Relación de la aterosclerosis carotídea con la osteoporosis de columna lumbar y caderas en el infarto agudo de miocardio / Relationship between carotid atherosclerosis and lumbar spine and hip osteoporosis in acute myocardial infarction

OBJETIVO: determinar en pacientes con infarto agudo del miocardio, la existencia de asociación entre la aterosclerosis carotídea y la osteoporosis de la columna lumbar y caderas. MÉTODOS: se exploraron 104 pacientes con diagnóstico clínico y de laboratorio de infarto agudo del miocardio. A cada paciente se les realizó ultrasonido doppler carotídeo, en el que se describió grosor íntima-media, localización y tipo de placas ateromatosas, grado de estenosis e índice aterogénico; seguido de densitometría de columna lumbar y caderas. Se clasificaron los niveles de densidad mineral ósea en normal, osteopenia y osteoporosis, según T score. RESULTADOS: no se encontró correlación entre el valor de la densidad mineral ósea y la magnitud del daño aterosclerótico del sector carotídeo. La mayoría de los factores de riesgo se asociaron con valores normales de grosor íntima-media, índice aterogénico aumentado y baja prevalencia de estenosis significativa, así como de osteopenia densitométrica; el envejecimiento y la hipertensión resultaron los predominantes. CONCLUSIONES: más allá de la existencia de factores de riesgo en común, no hubo asociación entre la osteoporosis y la aterosclerosis carotídea en los pacientes con infarto agudo del miocardio.

OBJECTIVE: determine the relationship between carotid atherosclerosis and lumbar spine and hip osteoporosis in patients with acute myocardial infarction. METHODS: a study was conducted of 104 patients with a clinical and laboratory diagnosis of acute myocardial infarction. All patients underwent carotid Doppler ultrasonography for intima media thickness, location and type of atheromatous plaques, stenosis degree and atherogenic index, followed by lumbar spine and hip densitometry. Bone mineral density levels were classified as normal, osteopenia or osteoporosis, according to the T-score. RESULTS: no correlation was found between bone mineral density values and the extent of atherosclerotic damage to the carotid sector. Most risk factors were associated with normal intima media thickness values, an increased atherogenic index, a low prevalence of significant stenosis, and densitometric osteopenia. Aging and hypertension were the predominant risk factors. CONCLUSIONS: except for the existence of common risk factors, no association was found between osteoporosis and carotid atherosclerosis in patients with acute myocardial infarction.

Subchondral Insufficiency Fracture of the Femoral Head in Elderly People

We evaluated the clinical course of subchondral insufficiency fracture of the femoral head (SIFFH) and its characteristic findings with special regard to joint space narrowing (JSN). Thirty-one cases of SIFFH of mean age 68.9 yr initially underwent limited weight-bearing conservative treatment. During the follow-up period, the patients with intractable pain underwent total hip arthroplasty (THA). For radiographic evaluation, lateral center-edge angle, JSN and femoral head collapse (FHC) were documented, and the extent of FHC was classified as mild (4 mm). The progression or new development of FHC more than 2 mm was evaluated on sequential plain radiographs. The relationship between radiographic parameters and clinical outcomes were evaluated. THAs were performed in 15 cases (48.4%). There was no significant correlation between clinical outcomes and the extent of initial FHC. However, a significantly larger proportion of patients that underwent THA showed JSN and FHC progression compared to the symptom improvement group. The risk factor significantly associated with failed conservative treatment was JSN (P=0.038; OR, 11.8; 95% CI, 1.15-122.26). Clinical results of conservative treatment for SIFFH in elderly patients are relatively poor. The patients with JSN are at higher risk of failed conservative treatment.

