Tumor de rápido crecimiento en el primer dedo del pie derecho / Rapidly Growing Tumor on the Left Big Toe

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Evaluación de resultados funcionales y Notching tras el tratamiento de fracturas de húmero mediante artroplastia total invertida a medio plazo / Treatment of proximal humeral fractures by reverse shoulder arthroplasty: mid-term evaluation of functional results and Notching

Objetivo. Evaluar la relación entre el Notching y los resultados clínico-funcionales y radiológicos tras el tratamiento de las fracturas de húmero proximal con prótesis invertida de hombro (PTHi). Material y métodos. Estudio retrospectivo de 37 pacientes con fracturas de húmero proximal tratadas mediante PTHi con seguimiento medio de 24 meses. Se evaluó: tipo de fractura, rango de movilidad postoperatoria (antepulsión [AP], abducción [ABD], rotación externa [RE] y rotación interna [RI]), complicaciones y grado de satisfacción del paciente mediante la escala de Constant (CS). Se constató desarrollo de Notching según la clasificación de Nerot. Análisis estadístico de la relación Notching-posición de la glenosfera y resultados funcionales. Resultados. Los rangos medios de movilidad fueron AP 106,22°, ABD 104,46°, RE 46,08° y RI 40,27°. Se produjo Notching en el 29% de los pacientes al año de seguimiento. El valor medio del CS fue de 63 a los 18 meses post-IQ. Fueron estadísticamente no significativas las relaciones: Notching - balance articular final, Notching - CS, Notching - ángulo del cuello de la escápula, Notching - ángulo de la glena, Notching - distancia del bulón al borde inferior de la glena. Se encontró significación estadística entre la edad y el desarrollo de Notching y el Notching y el Tilt glenoideo. Conclusiones. La PTHi es una opción en pacientes con osteoporosis y artropatía del manguito rotador que presentan fractura humeral proximal. Permite alivio rápido del dolor y una funcionalidad aceptable. No está exenta de complicaciones: son necesarios estudios a largo plazo para determinar la relevancia del Notching (AU)

Objective. An analysis was made on relationship between Notching and functional and radiographic parameters after treatment of acute proximal humeral fractures with reverse total shoulder arthroplasty. Methods. A retrospective evaluation was performed on 37 patients with acute proximal humeral fracture treated by reversed shoulder arthroplasty. The mean follow-up was 24 months. Range of motion, intraoperative and postoperative complications were recorded. Nerot's classification was used to evaluate Notching. Patient satisfaction was evaluated with the Constant Score (CS). Statistical analysis was performed to evaluate the relationship between Notching and glenosphere position, or functional outcomes. Results. Mean range of elevation, abduction, external and internal rotation were 106.22°, 104.46°, 46.08° and 40.27°, respectively. Mean CS was 63. Notching was present at 12 months in 29% of patients. Statistical analysis showed significance differences between age and CS, age and notching development, and tilt with notching. No statistical significance differences were found between elevation, abduction, internal and external rotation and CS either with scapular or glenosphere-neck angle. Conclusion. Reverse shoulder arthroplasty is a valuable option for acute humeral fractures in patients with osteoporosis and cuff-tear arthropathy. It leads to early pain relief and shoulder motion. Nevertheless, it is not exempt from complications, and long-term studies are needed to determine the importance of notching (AU)

Comparative study of the effect of PTH (1-84) and strontium ranelate in an experimental model of atrophic nonunion.

UNLABELLED: This study aimed to set up an experimental model of long bone atrophic nonunion and to explore the potential role of PTH-1-84 (PTH 1-84) and strontium ranelate (SrR). A model of atrophic nonunion was created in Sprague-Dawley rats at the femoral midshaft level. The animals were randomised into four groups. Group A1: control rodents, fracture without bone gap; Group A2: rodents with subtraction osteotomy (non-union model control) treated with saline; Group B: rodents with subtraction osteotomy treated with human-PTH (PTH 1-84); and Group C: rodents with subtraction osteotomy treated with strontium ranelate (SrR). The groups were followed for 12 weeks. X-rays were be obtained at weeks 1, 6 and 12. After sacrificing the animals, we proceeded to the biomechanical study and four point bending tests to evaluate the resistance of the callus and histological study. In second phase, the expression of genes related to osteoblast function was analysed by reverse transcription-quantitative PCR in rats subjected to substraction osteotomy and treated for 2 weeks. The animals were randomised into three groups: Group A2: rodents treated with saline; Group B: rodents treated with PTH 1-84 and Group C: rodents treated with SrR. RESULTS: No significant histological differences were found between animals subjected to subtraction osteotomy and treated with either saline or PTH (p=0.628), but significant difference existed between animals receiving saline or SrR (p=0.005). There were no significant differences in X-ray score between the saline and PTH groups at either 6 or 12 weeks (p=0.33 and 0.36, respectively). On the other hand, better X-ray scores were found in the SrR group (p=0.047 and 0.006 in comparison with saline, at 6 and 12 weeks, respectively). In line with this, biomechanical tests revealed improved results in the SrR group. Gene expression analysis revealed a slightly decreased levels of DKK1, a Wnt pathway inhibitor, in rats treated with SrR. CONCLUSIONS: SrR increases has a beneficial effect in this atrophic non-union model in rats. This suggests that it might have a role may have important implications for the potential clinical role in the treatment of fracture nonunion.

