Comportamiento de pacientes con fracturas del pilón tibial tratados mediante fijación externa / Behavior of patients with tibial pilon fractures treated by external fixation

Resumen: Introducción: Las fracturas del pilón tibial constituyen lesiones de difícil manejo por su situación anatómica, mecanismo de producción y daño de las partes blandas que la rodean. El tratamiento quirúrgico es el más empleado, la fijación externa puede utilizarse de forma transitoria o definitiva. Objetivo: Evaluar el uso de la fijación externa en pacientes con fracturas del pilón tibial. Material y métodos: Se realizó un estudio con un nivel de evidencia IV, grado de recomendación B, en 34 pacientes con fractura del pilón tibial, atendidos de Enero de 2014 a Febrero de 2020. Desde el punto de vista estadístico se utilizó la distribución de frecuencias absolutas y relativas para variables cualitativas y para las cuantitativas la prueba de t Student. Resultados: El promedio de edad general fue de 45.8 años, predominó el sexo masculino con una razón de 1.4 a 1 y la fractura cerrada-abierta 1.8 a 1. Predominaron las fracturas tipo A según la clasificación del grupo AO. En relación a las fracturas abiertas predominaron las de tipo 3A. Se detectó significación entre un antes y un después al aplicar las escalas Olreud C y Molander H de la Sociedad Americana del Tobillo y Pie y el Ankle Scoring System. Las complicaciones del procedimiento quirúrgico fueron mínimas. Conclusiones: La fijación externa en pacientes con fracturas del pilón tibial es un método efectivo que puede emplearse de forma inmediata y definitiva en pacientes con fracturas abiertas y cerradas.

Abstract: Introduction: Tibial pylon fractures are difficult to manage injuries due to their anatomical situation, mechanism of production, and damage to the surrounding soft tissue. Surgical treatment is the most widely used, including external fixation that can be used temporarily or permanently. Objective: To evaluate the use of external fixation in patients with tibial pylon fractures. Material and methods: A pre-experimental study with a level of evidence II, recommendation grade B, was carried out in 34 patients with tibial pylon fracture, treated from January 2014 to February 2020. From the statistical point of view, the distribution of absolute and relative frequencies was used for qualitative variables and for quantitative variables, the Student's t test. Results: The general average age was 45.8 years, the male sex predominated with a ratio of 1.4 to 1 and the closed-open fractures 1.8 to 1. Type A fractures predominated according to the classification of the AO group. In relation to open fractures, 3A types predominated. Significance between a before and after was detected when applying the Olreud C and Molander H scales, from the American Ankle and Foot Society, and the Ankle Scoring System. The complications of the surgical procedure were minimal. Conclusions: External fixation in patients with tibial pylon fractures is an effective method that can be used immediately and definitively in patients with both open and closed fractures with few complications.

[Behavior of patients with tibial pilon fractures treated by external fixation]. / Comportamiento de pacientes con fracturas del pilón tibial tratados mediante fijación externa.

INTRODUCTION: Tibial pylon fractures are difficult to manage injuries due to their anatomical situation, mechanism of production, and damage to the surrounding soft tissue. Surgical treatment is the most widely used, including external fixation that can be used temporarily or permanently. OBJECTIVE: To evaluate the use of external fixation in patients with tibial pylon fractures. MATERIAL AND METHODS: A pre-experimental study with a level of evidence II, recommendation grade B, was carried out in 34 patients with tibial pylon fracture, treated from January 2014 to February 2020. From the statistical point of view, the distribution of absolute and relative frequencies was used for qualitative variables and for quantitative variables, the Student's t test. RESULTS: The general average age was 45.8 years, the male sex predominated with a ratio of 1.4 to 1 and the closed-open fractures 1.8 to 1. Type A fractures predominated according to the classification of the AO group. In relation to open fractures, 3A types predominated. Significance between a before and after was detected when applying the Olreud C and Molander H scales, from the American Ankle and Foot Society, and the Ankle Scoring System. The complications of the surgical procedure were minimal. CONCLUSIONS: External fixation in patients with tibial pylon fractures is an effective method that can be used immediately and definitively in patients with both open and closed fractures with few complications.

