Trombosis arterial subclavioaxilar y embolización distal tras luxación glenohumeral anterior traumática / Subclavian-axillary arterial thrombosis and distal embolisation after traumatic anterior glenohumeral dislocation

La lesión vascular arterial asociada a la luxación anterior de hombro es una complicación rara, pero potencialmente devastadora, a menudo en el contexto de traumatismos de alta energía o heridas penetrantes. Se trata de una urgencia médica que puede llegar a comprometer la viabilidad y funcionalidad del miembro, incluso la vida del paciente si no es identificada precozmente y tratada de forma adecuada. Sin embargo, su diagnóstico puede ser difícil, pues precisa un alto índice de sospecha. La presencia de una trombosis de la arteria axilar con una luxación de hombro por un mecanismo de baja energía es extraordinariamente poco frecuente, especialmente cuando se presenta de forma subaguda con embolismo en la arteria radial

Arterial vascular injury associated with anterior dislocation of the shoulder is a rare but potentially devastating complication, often seen in the context of high-energy trauma or penetrating injury. It is a medical emergency that can compromise both the viability and functionality of the limb, as well as the patient's life if it is not identified early and treated properly. However, its diagnosis can be difficult, since it requires a high index of suspicion. The presence of an axillary artery thrombosis after shoulder dislocation resulting from low-energy trauma is extremely rare, even more so with subacute clinical presentation associated with embolism to the radial artery

Subclavian-axillary arterial thrombosis and distal embolisation after traumatic anterior glenohumeral dislocation. / Trombosis arterial subclavioaxilar y embolización distal tras luxación glenohumeral anterior traumática.

Arterial vascular injury associated with anterior dislocation of the shoulder is a rare but potentially devastating complication, often seen in the context of high-energy trauma or penetrating injury. It is a medical emergency that can compromise both the viability and functionality of the limb, as well as the patient's life if it is not identified early and treated properly. However, its diagnosis can be difficult, since it requires a high index of suspicion. The presence of an axillary artery thrombosis after shoulder dislocation resulting from low-energy trauma is extremely rare, even more so with subacute clinical presentation associated with embolism to the radial artery.

Ultrasound (US) measurement of the distance between the Achilles tendon and the posterior tibial neurovascular bundle in equinus infantile deformity.

OBJECTIVE: To study the distance between the Achilles tendon and the posterior tibial neurovascular bundle via ultrasound (US) - Doppler, with the goal of preventing neurovascular bundle injuries. METHODS: We studied 36 feet with equinus deformity (18 cases on the right and left side) in children with a mean age of 20.9 months. The distance between the Achilles tendon and the posterior tibial artery was intraoperatively measured using linear US at 10 MHz with Doppler. The measurement was made 1 cm proximal to the calcaneus insertion of the Achilles, where we planned to perform the tenotomy. The patient's weight and height were also recorded. Kolmogorov-Smirnov, t test, and Pearson correlation analyses were applied. Statistical significance was defined as p < 0.05. RESULTS: Mean distance between Achilles tendon and posterior neurovascular tibial bundle was 7.3 mm, and no differences between sexes or sides were observed. The distance was significantly correlated with weight (r = 0.54, p = 0.01) but not height or age. CONCLUSIONS: The distance between the Achilles tendon and the tibialis posterior neurovascular bundle is small, and there is a risk of surgical injury during tenotomy of the Achilles tendon.

Aplicabilidad de análogos de la prostaglandina I2 en el tratamiento del síndrome de edema de médula ósea de la cabeza femoral. Caso clínico / Applicability of prostaglandin I2 analogs in the treatment of bone marrow edema syndrome of the femoral head. Clinical case

