[Interscalene block for total shoulder arthroplasty: comparative study (ultrasound vs. neurostimulation)]. / Bloqueo interescalénico para artroplastia total de hombro: estudio comparativo ultrasonido vs neuroestimulación.

BACKGROUND: Modern anesthesiology has integrated the use of ultrasonography as a tool that has displaced neurostimulation as a technique for locating peripheral nerves. The aim of this study was to determine which procedure is more effective for guiding interscalene block for total shoulder arthroplasty. METHODS: We carried out a comparative, prospective non-randomized study comprised of the group guided by neurostimulation interscalene block and the group guided by ultrasound. All patients in both groups were scheduled for total shoulder arthroplasty. Latency, degree of sensory and motor block, success rate, postoperative pain intensity at 6, 12, and 24 h, patient satisfaction and complications were measured. RESULTS: We included 110 patients, 55 per group. Patients were placed in beach chair position and the deltopectoral approach was used. There were no differences in demographic characteristics. Results for neurostimulation vs. ultrasound group: latency 19.11 ± 2.27 vs. 17.24 ± 1.42 min, p= 0.23. Block sensitivity in both groups was grade 0 motor block grade 0 in 76.4% and grade 1 in 23.6% vs. grade 0 to 100%. There was 100% success rate for both groups. Postoperative pain at 6 h was 0.13 ± 0.54 vs. 0.11 ± 0.13 p= 0.90, at 12 h 1.67 ± 1.15 vs. 1.65 ± 0.59 p= 0.89 and at 24 h 3.15 ± 1.66 vs. 2.99 ± 1.15 p= 0.78. Satisfaction 54.5% very satisfied and 45.5% satisfied 96.36% vs 3.6% very satisfied and satisfied. Complications 18.18% vs. 3.6% p= 0.023. CONCLUSION: Ultrasound-guided interscalene nerve block is the technique of choice in elective total shoulder arthroplasty.

ANTECEDENTES: la anestesiología moderna ha integrado a la ultrasonografía como una herramienta que ha desplazado a la neuroestimulación como técnica de localización de nervios periféricos: ¿cuál es más efectiva para guiar el bloqueo interescalénico en artroplastia total de hombro? OBJETIVO: comparar dos técnicas de localización del plexo braquial bloqueo interescalénico como técnica anestésica en artroplastia total de hombro. MATERIAL Y MÉTODOS: estudio comparativo, prospectivo, sin asignación al azar. Se incluyeron todos los pacientes programados para artroplastia total de hombro; se formaron 2 grupos: grupo neuroestimulación donde el bloqueo interescalénico fue guiado por neuroestimulación, grupo ultrasonido que fue guiado por ultrasonido. Se midió el tiempo de latencia, grado de bloqueo sensitivo y motor, tasa de éxito, intensidad del dolor postoperatorio a las 6, 12 y 24 horas, satisfacción, y complicaciones. RESULTADOS: se incluyeron 110 pacientes, 55 por grupo, posición de silla de playa y abordaje deltopectoral. No hubo diferencias en las características demográficas, neuroestimulación vs ultrasonografía: latencia 19.11 ± 2.27 vs 17.24 ± 1.42 minutos p= 0.23. Bloqueo sensitivo en ambos grupos grado 0, bloqueo motor grado 0 en 76.4% y grado 1 en 23.6%, vs grado 0 en 100%. Tasa de éxito 100% en ambos grupos, dolor postoperatorio 6 horas 0.13 ± 0.54 vs 0.11 ± 0.13 p= 0.90; 12 horas de 1.67 ± 1.15 vs 1.65 ± 0.59 p= 0.89, 24 horas 3.15± 1.66 vs 2.99 ± 1.15 p= 0.78. Satisfacción: 54.5% muy satisfecho, y 45.5% satisfecho vs 96.36% muy satisfecho y 3.6% satisfecho. Complicaciones 18.18% vs 3.6% p= 0.023. CONCLUSIÓN: el ultrasonido es la técnica de localización del plexo braquial de elección en artroplastia total de hombro.

Rotator cuff repair augmentation using a novel polycarbonate polyurethane patch: preliminary results at 12 months' follow-up.

