[Translated article] The efficacy of topical tranexamic acid in reverse shoulder arthroplasty.

INTRODUCTION: Topical tranexamic acid (TXA) has been shown to decrease blood loss in knee and hip arthroplasty. Despite there is evidence about its effectiveness when administered intravenous, its effectiveness and optimal dose when used topically have not been established. We hypothesised that the use of 1.5g (30mL) of topical TXA could decrease the amount of blood loss in patients after reverse total shoulder arthroplasty (RTSA). MATERIAL AND METHODS: One hundred and seventy-seven patients receiving a RSTA for arthropathy or fracture were retrospectively reviewed. Preoperative-to-postoperative change in haemoglobin (ΔHb) and hematocrit (ΔHct) level drain volume output, length of stay and complications were evaluated for each patient. RESULTS: Patients receiving TXA has significant less drain output in both for arthropathy (ARSA) (104 vs. 195mL, p=0.004) and fracture (FRSA) (47 vs. 79mL, p=0.01). Systemic blood loss was slightly lower in TXA group, but this was not statistically significant (ARSA, ΔHb 1.67 vs. 1.90mg/dL, FRSA 2.61 vs. 2.7mg/dL, p=0.79). This was also observed in hospital length of stay (ARSA 2.0 vs. 2.3 days, p=0.34; 2.3 vs. 2.5, p=0.56) and need of transfusion (0% AIHE; AIHF 5% vs. 7%, p=0.66). Patients operated for a fracture had a higher rate of complications (7% vs. 15.6%, p=0.04). There were no adverse events related to TXA administration. CONCLUSION: Topical use of 1.5g of TXA decreases blood loss, especially on the surgical site without associated complications. Thus, haematoma decrease could avoid the systematic use of postoperative drains after reverse shoulder arthroplasty.

The efficacy of topical tranexamic acid in reverse shoulder arthroplasty. / Eficacia del ácido tranexámico tópico en la artroplastia invertida de hombro.

INTRODUCTION: Topical tranexamic acid (TXA) has been shown to decrease blood loss in knee and hip arthroplasty. Despite there is evidence about its effectiveness when administered intravenous, its effectiveness and optimal dose when used topically has not been established. We hypothesized that the use of 1.5g (30mL) of topical TXA could decrease the amount of blood loss in patients after reverse total shoulder arthroplasty (RTSA). MATERIAL AND METHODS: One hundred and seventy-seven patients receiving a RSTA for arthropathy or fracture were retrospectively reviewed. Preoperative-to-postoperative change in hemoglobin (ΔHb) and hematocrit (ΔHct) level drain volume output, length of stay and complications were evaluated for each patient. RESULTS: Patients receiving TXA has significant less drain output in both for arthropathy (ARSA) (104 vs. 195mL, p=0.004) and fracture (FRSA) (47 vs. 79mL, p=0.01). Systemic blood loss was slightly lower in TXA group, but this was not statistically significant (ARSA, ΔHb 1.67 vs. 1.90mg/dL, FRSA 2.61 vs. 2.7mg/dL, p=0.79). This was also observed in hospital length of stay (ARSA 2.0 vs. 2.3 days, p=0.34; 2.3 vs. 2.5, p=0.56) and need of transfusion (0% AIHE; AIHF 5% vs. 7%, p=0.66). Patients operated for a fracture had a higher rate of complications (7% vs. 15.6%, p=0.04). There were no adverse events related to TXA administration. CONCLUSION: Topical use of 1.5g of TXA decreases blood loss, especially on the surgical site without associated complications. Thus, hematoma decrease could avoid the systematic use of postoperative drains after reverse shoulder arthroplasty.

Percutaneous plate fixation of displaced proximal humerus fractures: Do minimally invasive techniques improve outcomes and reduce complications?

