Birmingham mid-head resection periprosthetic fractures: Case report.

INTRODUCTION: Total hip arthroplasty in young patients can cause problems when it comes to choosing a suitable implant. The Birmingham Mid-Head Resection prosthesis (BMHR) offers the option of preserving bone stock despite its poor quality in the femoral neck. Femoral neck fractures are a known complication of hip resurfacing prostheses and the main reason for revision surgery. Retaining the femoral implant may cause difficulties in osteosynthesis carried out with implants habitually used for intertrochanteric or femoral neck fractures (e.g., a screw-plate device or a cephalomedullary nail) [2]. PRESENTATION OF CASE: We present the case of an 81-year-old patient who underwent surgery for right hip osteoarthritis and received a Birmingham Mid-Head Resection prosthesis. She had no history of previous fractures due to frailty. While on holiday, she sustained a periprosthetic fracture as a result of a fall. While the most common fracture in resurfacing prosthesis is produced in the femoral neck, in this case the patient sustained a subtrochanteric fracture. This fracture was surgically treated by means of open reduction and internal fixation with trochanteric plate and three cerclages. DISCUSSION: Olsen et al. [8] described two fracture patterns: transcervical vertical shear type and subcapital type. In our patient's case, the fracture pattern was different to those described, as the fracture started in the cervical area and reached the subtrochanteric area. This change in the standard periprosthetic fracture pattern leads to a change in the therapeutic attitude that must be adopted. CONCLUSION: BMHR prostheses are metal-on-metal implants that resulted from the development of the standard resurfacing prostheses used to treat hip osteoarthritis in young patients with the goal of preserving as much bone stock as possible. In this paper we will describe a rare complication in this type of prosthesis and how it was surgically treated after reviewing the available literature.

Differences in pain perception, health-related quality of life, disability, mood, and sleep between Brazilian and Spanish people with chronic non-specific low back pain

ABSTRACT Background Cultural and social factors play an important role in the development and persistence of Low Back Pain (LBP). Nevertheless, there are few studies investigating differences in LBP features between countries. Objective To determine differences in pain perception between individuals with LBP living in Brazil and Spain. Method Thirty Spanish individuals and 30 age- and sex-comparable Brazilian individuals with LBP were recruited from the Public Health Services of both countries. The Numerical Pain Rating Scale and the pain rating index (PRI), the number of words chosen (NWC), and the present pain index (PPI) extracted from the McGill Pain Questionnaire were used to assess pain. The Oswestry Disability Index, the Short Form-36, Beck Depression Inventory-II, and Pittsburgh Sleep Quality Index were also applied. Differences between countries and the correlation between demographic and clinical variables in each country were assessed with parametric and the nonparametric tests. Results A significant Country by Gender interaction was found for the PRI total score (P=0.038), but not for intensity of pain, disability, PPI, or NWC, in which Spanish women exhibited greater pain ratio than Spanish men (P=0.014), and no gender differences were identified in Brazilians. The Spanish group showed a consistent pattern of correlations for clinical data. Within Brazilian patients, fewer correlations were found and all of the coefficients were lower than those in the Spanish group. Conclusion The pain perception in patients with LBP is different depending on the country. Within Spanish patients, LBP is considered a more global entity affecting multidimensional contexts.

Differences in pain perception, health-related quality of life, disability, mood, and sleep between Brazilian and Spanish people with chronic non-specific low back pain.

BACKGROUND: Cultural and social factors play an important role in the development and persistence of Low Back Pain (LBP). Nevertheless, there are few studies investigating differences in LBP features between countries. OBJECTIVE: To determine differences in pain perception between individuals with LBP living in Brazil and Spain. METHOD: Thirty Spanish individuals and 30 age- and sex-comparable Brazilian individuals with LBP were recruited from the Public Health Services of both countries. The Numerical Pain Rating Scale and the pain rating index (PRI), the number of words chosen (NWC), and the present pain index (PPI) extracted from the McGill Pain Questionnaire were used to assess pain. The Oswestry Disability Index, the Short Form-36, Beck Depression Inventory-II, and Pittsburgh Sleep Quality Index were also applied. Differences between countries and the correlation between demographic and clinical variables in each country were assessed with parametric and the nonparametric tests. RESULTS: A significant Country by Gender interaction was found for the PRI total score (P=0.038), but not for intensity of pain, disability, PPI, or NWC, in which Spanish women exhibited greater pain ratio than Spanish men (P=0.014), and no gender differences were identified in Brazilians. The Spanish group showed a consistent pattern of correlations for clinical data. Within Brazilian patients, fewer correlations were found and all of the coefficients were lower than those in the Spanish group. CONCLUSION: The pain perception in patients with LBP is different depending on the country. Within Spanish patients, LBP is considered a more global entity affecting multidimensional contexts.