Is There Relationship between Brain Atrophy and Higher Incidence of Hip Fracture in Old Age?: A Preliminary Study

PURPOSE: The studies on the correlation between incidence of fall and brain atrophy have been going on to find out the cause of fall and its prevention. The purpose of this study was to explore the relationship between incidence of hip fracture and brain volume, measured by magnetic resonance image. MATERIALS AND METHODS: A total of 14 subjects with similar conditions (age, height, weight, and past history) were selected for this study. Fracture group (FG) was consisted of 5 subjects with intertrochanteric fracture. Control group (CG) had 9 subjects without intertrochanteric fracture. MRI-based brain volumetry was done in FG and CG with imaging software (V-works, CyberMed Co., Korea). Total brain (tBV), absolute cerebellar volumes (aCV) and relative cerebellar volumes (rCV) were compared between two groups. Student t-test was used to statistically analyze the results. RESULTS: In FG, average tBV, aCV and rCV were 1034.676+/-38.80, 108.648+/-76.80 and 10.50+/-0.72 cm3, respectively. In CG, average tBV, aCV and rCV were found to be 1106.459+/-89.15, 114.899+/-98.06 and 10.39+/-0.53 cm3, respectively, having no statistically significant difference (p>0.05). CONCLUSION: There was no significant difference between the fracture and control groups. Patients with neurologic disease such as cerebellar ataxia definitely have high incidence of fall that causes fractures and have brain changes as well. However, FG without neurologic disease did not have brain volume change. We consider that high risk of fall with hip fracture might decrease brain function which is not obvious to pickup on MRI.

Síndrome de compresión longitudinal del miembro inferior: reporte de un caso / Lower limb`s longitudinal compression syndrome: a case report

El Síndrome de Compresión Longitudinal del Miembro Inferior (SCLMI) es la asociación de una fractura diafisiaria de fémur con una fractura de cadera ipsilateral. Es una condición clínica muy rara con una incidencia de 2,5 % al 5 %. La fractura de cadera es considerada de baja energía, ocasionada por la energía residual no disipada de del accidente a alta velocidad, que principalmente originó la fractura diafisiaria, y son fracturas de con mínimo o sin desplazamiento, lo cual dificulta su diagnóstico. Se ha reportado que cerca de un 30 % de las fracturas de cadera en un SCLMI pasa desapercibida. Las lesiones de rodilla ipsilateral se encuentran presentes en 34 % y las de pierna, tobillo y pié en 19 %. Se presenta el caso de un paciente masculino de 24 años, quien ingresa posterior a hecho vial por colisión en moto, presentando fractura diafisiaria del fémur y posterior a la realización de estudios protocolares de pelvis, se diagnóstica la fractura de cadera. Se presenta su tratamiento y evolución

Lower limb’s Longitudinal Compression Syndrome (LLLCS) is the association of a femoral shaft fractures with ipsilateral hip fracture. It’s a very rare clinical condition with an incidence of 2.5% to 5%. Hip fracture is considered low-energy, caused by residual energy dissipated at high speed crash, which originated mainly diaphyseal fracture, and are fractures with minimal or no displacement, which makes hard their diagnosis. It is reported that about 30% of hip fractures in a LLLCS unnoticed. Ipsilateral knee injuries are present in 34% and leg, ankle and foot in 19%. We report of a 24 years male, who is admitted after motorcycle collision presenting femoral diaphyseal fracture. After post-protocol studies of pelvis, hip fracture is diagnosis. We present his treatment and evolution

Epidemiologia das fraturas intertrocantéricas do fêmur / Epidemiology intertrochanteric fractures of the femur

As fraturas intertrocantéricas do fêmur ocorrem normalmente na população idosa e o número de novas fraturas cresce devido ao aumento na expectativa de vida. O objetivo deste estudo foi realizar uma revisão sobre aspectos epidemiológicos de prevenção e reabilitação das fraturas intertrocantéricas do fêmur no idoso. Foi realizada uma revisão da literatura de artigos em português, inglês e espanhol, dos últimos 10 anos, sobre a incidência, fatores de risco, prevenção, tratamento, taxa de mortalidade e morbidade das fraturas intertrocantéricas do fêmur. As fraturas do quadril são consideradas atualmente como um problema de saúde pública e a segunda principal causa de hospitalização do idoso, o que provoca aumento nos gastos com os serviços de saúde. Apesar da constante evolução do tratamento cirúrgico, as taxas de morbidade e mortalidade continuam elevadas. No primeiro ano pós-fratura a expectativa de vida reduz de 15 por cento a 20 por cento e a taxa de mortalidade pode chegar a 50 por cento. Vários fatores podem predispor o idoso a apresentar a fratura intertrocantérica, como a osteoporose, diminuição da acuidade visual, menopausa, dentre outros. A visão multidisciplinar envolvendo a atenção de outros especialistas além do ortopedista é de fundamental importância para a boa evolução clínica dos pacientes.

