A Customized System to Test Pelvic Floor Muscles Contraction: A Proof of Concept.

Studies show that there is a high prevalence of pelvic floor dysfunctions which negatively affect the quality of life of people who suffer from them. The few sensory mechanisms that pelvic floor muscles have to inform the brain of their situation can make it difficult to perform voluntary contractions or identify risk factors. Currently, there is no consensus to improve this proprioception. This work introduces the development of a novel intravaginal device that is connected to a mobile data acquisition system and able to discern the correct contraction of the pelvic floor muscles versus contraction of adjacent muscles or abdominal thrust efforts. A cross-sectional pilot clinical study has been carried out to validate this end with healthy adult nulliparous woman with good pelvic floor muscles contraction capability in supine position.Clinical relevance- The proposed system allows a personalized and real-time assessment of the contractile capability of the pelvic floor muscles (PFM), distinguishing between muscular plans (deep/superficial PFM), between sides (right/left PFM), and between pressures from the PFM and intra-abdominal muscles (IAP). The development of an intravaginal device which is able to simultaneously measure all these features is an important advancement in this field since it can provide information in real time on the contraction capability of all the PFM as well as on the influence of the IAP during different PFM exercises.

Visualization of π-hole in molecules by means of Kelvin probe force microscopy.

Submolecular charge distribution significantly affects the physical-chemical properties of molecules and their mutual interaction. One example is the presence of a π-electron-deficient cavity in halogen-substituted polyaromatic hydrocarbon compounds, the so-called π-holes, the existence of which was predicted theoretically, but the direct experimental observation is still missing. Here we present the resolution of the π-hole on a single molecule using the Kelvin probe force microscopy, which supports the theoretical prediction of its existence. In addition, experimental measurements supported by theoretical calculations show the importance of π-holes in the process of adsorption of molecules on solid-state surfaces. This study expands our understanding of the π-hole systems and, at the same time, opens up possibilities for studying the influence of submolecular charge distribution on the chemical properties of molecules and their mutual interaction.

Resultados clínicos de la artroplastia radial en la tríada terrible de Hotchkiss, a propósito de 47 casos / Clinical results of radial arthroplasty in Hotchkiss' terrible triad, a case series of 47

INTRODUCCIÓN: Las fracturas de cabeza radial representan el 33-75% de las fracturas del codo (30 casos/100.000 habitantes/año). La «tríada terrible de Hotchkiss» se caracteriza por fractura de cúpula radial, coronoides y luxación del codo. Nuestro objetivo principal es comparar los resultados según el tipo de prótesis utilizada en el contexto de la tríada. MATERIAL Y MÉTODOS: Estudio observacional, descriptivo y retrospectivo. Tamaño muestral de 47 pacientes. Variables analizadas: filiación, clasificación de Mason, aspectos quirúrgicos (demora, tiempo quirúrgico, tipo de prótesis, reintervenciones), tiempo rehabilitador, causas de fracaso protésico, complicaciones, hallazgos radiológicos (según Van-Riet), zonas de aflojamiento (Popovic), escalas MEPS y Cassebaum. Se realizó un estudio intergrupal entre los tipos protésicos monopolar y bipolar, para ver los resultados obtenidos. RESULTADOS: Edad media: 43,5+/-8,9 años. El 72,7% de profesionales de grandes esfuerzos. La fractura Mason IV apareció en todos los casos y la tipo I de Regan y Morrey para coronoides (42,6%); 22 prótesis bipolares y 25 prótesis monopolares. Tiempo de intervención: 112,3+/-59,1 min. Fijación externa en el 6,4%. MEPS final: 85,9+/-15 puntos. Tiempo rehabilitador: 4,7+/-2,5 meses. Alta por mejoría: 76,6%. Cassebaum bueno-excelente en el 74,5%. Hubo 3 casos de movilización protésica, 29,8% de osificaciones heterotópicas y sobredimensionado en el 15,2%. En el estudio intergrupal, objetivamos que con prótesis monopolares hubo menor tiempo quirúrgico (p = 0,006), menores reintervenciones (p = 0,05), menor rigidez (p = 0,04), osificación heterotópica (p = 0,004) o aflojamiento protésico (p = 0,005), sin influir en escala MEPS (p = 0,44). CONCLUSIONES: Los resultados obtenidos en tríadas terribles con prótesis en nuestra experiencia son favorables. El tipo protésico sí influye, ya que el tiempo quirúrgico para la implantación de una prótesis monopolar fue menor, aunque el tiempo de rehabilitación fue algo mayor. Con las prótesis bipolares se requirió más la fijación externa, siendo también mayor la tasa de reintervenciones, rigidez, movilización protésica, osificación heterotópica y aflojamiento protésico. Sin embargo, no hubo diferencias entre ambos tipos protésicos en cuanto a resultados clínicos, ya fuera MEPS o Cassebaum

