La artroplastia invertida de hombro ante defectos óseos glenoideos / Reverse shoulder arthroplasty due to glenoid bone defects

Objetivo. La artroplastia invertida se está convirtiendo en una herramienta útil para afecciones muy variadas en el hombro. Un defecto óseo importante de la glena puede afectar a la fijación del componente glenoideo. El propósito de nuestro estudio es evaluar a medio plazo los resultados de la artroplastia invertida de hombro asociados a una glenoplastia. Material y métodos. Se realizó un estudio retrospectivo de 5 pacientes de nuestro hospital con defectos glenoideos de distinta etiología que fueron tratados mediante artroplastia invertida de hombro asociada a glenoplastia. Resultados. El seguimiento mínimo de estos pacientes fue de un año (con una media de 30,4 meses). Todos los injertos estaban radiológicamente integrados, sin observarse signos de resorción o necrosis. A los 12 meses el test de Constant era de 66,75 de media y el EVA medio era de 1. Discusión. La glenoplastia es una intervención de alta demanda técnica que consigue restaurar el remanente óseo en pacientes con defectos estructurales, permitiendo así implantar una artroplastia invertida. De esa forma podemos mejorar la función y la clínica en pacientes con diversas afecciones glenohumerales, proporcionándoles una solución (AU)

Objective. Reverse shoulder arthroplasty is becoming a useful tool for many diseases of the shoulder. Any severe glenoid bone defect may affect the fixing of the glenoid component. The aim of this paper is to evaluate the medium-term outcomes of reverse shoulder arthroplasty associated with a glenoplasty. Materials and methods. A retrospective study was conducted on 5 patients from our hospital, selected due to glenoid defects of different etiology. All of them where treated with reverse shoulder arthroplasty associated with glenoplasty with bone graft. Results. The minimum follow-up was one year (mean 30.4 months). All grafts were radiologically integrated, with no signs of resorption or necrosis being observed. At 12 months, the Constant score was 66.75 and the mean EVA score was 1. Discussion. Glenoplasty surgery is technically demanding for restoring original bone size in patients with glenoid structural defects, enabling a reverse shoulder arthroplasty to be implanted. Thus improving both the function and clinical outcomes in selected patients with glenohumeral pathology and providing them with a solution (AU)

Reverse shoulder arthroplasty due to glenoid bone defects. / La artroplastia invertida de hombro ante defectos óseos glenoideos.

OBJECTIVE: Reverse shoulder arthroplasty is becoming a useful tool for many diseases of the shoulder. Any severe glenoid bone defect may affect the fixing of the glenoid component. The aim of this paper is to evaluate the medium-term outcomes of reverse shoulder arthroplasty associated with a glenoplasty. MATERIALS AND METHODS: A retrospective study was conducted on 5 patients from our hospital, selected due to glenoid defects of different etiology. All of them where treated with reverse shoulder arthroplasty associated with glenoplasty with bone graft. RESULTS: The minimum follow-up was one year (mean 30.4 months). All grafts were radiologically integrated, with no signs of resorption or necrosis being observed. At 12 months, the Constant score was 66.75 and the mean EVA score was 1. DISCUSSION: Glenoplasty surgery is technically demanding for restoring original bone size in patients with glenoid structural defects, enabling a reverse shoulder arthroplasty to be implanted. Thus improving both the function and clinical outcomes in selected patients with glenohumeral pathology and providing them with a solution.

Guía SECOT-GEIOS en osteoporosis y fractura por fragilidad. Actualización / SECOT-GEIOS guidelines in osteoporosis and fragility fracture. An update

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Reconstrucción de defecto troclear lateral traumático con autoinjerto de cabeza radial / Reconstruction of a traumatic lateral trochlear defect with a radial head autograft

Objetivo. Presentar el resultado de la reparación de un defecto troclear severo en el codo mediante un autoinjerto óseo con la cabeza radial ipsilateral, como una alternativa a la artroplastia total. Caso clínico. Presentamos el caso de un paciente, que sufrió una fractura abierta de codo con pérdida ósea importante en la región humeral distal, y que precisó tras la estabilización inicial una cirugía de reconstrucción mediante autoinjerto ipsilateral de cabeza radial. Discusión. Las fracturas abiertas de codo son infrecuentes. Cuando existe un defecto troclear severo, las alternativas quirúrgicas son la artroplastia total de codo, con unos resultados a corto y medio plazo que parecen ser insuficientes, o la artrodesis. Creemos que la reconstrucción del defecto empleando un autoinjerto de cabeza radial homolateral es una alternativa más funcional que los otros procedimientos descritos. Conclusión. La reconstrucción con cabeza radial ipsilateral de los defectos trocleares laterales es una técnica, que al contrario que la artrodesis, conserva la funcionalidad sin los inconvenientes de la artroplastia total de codo (AU)

