and perinatal results considering race. Results: Among 7,139 women with severe maternal morbidity evaluated, 90.5% were classified as PLTC, 8.5% as MNM, and 1.6% as MD. There was a significantly higher prevalence of MNM and MD among white women. MNMR (maternal near miss ratio) was 9.37 per thousand live births (LB). SMOR (severe maternal outcome ratio) was 11.08 per 1000 LB, and MMR (maternal mortality ratio) was 170.4 per 100,000 LB. Maternal mortality to maternal near miss ratio was 1 to 5.2, irrespective of maternal skin color. Hypertension, the main cause of maternal complications, affected mostly nonwhite women. Hemorrhage, the second more common cause of maternal complication, predominated among white women. Nonwhite skin color was associated with a reduced risk of SMO in multivariate analysis. Conclusion: Nonwhite skin color was associated with a lower risk for severe maternal outcomes. This result could be due to confounding factors linked to a high rate of Brazilian miscegenation.

Electron-phonon dynamics in 2D carbon based-hybrids XC (X = Si, Ge, Sn).

The effect of the presence of electron-phonon (e-ph) coupling in the SiC, GeC and SnC hybrids is studied in the framework of the ab initio perturbation theory. The electronic bang gap thermal dependence reveals a normal monotonic decrease in the SiC and GeC semiconductors, whereas SnC exhibits an anomalous behavior. The electron line widths were evaluated and the contributions of acoustic and optical phonon modes to the imaginary part of the self-energy were determined. It has been found that the e-ph scattering rates are globally controlled by the out-of-plane acoustic transverse mode ZA in SiC while both ZA and ZO are overriding in GeC. In SnC, the out-of-plane transverse optical mode ZO is the most dominant. The relaxation lifetime of the photo-excited electrons shows that the thermalization of the hot carrier occurs at 90 fs, 100 fs and 120 fs in SiC, GeC and SnC, respectively. The present study properly describes the subpicosecond time scale after sunlight illumination using an approach that requires no empirical data. The results make the investigated structures suitable for providing low cost and high-performance optical communication and monitoring applications using 2D materials.

Time series analysis of ambient air-temperature during the period 1970-2016 over Sydney, Australia.

Providing evidence of potential changes in the climate has become increasingly important as it is the first step towards adopting mitigation and adaptation measures and planning for urban resilience. In this study a statistical analysis of the ambient air temperature time series over Sydney, Australia during 1970-2016 has been carried out with the aim to investigate potential changes towards higher temperatures. The dataset has been statistically analyzed using different techniques, concluding that the investigation should be performed on a monthly basis. A persistence analysis was conducted using different statistical approaches to investigate the dependence between consecutive monthly and daily ambient air temperature values. A trend analysis of the ambient air temperature and degree days time series has been conducted using linear regression to estimate the linear trend (slope) and its statistical significance (using a Student-t-test) and the Kendall-Mann test to identify the time at which the tendency starts to occur as well as the time after which it becomes statistically significant.

Association of protein intake with the outcomes of critically ill patients: a post hoc analysis of the PermiT trial.

