Fractura bilateral de cadera en un paciente con síndrome de Down / Bilateral hip fracture in a patient with Down syndrome

Existen pocos datos publicados de fracturas de cadera bilaterales simultáneas. Presentamos el caso de un varón de 56 años con síndrome de Down y demencia tipo Alzheimer afecto de fractura bilateral de cadera y cuyo tratamiento fue la artroplastia parcial de cadera cementada bilateral. Con ella se intentó evitar el periodo de carga parcial que podría derivarse del tratamiento mediante osteosíntesis, ya que se trataba de un paciente poco cooperador debido a su falta de independencia para las actividades básicas de la vida diaria y a su deterioro mental. Hasta el momento de su fallecimiento, cuatro años después de la cirugía, pudo caminar sin ayuda, con total autonomía. En nuestra experiencia, la cirugía en un solo tiempo, mediante prótesis de cadera bilateral, es segura y proporciona buenos resultados en pacientes con deficiencia mental severa

There are few published data available about simultaneous bilateral hip fractures. We present the case of a 56-year-old man with Down syndrome and Alzheimer-like dementia with simultaneous bilateral hip fracture. A bilateral partial hip cemented arthroplasty was performed on this patient. The aim was to avoid the partial burden that could be caused by ostheosynthesis, due to the patient's lack of cooperation arising from his mental deterioration and his problems realizing everyday activities. He was able to walk unaided with complete autonomy until his death fourth years later. In our experience, one stage surgery for bilateral hip prosthesis is safe and provides good results in patients with severe mental impairment

[Bilateral hip fracture in a patient with Down syndrome]. / Fractura bilateral de cadera en un paciente con síndrome de Down.

There are few published data available about simultaneous bilateral hip fractures. We present the case of a 56-year-old man with Down syndrome and Alzheimer-like dementia with simultaneous bilateral hip fracture. A bilateral partial hip cemented arthroplasty was performed on this patient. The aim was to avoid the partial burden that could be caused by ostheosynthesis, due to the patient's lack of cooperation arising from his mental deterioration and his problems realizing everyday activities. He was able to walk unaided with complete autonomy until his death fourth years later. In our experience, one stage surgery for bilateral hip prosthesis is safe and provides good results in patients with severe mental impairment.

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) / 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)

Objetivo. Analizar en la práctica clínica diaria española la efectividad y seguridad de rivaroxaban vs. el tratamiento estándar (TE) en la prevención del tromboembolismo venoso tras artroplastia de cadera o rodilla. Material y método. Subanálisis de datos españoles del estudio observacional internacional XAMOS, que incluyó a pacientes > 18 años que recibieron 10 mg o.d. rivaroxaban o TE. Seguimiento: hasta 3 meses tras la cirugía. Variables primarias: incidencia de eventos tromboembólicos sintomáticos/asintomáticos, sangrados, mortalidad, otros acontecimientos adversos; variables secundarias: consumo de recursos sanitarios/satisfacción tras el alta. Resultados. Se incluyeron 801 pacientes: 410 recibieron rivaroxaban y 391 TE (un 64,7% heparina, un 24% fondaparinux y un 11% dabigatran). La incidencia de eventos tromboembólicos sintomáticos y de sangrado mayor fue similar en ambos grupos (0,2 vs. 0,8% con TE y 0,7 vs. 1,3% con TE [criterios EMA]/0 vs. 0,3% con TE [criterios RECORD]). La incidencia de acontecimientos adversos relacionados con el fármaco fue significativamente superior con rivaroxaban (globales: 4,4 vs. 0,8% con TE [p = 0,001]; graves: 1,5 vs. 0% con TE [p = 0,03]). El grupo rivaroxaban consumió menos recursos sanitarios tras el alta y consideró la tolerabilidad «muy buena» y el tratamiento «muy cómodo» en una proporción mayor. Discusión. Rivaroxaban es al menos tan efectivo como el TE en la prevención del tromboembolismo venoso en la práctica clínica diaria, con una incidencia similar de hemorragias. Aporta mayor satisfacción/comodidad, y menor gasto de recursos sanitarios tras el alta. Estos resultados han de ser interpretados considerando a las limitaciones inherentes a los estudios observacionales (AU)

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 10 mg 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 comfortable». 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 (AU)

[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.

