Prognostic factors and survival in Ewing's sarcoma treated by limb salvage surgery.

PURPOSE: Survival in Ewing's sarcoma (ES) has increased with the use of chemotherapy. Surgical techniques such as limb salvage (LS) have been developed. Survival and adverse events have been widely studied in general series of ES, but there are few specific series of ES cases treated by LS, despite this being the most commonly used (surgical) approach. The aim of this study was to determine survival and prognostic factors in ES patients undergoing LS. PATIENTS AND METHODS: We analysed all ES patients treated between January 1984 and May 2008 and selected all those treated by systemic multimodal therapy and LS. We assessed the influence of patient characteristics, tumour parameters and therapeutic results in event-free survival (EFS). RESULTS: Ninety patients were included. Fifty of them were treated by systemic multimodal therapy and locally by LS. ean age was 20 years. Overall survival (OS) was 68.8% and EFS was 60.6% at years. In the univariate analysis, pelvic location, age and response to chemotherapy were associated with poor prognosis. After multivariate analysis, poor response to treatment, pelvis location and age between 12 and 17 years were found to be independent prognostic factors. Dissemination at diagnosis was not a prognostic factor. CONCLUSIONS: OS and EFS in ES treated by LS were similar to findings in previous ES studies. factors are no different, except for the presence of metastasis at diagnosis.

Luxación de codo con fractura ipsilateral del extremo distal del radio asociada a lesión de la arteria braquial. Una nueva entidad patológica de origen traumático / Elbow dislocation with ipsilateral fracture of the distal radius associated with a brachial artery injury: a new pathological condition of traumatic origin

La luxación de codo asociada a fractura ipsilateral del radio distal y lesión de la arteria braquial constituye una patología traumática infrecuente. Las 2 referencias de esta asociación de lesiones aparecieron en 2015, aunque en ambas, los autores no advirtieron que constituían los 2 primeros casos publicados en la literatura médica; incluso en el título de sus artículos, no se hizo mención de la fractura del extremo distal del radio, pero sí en sus textos. El objeto de este trabajo es dar a conocer 3 casos con esta nueva entidad patológica traumática, explicar su posible mecanismo patogénico, el tratamiento utilizado y los resultados obtenidos (AU)

Elbow dislocation associated with ipsilateral fracture of the distal radius and a brachial artery injury is an uncommon traumatic entity. The two references of this injury combination appeared in 2015, although both authors did not realise that they were the first two cases published in the medical literature. Although mentioned in the text of the articles, no mention was made of the fracture of the distal radius in the titles. The purpose of this paper is to present three cases with this new traumatic pathological entity, explaining its pathogenetic mechanism, the treatment used, and the results obtained (AU)

Elbow dislocation with ipsilateral fracture of the distal radius associated with a brachial artery injury: A new pathological condition of traumatic origin. / Luxación de codo con fractura ipsilateral del extremo distal del radio asociada a lesión de la arteria braquial. Una nueva entidad patológica de origen traumático.

Elbow dislocation associated with ipsilateral fracture of the distal radius and a brachial artery injury is an uncommon traumatic entity. The two references of this injury combination appeared in 2015, although both authors did not realise that they were the first two cases published in the medical literature. Although mentioned in the text of the articles, no mention was made of the fracture of the distal radius in the titles. The purpose of this paper is to present three cases with this new traumatic pathological entity, explaining its pathogenetic mechanism, the treatment used, and the results obtained.

Artroplastia de la articulación interfalángica proximal: comparación entre el abordaje palmar y dorsal / Proximal interphalangeal joint replacement: a comparison between the volar and dorsal approach

Introducción. La artropatía de las articulaciones interfalángicas proximales (AIP) cursa con síntomas muy restrictivos, siendo algunos casos tributarios de artroplastia. En la mayoría de las series de artroplastias de las AIP la técnica utilizada es a través de un abordaje dorsal. El papel del abordaje palmar en la artroplastia de las AIP todavía no se ha valorado suficientemente. Objetivo. Revisar retrospectivamente los pacientes intervenidos de artroplastia de la AIP, y determinar si las realizadas por vía palmar consiguen un rango de extensión mayor que las realizadas por vía dorsal. Pacientes y métodos. Entre 2005-2010 se realizaron 22 artroplastias de AIP. La media de seguimiento fue de 29 meses. El implante que se utilizó en todos los pacientes fue el implante de silicona de AIP modelo Avanta® (Avanta Orthopaedics, San Diego, California, EE. UU.). Se realizó un abordaje dorsal en 14 articulaciones y un abordaje palmar en 8. La valoración clínica preoperatoria incluyó la escala visual analógica (EVA) y el arco de movimiento. El arco de movimiento preoperatorio medio era de -15°/60° en ambos grupos. En la última visita del seguimiento, la EVA y el rango de movimiento se registraron y se compararon con los valores preoperatorios. Resultados. El arco medio de flexo-extensión postoperatorio del grupo del abordaje dorsal era de -15°/60°, y el del abordaje palmar de -2°/62°. Conclusión. En nuestra serie hemos observado que las artroplastias de AIP realizadas por vía palmar consiguen un rango de extensión mayor que aquellas realizadas por vía dorsal. El abordaje palmar ofrece las ventajas de mantener la integridad del mecanismo extensor (AU)

