Embolismo gaseoso tras el uso del sistema de lavado CarboJet® durante la hemiartroplastía de cadera: Caso clínico y revisión de la literatura / Gas embolism after the use of the CarboJet® lavage system during hip hemiarthroplasty: Clinical case and literature review

Presentamos el caso de una paciente de 89 años de edad que sufrió paro cardiorrespiratorio durante la realización de hemiartroplastía de cadera cementada que precisó resucitación cardiopulmonar. Esta complicación ocurrió inmediatamente después de usar el sistema de lavado mediante dióxido de carbono CarboJet®, y se atribuyó a embolismo gaseoso, tras descartar otras entidades. Se discuten los posibles factores que pueden contribuir a esta complicación quirúrgica.

Case report of an 89 year-old patient who had cardiorespiratory arrest during cemented hip hemiarthroplasty and required cardiopulmonary resuscitation. This complication occurred immediately after using the carbon dioxide-based lavage system known as CarboJet® and was attributed to gas embolism once other entities were ruled out. The possible factors that may contribute to this surgical complication are discussed.

[Large intraosseous ganglion in the femoral condyle treated with resorbable cement: clinical case and differential diagnosis]. / Ganglión intraóseo de gran tamaño en cóndilo femoral tratado con cemento reabsorbible: caso clínico y diagnóstico diferencial.

We report a case of a very large intraosseous ganglion in a patient with Down's syndrome. The lesion was located in the medial femoral condyle and was diagnosed with imaging techniques (X-rays, CAT scan, bone scan and magnetic resonance imaging) that allowed measuring it. Treatment consisted of curettage and filling of the defect with the skeletal repair system carbonated apatite resorbable cement which allowed for immediate early weight bearing during the postoperative period in a non-cooperative patient. We think the location and size of the lesion are of interest, as well as the peculiarities of the patient, which may help understand the pathophysiology of this entity. As far as we know, the use of resorbable cement to treat this kind of lesions has not been reported.

[Femoral superficial vein thrombosis due to a large iliopsoas bursitis secondary to polyethylene wear debris in total hip arthroplasty]. / Trombosis de la vena femoral superficial por gran bursitis en psoas secundaria a enfermedad de las partículas en artroplastia total de cadera.

A 76 year old male patient with a history of implantation of a total hip arthroplasty Perfecta (Orthomet(®)), who presented with an iliac fossa mass, increased diameter of the thigh, and pain during hip flexion and extension. CT and ultrasound show the presence of a giant cystic mass in left iliac fossa about 7 cm in diameter next to the prosthesis. A pseudo-tumour secondary to wear debris after placement of a total arthroplasty is rare. We present a case of a large iliopsoas bursitis caused by polyethylene particles, which caused compression and thrombosis of the superficial femoral vein.

Trombosis de la vena femoral superficial por gran bursitis en psoas secundaria a enfermedad de las partículas en artroplastia total de cadera / Femoral superficial vein thrombosis due to a large iliopsoas bursitis secondary to polyethylene wear debris in total hip arthroplasty

Paciente varón de 76 años, con antecedente de implantación de prótesis total de cadera tipo Perfecta (Orthomet®), que consulta por masa en fosa ilíaca, con aumento del diámetro del muslo y dolor flexión y extensión de la cadera. Los estudios complementarios de ecografía y tomografía evidencian la presencia de una tumoración quística gigante lobulada en fosa ilíaca izquierda de unos 7cm de diámetro en la proximidad de la prótesis. La formación quística ocasionada por la enfermedad del polietileno tras la colocación de una artroplastia total de cadera es poco frecuente. Presentamos un caso de bursitis del psoas de gran tamaño, secundaria a la liberación de partículas del polietileno, que ocasionó compresión y trombosis de la vena femoral superficial (AU)

