[Quantification of changes in the external morphology of the back by means of surface topography based on structured light in idiopathic scoliosis in adolescents after a year of treatment with orthopedic corse]. / Cuantificación de cambios en la morfología externa de la espalda mediante topografía de superficie basada en luz estructurada en la escoliosis idiopática del adolescente tras un año de tratamiento con corsé ortopédico.

BACKGROUND: To quantify the morphological changes in the surface of the back of adolescents with idiopathic scoliosis as a result of treatment with braces and to correlate them with radiographic changes. MATERIAL AND METHODS: An analytical, cohort, prospective study on a sample of 31 adolescents with idiopathic scoliosis. We divided them into two groups: eleven treated with braces and twenty without them. Quantification of the deformity was performed on two separate occasions with an interval of one year using three systems: 1) angle of trunk rotation (scoliometer); 2) surface topography; 3) full spine X-rays. RESULTS: No statistically significant differences were detected between the initial and final assessment of the topographic and radiographic variables in the group with braces. In the untreated group, only in measures with the scoliometer significant differences were registered. A positive correlation was found between the Cobb angle difference of the main curve with two topographic variables that quantify the asymmetry in the axial and coronal plane, respectively. DISCUSSION: In following patients with scoliosis treated with braces, we should consider and evaluate not only radiographic parameters such as the Cobb angle, but also clinical and topographic parameters that quantify the external deformity of the back, as there is a clinical-radiographic discrepancy amply demonstrated in the literature. The improvement of the external shape of the back is a very important factor for the patient, and can influence a better completion of the orthopedic treatment. In our study, the scoliotic curve and external deformity of the back remained stable during the follow-up period in both treated and untreated patients.

ANTECEDENTES: Cuantificar los cambios morfológicos producidos en la superficie de la espalda de adolescentes con escoliosis idiopática como resultado del tratamiento mediante corsé y correlacionarlos con las variaciones radiográficas. MATERIAL Y MÉTODOS: Estudio analítico, de cohortes, prospectivo, sobre una muestra de 31 adolescentes con escoliosis idiopática divididos en dos grupos: 11 con tratamiento mediante corsé y 20 sin corsé. Se realizó una cuantificación de la deformidad en dos ocasiones separadas entre sí por un intervalo de un año mediante tres sistemas: 1) ángulo de rotación del tronco (escoliómetro); 2) topografía de superficie; 3) radiografía simple de raquis completo. RESULTADOS: No se detectaron diferencias estadísticamente significativas entre la valoración inicial y final de las variables topográficas y radiográficas en el grupo con corsé. En el grupo no tratado, sólo hubo diferencias significativas para las medidas del escoliómetro. Se encontró una correlación positiva entre la diferencia del ángulo de Cobb de la curva principal con la de dos variables topográficas que cuantifican la asimetría en el plano axial y en el coronal, respectivamente. DISCUSIÓN: En el seguimiento de pacientes con escoliosis tratados con corsé, se deben tener en cuenta y valorar no sólo parámetros radiográficos como el ángulo de Cobb, sino también parámetros clínicos y topográficos que cuantifiquen la deformidad externa de la espalda, ya que existe una discrepancia clínico-radiográfica demostrada de manera amplia en la literatura. La mejoría de la forma externa de la espalda es un factor muy importante para el paciente y es lo que va a percibir fundamentalmente, lo que puede influir en una mejor cumplimentación del tratamiento ortopédico. En nuestro estudio, la curva escoliótica, así como la deformidad externa de la espalda, se mantuvo estable en el período de seguimiento tanto en los pacientes tratados con corsé como en los no tratados.

Cuantificación de cambios en la morfología externa de la espalda mediante topografía de superficie basada en luz estructurada en la escoliosis idiopática del adolescente tras un año de tratamiento con corsé ortopédico / Quantification of changes in the external morphology of the back by means of surface topography based on structured light in idiopathic scoliosis in adolescents after a year of treatment with orthopedic corse

