La prótesis de cadera de entrada en las fracturas acetabulares: indicaciones y dificultades / Initial hip prosthesis in the acetabular fractures: indications and difficulties

Las fracturas de acetábulo presentan un aumento de incidencia con afectación en pacientes de edad avanzada en los que un factor contribuyente es la pérdida de resistencia ósea que hace que traumatismos de baja energía puedan ocasionar lesiones en este segmento anatómico. De igual forma existen factores pronósticos; afectación de la cabeza femoral, conminución del techo, etc que pueden condicionar un mal resultado retrasando la reincorporación a las actividades de la vida diaria del paciente. Cuando se dan estas dos circunstancias, la artroplastia total de cadera puede tener un papel importante en el tratamiento y recuperación precoz de estos pacientes. (AU)

Acetabulum fractures have an increased incidence, affecting elderly patients in whom a contributing factor is the loss of bone resistance, which means that low-energy trauma can cause injuries to this anatomical segment. Likewise, there are prognostic factors; involvement of the femoral head, comminution of the roof, etc. that can lead to a poor outcome, delaying the patient's return to activities of daily living. When these two circumstances occur, total hip arthroplasty can play an important role in the treatment and early recovery of these patients. (AU)

Factores de riesgo asociados a luxación en el paciente con fractura del cuello femoral: estudio de casos y controles / Risk factors associated to prosthetic hip dislocation in patients with femur neck fracture: a case-control study

Introducción La luxación tras una cirugía de artroplastia de cadera es una temible complicación que se ha presentado desde el desarrollo de la técnica. Se han realizado múltiples estudios comparativos que intentan aclarar cuáles son los factores que influyen en este suceso adverso. Métodos En nuestro caso hemos llevado a cabo un estudio retrospectivo analizando 476 pacientes, que han sido divididos en función de si habían sufrido un episodio de luxación o no y llevando a cabo un análisis estadístico de las posibles variables que podrían haber afectado en ello; diseñándose así un estudio de casos y controles. Resultados y conclusiones En nuestro estudio hemos obtenido que la enfermedad mental aumenta hasta 6 veces más el riesgo de sufrir un episodio de luxación tras someterse al paciente a una artroplastia de cadera por fractura (OR 6,429; IC 95% 1,568 - 26,361), al igual que el hecho de padecer una infección post-quirúrgica (OR 11,667; IC 95% 2,147 - 63,394). No obstante, sería adecuado realizar más estudios para su confirmación, al igual que el hecho de realizar estudios con un mayor tamaño muestral podrían apoyar o rebatir nuestros hallazgos. (AU)

Introduction Dislocation after a hip arthroplasty is a terrible complication that has been present since the technique was developed. Many studies have been developed in order to see which risk factors affect on this adverse effect. Methods We have made a retrospective study, analysing 476 patients. They have been divided in two groups, one if they have suffered from prosthetic hip dislocation and the other if they have not. After that, we did a stadistical analysys of posible risk factors, designing a case-control study. Results and conclusión In our study, we have found that mental illness increseases up to 6 times the risk of suffering a hip dislocation (OR 6,429; IC 95% 1,568 - 26,361). We also found relation with suffering from an acu-te infection (OR 11,667; IC 95% 2,147 - 63,394). However, more studies, or with a bigger popula-tion should be performed in order to make a statement. (AU)

La prótesis de cadera de entrada en las fracturas acetabulares: indicaciones y dificultades / Initial hip prosthesis in the acetabular fractures: indications and difficulties

Las fracturas de acetábulo presentan un aumento de incidencia con afectación en pacientes de edad avanzada en los que un factor contribuyente es la pérdida de resistencia ósea que hace que traumatismos de baja energía puedan ocasionar lesiones en este segmento anatómico. De igual forma existen factores pronósticos; afectación de la cabeza femoral, conminución del techo, etc que pueden condicionar un mal resultado retrasando la reincorporación a las actividades de la vida diaria del paciente. Cuando se dan estas dos circunstancias, la artroplastia total de cadera puede tener un papel importante en el tratamiento y recuperación precoz de estos pacientes. (AU)

Acetabulum fractures have an increased incidence, affecting elderly patients in whom a contributing factor is the loss of bone resistance, which means that low-energy trauma can cause injuries to this anatomical segment. Likewise, there are prognostic factors; involvement of the femoral head, comminution of the roof, etc. that can lead to a poor outcome, delaying the patient's return to activities of daily living. When these two circumstances occur, total hip arthroplasty can play an important role in the treatment and early recovery of these patients. (AU)