INTRODUCTION: Radial head fractures represent 33-75% of elbow fractures (30 cases/100,000 population/year). "Terrible triad's Hotchkiss" is characterized by radial head fracture, coronoid fracture and elbow dislocation. Our principal goal is to compare our results on each type of prosthesis in the context of the triad. MATERIAL AND METHODS: We conducted an observational, descriptive and retrospective study. Sample size was 47 patients. Variables analyzed were affiliation, Mason's classification, surgical aspects (moment of surgery, surgical time, prosthesis type, re-surgery), rehabilitation time, causes of prosthetic failure, complications, radiographic findings (according to van Riet), Popovic's loosening areas, MEPS and Cassebaum's scales. We performed an inter-group study, on patients treated with monopolar or bipolar prosthesis, in order to see results. RESULTS: Average age was 43.5+/-8.9 years. 72.7% were in highly demanding jobs. Mason's fracture type IV appeared in all the cases and Regan-Morrey's type I was the most frequent coronoid fracture (42.6%). There were 22 bipolar prosthesis and 25 monopolar prosthesis. Surgery time was about 112.3+/-59.1minutes. External fixation was used in 6.4%. MEPS final: 85.9+/-15 points. Rehabilitation time was about 4.7+/-2.5 months. Of the patients, 76.6% returned to work. Cassebaum's results were good-excellent in 74.5% of patients. There were 3 cases of prosthetic mobilization. Heterotopic ossification appeared in 29.8% of cases and 15.2% presented overstuffing. With regard to the inter-group study, we observed that there was less surgical time with monopolar prosthesis (P=.006), fewer second look surgeries (P=.05), less stiffness (P=.04), less heterotopic ossification (P=.004) and septic loosening (P=.005), without any influence on MEPS (P=.44). CONCLUSIONS: Results obtained in terrible triads with prostheses in our experience are good. Prosthetic type influences results, because surgical time for implantation of a monopolar prosthesis was less than for a bipolar one, although rehabilitation time was longer. With bipolar prostheses, external fixation was required, with a higher rate of reinterventions, stiffness, prosthetic mobilization, heterotopic ossification and prosthetic loosening. However, there were no differences between the 2prosthetic types in terms of clinical results, like MEPS or Cassebaum scores

Clinical results of radial arthroplasty in Hotchkiss' terrible triad, a case series of 47. / Resultados clínicos de la artroplastia radial en la tríada terrible de Hotchkiss, a propósito de 47 casos.

INTRODUCTION: Radial head fractures represent 33-75% of elbow fractures (30 cases/100,000 population/year). "Terrible triad's Hotchkiss" is characterized by radial head fracture, coronoid fracture and elbow dislocation. Our principal goal is to compare our results on each type of prosthesis in the context of the triad. MATERIAL AND METHODS: We conducted an observational, descriptive and retrospective study. Sample size was 47 patients. Variables analyzed were affiliation, Mason's classification, surgical aspects (moment of surgery, surgical time, prosthesis type, re-surgery), rehabilitation time, causes of prosthetic failure, complications, radiographic findings (according to van Riet), Popovic's loosening areas, MEPS and Cassebaum's scales. We performed an inter-group study, on patients treated with monopolar or bipolar prosthesis, in order to see results. RESULTS: Average age was 43.5±8.9 years. 72.7% were in highly demanding jobs. Mason's fracture type iv appeared in all the cases and Regan-Morrey's type I was the most frequent coronoid fracture (42.6%). There were 22 bipolar prosthesis and 25 monopolar prosthesis. Surgery time was about 112.3±59.1minutes. External fixation was used in 6.4%. MEPS final: 85.9±15 points. Rehabilitation time was about 4.7±2.5 months. Of the patients, 76.6% returned to work. Cassebaum's results were good-excellent in 74.5% of patients. There were 3 cases of prosthetic mobilization. Heterotopic ossification appeared in 29.8% of cases and 15.2% presented overstuffing. With regard to the inter-group study, we observed that there was less surgical time with monopolar prosthesis (P=.006), fewer second look surgeries (P=.05), less stiffness (P=.04), less heterotopic ossification (P=.004) and septic loosening (P=.005), without any influence on MEPS (P=.44). CONCLUSIONS: Results obtained in terrible triads with prostheses in our experience are good. Prosthetic type influences results, because surgical time for implantation of a monopolar prosthesis was less than for a bipolar one, although rehabilitation time was longer. With bipolar prostheses, external fixation was required, with a higher rate of reinterventions, stiffness, prosthetic mobilization, heterotopic ossification and prosthetic loosening. However, there were no differences between the 2prosthetic types in terms of clinical results, like MEPS or Cassebaum scores.

Torsión testicular prenatal: revisión a propósito de un caso / Prenatal torsion of the testis: a review based on one case

La torsión testicular prenatal ocurre intraútero y se des-cubre inmediatamente en la exploración del recién nacido. Existen antecedentes familiares en un 10% de los niños. La clínica varía dependiendo del momento en el que ha ocurrido la torsión durante la gestación. En cuanto al diagnóstico, se basa en la sospecha clínica y el empleo de la ecografía, que se puede complementar con otras técnicas novedosas en pediatría como la elastografía. El manejo terapéutico sigue siendo controvertido. El objetivo de la comunicación es hacer una revisión y puesta al día de la torsión testicular prenatal, valorando el empleo de la elastografía como técnica complementaria de ayuda en el diagnóstico. Presentamos el caso de un neonato de 18 horas de vida, que en la primera exploración presentaba un testículo aumentado de tamaño, indoloro y de consistencia dura. En la historia familiar, el padre refería haber sufrido una torsión testicular también intraútero. Se realizó una ecografía que confirmó la sospecha clínica de torsión testicular prenatal, completándose el estudio con una elastografía, que mostró un testículo duro y rígido. El paciente fue valorado por Cirugía Pediátrica, decidiendo actitud expectante inicial y controles clínicos evolutivos

