Análisis de las complicaciones en pacientes con fractura-luxación de Lisfranc / Complication analysis in Lisfranc fracture-dislocation

Resumen: Objetivo: Valorar las complicaciones y secuelas del tratamiento de la fractura-luxación de Lisfranc (FLL). Material y métodos: Se realizó un estudio de cohortes ambispectivo trasversal de 83 pacientes con diagnóstico de fractura-luxación de Lisfranc. Se utilizó un protocolo de recopilación de datos con variables relacionadas con la lesión, parámetros clínicos, terapéuticos, complicaciones y escalas de valoración clínica. Resultados: 66 pacientes (79.5%) presentaron complicaciones tanto precoces como tardías. Las complicaciones precoces sumaron nueve casos de edema postoperatorio, tres de infección superficial, dos de necrosis cutánea que precisó injerto libre de piel (ILPH), uno de lesión vascular, uno de tromboembolismo pulmonar (TEP), uno de pérdida de reducción en el postoperatorio precoz, uno de mala reducción que precisó de nueva intervención. Entre las complicaciones tardías, 41 pacientes (49.40%) presentaron signos radiológicos de artrosis en la articulación tarsometatarsiana, cinco con enfermedad de Sudeck que precisó tratamiento, ocho con descalcificación por desuso, 12 con edema residual, uno con pérdida de reducción en fase tardía, uno con cicatriz hipertrófica y brida retráctil, uno con osteomielitis crónica, uno con seudoartrosis, tres con intolerancia/infección tardía al material de osteosíntesis; también hubo reintervención de siete pacientes en fase de secuelas donde se les realizó artrodesis. No se observó ninguna rotura de material de osteosíntesis. Casi la mitad de los pacientes (49.4%) recibieron algún tipo de indemnización económica tras el accidente. Conclusiones: El tratamiento de las FLL debe realizarse lo antes posible, ya que la estabilización en un breve plazo de tiempo puede ayudar a mejorar los resultados. La reducción anatómica no predice los buenos resultados. Un número importante de pacientes refirió dolor residual.

Abstract: Objective: To value the complications and sequels for patients with Lisfranc's fracture-luxation (FLL). Material and methods: A transverse ambispective study of cohorts was realized of 83 patients by diagnosis of Lisfranc's fracture-luxation. There was in use a protocol of withdrawal of information with variables related to the injury, clinical, therapeutic parameters, complications and scales of clinical valuation. Results: 66 patients (79.5%) presented complications grouping early and late. Analyzing the early complications, we observe 9 cases of postoperatory edema with inflammation and swelling, 3 cases of superficial infection, 2 cases of necrosis cutaneous that precise graft should free of skin (ILPH), 1 case of vascular complication, 1 case of pulmonary embolis (TEP), 1 case of loss of reduction in the precocious postoperatory, 1 case of bad reduction that was necessary new intervention. The late complications presented the following distribution: 41 patients (49.40%) presented radiological signs of degenerative osteoarthritis in the tarsometatarsal joint, 5 cases of Sudeck's disease that needed treatment, 8 cases of decalcification for disuse, 12 cases of edema and residual inflammation, 1 case of loss of reduction in late phase, 1 case of hypertrophic scar with retractable bridle, 1 case of chronic osteomyelitis, 1 case of seudodegenerative osteoarthritis, 3 cases of late intolerance/infection to the osteosynthesis material, reintervention of 7 patients in phase of sequels where they were realized artrodesis. No break of material was observed of osteosynthesis. Almost the half of the patients (49.4%) they received some type of economic indemnification after the accident. Conclusions: The treatment of the FLL must be realized as soon as possible, providing that the general condition of the patient and of the soft parts allows it, since the stabilization in the brief space of time can help to improve the results. The anatomical reduction cannot grant a good result. An important number of patients had residual pain.

[Complication analysis in Lisfranc fracture-dislocation]. / Análisis de las complicaciones en pacientes con fractura-luxación de Lisfranc.