[Treatment of proximal humeral fractures by reverse shoulder arthroplasty: mid-term evaluation of functional results and Notching]. / Evaluación de resultados funcionales y Notching tras el tratamiento de fracturas de húmero mediante artroplastia total invertida a medio plazo.

OBJECTIVE: An analysis was made on relationship between Notching and functional and radiographic parameters after treatment of acute proximal humeral fractures with reverse total shoulder arthroplasty. METHODS: A retrospective evaluation was performed on 37 patients with acute proximal humeral fracture treated by reversed shoulder arthroplasty. The mean follow-up was 24 months. Range of motion, intraoperative and postoperative complications were recorded. Nerot's classification was used to evaluate Notching. Patient satisfaction was evaluated with the Constant Score (CS). Statistical analysis was performed to evaluate the relationship between Notching and glenosphere position, or functional outcomes. RESULTS: Mean range of elevation, abduction, external and internal rotation were 106.22°, 104.46°, 46.08° and 40.27°, respectively. Mean CS was 63. Notching was present at 12 months in 29% of patients. Statistical analysis showed significance differences between age and CS, age and notching development, and tilt with notching. No statistical significance differences were found between elevation, abduction, internal and external rotation and CS either with scapular or glenosphere-neck angle. CONCLUSION: Reverse shoulder arthroplasty is a valuable option for acute humeral fractures in patients with osteoporosis and cuff-tear arthropathy. It leads to early pain relief and shoulder motion. Nevertheless, it is not exempt from complications, and long-term studies are needed to determine the importance of notching.

Tratamiento de la escoliosis juvenil: aumentar el tiempo entre alargamientos con la técnica de barras de crecimiento no debe comprometer necesariamente el crecimiento torácico / Treatment of juvenile scoliosis: increasing the lengthening interval with the growing rod technique should not necessarily compromise thoracic growth

Objetivo. Evaluar el crecimiento longitudinal del tórax y el control de la deformidad en una serie de pacientes con escoliosis juvenil tratados con barras de crecimiento aumentando los intervalos de tiempo entre alargamientos más de seis meses. Material y métodos. Estudio retrospectivo de ocho pacientes midiendo las siguientes variables: el ángulo de Cobb, la traslación vertebral apical, el balance coronal, la longitud torácica T1-L1, la cifosis torácica T5-T12, el ángulo de cifosis de unión proximal (CUP) y la lordosis lumbar. Se registraron las complicaciones. Resultados. Se evaluaron cinco escoliosis idiopáticas y tres casos de sindrómica (media de edad 9,4 ± 1,5 años). Se realizó una cirugía inicial y un promedio de dos retensados por paciente. El tiempo medio entre retensados fue de 15,7 meses. La corrección coronal final de la curva principal fue del 58%. La longitud torácica (T1-L1) preoperatoria fue de 20,8 cm, postoperatoria de 24,4 cm, y final de 26 cm. Al final del seguimiento el crecimiento medio del tórax fue de 5,2 cm. La cifosis preoperatoria (T5-T12) fue 33,5°, y final 32,1°. El cambio en el ángulo CUP fue de 2,5° en el seguimiento final. La mayoría de las complicaciones estuvieron relacionadas con la instrumentación. Se encontraron dos infecciones superficiales de la herida. Conclusión. En pacientes con escoliosis juvenil en formas «menos graves» tratados mediante barras de crecimiento, es posible espaciar los alargamientos más de un año y con ello disminuir el número de cirugías y al mismo tiempo controlar la deformidad y permitir el crecimiento longitudinal torácico (AU)

