Current trends in tendinopathy: consensus of the ESSKA basic science committee. Part II: treatment options.

The treatment of painful chronic tendinopathy is challenging. Multiple non-invasive and tendon-invasive methods are used. When traditional non-invasive treatments fail, the injections of platelet-rich plasma autologous blood or cortisone have become increasingly favored. However, there is little scientific evidence from human studies supporting injection treatment. As the last resort, intra- or peritendinous open or endoscopic surgery are employed even though these also show varying results. This ESSKA basic science committee current concepts review follows the first part on the biology, biomechanics and anatomy of tendinopathies, to provide a comprehensive overview of the latest treatment options for tendinopathy as reported in the literature.

Factores clínicos que afectan a la calidad de vida percibida en la reconstrucción artroscópica de las luxaciones acromioclaviculares / Clinical factors that affect perceived quality of life in arthroscopic reconstruction for acromioclavicular joint dislocation

Objetivo. Analizar los resultados de la reparación artroscópica de la luxación acromioclavicular en términos de calidad de vida percibida. Material y método. Estudio prospectivo de pacientes con luxación acromioclavicular grados iii-vde Rockwood, tratados artroscópicamente con un seguimiento medio de 25,4 meses. Se registraron los datos demográficos de la serie y se realizaron evaluaciones antes de la cirugía, a los 3 meses y a los 2 años con los cuestionarios validados Short Form-36 Health Survey (SF-36), escala visual analógica (EVA), The Disabilities of the Arm, Shoulder and Hand (DASH), Constant-Murley Shoulder Outcome Score (Constant) y Walch-Duplay Score (WD). Resultados. Se analizaron 20 pacientes, 17 hombres y 3 mujeres, con una edad media de 36,1 años. Según la clasificación de Rockwood, 3 pacientes fueron grado iii, 3 grado iv y 14 grado v. Se objetivó mejoría tanto funcional como clínica en todos los test clínicos analizados (SF-36, EVA y DASH) tanto a los 3 meses como a los 2 años (p<0,001). El valor final del test de Constant fue de 95,3±2,4 y el WD medio fue de 1,8±0,62. No se encontró que la calidad de vida percibida se viera afectada por ninguna variable a estudio, excepto por la evolución del DASH. Conclusiones. La calidad de vida percibida (valorada mediante el SF-36) en pacientes intervenidos artroscópicamente de luxación acromioclavicular grados iii-v no se ve influida por el sexo, la edad, el grado, el desplazamiento, la lateralidad, la evolución de la EVA, la puntuación del Constant ni por el WD. Sí se correlaciona con la evolución en el DASH (AU)

Objective. To analyse the results of arthroscopic repair of acromioclavicular dislocation in terms of health-related quality of life. Material and method. Prospective study of patients with acromioclavicular dislocation Rockwood grade iii-v, treated arthroscopically with a mean follow up of 25.4 months. The demographics of the series were recorded and evaluations were performed preoperatively, at 3 months and 2 years with validated questionnaires as Short Form-36 Health Survey (SF-36), visual analogue scale (VAS), The Disabilities of the Arm, Shoulder and Hand (DASH), Constant-Murley Shoulder Outcome Score (Constant) and Walch-Duplay Score (WD). Results. Twenty patients, 17 men and 3 women with a mean age of 36.1 years, were analysed. According to the classification of Rockwood, 3 patients were grade iii, 3 grade iv and 14 grade v. Functional and clinical improvement was detected in all clinical tests (SF-36, VAS and DASH) at 3 months and 2 years follow up (P<.001). The final Constant score was 95.3±2.4 and the WD was 1.8±0.62. It was not found that the health-related quality of life was affected by any variable studied except the evolution of DASH. Conclusions. The health-related quality of life (assessed by SF-36) in patients undergoing arthroscopic repair of acromioclavicular joint dislocation grades iii-v was not influenced by gender, age, grade, displacement, handedness, evolution of the VAS, scoring of the Constant or by the WD. However, it is correlated with the evolution in the DASH score (AU)

Clinical factors that affect perceived quality of life in arthroscopic reconstruction for acromioclavicular joint dislocation. / Factores clínicos que afectan a la calidad de vida percibida en la reconstrucción artroscópica de las luxaciones acromioclaviculares.