Validez de la artrorresonancia magnética como herramienta diagnóstica en el síndrome de atrapamiento femoroacetabular / Validity of magnetic resonance arthrography as a diagnostic tool in femoroacetabular impingement syndrome

Introducción. El síndrome de atrapamiento femoroacetabular es una de las causas de coxalgia en el adulto joven; así mismo, es una entidad clínica que contribuye en la etiopatogenia de la coxartrosis en estos pacientes. Un diagnóstico clínico certero apoyado por las técnicas de imagen diagnósticas disponibles es fundamental para poder determinar el mejor tratamiento. El objetivo de nuestro trabajo es determinar la correlación diagnóstica entre la artrorresonancia magnética directa y los hallazgos artroscópicos. Material y método. Revisamos una serie de 36 pacientes con diagnóstico de atrapamiento femoroacetabular intervenidos mediante artroscopia de cadera realizada entre 2009 y 2012 con estudio de artrorresonancia previo realizado en nuestro centro. Valoramos en ambos el hallazgo de lesiones labrales, deformidad tipo CAM femoral y lesiones condrales, tanto femorales como acetabulares. Resultado. Tomando los hallazgos de la artroscopia de cadera como el diagnóstico de certeza, calculamos una sensibilidad del 87% y una especificidad del 77% con un VPP del 87% para el diagnóstico de las lesiones labrales mediante artrorresonancia magnética directa, respectivamente. La especificidad para el diagnóstico de la deformidad tipo CAM femoral es del 100%, con una sensibilidad del 79% y un VPP del 100%. Para las lesiones condrales en acetábulo y cabeza femoral obtenemos valores más bajos, sensibilidad del 78,5%, especificidad del 82%, VPP del 73% y VPN del 80% para las acetabulares, sensibilidad del 71,5%, especificidad del 73%, VPP del 62,5% y VPN del 80% en las femorales. Conclusiones. Dadas la alta sensibilidad para la detección de lesiones labrales y la alta especificidad para determinar la presencia de deformidad en giba, la artrorresonancia magnética directa de cadera supone una buena herramienta diagnóstica en el atrapamiento femoroacetabular (AU)

Introduction. Femoroacetabular impingement (FAI) is one of the main causes of hip pain in young adult and a contributory factor for development of early primary osteoarthritis. An accurate clinical diagnosis, supported by imaging studies, is important to determine the best treatment for the patient. The aim of this study is to determine the diagnostic correlation between direct magnetic resonance imaging (MRI) arthrography and the arthroscopic findings. Materials and method. A review was performed on a series of 36 patients diagnosed with FAI, and who underwent hip arthroscopy surgery between 2009 and 2012. All of them had a direct MRI arthrography performed in our hospital. The presence of labral lesions, CAM deformity, and acetabular and femoral cartilage damage, were evaluated in both imaging techniques. Result. After analysing the results and taking the hip arthroscopy as ‘gold standard’, a sensitivity of 87% and a specificity of 77% were obtained, with a PPV of 87% for the diagnosis of labral lesions by direct MR arthrography. The specificity for CAM deformity was 100%, with a sensitivity of 79% and PPV of 100%. For chondral disorders lower values were found for both acetabulum and femoral head. For acetabular lesions the sensitivity was 78.5%, and specificity was 82% with a PPV of 73% and NPV of 80%. For femoral lesions, there was a sensitivity of 71.5%, a specificity of 73%, with a PPV of 62.5% and NPV of 80%. Conclusions. Due to the high sensitivity for the detection of labral lesions and the high specificity to detect CAM deformity, hip MR arthrography is a useful diagnostic tool for femoroacetabular impingement (AU)

Validity of magnetic resonance arthrography as a diagnostic tool in femoroacetabular impingement syndrome.

