[Results and complications of pertrochanteric hip fractures using an intramedullary nail with a helical blade (proximal femoral nail antirotation) in 200 patients]. / Resultados y complicaciones de la osteosíntesis de fracturas pertrocantéreas de fémur mediante clavo endomedular con espiral cefálica (clavo femoral proximal antirrotación) en 200 pacientes.

OBJECTIVES: Evaluation of the surgical management, outcome and complications in patients with pertrochanteric fractures treated with PFNA nail. MATERIAL AND METHOD: A retrospective study was conducted on 200 patients treated consecutively between April 2010 and February 2012. Radiological assessments were performed before and after the surgery, and during the follow-up (fracture reduction, blade position, consolidation or collapse signs). A clinical evaluation was performed as regards walking capabilities. The results were compared with those of a previous study on 700 patients treated with gamma 3 and TFN nails. RESULTS: The blade position was centre-centre in 64% of patients, and decreased to 53% in the mechanical complications group. Tip-apex distance was less than 25mm in 91.5%. The average hospital stay was 9.17 days, with a mean post-surgery stay of 5.95 days. Complications (7.5%): 2 cut out (1%), one cut through (0.5%), 4 cases of helical blade sliding (2%), one failure in distal locking procedure (0.5%), 2 cases with painful fasciae latae (1%), one union delay (0.5%), 2 cases of non-union with hardware failure (1%), one case of intense bleeding related to distal locking of the nail (0.5%), and one case of avascular necrosis (0.5%). CONCLUSIONS: The PFNA helical blade system seems to reduce the incidence of cut out and cut through in osteoporotic bone. Blade position was one of the main parameters associated with mechanical complications.

Resultados y complicaciones de la osteosíntesis de fracturas pertrocantéreas de fémur mediante clavo endomedular con espiral cefálica (clavo femoral proximal antirrotación) en 200 pacientes / Results and complications of pertrochanteric hip fractures using an intramedullary nail with a helical blade (proximal femoral nail antirotation) in 200 patients

Objetivos. Evaluación del manejo quirúrgico, evolución y complicaciones de pacientes afectados por fractura pertrocantérea de cadera tratados mediante enclavado PFNA. Material y método. Revisión retrospectiva de 200 pacientes intervenidos entre abril de 2010 y febrero de 2012 de forma consecutiva. Se realiza evaluación radiográfica preoperatoria, postoperatoria y durante el seguimiento (reducción de la fractura, posición de la espiral, consolidación o signos de colapso). La evaluación clínica se realizó en función de la autonomía para la marcha. Se comparan los resultados obtenidos con estudio previo, sobre muestra de 700 pacientes y enclavado gamma 3 y TFN. Resultados. La posición de la espiral es centro-centro en el 64% de los pacientes, que disminuye al 53% en el grupo de las complicaciones mecánicas, siendo la distancia punta-vértice menor a 25 mm en el 91,5% de los casos. La estancia hospitalaria media se sitúa en 9,17 días con una estancia media postintervención de 5,95 días. Las complicaciones (7,5%) fueron: 2 casos de cut out (1%), uno de cut through (0,5%), 4 casos de efecto telescopaje (2%), un fallo en el encerrojado distal (0,5%), 2 casos de molestias en la fascia lata (1%), un retardo en la consolidación (0,5%), 2 seudoartrosis que condicionaron la rotura del dispositivo (1%), un caso de sangrado relativo al clavo (0,5%) y un caso de necrosis avascular (0,5%). Conclusiones. El sistema de espiral cefálica PFNA parece reducir la incidencia de cut out y cut through en el hueso osteoporótico. La posición de la espiral supone uno de los principales parámetros relacionados con las complicaciones mecánicas (AU)

Objectives. Evaluation of the surgical management, outcome and complications in patients with pertrochanteric fractures treated with PFNA nail. Material and method. A retrospective study was conducted on 200 patients treated consecutively between April 2010 and February 2012. Radiological assessments were performed before and after the surgery, and during the follow-up (fracture reduction, blade position, consolidation or collapse signs). A clinical evaluation was performed as regards walking capabilities. The results were compared with those of a previous study on 700 patients treated with gamma 3 and TFN nails. Results. The blade position was centre-centre in 64% of patients, and decreased to 53% in the mechanical complications group. Tip-apex distance was less than 25 mm in 91.5%. The average hospital stay was 9.17 days, with a mean post-surgery stay of 5.95 days. Complications (7.5%): 2 cut out (1%), one cut through (0.5%), 4 cases of helical blade sliding (2%), one failure in distal locking procedure (0.5%), 2 cases with painful fasciae latae (1%), one union delay (0.5%), 2 cases of non-union with hardware failure (1%), one case of intense bleeding related to distal locking of the nail (0.5%), and one case of avascular necrosis (0.5%). Conclusions. The PFNA helical blade system seems to reduce the incidence of cut out and cut through in osteoporotic bone. Blade position was one of the main parameters associated with mechanical complications (AU)

Síndrome de Trousseau / Trousseau syndrome

El Síndrome de Tousseau se considera un síndrome paraneoplásico caracterizado por distintos eventos trombóticos, tanto rteriales como venosos, que pueden originarse tras el desarrollo de una enfermedad neoplásica o como signo premonitorio de la existencia de un cáncer oculto. La presencia de sucesos trombóticos idiopáticos nos debe alertar de la posible sospecha neoplásica. Una serie de pruebas diagnósticas son recomendables en estas circunstancias, tales como marcadores tumorales y ecografía abdomino-pélvica. Este síndrome conlleva un mal pronóstico en la evolución del proceso neoplásico, especialmente en los casos de trombosis arterial. A pesar de su relevancia clínica, alta incidencia de nuevas neoplasias y su pronóstico nefasto, esta patología sigue siendo bastante desconocida. En esta revisión se analiza su fisiopatología, las medidas terapéuticas antitrombóticas y modelos predictivos de riesgo, enfatizando la necesidad de nuevos estudios de investigación para una mayor comprensión de este síndrome (AU)

Tousseau Syndrome is regarded as a paraneoplasic syndrome characterized by thrombotic events, both arterial and venous occlusions, which can be originated after the development of a neoplasic disease or as a premonitory sign of the existence of a hidden cancer. The presence of thrombotic idiopathic events must warn us about the possible neoplasic suspect. A series of diagnostical studies are advisable in these circumstances, such tumoral markers and abdomino-pelvical ultrasound scan. This syndrome involves a bad prognosis in the evolution of the neoplasic process, especially in cases of arterial thrombosis. In spite of its clinical relevance, high incidence of new neoplasias and an ill-fated prognosis, this pathology continues to be unknown enough. In this revision its fisiopathology, the therapeutic antithrombotic treatment, and the risk predictive models are discussed, emphasizing the necessity of new research studies for a bigger understanding of this syndrome (AU)