Lesión electromiográfica del nervio axilar en fracturas del extremo proximal del húmero. Estudio prospectivo, observacional, analizando el patrón de fractura / Electromyographic axillary nerve injury in fractures of the proximal humerus: Prospective, observational study, analysing the fracture pattern

Objetivo: Descripción y análisis de la relación entre las fracturas de húmero proximal y la lesión traumática del nervio axilar circunflejo. Material y método: Estudio prospectivo, observacional, de una serie de casos consecutivos de fracturas de extremo proximal de húmero. Se realizó valoración radiográfica, clasificando las fracturas según el sistema AO (Arbeitsgemeinshaft für Osteosynsthesefragen, Asociación de Grupo de Trabajo para el Estudio de la Fijación Interna de las Fracturas), y electromiografía (EMG) para la evaluación de la lesión del nervio axilar. Resultados: De 105 casos consecutivos de fracturas de húmero proximal, 31 pacientes cumplían los criterios de inclusión. Muestra: 86% mujeres y 14% hombres con edad media de 71,8 años (30-96 años). De los pacientes incluidos en el estudio, 58% presentó una EMG normal o leve axonotmesis, 23% presentó neuropatía del nervio axilar sin denervación muscular y 19%, lesión con denervación del nervio axilar. Los pacientes que sufrieron fracturas complejas de húmero proximal (AO11B y AO11C) tuvieron más riesgo de presentar lesiones tipo neuropatía axilar con denervación muscular en la EMG, siendo esta relación estadísticamente significativa (p < 0,001). Conclusiones: Los pacientes que sufren fracturas complejas de húmero proximal (AO11B y AO11C) tienen más riesgo de presentar lesiones tipo neuropatía axilar con denervación muscular en la EMG (p < 0,001).(AU)

Objective: Description and analysis of the relation between the proximal humerus fracture patterns and the traumatic injury of the axillary nerve. Material and method: Prospective, observational study of a consecutive case series that analyzed proximal humerus fractures. Radiographic evaluation was performed, and AO (Arbeitsgemeinshaft für Osteosynsthesefragen) system was used to classify the fractures. Electromyography was used to diagnose the axillary nerve injury. Results: Thirty-one patients on 105 who had a proximal humerus fracture met inclusion criteria. Eighty-six percent of the patients included were women and 14% men. The mean age was 71.8 years (30–96 years). Of the patients included in the study, 58% had normal or mild axonotmesis EMG, 23% had axillary nerve neuropathy without muscle denervation and 19% had injury with axillary nerve denervation. Patients who suffered complex fractures of the proximal humerus (AO11B and AO11C) had a higher risk of presenting axillary neuropathy type lesions with muscle denervation in the EMG, this relationship being statistically significant (p<0.001). Conclusion: Patients who have more risk on presenting axillary nerve neuropathy with muscle denervation in electromyography are those who present complex proximal humerus fractures AO11B and AO11C (p<0.001).(AU)

[Translated article] Electromyographic axillary nerve injury in fractures of the proximal humerus: Prospective, observational study, analysing the fracture pattern / Lesión electromiográfica del nervio axilar en fracturas del extremo proximal del húmero. Estudio prospectivo, observacional, analizando el patrón de fractura

Objetivo: Descripción y análisis de la relación entre las fracturas de húmero proximal y la lesión traumática del nervio axilar circunflejo. Material y método: Estudio prospectivo, observacional, de una serie de casos consecutivos de fracturas de extremo proximal de húmero. Se realizó valoración radiográfica, clasificando las fracturas según el sistema AO (Arbeitsgemeinshaft für Osteosynsthesefragen, Asociación de Grupo de Trabajo para el Estudio de la Fijación Interna de las Fracturas), y electromiografía (EMG) para la evaluación de la lesión del nervio axilar. Resultados: De 105 casos consecutivos de fracturas de húmero proximal, 31 pacientes cumplían los criterios de inclusión. Muestra: 86% mujeres y 14% hombres con edad media de 71,8 años (30-96 años). De los pacientes incluidos en el estudio, 58% presentó una EMG normal o leve axonotmesis, 23% presentó neuropatía del nervio axilar sin denervación muscular y 19%, lesión con denervación del nervio axilar. Los pacientes que sufrieron fracturas complejas de húmero proximal (AO11B y AO11C) tuvieron más riesgo de presentar lesiones tipo neuropatía axilar con denervación muscular en la EMG, siendo esta relación estadísticamente significativa (p < 0,001). Conclusiones: Los pacientes que sufren fracturas complejas de húmero proximal (AO11B y AO11C) tienen más riesgo de presentar lesiones tipo neuropatía axilar con denervación muscular en la EMG (p < 0,001).(AU)