OBJECTIVE: The aim of this study was to analyze the outcomes and complications of minimally invasive plate osteosynthesis (MIPO) for displaced proximal humerus fractures and elucidate if the percutaneous technique reduces the rate of avascular necrosis (AVN) without jeopardizing fracture reduction. MATERIAL AND METHODS: 118 patients with a displaced proximal humerus fracture were treated with a polyaxial locking-plate through a standardized percutaneous approach. 73 % were women and mean age was 63 years (18-89) with an average follow-up of 51 months (12-256). There were 32 two-part fractures (27 %), 57 three-part fractures (48 %) and 24 four-part fractures (25 %). Shoulder function at the last follow-up, including ROM and ability to perform daily living activities, was objectively evaluated with an adjusted Constant Score (CS). Subjective patient satisfaction was rated with an Visual Analogic Scale from 0 to 10 and the degree of residual pain with a Verbal Rating Scale (VRS). Radiographic analysis at the most recent follow-up evaluated the presence of AVN, degree of residual medial calcar displacement, and the cervicodiaphiseal angle. RESULTS: Forty patients (34 %) had a complication, 25 of them (21 %) requiring further surgery. ROM at the last follow-up was 131° of elevation (40°-180°), 38° of external rotation (SD: 17.7) and internal rotation to L3. Average adjusted Constant Score was 68 (SD: 17.76). Twenty-one patients (18 %) complained of shoulder pain (14 moderate and 7 severe) and seven were not satisfied. Radiographically, 29 patients (25 %) had varus malunion and 17 patients (14 %) showed some degree of AVN. Patients with varus malunion (CS 64.3 versus 69.8, p = 0.16) and AVN (CS 56.9 versus 70.4, p = 0.005) had lower CS. The presence of a varus malunion was directly related to the degree of initial medial calcar displacement (p = 0.001) and deficient calcar reduction at surgery (p = 0.004). AVN was statistically more prevalent when the medial calcar was inadequately reduced (p = 0.01). CONCLUSIONS: MIPO surgery for proximal humerus fractures through an anterolateral approach does not reduce the rate of mechanical complications or AVN compared with standard ORIF techniques. Moreover, percutaneous plating may preclude adequate medial calcar reduction, leading to humeral head malunion and a worse clinical outcome.

Test de Distensión en Rotación Externa Pasiva (TDREP): validación de una nueva prueba clínica para el diagnóstico precoz de la capsulitis adhesiva de hombro / Distension test in passive external rotation: Validation of a new clinical test for the early diagnosis of shoulder adhesive capsulitis

Objetivo. El propósito de este estudio es evaluar la validez interna de una prueba clínica descrita para el diagnóstico precoz de la capsulitis adhesiva de hombro: el Test de Distensión en Rotación Externa Pasiva (TDREP). Material y método. El TDREP se realiza con el paciente de pie, el brazo adducido y el codo flexionado a 90°. Desde esta posición, se inicia un movimiento suave de rotación externa pasiva, sosteniendo el brazo afectado con una mano del examinador en la muñeca y otra manteniendo el codo abducido hasta que se alcanza el punto máximo de rotación indolora. Desde este punto de máxima rotación externa con el brazo en aducción y sin dolor, se realiza un movimiento brusco de distensión, incrementando la rotación externa, causando dolor en el hombro si la prueba es positiva. Es test se realizó en un grupo de 155 pacientes con dolor de hombro de múltiples orígenes para analizar los valores predictivos, la sensibilidad, especificidad y razón de verosimilitud. Resultados. El TDREP mostró una sensibilidad de 100% (IC 95%, de 91,8 a 100%) y una especificidad del 90% (IC 95%, de 82,4 a 94,8%). El valor predictivo positivo fue de 0,62 y la razón de verosimilitud de 10,22 (IC 95%: 5,5 a 19,01). Los falsos positivos se encontraron solo en enfermos con tendinopatías del subescapular o con artrosis glenohumeral. Discusión. El TDREP tiene una alta sensibilidad para diagnosticar CA y cuando es negativo prácticamente la excluye. Los falsos positivos se pueden identificar fácilmente si existe una rotación externa sin limitación (tendinopatía subescapular) o con una radiografía simple de hombro (artrosis glenohumeral) (AU)