Objective. To report the result of a severe articular defect secondary to a complex open fracture of the distal humerus, using the ipsilateral radial head as a bone autograft for the trochclear region as an alternative to total arthroplasty. Case report. We describe a patient who suffered an open fracture of the elbow with bone loss in the distal humeral region and, after the initial stabilisation surgery, needed a reconstruction with an ipsilateral radial head autograft. Discussion. Open fractures of elbow are rare. When there is a severe trochlear defect, surgical options are total elbow arthroplasty, where the short and medium term results appear to be insufficient, or elbow arthrodesis. We believe that reconstruction of the defect using an ipsilateral radial head autograft is a more functional alternative than the other procedures described. Conclusion. Radial head reconstruction with ipsilateral lateral trochlear defects is a technique that, unlike fusion, preserves functionality without the problems of total elbow arthroplasty (AU)

Aspectos de interés para el cirujano ortopédico y traumatólogo sobre la vitamina D / Aspects of interest on vitamin D for the traumatologist and orthopaedic surgeon

La deficiencia (insuficiencia o deficiencia) de vitamina D es un problema clínico especialmente prevalente en ancianos con fracturas de baja energía, sobre todo de cadera, aunque también se ha relacionado con fracturas de estrés y de alta energía. Son muchas las evidencias que apoyan la necesidad de mantener unos niveles adecuados de vitamina D en sangre para reducir el número de fracturas por fragilidad, favorecer la consolidación de las mismas, mejorar la función neuromuscular de los pacientes, evitar las caídas, prevenir las infecciones quirúrgicas o mejorar la duración de las artroplastias. Sin embargo, no es habitual que el cirujano ortopédico y traumatólogo considere determinar los valores de vitamina D en este tipo de pacientes e instaurar el tratamiento adecuado. Se recomienda mantener niveles superiores a 30-40ng/ml (75-100nmol/l) de vitamina D y la ingesta, en casi todos los casos, de 800 a 1.000UI/día de vitamina D para alcanzar estos niveles (AU)

Vitamin D deficiency or insufficiency is a clinical problem particularly prevalent in elderly patients with low-energy fractures, particularly hip fractures, but has also been associated with stress fractures and high energy fractures. There is much evidence that supports the need to maintain adequate levels of vitamin D in the blood in order to; reduce the number of fragility fractures, furthering the consolidation of these, improve neuromuscular function of patients, prevent falls, prevent surgical infections, or improve the length of arthroplasties. However, it is rare for the orthopaedic surgeon to request the values of vitamin D in these patients and give the appropriate treatment It is recommended to maintain levels higher than 30-40ng/ml (75-100nmol/l) and increase vitamin D intake, in almost all cases, from 800 to 1,000IU/day to achieve these levels (AU)

[Aspects of interest on vitamin D for the traumatologist and orthopaedic surgeon]. / Aspectos de interés para el cirujano ortopédico y traumatólogo sobre la vitamina D.

Vitamin D deficiency or insufficiency is a clinical problem particularly prevalent in elderly patients with low-energy fractures, particularly hip fractures, but has also been associated with stress fractures and high energy fractures. There is much evidence that supports the need to maintain adequate levels of vitamin D in the blood in order to; reduce the number of fragility fractures, furthering the consolidation of these, improve neuromuscular function of patients, prevent falls, prevent surgical infections, or improve the length of arthroplasties. However, it is rare for the orthopaedic surgeon to request the values of vitamin D in these patients and give the appropriate treatment It is recommended to maintain levels higher than 30-40ng/ml (75-100nmol/l) and increase vitamin D intake, in almost all cases, from 800 to 1,000IU/day to achieve these levels.

[Reconstruction of a traumatic lateral trochlear defect with a radial head autograft]. / Reconstrucción de defecto troclear lateral traumático con autoinjerto de cabeza radial.