The intertrochanteric fractures of the femur occur normally in aged population and the number of new fractures increases due to rise in life expectancy. The aim of this study was to carry out a revision about epidemiological aspects of prevention and rehabilitation of intertrochanteric fractures in elderly people. A literature review of articles in Portuguese, English and Spanish, during the last 10 years, about the incidence, risk factors, prevention, treatment, mortality and morbidity of intertrochanteric fractures was carried out. The hip fractures are considered nowadays a problem of public health and the second leading cause of hospitalization in elderly population, increasing health services costs. Although the constant evolution of the surgical treatment, rates of mortality and morbidity is still high. In the first year after hip fractures life expectancy decreases from 15 percent to 20 percent and rates of mortality can reach 50 percent. Some factors can predispose the elderly population to develop intertrochanteric fractures: osteoporosis, reduction of visual acuity, menopause, among others. The multidisciplinary attention involving other specialists besides the orthopedists is very important for patients’ good clinical evolution.

Fracturas periprotesicas de cadera: Hospital Dr. Domingo Luciani periodo enero 2001- diciembre 2005 / Periprotesicas hip fractures: Hospital Dr. Domingo Luciani

El presente trabajo tiene como objetivo revisar las historias clínicas de todos los pacientes intervenidos quirúrgicamente de prótesis de cadera, en un período de 5 años para determinar que prótesis se complicaron con fracturas periprotésicas; obteniéndose un total de 190 pacientes; de las cuales 12 tuvieron fracturas alrededor de la prótesis, 03 casos intraoperatorios. 05 ocurrieron en prótesis total y 7 en prótesis parcial. Los 12 casos se presentaron en prótesis cementadas. Todas las fracturas ocurrieron alrededor del vástago femoral y fueron clasificadas según la región anatómica comprometida en: Tipo 1 Proximal: 03 casos, Tipo T1 Medio: 05 casos, Tipo III Distal: 04 casos, prótesis de tallo largo: 04 casos, cerclaje:03 casos, placa BMP: 1 caso.

Aplicación de un protocolo de atención kinésica postquirúrgico en pacientes con fractura de cadera / Application of a postsurgical kinesics protocol to patients with hip fracture

Las fracturas de cadera constituyen una patología de importante repercusión socio-económica y de salud pública, dado por el incremento de la población adulta mayor en las últimas décadas. Esto ha llevado a realizar mejoras en el tratamiento quirúrgico y a renovar los enfoques de los programas de rehabilitación. Este estudio clínico pretende evaluar la aplicación de un protocolo kinésico en pacientes con fractura de cadera, extraído de la tesis de grado "Revisión del tratamiento kinésico postquirúrgico inmediato en pacientes con fractura de cadera" (2001), y además dimensionar su repercusión en la funcionalidad a corto plazo, mediante la utilización de escalas de valoración funcional para la cadera, en pacientes del Servicio de Traumatología del Hospital Regional de Talca entre noviembre del 2001 y enero del 2002.