Resumen: Antecedentes: Cuantificar los cambios morfológicos producidos en la superficie de la espalda de adolescentes con escoliosis idiopática como resultado del tratamiento mediante corsé y correlacionarlos con las variaciones radiográficas. Material y métodos: Estudio analítico, de cohortes, prospectivo, sobre una muestra de 31 adolescentes con escoliosis idiopática divididos en dos grupos: 11 con tratamiento mediante corsé y 20 sin corsé. Se realizó una cuantificación de la deformidad en dos ocasiones separadas entre sí por un intervalo de un año mediante tres sistemas: 1) ángulo de rotación del tronco (escoliómetro); 2) topografía de superficie; 3) radiografía simple de raquis completo. Resultados: No se detectaron diferencias estadísticamente significativas entre la valoración inicial y final de las variables topográficas y radiográficas en el grupo con corsé. En el grupo no tratado, sólo hubo diferencias significativas para las medidas del escoliómetro. Se encontró una correlación positiva entre la diferencia del ángulo de Cobb de la curva principal con la de dos variables topográficas que cuantifican la asimetría en el plano axial y en el coronal, respectivamente. Discusión: En el seguimiento de pacientes con escoliosis tratados con corsé, se deben tener en cuenta y valorar no sólo parámetros radiográficos como el ángulo de Cobb, sino también parámetros clínicos y topográficos que cuantifiquen la deformidad externa de la espalda, ya que existe una discrepancia clínico-radiográfica demostrada de manera amplia en la literatura. La mejoría de la forma externa de la espalda es un factor muy importante para el paciente y es lo que va a percibir fundamentalmente, lo que puede influir en una mejor cumplimentación del tratamiento ortopédico. En nuestro estudio, la curva escoliótica, así como la deformidad externa de la espalda, se mantuvo estable en el período de seguimiento tanto en los pacientes tratados con corsé como en los no tratados.

Abstract: Background: To quantify the morphological changes in the surface of the back of adolescents with idiopathic scoliosis as a result of treatment with braces and to correlate them with radiographic changes. Material and methods: An analytical, cohort, prospective study on a sample of 31 adolescents with idiopathic scoliosis. We divided them into two groups: eleven treated with braces and twenty without them. Quantification of the deformity was performed on two separate occasions with an interval of one year using three systems: 1) angle of trunk rotation (scoliometer); 2) surface topography; 3) full spine X-rays. Results: No statistically significant differences were detected between the initial and final assessment of the topographic and radiographic variables in the group with braces. In the untreated group, only in measures with the scoliometer significant differences were registered. A positive correlation was found between the Cobb angle difference of the main curve with two topographic variables that quantify the asymmetry in the axial and coronal plane, respectively. Discussion: In following patients with scoliosis treated with braces, we should consider and evaluate not only radiographic parameters such as the Cobb angle, but also clinical and topographic parameters that quantify the external deformity of the back, as there is a clinical-radiographic discrepancy amply demonstrated in the literature. The improvement of the external shape of the back is a very important factor for the patient, and can influence a better completion of the orthopedic treatment. In our study, the scoliotic curve and external deformity of the back remained stable during the follow-up period in both treated and untreated patients.

Positioning of the cross-stitch on the modified Kessler core tendon suture.

Cryopreserved human tendons were sutured with different variations of a modified Kessler-type grasping suture in a series of different designs in order to assess the influence of the distance between the cross-stitch on the core suture (5 and 10 mm from the cut tendon edge) on the peripheral suture. An original mathematical model was employed to explain the mechanical behavior (strength, deformation, and distribution of load) of the different suture designs. The effect of the peripheral epitendinous suture, combined with the distance of the core suture, was evaluated. The variation of core suture distance had no relevant consequences on the overall resilience of the design. However, increasing the distance between the cross-stitches of the core suture reduces the deformation that is absorbed not only by the core suture itself but also by the peripheral suture. Adding a peripheral epitendinous suture to a 10-mm design almost doubles the breaking load in absolute values. The mathematical model predicts that the peripheral suture will support a greater load when the distance of the core suture cross-stitches is increased. The evidence level is II.

Osteotomía cupuliforme combinada con transposición del nervio cubital como tratamiento del cúbito valgo postraumático en una paciente pediátrica / Combined dome-shaped osteotomy and ulnar nerve transposition for the treatment of traumatic cubitus valgus

Resumen: Una secuela de las fracturas supracondíleas de húmero distal en la infancia es la deformidad angular. Generalmente es más frecuente el cúbito varo, pero también existen casos descritos de cúbito valgo. Esta última puede ser la causa de la aparición de una neuropatía tardía del nervio cubital, que requerirá de tratamiento. Existe controversia en cuanto si es posible tratar con éxito ambos problemas en un mismo procedimiento quirúrgico. En este artículo se presenta el caso de una niña de 11 años, que presenta una deformidad en cúbito valgo secundaria a una fractura supracondílea de húmero distal de codo derecho a la edad de siete años, asociada con una clínica progresiva de neuropatía del nervio cubital. Esta paciente se trató de forma satisfactoria mediante un procedimiento único de osteotomía correctora cupuliforme supracondilar asociada con una transposición anterior subcutánea del nervio cubital a través de un abordaje posterior.

