Embolismo gaseoso tras el uso del sistema de lavado CarboJet® durante la hemiartroplastía de cadera: Caso clínico y revisión de la literatura / Gas embolism after the use of the CarboJet® lavage system during hip hemiarthroplasty: Clinical case and literature review

Presentamos el caso de una paciente de 89 años de edad que sufrió paro cardiorrespiratorio durante la realización de hemiartroplastía de cadera cementada que precisó resucitación cardiopulmonar. Esta complicación ocurrió inmediatamente después de usar el sistema de lavado mediante dióxido de carbono CarboJet®, y se atribuyó a embolismo gaseoso, tras descartar otras entidades. Se discuten los posibles factores que pueden contribuir a esta complicación quirúrgica.

Case report of an 89 year-old patient who had cardiorespiratory arrest during cemented hip hemiarthroplasty and required cardiopulmonary resuscitation. This complication occurred immediately after using the carbon dioxide-based lavage system known as CarboJet® and was attributed to gas embolism once other entities were ruled out. The possible factors that may contribute to this surgical complication are discussed.

[Gas embolism after the use of the CarboJet lavage system during hip hemiarthroplasty. Clinical case and literature review]. / Embolismo gaseoso tras el uso del sistema de lavado CarboJet durante la hemiartroplastía de cadera. Caso clinico y revisión de la literature.

Case report of an 89-year-old patient who had cardiorespiratory arrest during cemented hip hemiarthroplasty and required cardiopulmonary resuscitation. This complication occurred immediately after using the carbon dioxide-based lavage system known as CarboJet and was attributed to gas embolism once other entities were ruled out. The possible factors that may contribute to this surgical complication are discussed.

[Large intraosseous ganglion in the femoral condyle treated with resorbable cement: clinical case and differential diagnosis]. / Ganglión intraóseo de gran tamaño en cóndilo femoral tratado con cemento reabsorbible: caso clínico y diagnóstico diferencial.

We report a case of a very large intraosseous ganglion in a patient with Down's syndrome. The lesion was located in the medial femoral condyle and was diagnosed with imaging techniques (X-rays, CAT scan, bone scan and magnetic resonance imaging) that allowed measuring it. Treatment consisted of curettage and filling of the defect with the skeletal repair system carbonated apatite resorbable cement which allowed for immediate early weight bearing during the postoperative period in a non-cooperative patient. We think the location and size of the lesion are of interest, as well as the peculiarities of the patient, which may help understand the pathophysiology of this entity. As far as we know, the use of resorbable cement to treat this kind of lesions has not been reported.

[Femoral superficial vein thrombosis due to a large iliopsoas bursitis secondary to polyethylene wear debris in total hip arthroplasty]. / Trombosis de la vena femoral superficial por gran bursitis en psoas secundaria a enfermedad de las partículas en artroplastia total de cadera.

A 76 year old male patient with a history of implantation of a total hip arthroplasty Perfecta (Orthomet(®)), who presented with an iliac fossa mass, increased diameter of the thigh, and pain during hip flexion and extension. CT and ultrasound show the presence of a giant cystic mass in left iliac fossa about 7 cm in diameter next to the prosthesis. A pseudo-tumour secondary to wear debris after placement of a total arthroplasty is rare. We present a case of a large iliopsoas bursitis caused by polyethylene particles, which caused compression and thrombosis of the superficial femoral vein.

Trombosis de la vena femoral superficial por gran bursitis en psoas secundaria a enfermedad de las partículas en artroplastia total de cadera / Femoral superficial vein thrombosis due to a large iliopsoas bursitis secondary to polyethylene wear debris in total hip arthroplasty

Paciente varón de 76 años, con antecedente de implantación de prótesis total de cadera tipo Perfecta (Orthomet®), que consulta por masa en fosa ilíaca, con aumento del diámetro del muslo y dolor flexión y extensión de la cadera. Los estudios complementarios de ecografía y tomografía evidencian la presencia de una tumoración quística gigante lobulada en fosa ilíaca izquierda de unos 7cm de diámetro en la proximidad de la prótesis. La formación quística ocasionada por la enfermedad del polietileno tras la colocación de una artroplastia total de cadera es poco frecuente. Presentamos un caso de bursitis del psoas de gran tamaño, secundaria a la liberación de partículas del polietileno, que ocasionó compresión y trombosis de la vena femoral superficial (AU)