INTRODUCTION: Femoroacetabular impingement (FAI) is one of the main causes of hip pain in young adult and a contributory factor for development of early primary osteoarthritis. An accurate clinical diagnosis, supported by imaging studies, is important to determine the best treatment for the patient. The aim of this study is to determine the diagnostic correlation between direct magnetic resonance imaging (MRI) arthrography and the arthroscopic findings. MATERIALS AND METHOD: A review was performed on a series of 36 patients diagnosed with FAI, and who underwent hip arthroscopy surgery between 2009 and 2012. All of them had a direct MRI arthrography performed in our hospital. The presence of labral lesions, CAM deformity, and acetabular and femoral cartilage damage, were evaluated in both imaging techniques. RESULT: After analysing the results and taking the hip arthroscopy as 'gold standard', a sensitivity of 87% and a specificity of 77% were obtained, with a PPV of 87% for the diagnosis of labral lesions by direct MR arthrography. The specificity for CAM deformity was 100%, with a sensitivity of 79% and PPV of 100%. For chondral disorders lower values were found for both acetabulum and femoral head. For acetabular lesions the sensitivity was 78.5%, and specificity was 82% with a PPV of 73% and NPV of 80%. For femoral lesions, there was a sensitivity of 71.5%, a specificity of 73%, with a PPV of 62.5% and NPV of 80%. CONCLUSIONS: Due to the high sensitivity for the detection of labral lesions and the high specificity to detect CAM deformity, hip MR arthrography is a useful diagnostic tool for femoroacetabular impingement.

Clinical and radiological short-term complications after single-stage bilateral uncemented total hip arthroplasty.

PURPOSE: Economic crisis time gives to efficient procedures an important role in healthy system. Total hip replacement is a common bilateral orthopedic procedure, but there exists an important controversy to perform it in single or two stages. Our aim is to report our clinical and radiological short-term complications of bilateral uncemented total hip arthroplasty in a single time. MATERIALS AND METHODS: We have retrospectively reviewed the patients treated between 2000 and 2011 in our center by bilateral uncemented total hip replacement in a single time. We have reviewed the medical history and analyzed by age, diagnosis and ASA parameters related to the procedure, hospital stay, transfusion requirements and clinical complications. Radiological evaluation was made with anteroposterior hip radiograph evaluation (acetabular radiolucencies and stem migration). Functional assessment was carried out by the Merle D'Aubigné score. RESULTS: Seventeen patients with mean age of 47.4 (18-68) years were reviewed with a mean follow-up of 44.3 (6-172) months. ASA distribution: 29.4 % grade I; 52.9 % grade II and 17.6 % grade III. Merlé D'Aubigné score improved from 11.01 to 16.45. Hospital stay was 6 days. Transfusion requirements were two hematic concentrates for each patient. Two external popliteal sciatic nerve neurapraxias fully recovered at follow-up. Radiological results showed one case of axial migration. CONCLUSIONS: With proper patient selection and multidisciplinary team, the bilateral uncemented total hip arthroplasty in a single time has low complication rates. Our results could be used in the development of future randomized controlled trials or prospective cohort studies. LEVEL OF EVIDENCE: IV.

Rivaroxaban is as efficient and safe as bemiparin as thromboprophylaxis in knee arthroscopy.

PURPOSE: The aim of this study is to compare effectiveness and safety profile of rivaroxaban with bemiparin in 3-week extended prophylaxis after knee arthroscopy. METHODS: Four hundred and sixty-seven patients were included in this review divided in two groups. One followed prophylaxis with rivaroxaban and the other one with bemiparin. All patients were interviewed and explored at 1 and 3 months postoperatively, looking for symptomatic signs of deep-vein thrombosis (DVT). In case of suspicion, diagnostic tests were performed. Collected data were age, sex, gender, diagnosis, time with ischemia, body mass index, concomitant diseases, concomitant therapy, DVT signs, treatment satisfaction, minor and major complications, treatment adherence and tolerability. RESULTS: No thromboembolic events were observed in any of the groups. In one case treated with rivaroxaban, the drug had to be withdrawn due to epistaxis. CONCLUSIONS: Our study showed that extended prophylaxis with 10 mg of rivaroxaban once daily for 3 weeks resulted as effective as bemiparin in knee arthroscopy thromboprophylaxis.

Prominencia esternoclavicular: hiperostosis u osificación interarticular ¿Un cajón de sastre? / Sterno-clavicular prominence: hyperostosis or interarticular ossifiction. ¿it is a ragbag?