Abstract: A sequel of supracondylar fractures of distal humerus in children is the angular deformity. It is usually more frequent cubitus varus, but there are reported cases of cubitus valgus. The latter may be the cause of the occurrence of a late ulnar nerve neuropathy, which will require treatment. There is controversy as to whether it is possible to successfully treat both problems at the same surgical procedure. This article describes the case of a girl of 11 years old, who has a cubitus valgus deformity secondary to supracondylar fracture of distal humerus of right elbow at the age of seven years, associated with progressive symptoms of ulnar nerve neuropathy. This patient was treated successfully by a single procedure for corrective dome-shaped supracondilar osteotomy associated with subcutaneous anterior transposition of the ulnar nerve through a posterior approach.

[Dome shaped osteotomy combined with transposition of the ulnar nerve as a treatment for post-traumatic ulnar valgus in a pediatric patient]. / Osteotomía cupuliforme combinada con transposición del nervio cubital como tratamiento del cúbito valgo postraumático en una paciente pediátrica.

A sequel of supracondylar fractures of distal humerus in children is the angular deformity. It is usually more frequent cubitus varus, but there are reported cases of cubitus valgus. The latter may be the cause of the occurrence of a late ulnar nerve neuropathy, which will require treatment. There is controversy as to whether it is possible to successfully treat both problems at the same surgical procedure. This article describes the case of a girl of 11 years old, who has a cubitus valgus deformity secondary to supracondylar fracture of distal humerus of right elbow at the age of seven years, associated with progressive symptoms of ulnar nerve neuropathy. This patient was treated successfully by a single procedure for corrective dome-shaped supracondilar osteotomy associated with subcutaneous anterior transposition of the ulnar nerve through a posterior approach.

Una secuela de las fracturas supracondíleas de húmero distal en la infancia es la deformidad angular. Generalmente es más frecuente el cúbito varo, pero también existen casos descritos de cúbito valgo. Esta última puede ser la causa de la aparición de una neuropatía tardía del nervio cubital, que requerirá de tratamiento. Existe controversia en cuanto si es posible tratar con éxito ambos problemas en un mismo procedimiento quirúrgico. En este artículo se presenta el caso de una niña de 11 años, que presenta una deformidad en cúbito valgo secundaria a una fractura supracondílea de húmero distal de codo derecho a la edad de siete años, asociada con una clínica progresiva de neuropatía del nervio cubital. Esta paciente se trató de forma satisfactoria mediante un procedimiento único de osteotomía correctora cupuliforme supracondilar asociada con una transposición anterior subcutánea del nervio cubital a través de un abordaje posterior.

Osificación heterotópica periarticular secundaria a disfunción neurogénica central / Periarticular heterotopic ossification secondary to central neurogenic dysfunction

Presentamos el caso clínico de una paciente de 48 años de edad con antecedentes de tetraparesia secundaria a lobectomía derecha y desarrollo de una osificación heterotópica periarticular que incluía ambas articulaciones de las rodillas. La valoración del metabolismo de las lesiones óseas motivó la realización de una gammagrafía ósea. El patrón gammagráfico demostró un predominio de afectación del compartimento medial y lateral de la rodilla izquierda y medial de la rodilla derecha, siendo atribuido inicialmente a una osteoartritis degenerativa. Creemos interesante la presentación de este caso clínico por dos circunstancias: 1) la rareza de afectación de las rodillas en la osificación heterotópica periarticular secundaria a disfunción cerebral y 2) por la posibilidad de realizar un diagnóstico falso positivo: afectación osteoartrítica idiopática versus osificación yuxtaarticular.Se pretende realizar una pequeña revisión de: la utilidad de los métodos diagnósticos por la imagen en la valoración de la osificación heterotópica periarticular y del diagnóstico gammagráfico diferencial respecto a enfermedades osteoarticulares más frecuentes entre la población general (AU)

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[Periarticular heterotopic ossification secondary to central neurogenic dysfunction]. / Osificación heterotópica periarticular secundaria a disfunción neurogénica central.