Objective. The aim of this study is to evaluate the internal validity of a clinical test for the early diagnosis of shoulder adhesive capsulitis, called the Distension Test in Passive External Rotation (DTPER). Material and method. The DTPER is performed with the patient standing up, the arm adducted, and the elbow bent at 90°. From this position, a smooth passive external rotation is started, the affected arm being supporting at the wrist with one hand of the examiner and the other maintaining the adducted elbow until the maximum painless point of the rotation is reached. From this point of maximum external rotation with the arm in adduction and with no pain, an abrupt distension movement is made, increasing the external rotation, causing pain in the shoulder if the test is positive. This term was performed on a group of patients with shoulder pain of many origins, in order to analyse the predictive values, sensitivity, specificity, and the likelihood ratio. Results. The DTPER showed a sensitivity of 100% (95% CI; 91.8 to 100%) and a specificity of 90% (95% CI; 82.4 to 94.8%). The positive predictive value was 0.62 and a likelihood ratio of 10.22 (95% CI; 5.5 to 19.01). False positives were only found in patients with subscapular tendinopathies or glenohumeral arthrosis. Discussion. The DTPER has a high sensitivity for the diagnosis of adhesive capsulitis, and is excluded when it is practically negative. False positives can easily be identified if there is external rotation with no limits (subscapular tendinopathy) or with a simple shoulder X-ray (glenohumeral arthrosis) (AU)

Resultados clínicos y radiológicos de las fracturas de húmero proximal tratadas mediante enclavado intramedular, así como posibles factores de riesgo de un mal resultado / Clinical and radiological results of fractures of the proximal humerus treated with intramedullary nailing and possible risk factors of a poor outcome

Antecedentes: Evaluar los resultados clínicos y radiográficos de las fracturas de húmero proximal tratadas mediante fijación con clavo intramedular, así como los factores de riesgo asociados a un mal resultado. Métodos: Se han revisado retrospectivamente a pacientes con un seguimiento mínimo de un año. Se realizó una revisión clínica objetiva mediante la escala de Constant y subjetiva del grado de satisfacción, EVA y valoración de discapacidad mediante la escala de DASH. Radiológicamente, los enfermos fueron revisados mediante radiografías AP y axial en el plano escapular. Resultados: Se incluyeron 46 pacientes, 91.3% se presentó clínicamente satisfechos con el tratamiento. La movilidad media fue de 155º de flexión, 60º de rotación lateral y rotación medial. La puntuación media del Constant fue de 70 y del DASH de 15 puntos. Se encontraron diferencias significativas en cuanto al Constant en menores de 60 años, no siendo éstas significativas con el tipo de fractura o teniendo en cuenta el DASH. Radiográficamente, la tasa de consolidación fue de 95.7%, apreciándose dos casos de seudoartrosis. En 17 pacientes se observó una consolidación en varo (38.6%). Se encontraron diferencias funcionales comparando los pacientes con consolidación en varo y consolidación anatómica. Discusión: La fijación mediante clavo intramedular es un tratamiento efectivo para las fracturas de húmero proximal, sobre todo para fracturas en dos partes del cuello quirúrgico. La alta tasa de colapso en varo, sobre todo en fracturas con gran conminución, puede acarrear una disminución en la movilidad.