BACKGROUND: Preventing anatomic failure after rotator cuff repair (RCR) remains a challenge. Augmentation with a surgical mesh may permanently reinforce the repair and decrease failure rates. The purpose of this study is to assess the postoperative outcomes of open RCR augmented with a novel reticulated polycarbonate polyurethane patch. MATERIALS AND METHODS: Ten patients with supraspinatus tendon tears underwent open RCR augmented with a polycarbonate polyurethane patch secured in a 6-point fixation construct placed over the repaired tendon. Patients were evaluated with preoperative and postoperative outcome measures, including the Simple Shoulder Test, visual analog pain scale, American Shoulder and Elbow Surgeons shoulder score, Cumulative Activities of Daily Living score, and University of California, Los Angeles shoulder scale, as well as range of motion. Postoperative magnetic resonance imaging was used to evaluate repair status. RESULTS: Patients showed significant improvements in visual analog pain scale, Simple Shoulder Test, and American Shoulder and Elbow Surgeons shoulder scores at both 6 and 12 months postoperatively (P < .05 and P < .01, respectively). The University of California, Los Angeles postoperative score was good to excellent in 7 patients at 6 months and in 8 patients at 12 months. Range of motion in forward flexion, abduction, internal rotation, and external rotation was significantly improved at both 6 and 12 months postoperatively (P < .05 and P < .01, respectively). Magnetic resonance imaging at 12 months showed healing in 90%; one patient had a definitive persistent tear. We found no adverse events associated with the patch, including the absence of fibrosis, mechanical symptoms, or visible subacromial adhesions. DISCUSSION: The polycarbonate polyurethane patch was designed to support tissue in growth and enhance healing as shown by preclinical animal studies. Clinically, the patch is well tolerated and shows promising efficacy, with a 10% retear rate at the 12-month time point.

[Cost analysis and economic impact of anterior cruciate ligament reconstruction]. / Análisis de costo e impacto económico de la reconstrucción de ligamento cruzado anterior (LCA).

INTRODUCTION: Health economics studies play an important role in all healthcare systems. The purpose of the latter is to offer effective and low-cost treatments. OBJECTIVE: Analyze the costs and the economic impact of the comprehensive ACL treatment. MATERIAL AND METHODS: An average cost study was done of primary ACL reconstruction. We studied 104 patients during 2005, 79 males and 25 females, with mean age 31.5 years. The assessment of the preoperative, operative and postoperative costs was related to each patient's socioeconomic stratum (SES). RESULTS: The hamstrings were the most frequently used graft (71%) versus the bone-patellar tendon-bone graft (BTB) (29%). Socioeconomic strata 2 and 3 were predominant. The following were the most frequent hamstrings implants used: Rigidfix/Intrafix and Endobutton/Xtralok, while the most frequent BTB grafts used were the metallic interference screws. No difference was found between the types of grafts and the SES in the preoperative and postoperative costs, including imaging studies, hospital say and rehabilitation. However, differences were found among the different groups in the cost of surgery, resulting from the type of implant used. The mean cost for SES 1 and 2 was $6475.20, for SES 3 and 4, $8057.51, and for SES 5 and 6, $16,242.5. The vulnerable population (SES 1) needs 7.34-fold its monthly income to pay for the comprehensive treatment, while the middle stratum (SES 3) needs 3.27-fold its monthly income. CONCLUSIONS: The comprehensive cost of treatment is proportionally higher than the patients' income. It is important to point out that the systems using state-of-the-art technology, which in another setting would be inaccessible, have significant advantages when compared with the less expensive systems. Thus the economically vulnerable SES benefit from the subsidy granted by the National Institutes of Health.

[Meniscal repair in patients with chronic lesions]. / Reparación meniscal en pacientes con lesiones crónicas.

OBJECTIVE: To analyze the subjective and objective outcome of arthroscopic meniscal repair in patients with chronic meniscal lesions. METHODS: A group of patients that underwent arthroscopic meniscal repair of chronic tears with a minimum follow-up of six months was retrospectively evaluated. Physical examination oriented at finding persistent meniscal lesions was performed. IKDC, Lysholm and Tegner scores were applied, and a control magnetic resonance imaging (MRI) was performed. RESULTS: Twenty seven menisci in 25 patients were repaired. There were 21 male and 4 female patients with a mean age of 29.6 +/- 8.2 years (20-45). Mean time from lesion to surgery was 25.24 +/- 26 months (6-120). 27. There was significant improvement in all parameters evaluated in 21 patients. Four patients were found to have signs and symptoms of persistent meniscal tears. Abnormal increased signal intensity in the repaired menisci was observed by MRI in all patients, not correlating with clinical findings. CONCLUSIONS: Short-term success rate of 85% was obtained with arthroscopic repair of chronic meniscal lesions in this study, which supports the fact that a long period of time before surgery does not necessarily lead to failure. It is valid to perform a meniscal repair in patients with chronic tears as long as the proper surgical technique and an adequate rehabilitation protocol are used.