A case of a 48 year old woman with a medical background of tetraparesis related to a right lobectomy and periarticular ossification development (that included both knee joints) is presented. Bone scintigraphy was performed to evaluate the metabolism of the bone lesions. The scintigraphic pattern showed an important involvement of the medial and lateral left knee and medial right knee compartments, initially attributed to degenerative osteoarthritis. We believe that the presentation of this case report is interesting for two reasons: 1) the rareness of knee involvement in periarticular heterotopic ossification related to cerebral dysfunction, and 2) the possibility of a false positive diagnosis: osteoarthritic involvement versus juxta-articular ossification. This paper reviews the role of diagnostic imaging methods in the assessment of periarticular heterotopic ossification and the differential scintigraphic diagnosis regarding to osteoarticular disorders (more frequent among the general population).

Nonreamed flexible locked intramedullary nailing in tibial open fractures.

Thirty-nine open unstable tibial shaft fractures were treated with a nonreamed flexible locked intramedullary nail between 1992 and 1995. There were 23 Grade I, 12 Grade II, three Grade IIIA, and one Grade IIIB fractures. The average time of followup assessment was 24 months. The average time to fracture union was 24 weeks. Complications were related in most cases to fractures with highly unstable patterns and extensive soft tissue lesions. There were five (12.5%) delayed unions and one (2.5%) nonunion. Deep infections developed in three (7.7%) patients. One patient required an additional procedure to correct a varus malunion. There were no implant failures. It was concluded that nonreamed flexible locked nailing provides effective control of axial and rotational stability in unstable Grades I to IIIA open fractures with acceptable union rates and a low incidence of complications secondary to the fixation system.

Intracapsular hip pressure after femoral neck fracture.

A consecutive series of 34 patients with femoral neck fractures was included in a prospective study aimed at evaluating preoperative variations in intracapsular pressure after changes in hip position, hip traction, and aspiration of hemarthrosis and their influence on the development of femoral head necrosis. Patients were observed for 7 years after surgery. Before aspiration, the mean intracapsular pressure in the antalgic physiologic position was 44.4 mm Hg. There were no differences between displaced and undisplaced fractures. The pressure was a maximum (mean value, 124.8 mm Hg) with the hip in extension and inward rotation, this pressure being greater than the blood systolic pressure in most cases. Hip traction of 3 kg in the antalgic physiologic position was found to be highly effective in preventing any bone flow tamponade effect in displaced and undisplaced femoral neck fractures: the mean intracapsular pressure decreased to 28.5 mm Hg. Aspiration of the hemarthrosis induced a significant decrease in intracapsular pressure only in cases with impaired vascularity of the femoral head as measured by scintigraphy using 99mTc labeled methyldiphosphonate. Aspiration of the hemarthrosis therefore is indicated only in the above cases, although it is less effective than hip traction in the antalgic position. There was no significant correlation between intracapsular pressure and the scintigraphy ratio. Avascular necrosis of the femoral head was detected in six cases. Among these, five patients had an intracapsular pressure below their diastolic blood pressure. This could indicate that vascular damage related to the fracture could be an important cause of bone necrosis despite that blood supply can be decreased by a tamponade effect.

Kuntscher nailing of femoral shaft fractures in children and adolescents.

We have reviewed 29 cases of very unstable diaphyseal fractures of the femur in children and adolescents treated by Kuntscher nailing. Follow up was for at least 5 years, and in most cases until after the end of growth. There were no postoperative complications, and the mean overgrowth of the femur was 7.06 mm. There was growth disturbance of the proximal femur in one case, but this did not interfere with function. We believe that Kuntscher nailing is indicated in children and adolescents with unstable high velocity fractures of the femoral shaft.

Double patella. A case of duplication in the coronal plane.

A case of duplication of the patella in the coronal plane is reported. Previously reported cases of double patella have shown sagittal or vertical duplication, and some have been associated with multiple epiphyseal dysplasia. In our case, excision of one patella and realignment of the extensor mechanism relieved symptoms of giving-way.

Repair of osteochondral defects in articular weightbearing areas in the rabbit's knee. The use of autologous osteochondral and meniscal grafts.

Repair of osteochondral defects in articular weightbearing areas presents its own particular problems because of the low potential of hyaline cartilage for regeneration. Our first group of experiments on the knee of the rabbit confirms that the new regenerated cartilage comes from bone marrow which degenerates before developing into true hyaline cartilage. The second group of experiments shows that autologous grafts from the non-weightbearing articular area suitable for the repair of defects in weightbearing areas. In an third group, autologous meniscal fibrocartilage was used as a graft for the repair of osteochondral defects.