Introducción. En la práctica clínica observamos con cierta frecuencia una prominencia esternoclavicular dolorosa, deformidad que constituye el principal signo de dos entidades con baja incidencia, aunque bien definidas: la hiperostosis esterno-costo-clavicular (HECC) y la osificación inter-esterno-costo-clavicular (OIECC). El diagnóstico diferencial de estas afecciones debe incluir la artrosis esterno-clavicular, la enfermedad de Paget, la osteitis condensante, la osteomielitis, la pustulosis, la enfermedad de Friederich, el síndrome de Tietze y el osteoma osteoide. Esto es especialmente importante en los casos en los que la afectación sea unilateral. Material y método. Presentamos una serie de nueve pacientes cuyo motivo de consulta fue una prominencia esterno-costo-clavicular, compatible con HECC u OIECC. El motivo de consulta en la mayoría de los pacientes fue el descartar la presencia de un tumor en esa localización. Resultados. Los estudios radiológicos mostraron un aumento variable tanto de la densidad como de la masa ósea, así como diferentes intensidades de afectación de la articulación esterno-costo-clavicular. Discusión. Descartado un tumor y con un diagnóstico concreto de la causa de la prominencia, generalmente, se considera suficiente con el tratamiento antiinflamatorio en la mayoría de los pacientes. En la práctica clínica parece irrelevante la diferenciación entre HECC y OIECC, ya que el tratamiento y el pronóstico de ambas afecciones son superponibles. La biopsia de la articulación y los procedimientos diagnósticos invasivos pueden ser innecesarios(AU)

Introduction. In clinical practice, we see quite often painful sterno-clavicular prominence, deformity, which is the hallmark of two entities with a low incidence, although well defined hyperostosis cost sterno-clavicular (HECC) and ossification cost inter-sterno-clavicular (OIECC). The differential diagnosis of these conditions, you must include sterno-clavicular arthritis, Paget's disease, condensing osteitis, osteomyelitis, pustulosis, Friederich's disease, Tietze's syndrome and osteoid osteoma. This is especially important in cases where the involvement is unilateral. Material and methods. We present a series of nine patients complaining of a painful sterno- clavicular prominence, compatible with HECC or OIECC. The reason for consultation in most patients was rule out the presence of a tumor in that location. Results. Image studies showed a variable increase both the density and bone mass as well as different intensities of joint involvement sterno-clavicular cost. Conclusion. Ruled out a tumor and a specific diagnosis of these, you do not need aggressive treatment, is generally considered sufficient anti-inflammatory treatment in most patients. In clinical practice, it is irrelevant and OIECC HECC differentiation, since treatment and prognosis of both conditions are similar. The biopsy of the joint and aggressive diagnostic procedures may be unnecessary (AU)

Valoración clínico-radiológica del vástago CLS Spotorno a largo plazo / Long-term clinical-radiological evaluation of the CLS Spotorno stem

Objetivo: Analizar los resultados a largo plazo del vástago no cementado de anclaje metafisario tipo CLS Spotorno (Sulzer/Zimmer). Material y métodos: Se han revisado 166 pacientes a los que se colocó, de forma primaria y consecutiva 189 vástagos CLS (CementLess Spotorno) (Sulzer/Zimmer). El seguimiento mínimo ha sido de 13 a˜nos. Los parámetros clínicos se han valorado según la escala de Harris modificada, y los radiológicos según las zonas de Gruen. También se ha analizado la medición del hundimiento del vástago. Resultados: El seguimiento medio ha sido de 180 meses (156-228) 12 pacientes (12 vástagos) habían fallecido y no se ha completado el seguimiento por diferentes motivos en 24 pacientes (29 vástagos). Así, el trabajo se ha realizado sobre 130 pacientes (148 vástagos) que tienen el seguimiento mínimo. La tasa de supervivencia global del vástago ha sido del 95% al final del seguimiento (intervalo de confianza 89-98). Las mediciones de la escala de Harris han pasado de 48 (9-76) puntos antes de la cirugía a 90 (63-100) puntos al final del seguimiento. Conclusiones: El vástago femoral CLS obtiene unos excelentes resultados tanto clínicos como de supervivencia a largo plazo (AU)