OBJECTIVE: To value the complications and sequels for patients with Lisfrancs fracture-luxation (FLL). MATERIAL AND METHODS: A transverse ambispective study of cohorts was realized of 83 patients by diagnosis of Lisfrancs fracture-luxation. There was in use a protocol of withdrawal of information with variables related to the injury, clinical, therapeutic parameters, complications and scales of clinical valuation. RESULTS: 66 patients (79.5%) presented complications grouping early and late. Analyzing the early complications, we observe 9 cases of postoperatory edema with inflammation and swelling, 3 cases of superficial infection, 2 cases of necrosis cutaneous that precise graft should free of skin (ILPH), 1 case of vascular complication, 1 case of pulmonary embolis (TEP), 1 case of loss of reduction in the precocious postoperatory, 1 case of bad reduction that was necessary new intervention. The late complications presented the following distribution: 41 patients (49.40%) presented radiological signs of degenerative osteoarthritis in the tarsometatarsal joint, 5 cases of Sudecks disease that needed treatment, 8 cases of decalcification for disuse, 12 cases of edema and residual inflammation, 1 case of loss of reduction in late phase, 1 case of hypertrophic scar with retractable bridle, 1 case of chronic osteomyelitis, 1 case of seudodegenerative osteoarthritis, 3 cases of late intolerance/infection to the osteosynthesis material, reintervention of 7 patients in phase of sequels where they were realized artrodesis. No break of material was observed of osteosynthesis. Almost the half of the patients (49.4%) they received some type of economic indemnification after the accident. CONCLUSIONS: The treatment of the FLL must be realized as soon as possible, providing that the general condition of the patient and of the soft parts allows it, since the stabilization in the brief space of time can help to improve the results. The anatomical reduction cannot grant a good result. An important number of patients had residual pain.

OBJETIVO: Valorar las complicaciones y secuelas del tratamiento de la fractura-luxación de Lisfranc (FLL). MATERIAL Y MÉTODOS: Se realizó un estudio de cohortes ambispectivo trasversal de 83 pacientes con diagnóstico de fractura-luxación de Lisfranc. Se utilizó un protocolo de recopilación de datos con variables relacionadas con la lesión, parámetros clínicos, terapéuticos, complicaciones y escalas de valoración clínica. RESULTADOS: 66 pacientes (79.5%) presentaron complicaciones tanto precoces como tardías. Las complicaciones precoces sumaron nueve casos de edema postoperatorio, tres de infección superficial, dos de necrosis cutánea que precisó injerto libre de piel (ILPH), uno de lesión vascular, uno de tromboembolismo pulmonar (TEP), uno de pérdida de reducción en el postoperatorio precoz, uno de mala reducción que precisó de nueva intervención. Entre las complicaciones tardías, 41 pacientes (49.40%) presentaron signos radiológicos de artrosis en la articulación tarsometatarsiana, cinco con enfermedad de Sudeck que precisó tratamiento, ocho con descalcificación por desuso, 12 con edema residual, uno con pérdida de reducción en fase tardía, uno con cicatriz hipertrófica y brida retráctil, uno con osteomielitis crónica, uno con seudoartrosis, tres con intolerancia/infección tardía al material de osteosíntesis; también hubo reintervención de siete pacientes en fase de secuelas donde se les realizó artrodesis. No se observó ninguna rotura de material de osteosíntesis. Casi la mitad de los pacientes (49.4%) recibieron algún tipo de indemnización económica tras el accidente. CONCLUSIONES: El tratamiento de las FLL debe realizarse lo antes posible, ya que la estabilización en un breve plazo de tiempo puede ayudar a mejorar los resultados. La reducción anatómica no predice los buenos resultados. Un número importante de pacientes refirió dolor residual.

Isolated talonavicular joint arthrodesis through minimal incision surgery.

BACKGROUND: The purpose of this study was to analyze bony fusion and functional outcomes after talonavicular arthrodesis (TNA) using an original minimally invasive surgery (MIS). METHODS: There was a total of 11 feet in 11 patients who underwent TNA and were followed up for 47 months (range 40.8-53.1). Functional outcomes were measured by AOFAS and quality of life by eight sections of SF-36. RESULTS: Radiographic and clinical consolidation was achieved in 10 of 11 cases. In the AOFAS score, physical function improved a mean of 34.4 points (95% CI: 23.2-45.6; p<.0001) and pain improved a mean of 23.6 points (95% CI: 17.4-29.8; p<.0001). One osteoporotic and rheumatic patient had a non-union. No cases of early complications, such as wound infections, neurovascular damage or delayed wound healing, occurred. CONCLUSION: Isolated TNA by MIS could be an option for the treatment of TN arthritis, especially for patients at greater risk of wound healing complications. LEVEL OF EVIDENCE: Level IV, case series.

Minimal incision surgery for tibiotalocalcaneal arthrodesis.

