Results after the application of biodegradable spacer balloons as a therapeutic option in non-repairable massive ruptures of the shoulder rotator cuff / Resultados tras la aplicación de balones espaciadores biodegradables como opción terapéutica en roturas masivas no reparables del manguito de los rotadores del hombro

Introduction: One of the most frequently treated pathologies in our department are tendon lesions that affect the rotator cuff of the shoulder. There are different types of treatment for massive or irreparable tears. For a few years, a low-invasive technique was introduced based on the placement of a biodegradable subacromial spacer. The objective of the work is to analyse the results of our experience with the use of this device (InSpaceTM).Material and method: The study collects the results obtained in 25 patients with irreparable ruptures of rotator cuff defined by RM, in which they were implanted a balloon subacromial in our centre in the period from January 2015 – until December 2017. All patients were evaluated preoperatively and one year after surgery including the visual analogue scale (VAS), the Constant test (CS) and the QuickDASH (QD). Results: Of the 25 patients, 5 patients (20%) were operated by arthroscopy and 20 (80%) By open approach (mini-open). A total of 22 patients completed the follow-up year. At 12 months, 64% of the patients obtained an improvement of at least 10 points in the CS. Patients departed from an initial average CS of 32 points that improved to 54.9 points of average in the postoperative evaluation at 12 months (average improvement 22.9 points; Value-p < 0.05). In terms of pain assessment, in our study, 87% of patients obtained an improvement of at least 2 points in the EVA at 12 months of follow-up (P-value < 0.05). Patients departed from an initial average EVA of 8.7 that improved to 3.7 points average at 12 months. 73% of the patients responded to be satisfied with the intervention and would return to the surgery.(AU)

Introducción: Una de las patologías más frecuentemente atendida en nuestro medio son las lesiones tendinosas que afectan al manguito rotador del hombro. Existen diferentes modalidades de tratamiento para las roturas masivas o irreparables. Desde hace unos años, se introdujo en el mercado una técnica poco invasiva basada en la colocación de un espaciador subacromial biodegradable. El objetivo del trabajo es analizar los resultados de nuestra experiencia con el uso de este dispositivo (InSpace®). Material y método: En el estudio se recogen los resultados obtenidos en 25 pacientes con roturas irreparables del manguito rotador definidas mediante resonancia magnética (RM), en los que se les implantó un balón subacromial en nuestro centro en el periodo comprendido entre enero de 2015 hasta diciembre de 2017. Todos los pacientes fueron evaluados preoperatoriamente y un año después de la cirugía incluyendo la escala visual analógica (EVA), el test de Constant (CS) y el QuickDASH (QD). Resultados: De los 25 pacientes, cinco pacientes (20%) fueron intervenidos mediante artroscopia y 20 (80%) mediante abordaje abierto (mini-open). Un total de 22 pacientes completaron el año de seguimiento. A los 12 meses, el 64% (14/22) de los pacientes obtuvo una mejoría de al menos 10 puntos en el CS. Los pacientes partían de un CS promedio inicial de 32 puntos que mejoró hasta los 54,9 puntos de media en la evaluación postoperatoria a los 12 meses (Promedio de mejoría 22,9 puntos; p < 0,05). En cuanto a la evaluación del dolor, en nuestro estudio, el 87% (19/22) de los pacientes obtuvo una mejoría de al menos 2 puntos en la EVA a los 12 meses de seguimiento (p < 0,05). Los pacientes partían de una EVA media inicial de 8,7 que mejoró hasta los 3,7 puntos de media a los 12 meses. Un 73% de los pacientes contestaron estar satisfechos con la intervención y volverían a someterse a la cirugía.(AU)

Resultados tras la aplicación de balones espaciadores biodegradables como opción terapéutica en roturas masivas no reparables del manguito de los rotadores del hombro / Results after the application of biodegradable spacer balloons as a therapeutic option in non-repairable massive ruptures of the shoulder rotator cuff