Visual function and quality of life in pseudophakic patients before and after capsulotomy.

PURPOSE: To assess the correlation between visual acuity, visual function, and health-related quality of life before and after neodymium:YAG laser posterior capsulotomy. METHODS: A total of 150 patients with posterior capsule opacification (PCO) were examined before and after capsulotomy. Ocular examination, visual acuity, patient reports of satisfaction with vision, and disease-specific (VF-14 Index of Visual Functions) and generic (EuroQol: EQ-5D) outcomes were measured at baseline and 3 weeks after treatment. RESULTS: After capsulotomy, patients showed significant improvements in binocular visual acuity, VF-14 index, satisfaction with vision, and EQ-5D measures. The average gains in visual function and quality of life were apparent in groups with good visual outcome and poor visual outcome. The VF-14 score improvement was moderately correlated with the EuroQol Visual Analogue Scale score improvement, showing stronger correlations with changes in self-reported satisfaction with vision than did gains in binocular visual acuity. CONCLUSIONS: Measuring of the outcomes of capsulotomy by clinical indicators alone may underestimate the overall benefits of treatment. Visual acuity in conjunction with visual function and health-related quality of life questionnaires will likely prove to be better indicators of the need for and outcome of capsulotomy.

Apósitos de colágeno en polvo en la cicatrización de heridas por segunda intención / Collagene powder dressings use for cicatrisation over wounds during follow up treatment

Las heridas significan no sólo un importante problema bio-psico-social para el paciente que las padece, sino también un importante gravamen económico para el sistema sanitario. Una de las muchas clasificaciones sobre heridas nos permite diferenciar entre agudas (traumatismos leves, heridas quirúrgicas...) y crónicas (úlceras por presión, ulceras vasculares...); esta diferenciación nos permite distinguir entre cicatrización por primera intención (aquella que se da en las heridas agudas) y que se caracteriza por no necesitar el relleno de ninguna cavidad. Y la cicatrización por segunda intención (por la que normalmente se resuelven las heridas crónicas), que constituye un proceso largo en el tiempo dado que necesita el relleno de la cavidad mediante tejido de neoformación, el tejido de granulación.En el presente artículo describimos la utilización de un nuevo apósito de colágeno exógeno (Catrix®) en la cicatrización de heridas por segunda intención, así como las acciones del mismo en las diferentes fases de la cicatrización. Para todo ello, nos apoyamos en un caso clínico tratado en nuestra unidad que corresponde a la cicatrización por segunda intención de una herida post-quirúrgica secundaria a un desbridamiento por una hidrosadenitis supurativa, que ingresó en nuestra unidad en espera de injerto cutáneo (AU)

[Collagen powder dressings in the healing of secondary intention wounds. Report of a case]. / Apósitos de colágens en polvo en la cicatrización de heridas por segunda intención. A propósito de un caso.

The wounds mean not only an important bio-psico-social problem for the patient who suffers them, but also an important economic burden for the sanitary system. One of the many wounds classifications allows us to differentiate between acute wounds (slight traumatism, surgical wounds...) and chronic wounds (pressure ulcers, vascular ulcers...), this differentiation allows us to distinguish between wound healing by primary intention (that occurs in acute wounds where filling of cavity is not needed). And wound repair by secondary intention (the way by which chronic wounds are normally solved), a long process in time that needs the filling of the cavity with a neoformation tissue, the granulation tissue. In the present article we described the use of a new dressing of exogenous collagen (Catrix) in the healing of wounds by secondary intention, as well as the actions of this dressing in the different phases of healing. For all it, we supported by a clinical case treated in our unit that corresponds to the healing by second intention of a post-surgical wound secondary to debride by a suppurative hydrosadenitis, that was admitted to our unit waiting for skin graft.