A 76 year old male patient with a history of implantation of a total hip arthroplasty Perfecta (Orthomet®), who presented with an iliac fossa mass, increased diameter of the thigh, and pain during hip flexion and extension. CT and ultrasound show the presence of a giant cystic mass in left iliac fossa about 7cm in diameter next to the prosthesis. A pseudo-tumour secondary to wear debris after placement of a total arthroplasty is rare. We present a case of a large iliopsoas bursitis caused by polyethylene particles, which caused compression and thrombosis of the superficial femoral vein (AU)

Placa de compresión percutánea (PCCP) en el tratamiento de las fracturas intertrocantéreas estables / The percutaneous compression plate (PCCP) in the treatment of stable intertrochanteric fractures

Objetivo. Estudiar los resultados de la placa de compresión percutánea (PCCP) en el tratamiento de las fracturas trocantéreas estables.Material y método. Estudio prospectivo de 42 pacientes con fractura trocantérea estable, según la clasificación de la AO/OTA, intervenidos entre 2003 y 2005 con placa decompresión percutánea (PCCP, percutaneous compressionplate). Fueron 12 varones y 30 mujeres, con una edad media de 82,3 años. Previo a la fractura, 19 pacientes presentaban una deambulación independiente, 16 deambulaban con bastones y 7 precisaban la ayuda de un andador o tercera persona.Resultados. El tiempo quirúrgico medio fue de 87 minutos,15 pacientes precisaron transfusión sanguínea con una media de 0,60 concentrados por paciente, y tuvieron un consumo medio de analgésicos de 3,5 días. La estancia media fue de 16,9 días. Posoperatoriamente el 73% tenían deambulación por sí mismos. Hubo 5 éxitus en el primer año posoperatorio. No hubo complicaciones quirúrgicas. Radiológicamente no hubo complicaciones mecánicas ni fracasos del material.Conclusiones. El sistema de placa de compresión percutánea PCCP nos parece válido y eficaz en el tratamiento de las fracturas trocantéreas estables (AU)

Purpose. To assess the results of the PCCP (percutaneouscompression plate) in the treatment of stable intertrochanteric fractures.Materials and methods. Prospective study of 42 patientswith a stable intertrochanteric fracture, classified according to the AO/OTA scale, implanted between 2003 and 2005 with a PCCP percutaneous compression plate. There were 12 males and 30 females, with a mean age of 82.3 years. Prior to the fracture, 19 patients were independent walkers, 16 required a walking-stick and 7 required a walking frame or someone’s assistance.Results. Mean OR time was 87 minutes. Fifteen patients required a blood transfusion with a mean of 0.60 concentrates per patient and a mean analgesic consumption period of 3.5 days. Mean hospital stay was 16.9 days. Postoperatively, 73% could ambulate independently. There were five deaths in the first year post-op. No surgical complications were recorded.Radiologically, there were no mechanical complicationsor material-related failures.Conclusions. The PCCP percutaneous compression platecomes across as a valid and effective system for the treatment of stable intertrochanteric fractures (AU)

Aflojamiento de las artroplastias de cadera / Wearing away of hip arthroplasties

La revisión de una prótesis puede sere debida a diferentes causas que requieren tratamientos específicos. El factor fundamental es el tipo de fijación del implante. El cemento y su forma de utilización influyen en los buenos resultados actuales. Es necesario adoptar una clasificación de los aflojamientos radiográficos femorales, siendo las más conocidas las propuestas por Harris y Johnston para los vástagos cementados y la de Engh para los no cementados. No hay una técnica general que pueda aplicarse a todos los casos con las mismas posibilidades de buenos resultados. La cirugía de reconstrucción acetabular y femoral, la debe indicar el cirujano según la osteolisis periprotésica y los síntomas del enfermo

Revision of a prosthesis may be due to different causes requiring specific treatments. The fundamental factor is the type of implant fixation involved. The cement and its method of use influence the good results presently obtained. A classification is required of femoral radiographic loosening - the best known being the classification proposed by Harris and Johnston for cemented stems, and the Engh classification for non-cemented stems. There is no general technique for application to all cases with the same possibilities of good results. Acetabular and femoral reconstruction surgery should be indicated by the surgeon according to the observed periprosthetic osteolysis and patient symptoms

Celulitis de codo / Cellulitis of the elbow

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