Objective: Description and analysis of the relation between the proximal humerus fracture patterns and the traumatic injury of the axillary nerve. Material and method: Prospective, observational study of a consecutive case series that analyzed proximal humerus fractures. Radiographic evaluation was performed, and AO (Arbeitsgemeinshaft für Osteosynsthesefragen) system was used to classify the fractures. Electromyography was used to diagnose the axillary nerve injury. Results: Thirty-one patients on 105 who had a proximal humerus fracture met inclusion criteria. Eighty-six percent of the patients included were women and 14% men. The mean age was 71.8 years (30–96 years). Of the patients included in the study, 58% had normal or mild axonotmesis EMG, 23% had axillary nerve neuropathy without muscle denervation and 19% had injury with axillary nerve denervation. Patients who suffered complex fractures of the proximal humerus (AO11B and AO11C) had a higher risk of presenting axillary neuropathy type lesions with muscle denervation in the EMG, this relationship being statistically significant (p<0.001). Conclusion: Patients who have more risk on presenting axillary nerve neuropathy with muscle denervation in electromyography are those who present complex proximal humerus fractures AO11B and AO11C (p<0.001).(AU)

Electromyographic axillary nerve injury in fractures of the proximal humerus: Prospective, observational study, analysing the fracture pattern. / Lesión electromiográfica del nervio axilar en fracturas del extremo proximal del húmero. Estudio prospectivo, observacional, analizando el patrón de fractura.

OBJECTIVE: Description and analysis of the relation between the proximal humerus fracture patterns and the traumatic injury of the axillary nerve. MATERIAL AND METHOD: Prospective, observational study of a consecutive case series that analyzed proximal humerus fractures. Radiographic evaluation was performed, and AO (Arbeitsgemeinshaft für Osteosynsthesefragen) system was used to classify the fractures. Electromyography was used to diagnose the axillary nerve injury. RESULTS: Thirty-one patients on 105 who had a proximal humerus fracture met inclusion criteria. Eighty-six percent of the patients included were women and 14% men. The mean age was 71.8 years (30-96 years). Of the patients included in the study, 58% had normal or mild axonotmesis EMG, 23% had axillary nerve neuropathy without muscle denervation and 19% had injury with axillary nerve denervation. Patients who suffered complex fractures of the proximal humerus (AO11B and AO11C) had a higher risk of presenting axillary neuropathy type lesions with muscle denervation in the EMG, this relationship being statistically significant (p<0.001). CONCLUSION: Patients who have more risk on presenting axillary nerve neuropathy with muscle denervation in electromyography are those who present complex proximal humerus fractures AO11B and AO11C (p<0.001).

[Translated article] Electromyographic axillary nerve injury in fractures of the proximal humerus: Prospective, observational study, analysing the fracture pattern.

OBJECTIVE: Description and analysis of the relation between the proximal humerus fracture patterns and the traumatic injury of the axillary nerve. MATERIAL AND METHOD: Prospective, observational study of a consecutive case series that analysed proximal humerus fractures. Radiographic evaluation was performed, and AO (Arbeitsgemeinshaft für Osteosynsthesefragen) system was used to classify the fractures. Electromyography was used to diagnose the axillary nerve injury. RESULTS: Thirty-one patients on 105 who had a proximal humerus fracture met inclusion criteria. Eighty-six percent of the patients included were women and 14% men. The mean age was 71.8 years (30-96 years). Of the patients included in the study, 58% had normal or mild axonotmesis EMG, 23% had axillary nerve neuropathy without muscle denervation and 19% had injury with axillary nerve denervation. Patients who suffered complex fractures of the proximal humerus (AO11B and AO11C) had a higher risk of presenting axillary neuropathy type lesions with muscle denervation in the EMG, this relationship being statistically significant (p<0.001). CONCLUSION: Patients who have more risk on presenting axillary nerve neuropathy with muscle denervation in electromyography are those who present complex proximal humerus fractures AO11B and AO11C (p<0.001).

The IL-1ß (+3953 T/C) gene polymorphism associates to symptomatic lumbar disc herniation.