OBJECTIVE: To analyse the results of arthroscopic repair of acromioclavicular dislocation in terms of health-related quality of life. MATERIAL AND METHOD: Prospective study of patients with acromioclavicular dislocation Rockwood grade iii-v, treated arthroscopically with a mean follow up of 25.4 months. The demographics of the series were recorded and evaluations were performed preoperatively, at 3 months and 2 years with validated questionnaires as Short Form-36 Health Survey (SF-36), visual analogue scale (VAS), The Disabilities of the Arm, Shoulder and Hand (DASH), Constant-Murley Shoulder Outcome Score (Constant) and Walch-Duplay Score (WD). RESULTS: Twenty patients, 17 men and 3 women with a mean age of 36.1 years, were analysed. According to the classification of Rockwood, 3 patients were grade iii, 3 grade iv and 14 grade v. Functional and clinical improvement was detected in all clinical tests (SF-36, VAS and DASH) at 3 months and 2 years follow up (P<.001). The final Constant score was 95.3±2.4 and the WD was 1.8±0.62. It was not found that the health-related quality of life was affected by any variable studied except the evolution of DASH. CONCLUSIONS: The health-related quality of life (assessed by SF-36) in patients undergoing arthroscopic repair of acromioclavicular joint dislocation grades iii-v was not influenced by gender, age, grade, displacement, handedness, evolution of the VAS, scoring of the Constant or by the WD. However, it is correlated with the evolution in the DASH score.

Current trends in tendinopathy: consensus of the ESSKA basic science committee. Part I: biology, biomechanics, anatomy and an exercise-based approach.

Chronic tendinopathies represent a major problem in the clinical practice of sports orthopaedic surgeons, sports doctors and other health professionals involved in the treatment of athletes and patients that perform repetitive actions. The lack of consensus relative to the diagnostic tools and treatment modalities represents a management dilemma for these professionals. With this review, the purpose of the ESSKA Basic Science Committee is to establish guidelines for understanding, diagnosing and treating this complex pathology.

Randomized controlled trial comparing the effectiveness of the ultrasound-guided galvanic electrolysis technique (USGET) versus conventional electro-physiotherapeutic treatment on patellar tendinopathy.

BACKGROUND: Patellar tendinopathy has a high prevalence rate among athletes. Different therapeutic options can be found in the current literature, but none of them has been clearly established as the gold standard. The purpose of this study is to compare, in a randomized controlled trial, the clinical efficacy of eccentric exercise combined with either an ultrasound-guided galvanic electrolysis technique (USGET) or conventional electrophysiotherapy to treat patellar tendinopathy. METHODS: Sixty patients diagnosed with patellar tendinopathy were randomized into two groups. Group 1 (n = 30) received electrophysiotherapy treatment consisting of ultrasound, laser and interferential current techniques. Group 2 (n = 30) received USGET. Both groups did the same standardized eccentric exercise program. Periodic assessments of the subjects were carried out with the Victorian Institute of Sport Assessment-Patella (VISA-P) score. An analysis of means and a survival study were performed. RESULTS: There were statistically significant differences in the VISA-P between the baseline and final follow-up in each treatment group. Group 1 (conventional electrophysiotherapy) went from 52.5 ± 18.8 to 61.9 ± 13.7 (in VISA-P < 90 subgroup) and from 69.1 ± 9.1 to 95.2 ± 2.5 (in VISA-P > 90 subgroup). Group 2 (USGET) went from 51.4 ± 17.9 to 63.3 ± 14.3 (in VISA-P < 90 subgroup) and from 66.3 ± 13.1 to 97.1 ± 1.7 (in VISA-P > 90 subgroup). There were statistically significant correlations between the baseline and final score in the VISA-P > 90 subjects upon completing the study but no statistically significant correlations between subjects with VISA-P < 90. The mean number of sessions applied was 22.6 ± 2.5 in Group 1 and 3.2 ± 0.9 in Group 2. The success probability in Group 1 was 36.1% versus 72.4% in Group 2. The difference was statistically significant. CONCLUSION: The results obtained with the combination of USGET and eccentric exercise reported better outcomes than with the conventional electrophysiotherapy techniques in the treatment of patellar tendinopathy.

Tumor de células gigantes óseo. Noventa y siete casos con seguimiento medio de 12 años / Giant cell tumour of bone: a series of 97 cases with a mean follow-up of 12 years

Objetivo. Describir una serie de tumores óseos de células gigantes con largo seguimiento, mostrando los resultados obtenidos con nuestro protocolo terapéutico. Material y método. Entre 1982-2009, 97 pacientes con lesiones histológicamente confirmadas como tumores óseos de células gigantes fueron tratados en nuestro centro con un seguimiento medio de 12 años (2-27 años). El tratamiento recibido lo determinó la clasificación de Campanacci. La serie la formaron 53 mujeres (54,6%) y 44 hombres (54,4%) con una edad media de 34,16 años (15-71 años). Los datos recogidos se centraron en la presentación clínica, localización, estadio, extensión, recurrencias y complicaciones. Resultados. El tratamiento más utilizado en los estadios i y ii de Campanacci fue escisión intralesional con fresado a alta velocidad y rellenado con injerto homólogo, mientras que en los estadios iii que no podían ser tratados con este método se abogó por la resección en bloque. Se halló una recurrencias global del 25,8%. Siete casos (7,2%) presentaron malignización. La tasa de exitus fue del 2,1% (2 casos). Conclusión. La opción terapéutica presentada para los tumores óseos de células gigantes que consiste en legrado con fresado a alta velocidad y aporte de injerto óseo en los grados i y ii de Campanacci obtiene resultados comparables con literatura actual. Los tumores de grado iii, que no pueden ser tratados con la opción terapéutica mencionada anteriormente, requieren resección en bloque y reconstrucción posterior (AU)