Prenatal testicular torsion occurs intrauterine and is dis-covered immediately during the exploration of the newborn. There is a previous family history in 10% of the children. The symptomatology varies depending on the moment in which the torsion occurred during pregnancy. The diagnosis is based on clinical suspicion and the use of ultrasound, which can be complemented with other new techniques in Pediatrics such as elastography. The therapeutic treatment remains controversial. The objective is to review and update the sources about prenatal testicular torsion and introduce the use of elastography as a complementary technique to help with the diagnosis. We report an 18-hour old newborn, who presents an enlarged, painless testicle of a hard consistency in the first exploration. In his family history, the father reports having suffered intrauterine testicular torsion. An ultrasound was performed which confirmed the clini-cal suspicion of prenatal testicular torsion. The study was completed with an elastography, which showed a hard and rigid testicle. The patient was evaluated by the department of Pediatric Surgery, who initiately decided a conservative management and clinical evolutionary controls

Artrodesis de las cuatro esquinas del carpo con placa y tornillos / Carpal four corner arthrodesis with plate and screws

Introducción y objetivos: La artrodesis de las cuatro esquinas (grande, ganchoso, semilunar y piramidal) suprime el movimiento de la articulación mediocarpiana (30% del total del movimiento de la muñeca) y permite movimiento sin dolor en la articulación radiocarpiana (63-70%). Nuestro objetivo es revisar nuestra experiencia con esta técnica realizada con placa y tornillos. Material y métodos: Estudio observacional, descriptivo y retrospectivo, sobre 11 pacientes, en 6 años, seguimiento medio de 29.4 ± 8 meses. Las variables analizadas fueron filiación, lesiones asociadas, intervenciones previas, aspectos quirúrgicos, complicaciones, entre otras. La edad media fue de 41.6 ± 5.8 años. Todos los pacientes fueron varones. El 72.7% de las manos fueron derechas. La muñeca dominante fue la afectada en el 72.7%. Hubo una fractura previa escafoidea en 3 casos, inestabilidad escafolunar en 7 casos e inestabilidad lunotriquetal en 1 caso. El tiempo quirúrgico empleado fue de 92.2 ± 24.7 minutos. Resultados: La consolidación sucedió en unas 10.6 ± 1.6 semanas. Hubo hasta un 36.4% de reintervenciones, para retirar placa y realizar artrodesis total de muñeca. Los resultados clínicos fueron: Mayo Wrist Score: 53.6 ± 28.4 puntos y E.V.A. final: 2.86 ± 2 puntos. Hallamos más complicaciones en aquellos pacientes que habían presentado lesiones previas escafolunares, p=0.01 (Chi Cuadrado). Se observó pseudoartrosis en el 11.1%. Los arcos de movimiento finales fueron: Flexoextensión final de 58.2 ± 11º, desviación radial de 11.1 ± 1º y desviación cubital de 20.7 ± 1.7º. Discusión: En nuestra experiencia, la artrodesis de las cuatro esquinas del carpo con placa y tornillos, es una técnica útil, en el tratamiento de las secuelas fundamentalmente tras inestabilidad escafolunar, aunque con riesgo de otras complicaciones, que han llevado en esta serie a reintervenir a la tercera parte de los casos, para retirarla y realizar artrodesis total de muñeca

Introduction and objetives: Four corner arthrodesis (capitate, hamate, lunate and triquetrum) suppresses the movement of midcarpal joint (30% of the total movement of the wrist) and allows movement without radiocarpal joint pain (63-70%). Our goal is to review our experience with this technique performed with plate and screws. Material and methods: It was an observational, descriptive and retrospective study on 11 patients, in 6 years. Follow up was about 29.4 ± 8 months. We analyzed some variables: affiliation, associated injuries, previous surgeries, surgical aspects, complications, among others. The average age was 41.6 ± 5.8 years. 72.7% of wrists were right. Dominant wrist was affected on 72.7% of patients. We appreciated previously a scaphoid fracture in 3 cases, scapholunate instability in 7 cases and lunotriquetal instability in 1 case. Surgery time was about 92.2 ± 24.7 minutes. Results: Fusion was reached in 10.6 ± 1.6 weeks. 36.4% of patients required plate removal and perform complete wrist arthrodesis. Clinical results were: Mayo Wrist Score: 53.6 ± 28.4 points and V.A.S.: 2.86 ± 2 points. We found more complications in those patients who had previous scapholunate injuries p =0.01 (Chi Square). Pseudoarthrosis was observed in 11.1%. Final movement arcs were: flexoextension 58.2 ± 11º, radial deviation 11.1 ± 1º and ulnar deviation of 20.7 ± 1.7º. Discussion: In our experience, carpal four corner arthrodesis with plates and screws is an useful technique in treating consequences of scapholunate instability. However, it exists other complications, which have led to reoperate in this serie the third of cases, in order to remove and make full arthrodesis of the wrist

Utilización de injertos en la reparación de rerroturas del manguito rotador / Use of grafts in rotator cuff re-rupture

Introducción y objetivos. La rerrotura del manguito rotador aparece en un 38-65% de los casos. Con el fin de disminuir esta tasa se han realizado múltiples estudios que emplean diferentes tipos de biomateriales con fines puramente mecánicos (reforzar la sutura) o biológicos (transportadores de factores de crecimiento). Nuestro objetivo es revisar 22 casos tratados mediante xenoinjertos, así como analizar las diversas alternativas actuales. Material y método. Estudio observacional, descriptivo y retrospectivo donde consideramos edad, sexo, lateralidad, tiempos de intervención, afectación en RNM, número de anclajes empleados y resultados de movilidad final en las escalas de Constant y de la Universidad de California Los Ángeles (UCLA). Resultados. Se observó a 22 pacientes, con una edad media de 51,7±4,6 años, en los que utilizamos una media de 2 anclajes. De ellos, 13 pacientes fueron tratados con parches de submucosa intestinal porcina, 6 con pericardio equino y 3 con dermis porcina. Los resultados finales fueron de 37,6±13 puntos para el test de Constant frente a los 16,9±3,9 puntos para el test UCLA. Seguimiento de 36±10,2 meses. Conclusiones. En nuestra experiencia, los xenoinjertos proporcionan unos resultados funcionales aceptables para manguitos cuya sutura haya resultado ineficaz y son una alternativa a las transferencias tendinosas en casos de roturas masivas. Se precisan más estudios con otros tipos de biomateriales (AU)