PURPOSE: To determine whether polymorphisms (SNPs) in the genes encoding cytokines and nitric oxide synthase (NOS) might play some role in lumbar disc herniation (LDH). PATIENTS AND METHODS: Case-control study in which 179 patients were retrospectively reviewed. The case group was made of 50 patients with symptomatic LDH diagnosed by MRI while the control group was made of 129 individuals undergoing routine hip or knee arthroplasty with a lifetime lack of low back pain. SNPs in the cytokine genes of IL-1 [IL-1α (-889 C/T), IL-1ß (+3953 T/C)], TNF-α (-308 G/A and -238 G/A) and NOS genes [eNOS (r 27 bp, intron 4 and -786 T/C) and iNOS (22 G/A)]. RESULTS: The CC genotype and C allele of the IL-1ß (+3953 T/C) SNP were significantly more frequent among LDH patients compared to controls. On the other hand, eNOS (-768 T/C) and iNOS (22 G/A) SNPs were significantly more common in the control group. CONCLUSIONS: Carriers of the CC genotype of the IL-1ß (+3953 T/C) SNP were more frequent among LDH patients suggesting some potential role of the IL-1ß SNP on LDH pathogenesis. The eNOS (-786 T/C) and iNOS (22 G/A) SNPs were more frequent among the control subjects, suggesting their possible protective role against LDH. Genotyping these SNPs could be useful to identify persons with an increased lifetime risk of disc herniation in whom measures to avoid LDH could be implemented.

Asociación entre el polimorfismo genético de la interleucina-1Beta (3953 T/C) y la hernia discal lumbar sintomática / Association between the genetic polymorphism of interleukin-1Beta (3953 T/C) and symptomatic lumbar herniated disc

Objetivo. Evaluar la asociación entre la presencia en el genotipo de determinados polimorfismos genéticos (PG) de las citocinas y del óxido nítrico sintasa (NOS) y el desarrollo de la hernia discal lumbar (HDL) sintomática.Material y método. Se revisaron 179 pacientes en un estudio retrospectivo de casos y controles. El grupo de casos estaba formado por 50 pacientes con HDL confirmada mediante resonancia magnética. El grupo control lo componían pacientes ingresados para cirugía protésica de la cadera o de la rodilla que no presentaban ni habían presentado nunca clínica compatible con HDL. Se realizó una extracción de sangre a todos los participantes del estudio. Se genotiparon los PG de las citocinas que pretendíamos estudiar: interleucina (IL)-1 (IL-1alfa [−889 C/T] e IL-1Beta [+3953 T/C]) y factor de necrosis tumoral-alfa (TNF-alfa´ [−308 G/A] y TNF-alfa´ [−238 G/A]). Resultados. El genotipo CC y la frecuencia del alelo C del PG IL-1Beta (+3953 T/C) fueron significativamente mayores en el grupo de pacientes con HDL respecto a la población control. Por el contrario, los pacientes del grupo control portaban los PG de NOS endotelial (−768 T/C) y de NOS inducible 22 G/A con mayor frecuencia que el grupo de pacientes con HDL, esta diferencia es estadísticamente significativa para ambos polimorfismos. Conclusiones. Encontramos que ser portador del alelo C del PG IL-1Beta (+3953 T/C) puede ser un factor de predisposición para desarrollar una HDL. Por otro lado, ser portador del PG NOS endotelial (−768 T/C) y del NOS inducible 22 G/A parece comportarse como un factor protector frente al desarrollo de esta enfermedad (AU)

Objective. To evaluate the association between the presence of the genotype of certain genetic polymorphisms (GP) of the cytokine and oxide nitric synthase (NOS) and the development of lumbar herniated disc (LHD). Materials and methods. We reviewed 179 patients in a retrospective case-control study. The case group was made up of 50 patients with confirmed lumbar herniated disc diagnosed by Magnetic Resonance Imaging (MRI). The control group was made up of patients admitted for hip and knee prosthetic surgery who did not have or had not had any symptoms consistent with LHD. Blood was drawn from all of the study participants. The genotypes of the GP were obtained of the cytokines to be studied: Interleukin-1 [IL-1alpha(−889 C/T), IL-1Beta(+3953 T/C)], Tumor Necrosis Factor-alpha [TNF-alpha (−308 G/A) and (−238G/A)]. Results. The CC genotype and C allele frequency of the IL-1Betaβ PG (+3953T/C) polymorphism were significantly more frequent in patients with LDH compared to the controls. On the contrary, the control group patients carried eNos GPs (−768 T/C) and iNOS22 G/A polymorphisms more frequently than the LHD group, this difference being statistically different for both polymorphisms. Conclusions. We found that individuals who were carriers of the CC genotype of the IL-1b(+3953T/C) polymorphism showed higher susceptibility to suffer lumbar disc herniation. Furthermore, being a carrier of ENOS (−786 T/C) and iNOS (22 G/A) polymorphisms suggests that this could behave as a protection factor against disc herniation (AU)