A 76 year old male patient with a history of implantation of a total hip arthroplasty Perfecta (Orthomet®), who presented with an iliac fossa mass, increased diameter of the thigh, and pain during hip flexion and extension. CT and ultrasound show the presence of a giant cystic mass in left iliac fossa about 7cm in diameter next to the prosthesis. A pseudo-tumour secondary to wear debris after placement of a total arthroplasty is rare. We present a case of a large iliopsoas bursitis caused by polyethylene particles, which caused compression and thrombosis of the superficial femoral vein (AU)

[Superficial femoral vein thrombosis due to large psoas bursitis secondary to particle disease in total hip arthroplasty]. / Trombosis de vena femoral superficial por bursitis del psoas posterior a artroplastía total de cadera.

Male, 76 year-old patient with a history of total hip arthroplasty who presents with a mass in the iliac fossa with swelling of the thigh and hip pain upon flexion and extension. Complementary ultrasound and computed tomography scan studies show a giant lobulated cystic mass in the left iliac fossa, 7 cm in diameter, near the prosthesis. Cyst formation caused by polyethylene disease after total hip arthroplasty is infrequent. We present a case of large psoas bursitis secondary to the release of polyethylene particles which caused superficial femoral vein compression and thrombosis.

[Thrombosis of the superficial femoral vein due to psoas bursitis secondary to particle disease in total hip arthroplasty]. / Trombosis de la vena femoral superficial por bursitis del psoas secundaria a enfermedad de las partículas en artroplastía total de cadera.

The case of a male 76 year-old patient with a history of total hip replacement surgery is presented herein. The patient had tumors in the iliac fossa with swelling of the thigh and pain upon hip flexion and extension. The complementary ultrasound and computed tomography show a large lobed cystic tumor in the left iliac fossa, 7 cm in diameter, close to the prosthesis. The diagnosis was psoas bursitis secondary to the release of polyethylene particles that caused compression and thrombosis of the superficial femoral vein. Cyst formation caused by polyethylene disease after total hip arthroplasty is infrequent.

Resultados del tratamiento de las fracturas de radio distal con placa volar / Results of treating distal radial fractures with a volar plate

Objetivovalorar el resultado de las fracturas de radio distal tratadas mediante placa volar. Como objetivos secundarios estaban comparar la concordancia entre escalas funcionales y la escala radiológica de Castaing y realizar un análisis multivariable de los datos preoperatorios para conocer cuáles eran relevantes en el resultado final. Material y métodose realizó un estudio retrospectivo de 31 pacientes con fractura de radio distal tratada con placa volar. Se analizó a los pacientes en función de la edad, el lado afecto, el patrón de fractura según la clasificación de Fernández y la demora quirúrgica. Se realizó una evaluación funcional mediante la escala de Gartland modificada por Sarmiento, Mayo Wrist Score modificada, la escala funcional de Castaing y la escala DASH. También se realizó evaluación radiográfica con la escala de Castaing y se valoró si aparecieron o no complicaciones precoces y/o tardías. Resultadostodas las fracturas consolidaron. La mayoría de los pacientes obtuvieron unos resultados funcionales excelentes o buenos en las distintas escalas de valoración funcional. La puntuación DASH promedio fue 10,92. No podemos afirmar que los resultados estén influidos por el tipo de fractura de los pacientes. Hubo un caso de desplazamiento secundario en una paciente osteoporótica. Conclusionesel tratamiento de las fracturas de radio distal mediante placa volar es una alternativa segura, que permite una reducción anatómica y estable, así como la movilización precoz de la muñeca, con buenos resultados funcionales y radiológicos con pocas complicaciones