Introduction and objectives. Rotator cuff re-ruptures appear in 38-65% of cases. In order to reduce this rate, many studies have been performed using different types of biomaterial for purely mechanical aims (re-inforce the suture) and/or biological agents (growth factor transporterts). The aim of this study is to review 22 cases treated with xenografts and analyse various current alternatives. Materials and methods. A descriptive and retrospective study was conducted using the variables of age, sex, laterality, time of surgery, involvement in MRI, number of anchors, and final mobility results on the Constant and the University of California Los Angeles (UCLA) validated scales. Results. The study included 22 patients, with a mean age of 51.7±4.6 years. A mean of 2 anchors were used and 13 patients were treated with a porcine intestinal submucosa implant, 6 with equine pericardium, and 3 with porcine dermis. Final results were: 37.6±13 points for the Constant test, and 16.9±3.9 points on the UCLA scale. The follow up was 36±10.2 months. Conclusions. In our experience, xenografts could provide good functional results and they would be a surgical alternative to tendon transfers in cases of massive tears. Further studies should be conducted with other biomaterials (AU)

Transferencias del extensor indicis proprius en casos de roturas del extensor pollicis longus / Extensor indicis proprius transferences in cases of extensor pollicis longus ruptures

Introducción y objetivos: La sutura directa en los casos de rotura del extensor pollicis longus (EPL) puede llevar asociado el fallo de la misma. Por ello, la transferencia tendinosa del extensor indicis proprius (EPI) es una buena alternativa. Nuestro objetivo es describir nuestra experiencia con esta técnica. Material y métodos: Estudio observacional descriptivo y retrospectivo sobre 29 casos. Variables: Edad, sexo, mano dominante, actividad laboral, tiempo quirúrgico. Análisis de resultados obtenidos en test de Geldmacher, SEEM y EVA. Resultados: Edad media de 48.04 ± 9.4 años. 72.4% varones, 27.6% mujeres. Brazo dominante en el 55.2%. 3.4% diabéticos y 6.9% con tratamiento corticoideo. Traumatismo directo en el 58.6%. Diagnóstico ecográfico en el 89.7%. Tiempo quirúrgico: 51.8 ± 12.5 minutos. Escala Geldmacher: 15.79 ± 5.8 puntos. Escala SEEM: 70.36 ± 20.4 puntos. Rotura de plastia en 13.8%. Altas por mejoría en 96.6%. Conclusiones: Las roturas de este tendón se asocian a fracturas de radio distal, tratamiento con corticoides, artritis reumatoide o tras osteosíntesis de fracturas de radio con placas volares. En nuestra experiencia, en los casos de rotura del EPL, consideramos que la trasposición del EPI es una alternativa eficaz, con un reducido número de complicaciones

Introduction and objectives: Direct suture in cases of rupture of extensor pollicis longus (EPL) tendon has been associated to suture tear. For this reason, tendon transfer of extensor indicis proprius (EPI) tendon is a good alternative. Our objective is describe our experience with this technique. Matherial and methods: Observational descriptive and retrospective study about 29 cases. Variables: Age, sex, dominant hand, laboral activity, time of surgery. We analize results with Geldmacher’ scale, SEEM and VAS scores. Results: Average age was 48.04 ± 9.4 years. 72.4% were males and 27.6% were females. Dominant arm was affected in 55.2% of cases. 3.4% were diabetics and 6.9% received corticoid treatment. Direct trauma appeared in 58.6% of cases. Sonographic diagnosis was in 89.7% of cases. Surgical time was of 51.8 ± 12.5 minutes. Geldmacher’ scale: 15.79 ± 5.8 points. SEEM score: 70.36 ± 20.4 points. Plastia rupture happened in 13.8% of patients. 96.6% of patients returned to their work. Conclusions: Ruptures of this tendon have been associated with distal radius fractures, corticoid treatment, rheumathoid arthritis or after osteosynthesis with volar plates in radius fractures. In our experience, in cases of rupture of EPL, we consider that transposition of EIP it is an effective alternative, with minimal number of complications

Toxicidad cerebelosa por citarabina: serie de 4 casos / Cerebellar toxicity due to cytarabine: A series of 4 cases

No disponible

Use of grafts in rotator cuff re-rupture. / Utilización de injertos en la reparación de rerroturas del manguito rotador.

INTRODUCTION AND OBJECTIVES: Rotator cuff re-ruptures appear in 38-65% of cases. In order to reduce this rate, many studies have been performed using different types of biomaterial for purely mechanical aims (re-inforce the suture) and/or biological agents (growth factor transporterts). The aim of this study is to review 22 cases treated with xenografts and analyse various current alternatives. MATERIALS AND METHODS: A descriptive and retrospective study was conducted using the variables of age, sex, laterality, time of surgery, involvement in MRI, number of anchors, and final mobility results on the Constant and the University of California Los Angeles (UCLA) validated scales. RESULTS: The study included 22 patients, with a mean age of 51.7±4.6 years. A mean of 2 anchors were used and 13 patients were treated with a porcine intestinal submucosa implant, 6 with equine pericardium, and 3 with porcine dermis. Final results were: 37.6±13 points for the Constant test, and 16.9±3.9 points on the UCLA scale. The follow up was 36±10.2 months. CONCLUSIONS: In our experience, xenografts could provide good functional results and they would be a surgical alternative to tendon transfers in cases of massive tears. Further studies should be conducted with other biomaterials.