Mionecrosis de la extremidad inferior por Clostridium septicum en paciente con leucemia mieloide aguda / Lower limb myonecrosis due to Clostridium septicum in a patient with acute myeloid leukemia

Objetivo y caso clínico. Se expone el caso clínico de un paciente de 64 años de edad diagnosticado de leucemia mieloide aguda (LMA) con aplasia medular que desarrolló un proceso compatible con una infección necrosante de partes blandas (INPB) en el muslo derecho en un plazo de 12 horas. Se realizó de urgencia una fasciotomía y desbridamiento radical de la extremidad afecta y se instauró tratamiento antibiótico con penicilina. A las cuatro horas de la intervención se produjo el fallecimiento del paciente. Conclusiones. La singularidad del caso presentado reside en el hallazgo en la necropsia de una mionecrosis de la extremidad inferior, producida por contigüidad a partir de una enterocolitis necrosante por Clostridium septicum en el contexto de un paciente inmunodeprimido, hecho que sin duda contribuyó al rápido desenlace del cuadro clínico, a pesar del tratamiento realizado

Purpose and clinical case. This is a clinical case of a 64 year-old patient diagnosed with acute myeloid leukemia (AML) with medullary aplasia who developed infectious soft tissue necrosis (ISTN) of the right thigh in a time-frame of 12 hours. An emergency fasciotomy and radical debridement of the affected limb were carried out and antibiotic treatment with penicillin was initiated. Four hours after surgery the patient died. Conclusions. The unique nature of this case lies in the fact that on autopsy lower limb myonecrosis was found, caused by contiguity to necrotizing enterocolitis caused by Clostridium septicum in an immunodepressed patient, a fact that undoubtedly contributed to the rapid clinical progress of the condition and its end-result, in spite of the treatment applied (AU)

Utilización de aprotinina como agente hemostático en la prótesis total de cadera / Aprotinin used as a hemostatic agent in THR

Objetivo. Estudiar el efecto de la administración de aprotinina sobre el sangrado postoperatorio de la prótesis total de cadera. Material y método. Estudio retrospectivo sobre 88 pacientes divididos en un grupo de casos (44 pacientes) que recibió una dosis de aprotinina de 2 × 10 unidades inhibidoras de kalicreína (KIU), y un grupo de control (44 pacientes) que no recibió ninguna dosis del fármaco. Se estudiaron la hemoglobina, el hematocrito y el número de plaquetas en hemogramas preoperatorio y postoperatorio (sala de reanimación, a las 6-12 y a las 24 horas de la intervención). Se registró el volumen recogido por los drenajes de Redón. Se contabilizó el número de concentrados de hematíes transfundido en cada caso. Resultados. Los hemogramas de control obtenidos en el postoperatorio mostraron valores semejantes de hemoglobina y hematocrito en ambos grupos. Hubo menor pérdida de sangre y exudados en los drenajes del grupo de casos. Se transfundieron menor número de pacientes del grupo de casos y globalmente menor número de concentrados de hematíes al grupo de casos que al de controles. Las diferencias halladas entre los valores estudiados de ambos grupos, resultaron estadísticamente significativas. Conclusión. La administración de aprotinina contribuye a reducir la cantidad de hemoderivados que es preciso administrar en el postoperatorio de la prótesis total de cadera, así como las pérdidas en los drenajes. La administración de menor número de concentrados al grupo de casos no implicó diferencias en los valores de hemoglobina y hematocrito frente al grupo control

Purpose. To study the effect of the administration of aprotinin on postoperative bleeding in total hip replacement. Materials and methods. Retrospective study of 88 patients divided into two groups: the first group contained 44 patients that received a dose of aprotinin of 2 × 10 kallicrein inhibiting units (KIUs) and the other, also containing 44 patients, was the control group, which was not given any aprotonin at all. Pre- and postoperative blood counts were carried out to study hemoglobin, hematocrit and platelet count (shock room at 6-12 hours and 24 hours post-op). The amount of blood collected during Redon drainage was recorded. The number of red blood cells concentrates transfused was also noted. Results. Control blood counts make during the postoperative period showed similar hemoglobin and hematocrit values in both groups. Less blood loss and fewer exudates were recorded in the treated group. Fewer patients were transfused in the treated group and, on the whole, fewer red blood cell concentrates were transfused in the treated group than in the control group. The differences found between the values studied in both groups turned out to be statistically significant. Conclusion. The administration of aprotinin contributes to reducing the amount of hemoderivatives administered further to THR and the volume of blood loss in drainage. The administration of fewer concentrates to the treated group did not lead to differences vis-à-vis the control group in terms of the values for hemoglobin and hematocrit

