Enclavado percutáneo de fracturas complejas intraarticulares de la extremidad distal del radio. A propósito de dos casos / Percutaneous pinning in complex intraarthicular fractures of the distal radius. Report of two cases

Objetivo: Señalar el buen resultado con enclavijado percutáneo combinado de estas lesiones y analizar la literatura al respecto. Pacientes y metodología: Presentamos dos casos de fractura compleja e intraarticular de la extremidad distal del radio, tratadas mediante enclavijado percutáneo con agujas de Kirschner. Seguimiento anual. Valoración radiológica y funcional. Resultados: Evolución muy satisfactoria, uno con mínima limitación en la movilidad y ambos con algodistrofia, con total recuperación. Los dos se reintegraron a sus trabajos previos. Conclusión: Con calidad ósea subyacente, este tratamiento es idóneo por sencillez, rapidez y economía, pudiendo realizarse incluso por un único cirujano. Por contra, precisa un exhaustivo seguimiento postoperatorio e inmovilización temporal (AU)

Objective: To note the good results with combined percutaneous pinning of these lesions and to analyze literature related to this topic. Material and method: We present two cases with complex and intra-articular distal radius fractures, treated by percutaneous pinning with Kirschner wires. Anual follow-up. Radiological and functional outcomes. Results: Quite good evolution, one with minimal mobility limitation and both with algodystrophy with total recovery. Both returned to previous works. Conclusion: If the bone has a good quality, this orthopedic fixation device is useful because it is simply, fast and a low-cost method. One surgeon can do it alone. On the other hand, it needs an exhaustive postoperative follow-up and a cast is imperative during a variable period (AU)

[Monostotic patellar Paget's disease]. / Enfermedad de Paget monostótica rotuliana.

Paget's disease or osteitis deformans is a bone metabolic disease characterized by an increased bone resorption followed by an increased but irregular bone formation. This results in a weakened, deformed bone and an increase bone mass with collagen fibers forming an irregular and pathologic mosaic instead of the parallel symmetry that characterizes healthy bone. It is considered as a non-neoplastic disorder that mimics a bone tumor. Its origin is still uncertain; however, it has been postulated that genetic or environmental factors are involved in its etiology. It rarely occurs in young patients and its prevalence increases with age. It usually affects both genders with a slight predominance of males. It may be symptomatic or asymptomatic depending on the bones involved, with the most common clinical manifestation being pain of the affected bone. Lesion distribution varies from monostotic involvement (25%) to generalized disease (75%). The most frequent complication is a fracture in a pathological area, while the most serious one is sarcomatous degeneration (approximately 1%; higher in the generalized form). The diagnosis is usually radiologic, by means of plain X-rays and biochemical markers such as alkaline phosphatase, among others, which is elevated in 85% of patients. Treatment of this disease consists of bisphosphonates, which have a proven efficacy and high remission rates. They are indicated in patients with clinical manifestations and in asymptomatic patients with evidence of disease activity. We report the case of a patient with Paget's disease in an infrequent location as is the patella.

Dificultades de planificación y quirúrgicas en artoplastia de cadera sobre displasia tipo Crowe IV / Preoperative and surgical difficulties of total hip arthoplasty in Crowe type IV dysplasia of the hip

Analizamos las dificultades de planificación preoperatoria y su aplicación quirúrgica en la artroplastia total de cadera en un caso con displasia alta de cadera o displasia tipo IV de Crowe. Los principales problemas fueron: la elección de la vía de abordaje, la restitución del centro de rotación en el paleocotilo deficiente y la prevención de la lesión del nervio ciático. La elección de una prótesis modular no cementada permitió cumplir estos objetivos garantizando la mayor fiabilidad y versatilidad intraoperatorias y creemos que es el implante de elección para minimizar las complicaciones. La artroplastia total de cadera en displasia Crowe IV es un procedimiento complejo pero reproducible

Performing a total hip arthroplasty in a patient with Crowe IV type dysplasia of the hip requires a careful preoperative planning and surgical technique. Selection of surgical exposure, restitution of hip center, prevention of nerve lesions as well as obtaining good fixation and long term survivorship of the implant are the main difficulties and goals for the orthopaedic surgeon. These goals can be accomplished with an uncemented, modular prosthesis. The procedure is complex but reproducible and complications can be minimised by a combination of careful preoperative planning and intraoperative decision making