Radiological evaluation of ulnar thumb metacarpophalangeal ligament reconstruction for chronic thumb instability in cadavers.

Various techniques have been described to restore metacarpal stability in the thumb. Ligament reconstruction techniques that position the bone tunnels in a triangular configuration, with the apex proximally, are optimal for stabilizing the metacarpophalangeal (MCP) joint, while preserving the thumb's range of motion. Using an interference screw ensures this reconstruction is as strong as the native ligament. Our purpose was to evaluate a new technique designed to treat cases of chronic thumb instability. We created metacarpal instability in 10 fresh cadaver forearms by sectioning the ulnar collateral ligament (UCL). Ulnar thumb MCP ligament reconstruction (UTMP) was performed in five thumbs and Littler reconstruction in the other five. Radiographic analysis was performed after ligament transection and after ligament reconstruction to compare MCP angles on posterior-anterior (MCPFA) and lateral views (MCPLA), and to evaluate MCP congruence and sesamoid bone parallelism. After UCL transection, thumb instability was present in all cadaver specimens. A significative increase in the MCPFA value was found: Littler (P=0.01) and UTMP (P=0.01). The MCPFA with thumb loading was not significantly changed with the Littler (P=0.83) or UTMP (P=0.46) relative to pre-transection. All parameters were significantly improved, reflecting a return to normal values. There was no significant difference between the two reconstruction techniques. Based on the findings in this cadaver study, UTMP reconstruction appears to correct the radiologic features of lateral thumb instability. It is a simple technique that restores MCP stability without limiting MCP flexion. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

[Rivaroxaban versus standard of care in venous thromboembolism prevention following hip or knee arthroplasty in daily clinical practice (Spanish data from the international study XAMOS)]. / Rivaroxaban frente al tratamiento estándar en la prevención del tromboembolismo venoso tras artroplastia de cadera o rodilla en la práctica clínica diaria (datos de España del estudio internacional XAMOS).

OBJECTIVE: To analyse the effectiveness and safety of rivaroxaban vs. standard treatment (ST) in the prevention of venous thromboembolism after hip or knee replacement in daily clinical practice in Spain. MATERIAL AND METHOD: A sub-analysis of the Spanish data in the XAMOS international observational study that included patients>18 years who received 10mg o.d. rivaroxaban or ST. FOLLOW-UP: up to 3 months after surgery. PRIMARY OUTCOMES: incidence of symptomatic/asymptomatic thromboembolic events, bleeding, mortality, and other adverse events; SECONDARY OUTCOMES: use of health resources and satisfaction after hospital discharge. RESULTS: Of the total 801 patients included, 410 received rivaroxaban and 391 ST (64.7% heparin, 24.0% fondaparinux, 11% dabigatran). The incidence of symptomatic thromboembolic events and major bleeding was similar in both groups (0.2% vs. 0.8% wit ST and 0.7% vs. 1.3% with ST [EMA criteria]/0.0% vs. 0.3% with ST [RECORD criteria]). The adverse events incidence associated with the drug was significantly higher rivaroxaban (overall: 4.4% vs. 0.8% with ST, P=.001; serious: 1.5% vs. 0.0% with ST, P=.03). The rivaroxaban used less health resources after discharge, and the majority considered the tolerability as «very good« and the treatment as «very comfortable¼. DISCUSSION: Rivaroxaban is at least as effective as ST in the prevention of venous thromboembolism prevention in daily clinical practice, with a similar incidence of haemorrhages. It provides greater satisfaction/comfort, and less health resources after discharge. These results should be interpreted taking into account the limitations inherent in observational studies.

[Arterial hypertension and sleep apnea hypopnea syndrome in primary care]. / Hipertensión arterial y síndrome de apneas-hipoapneas del sueño en atención primaria.

INTRODUCTION AND OBJECTIVES: Sleep apnea hypopnea syndrome (SAHS) is frequent in hypertensive patients and plays a role in a greater incidence of cardiovascular morbidity-mortality. This study aims to know the clinical profile of hypertensive patients with SAHS compared to hypertensive patients without SAHS to know which variables should be used to orient their screening from primary care. METHODOLOGY: An observational, descriptive, retrospective study of cases (hypertensive patients with SAHS) and controls (hypertensive patients without) was performed in an urban health care center. Based on a computerized registry of the site, patients diagnosed of SAHS and hypertension over 30 years of age were selected. For each case, one control case of hypertensive patients without SAHS paired by age and gender was randomly obtained. RESULTS: A total of 64 cases and 64 controls were selected. Standing out in the bivariate analysis were greater BMI (34.3±12.8 vs. 28.6±3.6), predominance of obesity (70.3 vs. 35.9%), metabolic syndrome (77.3 vs. 42.2%), consumption of psychopharmaceuticals (19.7 vs. 7.8%) and anithypertensive drugs (26.5 vs. 14.0%), ischemic heart disease (20.3 vs. 9.4%) in the case group versus control group (P<.05 for all the variables). The multivariate analysis showed that only the presence of metabolic syndrome was related with the presence of SAHS in hypertensive patients (OR 4.65; 95% CI: 2.03-10.64; P<.001). CONCLUSIONS: Screening for SAHS should be performed in hypertensive patients seen in primary care if they have metabolic syndrome criteria.