Purpose. To describe our series of patients with giant cell tumour of bone with a long-term follow-up to show the results obtained with our treatment protocol. Material and methods. A total of 97 histologically confirmed giant cell tumour of bone were treated in our center between 1982 and 2009. The mean follow-up period was 12 years (2-27 years). The treatment received was determined by the radiological grade based on the Campanacci classification. The series consisted of 53 women (54.6%) and 44 men (54.4%) with a median age of 34.16 years (15-71 years). The data collected was focused on the clinical presentation, location, phase, extension, recurrences, and complications. Results. The treatment most used in Campanacci grades i and ii was intralesional excision with high velocity drilling and filling with a graft. In grades iii that could not be treated with the aforementioned method, it was decided to perform en bloc resection. An overall recurrence rate of around 25.8% was observed. Seven cases (7.2%) presented with a recurrence of the malignancy. The death rate at the end of follow-up was 2.1% (2 cases). Conclusions. Curettage with a high-velocity drill and a bone graft in giant cell tumour of bone Campanacci grades i and ii obtain good results after long-term follow-up. Some grade iii giant cell tumour of bone that cannot be treated with this therapeutic option require en bloc resection and reconstruction (AU)

[Giant cell tumour of bone: a series of 97 cases with a mean follow-up of 12 years]. / Tumor de células gigantes óseo. Noventa y siete casos con seguimiento medio de 12 años.

PURPOSE: To describe our series of patients with giant cell tumour of bone with a long-term follow-up to show the results obtained with our treatment protocol. MATERIAL AND METHODS: A total of 97 histologically confirmed giant cell tumour of bone were treated in our center between 1982 and 2009. The mean follow-up period was 12 years (2-27 years). The treatment received was determined by the radiological grade based on the Campanacci classification. The series consisted of 53 women (54.6%) and 44 men (54.4%) with a median age of 34.16 years (15-71 years). The data collected was focused on the clinical presentation, location, phase, extension, recurrences, and complications. RESULTS: The treatment most used in Campanacci grades i and ii was intralesional excision with high velocity drilling and filling with a graft. In grades iii that could not be treated with the aforementioned method, it was decided to perform en bloc resection. An overall recurrence rate of around 25.8% was observed. Seven cases (7.2%) presented with a recurrence of the malignancy. The death rate at the end of follow-up was 2.1% (2 cases). CONCLUSIONS: Curettage with a high-velocity drill and a bone graft in giant cell tumour of bone Campanacci grades i and ii obtain good results after long-term follow-up. Some grade iii giant cell tumour of bone that cannot be treated with this therapeutic option require en bloc resection and reconstruction.

Clinical results after ultrasound-guided intratissue percutaneous electrolysis (EPI®) and eccentric exercise in the treatment of patellar tendinopathy.

PURPOSE: To investigate the outcome of ultrasound (US)-guided intratissue percutaneous electrolysis (EPI(®)) and eccentric exercise in the treatment of patellar tendinopathy during a long-term follow-up. METHODS: Forty patients with patellar tendinopathy were prospectively evaluated over a 10-year follow-up period. Pain and function were evaluated before treatment, at 3 months and at 2, 5 and 10 years using the Victorian Institute of Sport Assessment-Patella (VISA-P) score, the Tegner score and Blazina's classification. According to VISA-P score at baseline, patients were also dichotomized into Group 1 (<50 points) and Group 2 (≥50 points). There were 21 patients in Group 1 and 19 in Group 2. Patient satisfaction was measured according to the Roles and Maudsley score. RESULTS: The VISA-P score improved globally by 41.2 points (p < 0.01) after a mean 4.1 procedures. In Group 1, VISA-P score improved from 33.1 ± 13 to 78.9 ± 14.4 at 3-month and to 88.8 ± 10.1 at 10-year follow-up (p < 0.001). In Group 2, VISA-P score improved from 69.3 ± 10.5 to 84.9 ± 9 at 3-month and to 96.0 ± 4.3 at 10-year follow-up (p < 0.001). After 10 years, 91.2 % of the patients had a VISA-P score >80 points. The same level (80 % of patients) or the Tegner score at no more than one level lower (20 % of patients) was restored, and 97.5 % of the patients were satisfied with the procedure. CONCLUSION: Treatment with the US-guided EPI(®) technique and eccentric exercises in patellar tendinopathy resulted in a great improvement in knee function and a rapid return to the previous level of activity after few sessions. The procedure has proved to be safe with no recurrences on a long-term basis. LEVEL OF EVIDENCE: Therapeutic study, Level IV.