¿Son seguros nuestros quirófanos? / No disponible

La seguridad de la cirugía es una prioridad de salud pública. Nuestro objetivo: confirmación de las prácticas seguras en quirófano. Hemos revisado numerosos documentos sobre medidas de prácticas quirúrgicas seguras. Tras analizar estas recomendaciones, las hemos comprobado con nuestras actuaciones diarias en todas las intervenciones programadas que se han realizado en el quirófano de urología en 2014 en el Hospital Valme, Sevilla. Los puntos que hemos detectado con áreas de mejora son: prevención de la infección de la herida quirúrgica, lavado quirúrgico de manos y mantenimiento de la normotermia. Los puntos de actuación correcta son: profilaxis antibiótica, prevención TEV, aspectos derivados de la anestesia, listado verificación quirúrgica, medicamentos de aspecto o nombres parecidos y realización del procedimiento correcto en el lugar correcto del cuerpo. Hemos detectado áreas de mejora, que nos han planteado revisión de protocolos y sesiones. Tenemos importantes líneas de investigación futuras. Concluimos que nuestros quirófanos son seguros

The safety of surgery is a public health priority. Objective: confirmation of safe practices in the operating room. We have reviewed several documents about safety measures in surgery practice. After analyzing these recommendations we have compared with our daily practice in all programmed interventions that have been performed in the urology operating room in 2014 at hospital Valme, Seville. The main areas we have detected for improvement are: prevention of infection of the surgical wound, surgical hand washing and maintenance of normothermia. The correct action points are: antibiotic prophylaxis, VTE prevention, issues arising from anesthesia, surgical check list, drugs with similar appearance or name and achievement of the right procedure at the right place in the body. We have identified areas for improvement, and as a consequence we have reviewed protocols and sessions. We have important future research. We conclude that our operating rooms are safe

Tratamiento de la Triada Terrible de codo con prótesis de cúpula radial / Treatment of terrible triad of the elbow with radial head prosthesis

Introducción: Las fracturas de cabeza radial representan 30 casos/100000 habitantes/año. Constituyen el 33-75% de las fracturas del codo. La "Triada terrible de Hotchkiss" se caracteriza por fractura de cúpula radial, coronoides y luxación del codo. Nuestro objetivo es valorar los resultados del tratamiento con artroplastia de cabeza radial. Material y métodos: Estudio observacional, descriptivo y retrospectivo. Tamaño muestral de 22 pacientes. Variables analizadas: filiación, clasificación de Mason, aspectos quirúrgicos (demora, tiempo quirúrgico, tipo de prótesis, reintervenciones), tiempo rehabilitador, causas de fracaso protésico, complicaciones, hallazgos radiológicos (según Van-Riet), zonas de aflojamiento (Popovic), escalas M.E.P.S. y Cassebaum. Resultados: Edad media: 42,2 ± 9,9 años. 72.7% profesionales de grandes esfuerzos. La fractura Mason IV fue la más frecuente (72.7%) y la tipo I de Regan Morrey para coronoides (50%). Tiempo de intervención: 130,4 ± 79,8 minutos. Fijación externa en el 13.6%. M.E.P.S. final: 84,1 ± 15,7 puntos. Tiempo rehabilitador: 4,2 ± 1,4 meses. Alta por mejoría: 72.7%. Cassebaum bueno-excelente en el 85.7%. Hubo 13.6% de movilización protésica, 45.5% de osificaciones heterotópicas y sobredimensionado en el 22.7%. Conclusiones:: No hubo diferencias estadísticamente significativas en cuanto al momento quirúrgico, tipo protésico o tipo de fractura de coronoides. Tan sólo en este último punto hubo más riesgo de infección a mayor tipo de Regan, asociado a una mayor manipulación quirúrgica. El tratamiento de la triada terrible con prótesis de cúpula radial, en nuestra experiencia arrojó buenos resultados, aunque no está exento de complicaciones

Introduction: Radial head fractures represent 30 cases/100,000 population/year. They constitute 33- 75% of elbow fractures. 'Terrible Triad’s Hotchkiss' is characterized by radial head fracture, coronoid fracture and elbow dislocation. Our goal is to review results of treatment with radial head arthroplasty. Material and methods: Observational, descriptive and retrospective study. Sample size of 22 patients. Variables analyzed were affiliation, Mason’s classification, surgical aspects (moment of surgery, surgical time, type of prosthesis, reoperation), rehabilitation time, causes of prosthetic failure, complications, radiographic findings (according to Van Riet), Popovic’s loosening areas, MEPS and Cassebaum’s scales. Results: Average age: 42.2 ± 9.9 years. 72.7% realized high demanding jobs. Mason’s fracture type IV was the most frequent (72.7%) and the Regan-Morrey’s type I was the most frequent of coronoid fracture (50%). Surgery time: 130.4 ± 79.8 minutes. External fixation was used in 13.6%. M.E.P.S. final: 84.1 ± 15.7 points. Rehabilitation time: 4.2 ± 1.4 months. 72.7% of patients came back to work. Cassebaum’s results were good-excellent in 85.7% of patients. There were 13.6% of prostheses mobilization. heterotopic ossification appeared in 45.5% of cases and 22.7% presented overstuffing. Conclusions: There was no statistically significative difference about moment of surgery, prosthetic type, or coronoid fracture. Just about this last point there was more risk of infection when there was a worse Regan-Morrey’s type, probably due to greater surgical manipulation. Treatment of the terrible triad with radial head prosthesis, in our experience, yielded good results, although it is not without complications