Introducción: Una de las patologías más frecuentemente atendida en nuestro medio son las lesiones tendinosas que afectan al manguito rotador del hombro. Existen diferentes modalidades de tratamiento para las roturas masivas o irreparables. Desde hace unos años, se introdujo en el mercado una técnica poco invasiva basada en la colocación de un espaciador subacromial biodegradable. El objetivo del trabajo es analizar los resultados de nuestra experiencia con el uso de este dispositivo (InSpace®). Material y método: En el estudio se recogen los resultados obtenidos en 25 pacientes con roturas irreparables del manguito rotador definidas mediante resonancia magnética (RM), en los que se les implantó un balón subacromial en nuestro centro en el periodo comprendido entre enero de 2015 hasta diciembre de 2017. Todos los pacientes fueron evaluados preoperatoriamente y un año después de la cirugía incluyendo la escala visual analógica (EVA), el test de Constant (CS) y el QuickDASH (QD). Resultados: De los 25 pacientes, cinco pacientes (20%) fueron intervenidos mediante artroscopia y 20 (80%) mediante abordaje abierto (mini-open). Un total de 22 pacientes completaron el año de seguimiento. A los 12 meses, el 64% (14/22) de los pacientes obtuvo una mejoría de al menos 10 puntos en el CS. Los pacientes partían de un CS promedio inicial de 32 puntos que mejoró hasta los 54,9 puntos de media en la evaluación postoperatoria a los 12 meses (Promedio de mejoría 22,9 puntos; p < 0,05). En cuanto a la evaluación del dolor, en nuestro estudio, el 87% (19/22) de los pacientes obtuvo una mejoría de al menos 2 puntos en la EVA a los 12 meses de seguimiento (p < 0,05). Los pacientes partían de una EVA media inicial de 8,7 que mejoró hasta los 3,7 puntos de media a los 12 meses. Un 73% de los pacientes contestaron estar satisfechos con la intervención y volverían a someterse a la cirugía.(AU)

Introduction: One of the most frequently treated pathologies in our department are tendon lesions that affect the rotator cuff of the shoulder. There are different types of treatment for massive or irreparable tears. For a few years, a low-invasive technique was introduced based on the placement of a biodegradable subacromial spacer. The objective of the work is to analyse the results of our experience with the use of this device (InSpaceTM).Material and method: The study collects the results obtained in 25 patients with irreparable ruptures of rotator cuff defined by RM, in which they were implanted a balloon subacromial in our centre in the period from January 2015 – until December 2017. All patients were evaluated preoperatively and one year after surgery including the visual analogue scale (VAS), the Constant test (CS) and the QuickDASH (QD). Results: Of the 25 patients, 5 patients (20%) were operated by arthroscopy and 20 (80%) By open approach (mini-open). A total of 22 patients completed the follow-up year. At 12 months, 64% of the patients obtained an improvement of at least 10 points in the CS. Patients departed from an initial average CS of 32 points that improved to 54.9 points of average in the postoperative evaluation at 12 months (average improvement 22.9 points; Value-p < 0.05). In terms of pain assessment, in our study, 87% of patients obtained an improvement of at least 2 points in the EVA at 12 months of follow-up (P-value < 0.05). Patients departed from an initial average EVA of 8.7 that improved to 3.7 points average at 12 months. 73% of the patients responded to be satisfied with the intervention and would return to the surgery.(AU)

Results after the application of biodegradable spacer balloons as a therapeutic option in non-repairable massive ruptures of the shoulder rotator cuff. / Resultados tras la aplicación de balones espaciadores biodegradables como opción terapéutica en roturas masivas no reparables del manguito de los rotadores del hombro.

INTRODUCTION: One of the most frequently treated pathologies in our department are tendon lesions that affect the rotator cuff of the shoulder. There are different types of treatment for massive or irreparable tears. For a few years, a low-invasive technique was introduced based on the placement of a biodegradable subacromial spacer. The objective of the work is to analyse the results of our experience with the use of this device (InSpaceTM). MATERIAL AND METHOD: The study collects the results obtained in 25 patients with irreparable ruptures of rotator cuff defined by RM, in which they were implanted a balloon subacromial in our centre in the period from January 2015 - until December 2017. All patients were evaluated preoperatively and one year after surgery including the visual analogue scale (VAS), the Constant test (CS) and the QuickDASH (QD). RESULTS: Of the 25 patients, 5 patients (20%) were operated by arthroscopy and 20 (80%) By open approach (mini-open). A total of 22 patients completed the follow-up year. At 12 months, 64% of the patients obtained an improvement of at least 10 points in the CS. Patients departed from an initial average CS of 32 points that improved to 54.9 points of average in the postoperative evaluation at 12 months (average improvement 22.9 points; Value-p < 0.05). In terms of pain assessment, in our study, 87% of patients obtained an improvement of at least 2 points in the EVA at 12 months of follow-up (P-value < 0.05). Patients departed from an initial average EVA of 8.7 that improved to 3.7 points average at 12 months. 73% of the patients responded to be satisfied with the intervention and would return to the surgery. CONCLUSIóN: The results obtained in our series to one year of follow-up speak in favour of the use of the Subacromial Balloon (InSpaceTM), as a therapeutic option available for patients with irreparable ruptures of the rotator cuff. It can be used as an interim procedure, delaying the need for more invasive surgery, or as a definitive procedure in patients medically non-candidates for reverse arthroplasty. It is important to have clear indications of this procedure in order not to make mistakes.