Background: To assess the clinical and radiological results of fractures of the proximal humerus treated with intramedullary nail fixation as well as the risk factors associated with a poor outcome. Methods: Patients were analyzed retrospectively with a minimum follow-up of one year. An objective clinical assessment was made using the Constant scale, the subjective satisfaction scale, VAS, and the DASH scale to measure disability. The radiological assessment included AP and axial X-rays in the scapular plane. Results: Forty-six patients were enrolled. The clinical assessment showed that 91.3% of them were satisfied with treatment. Mean mobility was 155º of flexion, 60º of lateral and medial rotation. The mean Constant score was 70 and the DASH score was 15. Significant differences were found in the Constant score in individuals under 60 years of age, but they were not significant considering the type of fracture or the DASH score. X-rays showed a healing rate of 95.7%, with two cases of pseudarthrosis. Varus healing was observed in 17 patients (38.6%). Functional differences were found when patients with varus healing were compared with those who had anatomical healing. Discussion: Fixation with intramedullary nailing is an effective treatment for fractures of the proximal humerus, particularly for two-segment fractures of the surgical neck. The high rate of varus collapse, particularly in very comminuted fractures, may lead to decreased mobility.

Uso de células troncales derivadas de lipoaspirado en un modelo experimental animal de rotura de manguito rotador / Use of adipose-derived stem cells in an experimental rotator cuff fracture animal model

Objetivo. La reparación del manguito rotador tiene una alta tasa de fracaso. Se investiga si la aplicación de células troncales derivadas de lipoaspirado mejorará la resistencia de la reparación y recreará la entesis original. Material y métodos. Estudio experimental en 44 ratas BDIX con sección y reparación con sutura del tendón supraespinoso y asignación aleatoria a uno de 3 grupos: grupo A, nada (control); grupo B, aplicación local de vehículo de fibrina; y grupo C, aplicación de 2 x 106 células troncales derivadas de lipoaspirado. Se realiza estudio mecánico en célula de carga y estudio histológico en hematoxilina-eosina. Resultados. En el estudio mecánico no hubo diferencias entre grupos. La carga hasta el fracaso aumentó de los grupos de 4-8 semanas. En el estudio histológico se observó la unión hueso-tendón mediante un tejido fibrovascular desorganizado. En el grupo C se observó un aumento de células plasmáticas a las 4 y 8 semanas. Conclusión. La utilización de células troncales derivadas de lipoaspirado no recrea la organización celular de la entesis ni mejoran las propiedades biomecánicas de la misma. Son necesarios más estudios para investigar técnicas que mejoren la cicatrización del tendón (AU)

Aim. Rotator cuff repairs have shown a high level of re-ruptures. We hypothesized that the use of adipose-derived stem cells (ASC) could improve the biomechanical and histological properties of the repair. Material and methods. Controlled experimental study conducted on 44 BDIX rats with section and repair of the supraspinatus tendon and randomization to one of three groups: group A, no intervention (control); group B, local applications of a fibrin sealant; and group C, application of the fibrin sealant with 2 x 106 ASC. At 4 and 8 weeks a biomechanical and histological analysis was performed. Results. There were no differences in load-to-failure at 4 and 8 weeks between groups. The load-to-failure did increase between week 4 and week 8. Histologically the tendon-to bone union showed a disorganized fibrovascular tissue. Group C showed a different inflammatory pattern, with less presence of neutrophils and more presence of plasma cells. Conclusion. The use of ASC does not improve the biomechanical or histological properties of the repair site. More studies are needed to improve techniques that enhance the healing site of the repair (AU)

[Use of adipose-derived stem cells in an experimental rotator cuff fracture animal model]. / Uso de células troncales derivadas de lipoaspirado en un modelo experimental animal de rotura de manguito rotador.

AIM: Rotator cuff repairs have shown a high level of re-ruptures. We hypothesized that the use of adipose-derived stem cells (ASC) could improve the biomechanical and histological properties of the repair. MATERIAL AND METHODS: Controlled experimental study conducted on 44 BDIX rats with section and repair of the supraspinatus tendon and randomization to one of three groups: group A, no intervention (control); group B, local applications of a fibrin sealant; and group C, application of the fibrin sealant with 2 x 10(6) ASC. At 4 and 8 weeks a biomechanical and histological analysis was performed. RESULTS: There were no differences in load-to-failure at 4 and 8 weeks between groups. The load-to-failure did increase between week 4 and week 8. Histologically the tendon-to bone union showed a disorganized fibrovascular tissue. Group C showed a different inflammatory pattern, with less presence of neutrophils and more presence of plasma cells. CONCLUSION: The use of ASC does not improve the biomechanical or histological properties of the repair site. More studies are needed to improve techniques that enhance the healing site of the repair.