Mecanismos moleculares de reparación mediante la técnica Electrólisis Percutánea Intratisular en la tendinosis rotuliana / Molecular repair mechanisms using the Intratissue Percutaneous Electrolysis technique in patellar tendonitis

Objetivo. Investigar los mecanismos moleculares de respuesta tisular tras el tratamiento con la técnica Electrólisis Percutánea Intratisular (EPI®) en la tendinosis inducida por colagenasa tipo i en ratas Sprague Dawley. Métodos. En una muestra de 24 ratas Sprague Dawley de 7 meses de edad y 300 g se indujo tendinosis mediante la inyección en el tendón rotuliano de 50 μg de colagenasa tipo i . Se procedió a dividir la muestra en 4 grupos: un grupo control, un grupo colagenasa y 2 grupos de tratamiento con técnica EPI® a 3 y 6 mA, respectivamente. Se aplicó una sesión de tratamiento EPI® y tras 3 días se procedió al análisis de los tendones mediante técnicas de inmunodetección y electroforesis. Se analizaron las proteínas citocromo C, Smac/Diablo, factor de crecimiento endotelial vascular y su receptor 2. También se analizó el factor de transcripción nuclear peroxisoma proliferador activado del receptor gamma. Resultados. Se observó un aumento estadísticamente significativo en la expresión del citocromo C, Smac/Diablo, factor de crecimiento endotelial vascular, su receptor 2 y peroxisoma proliferador activado del receptor gamma en los grupos a los que se les aplicó la técnica EPI® respecto al grupo control. Conclusiones. La técnica EPI® produce, en la lesión tendinosa inducida con colagenasa tipo i en ratas, un aumento de los mecanismos moleculares antiinflamatorios y angiogénicos (AU)

Objective. To investigate the molecular mechanisms of tissue response after treatment with the Intratissue Percutaneous Electrolysis (EPI®) technique in collagenase-induced tendinopathy in Sprague-Dawley rats. Methods. Tendinopathy was induced by injecting 50 μg of type i collagenase into the patellar tendon of 24 Sprague Dawley rats of 7 months of age and weighting 300 g. The sample was divided into 4 groups: the control group, collagenase group, and two EPI® technique treatment groups of 3 and 6 mA, respectively. An EPI® treatment session was applied, and after 3 days, the tendons were analysed using immunoblotting and electrophoresis techniques. An analysis was also made of cytochrome C protein, Smac/Diablo, vascular endothelial growth factor and its receptor 2, as well as the nuclear transcription factor peroxisome proliferator-activated receptor gamma. Results. A statistically significant increase, compared to the control group, was observed in the expression of cytochrome C, Smac/Diablo, vascular endothelial growth factor, its receptor 2 and peroxisome proliferator-activated receptor gamma in the groups in which the EPI® technique was applied. Conclusions. EPI® technique produces an increase in anti-inflammatory and angiogenic molecular mechanisms in collagenase-induced tendon injury in rats (AU)

[Molecular repair mechanisms using the Intratissue Percutaneous Electrolysis technique in patellar tendonitis]. / Mecanismos moleculares de reparación mediante la técnica Electrólisis Percutánea Intratisular en la tendinosis rotuliana.

OBJECTIVE: To investigate the molecular mechanisms of tissue response after treatment with the Intratissue Percutaneous Electrolysis (EPI(®)) technique in collagenase-induced tendinopathy in Sprague-Dawley rats. METHODS: Tendinopathy was induced by injecting 50 µg of type i collagenase into the patellar tendon of 24 Sprague Dawley rats of 7 months of age and weighting 300 g. The sample was divided into 4 groups: the control group, collagenase group, and two EPI(®) technique treatment groups of 3 and 6 mA, respectively. An EPI(®) treatment session was applied, and after 3 days, the tendons were analysed using immunoblotting and electrophoresis techniques. An analysis was also made of cytochrome C protein, Smac/Diablo, vascular endothelial growth factor and its receptor 2, as well as the nuclear transcription factor peroxisome proliferator-activated receptor gamma. RESULTS: A statistically significant increase, compared to the control group, was observed in the expression of cytochrome C, Smac/Diablo, vascular endothelial growth factor, its receptor 2 and peroxisome proliferator-activated receptor gamma in the groups in which the EPI(®) technique was applied. CONCLUSIONS: EPI(®) technique produces an increase in anti-inflammatory and angiogenic molecular mechanisms in collagenase-induced tendon injury in rats.

[The snapping scapula as a sympton of a tumor in the scapulothoracic region]. / El chasquido escapular como síntoma de un tumor de la región escapulotorácica.

