¿Disminuyen las complicaciones cutáneas tras la cirugía de fracturas de tobillo con el uso de Aquacel Extra Ag(R)? / Do surgical site complications after ankle fracture surgery reduce with Aquacel Extra Ag(R)?

Introducción: Las fracturas de tobillo representan un 10% del total de fracturas. La mayor parte requieren tratamiento quirúrgico, que conlleva un importante riesgo de complicaciones de la herida. El objetivo de este estudio ha sido determinar si los apósitos impregnados con plata (Aquacel Ag Extra(R)) reducen la tasa de complicaciones de la herida quirúrgica tras el tratamiento de las fracturas de tobillo en comparación con el uso de gasas estériles. Métodos: De forma prospectiva se han reunido 233 pacientes con fracturas de tobillo subsidiarias de tratamiento quirúrgico. Desde el inicio del estudio en julio de 2017 hasta febrero de 2018, los traumatólogos participantes en el estudio cambiaron el uso de la gasa estéril estándar para cubrir la herida quirúrgica tras su cierre por Aquacel Ag Extra(R), manteniendo el resto del protocolo pre- y posquirúrgico igual. Se comparan la tasa de complicaciones cutáneas en ambos grupos, tras un seguimiento de 3 meses. Resultados: El análisis estadístico no reflejó diferencias significativas entre ambos grupos. Conclusiones: Se necesitan ensayos clínicos aleatorizados para demostrar las ventajas teóricas de los apósitos impregnados con plata y su indicación en Traumatología

Introduction: Ankle fractures account for up to 10% of total fractures. Most of them require surgical fixation, which involves an important risk of wound complications. The aim of this study was to determine whether a silver-impregnated occlusive surgical dressing (Aquacel Ag Extra(R)) was effective in reducing the rates of wound complications after ankle fracture open reduction and internal fixation compared to standard sterile dressing. Methods: We prospectively reviewed 233 patients who underwent ankle fracture open reduction and internal fixation. Surgeons switched from using a standard dressing to an Aquacel Ag Extra(R) from July 2017 to February 2018, without other major changes in perioperative management. We compared skin complications between both groups after 3 months' follow-up. Results: The statistical analysis showed that there is no difference in the prevalence of skin complications between both groups. Conclusions: The theoretical advantages of silver impregnated dressings need further prospective randomized controlled studies to assess the appropriate indications for their use in orthopaedic surgery

Do surgical site complications after ankle fracture surgery reduce with Aquacel Extra Ag®? / ¿Disminuyen las complicaciones cutáneas tras la cirugía de fracturas de tobillo con el uso de Aquacel Extra Ag®?

INTRODUCTION: Ankle fractures account for up to 10% of total fractures. Most of them require surgical fixation, which involves an important risk of wound complications. The aim of this study was to determine whether a silver-impregnated occlusive surgical dressing (Aquacel Ag Extra®) was effective in reducing the rates of wound complications after ankle fracture open reduction and internal fixation compared to standard sterile dressing. METHODS: We prospectively reviewed 233 patients who underwent ankle fracture open reduction and internal fixation. Surgeons switched from using a standard dressing to an Aquacel Ag Extra® from July 2017 to February 2018, without other major changes in perioperative management. We compared skin complications between both groups after 3 months' follow-up. RESULTS: The statistical analysis showed that there is no difference in the prevalence of skin complications between both groups. CONCLUSIONS: The theoretical advantages of silver impregnated dressings need further prospective randomized controlled studies to assess the appropriate indications for their use in orthopaedic surgery.

Cirugía de rescate en casos de desplazamiento secundario crónico de la tuberosidad tibial anterior en la adolescencia: a propósito de un caso / Rescue surgery in cases of secundary chronic displatibialcement of the previus tuberosity in the adolescence. Case report

Objetivos: Presentar una nueva forma de fijación en recidivas de arrancamiento de la tuberosidad tibial anterior (TTA) en niños. Material y Métodos: Varón de 14 años intervenido tras sufrir epifisiolisis tipo III de TTA fijando el fragmento avulsionado con 2 tornillos. Cuatro meses después presentaba una importante pérdida de movilidad con atrofia cuadricipital debido a un nuevo arrancamiento de la TTA. Se reconstruyó con injerto hueso-tendón-hueso (HTH) y se fijó con dos placas Quad (proximal y distal) con 4 tornillos. Resultados: Cuatro meses después presenta flexoextensión completa y está comenzando el retorno a la actividad deportiva. Conclusión: El desplazamiento secundario crónico de una avulsión de la TTA supone una rara, aunque grave complicación en el tratamiento de las fracturas desplazadas de la TTA, que menoscaba la situación funcional del paciente y dificulta de forma considerable la reconstrucción del aparato extensor. La mayoría de ellas intervienen y son fijadas con agujas y cerclajes de alambre que, aunque efectivos, causan molestias al paciente y requieren su retirada. Presentamos una nueva forma de osteosíntesis: la placa Quad con cuatro tornillos que consigue una fijación estable sin molestias, reduciendo la necesidad de retirada

We report a case of physeal fracture type III of tibial anterior tuberosity (TTA) in a 14 years old boy who underwent surgery consisting on fixation with two screws. After 4 months, he presented with an inability to extend and quadricipital atrophy due to a new avulsion. He underwent reconstruction of the patellar tendon using a massive BTB allograft, which was fixated with a Quad plate and 4 screws. Four months after surgery, the patient had full range of extension and 95º of flexion and he is returning to sport activities. Secondary chronic TTA avulsion is a rare, but serious complication after displaced TTA fractures. They affect significantly to functional outcomes. Extensor system reconstruction is a challenging pro cedure. Most of them are fixed with wire cerclage that sometimes become symptomatic and a second surgery is required. We expose a new way of osteosynthesis: Quad plate with four screws provides stable fixation without hardware symptoms

CLOVES syndrome: review of a PIK3CA-related overgrowth spectrum (PROS).

Overgrowth syndromes are characterized by global or localized disproportionate growth associated with other anomalies, including vascular malformations and neurological and/or visceral disorders. CLOVES (Congenital Lipomatous asymmetric Overgrowth of the trunk with lymphatic, capillary, venous, and combined-type Vascular malformations, Epidermal naevi, Scoliosis/Skeletal and spinal anomalies) is an overgrowth syndrome caused by mosaic activating mutation in gene PIK3CA, which gives rise to abnormal PI3K-AKT-mTOR pathway activation. These mutations are responsible for the clinical manifestations of the syndrome, which include low- and high-flow vascular malformations, thoracic lipomatous hyperplasia, asymmetric growth, and visceral and neurological disorders. These common anomalies are illustrated with figures from two personal cases. Identification of the clinical and genetic characteristics of CLOVES syndrome is crucial for the differential diagnosis with other overgrowth syndromes, such as Proteus or Klippel-Trenaunay (K-T) syndromes, and for the therapeutic management of the different anomalies. In this context, a new entity comprising different syndromes with phenotypic mutations in PIK3CA has been proposed, designated PIK3CA-related overgrowth spectrum (PROS), with the aim of facilitating clinical management and establishing appropriate genetic study criteria.