Comparison of Femoral Geometry Among Cases with and without Hip Fractures

Hip fractures have high morbidity and mortality rate for the people as a complication of osteoporosis and is generally seen in old age. It is known that femoral geometric measurements are important in the assessment of hip fracture risks. This study aimed to examine the association between hip geometry and hip fracture in post-menopausal elderly females. In the present study, 232 hip X-rays were taken from women with no hip fractures (Group 1) and 29 post-menopausal women with hip fractures (Group 2) after a minor trauma. After standard anterior-posterior plain pelvic X-ray radiographs were obtained, various radiographic measurements were performed in all cases, including the hip axis length (HAL), femoral neck axis length (FAL), acetabular width (AW), femoral head width (HW), femoral neck width (FW), femoral shaft width (FSW), intertrochanteric width (TW), lateral and medial cortical thickness of the femoral shaft (LCT, SMCT), femoral neck cortical thickness (NMCT) and femoral neck-shaft angle (Q-angle). In group 1, the mean age, weight and height were 62.5 +/-7.4 years, 70.8 +/-12.5 kg, and 157.5 +/-6.7 cm, respectively. In group 2, these values were 70.17 +/-6.8 years, 64.7 +/-11.5 kg, and 158.3 +/-2.7 cm, respectively. There were no statistically significant differences in the measurements of HAL, FAL, AW and HW between the two groups. In group 2, the mean FW value was significantly higher than in group 1 (p= 0.01). The mean values for FSW, TW, NMCT, SMCT, LCT were statistically lower in group 2 than those in group 1 (p= 0.01, p=0.038, p=0.001, p< 0.001, p< 0.001, respectively). Q-angle was also significantly higher in cases with hip fracture than in cases with no hip fracture (p=0.01). The values of FW, FSW, TW, NMCT, SMCT, LCT and Q-angle seem to be important parameters in the evaluation of hip fracture risks. However, further studies are needed to clarify this conclusion.

Fracturas de cadera en el Hospital San Pablo en el año 1987: estudio descriptivo / Hip fractures in the San Pablo Hospital in 1987: descriptive study

Las fracturas de cadera constituyen la principal repercusión del problema de osteiporosis. Se llevó a cabo una revisión de los expedientes médicos del total de la población de 50 años o más, hospitalizada con este diagnóstico en el Hospital San Pablo en el ano 1987. Se obtuvieron un total de 30 casos. La edad promedio en ambos sexos fue mayor a la descrita en la literatura. El promedio de días de hospitalización fue de 16.8. Hubo un cambio significativo en la función motora antes y después de la caída. El promedio de gastos intrahospitalarios fue de 8,826 dólares por pacientes, sin incluir la parte médica y los costos de rehabilitación. El total de muertes en los primeros 6 meses fue de 7(23%). Se estimó la incidencia en la región en 116,5 casos anuales por cada 100,000 habitantes de 50 años o más, la cual es significativamente inferior a la reportada por otros grupos en los Estados Unidos de América

Fracturas de la extremidad proximal del femur en ninos / Fractues of the proximal end of the femur in children

Se presenta un estudio comparativo entre las diferentes series publicadas, en 32 pacientes tratados en el Hospital Universitario Lorencita Villegas de Santos en un lapso de 7 anos, desde 1976 a 1982; con fracturas de la extremidad proximal del femur. De los 32 pacientes, se excluyeron 6 pacientes; 3 con fracturas intracapsulares y 3 con fracturas subtrocantericas por no cumplir los requisitos en cuanto a seguimiento, quedando en total 12 casos de fracturas de cadera y 14 de fracturas subtrocantericas. Se encontro una incidencia muy baja de fracturas de la extremidad proximal del femur que en la totalidad de los casos obedecieron a traumas violentos con una alta asociacion de lesiones. En todos los pacientes con fracturas de cadera, menos en uno, se practico reduccion y fijacion interna. Los resultados obtenidos se ajustan a lo publicado por las diferentes seris en cuanto a complicaciones, siendo las principales: necrosis avascular, cierre prematuro de la placa epifisiaria y coxa vara, que se presentaron entre el 30-50%de los pacientes. Por el contrario, el tratamiento de las fracturas subtrocantericas fue exitoso en la mayoria de los pacientes. En algunos casos se practico reduccion y fijacion interna, cuando las medidas ortopedicas fracasaron. El tratamiento de fracturas de cadera y de sus complicaciones, ofrece en la actualidad un campo muy amplio, pero con el agravante de que por su incidencia es muy dificil acumular experiencia.