Objetivo: Mostrar nuestra experiencia con el uso de la prostaciclina en el tratamiento del síndrome de edema de médula ósea de la cabeza femoral. Material y método: Se evalúa retrospectivamente la efectividad de la infusión intravenosa de prostaciclina en un caso clínico de una mujer de 40 años de edad con síndrome de edema de médula ósea de cabeza femoral, con pruebas de imagen (radiografía y resonancia magnética) y escalas analógicas (EVA) y funcionales (Harris). Resultados: Se objetivó la prácticamente plena resolución del edema óseo en resonancia magnética a las seis semanas de la infusión, con mejoría significativa tanto de la escala analógica como de la funcional. En el control clínico y radiográfico a los cuatro meses la paciente estaba asintomática, sin evidencia de osteonecrosis. Conclusión: Los análogos de la prostaglandina I2 podrían tener beneficio terapéutico en los síndromes de malperfusión ósea, si bien son necesarios más estudios para determinar su efectividad real (AU)

Objective: To show our experience with the use of prostacyclin in the treatment of bone marrow edema syndrome of the femoral head. Material and method: We retrospectively evaluated the effectiveness of intravenous infusion of prostacyclin in a case of a 40 year old woman with bone marrow edema syndrome of the femoral head, with imaging techniques (x-ray and MRI), pain scale (VAS) and functional scale (Harris). Results: We achieved nearly complete resolution of bone edema on MRI at seis weeks after infusion, with significant improvement of both the pain and the functional scale. At the clinical and radiographic control after four months the patient is asymptomatic, without evidence of osteonecrosis. Conclusion: Prostaglandin I2 analogues may have therapeutic benefit in bone malperfusion syndromes, although more research is necessary to determine its real effectiveness (AU)

Fractura incarcerada de epitróclea con lesión del nervio cubital / Incarcerated epitrochlear fracture with a cubital nerve injury

Las epifisiólisis de la epitróclea son lesiones relativamente frecuentes, que afectan fundamentalmente a niños entre los 7 y los 15 a˜nos. Las características anatómicas de esta apófisis puede dificultar el diagnóstico en las fracturas mínimamente desplazadas. En un peque˜no porcentaje de casos el fragmento fracturario puede ocupar el surco retroepitroclear. La presencia de disestesias en el territorio del nervio cubital obliga a la reducción abierta urgente del fragmento incarcerado. Se presenta el caso de un paciente varón de 7 a˜nos de edad, que precisó de una revisión quirúrgica por una fractura desplazada de epitróclea asociada a lesión del nervio cubital. Se realiza una revisión de la literatura médica respecto a esta enfermedad (AU)

Injuries of the medial epicondyle are relatively common, mostly affecting children between 7 and 15 years. The anatomical characteristics of this apophysis can make diagnosis difficult in minimally displaced fractures. In a small percentage of cases, the fractured fragment may occupy the retroepitrochlear groove. The presence of dysesthesias in the territory of the ulnar nerve requires urgent open reduction of the incarcerated fragment. A case of a sevenyear- old male patient is presented, who required surgical revision due to a displaced medial epicondyle fracture associated with ulnar nerve injury. A review of the literature is also made (AU)

[Incarcerated epitrochlear fracture with a cubital nerve injury]. / Fractura incarcerada de epitróclea con lesión del nervio cubital.

Injuries of the medial epicondyle are relatively common, mostly affecting children between 7 and 15 years. The anatomical characteristics of this apophysis can make diagnosis difficult in minimally displaced fractures. In a small percentage of cases, the fractured fragment may occupy the retroepitrochlear groove. The presence of dysesthesias in the territory of the ulnar nerve requires urgent open reduction of the incarcerated fragment. A case of a seven-year-old male patient is presented, who required surgical revision due to a displaced medial epicondyle fracture associated with ulnar nerve injury. A review of the literature is also made.

Tendinitis calcificante prevertebral aguda: a propósito de un caso y revisión de la literatura / Acute calcific prevertebral tendinitis: case report and literature review

La tendinitis calcificante prevertebral es una causa poco frecuente de cervicalgia aguda, caracterizada por la identificación de calcificaciones a nivel de C1-C2 y, la presencia de una colección líquida en el espacio prevertebral, que ocasiona un desplazamiento de la línea radiográfica prevertebral en los estudios de imagen. Resulta de gran importancia identificar esta rara entidad, benigna y autolimitada, y no confundirla con otros procesos que erróneamente propiciasen actitudes terapéuticas inadecuadas (AU)

Prevertebral calcific tendinitis is an uncommon cause of acute neck pain characterized by the identification of calcifications at C1-C2 level and the presence of a liquid collection at the prevertebral space which causes the displacement of the prevertebral radiographic line in imaging studies. It is very important to identify this rare, benign and self-limiting pathology, in order not to confuse it with other diseases that could erroneously lead to inappropriate treatment (AU)

[Acute calcific prevertebral tendinitis: case report and literature review]. / Tendinitis calcificante prevertebral aguda: a propósito de un caso y revisión de la literatura.