Epifisiólisis femoral proximal / Proximal femoral epiphysiolysis

Objetivo. La epifisiólisis de cadera es una entidad frecuente en el niño o adolescente, de etiopatogenia desconocida. La actuación del cirujano ortopédico para detener y corregir esta enfermedad es un tema controvertido. Se realiza una revisión de 108 casos intervenidos en nuestro Servicio en 94 pacientes entre los años 1976 y 2002, analizando los resultados obtenidos. Material y método. El tratamiento consistió en la mayoría de los casos en reducción y osteosíntesis in situ con agujas de Kirschner, tornillos de esponjosa o tornilllos canulados. Resultados. El 67% eran varones con una edad media al diagnóstico de 13,25 años; el 33% mujeres, con una media de 12,27 años. En 14 casos la afectación era bilateral (14,9%). Se obtuvieron buenos resultados en el 81% de los casos de epifisiólisis aguda, en el 73% de las agudas sobre crónicas y en el 89% de las crónicas. Discusión y conclusiones. Las técnicas quirúrgicas más agresivas, como osteotomías cervicales o transtrocantéreas, no parecen modificar en exceso el mal resultado de epifisiólisis con desplazamiento severo no corregido. Aquellos casos en los que se obtuvieron malos resultados pertenecían al grupo de epifisiólisis con desplazamiento inicial severo, o a aquellos en los que se desarrolló una necrosis aséptica de la cabeza femoral o una condrólisis. Se considera de gran importancia la «exquisitez» a la hora de realizar la fijación, evitando la penetración intraarticular del material y su colocación en valgo. Actualmente se prefiere la osteosíntesis con un solo tornillo canulado

Purpose. Hip epiphysiolysis of unknown origin is frequent in children and adolescents. It is a point of controversy whether the orthopedic surgeon should act to correct this disorder. We reviewed 108 cases in 94 patients operated on in our Department from 1976 to 2002 and analyzed the results. Materials and methods. In most cases treatment consisted of in situ reduction and osteosynthesis with K-wires, and cannulated or cancellous screws. Results. 67% of the patients were male with an average age at diagnosis of 13.25 years; 33% of the patients were female with an average age at diagnosis of 12.27; 14.9% of the patients were bilateral cases (14 patients). We had good results in 81% of the acute cases, in 73% of the acute on chronic cases and in 89% of the chronic cases. Discussion and conclusions. More aggressive surgical techniques such as neck or transtrochanteric osteotomies do not seem to excessively modify the poor results of epiphysiolysis with severe uncorrected displacement. Poor results were seen in the group of epiphysiolysis cases with severe initial slip or in those cases which developed chondrolysis or non-septic necrosis of the femur head. The fixation technique requires great skill; the osteosynthesis materials must not penetrate the intra-articular space; the procedure must not cause a valgus deformity. Currently, osteosynthesis using a single cannulated screw is the preferred procedure

Behavior of the femoral stem in the Bihapro hip prosthesis.

This study evaluated the hydroxyapatite-coated femoral stem of the Bihapro hip prosthesis (Biomet Ltd, Bridgend, United Kingdom) using radiography, TC-99 scintigraphy, and bone densitometry. Thirty stems with >2 years of follow-up (mean: 31 months) were evaluated. No loosening or changes in the position of the implant were seen, and the mean subsidence was 2.2 mm. Radiography revealed a densification in the metaphyseal zone with reconstruction of the trabecular lines in 21 cases, while in 22 patients, radiolucent lines in the distal area of the femoral component were observed. Scintigraphy showed a diaphyseal normo-captation in 19 cases and a hypercaptation <1.4 with a mean index of 1.1 in 10 patients. Metaphyseal hypercaptation >1.4 was seen in 24 patients. Bone densitometry revealed increased density in the metaphyseal zones in 29 patients with a periprosthetic/normal bone quotient of 1.4.