Síndrome compartimental agudo en la baja de combate: una revisión narrativa / Acute compartment syndrome in combat casualties: a narrative review

Introducción: El síndrome compartimental agudo (SCA) es una complicación frecuente y potencialmente devastadora en las heridas de guerra que afectan a las extremidades, debido principalmente a las lesiones vasculares, óseas y de tejidos blandos frecuentemente asociadas, y a la dificultad para reevaluar a la baja durante su evacuación. El objetivo de esta revisión es analizar la evidencia científica disponible y actualizada sobre el manejo diagnóstico-terapéutico del SCA en la baja de combate.Material y métodos:Para la elaboración de este trabajo se ha realizado una búsqueda bibliográfica exhaustiva en las bases de datos: PubMed, Google Scholar, Scopus, ScienceDirect, Scielo y Latindex. Para la selección de artículos, se han establecido como criterios de inclusión que fueran realizados en entornos militares o sobre poblaciones de bajas de combate, escritos en castellano o inglés, y publicados durante los últimos quince años.Resultados y conclusiones:En el entorno operativo, el diagnóstico del SCA será fundamentalmente clínico y el tratamiento consistirá en una fasciotomía precoz y completa de todos los compartimentos del miembro afectado, ya que la fasciotomía tardía o incompleta se ha asociado con peores resultados y a un aumento de la morbimortalidad. La formación continuada en cirugía de guerra ha disminuido las tasas de fasciotomías de revisión. (AU)

Introduction: Acute compartment syndrome (ACS) is a frequent and potentially devastating complication of extremity war wounds, mainly due to the frequently associated vascular, bone and soft tissue injuries, and the limit close monitoring during casualty evacuation. The objective of this review is to analyze the available and updated scientific evidence on the diagnostic-therapeutic management of ACS in combat casualty.Material and Methods:For the preparation of this work, an exhaustive bibliographic search was carried out in the databases: PubMed, Google Scholar, Scopus, ScienceDirect, Scielo and Latindex. For the selection of articles, inclusion criteria have been established: carried out in military environments or on combat casualties populations, written in Spanish or English, and published during the last fifteen years.Results and Conclusions:In the combat zone, the diagnosis is even more heavily weighted toward clinical evaluation and the treatment will consist of a prompt and complete fasciotomy of all compartments of the affected limb, inasmuch as delayed or incomplete fasciotomy has been associated with worse outcomes and increased morbidity and mortality. Pre-deployment training of surgeons has decreased the rate of revision fasciotomies. (AU)

Lesiones osteolíticas multifocales / Multifocal osteolytic lesions

A 79-year-old woman with multiple pathologies and multiple osteolytic lesions during the Covid-19 pandemic. Histopathological and radiological differential diagnosis of injuries. (AU)

Haemodynamic instability during hip prothesis removal due to metallosis: An acute chrome/cobalt intoxication? A case report.

INTRODUCTION: Metallosis is produced by friction between prothesis pieces, release of metal particles that can enter systemic circulation provoking cobalt or chromium poisoning. No studies have been found in which the mobilization of metal particles causes haemodynamic instability. CASE PRESENTATION: We present the case of an 85 years old male with metallosis, programmed for washing and prothesis extraction (Girldlestone procedure). During pseudotumor drainage and washing, patient presented sudden desaturation and hypotension refractory to volume and phenylephrine administration. Echocardiogram showed overall hypocontractility. Situation was controlled with high inspired oxygen fraction and noradrenaline perfusion. In postoperative period E. coli grew in pseudotumor samples and metal particles could be seen in soft parts as the testicles. Plasma metal concentration showed high levels of chromium, but no chelator treatment was needed. DISCUSSION: Intraoperative hypotension raises several differential diagnoses. Echocardiography was useful to rule out hypovolaemia, pulmonary embolism and cardiac ischaemia. The results of analytical tests are often delayed, especially cultures and plasma metal levels; therefore, if metal poisoning is suspected, supportive treatment should be performed. Chelation and plasmapheresis should be used once the diagnosis is certain and are therefore not useful in the acute phase. CONCLUSION: Intraoperative hemodynamic instability during hip prosthesis explant may be due to bleeding, release of inflammatory or infectious detritus, acute pulmonary thromboembolism, etc. However, the sudden increase of cobalt or chromium ions should be considered as a feasible option in patients with metallosis, despite not presenting previous clinical manifestations of intoxication.

