Osteointegración con el sistema Keep Walking Advanced® en una paciente amputada transfemoral / Osseointegration with the Keep Walking Advanced® system in a transfemoral patient

Aproximadamente una tercera parte de los pacientes con una amputación transfemoral van a padecer problemas crónicos relacionados con el encaje de su prótesis. El 72% de los pacientes amputados refieren sudoración o sensación de calor por culpa del encaje, el 62% reportan lesiones cutáneas o irritaciones de la piel del muñón, el 53% fatiga del muñón, el 51% dolor del muñón y el 38% acaban abandonando el uso de la prótesis. La osteointegración es una técnica que evita estos problemas generados en la piel del paciente, ya que permite un anclaje directo de la prótesis al implante intramedular colocado en el fémur del paciente. Presentamos el caso de una paciente amputada transfemoral de 38 años tratada mediante una cirugía de osteointegración con el implante Keep Walking Advanced® para mejorar el uso de la prótesis sin la necesidad de encaje (AU)

Approximately one third of patients with a transfemoral amputation will have chronic problems related to the fitting of the prosthesis. More than two thirds (72%) of amputees report sweating or feeling hot because of the socket, 62% report skin lesions or skin irritation of the stump, 53% stump fatigue, 51% stump pain and 38% do not use the prosthesis. Osseointegration is a technique that avoids these problems in the patient's skin, allowing direct anchoring of the prosthesis to the intramedullary implant placed in the patient's femur. We report the case of a 38-year-old transfemoral amputee who underwent implantation of the Keep Walking Advanced® implant to improve the use of the prosthesis without the need for socket fitting (AU)

[Prosthetic joint infection by Candida spp.]. / Infección por Candida spp. sobre prótesis articulares.

INTRODUCTION: Fungal periprosthetic infectionis a rare entity. The aim of this report was to review our experience in two different educational hospitals. MATERIAL AND METHODS: patients with documented prosthetic joint infection due to Candida spp. from February 2002 to October 2010 were retrospectively reviewed. Demographics, microbiological data, treatment and outcome of each patient was recorded. RESULTS: Ten patients, 8 women and 2 men, with a meanage of 77.7 (range 66-92) years were identified. Nine patients had previous bacterial infection, received antibiotic treatment for more than 15 days and required multiple surgeries. The most frequent species was C. albicans with 6 cases. All patients received fluconazole and surgical treatment consisted of debridement without removing the implant in 3 cases and 2-stage exchange with a spacer in 7. The first surgical and antifungal approach failed in all cases and a second debridement was necessary in one case, a resection arthroplasty in 8 and chronic suppressive treatment with fluconazol in one. After a mean follow-up of 31 (range 2-67) months, two patients were free of infection. CONCLUSION: Prosthetic joint infection was associated with long-term antibiotic treatment and multiples previous surgeries. Treatment with fluconazol and debridement or two stage replacement with a spacer was associated with a high failure rate.

Hernia through iliac crest defects. A report of four cases.

Herniation of abdominal contents through the donor site in the ilium occurred in 5% of a series of 59 bone grafts. Four patients had this condition at a 7 year follow up, and 2 were repaired with synthetic mesh. Age, gender, obesity and surgical technique are important causative factors. Preventive measures are proposed which have been successful during the past 3 years.

Tuberculosis of the neural arch. A report of four cases.

Four cases of spinal tuberculosis involving the posterior neural elements are reported; all the patients were from Africa. The condition is rare and its incidence may be different in different races. Neural arch involvement is likely to be associated with neurological complications.