[Trabecular metal box for acute acetabular fracture in an elderly patient]. / Caja de metal trabecular para fractura acetabular aguda en paciente anciano.

BACKGROUND: We are currently observing an increase in the incidence of acetabular fractures in elderly patients due to the increase in this population age group. These fractures represent a challenge to the traumatologist because in some cases there is the surgical alternative of combining fixation with total acute hip arthroplasty. In this paper we explore the use of trabecular metal combining the stability provided by a cage with potential bone incorporation, applying the principles of revision surgery to speed-up the healing process without the limitations resulting from the restrictions in the load of the operated limb. MATERIAL AND METHODS: We assessed the clinical and radiological results, with a 2-year follow-up, after total hip arthroplasty for the acute treatment of an acetabular fracture of the anterior column, with involvement of the quadrilateral lamina in an elderly 85 year-old patient. RESULTS: Important pain relief occurred, with functional improvement and an appropriate range of motion using the Merle d'Aubigné system. Radiologically, the graft areas in the particles surrounding the acetabular component were uniformly integrated. No loosening, screw rupture or implant migration occurred. CONCLUSIONS: This indication using a revision technique based on a trabecular metal reconstruction cage should be considered as an alternative to bear in mind in these patients.

Estudio prospectivo de los reactantes fase aguda tras una artroplastia total de rodilla / Prospective study of acute phase response factors after total knee artrhoplasty

Introducción: La artroplastia total de rodilla actualmentees el tratamiento de elección para las artrosis evolucionadasde dicha articulación. Al igual que otras lesiones mayores, lasintervenciones quirúrgicas o los traumatismos, originan respuestasmetabólicas, hormonales y hemodinámicas. Nos proponemosvalorar los reactantes de fase aguda tanto en prótesistotales de rodilla normales como en infectadas.Material y método: De forma consecutiva, a partir de marzodel 2003, se reclutaron 36 pacientes a los que se les implantóuna prótesis total de rodilla (grupo I). Además se estudiaron10 pacientes (grupo II) a los que se les habíaimplantado una prótesis de rodilla y presentaban criterios deinfección.Resultado: En el grupo I, los leucocitos y la PCR presentanun pico máximo a las 24 horas de la intervención, observándoseniveles preoperatorios en la extracción obtenida al mes;El fibrinógeno y la VSG muestran un ascenso hasta la extraccióntomada al mes de la cirugía, y continúan con niveles superioresa los basales incluso después de tres meses.Lo pacientes del grupo II mostraron niveles, estadísticamentesignificativos, más altos de fibrinógeno, VSG y PCR.Conclusiones: Los reactantes de fase aguda ofrecen unamoderada eficacia diagnóstica por lo que deben apoyar aldiagnóstico basado en los criterios clínicos de infección

Introduction: Nowadays total knee arthroplasty (TKA) isthe choice treatment in evolved knee artrosis. Operations ortraumas cause metabolism and hormone responses.Patients and Methods: Consecutively, from 2003, we includedprospectively in this research, 36 patients undergoingelective TKA (group I). Also we studied 10 patients (group II)that were diagnosed as infected TKA.Results: Acute phase response evolution in group I showsmaximum leukocytes and C-reactive protein (CRP) levels duringthe first 24 hours after the surgery, returning to presurgicallevels after one month. Erythrocyte sedimentation (ESR)rate and fibrinogen are increased even 3 months after the surgery.The patients of the goup II showed hihger levels, statisticallysignificant, of fibrinogen, CRP and ESR.Discussion: Acute phase response factors offer modest diagnosticefficacy, so we always have to use the clinical criterionto achive a god diagnosis