Outcomes of cement augmentation in fragility trochanteric hip fractures - A multicenter randomized controlled trial follow-up.

PURPOSE: Cement augmentation is considered to improve the bone-implant construct stability in hip fragility fractures, additionally biomechanical studies show that cement augmentation improves the pull-out strength and increases resistance to failure. Thus far, the advantage of these technique used in a clinical scenario is yet to be determined METHODS: a randomized, multicenter, single-blinded clinical trial was conducted in patients aged 65 years or older who were admitted to two level I trauma centers with a fragility intertrochanteric hip fracture during September 2015 and December 2017. Patients were stratified into 2 groups: patients between 65 and 85 years and older than 85 years. A balanced block randomization was performed using blocks of 6 patients: 3 patients assigned to the control group (no augmentation) and 3 patients to the intervention group. Follow-up visits were done at 1, 3, 6 and 12 postoperative months documenting the tip-apex distance (TAD) as well as followed up after 5 to 7 years of surgical procedure documenting EQ5D, Parker Mobility Score and mortality rates at these different time points. RESULTS: A total of 90 patients were included but only 53 patients completed a one-year follow up. The mean immediate postoperative and one-year follow up TAD measurement from the whole cohort (20.99 mm vs 21.3 mm, respectively) showed no statistical significance (P = 0.18). For patients in the control group, the difference of TAD measurements from the immediate postoperative and one-year follow-up was -0.25 mm (P = 0.441). For patients included in the intervention group, the difference of TAD measurement from the immediate postoperative and 1-year follow up was -0.48 mm (P = 0.383). No statistical difference was found when stratified by age (p = 0.78). One patient from the control group had an implant failure after 1-month postoperative. Readmission after 30 days showed no statistical difference between both groups (7 vs. 7 patients, p = 0.754). Augmentation did not show a difference in most of the functional outcomes nor quality of life after 5 to 7 years of surgical procedure. CONCLUSIONS: The use of augmentation can be considered a safe procedure for the fixation of fragility hip fractures.

Mixoma auricular asociado a evento cerebrovascular isquémico / Atrial myxoma related with ischemic cerebrovascular event

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Estudio histopatológico en rotura aguda del ligamento cruzado anterior de rodilla / Histopathological study in acute rupture of the anterior cruciate ligament of the knee

Introducción: la estructura histológica de los ligamentos, inclusive el ligamento cruzado anterior, está compuesta por colágeno y elastina envueltos en una matriz de agua y proteoglicanos. El colágeno es el componente principal de los tendones y ligamentos, representa el 65-75% de su peso en seco. El objetivo de este estudio es realizar una evaluación histopatológica de los fragmentos de ligamento cruzado anterior rotos, tomados en el momento de la cirugía artroscópica.Materiales y Métodos: Estudio prospectivo observacional sobre 50 casos con rotura de ligamento cruzado anterior. Se tomaron muestras de ligamento cruzado anterior en el procedimiento artroscópico y se evaluó la histopatología del ligamento. Resultados: Se mencionan los resultados de la anatomía patológica y la evolución posoperatoria. Conclusión: Se observaron cambios degenerativos en la histopatología; no puede demostrarse si estos cambios son anteriores o posteriores a la rotura ligamentaria.

Introduction: histological structure of ligaments, including the anterior cruciate ligament, is composed of collagen and elastin wrapped in a matrix of water and proteoglycans. Collagen is the main component of tendons and ligaments, accounting for 65-75% of its dry weight. The aim of the present study is to perform a histopathological evaluation of the ruptured anterior cruciate ligament fragments taken at the time of surgical procedure by arthroscopy.Methods: A prospective observational study of 50 cases with anterior cruciate ligament rupture. Anterior cruciate ligament samples were taken in an arthroscopic procedure and histopathology of the ligament was evaluated.Results: Pathology results and post-operative evolution are mentioned.Conclusion: Degenerative changes were observed in the histopathology exam; it cannot be demonstrated if these changes are previous or posterior to ligament rupture.