Factores de riesgo asociados a luxación en el paciente con fractura del cuello femoral: estudio de casos y controles / Risk factors associated to prosthetic hip dislocation in patients with femur neck fracture: a case-control study

Introducción La luxación tras una cirugía de artroplastia de cadera es una temible complicación que se ha presentado desde el desarrollo de la técnica. Se han realizado múltiples estudios comparativos que intentan aclarar cuáles son los factores que influyen en este suceso adverso. Métodos En nuestro caso hemos llevado a cabo un estudio retrospectivo analizando 476 pacientes, que han sido divididos en función de si habían sufrido un episodio de luxación o no y llevando a cabo un análisis estadístico de las posibles variables que podrían haber afectado en ello; diseñándose así un estudio de casos y controles. Resultados y conclusiones En nuestro estudio hemos obtenido que la enfermedad mental aumenta hasta 6 veces más el riesgo de sufrir un episodio de luxación tras someterse al paciente a una artroplastia de cadera por fractura (OR 6,429; IC 95% 1,568 - 26,361), al igual que el hecho de padecer una infección post-quirúrgica (OR 11,667; IC 95% 2,147 - 63,394). No obstante, sería adecuado realizar más estudios para su confirmación, al igual que el hecho de realizar estudios con un mayor tamaño muestral podrían apoyar o rebatir nuestros hallazgos. (AU)

Introduction Dislocation after a hip arthroplasty is a terrible complication that has been present since the technique was developed. Many studies have been developed in order to see which risk factors affect on this adverse effect. Methods We have made a retrospective study, analysing 476 patients. They have been divided in two groups, one if they have suffered from prosthetic hip dislocation and the other if they have not. After that, we did a stadistical analysys of posible risk factors, designing a case-control study. Results and conclusión In our study, we have found that mental illness increseases up to 6 times the risk of suffering a hip dislocation (OR 6,429; IC 95% 1,568 - 26,361). We also found relation with suffering from an acu-te infection (OR 11,667; IC 95% 2,147 - 63,394). However, more studies, or with a bigger popula-tion should be performed in order to make a statement. (AU)

Relación entre delirium postoperatorio y mortalidad tras la cirugía de fractura trocantérica en el paciente anciano / Relationship between postoperative delirium and mortality after trochanteric fracture surgery in elderly patients

INTRODUCCIÓN: El delirium postoperatorio en el paciente anciano con fractura trocantérica se ha relacionado con la mortalidad postoperatoria. OBJETIVO: Determinar los factores de riesgo asociados al delirium postoperatorio del paciente anciano con fractura trocantérica y la relación de éste con la mortalidad postoperatoria. MATERIAL Y MÉTODO: Estudio de cohortes histórico en el que se analizan los factores de riesgo para la aparición de delirium postoperatorio y su relación con la mortalidad postoperatoria en 264 pacientes intervenidos de fractura trocantérica. RESULTADOS: Se ha encontrado asociación estadística significativa entre la aparición de delirium postoperatorio e insuficiencia renal crónica (p = 0,01), demencia (p = 0,000) y una edad superior a 80 años (p = 0,016). Se encontró asociación estadística significativa entre delirium postoperatorio y mortalidad tras el alta hospitalaria, tanto en el primer mes tras la cirugía (p = 0,003 RR 1,11 IC 95% 1,01-1,23), como durante el primer año tras la misma (p = 0,000 RR 1,46 IC 95% 1,17-1,81). Sin embargo, no se encontró asociación estadística significativa entre el delirium postoperatorio y la mortalidad intrahospitalaria (p = 0,1). CONCLUSIÓN: La presencia de delirium postoperatorio en el paciente anciano intervenido de fractura trocantérica podría aumentar el riesgo de fallecimiento durante el primer año tras el alta hospitalaria

INTRODUCTION: Postoperative delirium in the elderly patient with trochanteric fracture has been associated with postoperative mortality. Objective: To determine the risk factors associated with postoperative delirium atfer trochanteric surgery in elderly patients. MATERIAL AND METHODS: Retrospective cohort study was designed, analyzing delirium risk factors and postoperative mortality in 264 elderly patients operated from trochanteric hip surgery. RESULTS: We reported statistical association between the happening of delirium and also and chronic renal failure (p = 0,01), dementia (p = 0,000), age over 80 years (p = 0,016). We reported statistical association between postoperative delirium and mortality after discharge within the first month after surgery (p = 0,003 RR 1,11 IC 95% 1,01-1,23) and within the first year after surgery (p = 0,000 RR 1,46 IC 95% 1,17-1,81). No statistical association was reported difference between postoperative delirium and intrahospitalary mortality (P = 0,1). CONCLUSION: Postoperative delirium an elderly patient during the stay in the hospital due to a trochanteric hip fracture would increase the risk of mortality after the discharge during the first year after surgery