OBJECTIVE: To report the result of a severe articular defect secondary to a complex open fracture of the distal humerus, using the ipsilateral radial head as a bone autograft for the trochclear region as an alternative to total arthroplasty. CASE REPORT: We describe a patient who suffered an open fracture of the elbow with bone loss in the distal humeral region and, after the initial stabilisation surgery, needed a reconstruction with an ipsilateral radial head autograft. DISCUSSION: Open fractures of elbow are rare. When there is a severe trochlear defect, surgical options are total elbow arthroplasty, where the short and medium term results appear to be insufficient, or elbow arthrodesis. We believe that reconstruction of the defect using an ipsilateral radial head autograft is a more functional alternative than the other procedures described. CONCLUSION: Radial head reconstruction with ipsilateral lateral trochlear defects is a technique that, unlike fusion, preserves functionality without the problems of total elbow arthroplasty.

Análisis morfológico, biomecánico y textural de imágenes de densitómetro central DEXA como complemento diagnóstico de la osteoporosis / Morphological, textural and biomechanical analysis of central DXA images as a diagnostic complement of osteoporosis

Objetivo: analizar asistido por ordenador, imágenes densitométricas digitalizadas de cadera mediante DEXA, para determinar su utilidad en el análisis textural óptico-fractal del hueso, y diferenciar poblaciones con densidad mineral ósea (DMO) de rango normal, osteopénico u osteoporótico. Una única prueba diagnóstica, obtendría además de la DMO, otros parámetros relacionados con la estructura y resistencia ósea. Material y método: se seleccionaron imágenes densitométricas DEXA de cadera de 18 pacientes con DMO en rango normal, 16 pacientes osteopénicos y otros 16 pacientes osteoporóticos, efectuando sobre ellas un análisis morfológico, biomecánico y textural-fractal mediante el programa informático Q-Bone®. Resultados: Las variables morfológicas y biomecánicas analizadas proporcionan una información complementaria y discriminadora entre los referidos grupos. Sin embargo, el análisis textural fractal uni o multidireccional aportó escasa información adicional, aunque asociado a variables ópticas (densidad lumínica) permitió una mayor capacidad de diferenciación entre grupos de pacientes con DMO en rango normal y patológico

Objective: the computational analysis of digitized hip densitometric DXA images to determining if this type of images are useful for the optical-fractal textural analysis of bone, and, to differentiate better among populations with normal, osteopenic or osteoporótic bone mineral density (BMD) levels. Material and methods: DXA densitometric hip images of 18 patients with normal BMD, 16 patients with osteopenic BMD levels and 16 patients with osteoporotic BMD levels were selected. Morphological, biomechanical and texturalfractal analyses of these images were carried out by means of Q-Bone® software. Results: the analyzed morphological and biomechanical variables give complementary and discriminating information between the referred groups. Nevertheless, the unidirectional and multidirectional fractal textural analysis give only a little additional information, although when associated to optical variables (luminic density) seem to add a greater capacity of differentiation between groups of patients with normal and pathological BMD

[The role of malnutrition and other medical factors in the evolution of patients with hip fracture]. / Importancia de la malnutrición y otros factores médicos en la evolución de los pacientes con fractura de cadera.

As the population progressively ages, hip fractures have become increasingly common and are associated with high morbidity and mortality and a pronounced decline in functional status. Hip fractures frequently occur in elderly patients with a high rate of comorbidity and polymedication. Patients hospitalised with hip fractures often display signs of protein malnutrition and may develop medical complications requiring intrahospital care. These factors, more than simply surgical ones, unfavourably influence the vital status and functional outcome of these patients. For this reason, it is necessary to improve the management of pre-existing conditions during hospitalisation, assess and treat malnutrition and prevent medical complications to achieve optimal outcomes for these patients. With this objective, we believe that care should be provided by multidisciplinary teams in close partnership with internists.

Importancia de la malnutrición y otros factores médicos en la evolución de los pacientes con fractura de cadera / The role of malnutrition and other medical factors in the evolution of patients with hip fracture

Debido al progresivo envejecimiento de la población, la fractura de cadera es una patología cada vez más frecuente, que además conlleva una gran morbimortalidad y un enorme deterioro funcional. Habitualmente son pacientes ancianos, con un alto índice de comorbilidad y una marcada polimedicación. Es frecuente que al ingreso presenten desnutrición, sobre todo de predominio proteico, y que desarrollen complicaciones médicas intrahospitalarias. Todos estos factores, más que los meramente quirúrgicos, influyen de forma negativa en el pronóstico vital y funcional de estos enfermos. Por ello, sería necesario mejorar el control de la patología previa del paciente durante su hospitalización, valorar y tratar la malnutrición y prevenir las complicaciones médicas para intentar mejorar el pronóstico de estos enfermos. Para ello creemos que es necesario que sean atendidos por equipos multidisciplinarios y pensamos que el internista debería formar parte de estos equipos (AU)

Osteonecrosis of the tibial plateau.