INTRODUCTION: The snapping scapula syndrome is a grating sensation located in the scapulothoracic region that appears with movement.This sign is occasionally related to tumors. OBJECTIVE: To show the high incidence of this relationship (clinical sign-tumor), and to be aware of it when performing a differential diagnosis. MATERIAL AND METHOD: Retrospective study of the elastofibromas dorsi (ED) and scapular osteochondromas (SO), which may have presented with the sign under study in our center over the last 17 years (1993-2009). Thirty-seven ED and 6 SO were identified. The series was divided into group A (ED) and group B (SO). Mean follow-up was 7 years. The cohorts are made up of 23 women and 4 men with a mean age of 57 years (42-78) in group A, there were 2 women and 4 men with a mean age of 20 years (11-28) in group B. Action was taken to identify the initial medical sign at diagnosis, the treatment carried out, and the outcome. RESULTS: Around 21% of these tumors are reported to be associated with physical activity. The initial symptom was a painful mass in 81% of the patients, followed by a scapular snapping or clicking in 30 out of the 43 patients (70%). The treatment of choice was resection in both groups. A noticeable improvement in terms of pain was seen (VAS 7.5 preoperatively, 2.8 postoperatively). CONCLUSION: The presence of snapping scapula has a strong relationship to tumors of the scapulothoracic region. Therefore it is important to be aware of this.

El chasquido escapular como síntoma de un tumor de la región escapulotorácica / The snapping scapula as a sympton of a tumor in the scapulothoracic region

Introducción. El chasquido escapular es un crujido localizado en la región escapulotorácica que aparece con los movimientos. Este signo clínico está relacionado en ocasiones con los tumores escapulares. Objetivo. Mostrar la alta incidencia de esta relación (tumor escapular-chasquido) para recordar la misma al realizar el diagnóstico diferencial. Material y método. Estudio retrospectivo de elastofibromas dorsi (ED) y osteocondromas escapulares (OE), que puedan presentar el signo clínico a estudio, en nuestro centro en los últimos 17 años (1993-2009). Se han identificado 37 ED y 6 OE. El tiempo medio de seguimiento ha sido de 7 años. Se ha divido la serie en grupo A (ED) y grupo B (OE). Las cohortes las forman, en el grupo A: 23 mujeres y 4 varones, media de 57 años (42-78), y en el grupo B: 2 mujeres y 4 varones, media de 20 años (11-28). Se ha procedido a identificar el signo clínico inicial al diagnóstico, el tratamiento realizado y la evolución. Resultados. Se reporta una asociación entre la actividad física y la presencia de estas tumoraciones del 21%. La clínica inicial fue una masa dolorosa en el 81% de los pacientes, y un chasquido escapular en el 70% (30 de 43). El tratamiento de elección fue la exéresis en ambos grupos, obteniendo una notable mejoría en el dolor (VAS: 7,5 preoperatorio; 2,8 postoperatorio). Conclusión. La presencia de chasquido escapular tiene una fuerte relación con los tumores de la región escapulotorácica, por lo que debemos conocer esta asociación (AU)

Introduction. The snapping scapula syndrome is a grating sensation located in the scapulothoracic region that appears with movement.This sign is occasionally related to tumors. Objective. To show the high incidence of this relationship (clinical sign-tumor), and to be aware of it when performing a differential diagnosis. Material and method. Retrospective study of the elastofibromas dorsi (ED) and scapular osteochondromas (SO), which may have presented with the sign under study in our center over the last 17 years (1993-2009). Thirty-seven ED and 6 SO were identified. The series was divided into group A (ED) and group B (SO). Mean follow-up was 7 years. The cohorts are made up of 23 women and 4 men with a mean age of 57 years (42-78) in group A, there were 2 women and 4 men with a mean age of 20 years (11-28) in group B. Action was taken to identify the initial medical sign at diagnosis, the treatment carried out, and the outcome. Results. Around 21% of these tumors are reported to be associated with physical activity. The initial symptom was a painful mass in 81% of the patients, followed by a scapular snapping or clicking in 30 out of the 43 patients (70%). The treatment of choice was resection in both groups. A noticeable improvement in terms of pain was seen (VAS 7.5 preoperatively, 2.8 postoperatively). Conclusion. The presence of snapping scapula has a strong relationship to tumors of the scapulothoracic region. Therefore it is important to be aware of this (AU)

[Fracture of the carpal scaphoid in children. Case report and literature review]. / Fractura de escafoides carpiano en el niño. A propósito de un caso y revisión de la bibliografía.

OBJECTIVE: To conduct a bibliographic review of the infrequent fractures of the carpal scaphoid in pediatric cases based on a clinical case. The diagnosis is usually a difficult one and treatment should be stringent in order to minimize the chance of delayed healing or pseudoarthrosis. MATERIAL AND METHODS: Ten year-old child with a carpal scaphoid fracture visible in the plain films. The patient did not comply with treatment and removed the cast at three weeks. Despite this healing occurred without any clinical sequelae. DISCUSSION: This case is especially infrequent given the excellent result obtained despite the fact that the immobilization period was considerably shorter than the minimum recommended.