Prevertebral calcific tendinitis is an uncommon cause of acute neck pain characterized by the identification of calcifications at C1-C2 level and the presence of a liquid collection at the prevertebral space which causes the displacement of the prevertebral radiographic line in imaging studies. It is very important to identify this rare, benign and self-limiting pathology, in order not to confuse it with other diseases that could erroneously lead to inappropriate treatment.

Evaluación de los resultados de la artrodesis tibiotalocalcánea con enclavado retrógrado como técnica de rescate en 15 casos / Evaluation of tibiotalocalcaneal arthrodesis using a retrograde nail as a rescue technique in 15 cases

Evaluar la utilidad de la artrodesis tibiotalocalcánea mediante clavo retrógrado como técnica de rescate en pacientes con deformidad y dolor de las articulaciones tibioastragalina y subastragalina. Material y método. Estudio retrospectivo de 15 casos consecutivos (9 hombres, 5 mujeres), edad media de 46 años, en los que se realizó una artrodesis tibiotalocalcánea con clavo retrógrado. En todos los pacientes habían fracasado otras medidas. Se realizó una anamnesis, exploración y estudio radiográfico detallados previa intervención, valoración funcional mediante la escala AOFAS y el grado de fusión tras la cirugía mediante estudio radiográfico y TC. Resultados. La indicación más frecuente fue la artrosis postraumática en 8 de los 15 casos, seguida en frecuencia por artrosis primaria en 4 casos. Se obtuvo la consolidación en el 93% de los casos (14 de los 15 pacientes) en un tiempo medio aproximado de 20 semanas y un seguimiento medio de 20 meses. El 73% de los pacientes presentaron complicaciones siendo el retardo de consolidación y la pseudoartrosis las más importantes. La mejoría media en la escala AOFAS fue de 43,8 puntos, a expensas fundamentalmente de la mejoría del dolor. Conclusión. Coincidimos con la literatura publicada en considerarla una técnica de rescate útil en pacientes en los que han fracaso cirugías previas y como procedimiento de elección en pacientes con artropatia inflamatoria. Sin embargo, es una técnica exigente, con un alto porcentaje de complicaciones, por lo que requiere una selección cuidadosa de los casos y un diálogo detallado sobre las expectativas de los pacientes (AU)

Objective: To evaluate the usefulness of tibiotalocalcaneal arthrodesis using a retrograde nail as a rescue technique in patients with deformity and pain in the tibia-astragalus and sub-astragalus joints. Material and method: A retrospective study of 15 consecutive cases (9 men, 5 women), with a mean age of 46 years, in whom a tibiotalocalcaneal arthrodesis using a retrograde nail was performed. Other measures had failed in all the patients. An anamnesis, physical and radiographic examination, details of previous treatments were carried out, as well as functional assessment using the American Orthopedic Foot and Ankle Society (AOFAS) scale and the degree of fusion after surgery with x-rays and CT. Results: The most common indication was post-traumatic arthrosis 8 of the 15 cases, followed in frequency by primary arthrosis in 4 cases. Consolidation was achieved in 93% of cases (14 of the 15 patients) in a mean time of approximately 20 weeks and a mean follow up of 20 months. Complications were observed in 73% of patients, with delayed consolidation and pseudoarthrosis being the most important. The mean improvement on the AOFAS scale was 43.8 points, mainly due to the improvement in pain. Conclusion: We agree with that published in the literature in considering this a useful rescue technique in patients where previous surgery has failed, and as a procedure of choice in patients with inflammatory arthritic disease. However, it is a demanding technique, with a high percentage of complications, and requires careful selection of the cases and a detailed dialogue on the expectations of the patients (AU)