INTRODUCCIÓN: Las fracturas del pilón tibial constituyen lesiones de difícil manejo por su situación anatómica, mecanismo de producción y daño de las partes blandas que la rodean. El tratamiento quirúrgico es el más empleado, la fijación externa puede utilizarse de forma transitoria o definitiva. OBJETIVO: Evaluar el uso de la fijación externa en pacientes con fracturas del pilón tibial. MATERIAL Y MÉTODOS: Se realizó un estudio con un nivel de evidencia IV, grado de recomendación B, en 34 pacientes con fractura del pilón tibial, atendidos de Enero de 2014 a Febrero de 2020. Desde el punto de vista estadístico se utilizó la distribución de frecuencias absolutas y relativas para variables cualitativas y para las cuantitativas la prueba de t Student. RESULTADOS: El promedio de edad general fue de 45.8 años, predominó el sexo masculino con una razón de 1.4 a 1 y la fractura cerrada-abierta 1.8 a 1. Predominaron las fracturas tipo A según la clasificación del grupo AO. En relación a las fracturas abiertas predominaron las de tipo 3A. Se detectó significación entre un antes y un después al aplicar las escalas Olreud C y Molander H de la Sociedad Americana del Tobillo y Pie y el Ankle Scoring System. Las complicaciones del procedimiento quirúrgico fueron mínimas. CONCLUSIONES: La fijación externa en pacientes con fracturas del pilón tibial es un método efectivo que puede emplearse de forma inmediata y definitiva en pacientes con fracturas abiertas y cerradas.

[Behavior of patients with patellofemoral osteoarthritis]. / Comportamiento de pacientes con artrosis patelofemoral.

BACKGROUND: Patellofemoral osteoarthritis affects a great number of patients complaining chiefly of knee pain, treatment vary from conservative to surgical, especially arthroscopy. OBJECTIVE: The aim of this study was to show the behavior of a group of patients with patellofemoral osteoarthritis. MATERIAL AND METHODS: A descriptive and transversal study with a level of evidence IV and recommendation grade C in the provincial teaching hospital Manuel Ascunce Domenech in Camaguey city from January 2015 to April 2017 was performed in 96 patients with the diagnosis of patellofemoral osteoarthritis, but 77 of them were selected as a non-probabilistic sample, based on selected criteria. RESULTS: Mean age was 52.2 years. Female sex, right patella and primary etiology prevailed. Rest pain was the most common symptom. There is a strong correlation between Iwano T and Outerbridge RE classifications systems. In general, more than one compartment of the knee is aff ected in patellofemoral osteoarthritis, isolated presentation is rare and treatment by arthroscopy is of great help. CONCLUSIONS: Patellofemoral osteoarthritis is a common disease, patients usually complain of a great number of symptoms and signs. Patellofemoral osteoarthritis is usually associated to aff ection of other compartments and patients may be treated by arthroscopy.

ANTECEDENTES: La artrosis patelofemoral es detectada en un gran número de pacientes y es responsable de múltiples síntomas y signos entre los que predomina el dolor, su tratamiento es variado y va desde el conservador hasta el quirúrgico, en el que destaca la vía artroscópica. OBJETIVO: Mostrar el comportamiento de un grupo de pacientes con artrosis patelofemoral. MATERIAL Y MÉTODOS: Se realizó un estudio observacional descriptivo en 96 pacientes con el diagnóstico clínico y radiográfico de artrosis patelofemoral desde Enero de 2015 hasta Abril de 2017. La muestra no probabilística e intencionada quedó constituida por 77 pacientes que reunieron los criterios de selección (inclusión y exclusión). RESULTADOS: El promedio de edades fue de 52.2 años, predominó el sexo femenino, la rótula derecha y la causa que más se observó fue la primaria. El dolor durante el reposo es una de sus principales manifestaciones. Existe correlación entre la clasificación de Iwano T y Outerbridge RE. Por lo general, existen otros compartimentos afectados de la articulación, la presencia aislada es muy infrecuente y el tratamiento por vía artroscópica es de gran utilidad. CONCLUSIONES: La artrosis patelofemoral es frecuente, genera síntomas y signos en un grupo grande de pacientes. La presencia de esta afección por lo regular está asociada a otras lesiones de la articulación y los enfermos pueden ser tratados por vía artroscópica.