Background: The optimal amount of protein intake in critically ill patients is uncertain. Objective: In this post hoc analysis of the PermiT (Permissive Underfeeding vs. Target Enteral Feeding in Adult Critically Ill Patients) trial, we tested the hypothesis that higher total protein intake was associated with lower 90-d mortality and improved protein biomarkers in critically ill patients. Design: In this post hoc analysis of the PermiT trial, we included patients who received enteral feeding for ≥3 consecutive days. Using the median protein intake of the cohort as a cutoff, patients were categorized into 2 groups: a higher-protein group (>0.80 g · kg-1 · d-1) and a lower-protein group (≤0.80 g · kg-1 · d-1). We developed a propensity score for receiving higher protein. Primary outcome was 90-d mortality. We also compared serial values of prealbumin, transferrin, 24-h urinary nitrogen, and 24-h nitrogen balance on days 1, 7, and 14. Results: Among the 729 patients included in this analysis, the average protein intake was 0.8 ± 0.3 g · kg-1 · d-1 [1.0 ± 0.2 g · kg-1 · d-1 in the higher-protein group (n = 365) and 0.6 ± 0.2 g · kg-1 · d-1 in the lower-protein group (n = 364); P < 0.0001]. There was no difference in 90-d mortality between the 2 groups [88/364 (24.2%) compared with 94/363 (25.9%), propensity score-adjusted OR: 0.80; 95% CI: 0.56, 1.16; P = 0.24]. Higher protein intake was associated with an increase in 24-h urea nitrogen excretion compared with lower protein intake, but without a significant change in prealbumin, transferrin, or 24-h nitrogen balance. Conclusions: In the PermiT trial, a moderate difference in protein intake was not associated with lower mortality. Higher protein intake was associated with increased nitrogen excretion in the urine without a corresponding change in prealbumin, transferrin, or nitrogen balance. Protein intake needs to be tested in adequately powered randomized controlled trials targeting larger differences in protein intake in high-risk populations.

Expression differences of genes in the PI3K/AKT, WNT/b-catenin, SHH, NOTCH and MAPK signaling pathways in CD34+ hematopoietic cells obtained from chronic phase patients with chronic myeloid leukemia and from healthy controls.

PURPOSE: The fusion gene BCR-ABL has an important role to the progression of chronic myeloid leukemia (CML) and several signaling pathways have been characterized as responsible for the terminal blastic phase (BP). However, the initial phase, the chronic phase (CP), is long lasting and there is much yet to be understood about the critical role of BCR-ABL in this phase. This study aims to evaluate transcriptional deregulation in CD34+ hematopoietic cells (CD34+ cells) from patients with untreated newly diagnosed CML compared with CD34+HC from healthy controls. METHODS: Gene expression profiling in CML-CD34 cells and CD34 cells from healthy controls were used for this purpose with emphasis on five main pathways important for enhanced proliferation/survival, enhanced self-renewal and block of myeloid differentiation. RESULTS: We found 835 genes with changed expression levels (fold change ≥ ±2) in CML-CD34 cells compared with CD34 cells. These include genes belonging to PI3K/AKT, WNT/b-catenin, SHH, NOTCH and MAPK signaling pathways. Four of these pathways converge to MYC activation. We also identified five transcripts upregulated in CD34-CML patients named OSBPL9, MEK2, p90RSK, TCF4 and FZD7 that can be potential biomarkers in CD34-CML-CP. CONCLUSION: We show several mRNAs up- or downregulated in CD34-CML during the chronic phase.

Development of the New Zealand White Rabbit Eye: I. Pre- and Postnatal Development of Eye Tunics.

The New Zealand white (NZW) rabbit has been and is right now regularly utilized in ophthalmic surgery evaluation. Inside NZW rabbit eye, the visibility of ocular structures throughout surgical procedure is fantastic. Younger rabbits are used in different ages for the evaluation of ophthalmic surgery. Complete studies of ocular development in the NZW rabbits have not been reported previously. The aim of the present investigation was to describe the major landmarks and the time course of the pre- and post-natal development of the complete eye tunics of the NZW rabbit to give a superb model as well as a fruitful area for further ophthalmological investigations. Serial histological sections of NZW rabbit prenatal (E13-E28) and post-natal (P1-P14) stages were examined, respectively. The eye of the NZW rabbit developed in a similar manner to that of the human and domestic animals eyes; the principal differences were at the time of occurrence of certain developmental events, absence of pigmentation which represent an exploited benefit for ophthalmic surgery, remarkable Bowman's membrane at E25, poor developed ciliary stroma and juvenile retinal layer until P9. In human, the basic morphogenetic processes of the development of eye tunics are completed towards the end of the first half of gestation period. However, the latter represents the beginning stage of the development of eye tunics in the rabbit. Thus, allowing various extensive ophthalmic researches to be performed.