El uso del WhatsApp(R) en nuestra práctica clínica: estudio piloto / Using WhatsApp(R) in our clinical practice: a pilot study

OBJETIVO: Evaluar el uso del WhatsApp como una herramienta clínica y determinar la percepción de los cirujanos ortopédicos sobre su utilidad. MATERIAL Y MÉTODO: Se invitó a los cirujanos ortopédicos asistentes a una reunión científica a completar in situ una encuesta anónima y estructurada sobre el uso de la aplicación en el ámbito clínico. RESULTADOS: En total 41 (38%) encuestas fueron correctamente completadas. La totalidad de los que respondieron habían sido emisores o receptores de información clínica a través de la aplicación. El 93% había utilizado la aplicación para consultar con relación a un caso clínico. El 78% pertenecían a un grupo de WhatsApp en el cual se compartía información clínica. El 71% se mostró de acuerdo con que la comunicación entre clínicos a través del Whatsapp es una herramienta útil para la toma de decisiones terapéuticas. CONCLUSIÓN: El uso del WhatsApp para fines clínicos de los cirujanos ortopédicos está generalizado. La mayoría de estos lo consideran una herramienta útil en la toma de decisiones terapéuticas

OBJECTIVE: To evaluate the use of WhatsApp as a clinical tool and determine the perception of orthopaedic surgeons of its usefulness. MATERIAL AND METHODS: Orthopaedic surgeons attending a scientific meeting were invited to complete an anonymous and structured survey on the use of the application in the clinical setting. RESULTS: A total of 41 (38%) surveys were correctly completed. Of the respondents, 100% had been either senders or receivers of clinical information via the application. Ninety-three percent had used the application to consult in relation to a clinical case. Of the respondents, 78% belonged to a WhatsApp group in which clinical information is shared: 71% agreed that communication between clinicians through WhatsApp is a useful tool for making therapeutic decisions. CONCLUSION: The use of WhatsApp for clinical purposes by orthopaedic surgeons is widespread. Most consider it a useful tool in therapeutic decision making

Using WhatsApp® in our clinical practice: a pilot study. / El uso del WhatsApp® en nuestra práctica clínica: estudio piloto.

OBJECTIVE: To evaluate the use of WhatsApp as a clinical tool and determine the perception of orthopaedic surgeons of its usefulness. MATERIAL AND METHODS: Orthopaedic surgeons attending a scientific meeting were invited to complete an anonymous and structured survey on the use of the application in the clinical setting. RESULTS: A total of 41 (38%) surveys were correctly completed. Of the respondents, 100% had been either senders or receivers of clinical information via the application. Ninety-three percent had used the application to consult in relation to a clinical case. Of the respondents, 78% belonged to a WhatsApp group in which clinical information is shared: 71% agreed that communication between clinicians through WhatsApp is a useful tool for making therapeutic decisions. CONCLUSION: The use of WhatsApp for clinical purposes by orthopaedic surgeons is widespread. Most consider it a useful tool in therapeutic decision making.

Wrist kinetics after scaphoidectomy.