[Occipital condyle fracture: clinical case and a review of the literature]. / Fractura del cóndilo occipital. Reporte clínico y revisión de la literatura.

OBJECTIVE: We present a case report of an occipital condyle fracture, a rarely seen injury in patients of any age, and particularly so in paediatric patients. The objective of this article is to inform about this lesion, such often going unnoticed, but should be especially looked for in cranial trauma cases with neck pain. An X-ray may be normal and diagnosis is best made by using computed tomography imaging. Treatment should depend on whether the fracture is stable or not. MATERIAL AND METHODS: We report on two patients, 17 and 40 -year-old males who presented with an impacted right occipital condyle fracture following a motorbike accident. Cervical immobilization was carried out with a hard collar. RESULTS: Good results were obtained and there were no secondary effects of a neurological or functional nature. CONCLUSION AND CLINICAL RELEVANCE: In conclusion, the knowledge of this condition, its correct diagnosis and the correct treatment choice is crucial to the avoidance of brachial plexus injuries and other important sequelae.

Elastofibroma dorsi: 7 años de seguimiento de 37 casos y revisión de la literatura / Elastofibroma dorsi: a 7-year follow-up of 37 cases and a review of the literature

Introducción. El elastofibroma dorsi (ED) es una tumoración benigna infrecuente de partes blandas, crecimiento lento y localización preferentemente escapular. Material y método. Revisión retrospectiva de 37 ED diagnosticados y tratados en nuestro centro entre agosto de 1993 y noviembre de 2009, con un seguimiento medio de 7 años. La presentación clínica, los resultados anatomopatológicos y los estudios por imagen han sido revisados. En 10 ocasiones la presentación fue bilateral. El ratio varón/mujer fue (4:23) con una edad media de 57 años. La duración media de los síntomas fue de 14 meses. En todos los casos se realizó estudio de RM y confirmación del diagnóstico mediante anatomía patológica. Siete casos fueron tratados conservadoramente. Los pacientes fueron estudiados por un traumatólogo especialista en oncología, así como por un radiólogo experimentado. Los resultados clínicos fueron evaluados mediante Escala Visual Analógica (EVA) para el dolor y comparación del rango de movilidad durante el seguimiento. Resultados. No se halló ningún caso de antecedentes familiares de ED. El 18% de los pacientes realizaban trabajos o deportes que implicaban la extremidad afectada. El 40% de los pacientes requirieron transfusión postoperatoria por hemoglobina <8g/dl. La EVA mejoró de 6 preoperatoriamente, a 2 postoperatoriamente. El rango de movilidad mejoró de media en 40°. Las complicaciones incluyen una infección de la herida, un caso de cicatriz hiperálgica, 8 hematomas y 3 seromas posquirúrgicos que se solucionaron sin incidencias en el seguimiento. Tras un seguimiento medio de 85 meses todos los pacientes se encuentran libres de enfermedad. Conclusiones. Se han obtenido buenos resultados con un amplio seguimiento. Basándonos en estos resultados y en una revisión bibliográfica del estado actual de esta patología sugerimos un algoritmo para su diagnóstico y tratamiento (AU)

Background. Elastofibroma dorsi (ED) is an infrequent benign, slow growing, soft tissue tumour that is usually located in the scapular zone. Material and methods. A series of 37 ED patients diagnosed and treated in our hospital between August 1993 and November 2009 were retrospectively reviewed. The average follow up was 7 years. Ten of them presented bilaterally. The male/female ratio was 4:3, and the mean age was 57 years. An MRI was performed, and the diagnosis confirmed by histopathology. Seven cases were treated conservatively. The clinical results were evaluated using a visual analogue score (VAS) for pain and a comparison of the range of movement during follow up. Results. Some 18% of the patients worked or practiced sports that called for the use of the affected limb. The 40% of the patients required a post-operative transfusion was required by 40% of the patients, due to having a haemoglobin <8g/d. The VAS improved from 6 to 2 after the surgery. The range of movement improved on an average of 40. The complications included an infection, 1 hyperalgesic scar, 8 haematomas and 3 seromas, which were resolved in the follow up without incidence. All the patients were free of illness after a mean follow-up of 85 months. Conclusions. Good results were achieved with a long follow-up. Based on these results and a literature review of the current state of this pathology, an algorithm for its diagnosis and treatment is suggested (AU)

Fractura del cóndilo occipital. Reporte clínico y revisión de la literatura / Occipital condyle fracture: clinical case and a review of the literature

