[Analysis of judicial sentences issued against traumatologists between 1995 and 2011 as regards medical negligence]. / Análisis de sentencias judiciales relativas a negligencias médicas emitidas contra traumatólogos entre 1995 y 2011.

INTRODUCTION AND OBJECTIVES: Traumatology and Orthopaedic Surgery is one of the specialities with most complaints due to its scope and complexity. The aim of this study is to determine the characteristics of the complaints made against medical specialists in Traumatology, taking into account those variables that might have an influence both on the presenting of the complaint as well as on the resolving of the process. MATERIAL AND METHODS: An analysis was performed on 303 legal judgments (1995-2011) collected in the health legal judgements archive of the Madrid School of Medicine, which is linked to the Westlaw Aranzadi data base. RESULTS: Civil jurisdiction was the most used. The specific processes with most complaints were bone-joint disorders followed by vascular-nerve problems and infections. The injury claimed against most was in the lower limb, particularly the knee. The most frequent general cause of complaint was surgical treatment error, followed by diagnostic error. There was lack of information in 14.9%. There was sentencing in 49.8% of the cases, with compensation mainly being less than 50,000 euros. CONCLUSIONS: Traumatology and Orthopaedic Surgery is a speciality prone to complaints due to malpractice. The number of sentences against traumatologists is high, but compensations are usually less than 50,000 euros. The main reason for sentencing is surgical treatment error; thus being the basic surgical procedure and where precautions should be maximised. The judgements due to lack of information are high, with adequate doctor-patient communication being essential as well as the correct completion of the informed consent.

[Safety and efficacy of kyphoplasty in the treatment of tumoral disease of the spine]. / Seguridad y eficacia de la cifoplastia en el tratamiento de la enfermedad tumoral de la columna vertebral.

UNLABELLED: Vertebral fractures in oncology patients cause significant pain and disability, with decreased quality of life. The aim of the study is to assess the efficacy and safety of kyphoplasty in this type of vertebral fracture in the acute phase. MATERIALS AND METHODS: A retrospective study was conducted on 75 consecutive oncology patients with 122 acute vertebral fractures, who underwent bilateral balloon kyphoplasty, with a mean follow up of 11 months. RESULTS: Almost all (91%) of the patients improved their pain level. The mean improvement in the Visual Analogue Scale (VAS) was 4.28 points (preoperative value 7.49 [SD 1.19], postoperative 3.21 [SD 0.95]). Before surgery, 53% of patients needed major opioids (40 cases), and one month after surgery only 12% (9 patients) required them. Quality of life determined by the Karnofsky index improved from 60.2 (SD 10) to 80.7 (SD 12.1). Cement leaks were found in 5.7% (7 cases), all without neurological repercussions. New fractures appeared in 11 patients. This subgroup showed a slight worsening of the initially acquired clinical improvement. No neurological or pulmonary complications related to surgical technique were found. CONCLUSIONS: Kyphoplasty is an effective and safe for treating vertebral fractures in patients with cancer. LEVEL OF EVIDENCE: Level IV.

Differential proteome of bone marrow mesenchymal stem cells from osteoarthritis patients.

OBJECTIVE: Adult mesenchymal stem cells (MSCs) are multipotent cells whose primary reservoir is bone marrow (BM). Following situations of extensive tissue damage, MSCs are mobilized and migrate to the site of injury. Osteoarthritis (OA) is a condition that involves extensive cartilage and bone damage. To gain insight into the pathogenesis of OA, we have analyzed the differential BM-MSCs proteome of OA patients. METHODS: MSCs protein extracts were prepared from BM aspirates from six patients with OA and from six hip fracture subjects without OA, and analyzed by Two-dimensional gels, using the differential in-gel electrophoresis approach. Differentially expressed proteins were identified by mass spectrometry. In addition, the chemotactic responses of OA and control MSCs were assessed. RESULTS: The majority of proteins that changed at least 1.5-fold (P<0.05) belonged to the following three categories: metabolic enzymes (14 proteins, 36%), cytoskeleton/motility (12 proteins, 32%), and transporters (three proteins, 8%). In OA MSCs, a high percentage of metabolic enzymes (n=8, 57%) were up-regulated and most of the proteins related to cytoskeleton/motility (n=9, 75%) were down-regulated. There was a significant increase in the migration response of OA MSCs to platelet-derived growth factor-BB (chemotaxis index CI: 5.13+/-1.19 vs 3.35+/-0.42, P=0.043). CONCLUSIONS: In this study, we have described the differential proteome of BM-MSCs from OA patients together with an increased chemotactic response of these cells in the context of OA. These results could indicate an activation of OA BM-MSCs in response to chemotactic signals sent by the altered subchondral bone in an attempt to heal damaged tissue.