Cultivo condral in vitro bajo estímulos de compresión y cizallamiento. De las células troncales mesenquimales al cartílago hialino / In vitro chondral culture under compression and shear stimuli. From mesenchymal stem cells to hyaline cartilage

INTRODUCCIÓN: La creación in vitro de cartílago hialino articular supone un reto, ya que, a día de hoy, no se ha conseguido la síntesis ex vivo de un tejido estructurado con las mismas propiedades biomecánicas e histológicas del cartílago articular. Para simular las condiciones fisiológicas hemos diseñado un sistema de cultivo in vitro que reproduce el movimiento articular. MATERIAL Y MÉTODO: Hemos desarrollado un biorreactor de cultivo celular que imprime un estímulo mecánico sobre una matriz de elastina en la que están embebidas células troncales mesenquimales (MSC). La primera fase de estudio corresponde al desarrollo de un biorreactor para cultivo de cartílago hialino y la comprobación de la viabilidad celular en la matriz de elastina en ausencia de estímulo. La segunda fase del estudio engloba el cultivo de MSC bajo estímulo mecánico y el análisis del tejido resultante. RESULTADOS: Tras el cultivo bajo estímulo mecánico no obtuvimos tejido hialino por falta de celularidad y desestructuración de la matriz. CONCLUSIÓN: El patrón de estímulo utilizado no ha resultado efectivo para la generación de cartílago hialino, por lo que se deberán explorar otras combinaciones en futuras investigaciones

INTRODUCTION: The in vitro creation of hyaline joint cartilage is a challenge since, to date, the ex vivo synthesis of a structured tissue with the same biomechanical and histological properties of the joint cartilage has not been achieved. To simulate the physiological conditions we have designed an in vitro culture system that reproduces joint movement. MATERIAL AND METHOD: We have developed a cell culture bioreactor that prints a mechanical stimulus on an elastin matrix, in which mesenchymal stem cells (MSC) are embedded. The first phase of study corresponds to the development of a bioreactor for hyaline cartilage culture and the verification of cell viability in the elastin matrix in the absence of stimulus. The second phase of the study includes the MSC culture under mechanical stimulus and the analysis of the resulting tissue. RESULTS: After culture under mechanical stimulation we did not obtain hyaline tissue due to lack of cellularity and matrix destructuring. CONCLUSION: The stimulus pattern used has not been effective in generating hyaline cartilage, so other combinations should be explored in future research

In vitro chondral culture under compression and shear stimuli. From mesenchymal stem cells to hyaline cartilage. / Cultivo condral in vitro bajo estímulos de compresión y cizallamiento. De las células troncales mesenquimales al cartílago hialino.

INTRODUCTION: The in vitro creation of hyaline joint cartilage is a challenge since, to date, the ex vivo synthesis of a structured tissue with the same biomechanical and histological properties of the joint cartilage has not been achieved. To simulate the physiological conditions we have designed an in vitro culture system that reproduces joint movement. MATERIAL AND METHOD: We have developed a cell culture bioreactor that prints a mechanical stimulus on an elastin matrix, in which mesenchymal stem cells (MSC) are embedded. The first phase of study corresponds to the development of a bioreactor for hyaline cartilage culture and the verification of cell viability in the elastin matrix in the absence of stimulus. The second phase of the study includes the MSC culture under mechanical stimulus and the analysis of the resulting tissue. RESULTS: After culture under mechanical stimulation we did not obtain hyaline tissue due to lack of cellularity and matrix destructuring. CONCLUSION: The stimulus pattern used has not been effective in generating hyaline cartilage, so other combinations should be explored in future research.

Infección periprótesica en pacientes ancianos tratados mediante hemiartroplastia de cadera tras fractura intracapsular. ¿Debemos usar cementación con antibiótico? / Periprosthetic infection in elderly patients treated with hemiarthroplasty of the hip following intracapsular fracture. Should we use antibiotic-loaded bone cement?