Purpose: To assess the results of treating distal radial fractures with a volar plate. Other aims were to evaluate the concordance between functional scales and the Castaing radiological score and carry out a multivariate analysis of the preoperative data in order to find out which data was most relevant ones for the final result. Materials and methodsA retrospective study was performed of 31 patients with a distal radial fracture treated with a volar plate. Patients were analyzed on the basis of age, side involved, fracture pattern according to Fernandez¿ classification, and time-to-surgery. A functional evaluation was made using Gartland's scale as modified by Sarmiento, the modified Mayo Wrist Score, Castaing's functional scale and the DASH scale. In addition, a radiographic assessment was also carried out using Castaing's score and taking into account the appearance of early and/or late complications. ResultsAll fractures went on to heal. Most patients obtained excellent or good functional results on the different functional scales used. Mean DASH score was 10.92. We cannot claim that the results have been influenced by the type of fracture sustained. There was one case of secondary displacement in an osteoporotic patient. ConclusionsTreatment of distal radial fractures by means of a volar plate is a safe alternative that permits an anatomic and stable reduction as well as early wrist mobility. Good functional and radiological results can be obtained with few complications (AU)

Factores pronósticos en el tratamiento de las fracturas de radio distal: comparación entre placa volar y fijador externo / Prognostic factors in the treatment of distal radial fractures: volar plate vs. external fixation

Objetivo. Determinación de los factores que influyen enconseguir un resultado excelente en las escalas de valoración funcional de Mayo y radiológica de Castaing en pacientes con fractura de radio distal inestable, operados con placa volar o fijador externo.Material y método. Se realiza un estudio trasversal incluyendo pacientes con fractura de tercio distal de radio intervenidos desde 2001 a 2005. Las variables estudiadas fueron: sexo, edad, mecanismo de lesión, actividad laboral, clasificación de la fractura según Fernández, técnica quirúrgica, demora quirúrgica, tiempo en rehabilitación, tiempo de seguimiento, escala funcional de Mayo y escala radiológicade Castaing. Considerando la puntuación excelente enestas escalas se realizó un análisis multivariante, determinando qué variables influían en ese resultado.Resultados. Se estudiaron 30 pacientes intervenidos con placa y 27 con fijador externo. En el resultado excelente según la escala funcional Mayo influye la actividad laboral y la demora quirúrgica. En la puntuación excelente según la escala radiológica de Castaing influye la técnica quirúrgica y elgrado de la fractura según la clasificación de Fernández.Conclusiones. Por cada día de demora quirúrgica disminuyeen un 20% la probabilidad de obtener un resultado funcional final excelente. Los trabajadores autónomos consiguen mejores resultados funcionales. Se obtienen peores resultados radiológicos en los grados III, IV y V de Fernández y al utilizar fijador externo

Purpose. The purpose of this study was to compare the outcomes of 2 kinds of treatment for unstable distal radial fractures (open reduction internal fixation (ORIF) and standard external fixation [EF]) and to determine the factors that might have lain behind the achievement of excellent results, using two different scales: the Mayo functional scale and Castaing´s radiological scale.Materials and methods. This is a cross-sectional retrospective study including patients with unstable distal radial fractures treated betwen 2001 and 2005. The inclusion criteria were: patients with unstable distal radial fractures treated with ORIF or EF, with complete clinical and radiological studies, and who agreed to be enlisted in the study (30 ORIF and 27 EF). The two groups were compared for sex, age, mechanism of injury, profession, Fernandez’s fractureclassification, range of motion, surgical technique, time to surgery, duration of physical therapy, follow-up time, the Mayo functional scale and Castaing’s radiological scale. We performed a multivariate logistic regression analysis, evaluating the factors that were involved in obtaining excellent results.Results. We studied 30 patients treated with ORIF (24 menand 7 women) and 27 treated with EF (10 men and 17 women). The factors related to excellent results on the Mayo functional scale were occupation and time to surgery. On the Castaing´s radiologic scale, these factors were surgical technique and fracture degree according to Fernández’s classificationConclusions. For each day of surgical delay, there is a 20% decrease in the probability of obtaining an excellent result. Patients with self-owned businesses achieve better functional results. Grades III, IV and V of the Fernández classification and the use of EF are associated with poorer radiological results (AU)