Inestabilidad sutil de la sindesmosis tibioperonea: diagnóstico mediante TAC con carga axial y posiciones forzadas del pie / Subtle tibiofibular syndesmotic instability: diagnosis by CT with axial load and forced foot positions

Objetivo: Probar un método diagnóstico objetivo, fiable y reproducible que permita detectar la inestabili- dad sutil de la sindesmosis tibioperonea. Material y métodos: Se presenta el caso de un paciente con dolor recurrente sobre la articulación tibioperonea tras un esguince de tobillo. Ante la sospecha de lesión de los ligamentos tibioperoneos se realizó un TAC con carga axial y posiciones forzadas de ambos pies. Resultados: La diferencia en el área del espacio tibiopero- neo entre la posición de relajación y la posición de tensión de la sindesmosis en el tobillo sano fue de 5,79 mm2, mientras que en el tobillo lesionado fue de 22,58 mm2. Conclusión: El TAC con carga axial y posiciones forzadas de ambos pies puede ser útil para el diagnóstico de la inestabilidad sutil de la sindesmosis tibio- peronea. (AU)

Objetive: To test an objective, reliable and reproducible diagnostic method to detect subtle tibiofibular syn- desmosis instability. Material and methods: A case with recurrent pain over tibiofibular joint after an ankle sprain is presented. It was sus- pected injury to the tibiofibular ligaments so a CT with axial load and forced foot positions was done. Results: Difference in tibiofibular space area between the syndesmosis relaxed position and the tension position in the uninjured ankle was 5.79 mm2, while in the injured ankle it was 22.58 mm2. Conclusion: CT with axial load and forced foot positions can be useful for the diagnosis of subtle tibiofibular syndesmosis instability. (AU)

Assessment of paraspinal muscle hardness in subjects with a mild single scoliosis curve: a preliminary myotonometer study.

OBJECTIVE: The purpose of this study was to evaluate the hardness of the paraspinal muscles in the convexity and concavity of patients with scoliosis curvatures and in the upper trapezius (UT) muscle in subjects with mild idiopathic scoliosis (IS) and to observe the correlation between the myotonometer (MYO) measurements and the value of body mass index (BMI) and the Cobb angle. METHODS: The sample included 13 patients with a single-curve mild IS (Risser sign ≤ 4) at thoracic, lumbar, or thoracolumbar level (mean Cobb angle of 11.53º). Seven females and 6 males were recruited, with a mean age of 12.84 ± 3.06 (9-18) years. A MYO was used to examine the differences in muscle hardness on both sides of the scoliosis curvature at several points: (a) apex of the curve, (b) upper and lower limits of the curve, and (c) the midpoint between the apex and the upper limit and between the apex and the lower limit. The UT was also explored. RESULTS: Although the MYO recorded lower values in all points on the concave side of the scoliosis, there were no significant differences in the comparison between sides (P > .05). No association was observed between BMI and MYO values, whereas the Cobb angle negatively correlated with muscle hardness only at 2 points on the convex side. CONCLUSION: The preliminary findings show that, in subjects with a single-curve mild IS, muscular hardness in the UT and paraspinal muscles, as assessed using a MYO, was not found to differ between the concave and the convex sides at different reference levels.

Popliteal pseudoaneurysm after unicompartmental knee replacement: a case report.

UNLABELLED: Popliteal pseudoaneurysm is a rare but important complication of knee arthroplasties. To our knowledge, this complication has not been reported previously in the literature after unicompartmental knee arthroplasty. Apart from intraoperatively caused arterial injuries, obese patients and other previous cardiovascular diseases may be potential factors of risks for pseudoaneurysm in knee surgeries. As it is an uncommon complication and it has inconspicuous symptoms, both diagnosis and treatment can be delayed. This means that a high level of suspicion is necessary to prevent serious complications derived from pseudoaneurysms. LEVEL OF EVIDENCE: Level IV.

Análisis del síndrome Inestable-Doloroso de la articulación subastragalina mediante el sistema estrés dinámico BaroPodoTAC / Analysis of Unstable-painful Subtalar Joint Syndrome using Dynamic Stress System CT scan

Introducción: La inestabilidad de tobillo y de retropié coexisten frecuentemente sin que existan en la actualidad métodos objetivos no quirúrgicos para su diagnóstico diferencial. Además, la inestabilidad y el dolor en la articulación subastragalina pueden desembocar en la temida artrosis de retropié en pacientes de cualquier edad. El presente trabajo tiene como propósito principal comparar el rango de movilidad del retropié sintomático respecto al retropié sano en una serie consecutiva de pacientes afectos de inestabilidad de tobillo. Material y Método: Se diseñó un dispositivo que simula condiciones de carga con movimientos extremos de la articulación subastragalina sobre la mesa de TAC (Estrés-BaroPodo-TAC). Se realizó TAC en carga y en dos posiciones extremas de inversión-rotación interna y eversión-rotación externa sobre 26 pies de 13 pacientes diagnosticados de inestabilidad crónica de tobillo. Se midieron los ángulos de divergencia y flexión astrágalo-calcánea en las dos posiciones mencionadas y se calculó el rango de movimiento total. Se comparó el retropié problema con el retropié sano en cada paciente. Resultados: Los pies problemas presentaron mayor rango de movilidad de divergencia astrágalo-calcáneo que los pies sanos de los pacientes. No hubo diferencias en el rango de movilidad de flexión astrágalo-calcáneo. No se correlacionó estadísticamente el movimiento de divergencia en el plano axial con el movimiento de flexión astrágalo-calcánea en el plano sagital. Conclusión: Mediante este método se midió objetivamente mediante TAC el rango de movimiento de la articulación subastragalina. Los pacientes con inestabilidad de tobillo y dolor en retropié presentaron mayor rango de movilidad en la articulación subastragalina en el retropié doloroso respecto al contralateral (AU)