Objective. Serial lengthening with growing rods is recommended every six months for the treatment of early onset scoliosis. The objective of this study was to evaluate the longitudinal growth of the thorax and control of the deformity in a series of patients with juvenile scoliosis when time intervals were increased between lengthenings. Material and methods. Retrospective study of eight patients. The following variables were measured: the Cobb angle, the apical vertebral translation, the coronal balance, thoracic T1-L1 length, thoracic T5-T12 kyphosis, the proximal junctional kyphosis (PJK) angle, and the lumbar lordosis. Complications were recorded. Results. Five idiopathic and three syndromic scoliosis cases (mean age 9.4 ± 1.5 years) were evaluated. The initial surgery was followed by with an average of two distractions per patient. The mean time between distractions was 15.7 months. The final coronal main curve correction was 58%. Apical translation and coronal balance were improved and maintained after the surgeries. The thoracic (T1-L1) preoperative length was 20.8 cm, the postoperative length was 24.4 cm, and the final length was 26 cm. At the end of follow-up, the average growth of the thorax was 5.2 cm. The preoperative (T5-T12) kyphosis was 33.5°, and final 32.1°. The change in the PJK angle was 2.5° at the end of follow-up. Most complications were related to instrumentation. Two superficial wound infections were encountered. Conclusion. For less severe juvenile scoliosis patients treated with growing rods, spacing out lengthenings over more than a year can decrease the number of surgeries, while still controlling the deformity and allowing longitudinal thoracic growth (AU)

[Treatment of juvenile scoliosis: Increasing the lengthening interval with the growing rod technique should not necessarily compromise thoracic growth]. / Tratamiento de la escoliosis juvenil: aumentar el tiempo entre alargamientos con la técnica de barras de crecimiento no debe comprometer necesariamente el crecimiento torácico.

OBJECTIVE: Serial lengthening with growing rods is recommended every six months for the treatment of early onset scoliosis. The objective of this study was to evaluate the longitudinal growth of the thorax and control of the deformity in a series of patients with juvenile scoliosis when time intervals were increased between lengthenings. MATERIAL AND METHODS: Retrospective study of eight patients. The following variables were measured: the Cobb angle, the apical vertebral translation, the coronal balance, thoracic T1-L1 length, thoracic T5-T12 kyphosis, the proximal junctional kyphosis (PJK) angle, and the lumbar lordosis. Complications were recorded. RESULTS: Five idiopathic and three syndromic scoliosis cases (mean age 9.4 ± 1.5 years) were evaluated. The initial surgery was followed by with an average of two distractions per patient. The mean time between distractions was 15.7 months. The final coronal main curve correction was 58%. Apical translation and coronal balance were improved and maintained after the surgeries. The thoracic (T1-L1) preoperative length was 20.8 cm, the postoperative length was 24.4 cm, and the final length was 26 cm. At the end of follow-up, the average growth of the thorax was 5.2 cm. The preoperative (T5-T12) kyphosis was 33.5°, and final 32.1°. The change in the PJK angle was 2.5° at the end of follow-up. Most complications were related to instrumentation. Two superficial wound infections were encountered. CONCLUSION: For less severe juvenile scoliosis patients treated with growing rods, spacing out lengthenings over more than a year can decrease the number of surgeries, while still controlling the deformity and allowing longitudinal thoracic growth.

Parálisis del nervio ciático poplíteo externo como consecuencia de fractura de tobillo. Revisión de un caso / Case report. Common peroneal nerve palsy after an infrasindesmotic ankle fracture

Objetivo: La lesión del nervio ciático poplíteo externo se presenta de forma infrecuente asociada a fracturas de tobillo con mecanismo de inversión forzada y su relación no parece claramente establecida. Material y método: Paciente de 52 años con una fractura infrasindesmal de tobillo derecho y parálisis del nervio ciático poplíteo externo. Conclusión: El conocimiento y sospecha de esta lesión tan poco reconocida nos permitirá un precoz tratamiento de la misma, vital para el buen resultado funcional (AU)

Objective: The common peroneal nerve palsy after an infrasindesmotic ankle fracture is an uncommon pathology and the association between them remains unclear. Material and method: 52 year old patient with an infrasindesmotic ankle fracture and a common peroneal nerve palsy. Conclusion: The knowlegde of this unrecognized pathology will allow us to detect it early, which is very important for having a good outcome (AU)