Comportamiento de pacientes con artrosis patelofemoral / Behavior of patients with patellofemoral osteoarthritis

Resumen: Antecedentes: La artrosis patelofemoral es detectada en un gran número de pacientes y es responsable de múltiples síntomas y signos entre los que predomina el dolor, su tratamiento es variado y va desde el conservador hasta el quirúrgico, en el que destaca la vía artroscópica. Objetivo: Mostrar el comportamiento de un grupo de pacientes con artrosis patelofemoral. Material y métodos: Se realizó un estudio observacional descriptivo en 96 pacientes con el diagnóstico clínico y radiográfico de artrosis patelofemoral desde Enero de 2015 hasta Abril de 2017. La muestra no probabilística e intencionada quedó constituida por 77 pacientes que reunieron los criterios de selección (inclusión y exclusión). Resultados: El promedio de edades fue de 52.2 años, predominó el sexo femenino, la rótula derecha y la causa que más se observó fue la primaria. El dolor durante el reposo es una de sus principales manifestaciones. Existe correlación entre la clasificación de Iwano T y Outerbridge RE. Por lo general, existen otros compartimentos afectados de la articulación, la presencia aislada es muy infrecuente y el tratamiento por vía artroscópica es de gran utilidad. Conclusiones: La artrosis patelofemoral es frecuente, genera síntomas y signos en un grupo grande de pacientes. La presencia de esta afección por lo regular está asociada a otras lesiones de la articulación y los enfermos pueden ser tratados por vía artroscópica.

Abstract: Background: Patellofemoral osteoarthritis affects a great number of patients complaining chiefly of knee pain, treatment vary from conservative to surgical, especially arthroscopy. Objective: The aim of this study was to show the behavior of a group of patients with patellofemoral osteoarthritis. Material and methods: A descriptive and transversal study with a level of evidence IV and recommendation grade C in the provincial teaching hospital Manuel Ascunce Domenech in Camaguey city from January 2015 to April 2017 was performed in 96 patients with the diagnosis of patellofemoral osteoarthritis, but 77 of them were selected as a non-probabilistic sample, based on selected criteria. Results: Mean age was 52.2 years. Female sex, right patella and primary etiology prevailed. Rest pain was the most common symptom. There is a strong correlation between Iwano T and Outerbridge RE classifications systems. In general, more than one compartment of the knee is affected in patellofemoral osteoarthritis, isolated presentation is rare and treatment by arthroscopy is of great help. Conclusions: Patellofemoral osteoarthritis is a common disease, patients usually complain of a great number of symptoms and signs. Patellofemoral osteoarthritis is usually associated to affection of other compartments and patients may be treated by arthroscopy.

Epiteliopatía pigmentaria placoide posterior aguda de presentación atípica / Atypical manifestations of acute posterior placoid pigment epitheliopathy

Caso clínicoVarón de 35 años con disminución brusca de la visión de su OI y antecedentes de proceso pseudogripal. A la exploración se observa una lesión blanco-amarillenta foveal acompañada de desprendimiento de la retina neurosensorial y un quiste subfoveal. Se decide instaurar tratamiento con corticoides vía oral consiguiéndose una mejoría significativa de la agudeza visual en 4 semanas.DiscusiónLa epiteliopatía pigmentaria placoide posterior aguda es una enfermedad que afecta a adultos jóvenes y sanos, que se caracteriza por tener buen pronóstico visual sin la necesidad, en la mayoría de los casos, de tratamiento. Existen casos en los que se manifiesta de forma atípica, en los que consideramos que se tendría que contemplar el tratamiento farmacológico con corticoides(AU)

Clinical caseA 35-year-old male with rapid loss of vision of his left eye. He complained of a flulike syndrome one week before the beginning of the symptoms. At the left posterior pole there was a white-yellowish subfoveal lesion associated with a subfoveal cyst and neurosensory retina detachment. We decided to initiate treatment with systemic corticosteroids and the sight improved after 4 weeks.DiscussionAcute posterior placoid pigment epitheliopathy is a disease that typically affects young and healthy adults. It is generally self-limiting and has good visual prognosis. Sometimes the disease includes atypical features such as serous detachment of the neurosensory retina. In these cases we consider that the use of systemic corticosteroids would be necessary(AU)

[Atypical manifestations of acute posterior placoid pigment epitheliopathy]. / Epiteliopatía pigmentaria placoide posterior aguda de presentación atípica.

