ABSTRACT
Introducción: Se presenta un caso clínico de seudoaneurisma de la arteria femoral circunfleja lateral secundario a una fractura pertrocantérica de cadera. Materiales y métodos: Como el cuadro y su localización son infrecuentes, se llevó a cabo una revisión bibliográfica sistematizada que incluyó todos los casos publicados sobre esta enfermedad (n = 40) en los últimos 15 años. Resultados: No se hallaron asociaciones estadísticamente significativas entre ninguna de las variables estudiadas. Sin embargo, parece existir cierto consenso en mantener una alta sospecha clínica para una intervención precoz y así obtener mejores resultados. Tanto su etiología como su localización se relacionan con la morfología de la fractura, el gesto quirúrgico y el material de osteosíntesis. Asimismo, hay una tendencia mayor a utilizar la angiotomografía para el diagnóstico y la localización del seudoaneurisma. Conclusiones: Nuestra paciente es el primer caso de resolución espontánea. Es fundamental conocer esta complicación tan poco frecuente para optimizar los resultados terapéuticos. Esta revisión, la más reciente sobre el tema, es muy útil para enumerar y subrayar los aspectos más importantes sobre el manejo y la prevención de los seudoaneurismas secundarios a una fractura de cadera. Nivel de Evidencia: IV
Introduction: We present a case of a lateral circumflex femoral artery pseudoaneurysm associated with pertrochanteric hip fracture. Materials and methods: We performed a systematic review considering all cases published in the last 15 years about this pathology (n=40). Results: No statistically significant associations were found between any of the variables studied. However, there seems to be some consensus in maintaining a high clinical suspicion for early intervention, thus obtaining better outcomes. Both its etiology and location are related to the morphology of the fracture, the surgical procedure, and the osteosynthesis material. Likewise, there is a greater tendency to use CT angiography for the diagnosis and localization of the pseudoaneurysm. Conclusion: Our patient is the first reported case of spontaneous resolution. Knowing this rare complication is essential to optimize therapeutic results. This review, the most recent on the subject, is very useful in listing and highlighting the most important aspects of the management and prevention of pseudoaneurysms secondary to hip fracture. Level of Evidence: IV
Subject(s)
Aneurysm, False , Femoral Artery , Hip FracturesABSTRACT
PURPOSE: Metaphyseal titanium sleeves have been used to provide cementless fixation in challenging bone defects in revision knee arthroplasty. The aim of this study was to evaluate the mid-term results of radiological and clinical outcomes, for metaphyseal sleeves in type 1B and 2 defects of tibia and femur under the hypothesis that they would provide stable and prolonged fixation. METHODS: One hundred and thirty-four patients were included in a prospective study to evaluate the outcomes of knee revision with sleeves, together with stems and varus-valgus constrained mobile bearing prosthesis. Median follow-up was 71.5 months (range 36-107). Analysis included American Knee Society Score (KSS), Western Ontario and Mcmaster Universities Osteoarthritis Index (WOMAC), SF12 Health Survey and radiographic assessment. RESULTS: All clinical scores improved significantly in all patients during the follow-up. The median of Knee KSS increased from 33 to 78 and functional KSS from 30 to 80. The median of WOMAC pain index changed from 12 to 4; pre-operative median of WOMAC stiffness and WOMAC function score improved from 5 to 2 and from 45 to 14, respectively. The median of physical SF12 varied from 27 to 44, while mental SF-12 from 43 to 54. Radiological evaluation showed optimal osseous integration in all patients, and neither implant migration nor progressive radiolucency around components was observed. Complications included three cases of end-of-stem pain at tibial side and two revisions due to septic loosening in the first post-operative year. No aseptic loosening was reported. CONCLUSION: The use of metaphyseal sleeves, in combination with uncemented stems and varus-valgus constrained components with rotating platform, has shown excellent mid-term results allowing osseous ingrowth with no evidence of osteolysis or displacement. This is a promising option for better implant fixation in revision TKA. LEVEL OF EVIDENCE: Case series with no comparison group, Level IV.
Subject(s)
Arthroplasty, Replacement, Knee/methods , Reoperation/instrumentation , Aged , Aged, 80 and over , Female , Humans , Knee Prosthesis/adverse effects , Male , Middle Aged , Outcome Assessment, Health Care , Prospective Studies , Prosthesis Design , Reoperation/methods , TitaniumABSTRACT
Fundamento y objetivo: El propósito del estudio ha sido comprobar si la administración de hierro intravenoso en un paciente diagnosticado de fractura de cadera disminuye la necesidad de transfundir sangre. Pacientes y método: Se ha realizado un estudio observacional de casos y controles comparando un grupo control de 63 pacientes intervenidos de fractura de cadera y sin la administración de hierro intravenoso, frente a otro grupo de 57 pacientes en el que se administraron dosis de hierro sacarosa. Se describieron las diferencias demográficas, clínicas y hematométricas entre los casos y controles. Se valoraron la aparición de complicaciones de carácter infeccioso y la mortalidad. Se utilizó el programa SPSS® para el estudio estadístico. Resultados: Existe una correlación estadísticamente significativa entre una menor necesidad de transfusión y la administración de hierro sacarosa intravenoso, siendo necesario un menor número de concentrados en el grupo de casos (1,37 frente a 0,6). En dicho grupo se observa una tendencia decreciente estadísticamente significativa en la tasa de mortalidad hospitalaria (grupo caso: 0,8%/grupo control: 8,3%). No se ha demostrado una disminución de la infección intrahospitalaria con la administración del hierro intravenoso. Se observa una mayor necesidad de transfusión (80%) cuando los valores de hemoglobina son iguales o inferiores a 11 g/dl (p < 0,05). Conclusiones: La administración de hierro sacarosa intravenoso en pacientes diagnosticados de fractura de cadera antes de ser operados podría ser una medida efectiva de ahorro de sangre en esta cirugía traumática. Además, su utilización ha sido segura, sin presentar ningún efecto secundario (AU)
No disponible
Subject(s)
Humans , Iron/administration & dosage , Hip Fractures/surgery , Preoperative Care/methods , Administration, Intravenous , Blood Loss, Surgical , Blood TransfusionABSTRACT
BACKGROUND AND OBJECTIVE: To determine whether administration of intravenous iron in a patient diagnosed with hip fracture reduces the need for blood transfusion. PATIENTS AND METHODS: A retrospective observational case-control study was performed comparing a control group of 63 patients diagnosed with hip fracture with another group of 57 patients treated with parenteral iron. Demographic, clinical condition/clinical record and hematometric differences of the case-control patients were described. We analyzed the morbidity (post-surgical infection) and mortality rate. SPSS(®) was used for statistical studies. RESULTS: Being statistically significant, after the administration of intravenous iron sucrose, the need of blood transfusion was reduced in the case group, as well as the quantity of concentrates required (1.37 vs 0.6). In the case group, there was a statistically significant decreasing trend in hospital mortality rate (case group: 0.8%/control group: 8.3%). It was not been proven the relation between the decrease in nosocomial infection and the administration of intravenous iron CONCLUSIONS: The administration of intravenous iron sucrose in patients diagnosed with hip fracture before surgery could be effective blood saving measure in this type of trauma surgery. Furthermore, its use has been reliable without causing any side effects.