INTRODUCCIÓN: Las infecciones protésicas son una complicación potencialmente devastadora, más aún en pacientes ancianos. Los cementos con antibiótico han sido usados como tratamiento y como profilaxis en la infección protésica, aunque no se encuentra bien documentado su uso en la profilaxis de la infección periprotésica en pacientes tratados mediante hemiartroplastia. MATERIAL: Estudio descriptivo retrospectivo en el que se obtuvieron datos de todos los pacientes intervenidos mediante hemiartroplastia de cadera por fractura subcapital entre los años 2011 y 2017 (N=241). Se realizó un estudio epidemiológico de los pacientes. Se analizó la incidencia de infección periprotésica en los grupos tratados con cemento sin antibiótico y con antibiótico, así como el efecto protector. A su vez, se realizó análisis de costes piloto. RESULTADOS: En el grupo que recibió cemento con antibiótico (n=94) se produjeron 8 infecciones (8%), mientras que en el grupo con cemento sin antibiótico (n=147) se produjeron 28 infecciones (19%). Se calculó la odds ratio y se observó un 55,3% de disminución de riesgo de desarrollar infección tardía en el grupo que recibió cemento con antibiótico (IC 95%: 6,2-78,7%; p = 0,0025). El uso de cemento con antibiótico conllevó un importante ahorro de costes por paciente. CONCLUSIONES: El uso de cementos con antibiótico resulta un factor protector en el desarrollo de infección tardía en hemiartroplastia de cadera en pacientes ancianos con fractura de cadera

INTRODUCTION: Prosthetic infections are a potentially devastating complication, especially in elderly patients. Antibiotic-loaded bone cement has been used both as a treatment and prophylaxis in prosthetic infection, and its use is not well documented in the prophylaxis of infection in patients who have suffered a hip fracture. MATERIAL: A retrospective descriptive was performed. The data were obtained from all the patients who underwent hip hemiarthroplasty due to a subcapital fracture between 2011 and 2017 (N=241). An epidemiological study of the patients studied was carried out. We analysed the incidence of periprosthetic infection in the groups treated with cement without antibiotic and antibiotic-loaded bone cement, as well as the protective effect of the antibiotic-loaded bone cement. At the same time, a pilot cost analysis study was carried out. RESULTS: In the group that received antibiotic-loaded bone cement (n=94) there were 8 infections (8%), while in the group with cement without antibiotic (n=147) there were 28 infections (19%). The odds ratio (OR) was calculated, showing a 55.3% reduction in the risk of developing late infection in the group that received cement with antibiotic (95% CI: 6.2-78.7%, P=.0025). The use of antibiotic-loaded bone cement led to significant cost savings per patient. CONCLUSIONS: The use of antibiotic-loaded bone cement is a protective factor in the development of late infection after hip hemiarthroplasty surgery in elderly patients with hip fracture

Periprosthetic infection in elderly patients treated with hemiarthroplasty of the hip following intracapsular fracture. Should we use antibiotic-loaded bone cement? / Infección periprótesica en pacientes ancianos tratados mediante hemiartroplastia de cadera tras fractura intracapsular. ¿Debemos usar cementación con antibiótico?

INTRODUCTION: Prosthetic infections are a potentially devastating complication, especially in elderly patients. Antibiotic-loaded bone cement has been used both as a treatment and prophylaxis in prosthetic infection, and its use is not well documented in the prophylaxis of infection in patients who have suffered a hip fracture. MATERIAL: A retrospective descriptive was performed. The data were obtained from all the patients who underwent hip hemiarthroplasty due to a subcapital fracture between 2011 and 2017 (N=241). An epidemiological study of the patients studied was carried out. We analysed the incidence of periprosthetic infection in the groups treated with cement without antibiotic and antibiotic-loaded bone cement, as well as the protective effect of the antibiotic-loaded bone cement. At the same time, a pilot cost analysis study was carried out. RESULTS: In the group that received antibiotic-loaded bone cement (n=94) there were 8 infections (8%), while in the group with cement without antibiotic (n=147) there were 28 infections (19%). The odds ratio (OR) was calculated, showing a 55.3% reduction in the risk of developing late infection in the group that received cement with antibiotic (95% CI: 6.2-78.7%, P=.0025). The use of antibiotic-loaded bone cement led to significant cost savings per patient. CONCLUSIONS: The use of antibiotic-loaded bone cement is a protective factor in the development of late infection after hip hemiarthroplasty surgery in elderly patients with hip fracture.

Infección periprotésica de rodilla ¿influye la estrategia quirúrgica en el resultado funcional? / Total knee arthroplasty infection, what is the best strategy for better functional outcomes?