On-Call Communication in Orthopaedic Trauma: "A Picture Is Worth a Thousand Words"--A Survey of OTA Members.

OBJECTIVES: To quantify the effects of varying clinical communication styles (verbal and pictorial) on the ability of orthopaedic trauma surgeons in understanding an injury and formulate an initial management plan. METHODS: A Research Electronic Data Capture survey was e-mailed to all OTA members. Respondents quantified (5-point Likert scale) how confident they felt understanding an injury and establishing an initial management plan based on the information provided for 5 common orthopaedic trauma scenarios. Three verbal descriptions were created for each scenario and categorized as limited, moderate, or detailed. The questions were repeated with the addition of a radiographic image and then repeated a third time including a clinical photograph. Statistical evaluation consisted of descriptive statistics and Kruskal-Wallis analyses using STATA (version 12.0). RESULTS: Of the 221 respondents, there were a total of 95 who completed the entire survey. Nearly all were currently taking call (92/95 = 96.8%) and the majority were fellowship trained (79/95 = 83.2%). Most practice at a level I trauma center (58/95 = 61.1%) and work with orthopaedic residents (62/95 = 65.3%). There was a significant increase in confidence scores between a limited, moderate, and detailed description in all clinical scenarios for understanding the injury and establishing an initial management plan (P < 0.05). There was a significant difference in confidence scores between all 3 types of evidence presented (verbal, verbal + x-ray, verbal + x-ray + photograph) in both understanding and managing the injury for limited and moderate descriptions (P < 0.001). No differences were seen when adding pictorial information to the detailed verbal description. When comparing confidence scores between a detailed description without images and a limited description that includes radiographs and a photograph, no difference in confidence levels was seen in 7 of the 10 scenarios (P > 0.05). CONCLUSIONS: The addition of images in the form of radiographs and/or clinical photographs greatly improves the confidence of orthopaedic trauma surgeons in understanding injuries and establishing initial management plans with limited verbal information (P < 0.001). The inclusion of x-rays and photographs raises the confidence for understanding and management with limited verbal information to the level of a detailed verbal description in most scenarios. Mobile technology allows for easy secure transfer of images that can make up for the lack of available information from limited verbal descriptions because of the knowledge base of communicating providers.

Creencias y entrenamiento psicológico / Beliefs and psychological training

En ocasiones el entrenamiento psicológico no es del todo efectivo. Si trabajamos con un deportista con el objetivo de optimizar su rendimiento y diseñamos un programa de entrenamiento psicológico sin tener en cuenta sus limitaciones, es muy posible que no obtengamos los beneficios esperados. Presentamos un modelo de trabajo en el cual, el entrenamiento psicológico pasaría a un segundo plano y se pondría en práctica exclusivamente cuando el deportista presencie unas creencias que no limiten su rendimiento. El trabajo el psicólogo del deporte en la mayoría de los casos debe centrarse en modificar creencias que limiten el rendimiento y dejar el entrenamiento psicológico para los casos puntuales en los que esas creencias no interfieran(AU)

In occasions the psychological training is not completely effective. If we work with a sportsman with the aim to optimize his performance and design a program of psychological training without bearing his limitations in mind, it is very possible that we do not obtain the awaited benefits. Let's sense beforehand a model of work in which, the psychological training would go on to a background and would be put into practice exclusively when the sportsman attends a few beliefs that do not limit his performance. The work the psychologist of the sport in most cases must centre on modifying beliefs that limit the performance and to leave the psychological training for the punctual cases in which these beliefs does not interfere(AU)

Pielonefritis enfisematosa / Emphysematous pyelonephritis

La pielonefritis enfisematosa (PE) es una entidad clínica inusual, que constituye una infección necrotizante aguda con formación de gas en el parénquima renal, sistema colector y/o espacio perirrenal. La población diabética es claramente más propensa a este tipo de pielonefritis, sin embargo, se han descrito casos de PE recurrente en pacientes con obstrucción de la vía urinaria en ausencia de diabetes mellitus. En cerca del 69 por ciento al 97 por ciento de los casos, el germen implicado en la génesis de la enfermedad es la Escherichia coli, seguido por la Klebsiella pneumoniae, responsables de una enfermedad con alto impacto en la morbimortalidad de los pacientes diabéticos. Por lo tanto, el familiarizarnos con esta entidad clínica, nos permitirá realizar un diagnóstico precoz con el fin de establecer el tratamiento más adecuado que permita una mejor sobrevida en el paciente.

