Nuevas perspectivas en la formación especializada / No disponible

No disponible

Effect of vitamin C on fracture healing in elderly Osteogenic Disorder Shionogi rats.

We studied the effect of vitamin C on fracture healing in the elderly. A total of 80 elderly Osteogenic Disorder Shionogi rats were divided into four groups with different rates of vitamin C intake. A closed bilateral fracture was made in the middle third of the femur of each rat. Five weeks after fracture the femora were analysed by mechanical and histological testing. The groups with the lower vitamin C intake demonstrated a lower mechanical resistance of the healing callus and a lower histological grade. The vitamin C levels in blood during healing correlated with the torque resistance of the callus formed (r = 0.525). Therefore, the supplementary vitamin C improved the mechanical resistance of the fracture callus in elderly rats. If these results are similar in humans, vitamin C supplementation should be recommended during fracture healing in the elderly.

Calidad de vida en pacientes con fémur corto congénito / Quality of life in patients with congenital short femur

Objetivo. Valorar la calidad de vida en personas con defecto congénito de fémur. Material y método. Se trata de un estudio transversal. La población está formada por 92 pacientes diagnosticados de fémur corto congénito desde 1969. Los criterios de inclusión fueron tener 15 años de edad o más y tener datos de domiciliación o de teléfono de contacto. La calidad de vida se midió con el cuestionario de salud SF-12 aplicado de mayo a octubre de 2003 telefónicamente, previa petición de consentimiento informado. Los resultados fueron comparados con una población de referencia. Resultados. Sólo 39 pacientes se incluyeron en el estudio. La media de edad fue de 26,2 años (hombres 24,8 años; mujeres 27,6 años). El 48,7% eran hombres y el 51,3% mujeres. No se detectaron diferencias en las medias de los componentes físico (PCS) y mental (MCS) entre hombres y mujeres, ni entre los distintos estratos de edad. El 100% obtuvo una puntuación MCS considerada como normal y el 20,5% obtuvo una puntuación PCS anormal. Conclusión. La calidad de vida de estos pacientes para el componente físico es anormal en los pacientes más jóvenes. Sorprende que el componente mental sea normal en todos. Podría deberse al hecho de ser un trastorno que se padece desde el mismo momento del nacimiento, y no tener un impacto psicosocial tan fuerte como con otro tipo de problemas

Materials and methods. This was a cross-sectional study. The study population was 92 patients diagnosed since 1969 with congenital short femur. Inclusion criteria were: patients should be over 15 years of age and possess a known address or telephone number. Quality of life was determined from May to October 2003 by means of telephone interviews, carried out after obtaining informed consent, using Health Questionnaire SF-12. The results were compared to those obtained in a reference population. Results. Only 39 patients participated in the study, of whom 48.7% were male and 51.3% were female. Mean age: 26.2 years (men: 24.8 years; women: 27.6 years). No differences were detected between men and women, nor across different age groups, with reference to the mean physical (PCS) and mental (MCS) variables. One hundred percent of the population had a normal MCS and 20.5% had an abnormal PCS. Conclusion. Quality of life based on PCS is abnormal in younger patients. It is surprising that MCS should be normal in all patients. This could be due to the fact that this condition is present from birth and therefore does not have such a strong psychosocial impact as other conditions

Gold chloride technique to study articular innervation. A protocol validated through computer-assisted colorimetry.

