Uso de catéter intraarticular en fast track de artroplastia primaria de rodilla. ¿Supone un avance? / The use of an intraarticular catheter on fast-track primary knee arthroplasty, is it a step forward?

Objetivo. Comparar la eficacia en el control del dolor postoperatorio de pacientes sometidos a artroplastia total de rodilla primaria comparando catéter intraarticular versus epidural. Material y método. Ensayo clínico aleatorizado formado por dos grupos de pacientes: un grupo control con anestesia intradural y un catéter epidural (ropivacaína) y un grupo de intervención con la misma técnica anestésica, a la que se añadió un catéter intraarticular con bomba elastomérica (ropivacaína + dexketoprofeno). Se registraron variables demográficas, anestésicas y quirúrgicas, intensidad del dolor según Escala Verbal Numérica, consumo de opiáceos y complicaciones, balance articular, inicio de la deambulación y estancia hospitalaria. Resultados. Se observó menor incidencia y severidad en la Escala Verbal Numérica en el grupo de intervención y mejor control del dolor postoperatorio (p<0,0014). El balance articular presentó resultados significativos en la flexión y el 74% de estos pacientes deambularon antes de las 36h cuando el grupo control aún no lo había hecho. El 54,1% de pacientes se mostraron «muy satisfechos» a favor del uso del catéter (p>0,001). Por último, la estancia hospitalaria disminuyó, siendo el 33,3% de los pacientes del grupo de intervención dados de alta a las 48h de la intervención, hecho que no sucedió en ninguno de los casos del grupo control. Discusión y conclusiones. El uso del catéter intraarticular como analgesia postoperatoria es una alternativa válida y segura. Disminuye la aparición de efectos secundarios y mejora el balance articular, el inicio de la deambulación y el control del dolor y contribuye a una mayor satisfacción del paciente y a un alta más precoz (AU)

Objective. This study compares the efficacy in post-operative pain control of the intraarticular catheter compared to the epidural catheter after primary total knee arthroplasty. Material and method. Randomised clinical trial consisting of two groups of patients. A control group with intradural anaesthesia and an intraoperative epidural catheter (ropivacaine) and an intervention group using the same anaesthetic technique and an intraarticular catheter with an elastomeric pump (ropivacaine+dexketoprofen). Data such as demographic, anaesthetic and surgical variables, pain intensity according to Verbal Rating Scale, opioid use and complications, joint balance, onset of walking and hospital stay were recorded. Results. A lower incidence and severity on Verbal Rating Scale and a better control of postoperative pain (p<.0014) were observed in the intervention group. Joint balance also presented significant results in flexion and 74% of these patients started walking before the first 36h and the control group had not yet done so. Regarding patient satisfaction, 54.1% of the patients were "very satisfied" with the use of the catheter (p>.001). Finally, the hospital stay decreased significantly, with 33.3% of intervention group patients discharged within the first 48h compared to none of the control group. Discussion and conclusions. The use of the intraarticular catheter as postoperative analgesia is a useful and safe alternative. It reduces the possibility of side effects. It helps in early improvement of joint balance, onset of walking and control of pain. All of which increase patient satisfaction and result in a shorter period of hospitalisation (AU)

The use of an intraarticular catheter on fast-track primary knee arthroplasty, is it a step forward? / Uso de catéter intraarticular en fast track de artroplastia primaria de rodilla. ¿Supone un avance?

OBJECTIVE: This study compares the efficacy in post-operative pain control of the intraarticular catheter compared to the epidural catheter after primary total knee arthroplasty. MATERIAL AND METHOD: Randomised clinical trial consisting of two groups of patients. A control group with intradural anaesthesia and an intraoperative epidural catheter (ropivacaine) and an intervention group using the same anaesthetic technique and an intraarticular catheter with an elastomeric pump (ropivacaine+dexketoprofen). Data such as demographic, anaesthetic and surgical variables, pain intensity according to Verbal Rating Scale, opioid use and complications, joint balance, onset of walking and hospital stay were recorded. RESULTS: A lower incidence and severity on Verbal Rating Scale and a better control of postoperative pain (p<.0014) were observed in the intervention group. Joint balance also presented significant results in flexion and 74% of these patients started walking before the first 36h and the control group had not yet done so. Regarding patient satisfaction, 54.1% of the patients were "very satisfied" with the use of the catheter (p>.001). Finally, the hospital stay decreased significantly, with 33.3% of intervention group patients discharged within the first 48h compared to none of the control group. DISCUSSION AND CONCLUSIONS: The use of the intraarticular catheter as postoperative analgesia is a useful and safe alternative. It reduces the possibility of side effects. It helps in early improvement of joint balance, onset of walking and control of pain. All of which increase patient satisfaction and result in a shorter period of hospitalisation.