En plena histeria colectiva por el coranovirus / No disponible

No disponible

56 Congreso de la SECOT / No disponible

No disponible

La relación médico-enfermo / The doctor-sick relationship

No disponible

XLIX Congreso de la SATO / No disponible

No disponible

Novedades en Artroplastia de Cadera. 2017 / News in Hip Arthroplasty. 2017

No disponible

La rúbrica en el examen oral de Traumatología y Ortopedia / The rubric in the oral exam in Traumatology and Orthopaedics

OBJETIVO: Conocer si el uso de la rúbrica para el examen oral de Traumatología y Ortopedia aporta información sobre competencias transversales. TIPO DE ESTUDIO: Experimental con un grupo control. MATERIAL Y MÉTODOS: Grupo control: 67 alumnos calificados globalmente mediante examen oral. Grupo intervención: 68 alumnos valorados con rúbrica que contiene las dimensiones: conocimiento teórico, precisión en la terminología, concreción en el lenguaje y uso de fuentes adicionales de información. RESULTADOS: Existe diferencia entre las calificaciones del grupo control (mediana 9, RIC: 9, 9) y el experimental (mediana 7,63, RIC: 6,48, 8,54). En el grupo experimental, la calificación más alta se obtiene en la pregunta propuesta por el profesor y la más baja en la elegida por el alumno. Precisión y concreción han alcanzado un 72 y un 70% del máximo posible. El conocimiento teórico ha conseguido el 76,26%. Se observa un efecto monotonía de las calificaciones del grupo control a partir del alumno evaluado en décimo lugar. CONCLUSIONES: Utilizar rúbrica influye en la calificación final del alumno. La precisión y la concreción en la exposición alcanzan un mínimo del 70% de la valoración adscrita

AIM: To find out if the use of the rubric for the oral examination of Traumatology and orthopaedics provides information on cross-disciplinary skills. STUDY TYPE: Experimental with a control group. MATERIAL AND METHODS: Control Group: 67 students globally qualified by oral examination. Intervention Group: 68 students evaluated with a scoring rubric that comprises the dimensions: Theoretical knowledge, precision in the terminology, accuracy in the language, and the use of additional information sources. RESULTS: There was a significant difference between the results of the control group (median 9, IQR: 9.9) and the experimental group (median 7.63, 95% CI: 6.48 - 8.54). In the experimental group, the higher qualification is obtained in the question proposed by the teacher and the lower one in the question chosen by the student. Precision and specificity were 72% and 70% of the maximum, respectively. Theoretical knowledge achieved 76.26%. A monotony effect is observed in the scores of the control group after the tenth evaluated student. CONCLUSIONS: The use of a rubric influences the final assessment of the student. The precision and accuracy achieved a minimum of 70% of the assigned valuation

Floating hip and associated injuries.

AIM: To describe our experience in treating patients diagnosed with floating hip injury and to communicate the outcomes achieved and the rate of complications. A secondary aim is to compare the results of this group in terms of quality of life with those of patients presenting with a fracture either of the pelvis or of the acetabulum, but in which the femoral segment is not involved. PATIENTS AND METHODS: This is a descriptive study of the patients diagnosed with floating hip injury (25 patients) who were treated at our hospital between 2004 and 2007, with a minimum follow-up of seven years. The results are compared with those of a control group of 56 patients diagnosed with an isolated pelvic or acetabular injury. We describe the injuries and the associated lesion. The patients' quality of life was assessed using the EUROQOL tool. RESULTS: Among the floating hip group of patients, three suffered an additional arterial lesion and were later treated with a supracondylar amputation. Seven patients presented heterotopic ossification. No significant difference was observed between the study and control groups, according to the EUROQOL tool, although the scores for every dimension were lower among the floating hip patients. Among the patients in the control group, the quality of life scores were also affected in every dimension of the EUROQOL scale. DISCUSSION AND CONCLUSIONS: The addition of a femoral fracture to a pelvic or acetabular injury, the so-called floating hip, is a devastating injury which has an important impact on patients' quality of life, going beyond that experienced by patients with isolated injuries. Nevertheless, our results did not reflect statistically significant differences in the quality of life among the three groups analyzed: isolated fractures, floating hip and floating hip resulting in amputation.

