Tratamiento quirúrgico de las lesiones del manguito de los rotadores.Controversia y evidencia / Surgical treatment of rotator cuff lesions. Controversy and evidence

La lesión del manguito de los rotadores es el síndrome doloroso más frecuente en la articulación del hombro. El tratamiento conservador ofrece resultados satisfactorios en la mayoría de los casos. No obstante, muchos pacientes no evolucionan de forma adecuada con las medidas conservadoras y requieren tratamiento quirúrgico. En el presente trabajo realizamos un repaso comparativo, basado en la evidencia disponible, de diferentes procedimientos relacionados con la reparación de las lesiones del manguito de los rotadores. Se abordan de forma crítica las ventajas e inconvenientes de los mismos, así como las posibles controversias que aparecen en la literatura científica

Rotator cuff injuries are the most frequent painful, shoulder joint disorders. Conservative treatments provide satisfactory results in the majority of cases, however, many patients do not evolve satisfactorily with these measures and require surgical intervention. The present study performed a comparative evidence-based review of the various procedures related to the repair of the rotator cuff lesions. A critical approach was used to investigate the advantages and disadvantages of the same together with any possible controversies reported in the literature

Tratamiento quirúrgico de las lesiones del manguito de los rotadores. Indicación y planificación preoperatoria / Surgical treatment of rotator cuff lesions. Indication and preoperative planning

La lesión del manguito de los rotadores es el síndrome doloroso más frecuente en la articulación del hombro. El tratamiento conservador ofrece resultados satisfactorios en la mayoría de los casos. No obstante, muchos pacientes no evolucionan de forma adecuada con las medidas conservadoras y requieren tratamiento quirúrgico. El objetivo de este trabajo es revisar las indicaciones quirúrgicas actuales, así como evaluar numerosos parámetros, tanto clínicos como radiológicos, que resultan fundamentales en la planificación de una intervención quirúrgica dirigida a la reparación de lesiones en el manguito de los rotadores

Rotator cuff injuries are the most frequent painful, shoulder joint disorders. Conservative treatments provide satisfactory results in the majority of cases, however, many patients do not evolve satisfactorily with these measures and require surgical intervention. The present study reviewed the surgical indications as well as the numerous radiological and clinical parameters that were fundamental when planning surgical interventions aimed at repairing rotator cuff lesions

Es posible la osteosíntesis mínimamente invasiva de la diáfisis del húmero sin riesgos? Estudio en el cadáver (técnica y anatomía) / Is risk-free minimally invasive humeral shaft osteosynthesis possible? A cadaver study (technique and anatomy)

Objetivos: Determinar la viabilidad de aplicar la técnica MIPPO (minimally invasive percutaneous plate osteosynthesis, “osteosíntesis percutánea con placa mínimamente invasiva”) en el tratamiento de las fracturas diafisarias de húmero, y observar las relaciones anatómicas de las distintas estructuras nobles con la placa de osteosíntesis. Introducción: Las fracturas de la diáfisis humeral representan el 1,6% del total de las fracturas quirúrgicas. La reducción abierta y la osteosíntesis con placa a compresión es un método aceptado universalmente pero, al requerir una disección extensa, hay posibilidades de dañar el nervio radial; otra alternativa es el uso de clavos intramedulares, pero el porcentaje de complicaciones es similar. Material y método: Para esto, se realizó un estudio en 5 cadáveres. Se procedió a realizar un miniabordaje deltopectoral en la zona proximal y se realizó la incisión distal a unos 5 cm, proximal a la flexura del codo en la región inferoexterna del brazo. Una vez realizados los 2 miniabordajes, se procedió a realizar un túnel subraquial anterior extraperióstico con un objeto romo, siempre por la cara anterior del húmero, y se introdujo una placa recta estrecha de 10 orificios de proximal a distal. Resultados: Una vez realizada la osteosíntesis, se procedió a identificar la relación de las distintas estructuras anatómicas con la placa prolongando ambas incisiones: no se encontró ninguna estructura anatómica noble en la cara anterior del húmero que pudiera dañarse. Conclusiones: Aunque pueda ser técnicamente difícil, la técnica MIPPO descrita aquí es menos invasiva y traumática que la reducción abierta y la colocación de una placa, además no supone riesgos especiales de lesión en el nervio radial o musculocutáneo (AU)