BACKGROUND: The scaphoid cannot be excised without generating substantial carpal dysfunction. The extent and nature of such a destabilizing procedure, however, has never been properly studied in the laboratory. METHODS: We used a six-degrees-of-freedom motion tracking device to quantify the changes in carpal alignment produced by isometric simultaneous loading of five wrist motor tendons in 12 fresh normal cadaver arms, before and after excising the entire scaphoid. FINDINGS: In the intact wrist, tendon loading consistently extended and supinated the capitate while flexing the triquetrum. After scaphoidectomy, the opposite rotations were always found: the capitate collapsed into flexion and pronation, whereas the triquetrum migrated proximally, while extending and radial deviating. All these changes were statistically significant. INTERPRETATION: Unless it is supplemented by some sort of midcarpal stabilization, scaphoidectomy alone is much too aggressive as a procedure to be considered a treatment option for wrist osteoarthritis. LEVEL OF EVIDENCE: Laboratory study. Not applicable.

Artrodesis de la articulación metacarpofalángica del pulgar con tornillos intramedulares entrelazados de ángulo fijo XMCP(TM) / Metacarpophalangeal joint of the thumb arthrodesis using intramedullary interlocking screws XMCP(TM)

El objetivo de estudio fue valorar el resultado de la artrodesis de la articulación metacarpofalángica del pulgar mediante el sistema de tornillos intramedulares de ángulo fijo a 25°, XMCP(TM) (Extremity Medical, Parsippany, NJ). En las radiografías se evaluó el ángulo de artrodesis, el tiempo de fusión ósea y fijación del implante. Los resultados clínicos y funcionales se evaluaron mediante el cuestionario DASH y la escala EVA. Se observó cualquier complicación encontrada durante la cirugía o el período de seguimiento. Se estudiaron 9 pacientes. El seguimiento medio fue de 27,6 meses. Los pacientes presentaron evidencia clínica y radiológica de fusión en un promedio de 8 semanas, y el ángulo de fusión promedio fue de 25°. No se presentaron complicaciones y no se ha tenido que retirar ningún implante. En conclusión, el sistema XMCP(TM) proporciona un método fiable para la artrodesis metacarpofalángica del pulgar para una variedad de indicaciones, y puede usarse junto con otros procedimientos en la mano compleja

The study objective was to assess the results of a thumb metacarpophalangeal joint (MCPJ) arthrodesis using intramedullary interlocking screws at 25°, XMCP (TM) (Extremity Medical, Parsippany, NJ). Radiographs evaluated the angle of arthrodesis, time of fusion and fixation of the implant. Clinical and functional outcomes were assessed using the DASH questionnaire and the VAS scale. Any complications found during surgery or the follow-up period were noted. We studied 9 patients. The mean follow-up was 27.6 months. Patients showed clinical and radiological evidence of fusion in an average of 8 weeks, the angle of fusion was 25°. There were no complications and no implant had to be removed. The XMCP(TM) system provides a reliable method for MCPJ arthrodesis for several indications and can be used with other procedures in the complex hand

Artrodesis de la articulación Interfalángica proximal del 4° y 5° dedo utilizando un dispositivo de tornillos entrelazados a compresión en el tratamiento de la recidiva grave de la enfermedad de Dupuytren / Arthrodesis of the proximal interphalangeal joint of the 4th and 5th finger using an interlocking screw device to treat severe recurrence of Dupuytren's disease

Objetivo: Valorar el resultado radiológico y funcional de la artrodesis de la articulación IFP del 4.° o 5.° dedo de la mano mediante el sistema intramedular de tornillos entrelazados a compresión APEX(TM) (Extremity Medical, Parsippany, NJ) en pacientes afectos de recidiva grave de la enfermedad de Dupuytren. Material y método: Los resultados clínicos se valoraron mediante el cuestionario DASH y la escala EVA. En las radiografías se evaluó el ángulo de artrodesis, el tiempo de fusión ósea y la fijación del implante. Se observó cualquier complicación encontrada durante la cirugía o en el periodo de seguimiento. Resultados: La muestra estuvo representada por 6 pacientes. El seguimiento medio fue de 19,6 meses. Todos presentaron evidencia clínica y radiológica de fusión en 8 semanas, con un ángulo de fusión de 30° (3) y 45° (3). No se presentaron complicaciones y no se tuvo que retirar ningún implante. Los resultados funcionales en este tipo de pacientes fueron pobres. Conclusión: El sistema proporciona un método fiable para la artrodesis de la IFP en un ángulo preciso. Promueve una fijación estable que no requiere inmovilización prolongada. Puede usarse junto con otros procedimientos en la mano afecta por recidiva grave de ED. Los resultados funcionales con el uso de este dispositivo en este grupo de pacientes fueron pobres