Los registros de artroplastias / Arthoplasty registries

En este artículo se analiza qué son los registros de artroplastias, cómo deben realizarse, para qué sirven y a quién le interesa

In this paper, arthoplasty registries are described, emphasizing how should be done, what are they made for, and who are interested in their results

Evaluation of posterolateral lumbar fusion in sheep using mineral scaffolds seeded with cultured bone marrow cells.

The objective of this study is to investigate the efficacy of hybrid constructs in comparison to bone grafts (autograft and allograft) for posterolateral lumbar fusion (PLF) in sheep, instrumented with transpedicular screws and bars. Hybrid constructs using cultured bone marrow (BM) mesenchymal stem cells (MSCs) have shown promising results in several bone healing models. In particular, hybrid constructs made by calcium phosphate-enriched cells have had similar fusion rates to bone autografts in posterolateral lumbar fusion in sheep. In our study, four experimental spinal fusions in two animal groups were compared in sheep: autograft and allograft (reference group), hydroxyapatite scaffold, and hydroxyapatite scaffold seeded with cultured and osteoinduced bone marrow MSCs (hybrid construct). During the last three days of culture, dexamethasone (dex) and beta-glycerophosphate (ß-GP) were added to potentiate osteoinduction. The two experimental situations of each group were tested in the same spinal segment (L4-L5). Spinal fusion and bone formation were studied by clinical observation, X-ray, computed tomography (CT), histology, and histomorphometry. Lumbar fusion rates assessed by CT scan and histology were higher for autograft and allograft (70%) than for mineral scaffold alone (22%) and hybrid constructs (35%). The quantity of new bone formation was also higher for the reference group, quite similar in both (autograft and allograft). Although the hybrid scaffold group had a better fusion rate than the non-hybrid scaffold group, the histological analysis revealed no significant differences between them in terms of quantity of bone formation. The histology results suggested that mineral scaffolds were partly resorbed in an early phase, and included in callus tissues. Far from the callus area the hydroxyapatite alone did not generate bone around it, but the hybrid scaffold did. In nude mice, labeled cells were induced to differentiate in vivo and monitored by bioluminescence imaging (BLI). Although the cultured MSCs had osteogenic potential, their contribution to spinal fusion when seeded in mineral scaffolds, in the conditions disclosed here, remains uncertain probably due to callus interference with the scaffolds. At present, bone autografts are better than hybrid constructs for posterolateral lumbar fusion, but we should continue to seek better conditions for efficient tissue engineering.

Articular cartilage: structure and regeneration.

Articular cartilage (AC) has no or very low ability of self-repair, and untreated lesions may lead to the development of osteoarthritis. One method that has been proven to result in long-term repair or isolated lesions is autologous chondrocyte transplantation. However, first generation of these cells' implantation has limitations, and introducing new effective cell sources can improve cartilage repair. AC provides a resilient and compliant articulating surface to the bones in diarthrodial joints. It protects the joint by distributing loads applied to it, so preventing potentially damaging stress concentrations on the bone. At the same time it provides a low-friction-bearing surface to enable free movement of the joint. AC may be considered as a visco- or poro-elastic fiber-composite material. Fibrils of predominantly type II collagen provide tensile reinforcing to a highly hydrated proteoglycan gel. The tissue typically comprises 70% water and it is the structuring and retention of this water by the proteoglycans and collagen that is largely responsible for the remarkable ability of the tissue to support compressive loads.

Vascular complications in floating hip.

The so-called floating hip involves a pelvis or an acetabular fracture together with an ipsilateral femur bone fracture. Concurrent injuries are also common in these cases, with the evolution and outcome worse than expected when these fractures exist in isolation. We studied a series of 11 patients with floating hip lesions. They all presented within a general polytrauma diagnosis. Diaphyseal femur fracture together with ipsilateral acetabular fracture was the most common combination. Supracondylar fracture occurred in 3 cases; these patients also had a popliteal vascular injury, and underwent a subsequent vascular repair. Although that treatment was promptly performed by a vascular surgeon, all of these patients in the end underwent an above-knee amputation. Bladder lesion, sciatic nerve injury, myositis ossificans, and skin injuries were also associated with these patients with a floating hip. Although vascular injuries in a floating hip have not been previously described in the literature, in our series these constituted the most severe complication. Whenever a major lower limb vascular injury coexists with a floating hip, prompt vascular repair must be accomplished. However, according to our experience, the nature of these lesions makes any expectation of limb viability very unlikely.