Objective: To analyse the long-term results of the cementless, metaphyseal anchorage type, CLS Spotorno stem (Sulzer/Zimmer). Material y methods: A review has been made of 166 patients in whom were implanted, primarily and consecutively, 189 CLS (CementLess Spotorno) (Sulzer/Zimmer) stems. The mean follow up was 13 years. The clinical parameters were assessed using a modified Harris scale, and the radiological ones according to the Gruen zones. The stem sinking measurements were also analysed. Results: The mean follow up was 180 (156-228) months. Twelve patients (12 stems) died and 24 patients (29 stems) did not complete the follow up for different reasons. Thus the study was carried out on 130 patients (148 stems) who had the minimum follow up. The overall survival rate of the stem was 95% (confidence interval 89-98%) at the end of follow up. The Harris scale scores increased from 48 (9-76) points before surgery to 90 (63-100) points at the end of follow up (AU)

Embolización arterial selectiva de tumores del sacro / Selective arterial enbolization of sacral tumors

Objetivos. El objetivo de este estudio es valorar las posibilidades de la embolización arterial selectiva en el tratamiento coadyuvante y curativo de lesiones tumorales y pseudotumorales del sacro, su repercusión en la cirugía y en la evolución del paciente. Material y método. Revisión retrospectiva de 8 pacientes portadores de lesiones tumorales o pseudotumorales embolizados en nuestro centro con objetivo curativo en uno y coadyuvante a la cirugía en 7, entre los años 1986 y 2004 (3 tumores de células gigantes, 2 quistes óseos aneurismáticos, un cordoma, un condroblastoma, un schwanoma y una metástasis de carcinoma tiroideo). Resultados. El seguimiento fue de 6 años y 5 meses de promedio. Sólo un paciente presentó dolor postembolización como complicación. Se intervinieron 5 de los 7 pacientes cuyo objetivo fue disminuir el riesgo de hemorragia intraoperatoria. Un paciente portador de un quiste óseo aneurismático requirió dos embolizaciones con objetivo curativo y no presentó recurrencia de la enfermedad a los tres años. Conclusiones. Creemos que la embolización arterial selectiva es un método recomendable en el tratamiento curativo de lesiones pseudotumorales de difícil acceso quirúrgico. También es un método eficaz para disminuir el riesgo de hemorragia durante la cirugía de lesiones hipervasculares tumorales o pseudotumorales del sacro (AU)

Objectives. The aim of this study is to analyse the therapeutic possibilities of the selective arterial embolization for curative, palliative or adyuvant treatment of malignant or non malignant tumoral lesions of the sacrum, the repercussion in the surgery and in the evolution of the patients. Materials and methods. Retrospective review of eight patients with tumors or pseudotumoral lesions of the sacrum that were embolizated in our centre between 1986 and 2004. The embolization was done with curative aim in one and like adyuvant treatment to the surgery in seven, (3 giant cells tumors, 2 aneurysmal bone cysts, 1 cordoma, 1 condroblastoma, 1 shwanoma and 1 metastasis of a thyroid carcinoma). Results. The follow-up was six years and five months in average. Only one patient presented a minor complication (pain) after the embolization. Five of seven patients in whom the aim was to reduce the risk of surgical bleeding were finally operated on. The patient with an aneurysmal bone cyst that received embolization with curative aim did not present recurrence of the disease after three years of follow up. Conclusions. We believe that the selective arterial embolization is an advisable method in the curative treatment of pseudotumoral lesions of difficult surgical access. The arterial embolization is an effective method to reduce the risk of intraoperative bleeding in case of hipervascular, tumoral or pseudotumoral lesions in the sacrum (AU)

Cervicobrachialgia and pancoast tumor: value of standard anteroposterior cervical radiographs in early diagnosis.