Distension test in passive external rotation: Validation of a new clinical test for the early diagnosis of shoulder adhesive capsulitis.

OBJECTIVE: The aim of this study is to evaluate the internal validity of a clinical test for the early diagnosis of shoulder adhesive capsulitis, called the Distension Test in Passive External Rotation (DTPER). MATERIAL AND METHOD: The DTPER is performed with the patient standing up, the arm adducted, and the elbow bent at 90°. From this position, a smooth passive external rotation is started, the affected arm being supporting at the wrist with one hand of the examiner and the other maintaining the adducted elbow until the maximum painless point of the rotation is reached. From this point of maximum external rotation with the arm in adduction and with no pain, an abrupt distension movement is made, increasing the external rotation, causing pain in the shoulder if the test is positive. This term was performed on a group of patients with shoulder pain of many origins, in order to analyse the predictive values, sensitivity, specificity, and the likelihood ratio. RESULTS: The DTPER showed a sensitivity of 100% (95% CI; 91.8 to 100%) and a specificity of 90% (95% CI; 82.4 to 94.8%). The positive predictive value was 0.62 and a likelihood ratio of 10.22 (95% CI; 5.5 to 19.01). False positives were only found in patients with subscapular tendinopathies or glenohumeral arthrosis. DISCUSSION: The DTPER has a high sensitivity for the diagnosis of adhesive capsulitis, and is excluded when it is practically negative. False positives can easily be identified if there is external rotation with no limits (subscapular tendinopathy) or with a simple shoulder X-ray (glenohumeral arthrosis).

[Clinical and radiological results of fractures of the proximal humerus treated with intramedullary nailing and possible risk factors of a poor outcome]. / Resultados clínicos y radiolígicos de las fracturas de húmero proximal tratadas mediante enclavado intramedular, así como posibles factores de riesgo de un mal resultado.

BACKGROUND: To assess the clinical and radiological results of fractures of the proximal humerus treated with intramedullary nail fixation as well as the risk factors associated with a poor outcome. METHODS: Patients were analyzed retrospectively with a minimum follow-up of one year. An objective clinical assessment was made using the Constant scale, the subjective satisfaction scale, VAS, and the DASH scale to measure disability. The radiological assessment included AP and axial X-rays in the scapular plane. RESULTS: Forty-six patients were enrolled. The clinical assessment showed that 91.3% of them were satisfied with treatment. Mean mobility was 1550 of flexion, 600 of lateral and medial rotation. The mean Constant score was 70 and the DASH score was 15. Significant differences were found in the Constant score in individuals under 60 years of age, but they were not significant considering the type of fracture or the DASH score. X-rays showed a healing rate of 95.7%, with two cases of pseudarthrosis. Varus healing was observed in 17 patients (38.6%). Functional differences were found when patients with varus healing were compared with those who had anatomical healing. DISCUSSION: Fixation with intramedullary nailing is an effective treatment for fractures of the proximal humerus, particularly for two-segment fractures of the surgical neck. The high rate of varus collapse, particularly in very comminuted fractures, may lead to decreased mobility.