CARACTERIZACIÓN DE MICROORGANISMOS ASOCIADOS A LA DESCOMPOSICIÓN DE HOJAS CONSUMIDAS POR Tremarctos ornatus (URCIDAE) Y POSIBLE RELACIÓN EN SU DATACIÓN / Characterization of Microorganisms Associated to Leave Decomposing Comsumed by Tremarctos ornatus (Urcidae) and Its Possible Data Relation

Se establecieron bases para un método de datación de hojas consumidas por Tremarctos ornatus, con base a la presencia de microorganismos aislados de restos vegetales de las hojas de Tillandsia spp. recogidos en campo, correspondientes a diferentes etapas de descomposición. Las muestras (2 cm de la base de la hoja consumida por el animal) fueron procesadas en el laboratorio para el aislamiento y caracterización de los microorganismos presentes, encontrando que los morfotipos bacterianos predominantes fueron cocobacilos (Pseudomonas sp.) y bacilos Gram negativos, (los primeros se encontraron en todas las edades de descomposición y los segundos solo en las muestras menores a seis meses). Morfotipos correspondientes a cocobacilos Gram positivos solo se encontraron en hojas entre 13 meses y bacilos Gram positivos (Bacillus sp.) en hojas de menos de un mes. Cocos y diplococos Gram positivos solo se presentaron en la muestra de hoja con 56 meses de descomposición. Se encontraron cuatro morfotipos de hongos, dos corresponden a Mucor sp. y Trichoderma sp., además de Epicoccum sp., Alternaria sp., Rhizoctonia sp. El género Trichoderma sp. se encontró asociado a por lo menos uno de los morfotipos anteriormente mencionados en rastros mayores de un mes e inferiores a cinco meses.

We established basis for a datetelling method of leaves (Tillandsia spp.) consumed by Tremarctos ornatus by determining or detecting the presence of microorganisms. We used samples from the field that corresponded to different states of decomposition. The samples (2 cm from the leaf base consumed by the animal) were processed in the laboratory, characterized and determined. Cocobacilli (Pseudomonas sp.) and negative bacilli Gram were the most common bacteria morphotypes, the first were founded on samples from all ages and the second on samples no older than six months. Positive cocobacili Gram (Bacillus sp.); were just present in samples between one and three months old. Positive Gram bacilli occurred only in samples no older than a month, cocos and diplococos in samples between five and six months. Four fungus morphotypes were found, two of them being Mucor sp., and Trichoderma sp., in addition to Epicoccum sp., Alternaria sp., Rhizoctonia sp. Trichoderma was associated with at least one more kind of fungus, for samples to older than one month, but no older than five months.

Estudio comparativo entre dinoprostona misoprostol y oxitocina para maduración cervical e inducción de parto / comparative Study between dinoprostona misoprostol and oxictocina for cervical maturation and induction of childbirth

El propóstio fue comparar la seguridad y eficacia de la administración intracervical de misoprostol versus dinoprostona y oxitocina para la maduración cervical e inducción de labor de parto. Para tal efecto, noventa pacientes con indicación médica de inducción de parto y score de Bishop menor a 5, excluyendo ruptura de membranas, fueron asignadas aleatoriamente a recibir misoprostol 50 ug intracervical, dinoprostona 0.5 mg intracervical u oxitocina. La dosis de misoprostol y dinoprostona fueron repetidas cada 3 horas, en tanto que el grupo oxitocina se mantuvo en infusión continua de acuerdo a protocolo establecido, hasta conseguir un score de Bishop superior a 8 o actividad uterina regular. Con la ayuda de una tabla de números aleatorios se asignaron 30 pacientes...