[Environment and lifestyle: Impacts on male fertility?] / Toxiques, mode de vie, environnement : quels impacts sur la fertilité masculine ?

In this last century, an increase of men infertility has been registered. It has been suggested that environmental factors could a negative impact over sperm quality. Among these factors, impact of environmental toxicant has been spread by media. In this review of scientific literature, we identify several environmental factors that could impact men fertility in a negative way. These factors are tobacco, marijuana, weight, body mass index, heat, nutritional state, electromagnetic waves and altitude. For each of these factors, the impact over men fertility, their mechanism, as well their influence over the use of Assisted Reproductive Technics are reported.

Fracturas de olécranon tipo II en mayores de 65 años. ¿Banda a tensión o placa preformada? Análisis y resultados / Type II olecranon fractures in patients over 65. Tension band or pre-formed plate? Analysis and results

Objetivo. El objeto de este estudio fue comparar los resultados clínicos del tratamiento quirúrgico mediante banda a tensión con agujas y las placas preconformadas en las fracturas de olécranon tipo II de Mayo en pacientes mayores de 65 años. Material y método. Estudio descriptivo, restrospectivo, de 49 pacientes con una edad media de 75,1 años, intervenidos quirúrgicamente de fractura de olécranon mediante 2 sistemas distintos de fijación. Se empleó la clasificación de Mayo para definirlas, excluyendo los tipos i y iii, y la EVA para valorar el dolor postoperatorio. Los pacientes fueron evaluados funcionalmente mediante el cuestionario Quick DASH. A todos se les realizó medición del balance articular con goniómetro y radiografías seriadas al mes, 3, 6 y 12 meses. El seguimiento mínimo fue de un año. Resultados. En 26 pacientes se empleó la banda a tensión y en 23, las placas preformadas. No hubo diferencias estadísticamente significativas en los resultados funcionales, el balance articular ni la EVA postoperatoria entre los 2 grupos. Sí destaca una mayor proporción de pacientes a los que hubo que intervenir por problemas relacionados con el material de osteosíntesis en aquellos en los que se emplearon placas preformadas. Conclusiones. El tratamiento quirúrgico de las fracturas de olécranon tipo ii en pacientes mayores de 65 años mediante el uso de placas preformadas no aportó mejores resultados que los obtenidos mediante la fijación con banda a tensión (AU)

Objective. The objective of this study was to compare the clinical outcomes of surgical treatment using tension band with needles and preformed plates in type II olecranon fractures according to the Mayo classification in patients older than 65 years. Material and method. A descriptive, retrospective study of 49 patients with a mean age of 75.1 years who underwent surgery olecranon fracture using 2 different fixing systems. The Mayo classification was used to define them, excluding type i and iii, and the VAS to assess postoperative pain. Patients were assessed functionally by the questionnaire Quick DASH. All measurement was performed with goniometer and joint balance serial radiographs at one month, 3, 6 and 12 months. Minimum follow-up was one year. Results. In 26 patients the tension band was used and the preformed plates in 23. There were no statistically significant differences in functional outcomes, joint balance or postoperative VAS between the 2 groups. There were a greater proportion of patients who had to be operated because of problems related to osteosynthesis material in those in which preformed plates were used. Conclusions. Treatment of olecranon fractures with tension band with needles and cerclage remains the surgery of choice in patients older than 65 years (AU)

Type II olecranon fractures in patients over 65. Tension band or pre-formed plate? Analysis and results. / Fracturas de olécranon tipo ii en mayores de 65 años. ¿Banda a tensión o placa preformada? Análisis y resultados.

OBJECTIVE: The objective of this study was to compare the clinical outcomes of surgical treatment using tension band with needles and preformed plates in type ii olecranon fractures according to the Mayo classification in patients older than 65 years. MATERIAL AND METHOD: A descriptive, retrospective study of 49 patients with a mean age of 75.1 years who underwent surgery olecranon fracture using 2 different fixing systems. The Mayo classification was used to define them, excluding type i and iii, and the VAS to assess postoperative pain. Patients were assessed functionally by the questionnaire Quick DASH. All measurement was performed with goniometer and joint balance serial radiographs at one month, 3, 6 and 12 months. Minimum follow-up was one year. RESULTS: In 26 patients the tension band was used and the preformed plates in 23. There were no statistically significant differences in functional outcomes, joint balance or postoperative VAS between the 2 groups. There were a greater proportion of patients who had to be operated because of problems related to osteosynthesis material in those in which preformed plates were used. CONCLUSIONS: Treatment of olecranon fractures with tension band with needles and cerclage remains the surgery of choice in patients older than 65 years.