Purpose: To determine the feasibility of using minimally invasive percutaneous plate osteosynthesis (MIPPO) in the treatment of humeral shaft fractures and analyze the anatomical relations of the different bodily structures with the fixation plate. Introduction: Humeral shaft fractures account for 1.6% of all surgical fractures. Open reduction and compression plate fixation is a universally accepted method, but since it requires an extended dissection it could cause a lesion to the radial nerve. Another alternative is to use intramedullary nails, but the percentage of complications associated to them is similar. Materials and methods: We conducted a study of 5 cadavers. At the proximal level, we carried out a deltopectoral mini approach; the distal incision was performed at about 5 centimeters proximally to the elbow flexure in the inferomedial region of the arm. Once the two mini approaches were completed, a blunt instrument was used to drive an anterior extraperiosteal subbrachial tunnel on the anterior aspect of the humerus through which a 10-hole straight narrow plate was introduced from proximal to distal. Results: Once the osteosynthesis was completed, we identified the relationship of the different anatomical structures with the plate, extending both incisions without finding any significant anatomical structure on the anterior aspect of the humerus that could be damaged. Conclusions: Even if technically challenging, the MIPPO technique described herein is less invasive or traumatic than open reduction and plate fixation, and it is not associated with any special risks of injury to the radial or musculocutaneous nerves (AU)

Arthroscopic repair of the posterior cruciate ligament: two techniques.

SUMMARY: Isolated posterior cruciate ligament injuries are rare and their treatment is controversial. These lesions have commonly been treated by open reduction and internal fixation using a posterior approach. However, this approach makes it difficult to explore other combined injuries of the knee joint. We report 2 cases of posterior cruciate ligament avulsion of the tibia that were arthroscopically reduced and fixed using 2 different methods, cannulated screws and tension band wire.

Intramedullary nailing and functional bracing of tibial shaft fractures: 167 cases followed for minimum 2 years.

We treated 167 diaphyseal tibial fractures without reaming and with intramedullary fixation, using an unlocked Küntscher nail. The patients were followed for a minimum of 2 years. The mean time to union was 16 weeks. There were no serious complications, but 1 case of nonunion, 1 case of deep infection and 2 cases of clinically relevant malalignment. Migration of the nail was observed in 11 cases. We conclude that this treatment is simple and gives satisfactory results in diaphyseal fractures after low- or mid-energy trauma.

Histologic analysis of distraction osteogenesis in the femoral shaft of the immature rabbit.

A study of the distraction callus in the femur of the growing rabbit was performed. Thirty animals separated into 10 groups were used. Distraction between both ends of a femoral osteotomy induced the formation of a connective callus which subsequently ossified. This callus disappeared between the fourth and the eighth week after the lengthening was completed. The osteogenesis model was of a mixed type, intramembranous and endochondral, with a predominance of the former. The bone healing and the initial signs of remodeling in the newly formed bony tissue were seen at the end of the first week of distraction. The original cortex was resorbed during the lengthening and was progressively substituted by a new cortex, whose formation and remodeling was not finished 24 weeks after the completion of the distraction. Experimental conditions could explain some of the findings.

Partial necrosis of the neck of the talus treated with arthroscopy.

An unusual case of an area of necrosis on the talar neck of a girl with a 2-year history of gradually increasing pain following an ankle sprain is presented. Initial radiographs were normal but follow-up radiography showed irregularity in the anterior talar neck. A definitive diagnosis was made by magnetic resonance imaging. Arthroscopic removal of a necrotic fragment from the anterior talar neck that was impinging on the tibia relieved her symptoms. Two years after the operation the patient has normal radiographs and full activity.