Can local infiltration analgesia increase satisfaction in postoperative short-term pain control in total knee arthroplasty?

BACKGROUND: One of the major challenges to total knee arthroplasty (TKA) is optimal pain control. Effective analgesia is capital in fast-track surgery programs to allow patient's early functional outcomes. OBJECTIVES: Compare length of stay (LOS) short-term pain control, and patients' satisfaction at 1 month between local infiltration analgesia (LIA) combined with femoral nerve block (FNB) and FNB only in patients undergoing TKA. PATIENTS AND METHODS: Two hundred and fifty-four patients were included in a randomized prospective study and distributed in two groups. The first group received an intraoperative LIA (150 mL mixture of ropivacaine 2.0 mg/mL + ketorolac 30 mg + adrenaline 10 µg/mL) combined to an FNB. The control group had only an FNB. Demographical data and visual analog scale (VAS) score were obtained preoperatively, at 36 h after surgery and at the 15-day follow-up. Patients' satisfaction at 1 month was also evaluated. Statistical analysis data was performed. RESULTS: No differences in demographical data and preoperative VAS score were observed between both groups. LIA group had a lower VAS score at 36 h after surgery (1.34 ± 1.31 vs. 3.68 ± 1.932 in the control group, p = 0.00), but these differences were not maintained at the 15-day follow-up (4.51 ± 1.889 vs. 4.11 ± 1.940 in the control group, p > 0.05). LOS and patients' satisfaction were comparable between groups. Patients with LIA had no additional complications. CONCLUSIONS: LIA is a safe adjuvant to FNB to reduce perioperative pain during the first 36 h after TKA. Its effects wean with time, but do cover the first crucial hours of rehabilitation in a fast-track program. LIA seems don't modify postoperative course nor patient's satisfaction at short-term follow-up. The final impact of LIA on surgical outcome is still to be determined.

¿Se deben tratar quirúrgicamente las fracturas de extremidad inferior en pacientes con lesiones medulares crónicas? Experiencia en un centro de referencia / Should lower limb fractures be treated surgically in patients with chronic spinal injuries? Experience in a reference centre

Objetivo. Conocer los resultados del tratamiento quirúrgico de las fracturas de extremidad inferior en los pacientes con lesiones medulares crónicas. Material y método. Entre el 2003-2012 se trataron 37 fracturas de extremidad inferior, divididas en 2 grupos según su tratamiento, 25 en el grupo quirúrgico y 12 en el grupo conservador. Resultados. El grupo quirúrgico presentó mejores resultados en cuanto a balance articular, consolidación ósea, alineación radiológica y menor número de úlceras por presión. No se detectaron diferencias entre grupos en cuanto a estancia hospitalaria, número de complicaciones médicas y control del dolor. Discusión. Actualmente no hay consenso respecto al manejo de las fracturas de extremidad inferior en lesionados medulares crónicos, pero la tendencia ha sido el tratamiento conservador escudándose en la alta tasa de complicaciones del tratamiento quirúrgico. Conclusiones. En fracturas de extremidad inferior en lesionados medulares crónicos, la estabilización quirúrgica presenta mejores resultados de consolidación ósea, un balance articular prácticamente libre, una baja tasa de complicaciones cutáneas y dolor asociado a la fractura. Todo ello permite un rápido retorno al nivel previo de la lesión, por lo que se debe tener en cuenta como alternativa al tratamiento conservador (AU)

