Síndrome piramidal y variaciones anatómicas como causa de dolor ciático insidioso / Pyrimidal syndrome and anatomical variations as a cause of insidious sciatic pain

Mujer de 42 años, que presentó durante 6 años clínica insidiosa de dolor e impotencia funcional de miembro inferior izquierdo con pruebas diagnósticas normales llegando a un diagnóstico de exclusión de origen funcional. Fue sometida a tratamientos y técnicas conservadores sin mejoría por lo que se decidió realizar cirugía exploratoria donde se observó una compresión del nervio ciático por una variación anatómica del músculo piriforme. Tras resecar parte del músculo piramidal y liberarse la rama del nervio ciático afectada, se constató mejoría del cuadro clínico quedando la paciente asintomática (AU)

The case is presented of a 42 year old woman who had been suffering a loss of strength in her left leg for six years. After an extensive diagnostic study, the pain was classified as of functional origin by a diagnosis of exclusion. Since then, the patient has tried all kind of drug treatments and conservative techniques without improvement. After an exhaustive study with inconclusive results, the case was discussed with the Orthopaedics Department, who performed an exploratory surgery, in which compression of the sciatic nerve due to an anatomical variation of the piriformis muscle was observed. Part of the muscle was resected during surgery and the sciatic nerve was freed, after which the patient experienced a great improvement (AU)

[Pyrimidal syndrome and anatomical variations as a cause of insidious sciatic pain]. / Síndrome piramidal y variaciones anatómicas como causa de dolor ciático insidioso.

The case is presented of a 42 year old woman who had been suffering a loss of strength in her left leg for six years. After an extensive diagnostic study, the pain was classified as of functional origin by a diagnosis of exclusion. Since then, the patient has tried all kind of drug treatments and conservative techniques without improvement. After an exhaustive study with inconclusive results, the case was discussed with the Orthopaedics Department, who performed an exploratory surgery, in which compression of the sciatic nerve due to an anatomical variation of the piriformis muscle was observed. Part of the muscle was resected during surgery and the sciatic nerve was freed, after which the patient experienced a great improvement.

Fracturas desplazadas de la espina tibial anterior. Valoración del tratamiento quirúrgico / Displaced fractures of the anterior tibial spine. Assessment of their surgical treatment

Objetivo. Analizar los resultados del tratamiento quirúrgico de las fracturas desplazadas de la espina tibial anterior y evaluar la reincorporación de estos pacientes a las actividades físicas previas. Material y método. Entre 1987 y 2003 fueron tratados quirúrgicamente 18 pacientes con fractura desplazada de espina tibial anterior de 19,9 años de edad; media (9-36). En dos pacientes se fracturaron ambas espinas tibiales. En 13 casos se realizó cirugía abierta y en 5 artroscópica. El método de fijación fue con tornillos en 13 casos, reinserciones transóseas en 3 y cerclajes alámbricos en 2 casos. La valoración clínica se realizó mediante la escala funcional de Lysholm y Gillquist, evaluando la reincorporación a las actividades deportivas mediante la escala de Tegner. Resultados. El seguimiento postquirúrgico medio fue de 36 meses (12-132). La puntuación media fue 94,7, con 14 resultados excelentes, 2 buenos y 2 regulares. Diecisiete pacientes (94%) no presentaron dolor y en dos casos (11%) se evidenció inestabilidad de rodilla. Dieciséis pacientes (88%) se reincorporaron al mismo nivel de actividad anterior a la lesión. Conclusiones. La fractura de la espina tibial anterior es una lesión con buen pronóstico, no suponiendo, en la mayoría de los casos, limitación significativa para las actividades físicas y deportivas, siendo la inestabilidad de rodilla la complicación más importante

Purpose. To analyze the results of the surgical treatment of displaced anterior tibial spine fractures and to assess the return of these patients to their former physical activities. Materials and methods. Between 1987 and 2003, 18 patients of a mean age of 19.9 (range: 9-23) underwent surgery for a displaced anterior tibial spine fracture. In two patients, both tibial spines were fractured. Open surgery was performed in 13 cases and arthroscopy in 5. Fixation was accomplished with screws in 13 cases, transosseous reattachments in 3 and cerclage wiring in 2 cases. The Lysholm-Gillquist score was used to carry out the patients' clinical assessment and return to sport activity was evaluated with the Tegner scale. Results. Mean postoperative follow-up was 36 months (range: 12-132). The average score was 94.7, with 14 excellent results, 2 good and 2 fair. Seventeen patients (94%) were pain free and in two cases (11%) knee instability was detected. Sixteen patients (88%) returned to the same level of activity as before the injury. Conclusions. Anterior tibial spine fractures are injuries with good prognosis and, in the majority of cases, do not lead to significant limitations on physical and sport activities. The most frequent complication is knee instability