Manejo de heridas complejas en fractura de cadera con terapia de presión negativa / Complex wound management after hip fracture with vacuum assisted therapy

Introducción: La Terapia con Presión Negativa (TPN) se considera un método avanzado para el manejo de las heridas, ya que promueve la curación de éstas mediante la aplicación de presión negativa, de manera que el uso de niveles controlados de presión subatmosférica y succión, acelera la resolución de las heridas favoreciendo la vascularización y el desbridamiento. Material y Métodos: Presentamos el caso de una fractura extracapsular de fémur en una paciente con obesidad mórbida, en el que con el uso de la TPN se consiguió un excelente resultado clínico. Resultados Tras 4 meses de uso continuado de TPN, se consiguió la curación completa de la herida con la resolución del caso. Conclusiones: Según la evidencia científica, el tratamiento con terapia de presión negativa, constituye un avance importante en el cuidado de las heridas, tiene un importante impacto en salud, y contribuye a reducir en gran medida las posibles complicaciones

Introduction: Negative pressure therapy is considered an advanced method for handling wounds because it promotes healing by applying negative pressure, so that the use of controlled levels of subatmospheric pressure and suction accelerates resolution of wounds by promoting vascularization and debridement. Material and methods: We present the case of extracapsular hip fracture in a patient with morbid obesity, in which case, with the use of negative pressure therapy, it was achieved an excellent clinical outcome. Results After four months of continuous use of negative pressure therapy, complete wound healing was achieved with the resolution of the case. Conclusions: According to scientific evidence, treatment with negative pressure therapy is a relevant progress in wound care, it has an important impact on health and helps to greatly reduce potential complications

Artroplastia total invertida de hombro. Evaluación de resultados clínicos y complicaciones tras una serie de 52 casos / Total reverse shoulder replacement. Evaluation of the clinical results and complications in a series of 52 cases

Objetivo. Evaluar los resultados clínicos y analizar las complicaciones de las prótesis totales invertidas de hombro realizadas en nuestro centro en un periodo de 8 años. Material y método. Se ha realizado un estudio retrospectivo sobre 50 pacientes (52 hombros), con edad promedio de 70,15 años en un rango de 51 a 84 años entre diciembre del 2004 y diciembre del 2012, a los que se les ha implantado una prótesis total invertida de hombro, todos intervenidos por el mismo cirujano. Se han evaluado los resultados según la clínica, el estudio radiográfico, la encuesta de satisfacción y la escala de Constant con un seguimiento mínimo de 16 meses. Cinco de los casos (9,62%) se han intervenido por fracturas de la extremidad proximal de húmero, 6 casos (11,53%) como consecuencia de cirugías de revisión protésica, 10 casos (19,23%) por secuelas de fracturas y 31 casos (59,62%) corresponden a pacientes con artropatía por rotura masiva del manguito rotador. Resultados. Tras un seguimiento medio de 35,78 meses (rango 16-82), en los que se han obtenido resultados clínicos satisfactorios en más del 80% de los casos con un Constant preoperatorio promedio de 22,7 puntos y alcanzando los 67,1 puntos a los 12 meses de la intervención. En la escala visual analógica se han obtenido 8,25 puntos en el preoperatorio hasta disminuir a los 2,25 puntos transcurridos 12 meses. La tasa de complicaciones es del 15,38%. Estas corresponden a: fractura intraoperatoria (1,92%), fractura de acromion (1,92%), infección profunda (3,84%), inestabilidad (3,84%) y aflojamiento mecánico precoz (3,84%). En el análisis del estudio radiográfico, se observa notching escapular en 9 casos (17,3%). Discusión y conclusiones. Tras los resultados obtenidos, podemos decir que la prótesis total invertida de hombro consigue resultados alentadores a corto plazo para el tratamiento de la artrosis glenohumeral y los desgarros masivos del manguito rotador. Al analizar nuestras series, comprobamos cómo la tasa de complicaciones es mucho más elevada cuando se usa para tratar secuelas de fracturas en las que tenemos una pérdida del stock óseo del húmero proximal (AU)