CLINICAL CASE: A 35-year-old male with rapid loss of vision of his left eye. He complained of a flulike syndrome one week before the beginning of the symptoms. At the left posterior pole there was a white-yellowish subfoveal lesion associated with a subfoveal cyst and neurosensory retina detachment. We decided to initiate treatment with systemic corticosteroids and the sight improved after 4 weeks. DISCUSSION: Acute posterior placoid pigment epitheliopathy is a disease that typically affects young and healthy adults. It is generally self-limiting and has good visual prognosis. Sometimes the disease includes atypical features such as serous detachment of the neurosensory retina. In these cases we consider that the use of systemic corticosteroids would be necessary.

Helical CT cholangiography in the evaluation of the biliary tract: application to the diagnosis of choledocholithiasis.

BACKGROUND: We evaluated the role of helical computed tomographic (HCT) cholangiography in the study of the biliary tract, especially in the detection of choledocholithiasis, and compared it with direct cholangiography. METHODS: One hundred one patients with biliary lithiasic pathology undergoing direct cholangiography to rule out choledocholithiasis were included in this study. HCT was performed before and after slow infusion of cholangiographic contrast. Three-dimensional reconstructions and axial images were reviewed by two independent observers. Ultrasonography also was performed on all patients. RESULTS: The success rate of HCT cholangiography was 99%, with only a slight reaction to the contrast. The density values were significantly higher in the distal region of the tract and showed a significant correlation with serum bilirubin levels. Anatomic evaluation of the biliary tract with CT was similar to that with direct cholangiography. Anatomic variants were found on 23 studies. Twenty-two patients had choledocholithiasis, and 21 cases were detected with HCT cholangiography. The sensitivity of this technique (95.5%) was greater than that with unenhanced CT (60%) and ultrasonography (27.3%). Maximum intensity projection reconstructions were the most valuable for detecting choledocholithiasis. CONCLUSION: HCT cholangiography is a reliable technique that is similar to direct cholangiography in visualizing biliary anatomy, anatomic variants, and choledocholithiasis.

[Cerebral ischemic disorders in the young subject. The causes of ischemic disorders]. / Accidents ischémiques cérébraux du sujet jeune. Les causes des accidents ischémiques.

PROTEIN CAUSES: Although cardiogenic emboli, arterial dissection, and to a lesser extent, arteriosclerosis are the major underlying causes, clinicians should keep in mind the wide spectrum of possible etiologies. UNCOMMON CONDITIONS: Rigorous history taking (toxic risk, family history), systematic search for skin or skeletal anomalies, and an ophthalmologic examination can help orient the diagnosis and lead to the appropriate complementary explorations. DIAGNOSTIC STRATEGY: The need for a precise etiologic diagnosis is obvious as many vascular conditions are amenable to specific treatments or require particular monitoring or preventive measures. A family survey many be indicated.

[Laparoscopic cholecystectomy in children]. / Colecistectomía laparoscópica en niños.

BACKGROUND: Laparoscopic cholecystectomy is the standard current treatment in adults with cholelithiasis, the experience in children has been reported recently. OBJECTIVE: To report the utility and results with this new technology in the pediatric age. METHODS: We found six children, 10 to 15 years old, with gallbladder lithiasic disease, all were operated with a modified laparoscopic cholecystectomy technique. RESULTS: The operation was performed without complications, the average surgical time was 90 minutes, and the recover, was short and successful. CONCLUSIONS: Laparoscopic cholecystectomy in children can be safe and effective.