Objetivo. Llamar la atención sobre la existencia de la fractura del cóndilo occipital y la facilidad con la que pasan desapercibidas durante la atención del paciente politraumatizado. Es una lesión poco frecuente, especialmente en pacientes adolescentes, y debe tenerse en cuenta ante un traumatismo craneal con dolor cervical por sus potenciales consecuencias si estas fracturas no se tratan correctamente. La exploración radiográfica puede parecer normal, debiendo hacer el diagnóstico mediante tomografía computarizada. El tratamiento de elección depende de la estabilidad de la fractura. Material y método. Dos pacientes varones de 17 y 40 años involucrados en sendos accidentes de motocicleta, presentaron una fractura impactada del cóndilo occipital. En ambos casos se realizó tratamiento conservador con collar cervical rígido. Resultados. Se obtuvieron buenos resultados funcionales sin secuelas neurológicas. Conclusión y relevancia clínica. El conocimiento y sospecha de esta infrecuente entidad y su correcto diagnóstico y tratamiento es crucial para conseguir un buen resultado funcional, para así evitar potenciales lesiones neurológicas asociadas (AU)

Objective. We present a case report of an occipital condyle fracture, a rarely seen injury in patients of any age, and particularly so in paediatric patients. The objective of this article is to inform about this lesion, such often going unnoticed, but should be especially looked for in cranial trauma cases with neck pain. An X-ray may be normal and diagnosis is best made by using computed tomography imaging. Treatment should depend on whether the fracture is stable or not. Material and methods. We report on two patients, 17 and 40 -year-old males who presented with an impacted right occipital condyle fracture following a motorbike accident. Cervical immobilization was carried out with a hard collar. Results. Good results were obtained and there were no secondary effects of a neurological or functional nature. Conclusion and clinical relevance. In conclusion, the knowledge of this condition, its correct diagnosis and the correct treatment choice is crucial to the avoidance of brachial plexus injuries and other important sequelae (AU)

[Elastofibroma dorsi: a 7-year follow-up of 37 cases and a review of the literature]. / Elastofibroma dorsi: 7 años de seguimiento de 37 casos y revisión de la literatura.

BACKGROUND: Elastofibroma dorsi (ED) is an infrequent benign, slow growing, soft tissue tumour that is usually located in the scapular zone. MATERIAL AND METHODS: A series of 37 ED patients diagnosed and treated in our hospital between August 1993 and November 2009 were retrospectively reviewed. The average follow up was 7 years. Ten of them presented bilaterally. The male/female ratio was 4:3, and the mean age was 57 years. An MRI was performed, and the diagnosis confirmed by histopathology. Seven cases were treated conservatively. The clinical results were evaluated using a visual analogue score (VAS) for pain and a comparison of the range of movement during follow up. RESULTS: Some 18% of the patients worked or practiced sports that called for the use of the affected limb. The 40% of the patients required a post-operative transfusion was required by 40% of the patients, due to having a haemoglobin <8 g/d. The VAS improved from 6 to 2 after the surgery. The range of movement improved on an average of 40. The complications included an infection, 1 hyperalgesic scar, 8 haematomas and 3 seromas, which were resolved in the follow up without incidence. All the patients were free of illness after a mean follow-up of 85 months. CONCLUSIONS: Good results were achieved with a long follow-up. Based on these results and a literature review of the current state of this pathology, an algorithm for its diagnosis and treatment is suggested.

Reparación artroscópica anatómica de las luxaciones agudas acromio-claviculares / Arthroscopic anatomic repair of acute acromioclavicular joint dislocations

Objetivo: Describir la técnica quirúrgica asistida por artroscopia para el tratamiento de las lesiones agudas acromio-claviculares (AC), basada en la reconstrucción anatómica córaco-clavicular (CC), y presentar los resultados clínicos preliminares. Material y método: Fueron tratados 12 pacientes de luxación AC, con edad media de 31 (19-45) años, con técnica artroscópica mediante reconstrucción con doble dispositivo de suspensión córaco-clavicular (Zip-tight). Seguimiento de entre tres y 12 meses. El tiempo medio entre lesión y cirugía fue de ocho días. Tres luxaciones fueron tipo III de Rockwood, dos tipo IV y siete tipo V. El diagnóstico se basó en radiografías ántero-posteriores y Alexander outlet. La evaluación clínica funcional se realizó con test SF-36, DASH y escala visual analógica (EVA) para el dolor. Resultados: Se obtuvo mejoría en todos los valores estudiados: DASH 79,4 (556 - 89) pre a 3,8 (1,9 - 9,5) post, SF36-físico 29,9 (17 - 43) pre a 56,1 (53 -60) post, SF36-mental 44,2 (27 - 52) pre a 55,4 (44 - 57) post. EVA 8,1 (6-9) pre a 1,3 (0-2) post. El grado de satisfacción fue de 8,5 sobre 10. Los resultados radiográficos fueron satisfactorios en 11 casos, en otro había pérdida de reducción menor al 50% sin repercusión clínica. No se presentaron complicaciones. Conclusión: La técnica presentada para estabilización de luxaciones AC en fase aguda mediante dos dispositivos de suspensión córaco-clavicular anatómicos es una técnica artroscópica segura, con alta demanda para el cirujano y baja tasa de complicaciones que obtiene óptimos resultados a corto plazo en pacientes seleccionados (AU)