Objective. To report the outcomes of surgical treatment of lower limb fractures in patients with chronic spinal cord injuries. Material and method. A total of 37 lower limb fractures were treated from 2003 to 2010, of which 25 fractures were treated surgically and 12 orthopaedically. Results. Patients of the surgical group had better clinical results, range of motion, bone consolidation, and less pressure ulcers and radiological misalignment. No differences were detected between groups in terms of pain, hospital stay, and medical complications. Discussion. There is no currently consensus regarding the management of lower limb fractures in patients with chronic spinal cord injuries, but the trend has been conservative treatment due to the high rate of complications in surgical treatment. Conclusions. Chronic spinal cord injuries patients with lower limb fractures who are treated surgically achieved a more reliable consolidation, practically a free range of motion, low rate of cutaneous complications, and pain associated with the fracture. This allows a quick return to the previous standard of living, and should be considered as an alternative to orthopaedic treatment in these patients (AU)

Effect of red blood cell preservation by droplet freezing with non-permeable cryoprotective agents in blood group antigen reactivity.

BACKGROUND: In the last few decades, various red blood cell (RBC) freezing techniques have been developed and improved to enable the preservation of erythrocytes for future use in pre-transfusion tests in reference immunohaematology laboratories. However, not all these techniques have been sufficiently evaluated for the preservation of blood group antigens. OBJECTIVES: In this study, we evaluated the antigenic pattern of RBCs preserved by droplet freezing in liquid nitrogen in a blood bank context. METHODS: Blood samples were evaluated for the reactivity of blood group antigens after droplet freezing using the non-permeable cryoprotective agent polyvinylpyrrolidone (PVP) and sucrose-dextrose (S + D) solutions. RESULTS: No qualitative changes were observed in RBC reactivity after freezing and thawing for the antigens Fyb , Leb , C, E, Cw , Lua , Lub , Kpa , Kpb and Dia . However, cryopreservation using PVP resulted in a significant increase in reactivity of Fyb antigen on comparing fresh and frozen samples (P < 0·001). CONCLUSION: The establishment of detailed protocols for cryopreservation of RBCs, which take into account the maintenance of antigenic characteristics, is necessary to increase security in pre-transfusion testing using frozen RBCs.

Adrenal gland hemangioma: A rare case of the incidentaloma: Case report.

BAKGROUND: Adrenal glands hemangiomas are rare, benign and non-functional tumors. They are often discovered as incidentalomas either during imaging or autopsies. Nearly 70 cases were reported in the literature. CASE REPORT: We report a case of a non-functional adrenal hemangioma (AH) that was incidentally found on abdominal ultra sonography (US) during the routine control of diabetes of a 58 year-old man. Imaging with US and Computed tomography (CT) showed an heterogeneous and partially calcified 6 cm tumor of the right adrenal gland. The mass was surgically excised and the histological examination concluded to an adrenal haemangioma. CONCLUSION: Although rare, AH should be included in the differential diagnosis of the adrenal neoplasmas.

Should lower limb fractures be treated surgically in patients with chronic spinal injuries? Experience in a reference centre. / ¿Se deben tratar quirúrgicamente las fracturas de extremidad inferior en pacientes con lesiones medulares crónicas? Experiencia en un centro de referencia.

OBJECTIVE: To report the outcomes of surgical treatment of lower limb fractures in patients with chronic spinal cord injuries. MATERIAL AND METHOD: A total of 37 lower limb fractures were treated from 2003 to 2010, of which 25 fractures were treated surgically and 12 orthopaedically. RESULTS: Patients of the surgical group had better clinical results, range of motion, bone consolidation, and less pressure ulcers and radiological misalignment. No differences were detected between groups in terms of pain, hospital stay, and medical complications. DISCUSSION: There is no currently consensus regarding the management of lower limb fractures in patients with chronic spinal cord injuries, but the trend has been conservative treatment due to the high rate of complications in surgical treatment. CONCLUSIONS: Chronic spinal cord injuries patients with lower limb fractures who are treated surgically achieved a more reliable consolidation, practically a free range of motion, low rate of cutaneous complications, and pain associated with the fracture. This allows a quick return to the previous standard of living, and should be considered as an alternative to orthopaedic treatment in these patients.