BACKGROUND: Tibiotalocalcaneal arthrodesis (TTCA) is a salvage procedure for severe diseases involving ankle and subtalar joints. However, this procedure is often associated with postoperative complications related to preoperative comorbidities. The purpose of this study was to present the clinical and functional outcomes of a consecutive series of TTCA using an original operative approach based on minimal incision surgery (MIS). METHODS: Forty patients were followed prospectively for a mean (SD) of 31 (12.5) months. Clinical data, which included x-rays, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, SF-36 scores, and a patient satisfaction survey, were collected. A further 25 patients were examined retrospectively. RESULTS: In the prospective group (n = 40), the mean AOFAS score improved by 44.8 points 1 year after the intervention (95% confidence interval [CI], 40.6-48.9), and the SF-36 improved by a mean of 17.5 points (95% CI, 1.4-20.9) in the mental component summary (MCS) score and 11.5 points (95% CI, 8.3-14.7) in the physical component summary (PCS) score. In the prospective group, postsurgical pain correlated with MCS score (r = 0.47, P < .001). In the entire group, bony union (defined as radiographic consolidation and absence of clinical symptoms) was observed in 86% of cases. Two deep infections, 2 nonunions in patients with preoperative persistent ulcers, and 7 delayed unions were the major complications observed in the entire group. One patient required amputation. No cases of superficial infection, wound dehiscence, or deep venous thrombosis were recorded. CONCLUSION: To our knowledge, the present series represents the largest study on TTCA using MIS. The data obtained in the present study showed clinical and functional improvement after surgery and similar bony union rates as previously reported in the literature but with fewer complications related to the surgical wounds. LEVEL OF EVIDENCE: Level IV, case series.

Análisis del síndrome Inestable-Doloroso de la articulación subastragalina mediante el sistema estrés dinámico BaroPodoTAC / Analysis of Unstable-painful Subtalar Joint Syndrome using Dynamic Stress System CT scan

Introducción: La inestabilidad de tobillo y de retropié coexisten frecuentemente sin que existan en la actualidad métodos objetivos no quirúrgicos para su diagnóstico diferencial. Además, la inestabilidad y el dolor en la articulación subastragalina pueden desembocar en la temida artrosis de retropié en pacientes de cualquier edad. El presente trabajo tiene como propósito principal comparar el rango de movilidad del retropié sintomático respecto al retropié sano en una serie consecutiva de pacientes afectos de inestabilidad de tobillo. Material y Método: Se diseñó un dispositivo que simula condiciones de carga con movimientos extremos de la articulación subastragalina sobre la mesa de TAC (Estrés-BaroPodo-TAC). Se realizó TAC en carga y en dos posiciones extremas de inversión-rotación interna y eversión-rotación externa sobre 26 pies de 13 pacientes diagnosticados de inestabilidad crónica de tobillo. Se midieron los ángulos de divergencia y flexión astrágalo-calcánea en las dos posiciones mencionadas y se calculó el rango de movimiento total. Se comparó el retropié problema con el retropié sano en cada paciente. Resultados: Los pies problemas presentaron mayor rango de movilidad de divergencia astrágalo-calcáneo que los pies sanos de los pacientes. No hubo diferencias en el rango de movilidad de flexión astrágalo-calcáneo. No se correlacionó estadísticamente el movimiento de divergencia en el plano axial con el movimiento de flexión astrágalo-calcánea en el plano sagital. Conclusión: Mediante este método se midió objetivamente mediante TAC el rango de movimiento de la articulación subastragalina. Los pacientes con inestabilidad de tobillo y dolor en retropié presentaron mayor rango de movilidad en la articulación subastragalina en el retropié doloroso respecto al contralateral (AU)

Introduction: In many cases, unstable ankle and heel coexist without there currently being any objective, non-surgical method for a differential diagnosis. Moreover, instability and pain in the subtalar joint could deteriorate into the so dreaded osteoarthritis of the heel in patients of any age. The main objective of this work is to compare the movement range of a symptomatic heel with regards to a healthy heel in a consecutive series of patients affected with ankle instability. Material and method: A device was designed to simulate weight-bearing conditions with extreme subtalar joint movement on the CAT scan examination table (Estrés-BaroPodo-TAC). A CAT scan was performed during weight-bearing and in two extreme positions of internal inversion rotation and external eversion rotation of 26 feet in 13 patients, all diagnosed with chronic, unstable ankle. The divergence and flexion of heel angles in the two positions mentioned and the total movement range was calculated. The heel problem was compared with the healthy heel in each patient. Results: The problem foot presented a greater range of heel divergence mobility than the patient’s healthy foot. There were no differences in the mobility range for heel flexion. The divergence of movement in the axial plane was not statistically correlated with the heel flexion movement in the sagittal plane. Conclusion: With this method, we objectively measured the movement range of the heel joint, using CAT scan. Patients with unstable ankle and heel pain presented a greater range of movement in the heel joint of the painful heel with respect to the contralateral movement (AU)

Isolated subtalar arthrodesis through minimal incision surgery.