Resumen: Introducción: La estrategia quirúrgica al enfrentarnos a las infecciones periprotésicas de rodilla sigue siendo controvertida. Los objetivos del tratamiento son la erradicación de la infección, la mejoría del dolor y de la función articular. El manejo quirúrgico incluye el desbridamiento y retención del implante, el recambio protésico en un tiempo o el recambio en dos tiempos. Esta última estrategia quirúrgica se considera el «gold standard¼, alcanzando unas tasas de curación hasta de 80%-100%, aunque poco se ha publicado acerca de los resultados funcionales. Material y métodos: Estudio retrospectivo de 65 pacientes, con infección periprotésica de rodilla. En 20 pacientes se realizó un recambio en un tiempo y en 45 pacientes fueron recambios en dos tiempos. Evaluación pre- y postoperatoriamente con la escala modificada HSS. Todos los pacientes fueron tratados con antibioterapia intravenosa, evaluamos la respuesta analítica y clínica para confirmar la erradicación o no de la infección. Resultados: La infección se resolvió en 39 de 65 pacientes, 12 en el grupo de recambio en un tiempo y 27 para el grupo de dos tiempos. Sin diferencia significativa entre los grupos en relación con curación ni resultado funcional. Sin embargo, hay una diferencia estadísticamente significativa entre aquellos pacientes que recibieron tratamiento antibiótico vía oral antes del diagnóstico y aquéllos que no lo recibieron. Conclusión: La tasa de curación es similar en los tratados con recambio en un tiempo y recambio en dos tiempos. No pudimos demostrar superioridad en los resultados funcionales entre los dos grupos.

Abstract: Introduction: Surgical strategy in dealing with periprosthetic knee infections remains controversial. The goals of treatment are to eradicate infection, improve pain and joint function. Surgical management includes implant debridement and retention, prosthetic replacement in one-time, or two-stage replacement. This latest surgical strategy is considered the «gold standard¼, reaching healing rates up to 80%-100%, although little has been published about functional results. Material and methods: Retrospective study of 65 patients with periprosthetic knee infection. In 20 patients a replacement was made in a time and in 45 patients were in two stages. Pre- and post-operative evaluation with the modified HSS scale. All patients were treated with intravenous antibiotherapy, we evaluated the analytical and clinical response to confirm the eradication or not of the infection. Results: The infection was resolved in 39 out of 65 patients, 12 in the replacement group in a time and 27 for the two-stages group. No significant difference between the groups in relation to healing or functional result. However, there is a statistically significant difference between those patients who received oral antibiotic treatment prior to diagnosis and those who did not. Conclusions: The healing rate is similarly treated with replacement in a time and replacement in two times. We were unable to demonstrate superiority in the functional results between the two groups.

[Total knee arthroplasty infection, what is the best strategy for better functional outcomes?] / Infección periprotésica de rodilla ¿influye la estrategia quirúrgica en el resultado funcional?

INTRODUCTION: Surgical strategy in dealing with periprosthetic knee infections remains controversial. The goals of treatment are to eradicate infection, improve pain and joint function. Surgical management includes implant debridement and retention, prosthetic replacement in one-time, or two-stage replacement. This latest surgical strategy is considered the «gold standard¼, reaching healing rates up to 80%-100%, although little has been published about functional results. MATERIAL AND METHODS: Retrospective study of 65 patients with periprosthetic knee infection. In 20 patients a replacement was made in a time and in 45 patients were in two stages. Pre- and post-operative evaluation with the modified HSS scale. All patients were treated with intravenous antibiotherapy, we evaluated the analytical and clinical response to confirm the eradication or not of the infection. RESULTS: The infection was resolved in 39 out of 65 patients, 12 in the replacement group in a time and 27 for the two-stages group. No significant difference between the groups in relation to healing or functional result. However, there is a statistically significant difference between those patients who received oral antibiotic treatment prior to diagnosis and those who did not. CONCLUSIONS: The healing rate is similarly treated with replacement in a time and replacement in two times. We were unable to demonstrate superiority in the functional results between the two groups.