Objective. To evaluate the clinical results and analyse the complications of total reverse shoulder replacement performed in our centre over an 8 year period. Material and method. A retrospective study was conducted on 50 patients (52 shoulders), with a mean age of 70.15 years (range 51 to 84 years) between December 2004 and December 2012, who received a total reverse shoulder replacement, all performed by the same surgeon. The results have been evaluated according to clinical data, radiography study, a satisfaction scale, and the Constant scale, with a minimum follow-up of 16 months. Five of the cases (9.62%) had been intervened due to fractures of the proximal end of the humerus, 6 cases (11.53%) as surgical consequence of a prosthesis revision, 10 cases (19.23%) due to fracture sequelae, and 30 cases (59.62%) were patients with arthropathy due to a massive fracture of the rotator cuff. Results. After a mean follow up of 35.78 months (range, 16-82), satisfactory clinical results were obtained in 80% of cases, with a mean preoperative Constant of 27.7 points, and reaching 67.1 points 12 months after the operation. On the visual analogue scale, 8.25 points were obtained before the surgery, which decreased to 2.25 points 12 months later. The complications rate was 15.38%, which were due to an intra-operative fracture (1.92%), deep infection (3.84%), instability (3.84%), and early mechanical loosening (3.84%). Scapular notching was observed in the radiographic study in 9 (17.3%) cases. Discussion and conclusions. After the results obtained, it could be said that total reverse shoulder replacement achieved encouraging results in the short term for the treatment of glenohumeral arthrosis and massive tears of the rotary cuff. On analysing our series, it can be seen that the complications rate is much higher when it is used to treat fracture sequelae in which there is a loss of proximal humerus bone stock (AU)

[Total reverse shoulder replacement. Evaluation of the clinical results and complications in a series of 52 cases]. / Artroplastia total invertida de hombro. Evaluación de resultados clínicos y complicaciones tras una serie de 52 casos.

OBJECTIVE: To evaluate the clinical results and analyse the complications of total reverse shoulder replacement performed in our centre over an 8 year period. MATERIAL AND METHOD: A retrospective study was conducted on 50 patients (52 shoulders), with a mean age of 70.15 years (range 51 to 84 years) between December 2004 and December 2012, who received a total reverse shoulder replacement, all performed by the same surgeon. The results have been evaluated according to clinical data, radiography study, a satisfaction scale, and the Constant scale, with a minimum follow-up of 16 months. Five of the cases (9.62%) had been intervened due to fractures of the proximal end of the humerus, 6 cases (11.53%) as surgical consequence of a prosthesis revision, 10 cases (19.23%) due to fracture sequelae, and 30 cases (59.62%) were patients with arthropathy due to a massive fracture of the rotator cuff. RESULTS: After a mean follow up of 35.78 months (range, 16-82), satisfactory clinical results were obtained in 80% of cases, with a mean preoperative Constant of 27.7 points, and reaching 67.1 points 12 months after the operation. On the visual analogue scale, 8.25 points were obtained before the surgery, which decreased to 2.25 points 12 months later. The complications rate was 15.38%, which were due to an intra-operative fracture (1.92%), deep infection (3.84%), instability (3.84%), and early mechanical loosening (3.84%). Scapular notching was observed in the radiographic study in 9 (17.3%) cases. DISCUSSION AND CONCLUSIONS: After the results obtained, it could be said that total reverse shoulder replacement achieved encouraging results in the short term for the treatment of glenohumeral arthrosis and massive tears of the rotary cuff. On analysing our series, it can be seen that the complications rate is much higher when it is used to treat fracture sequelae in which there is a loss of proximal humerus bone stock.

Dolor cubital de muñeca tras artrodesis cuatro esquinas / Ulnar wrist pain after arthrodesis four corners

Objetivo: Presentar un caso clínico apenas recogido en la bibliografía cuya existencia puede deberse a la alteración biomecánica de la muñeca tras la realización de una artrodesis cuatro esquinas. Material y método: Presentamos el caso de un paciente que comienza con dolor en lado cubital de muñeca tras la realización de una artrodesis cuatro esquinas por muñeca SNAC grado III existiendo previamente varianza cubital positiva asintomática. Resultados: El paciente se sometió a osteotomía de acortamiento cubital consiguiendo así la desaparición de los síntomas. Conclusiones: A la vista de los resultados de este caso y, apoyados en la bibliografía, estimamos que pacientes sometidos a artrodesis cuatro esquinas con varianza cubital positiva asintomática pueden manejarse más eficazmente mediante la realización de una osteotomía de acortamiento cubital

Objective: To present a case report just picked the existence in the literature may be due to altered biomechanics of the wrist after performing arthrodesis four-corners. Methods. We present the case of a patient who begins with pain in the ulnar side of the wrist after performing arthrodesis four corners for grade III SNAC wrist exist previously asymptomatic positive ulnar variance. Results: The patient underwent ulnar shortening osteotomy and getting the disappearance of symptoms. Conclusions: This case could suggest that patients undergoing arthrodesis four corners with positive ulnar variance asymptomatic can be managed more effectively by performing ulnar shortening osteotomy