Objective: To assess the radiological and functional outcome of arthrodesis of the 4th and 5th finger using the APEX(TM) (Extremity Medical, Parsippany,NJ)intermedullary interlocking screw system in patients with severe recurrence of Dupuytren's disease. Material and method: The DASH questionnaire and the VAS scale were used to assess the clinical outcomes. The angle of arthrodesis, fusion time and implant fixation were evaluated on x-rays. The patients were monitored for complications during surgery and the follow-up period. Results: The sample comprised 6 patients. Mean follow up was 19.6 months. All of the patients presented clinical and radiological evidence of fusion at 8 weeks, with fusion angles of 30° (3) and 45° (3). There were no complications and none of the implants had to be removed. The functional outcomes in these patients were poor. Conclusion: The system offers a reliable method for IPJ arthrodesis at a precise angle. It promotes stable fixation that does not require prolonged immobilisation. It can be used together with other procedures on the hand with severe recurrence of DD. The functional outcomes for this group of patients using this device were poor

Arthrodesis of the proximal interphalangeal joint of the 4th and 5th finger using an interlocking screw device to treat severe recurrence of Dupuytren's disease. / Artrodesis de la articulación Interfalángica proximal del 4.° y 5.° dedo utilizando un dispositivo de tornillos entrelazados a compresión en el tratamiento de la recidiva grave de la enfermedad de Dupuytren.

OBJECTIVE: To assess the radiological and functional outcome of arthrodesis of the 4th and 5th finger using the APEX™ (Extremity Medical, Parsippany,NJ)intermedullary interlocking screw system in patients with severe recurrence of Dupuytren's disease. MATERIAL AND METHOD: The DASH questionnaire and the VAS scale were used to assess the clinical outcomes. The angle of arthrodesis, fusion time and implant fixation were evaluated on x-rays. The patients were monitored for complications during surgery and the follow-up period. RESULTS: The sample comprised 6 patients. Mean follow up was 19.6 months. All of the patients presented clinical and radiological evidence of fusion at 8 weeks, with fusion angles of 30° (3) and 45° (3). There were no complications and none of the implants had to be removed. The functional outcomes in these patients were poor. CONCLUSION: The system offers a reliable method for IPJ arthrodesis at a precise angle. It promotes stable fixation that does not require prolonged immobilisation. It can be used together with other procedures on the hand with severe recurrence of DD. The functional outcomes for this group of patients using this device were poor.

Metacarpophalangeal joint of the thumb arthrodesis using intramedullary interlocking screws XMCP™. / Artrodesis de la articulación metacarpofalángica del pulgar con tornillos intramedulares entrelazados de ángulo fijo XMCP™.

The study objective was to assess the results of a thumb metacarpophalangeal joint (MCPJ) arthrodesis using intramedullary interlocking screws at 25°, XMCP ™ (Extremity Medical, Parsippany, NJ). Radiographs evaluated the angle of arthrodesis, time of fusion and fixation of the implant. Clinical and functional outcomes were assessed using the DASH questionnaire and the VAS scale. Any complications found during surgery or the follow-up period were noted. We studied 9 patients. The mean follow-up was 27.6 months. Patients showed clinical and radiological evidence of fusion in an average of 8 weeks, the angle of fusion was 25°. There were no complications and no implant had to be removed. The XMCP™ system provides a reliable method for MCPJ arthrodesis for several indications and can be used with other procedures in the complex hand.

Hemiartroplastia de hombro en las fracturas de húmero proximal / Shoulder hemiarthroplasty in proximal humerus fractures

Las fracturas de húmero proximal se presentan con marcada incidencia, sobre todo en personas mayores. El tratamiento constituye un reto y la hemiartroplastia de húmero se presenta como una opción para tratar las fracturas conminutas o con mala calidad ósea. Es un proceso técnicamente exigente en el que juegan un papel crucial las tuberosidades y su correcta colocación y consolidación. Correctamente indicada presenta resultados satisfactorios a la hora de dar una respuesta a este tipo de fracturas (AU)