The clinical, radiographic and scintigraphic findings in 12 patients diagnosed with osteonecrosis of the tibial plateau (10 of the medial and two of the lateral plateau) were analysed. The disease presented suddenly in most of the patients, as acute pain in the lateral side of the knee, with no major traumatic antecedents. X-ray findings were varied and non-specific, and hence of little value for initial diagnosis. On the other hand, scintigraphic findings were very useful for diagnostic purposes in all cases. All the patients were over 55 years of age and 11 out of 12 were women. The most frequent location of the disease was the medial tibial plateau; however, two cases involved the lateral plateau and two involved both plateaux. Seven patients were subjected to full knee arthroplasty, four to valgising osteotomy and one to grafting. The patients' diagnoses were considerably delayed (by more than 6 months), which affected their treatment and prognosis.

Enthesopathy in leprosy.

OBJECTIVE: To determine whether patients with leprosy have enthesopathy at the calcaneus of plantar fascia. METHODS: In a radiographic study of over 3 years, we investigated the presence and location of enthesophytes in patients with leprosy compared to healthy age and sex matched controls with no evidence of bone or joint disease. RESULTS: Calcaneus enthesopathy occurred significantly more frequently in patients with leprosy than in controls, but no difference in the location of enthesophytes was found between the 2 groups. Calcaneus spurs were detected more frequently in lepromatous patients than in tuberculoid patients. CONCLUSION: Enthesitis is a manifestation of leprosy and may be more common in lepromatous than in tuberculoid patients.

[Multicenter comparative study of synthetic salmon calcitonin administered nasally in the treatment of established postmenopausal osteoporosis]. / Estudio comparativo multicéntrico de la calcitonina sintética de salmón, administrada por vía nasal en el tratamiento de la osteoporosis postmenopáusica establecida.

We study the effectivity and tolerance of synthetic salmon calcitonin nasally administered (Miacalcic) in the treatment of established postmenopausic osteoporosis. During one year, two randomized groups of postmenopausic women diagnosed of osteoporosis were treated in an outpatient service either with 1 gr of calcium element per day during the whole study or with 100 daily I.U. of salmon synthetic calcitonin nasally administered in patterns of 14 days and the same period of rest, plus a supplement of 500 mgr of calcium element per day. Globally, 43 patients were assessed at the end of the study in the calcitonin plus calcium group and 45 in the group receiving only calcium. The main evaluation parameters were pain and presence of new fractures. At the beginning and at the end of the study, complementary tests of blood biochemistry were conducted, including alkalin phosphatase, calcium, phosphorus and uric acid, as well as calcium, hydroxiprolin and creatinini in the urine. The results showed a significant improvement of pain (p < 0.001) in the group treated with calcitonin, supported by a lower consumption of analgesics. The rate of vertebral fractures determined according to the Meunier's index, was also significantly lower (p < 0.001) in the group treated with calcitonin at the end of the study period. These results suggest that, compared to only calcium, nasally administered calcitonin precludes the formation of new vertebral fractures during one year of treatment and it is effective in terms of pain reduction.(ABSTRACT TRUNCATED AT 250 WORDS)

Modifications of the normal sonographic image in gluteal fibrosis.

There is no reference in the literature to the use of sonography in the diagnosis of muscular fibrosis. In this paper we report the sonographic findings observed in forty patients who had marked limitation of flexion of the hip joint and tightness and atrophy of the gluteal muscles from increased fibrous tissue in the gluteal musculature.

[The vascular risk factors in patients with adult ischemic necrosis of the femur head]. / Factores de riesgo vascular en pacientes con necrosis isquémica de cabeza femoral del adulto.

The authors studied 23 patients affected by ischemic necrosis of the femoral head, following a common standardised protocol, highlighting the habit (smoking and alcohol intake), lipids and biochemist parameters, as vascular risk factors to sufferers of this disease. They found that with the smoking habit, the high intake of lipids and the excess of alcohol ingestion were significant in the studied group. Neither obesity nor blood hypertension were significant. This supports the vascular etiology of ischemic necrosis of femoral head in adults.