Artroplastia de cúpula radial, experiencia de 11 años. Estudio sobre 82 pacientes / Radial head arthroplasty, 11 years experience: a series of 82 patients

Objetivos. Las indicaciones de artroplastia de cúpula radial son esencialmente fracturas complejas con daño ligamentoso (medial, lateral o Essex-Lopresti), y/o asoaciadas a daños óseos (coronoides u olécranon). Nuestro objetivo es revisar nuestra experiencia con la utilización de prótesis de cabeza del radio en un contexto traumático. Material y método. Estudio observacional, descriptivo y retrospectivo, con seguimiento de 1-11 años. El grupo de estudio tuvo un tamaño muestral de 82 pacientes, con una edad media de 41,6 años (± 9,2). Los criterios de inclusión fueron: pacientes en edad laboral (25-64 años) con fracturas de cúpula radial complejas (II, III, IV de Mason), con lesiones de partes blandas u óseas, que conllevarán inestabilidad, no reconstruibles mediante osteosíntesis y tratadas mediante artroplastia. Las principales variables analizadas fueron datos de filiación, clasificación de Mason o aspectos quirúrgicos, como demora, tiempo quirúrgico, tipo protésico (donde la prótesis bipolar fue la más utilizada, 88,6%), necesidad de cementación o reintervenciones. También se analizó el tiempo rehabilitador, las causas de fracaso protésico, complicaciones, hallazgos radiológicos (según Van-Riet), zonas de aflojamiento (según Popovic), así como las escalas MEPS y de Cassebaum. Se apreciaron diversas lesiones asociadas, como el daño en el ligamento colateral lateral cubital en el 39% de los casos, la fractura de coronoides, en el 25,6% y la fractura de olécranon, en el 15,9% de la serie. Hubo un caso de lesión de Essex Lopresti. Los test estadísticos utilizados fueron: para variables categóricas, las tablas de contingencia, Chi Cuadrado y test de Fisher. Para las variables numéricas, la U de Mann Whitney o el test de Kruskall Wallis. Nivel de evidencia IV. Resultados. El tiempo quirúrgico fue de 100 minutos (± 56,8). Se cementaron el 53,8% de las prótesis. El resultado de la escala MEPS: 80,4 puntos (± 19,3), siendo excelentes-buenos en el 71,6%. El codo era estable en el 93,7% de los casos, presentaba una moderada inestabilidad, inferior a 10° en varo-valgo, en el 4,9% de los casos y una franca inestabilidad, con 10° o más de inestabilidad en varo o en valgo, en el 1,3% restante de la serie. El tiempo de rehabilitación fue menor en las cementadas (p = 0,03), hubo mayor rigidez (p = 0,03) y más secuelas (limitaciones de movilidad, dolor residual), (p < 0,05) en los casos en los que hubo que reparar el ligamento colateral lateral cubital (dada la coexistencia de otras lesiones graves en estos casos). Se obtuvieron mejores resultados en la escala de Cassebaum (p = 0,02) y más resultados excelentes en la escala MEPS (p = 0,02), cuando la cirugía fue antes de una semana. Se retiró la prótesis en 11 casos (13,4%), donde la principal causa de retirada fue el dolor en la pronosupinación en 5 casos, las lesiones capitelares en 4 casos, una luxación y una infección. La complicación más frecuente fue la rigidez (30,5%)... (AU)

Objectives. The indications for radial head arthroplasty are essentially complex fractures with ligament damage (medial, lateral or Essex-Lopresti), and/or associated with bone damage (coronoids or olecranon). The aim of this study is to review our experience with the use of a radial head prosthesis in the context of a trauma. Material and method. An observational, descriptive and retrospective study, with a follow-up of 1- 11 years, was performed on a study group of 82 patients with a mean age of 41.6 (± 9.2) years. The inclusion criteria were: patients of working age (25-64 years) with complex radial head fractures (Mason II, III, IV), with soft tissue and bone injuries that caused instability, non-reconstructable by osteosynthesis and treated using arthroplasty. he primary variables analysed were social demographics, Mason classification, or surgical aspects such as delay, surgical time, type of prosthesis (where the bipolar prosthesis was most used, 88.6%), need of fixation or further surgery. Rehabilitation time, causes of prosthesis failure, radiological findings (according to Van-Riet), areas of loosening (according to Popovic), as well as the Mayo Elbow Performance Score (MEPS) and the Cassebaum scale. Various associated injuries were observed, such as injuries in the lateral collateral ligament of the elbow in 39% of cases, coronoid fractures in 25.6%, and an olecranon fracture in 15.9% of the series. There was one case of an Essex- Lopresti injury. The tests used for the statistical analysis were Chi squared and Fisher test for categorical variables and contingency tables. The Mann Whitney U or Kruskall Wallis tests were used for the numerical variables. Evidence level: IV. Results. The mean surgical time was 100 (± 56.8) minutes. The prosthesis was fixed in 53.8% of cases. The mean score on the MEPS scale was 80.4 (± 19.3) points, being good-excellent in 71.6%. The elbow was stable in 93.7% of cases. There was moderate instability, with 10° or more in varus or valgus, and in 1.3% in the rest of the series. The rehabilitation time was lower in the fixed cases (P=.03), and there was greater rigidity (P=.03) and more sequelae (limitations in mobility, residual pain), (P < 0.05) in the cases where the LCL had to be repaired (given that there were other serious injuries in these cases). When the surgical delay was less than one week, better results were obtained on the Cassebaum scale (P=.02), as well as more excellent results on the MEPS scale MEPS (P=.02). The prosthesis was removed in 11 cases (13.4%), with the main cause for removal being pain in pronosupination in 5 cases, and capitellar injuries in 4 cases, one dislocation, and one infections. The most frequent complication was rigidity (30.5%). There were 3 infections (3.7%). Popovic areas 1 and 7 had greater osteolysis. Conclusions. The presence of concomitant bone and ligament injuries determined a longer surgical time and more sequelae. Early surgery would achieve better clinical results (AU)