Human parvovirus B19, varicella zoster virus, and human herpesvirus-6 in mesenchymal stem cells of patients with osteoarthritis: analysis with quantitative real-time polymerase chain reaction.

OBJECTIVE: To investigate whether there is a possible viral transmission using mesenchymal stem cells (MSCs) in autologous or allogeneic transplantation in the context of osteoarthritis (OA) patients. The presence of parvovirus B19 (B19), varicella zoster virus (VZV), and human herpesvirus-6 (HHV-6) was studied in MSCs from bone marrow of patients with OA and healthy controls. METHODS: MSCs were prepared from bone marrow aspirates obtained from 18 patients undergoing joint replacement as a result of OA and from 10 healthy controls. DNA was extracted from primary MSCs' culture established from these cells and quantitative real-time polymerase chain reaction was performed to analyse the prevalence and viral load of B19, VZV and HHV-6. RESULTS: The prevalence of total viral DNA among patients with OA was 16.7% (3/18), with a mean viral load of 29.7 copies/microg of DNA. One out of 18 was positive for B19 (viral load, 61.2 copies/microg of DNA), two for VZV (mean viral load, 14.4 copies/microg of DNA), and none for HHV-6. The prevalence of total viral DNA in the control group was 20% (2/10), with a mean viral load of 13.4 copies/microg of DNA. Both positive results were of B19 parvoviruses. There were no statistically significant differences among patients and controls. CONCLUSIONS: This first approach to the viral prevalence in MSCs of bone marrow in OA patients and healthy controls seems to show a very low risk of viral transmission or reactivation in a possible MSCs' transplantation.

Retrograde nailing of femur: surgical technique with tibial traction.

A modified surgical technique for femoral retrograde nailing is described. A tibial skeletal traction in the proximal metaphysis is placed to obtain fracture reduction during surgery. This technique enables fracture control during the procedure, avoiding the need of an assistant.

A modified technique of four-bone fusion for advanced carpal collapse (SLAC/SNAC wrist).

This study reports the outcome of 16 patients treated with a modified four-bone fusion for symptomatic stage II and III advanced carpal collapse. The technique is based on fusion of the capitate, lunate, hamate and triquetrum using an autogenous corticocancellous bone-graft fixed with screws. The void left behind after scaphoid excision was filled with an extensor carpi radialis longus anchovy. After an average follow up of 3 years; there were 13 excellent and three good outcomes. In every patient pain relief was achieved with preservation of joint motion and grip strength. All the patients were able to return to their previous activities and jobs. Radiographic evaluation showed bone fusion in all 16 patients with a slight decrease in carpal height but a well preserved radiolunate joint space. In conclusion, this technique provides immediate stable fixation and early mobilization and assures bone fusion.

Hombro doloroso: evaluación del tratamiento con infiltraciones de orgoteína / Painful shoulder treated by subacromial orgoteine infiltration: assessment of treatment

El hombro doloroso es la tercera causa de consulta por dolor en la práctica médica general, por detrás de la cefalea y el dolor de espalda. El objeto de este trabajo es sentar las bases para la terapéutica de este síndrome mediante infiltraciones locales con orgoteína. Se han seguido 48 pacientes con hombro doloroso. El seguimiento se extiende desde enero de 1989 a diciembre de 1990, con una media de 17 meses. La media de edad entre los pacientes fue de 33 años con un limite entre 19 y 61 años. De los 48 pacientes, 16 eran hombres y 32 mujeres. Tras un estudio protocolizado prospectivo se pudo apreciar cómo todos los pacientes mejoraron su sintomatología y en períodos muy similares: el dolor nocturno desapareció en la segunda semana, mientras que el diurno lo hizo a la tercera semana. La rigidez matutina era de 10 minutos de duración ya a la primera semana y desapareció a partir de entonces. La movilidad en abducción alcanzó los 90-100 grados hacia la sexta semana del tratamiento. La orgoteína como sustancia aplicada en infiltración local cumple su misión de disminución de radicales libres de oxígeno contribuyendo a la acción antiflogística y en definitiva aliviando los síntomas generales del hombro doloroso.

Osseous hydatidosis.

Nineteen patients with osseous hydatidosis were treated over a period of thirteen years. There were four deaths. Ten patients became asymptomatic. The treatment used was either curetage or resection, often repeatedly, and protracted lavage of the wound with ethacridine. Five patients received a desensitization treatment (hydatin), but the results in these cases were indeterminate as far as the action of the drug was concerned.