Espaciador de cadera "invertido" para defectos masivos de fémur distal en infecciones periprotésicas de rodilla / "Reverse" hip spacer for massive distal femur defects in peri-prosthetic knee infections

Introducción. Los defectos óseos del fémur distal son un problema común en la cirugía de revisión de rodilla. El problema se agrava en el contexto de una infección activa. En casos extremos, esta pérdida de hueso compromete la viabilidad de un protocolo de recambio en dos tiempos usando espaciadores dinámicos, debido a la inestabilidad inherente de estos espaciadores. El uso de un espaciador prefabricado de cadera usado de manera «inversa» con una articulación tipo ball-and-socket es una opción terapéutica en casos de defecto óseo masivo e infección. Material y métodos. Se realiza una revisión retrospectiva de nuestra base de datos institucional desde enero del 2010 hasta diciembre del 2013 para localizar todos los casos de defecto femoral distal masivo en un contexto séptico en el que esta técnica ha sido utilizada. Se recogen datos epidemiológicos, características de la infección (clínicas y microbiológicas) y eventos entre los tiempos quirúrgicos. Evaluamos como objetivo principal la tasa de erradicación de la infección tras al menos 18 meses de evolución del 2.° tiempo. También evaluamos las complicaciones relacionadas con la técnica. Finalmente cada paciente completó una escala analógica visual de dolor, y un cuestionario de satisfacción (SAPS). Resultados. Finalmente seis pacientes cumplieron los criterios de inclusión. La mediana del defecto femoral fue de 117cm (rango: 32-191cm). El tiempo medio con espaciador fue de 7,6 meses. Entre las complicaciones relacionadas con la técnica solo tuvimos un caso de luxación del espaciador. A todos los pacientes, excepto uno, se le realizó el segundo tiempo, reconstruyendo la articulación con una megaprótesis cementada, con un seguimiento medio tras el segundo tiempo de 34,7 meses. Al final del seguimiento se controló la infección en todos los casos. Todos los pacientes manifestaron altos grados de satisfacción con la técnica empleada y un correcto control del dolor, con una media de la escala analógica visual de 1 (rango 0-4). Conclusión. Presentamos una técnica reproducible, segura y con una baja tasa de complicaciones. Los pacientes refieren una gran satisfacción con el procedimiento y no tuvimos casos de recidiva de la infección tras un seguimiento mínimo de 18 meses (AU)

Background. Bone loss in the distal femur is a common problem in knee revision surgeries. The problem is exacerbated in the context of an active infection. In extreme cases this bone loss could compromise the feasibility of a two-stage exchange protocol using dynamic spacers due to the inherent instability of this type of spacers. Use of a hip prefabricated spacer in a “reverse” way forming a ball-and- socket joint is a therapeutic option in cases of massive bone defect and infection. Material and methods. A retrospective review was performed of our institutional database to identify all cases of massive distal femoral defect in which this technique was used from January 2010 to December 2013. A record was made of the epidemiological data, characteristics of the infection (clinical and microbiological), and adverse event during the spacer stage. The main end-point was the infection eradication rate (minimum: 18 months of follow-up). The complications associated with the technique were also assessed. Finally, each patient completed a visual analogue pain scale, and a satisfaction questionnaire (SAPS). Results. This technique was successfully used in six cases so far, controlling the infection in all cases. Mean femoral defect was 117cm (range: 32-191cm). Mean time with spacer was 7.6 months, with no major complications. All but one patient reached second stage reconstruction with a mega-prosthesis, and mean time since second stage was 34.7 months. All patients stated high levels of satisfaction with the technique employed, as well as and low pain scores (mean visual analogue pain scale: 1; range: 0-4). Conclusion. A reproducible and safe technique is described. Patients report a high level of satisfaction with the procedure, and there were no cases of recurrence of the infection after a minimum follow-up of 18 months (AU)