Modulación del crecimiento de columnas escolióticas en animales de experimentación mediante el uso de barras de metal inteligente / Modulation of scoliotic spine growth in experimental animals using intelligent metal bars

Objetivo. Creación de un modelo experimental de escoliosis estructurada en ratas para evaluar la eficacia de los metales con memoria de forma para corregir gradualmente la deformidad a lo largo del tiempo. Material y método. Se generó una escoliosis experimental en ratas de 3 semanas mediante una sutura entre escápula y pelvis izquierdas durante 8 semanas, tras lo cual fueron aleatorizadas en 2 grupos: control, en los que se cortó la sutura, y nitinol, en los que además se implantó un alambre recto con memoria de forma anclado a la columna. Se realizaron radiografías seriadas para determinar la eficacia del nitinol en la corrección de la escoliosis. En un segundo tiempo, evaluamos los cambios histológicos a nivel del cuerpo vertebral apical y discos adyacentes pre y poscorrección. Resultados. Se indujo una cifoescoliosis progresiva media de 81,5°. En el grupo control, tras cortar la sutura, se produjo una reducción inicial de la deformidad pero luego permaneció estable a lo largo del tiempo (54° a las 2 semanas). En el grupo nitinol se observó una reducción progresiva del valor angular de la escoliosis, hasta 8,7° de media a las 2 semanas. El acuñamiento del cuerpo vertebral apical y de los discos adyacentes se corregía parcialmente tras 2 semanas de corrección de la deformidad. Conclusión. En este modelo de escoliosis, un alambre recto de nitinol anclado a la columna ha demostrado eficacia para la corrección gradual de la cifoescoliosis, y de los cambios estructurales asociados a la misma (AU)

Objective: To create an experimental structural scoliosis model in mice to evaluate the efficacy of shape-memory metals to gradually correct the deformity over time. Material and method: Experimental scoliosis was generated in 3 week-old mice by means of a suture between the left scapula and pelvis for 8 weeks. They were then randomised into two groups: a control group, in which the suture was cut, and another, in those that also had a Nitinol straight memory-wire implant fixed to the column. Serial X-rays were performed to determine the efficacy of the Nitinol in the correction of the scoliosis. In a second time, the histological changes at apical vertical body level and the adjacent discs were evaluated preand post-correction. Results: A mean 81.5◦ kyphoscoliosis was gradually induced. In the control group, after cutting the suture, an initial reduction in the deformity was observed, but later it remained stable throughout the time (54◦ at two weeks). In the Nitinol group, a gradual reduction was observed in the scoliosis angle value, to a mean of 8.7◦ at two weeks. The curvature of the apical vertebral body and adjacent discs were partially corrected after two weeks of correcting the deformity. Conclusion: This scoliosis model has demonstrated the efficacy of a straight Nitinol wire fixed to the spinal column in the gradual correction of kyphoscoliosis and in the changes in its adjacent structures (AU)

[Modulation of scoliotic spine growth in experimental animals using intelligent metal bars]. / Modulación del crecimiento de columnas escolióticas en animales de experimentación mediante el uso de barras de metal inteligente.

OBJECTIVE: To create an experimental structural scoliosis model in mice to evaluate the efficacy of shape-memory metals to gradually correct the deformity over time. MATERIAL AND METHOD: Experimental scoliosis was generated in 3 week-old mice by means of a suture between the left scapula and pelvis for 8 weeks. They were then randomised into two groups: a control group, in which the suture was cut, and another, in those that also had a Nitinol straight memory-wire implant fixed to the column. Serial X-rays were performed to determine the efficacy of the Nitinol in the correction of the scoliosis. In a second time, the histological changes at apical vertical body level and the adjacent discs were evaluated pre- and post-correction. RESULTS: A mean 81.5° kyphoscoliosis was gradually induced. In the control group, after cutting the suture, an initial reduction in the deformity was observed, but later it remained stable throughout the time (54° at two weeks). In the Nitinol group, a gradual reduction was observed in the scoliosis angle value, to a mean of 8.7° at two weeks. The curvature of the apical vertebral body and adjacent discs were partially corrected after two weeks of correcting the deformity. CONCLUSION: This scoliosis model has demonstrated the efficacy of a straight Nitinol wire fixed to the spinal column in the gradual correction of kyphoscoliosis and in the changes in its adjacent structures.