We studied variations in gold chloride techniques to elicit neural elements within articular samples, after "in toto" staining. These techniques attempt the differentiation of neural and vascular structures. Major changes in differential staining were observed when the gold chloride concentration was empirically modified. After the rest of the technique was standardized, we selected three gold chloride solutions to perform quantitative color experiments: 1%, 0.75%, and 0.5%. Significant sections of the same thickness were acquired with a digital camera to perform computer-assisted colorimetry. Color was measured through RGB (red-green-blue) channels in vessels, nerves, and background connective tissue as an internal control. By means of multivariate regression analysis, we compared differences in color measurements after 1%, 0.75% and 0.5% gold chloride preparation. Statistically significant coefficients confirmed that red color signals in vessels after the 0.75% and the 0.5% solution were both less intense than after the 1% preparation. Green and blue signals in vessels were also significantly less intense after the 0.5% protocol than after using the 1% solution. Red color signals in nerves between the 1% and the 0.75% preparation protocols were more intense and not significantly different, while the 0.5% preparation produced significantly less intense red signals in nerves. Non-significant differences were observed in green or blue signals from nerves after any protocol. We concluded that the 0.75% gold chloride solution protocol produced more intense red signals in nerves and less intense red signals in vessels. This was the most discriminant protocol in our series, based on color signals.

Ilizarov technique. Results and difficulties.

Of 100 cases treated by the Ilizarov method, 91 patients were reviewed from February 1985 to March 1990. There were 32 tibial fractures (29 open) and 21 nonunions (nine infected). There were 47 cases of limb lengthening (28 tibia and 19 femur). The results were as follows: good, 83%; fair, 13%; and poor, 4%. Slight and intermittent pain in some wire of the device was frequent (69%). Average bone healing time in tibial fractures was 4.95 months and 5.83 months in tibial nonunions. In bone-lengthening operations, the average lengthening index in the tibia was 1.02 months/cm (lengthenings ranged from 3 cm to 10 cm, with a mean of 5.71 cm), whereas in the femur, the average lengthening index was 1.14 months/cm (lengthenings ranged from 3 cm to 7 cm, with a mean of 5.34 cm). Manually-tensed wires produced frequent problems (24.5%), whereas wire tensed by the dynamometric tensioner produced problems in only 7.8% of the cases. Despite good results, the Ilizarov technique requires adequate training to reduce an overall complication rate (approximately 30%).

Fractures of the coracoid process: presentation of seven cases and review of the literature.

Coracoid process fracture is a rare and uncommon clinical entity. Seven cases of the base of the coracoid process are presented. This fracture was isolated in one case, being in the other six cases combined with injuries, either to acromioclavicular dislocation or to fracture of the superior glenoid cavity disorder. One of these patients had associated fractures of the clavicle and the coracoid process. The treatment was conservative in all cases. Results were satisfactory and therefore nonoperative management is advocated.

Acetabular development in congenital dislocation on the hip.

Acetabular dysplasia is one of the most common complications in the treatment of congenital dislocation of the hip (CDH). Acetabular development is analyzed in a series of 47 children with 55 CDH with delayed diagnosis. Cases were studied on an overall basis and according to the type of reduction realized: closed (group 1) or open (group 2). The incidence of acetabular dysplasia in relation with the development of avascular necrosis (AN) of the hip during treatment was studied. Cases with an acetabular index (AI) of greater than 25 degrees two or more years after reduction were considered suggestive of dysplasia. Acetabular development was better in CDH treated by open reduction. Acetabular remodeling in dislocated hips treated by reduction and affected by AN was less than in reduced CDH free of AN. AI improves progressively during treatment of CDH, more markedly in the first post-reduction year.

Tarsometatarsal fractures and dislocations.

A total of 32 cases of tarsometatarsal fracture dislocations, treated during a 15-year period, have been retrospectively reviewed. Results were assessed in 29 patients with a mean age of 33.8 years and a mean follow-up of 6.3 years. On the basis of Quénu and Küss' classification, five patients had homolateral dislocations, three had divergent dislocations, and 21 had partial dislocations (seven medial partial and 14 lateral partial). Treatment included closed manipulative reduction, occasionally followed by Kirschner (K)-wire fixation. If closed reduction was not achieved, open reduction was performed. Results were assessed according to Hardcastle's scoring system. On that basis, 20 good, 5 fair, and 3 poor results were obtained and there was one early amputation. Good results were associated with an accurate reduction. Open treatment is advocated if minor displacement persists. Routine K-wire fixation is advised for all cases.