Ten patients diagnosed with Pancoast tumor were studied retrospectively. The definitive diagnosis was made between 2 and 24 months after the onset of pain. Pain localization was hard to pinpoint; some patients reported pain in four different sites (neck, shoulder, arm, and scapula). Five patients had previously been diagnosed with degenerative, inflammatory, or infectious diseases of the cervical spine or shoulder. In the remaining five patients, the diagnosis was made during the first clinical visit. In three patients, an orthopedic surgeon made the diagnosis by viewing a standard anteroposterior (AP) cervical radiograph. The radiographic evidence arousing suspicion of a Pancoast tumor was the lack of pulmonary air at the top of the affected lung. Furthermore, a parallel study was conducted on 100 consecutive patients seeking treatment for neck pain. By examining the AP radiographs of their cervical spines, the third rib and the top of both lungs were observed in all cases. This study stresses the value of standard AP cervical radiographs in the diagnosis of Pancoast tumor.

Técnica de Krogius-Lecène en el tratamiento de la luxación habitual de rótula. Resultados a largo plazo / Krogius-Lecène technique in the treatment of recurrent patellar dislocation. Long-term results

Objetivo. La luxación habitual de rótula se trata de una patología en la que se produce una luxación de la misma cada vez que el paciente realiza una flexión de la rodilla, volviendo a su posición correcta en el surco intercondíleo con la rodilla en extensión. El tratamiento debe ir encaminado al recentraje rotuliano, y es importante realizarlo de forma precoz, para evitar daños irreparables producidos por las constantes luxaciones y choques de los cóndilos con el cartílago rotuliano. Cuando esta patología se produce en pacientes en los que el cartílago de crecimiento se encuentra todavía activo, la cirugía ósea no se puede llevar a cabo. El objeto del trabajo es valorar en este grupo de pacientes la cirugía de realineamiento rotuliano actuando exclusivamente sobre partes blandas. Material y método. Estudiamos la evolución de las rodillas de 11 pacientes (14 rodillas) afectos de luxación habitual de rótula antes de la madurez esquelética en los que se realizó realineamiento rotuliano mediante la técnica Krogius-Lecène. Resultados. El seguimiento medio de estos pacientes fue de 21,9 años, período tras el cual los resultados clínicos obtenidos fueron excelentes en 10 rodillas, buenos en tres y regulares en una. En ningún caso la rodilla volvió a sufrir episodios de luxación. Conclusión. La técnica de Krogius-Lecène para el tratamiento de la luxación habitual de rótula es un método que consigue buenos resultados a largo plazo en pacientes con el cartílago de crecimiento activo (AU)

Seguimiento evolutivo de las artroplastias de cadera en pacientes con espondiloartritis anquilosante / Follow-up of the outcome of hip arthroplasty in patients with ankylosing spondylitis

Introducción. Las manifestaciones articulares en los pacientes afectos de espondilitis anquilopoyética son relativamente frecuentes, llegando hasta el 50 por ciento en algunos casos. Material y método. Presentamos nuestra experiencia en el tratamiento de 26 pacientes afectos de espondilitis anquilopoyética a los que se les implantó una prótesis de cadera (bilateral en 7 casos). Se ha valorado el intervalo entre el diagnóstico de la enfermedad y la implantación de la prótesis, la movilidad pre y post-operatoria, el tipo de prótesis, las complicaciones, la presencia de aflojamiento y de osificaciones heterotópicas. Resultados. Todos los pacientes mostraron mejoría clínica y de la movilidad. Hubo dos casos de complicación (una amiloidosis y una infección de la prótesis que requirió su retirada), en ninguno de los pacientes se observaron osificaciones heterotópicas con repercusión clínica. Conclusiones. A pesar de la temprana edad de implantación (40 años), el resultado de los 10 años de seguimiento es satisfactorio, con un índice de aflojamiento aséptico similar al de otras series en este tipo de pacientes. El tratamiento de las osificaciones heterotópicas tanto con fármacos como con radioterapia está indicado en los pacientes de riesgo, debiendo evitarse en el resto dado el alto coste de los mismos y su tasa de efectos secundarios (AU)

Frozen cancellous bone allografts: positive cultures of implanted grafts in posterior fusions of the spine.