Introduction. Arthropathy of the proximal interphalangeal (PIP) joint symptoms is very restrictive, and in some cases arthroplasty is required. In most of the reported series of PIP silicone arthroplasty, the technique described is the dorsal approach. As far as we know, the role of the volar approach in PIP arthroplasty has still not been adequately assessed. Objectives. To retrospectively review the patients who had PIP joint arthroplasty, and to study the clinical and radiographic outcomes in relation to the approach: volar or dorsal. Methods. A total of 22 PIP joint replacements were performed between 2005 and 2010. The mean age was 56 years and the mean follow-up period was 29 months. The implant used in all patients was the Avanta® PIP Soft-Skeletal Implant (Avanta Orthopaedics, San Diego, USA). The dorsal approach was performed in 14 joints, and a volar approach in 8 joints. The preoperative clinical evaluation included a visual analogue scale (VAS) and the range of motion (ROM). The preoperative ROM mean was -15°/60° in both groups. The VAS and the ROM in the last follow-up visit were recorded and compared with preoperative values. Results. The postoperative ROM of the dorsal approach group had a mean of -15°/60°, and that of the volar approach was -2°/62°. Conclusion. It was found that the volar approach in this series offers the advantages of maintaining the integrity of the extensor mechanism, resulting in a complete restoration of the extension in the range of motion (AU)

Síndrome de Fenton / Fenton syndrome

El síndrome de la fractura-luxación transescafo-hueso grande o síndrome de Fenton, constituye una lesión muy poco frecuente. En este artículo se presentan 3 casos que fueron tratados mediante reducción abierta y fijación interna con minitornillos, obteniendo buenos resultados a los 16 meses del seguimiento medio (AU)

Scaphocapitate, or Fenton syndrome, is a rare injury. This article presents three new cases that were treated by open reduction and internal fixation with miniscrews, obtaining good results at 16 months follow-up (AU)

[Fenton syndrome]. / Síndrome de Fenton.

Scaphocapitate, or Fenton syndrome, is a rare injury. This article presents three new cases that were treated by open reduction and internal fixation with miniscrews, obtaining good results at 16 months follow-up.

Distal interphalangeal joint arthrodesis: treatment with Herbert screw.

From 1996 to 2000, 20 patients with a mean age of 53 underwent 20 arthrodeses with Herbert screws. There were 16 (80%) distal interphalangeal joint (DIP) and 4 (20%) thumb interphalangeal (IP) joint arthrodeses. Average follow-up was 25 months (range, 6-39 months). The diagnoses included rheumatoid arthritis in 10 patients, degenerative arthritis in 4, and post-traumatic arthritis in 6. Arthrodesis relieved pain and restored stability in all patients. Solid osseous union occurred in 19 patients (95%). The average interval to fusion was 8 weeks for DIP and 12 weeks for IP joint arthrodesis. Solid osseous union occurred in 19 patients (95%). The average interval to fusion was 8 weeks for distal interphalangeal joint arthrodesis and 12 weeks for interphalangeal joint of the thumb. There were three complications: one delayed union, one nonunion because of a short screw, and one dorsal skin necrosis with amputation. It was shown that distal interphalangeal joint arthrodesis with a Herbert screw is a technique with several advantages: good clinical results, high rates of fusion, early mobilization, and the screw does not need to be removed after the fusion heals. Potential complications may be avoided by using the Herbert mini-screw.

Artroplastia de silicona del semilunar en la enfermedad de Kienböck: seguimiento a largo plazo / Lunate bone silicone arthroplasty in Kienböck's disease: long-term follow-up

Entre 1986 y 1993 se trataron 20 pacientes con implantes de silicona para la enfermedad de Kienböck con un seguimiento medio de 7 años. La edad media de los pacientes era de 33 años y según la clasificación de Lichtman ocho fueron Grado II, ocho Grado IIIA y cuatro Grado IIIB. Al final del seguimiento el 75 por ciento presentaban persistencia del dolor y un balance articular limitado. A nivel radiológico hubo un colapso carpiano (altura carpiana media de 0,49) y una traslación cubital (distancia cubitocarpiana media de 0,26).Se presentaron las siguientes complicaciones: luxación del implante hacia cubital en dos pacientes; subluxación en dos, una palmar y otra dorsal; presencia de inestabilidad en DISI en seis y en VISI en dos; siliconitis e imágenes líticas intraóseas en ocho y presencia de artropatía degenerativa radio e intercarpiana en 10.Cuatro pacientes precisaron de reintervención: tres artrodesis del carpo y una resección de la primera fila. El implante de silicona genera a largo plazo una sinovitis reactiva con destrucción del carpo, siendo incapaz de frenar la evolución a colapso carpiano y a traslación cubital. A causa de sus limitaciones no creemos que tenga indicación actualmente en el tratamiento de la enfermedad de Kienböck (AU)