Resultados de la reparación artroscópica mediante anclaje óseo sin nudo de lesiones del fibrocartílago triangular asociadas a fractura de extremidad distal de radio / Arthroscopic knotless anchor repair of triangular fibrocartilage in distal radius fracture

Introducción y objetivo. Las lesiones del fibrocartílago triangular (FCT) están asociadas en muchas ocasiones con inestabilidad de la articulación radiocubital distal. El tratamiento artroscópico de estas lesiones mejora el pronóstico funcional de los pacientes afectados. El objetivo del presente trabajo es evaluar los resultados funcionales y laborales de la reparación artroscópica con anclaje óseo sin nudo de lesiones del FCT asociadas a fracturas de extremidad distal del radio. Material y método. Estudio observacional, descriptivo entre noviembre de 2011 y enero de 2014 de 21 pacientes con fractura de radio distal asociada a lesiones tipo IB de Palmer (clases 2 y 3 de Atzei) del FCT tratados mediante reparación artroscópica con anclaje óseo sin nudo (PopLok® 2,8 mm, ConMed, EE. UU.). El tiempo medio de seguimiento fue de 18 meses. Analizamos los resultados funcionales (Mayo Wrist Score) y laborales. La edad media fue de 43,0 ± 8,8 años, con un 19% de mujeres. Se hallaron 5 casos con lesión escafolunar asociada. Resultados. La media obtenida en la escala funcional de Mayo Wrist Score fue de 83,4 ± 16,1 puntos. El tiempo de baja medio fue de 153,16 ± 48,5 días. La recuperación laboral sin limitaciones fue posible en el 89,5% de los casos. No se recogieron complicaciones postoperatorias. Conclusiones. La reparación artroscópica con anclaje óseo sin nudo de lesiones IB del FCT en pacientes con fractura de radio distal supone un método de tratamiento mínimamente invasivo, que mejora la tensión en la reparación y evita el posterior destensado, en nuestra experiencia, con baja tasa de complicaciones y buenos resultados funcionales y laborales (AU)

Introduction and objective. Lesions of triangular fibrocartilage (TFC) are associated with distal radioulnar joint instability. Arthroscopic treatment of these lesions improves functional outcome of affected patients. The aim of the present work is to evaluate functional and occupational outcome of TCF repair using an arthroscopic knotless anchor device in patients with associated distal radius fracture. Material and methods. An observational, descriptive study was carried out between November 2011 and January 2014 including 21 patients with distal radius fracture and Palmer 1 B lesions of TCF (Atzei class 2 and 3) that were treated by arthroscopic knotless anchor (PopLok® 2,8 mm, ConMed, USA). Mean follow-up was 18 months. Functional (Mayo Wrist Score) and occupational outcome results were analyzed. Mean age of the group was 43.0 ± 8.8 years, with 19% of the patients being female. There was an associated scapholunate lesion in 5 cases. Results. Functional results reached a mean of 83.4 ± 16.1 points onMayo Wrist Score. Mean sick-leave time was 153.16 ± 48.5 days. Complete occupational reintegration was reached in 89.5% of cases. There were no postoperative complications. Conclusions. Arthroscopic knotless anchor repair of 1 B TFC tears is a minimally invasive method of treatment that improves tension of fixation, avoiding subsequent loosen, in our experience, with few complications and good functional and occupational results (AU)

Estudio clínico sobre dos técnicas para la construcción de las roturas del ligamento cruzado anterior (L. C. A.): Rigid Fix(R) y Aperfix / Clinical study about two texhniques for reconstruction of anterior cruciate ligament ruptures (A. C. L.): Rigid Fix(TM) y Aperfix(TM)

Introducción y objetivos: La reconstrucción del Ligamento Cruzado Anterior (L.C.A.) es uno de los 10 procedimientos más frecuentes en Cirugía Ortopédica en U.S.A. La reparación mediante hueso tendón hueso (H.T.H.) resistiría 2977 N. El semitendinoso y recto interno, resistirían 1216 N y 838 N, respectivamente. Nuestro objetivo fue comparar clínicamente la técnica (H.T.H. Rigid Fix), con la ligamentoplastia con pata de ganso (Aperfix). Material y métodos: Estudio observacional, descriptivo y retrospectivo de 64 pacientes. Seguimiento 1-5 años. HTH: 31 casos (48.4%). Aperfix 33 casos (51.6%). Las variables analizadas fueron filiación, exploración clínica pre y postquirúrgica, RNM, escala Lysholm, aspectos quirúrgicos y complicaciones, entre otros. Los tests estadísticos empleados fueron t de Student, U de Mann Whitney y Chi Cuadrado. Análisis mediante S.P.S.S. 15.0. Resultados: Lysholm pre y postoperatorio de 14 ± 7.5 puntos y 86.7 ± 9.9 puntos, respectivamente. Hubo diferencias estadísticamente significativas, (p<0.05), a favor de H.T.H. en tiempo quirúrgico (62.7 ± 10.6 minutos Vs 79 ± 15.6 minutos), tiempo rehabilitador (115.1 ± 30.5 días Vs 139.8 ± 31.8 días), tiempo de baja (132.9 ± 20 días Vs 155.3 ± 41.4 días) o Lachmann postquirúrgico negativo (100% Vs 45% de los casos). Sin embargo, hubo mayor reducción del espacio articular con H.T.H. (9.7% Vs 0%). Conclusiones: La reparación del L.C.A. en nuestra experiencia, requeriría menor tiempo quirúrgico, rehabilitador y presentaría un Lachmann postquirúrgico menor con H.T.H. frente a Aperfix. No habría diferencias clínicas entre ambos sistemas, en la escala Lysholm