Minimally invasive poly-axial screw plating for three-part fractures of the proximal humerus.

The purpose of this study was to evaluate the poly-axial locked plating system inserted through a minimally invasive approach for the treatment of three-part fractures of the proximal humerus. Twenty-three patients with a three-part fracture of the proximal humerus treated with a poly-axial locking plate through a percutaneous approach were available for clinical and radiological analysis at a minimum of 2 years follow up (average 36 months; range, 24-54 months). To assess objective and subjective outcomes the Constant Score (CS) and the Disabilities of the Arm, Shoulder, and Hand (DASH) score were obtained. All complications were recorded. There were 17 women and 6 men, with a mean age of 62 years (range, 18-86). All fractures healed. At final follow up, the mean forward flexion, external rotation and internal rotation were 126°, 44° and L1, respectively; the mean CS was 64 and the mean DASH score was 23. Twelve patients (52%) had a postoperative complication, which included screw cut-out, stiffness and infection. The poly-axial locked plating system through a minimally-invasive approach may be an appropriate treatment for three-part fractures of the proximal humerus and may reduce the biological aggression of conventional plate fixation.

Resultados funcionales tras la reparación artroscópica de roturas masivas del manguito rotador: influencia de la aplicación de plasma rico en plaquetas asociado a fibrina / Functional results after arthroscopic repair of massive rotator cuff tears; influence of the application platelet-rich plasma combined with fibrin

Objetivo. El objetivo de este trabajo es investigar si la aplicación de plasma rico en plaquetas con alto contenido en fibrina a la zona de reparación de roturas masivas del manguito de los rotadores tratadas mediante técnicas artroscópicas mejora los resultados funcionales y disminuye el índice de reroturas. Material y método. 28 enfermos (20 mujeres y 8 varones) con una edad media de 65 años (rango: 53 a 78) diagnosticados de una rotura masiva del manguito rotador (dos tendones afectados>5cm) fueron incluidos en este estudio prospectivo y aleatorizado. En todos los enfermos se realizó una reparación completa artroscópica del manguito rotador con técnica de una hilera. En 14 pacientes una vez finalizada la reparación se aplicó en la zona de transición osteotendinosa un concentrado de plasma rico en plaquetas y alto contenido de fibrina, mientras que en 14 enfermos se realizó la reparación sin ningún aporte de factores de crecimiento. Se evaluaron los resultados funcionales con la escala de Constant al año de la intervención, así como una artro-RM para comprobar la integridad del tendón reparado. Resultados. No hubo complicaciones ni reoperaciones en ninguno de los dos grupos. El Constant preoperatorio mejoró 30 puntos en el grupo sin PRP y 26 puntos en el grupo con PRP, sin diferencias entre ambos grupos. En el estudio de artro-RM 9 pacientes mostraban integridad de la reparación (32%), 4 presentaban una fuga de contraste y 15 una rerotura franca. No se encontraron diferencias en índice de reroturas entre el grupo en el que se aplicó plasma rico en plaquetas y en el que no. Conclusiones. La reparación artroscópica de roturas masivas del manguito rotador ofrece unos resultados clínicos satisfactorios a pesar de un elevado índice de nuevas roturas. La aplicación de plasma rico en plaquetas no mejora los resultados clínicos ni disminuye el índice de reroturas (AU)