BACKGROUND: In recent years there has been an increase in the use of minimally invasive techniques, such as arthroscopy, percutaneous, and minimally invasive incisions, for foot and ankle surgery. The purpose of this study was to analyze the fusion rate and clinical results of isolated subtalar arthrodesis (ISA) using the novel and original technique of minimal incision surgery (MIS). METHODS: There were a total of 77 feet in 76 patients who underwent ISA and were followed for 50 months on average (range, 15-108). The first 30 cases were evaluated retrospectively, and 47 cases were evaluated prospectively. MIS without tourniquet was used in all cases and fusion was assessed radiographically and clinically. Clinical outcome measures used were the Angus and Cowell Scoring System, AOFAS Ankle-Hindfoot, the SF-36, and a patient satisfaction questionnaire 12 months after the intervention. RESULTS: Radiographic and clinical consolidation was achieved in 92% of cases. Main outcomes were "good" in 57 patients as determined by the Angus and Cowell criteria, with 13 "fair" and 7 "poor" results. In the prospective group, AOFAS scores improved by 47.6 points (95% CI: 50.7-42.5) 12 months after surgical intervention. SF-36 outcomes improved by 14.5 points (95% CI: 11.58-17.31) in the mental summary component and 4.2 points (95% CI: 2.2-6.1) in the physical summary component. We recorded no cases of early complications such as wound infections, neurovascular damage, or delayed wound healing. CONCLUSIONS: To our knowledge, the present series represents the largest study on subtalar arthrodesis using minimally invasive surgery. The data obtained showed a similar rate of bony union and clinical outcomes compared with the literature, but without early wound complications. ISA using the MIS technique was a good option for patients at greater risk of wound healing complications. LEVEL OF EVIDENCE: Level IV, case series.

[Long-term results of the treatment of Lisfranc fracture dislocation]. / Resultados a largo plazo del tratamiento de la fractura-luxación tipo Lisfranc.

We conducted an ambispective cohort study of 83 patients with a diagnosis of Lisfranc fracture dislocation from 1993 to 2008. The lesions were classified into two groups: pure dislocations and fracture dislocations of the Lisfranc joint using the Hardcastle-Reschamer classification. The results included the following data: sociodemographic and epidemiologic variables, lesion-related variables, clinical parameters, and the following clinical and functional assessment scales: Baltimore Painful Foot Score, Creighton-Nebraska Health Foundation, American Orthopaedic Foot and Ankle Society (AOFAS), and Hannover Scoring System. Sixty-three patients were treated surgically. Closed reduction and minimally invasive fixation with Kirschner nails were performed in 53 patients (63.9%), and open reduction with a dorsal approach and fixation with Kirschner nails in 10 cases (15.2%). In 46 cases de medial column was fixed, in 61 cases the intermediate column, and in 42 the lateral column. Sixty-six (79.5%) of the patients had complications including both acute and late ones. Regardless of the technique used, the purpose of treatment was the anatomical reduction of the involved joints. Based on our experience, we think that the use of Kirschner nails is effective, as it provides enough stiffness and stability. In general terms, this injury is not as disabling as it had been considered in the literature. Patients consider their discomfort as tolerable and compatible with the demands of their activities of daily living and they may perform their work considering the time limitations.

[Disruption of anterointernal weight bearing: sequelae of surgical treatment of hallux valgus]. / Alteración del apoyo anterointerno como secuela del tratamiento quirúrgico del hallux valgus.

Sequelae of forefoot surgery range between 30 and 40%; the most frequent ones are transfer metatarsalgia and deformity relapse. Forefoot surgery complications disrupt biomechanics. Anterointernal weight bearing alteration is most frequent, due to involvement of the metatarsal, the phalanx or both. Metatarsophalangeal arthrodesis normalizes the length of the first ray and pressure transmission. The use of this technique has made it possible to confirm pain relief, as well as improved function and a better cosmetic result, which allows the patient to wear ormal footwear.