INTRODUCCIÓN: La estrategia quirúrgica al enfrentarnos a las infecciones periprotésicas de rodilla sigue siendo controvertida. Los objetivos del tratamiento son la erradicación de la infección, la mejoría del dolor y de la función articular. El manejo quirúrgico incluye el desbridamiento y retención del implante, el recambio protésico en un tiempo o el recambio en dos tiempos. Esta última estrategia quirúrgica se considera el «gold standard¼, alcanzando unas tasas de curación hasta de 80%-100%, aunque poco se ha publicado acerca de los resultados funcionales. MATERIAL Y MÉTODOS: Estudio retrospectivo de 65 pacientes, con infección periprotésica de rodilla. En 20 pacientes se realizó un recambio en un tiempo y en 45 pacientes fueron recambios en dos tiempos. Evaluación pre- y postoperatoriamente con la escala modificada HSS. Todos los pacientes fueron tratados con antibioterapia intravenosa, evaluamos la respuesta analítica y clínica para confirmar la erradicación o no de la infección. RESULTADOS: La infección se resolvió en 39 de 65 pacientes, 12 en el grupo de recambio en un tiempo y 27 para el grupo de dos tiempos. Sin diferencia significativa entre los grupos en relación con curación ni resultado funcional. Sin embargo, hay una diferencia estadísticamente significativa entre aquellos pacientes que recibieron tratamiento antibiótico vía oral antes del diagnóstico y aquéllos que no lo recibieron. CONCLUSIÓN: La tasa de curación es similar en los tratados con recambio en un tiempo y recambio en dos tiempos. No pudimos demostrar superioridad en los resultados funcionales entre los dos grupos.

Masa palpable en muslo con antecedente traumático / Palpable mass in thigh with trauma antecedent

No disponible

Fractura de pelvis tipo C de Tile, desde un país del tercer mundo hasta España / Pelvis fracture type C of Tile, from the tirad World to Spain

Noi disponible

Complicaciones a corto y medio plazo de las fracturas de extremo proximal de húmero tratadas mediante placa PHILOS / Complications in the short and medium term of fractures of the proximal humerus treated with PHILOS plate

Objetivo: Analizar la incidencia de las complicaciones a corto plazo en las fracturas de extremidad proximal de húmero en 2, 3 y 4 fragmentos, tratadas mediante el sistema de placas con tornillos de bloqueo o PHILOS. Material y metodología: Se realizó un análisis retrospectivo de la incidencia de complicaciones en 43 pacientes (17 hombres y 26 mujeres) con una edad media de 61 años y un seguimiento mínimo entre 12 y 24 meses. Resultado: La incidencia de complicaciones fue de un 36%, evidenciándose cuatro casos de desmontaje o protrusión de los tornillos, cuatro de infección profunda, dos de pseudoartrosis, otros dos de necrosis avascular de la cabeza humeral y otras complicaciones menores. Dichas complicaciones se asociaron a fracturas de cuatro fragmentos y a pacientes mayores de 60 años. Conclusión: Aunque la utilización de placas PHILOS es una buena elección terapéutica para las fracturas de húmero proximal, existe una alta tasa de complicaciones, especialmente en aquellas fracturas complejas y en los pacientes de mayor edad (AU)

Objective: To analyze the impact of short-term complications in fractures of the proximal end of humerus in two, three and four fragments, treated by the system of plates with locking screws or PHILOS. Patients and methodology: This retrospective analysis was performed to analyse the complications in 43 patients (17 men and 26 women) with a mean age of 61 years and a minimum follow-up between 12 and 24 months. Results: The incidence of complications was 36%, showing four cases of removal or protrusion of the screws, four cases of deep infection, two cases of nonunion, two cases of avascular necrosis of the humeral head and other minor complications. These complications are most often associated with fractures and patients four fragments over 60 years. Conclusion: Despite the use of PHILOS plate is a good therapeutic choice for proximal humerus fractures, there is a high rate of complications, especially in complex fractures and elderly patients (AU)

Transporte Oruga de Montaña ¿Vehículo de Transporte Sanitario? / Mountain Tracked Vehicle. MEDEVAC vehicle?

El vehículo transporte oruga de montaña, TOM, ha sido puesto a prueba como vehículo de transporte sanitario. Esta adaptación de vehículo de transporte de personal a vehículo de transporte sanitario viene precedida por los diferentes problemas encontrados por el Servicio de Sanidad destacado en Qala-eh-Naw, Afganistán, durante el planeamiento de posibles evacuaciones1, a lo largo de diciembre y enero de 2005 y 2006 respectivamente. Aún sin alterar la estructura original del vehículo fueron necesarios algunos cambios esenciales para su utilización sanitaria, siempre con objeto de asegurar las evacuaciones durante la época invernal (AU)

The mountain tracked vehicle (TOM) has been tested as a MEDEVAC vehicle. This adaptation from a personnel transportation mean to a MEDEVAC vehicle has been preceded by the different problems met by the medical support deployed in Qalaeh- Naw (Afghanistan) during the planning of possible evacuations, in December 2005 and January 2006. Even without altering the original structure of the vehicle some changes were necessary to make it suitable for medical utilization, keeping always in mind the need to ensure the evacuations during wintertime (AU)