Proximal humerus fractures present a high incidence, especially due to the growing elderly population. Their treatment is nowadays a challenge for the orthopaedic surgeon; the humeral hemiarthroplasty is presented as a promising option for the treatment of comminuted or poor quality bone fractures. This is a technically demanding process in which the tuberosities, and their correct placement and consolidation, play a crucial role. When properly indicated, it presents satisfactory results in the management of this kind of fractures, whose treatment remains controversial (AU)

Lesión del nervio axilar en las fracturas proximales de húmero: Estudio clínico y electromiográfico / Axillary nerve damage in proximal humeral fractures: Clinical and electromyographic study

Objetivo: Determinar la presencia y el tipo de lesiones neurológicas del nervio axilar en las fracturas proximales de húmero no intervenidas. Material y método: Estudio prospectivo en 12 pacientes, atendidos en urgencias, diagnosticados de fractura de extremidad proximal del húmero Se realizó exploración física, sensibilidad y fuerza muscular (0-5, escala MRC de fuerza motora) y electromiografía. Resultados: La exploración clínica de la sensibilidad no fue demostrativa y no hallamos trastornos en ninguno de los casos. Todos los pacientes ofrecieron disminución de la fuerza muscular en grados variables Los datos electromiográficos mostraron lesión neurológica en el 75% de los pacientes, siendo el tipo de lesión más frecuente una axonotmesis parcial del nervio axilar. Las lesiones se recuperaron en todos los casos satisfactoriamente. Conclusiones: La presencia de de axonotmesis parciales es más frecuente de lo que muestra la clínica, el mayor porcentaje de lesiones hallado en nuestro estudio posiblemente se deba al hecho de realizar electromiografías a todos los casos independientemente de la clínica neurológica, poniéndose de manifiesto formas lesionales que pasarían desapercibidas (AU)

Objetive: To determine the presence and type of neurological lesions of the axillary nerve in proximal humeral fractures not subjected to surgery. Material and method: A retrospective study was made of 12 patients seen in the emergency room with proximal humeral fractures. A physical examination was carried out with the evaluation of sensitivity and muscle strength (0-5, MRC motor strength scale), and electromyography. Results: The clinical evaluation of sensitivity revealed no alterations in any case. All patients showed diminished muscle strength to one degree or other. The electromyographic data revealed neurological damage in 75% of the subjects - the most common lesion being partial axonotmesis of the axillary nerve. The lesions recovered satisfactorily in all cases. Conclusions: The presence of partial axonotmesis is more common than reflected by the clinical findings. The greater percentage of lesions recorded in our study is possibly related to the fact that electromyography was performed in all cases regardless of the neurological clinical manifestations, revealing lesions that otherwise would not have been detected (AU)

[An analysis of patellar cartilage perfusion by dynamic magnetic resonance: its application to subjects with anterior pain of patellar origin]. / Análisis de la perfusión del cartílago rotuliano mediante resonancia magnética dinámica: aplicación en sujetos con dolor anterior de origen rotuliano.

INTRODUCTION: Patellar chondromalacia is thought to be secondary to a change in vascularization of subchondral tissue, which could affect the deeper layers of the cartilage. OBJECTIVE: To evaluate whether there are differences in joint cartilage perfusion and subchondral bone with dynamic studies of magnetic resonance (MR). MATERIALS AND METHODS: Seventeen consecutive patients were studied. Patients were divided into individuals with pain of likely femoropatellar origin (n = 11) and controls (n = 6) by means of dynamic MR after the administration of intravenous contrast. Parametric images were obtained by means of digital analysis of maximal uptake, mean uptake and maximal rate of contrast uptake in the joint cartilage and subchondral bone. RESULTS: Uptake and maximal rate of cartilage, in its outer slope, were statistically higher for subjects with pain of likely femoropatellar origin than for controls (40.9 +/- 24.6 versus 23.3 +/- 4.6, p = 0.04, and 30.4 +/- 17.7 versus 17.4 +/- 2.6, p = 0.03, respectively). A higher perfusion of the cartilage was also observed in the qualitative analysis in patients with pain of likely femoropatellar origin (p = 0.009). CONCLUSIONS: The different uptake observed in the patellar cartilage allows to suppose that in chondromalacia there are vascular changes in the deeper layers of joint cartilage, characterized by an increase in perfusion.