Diseño y desarrollo de un modelo experimental para estudios biomecánicos de fracturas tipo B de Tile del anillo pélvico / Design and development of an experimental model for biomechanical studies of Tile type B1 fracture of the pervic ring

Objetivo: Diseñar un modelo estandarizado y reproducible para la realización de ensayos biomecánicos de fracturas tipo B1 de Tile del anillo pélvico. Metodología: Establecida en dos fases. Fase 1, determinación de requerimientos fundamentales del sistema. Fase 2, diseño, testado y elección de las piezas del modelo experimental. Se empleó una máquina universal de ensayos (MTS- 810), programas de diseño gráfico (Solid Edge Academic), fantomas, rail de carga deslizante y materiales industriales de Fabricación del Sistema de Fijación. Resultados: Se obtuvo un modelo constituido por dos sistemas de anclaje, superior e inferior, que permiten articular la pelvis a la máquina de ensayo tanto proximalmente, a través del sacro y L5, como a nivel distal con ambos fémures. El sistema permitió fijación adecuada de especímenes a máquina de ensayo, mantener la estática postural de bipedestación a la carga y reproductibilidad de lesión B1 de Tile. Conclusión: Es posible diseñar y fabricar un sistema estandarizado de fijación de pelvis humanas a una máquina de análisis de materiales para el estudio biomecánico de las fracturas tipo B1 de Tile del anillo pélvico (AU)

Objetive: The aim of the study is to design a standardized and reproducible procedure for biomechanical testing of Tile B1 fractures of the pelvic ring. Methodology: The methodology for this study was divided in two phases. In the first phase, the requirements to be covered by the system were determined, and in the second one experimental model pieces were designed and chosen. An Universal Testing Machine (MTS-810), Graphic Design Plans Program Software (Solid Edge Academic), Fantomas, Bearing, Sliding Rail and Manufacturing Material Fixing System were used. Results: A specific loading biomechanic system has been created, consisting on an upper and a lower anchor, which allows pelvis ring fix to the test machine both proximally through the sacrum and the last lumbar vertebra, and in terms of both femurs to the database of the testing machine. The procedure make a correct bone fixation, place the pelvis in a stand position, getting to align the upper and lower anterior iliac spines in the same plane and reproduce Tile B1 fracture. Conclusion: It is possible to design and manufacture a simple standard system for determining human pelvis to a testing machine for biomechanical studies of Tile type B1 pelvic ring fractures (AU)

[Anterolateral ankle pain: differential diagnosis and approach. A case report]. / Dolor anterolateral de tobillo, diagnóstico diferencial y abordaje. Presentación de un caso.

The ankle soft tissue pathology represents a very painful disorder for patients who, often times, are not precisely diagnosed. Anterolateral ankle impingement is a condition that occurs in young people and athletes due to a plantar flexion-inversion mechanism. We report a case of anterolateral ankle impingement describing the arthroscopic technique and making the differential diagnosis considering other conditions.

[Benefit of the stabilization of long-bone fractures in polytraumatized patients]. / Beneficio de la estabilización de fracturas de huesos largos en politraumatizados.

INTRODUCTION: Early fracture fixation is increasingly common in medical practice, and femur shaft fractures are the perfect prototype of the lesion warranting early surgery in polytraumatized patients. Damage control orthopedics (DCO) is defined as the minimally-traumatic interventions intended to provide quick stabilization of orthopedic injuries to minimize the systemic inflammatory response. MATERIAL AND METHODS: By means of an evidence-based medicine tool (CAT) we approach the benefit of long-bone fracture stabilization in polytraumatized patients trying to answer a specific clinical question from a concrete situation: What is the evidence of the safety and benefit of early stabilization of long-bone fractures in polytraumatized patients? RESULTS: The patient group whose fractures were stabilized after 48 hours had more clinical complications, alterations of lung parameters and a longer hospital stay. There is no complete evidence showing that early stabilization of long bones in patients with moderate or severe head trauma worsens or improves the outcomes. CONCLUSIONS: Urgent fracture stabilization should be an adjuvant to resuscitation. Early fracture stabilization contributes to reducing the ICU stay, the incidence of acute respiratory distress syndrome (ARDS), multiple organ failure (MOF) and sepsis, thus improving patient survival.