[Tendon sheath lipoma associated with quadriceps tendon rupture. Case report]. / Lipoma de la vaina tendinosa asociado a ruptura de tendón del cuadríceps. Informe de un caso.

BACKGROUND: Tendon sheath lipoma is an uncommon tumor characterized morphologically by mature fatty tissue lobes adherent to the tendon or intersecting its fibers. The association with quadriceps tendon rupture is unusual. Etiologic factors that may condition those ruptures have not yet been fully described. However, several authors suggest the existence of a subjacent pathology such as metabolic or inflammatory diseases. Minimal trauma may lead to such ruptures as well as associated ligamentous or bony injuries. The prognosis regarding quadriceps tendon rupture mainly depends on the lap between injury and time of repair. CLINICAL CASE: We present the case of a quadricipital tendinous rupture produced by the presence of a benign neoplasm, which is a very infrequent association. The patient was surgically treated for quadriceps tendon reconstruction via tendinous reinsertion at the patella. Currently, during rehabilitation, the patient is symptom free with an almost-complete flexion/ extension of his left knee. CONCLUSIONS: We consider that importance must be given to neoplastic disease as a cause of tendinous rupture, regardless of their infrequency and unusual clinical presentation.

Lipoma de la vaina tendinosa asociado a ruptura de tendón del cuadríceps: informe de un caso / Tendon sheath lipoma associated with quadriceps tendon rupture: case report

BACKGROUND: Tendon sheath lipoma is an uncommon tumor characterized morphologically by mature fatty tissue lobes adherent to the tendon or intersecting its fibers. The association with quadriceps tendon rupture is unusual. Etiologic factors that may condition those ruptures have not yet been fully described. However, several authors suggest the existence of a subjacent pathology such as metabolic or inflammatory diseases. Minimal trauma may lead to such ruptures as well as associated ligamentous or bony injuries. The prognosis regarding quadriceps tendon rupture mainly depends on the lap between injury and time of repair. CLINICAL CASE: We present the case of a quadricipital tendinous rupture produced by the presence of a benign neoplasm, which is a very infrequent association. The patient was surgically treated for quadriceps tendon reconstruction via tendinous reinsertion at the patella. Currently, during rehabilitation, the patient is symptom free with an almost-complete flexion/ extension of his left knee. CONCLUSIONS: We consider that importance must be given to neoplastic disease as a cause of tendinous rupture, regardless of their infrequency and unusual clinical presentation.

La fractura inadvertida: Síndrome de compresión longitudinal del miembro pélvico: Informe de un caso / The missed fracture: Compressión longitudinal syndrome of the lower limb: Case report

La presencia de una fractura del cuello femoral, asociada con fracturas de la diáfisis femoral, es una condición rara y difícil para su tratamiento. Se presenta un caso clínico, en donde la fractura de la diáfisis femoral fue manejada con clavo centromedular bloqueado y en un segundo tiempo quirúrgico, se efectúo osteosíntesis de la fractura de la base del cuello femoral con tornillos canulados. La conclusión es que se debe sospechar la fractura proximal o distal de fémur, cuando exista una fractura diafisaria.

Procedimiento, técnicas y comunicacion en traumatología y patología quirúrgica del la rodilla: abordajes quirurgicos en la artroplastía total de rodilla / Proccedings, techniques and communications in orthopaedics: surgical approaches for total knee arthroplasty

Se presenta una revisión de los diversos abordajes quirúrgicos más usuales para la artroplastía total de la rodilla, entre los que destacan: el trivectorial, recomendado para el varo mayor de 10 grados o valgo menor de 15 grados no estructurados; el antero-lateral, recomendado para valgo mayor de 15 grados y valgo fijo o estructurado; el trans-vasto medial indicado en gonartrosis sin deformidad angular importante en varo o valgo menor de 10 grados y el trans-cuadricipital extenso en "V" o en "Y", que está indicado para las rodillas contracturadas en extensión rígida por adherencias del cuadríceps.