Objective: Describe the arthroscopically assisted surgical technique to treat acute acromio-clavicular injuries based on anatomic coracoclavicular (CC) reconstruction and present the preliminary clinical results. Material and methods: After AC dislocation, 12 patients were treated with the anatomic arthroscopic reconstruction technique using a dual coracoclavicular suspension device. Follow-up was from 3 to 12 months 8Xip-tight). The mean time between injury and surgery was 8 days. Three dislocations were Rockwood type III, 2 type IV and 7 type V. The mean age was 31 years (19-45). Diagnosis included antero-posterior and Alexander outlet radiographs. Clinical evaluation was performed with the SF-36 test, DASH and the visual analog scale (VAS) for pain. Results: Improvement was observed in all values studied. DASH 79.4 (556-89) pre to 3.8 (1.9-9.5) post, SF36- physical 29.9 (17-43) pre to 56.1 (53-60) post, SF36- mental 44.2 (27-52) pre to 55.4 (44-57) post. VAS 8.1 (6-9) pre to 1.3 (0-2) post. The degree of satisfaction was 8.5 over 10. Radiographic results were satisfactory in 11 cases. In one case, there was a loss of reduction of less than 50% that had no clinical impact. No complications such as tunnel fractures, infection or intolerance of material occurred. Conclusion: The technique for stabilization of acute AC dislocations with two anatomically configured CC suspension devices is safe but demanding. However, the complication rate is low and short-term results are optimum in selected patients (AU)

Fractura aislada del cuerpo del hueso ganchoso. A propósito de un caso / Isolated fracture of the body of the hamate bone. About a case

Objetivo. Mostrar mediante un caso clínico que las fracturas del hueso ganchoso son muy poco frecuentes, mucho menos aún las que afectan al cuerpo del mismo sin fracturas asociadas de otros huesos del carpo. Debido a su infrecuencia y a la inespecificidad de sus manifestaciones clínicas, suelen ser de difícil diagnóstico. Material y método. Presentamos el caso de un varón de 24 años, que sufrió fractura conminuta aislada del cuerpo del hueso ganchoso. Fue tratado de forma conservadora, obteniéndose una recuperación ad integrum sin déficit funcional. Conclusiones. Es importante considerar este tipo de fracturas ante un traumatismo directo sobre la mano. Es recomendable la realización de una tomografia computerizada (TC) para caracterizar correctamente la fractura y valorar las posibles lesiones asociadas. La decisión terapéutica depende del grado de conminución de la fractura, de su estabilidad y de la afectación articular (AU)

Objective. To demonstrate, through a clinical case, that fractures of the hamate bone are very infrequent and even more so those that affect its body without there being fractures of the other associated carpal bones. Due to its infrequency and to the non-specificity of its clinical manifestations, they are usually difficult to diagnose. Material and methods. We present a case of a 24 year old male who suffered an isolated comminuted fracture of the body of the hamate bone. It was treated conservatively and full recovery without any functional deficit was obtained. Conclusions. It is important to consider this type of fracture when confronted with a direct traumatism to the hand. Performing computed tomography (CT) is recommended in order to correctly identify the fracture and assess any possible associated lesions. The therapeutic decision depends on the degree of comminution of the fracture, its stability and any joint involvement (AU)

Luxación de los tendones extensores de la mano a nivel de la articulación metacarpofalángica / Luxation of the hand extensor tendons around the metacarpophalangeal joint

Objetivo. La luxación de los tendones extensores sobre la cabeza de los metacarpianos, constituye una entidad poco frecuente en pacientes que no presentan una artritis reumatoide. Sin embargo, con el incremento de actividades deportivas, especialmente aquellas que exigen un contacto físico permanente, el número de casos ha ido aumentando. Método. En cuanto al tratamiento se refiere, hay que distinguir los casos agudos (menos de tres semanas de evolución) de los crónicos, pues en los primeros casos suele ser suficiente la inmovilización, mientras que en los segundos es necesario practicar algún tipo de intervención quirúrgica. Resultados. En el presente trabajo se dan a conocer los resultados obtenidos sobre tres pacientes con dicha patología y a los cuales se procedió a la centralización quirúrgica del tendón mediante técnica de Kilgore (AU)

Objectives: Dislocation of the extensors over the head of the metacarpals constitutes a rare condition in patients who do not present rheumatoid arthritis. Nevertheless, with the increase in sport activities and especially those that demand a permanent physical contact, the number of cases has been increasing. Methods: As far as treatment its goes, it is necessary to distinguish the acute cases (less than three weeks evolution) from the chronic ones as immobilization is usually sufficient in the first case. On the other hand, it is necessary to practice some type of operation in the second case. Results: In the present work, the results obtained on three patients with this pathology on whom surgical centralization of the tendon by means of the Kilgore technique is made known (AU)