Dolor anterolateral de tobillo: diagnóstico diferencial y abordaje terapéutico / Anterolateral ankle pain: differential diagnosis and therapeutic approach

La patología de partes blandas del tobillo supone trastornos muy dolorosos para los pacientes que en muchas ocasiones carecen de diagnóstico preciso. El pinzamiento anterolateral de tobillo es una patología que aparece en gente joven y deportistas por mecanismo de flexión plantar-inversión. Se presenta un caso de pinzamiento anterolateral de tobillo, describiendo la técnica artroscópica y planteando el diagnóstico diferencial con otras patologías (AU)

Diseases of the ankle soft tissues are very painful disorders for patients for whom many times there is no accurate diagnosis. Anterolateral ankle impingement is a condition occurring in young people and athletes for plantar-inversion flexion mechanism. We report the case of anterolateral ankle impingement with a description of the arthroscopic technique and considering the differential diagnosis with other diseases (AU)

Injuries from palm tree thorn simulating tumoral or pseudotumoral bone lesions.

Three cases of bone changes caused by foreign bodies that appeared to be tumoral lesions or pseudotumors, were observed in young male patients who presented with pain, localized inflammation, and radiographic and bone scan findings suggestive of tumoral or pseudotumoral lesions. Accurate diagnosis was made at surgery when the foreign body was retrieved. Following removal of the foreign body, postoperative recovery was satisfactory. The common causative agent in all these cases was a palm tree thorn.

Fractura-luxación de Lisfranc / Lisfranc fracture-dislocation

La incidencia de la fractura-luxación de Lisfranc registrados en la literatura es baja, aunque seestima que su incidencia real es mayor por el importante número de ellos no detectados o mal diagnosticados en politraumatizados. Existe una controversia en cuanto a la necesidad de una reducción abierta en todos los casos, el tipo de osteosíntesis a realizar, así como en la relación entre los resultados funcionales finales y la radiología. OBJETIVO: Conocer los resultados obtenidos en nuestros pacientes. Se analizaron los 30 casos registrados en los últimos diez años, veintidós de los cuales cumplieron el protocolo de revisión. RESULTADOS: Las dos terceras partes de las reducciones fueron cerradas. Diecinueve pacientes recuperaron un nivel de actividad similar al prelesional. Cabe reseñar que en cuatro casos con un diagnóstico tardío (media de 11 días) se obtuvieron resultados similares. La incidencia global de complicaciones fue de uno de cada 3 pacientes. Los resultados funcionales fueron excelentes en 6 pacientes, buenos en 11, regulares en tres y malos en dos, según la escala de la Fundación Creighton (AU)

Neochondrogenesis in repair of full-thickness articular cartilage defects using free autogenous periosteal grafts in the rabbit. A follow-up in six months.

OBJECTIVE: To analyse the repair of lesions of articular cartilage with periosteum-free implants and follow-up at 6 months. DESIGN: Thirty-six New Zealand rabbits, 4-6 weeks old, were used. Full-thickness articular cartilage defects in the medial femoral condyle were created. Spontaneous evolution occurred in 18 animals; the other 18 animals were treated with a free autogenous periosteal tibial implant fixed with Tissucol. Animals were killed in groups of six at 8, 12 and 24 weeks. Macroscopic, histologic and histochemical results were evaluated and analysed statistically using the Mann-Whitney U-test. RESULTS: The spontaneous evolution of the lesion did not lead to complete repair in any case. The periosteum-free implant provided complete repair of the lesion and statistically significant restoration of the articular surface. CONCLUSIONS: In the rabbit, this study confirms the incomplete spontaneous repair of articular cartilage and the chondrogenic potential of tibial periosteum-free implants, with long-term maintenance of the macroscopic, histologic and histochemical characteristics of neo-cartilage. This raises the possibility of its use as an alternative method in the repair of circumscribed osteochondral lesions in young patients.

Carbon fiber implants in osteochondral defects of the rabbit patella.

Carbon fiber implants were used to fill osteochondral defects created on the articular surface of the patella of 36 rabbits, for the purpose of studying the long-term histological changes of the repair process. Six months after surgery the defect was filled by fibrous tissue, where the superficial area was organized parallel to the joint surface. Fibrocartilage developed after 9 months and, after 12 months, the defects were covered by hyaline cartilage tissue.

Deformidad en coxa vara en la disóstosis cleidocraneal / Coxa vara deformity in cleidocranial dysostosis

La disostosis cleidocraneal es una rara displasia ósea generalizada. La coxa vara o disminución anormal del ángulo de inclinación del cuello femoral está frecuentemente presente en la disostosis cleidocraneal. Se presenta un nuevo caso y se discute la revisión de la bibliografía (AU)