We have carried out a study on the behaviour pattern of implanted allografts initially stored in perfect conditions (aseptically processed, culture-negative and stored at -80 degrees C) but which presented positive cultures at the implantation stage. There is no information available on how to deal with this type of situation, so our aim was to set guidelines on the course of action which would be required in such a case. This was a retrospective study of 112 patients who underwent a spinal arthrodesis and in whom a total of 189 allograft pieces were used. All previous bone and blood cultures and tests for hepatitis B and C, syphilis and HIV (via PCR techniques) were negative. The allografts were stored by freezing them at -80 degrees C. A sample of the allograft was taken for culture in the operating theatre just before its implantation in all cases. The results of the cultures were obtained 3-5 days after the operation. There were 22 allografts with positive culture results (12%) after implantation. These allografts were implanted in 16 patients (14%). Cultures were positive for staphylococci coagulase negative (ECN) in 10 grafts (46%), Pseudomonas stutzeri in two grafts (9%), Corynebacterium jeikeium in two grafts (9%), staphylococci coagulase positive in two grafts (9%) and for each of the following organisms in one case each (4%): Corynebacterium spp., Actinomyces odontolyticus, Streptococcus mitis, Peptostreptococcus spp., Rhodococcus equi and Bacillus spp. No clinical infection was seen in any of these patients. Positive cultures could be caused by non-detected contamination at harvesting, storing or during manipulation before implantation. The lack of clinical signs of infection during the follow-up of our patients may indicate that no specific treatment different from our antibiotic protocol is required in the case of positive culture results of a graft piece after implantation.

Tratamiento de la espondilolistesis en niños y adolescentes / Treatment of spondylolisthesis in children and adolescents

La espondilolistesis es una de las causas identificables de dolor lumbar más frecuentes en la infancia, llegando a afectar al 6 por ciento de los niños mayores de 6 años. Cómo tratar esta patología ha sido motivo de controversia dado que no se pueden dar reglas generales. El tratamiento debe ser individualizado para cada paciente. Asimismo es importante recalcar el hecho de que aunque un paciente no necesite tratamiento, mientras tenga capacidad de crecer, podrá tener un avance en la deformidad, especialmente en las espondilolistesis displásicas, por lo que el seguimiento periódico de estos pacientes es obligatorio. Con este trabajo pretendemos mostrar nuestra experiencia en el tratamiento de esta patología presentando una serie de 139 pacientes con una media de edad en el diagnóstico de 11,8 años (9 meses-19años) controlados en nuestro centro con una evolución superior a los dos años (AU)

Positive culture in allograft ACL-reconstruction: what to do?

The transmission of disease or infection from the donor to the recipient is always a risk with the use of allografts. We carried out a research study on the behavioural pattern of implanted allografts, which were initially stored in perfect conditions (all cultures being negative) but later presented positive cultures at the implantation stage. Because there is no information available on how to deal with this type of situation, our aim was to set guidelines on the course of action which would be required in such a case. We conducted a retrospective study of 181 patients who underwent an ACL reconstruction using BPTB allografts. All previous bone and blood cultures and tests for hepatitis B and C, syphilis and HIV were negative. An allograft sample was taken for culture in the operating theatre just before its implantation. The results of the cultures were obtained 3-5 days after the operation. We had 24 allografts with positive culture (13.25%) after the implantation with no clinical infection in any of these patients. Positive cultures could be caused by undetected contamination while harvesting, storing or during manipulation before implantation. The lack of clinical signs of infection during the follow-up of our patients may indicate that no specific treatment-other than an antibiotic protocol-would be required when facing a case of positive culture of a graft piece after its implantation.

Bone metastases from osteosarcoma.

Bony metastases in patients with osteosarcoma are unusual and normally appear late in the course of the disease. We report our experience with eight such patients, four with solitary and four with multiple metastases. Those with solitary metastases were treated as new tumours with neoadjuvant chemotherapy and surgery. Three remain alive with no evidence of disease at 5, 7 and 8 years follow-up respectively. Histology and response to neoadjuvant chemotherapy was similar in both the primary and metastatic lesions and is a predictive factor of outcome. Those with multiple metastases were treated by palliative measures, and none survived. We conclude that resection of solitary metastases from osteosarcoma after neoadjuvant chemotherapy can be curative.