Objective. The aim of this work is to investigate whether the application of platelet-rich plasma (PRP) with a high fibrin content in the repair area of massive rotator cuff tears treated using arthroscopic techniques improves the functional results and decreases the number of re-tears. Material and method. This prospective, randomised study included 28 patients (20 females and 8 males) with a mean age of 65 years (range: 53 to 78) and diagnosed with a massive rotator cuff tear (two tendons affected, >5cm). A complete single row arthroscopic repair of the rotator cuff was performed on all patients. A concentrate of platelet rich plasma with a high fibrin content was applied to the osteotendinous transition area in 14 patients after the operation, whilst in the other 14 patients the repair was performed without any growth factor support. The functional results were evaluated with the Constant scale, as well as an arthro-MRI to check the integrity of the repaired tendon one year after the operation. Results. There were no complications or repeat operations in any of the two groups. The pre-operative Constant results improved 30 points in the group without PRP and 26 points in the group with PRP, with no significant differences between both groups. In the arthro-MRI study, integrity of the repair was observed in 9 (32%) patients, whilst 4 had a contrast leak and 15 a clear re-tear. No differences were found in the number of re-tears between the group in which the platelet-rich plasma was applied and in the one where it was not applied. Conclusions. The arthroscopic repair of massive rotator cuff tears gives clinically satisfactory results, despite a high rate of new tears. The application of platelet-rich plasma did not improve the clinic results or decrease the number of re-tears (AU)

Rigidez de codo postraumática / Elbow stiffness

Objetivo: La pérdida de movilidad del codo puede producir una grave limitación funcional. Las causas todavía no están claras y el grado de limitación funcional puede ser variable. La llegada de nuevas estrategias terapéuticas y la introducción de las técnicas artroscópicas han renovado el interés por esta afección. Material y método: Se realiza una discusión de la bibliografía médica para guiar la toma de decisiones de este difícil problema. Conclusiones: Las técnicas artroscópicas han introducido un método fiable para el tratamiento de la rigidez de codo moderada con el coste de un riesgo potencial de lesión de las estructuras neurovasculares locales. La capsulectomía abierta ha demostrado buenos resultados y es capaz de conseguir una ganancia de 50º en la mayor parte de los casos. Los casos con lesión articular se pueden tratar con una artroplastia de interposición o con una prótesis de codo, dependiendo de la edad y del grado de daño articular (AU)

Purpose: Loss of elbow mobility can result in a severe functional limitation. Its causes remain unclear and the degree of functional limitation may be variable. The advent of new therapeutic strategies and the introduction of arthroscopic techniques have rekindled interest in this pathology. Materials and methods: A review of the literature is carried out in order to assist the reader in making decisions concerning this complicated disorder (AU)

Prótesis parcial de hombro: revisión de conceptos básicos / Shoulder hemiarthroplasty: review of basic concepts

El objetivo de este trabajo es ofrecer una visión clara, completa y asequible sobre la artroplastia parcial de hombro, revisando los tipos de diseño y generaciones protésicas, técnicas de fijación, indicaciones y resultados. Actualmente, la artroplastia parcial de hombro ha demostrado resultados satisfactorios, reproducibles y duraderos en la resolución de cuadros clínicos como la artrosis glenohumeral, la necrosis avascular y la artritis reumatoide. En patologíadel manguito rotador y fracturas de húmero proximal ysus secuelas, los resultados son menos reproducibles. Laimitación de la anatomía, la mejora en técnicas de fijación de vástagos, las características del tamaño y orientación del segmento cefálico, y la preservación de las tuberosidades y el manguito rotador son fundamentales para la obtención de buenos resultados clínicos. La prótesis de superficializaciónpuede ser una opción válida y más conservadora. La artroplastia bipolar todavía debe demostrar sus ventajas teóricas

The aim of this publication is to offer a complete, easy-tounderstand and comprehensive overview on shoulder hemiarthroplasty focusing on the different design types, prosthetic generations, fixation techniques, indications and results.Nowadays, shoulder hemiarthroplasty has led to satisfactory, reproducible and lasting results in addressing conditions like glenohumeral arthritis, avascular necrosis and rheumatoid arthritis. In rotator cuff pathology and in proximal humeral fractures and their sequelae, results have been less predictable. Reproducing the patient’s anatomy, improvingstem fixation techniques and the size and orientationcharacteristics of the head component and preserving the tuberosities and the rotator cuff are essential for a good clinical outcome. Resurfacing could be a valid and more bonepreserving option. The advantages of bipolar arthroplasty are still to be demonstrated

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