Introduction: In many cases, unstable ankle and heel coexist without there currently being any objective, non-surgical method for a differential diagnosis. Moreover, instability and pain in the subtalar joint could deteriorate into the so dreaded osteoarthritis of the heel in patients of any age. The main objective of this work is to compare the movement range of a symptomatic heel with regards to a healthy heel in a consecutive series of patients affected with ankle instability. Material and method: A device was designed to simulate weight-bearing conditions with extreme subtalar joint movement on the CAT scan examination table (Estrés-BaroPodo-TAC). A CAT scan was performed during weight-bearing and in two extreme positions of internal inversion rotation and external eversion rotation of 26 feet in 13 patients, all diagnosed with chronic, unstable ankle. The divergence and flexion of heel angles in the two positions mentioned and the total movement range was calculated. The heel problem was compared with the healthy heel in each patient. Results: The problem foot presented a greater range of heel divergence mobility than the patient’s healthy foot. There were no differences in the mobility range for heel flexion. The divergence of movement in the axial plane was not statistically correlated with the heel flexion movement in the sagittal plane. Conclusion: With this method, we objectively measured the movement range of the heel joint, using CAT scan. Patients with unstable ankle and heel pain presented a greater range of movement in the heel joint of the painful heel with respect to the contralateral movement (AU)

Bone health, daily physical activity, and exercise tolerance in patients with cystic fibrosis.

BACKGROUND: Daily physical activity (PA) may be an excellent tool for the maintenance of bone health in patients with cystic fibrosis (CF). The aim of this study was to analyze the possible association between physical capacity and activity and bone mineral density (BMD) in young adults with CF. A secondary goal was to evaluate vertebral fractures in this population. METHODS: A cross-sectional study was conducted in 50 patients with CF who were clinically stable and aged > 16 years but not lung transplant recipients. PA was quantified with a portable motion monitor (BodyMedia Fit Armband). Cardiopulmonary exercise and 6-min walk tests were used to assess exercise capacity. BMD was obtained from dual-energy x-ray absorptiometry of the lumbar column, hip, and whole body. To analyze vertebral fractures and deformity, we performed the Genant and Cobb methods. RESULTS: Daily PA time at low (3-4.8 metabolic equivalent tasks [METs]) and moderate (4.8-7.2 METs) intensity, respectively, was correlated with Z score (BMD) of the lumbar column (r = 0.36, P < .01 and r = 0.59, P < .001), the neck of femur (r = 0.51, P < .001 and r = 0.72, P < .001), and the total hip (r = 0.54, P < .001 and r = 0.74, P < .001). PA, BMI, age, and sex were predictors of BMD. Vertebral fractures correlated with kyphosis (r = 0.42, P = .02), but not with BMD. Patients who were mildly and severely affected differed in vertebral fracture rate and kyphosis prevalence (P = .002 and P = .013, respectively). CONCLUSIONS: The most active patients with better exercise capacity had higher BMD. Those with more affected pulmonary function had a greater prevalence of vertebral fractures and dorsal kyphosis.

Onda de Osborn en la hipotermia / The Osborn, or J, wave in hypothermia

No disponible

Gangrena como manifestación inicial de un síndrome antifosfolipídico catastrófico / Gangrene as an initial manifestation of a catastrophic antiphospholipid syndrome

El síndrome de anticuerpos antifosfolipídicos catastrófico (SAAFC) es una forma rara de presentación del síndrome de anticuerpos antifosfolipídicos, de mal pronóstico, por lo que son necesarios un diagnóstico y un tratamiento precoces. Presentamos un paciente que tuvo gangrena como manifestación inicial de un SAAFC (AU)

Catastrophic antiphospholipid syndrome (CAPS) is an unusual form of presentation of antiphospholipid syndrome with a poor prognosis, so early diagnosis and treatment are necessary. We report a patient who had gangrene as the initial manifestation of CAPS (AU)

[Gangrene as an initial manifestation of a catastrophic antiphospholipid syndrome]. / Gangrena como manifestación inicial de un síndrome antifosfolipídico catastrófico.

Catastrophic antiphospholipid syndrome (CAPS) is an unusual form of presentation of antiphospholipid syndrome with a poor prognosis, so early diagnosis and treatment are necessary. We report a patient who had gangrene as the initial manifestation of CAPS.