Introduction and objectives: Reconstruction of Anterior Cruciate Ligament (ACL) is one of the 10 most common procedures in orthopedic surgery in U.S.A. Repair by means of Patellar Tendon resists 2977 N. gracilis and semitendinosus, resist 1216 N and 838 N, respectively. Our objective was to compare clinical results of two surgical techniques (Bone- Patellar tendon-Bone Graft: B.P.B. Rigid Fix(TM) with hamstring tendons (Aperfix(TM)). Material and methods: Observational, descriptive and retrospective study of 64 patients. Follow up: 1-5 years. B.P.B.: 31 cases (48.4%). Hamstring tendons: 33 cases (51.6%). Variables analyzed were affiliation, pre and postoperative clinical examination, MRI, Lysholm scale, surgical aspects and complications, among others. Statistical tests used were Student t, Mann Whitney and Chi Square. Analysis by S.P.S.S. 15.0. Level IV of evidence. Results: pre and postoperative Lysholm score was 14 ± 7.5 and 86.7 ± 9.9 points, respectively. There were statistically significant differences (p <0.05), in favor of patellar tendon in operative time (62.7 ± 10.6 minutes vs 79 ± 15.6 minutes), rehabilitation time (115.1 ± 30.5 days vs 31.8 ± 139.8 days), time whithout working (132.9 ± 20 days vs 155.3 ± 41.4 days) or negative postsurgical Lachmann (100% vs 45% of cases). However, there was a greater reduction in joint space with patellar tendon (9.7% vs. 0%). Conclusions: Repair of L.C.A. in our experience, requires minor surgical time, rehabilitation time and present a lower postoperative Lachmann’s test,with B.P.B. Rigid Fix(TM). There would be no clinical differences between the two systems about Lysholm's score

Radial head arthroplasty, 11 years experience: A series of 82 patients.

OBJECTIVES: The indications for radial head arthroplasty are essentially complex fractures with ligament damage (medial, lateral or Essex-Lopresti), and/or associated with bone damage (coronoids or olecranon). The aim of this study is to review our experience with the use of a radial head prosthesis in the context of a trauma. MATERIAL AND METHOD: An observational, descriptive and retrospective study, with a follow-up of 1- 11 years, was performed on a study group of 82 patients with a mean age of 41.6 (± 9.2) years. The inclusion criteria were: patients of working age (25-64 years) with complex radial head fractures (Mason II, III, IV), with soft tissue and bone injuries that caused instability, non-reconstructable by osteosynthesis and treated using arthroplasty. The primary variables analysed were social demographics, Mason classification, or surgical aspects such as delay, surgical time, type of prosthesis (where the bipolar prosthesis was most used, 88.6%), need of fixation or further surgery. Rehabilitation time, causes of prosthesis failure, radiological findings (according to Van-Riet), areas of loosening (according to Popovic), as well as the Mayo Elbow Performance Score (MEPS) and the Cassebaum scale. Various associated injuries were observed, such as injuries in the lateral collateral ligament of the elbow in 39% of cases, coronoid fractures in 25.6%, and an olecranon fracture in 15.9% of the series. There was one case of an Essex- Lopresti injury. The tests used for the statistical analysis were Chi squared and Fisher test for categorical variables and contingency tables. The Mann Whitney U or Kruskall Wallis tests were used for the numerical variables. Evidence level: IV. RESULTS: The mean surgical time was 100 (± 56.8) minutes. The prosthesis was fixed in 53.8% of cases. The mean score on the MEPS scale was 80.4 (± 19.3) points, being good-excellent in 71.6%. The elbow was stable in 93.7% of cases. There was moderate instability, with 10° or more in varus or valgus, and in 1.3% in the rest of the series. The rehabilitation time was lower in the fixed cases (P=.03), and there was greater rigidity (P=.03) and more sequelae (limitations in mobility, residual pain), (P<0.05) in the cases where the LCL had to be repaired (given that there were other serious injuries in these cases). When the surgical delay was less than one week, better results were obtained on the Cassebaum scale (P=.02), as well as more excellent results on the MEPS scale MEPS (P=.02). The prosthesis was removed in 11 cases (13.4%), with the main cause for removal being pain in pronosupination in 5 cases, and capitellar injuries in 4 cases, one dislocation, and one infections. The most frequent complication was rigidity (30.5%). There were 3 infections (3.7%). Popovic areas 1 and 7 had greater osteolysis. CONCLUSIONS: The presence of concomitant bone and ligament injuries determined a longer surgical time and more sequelae. Early surgery would achieve better clinical results.

Ectasia congénita de las arterias coronarias e hiperinsulinismo: ¿sólo una coincidencia? / Congenital ectasia of coronary e hyperinsulinism: just a coincidence?

Se presenta el caso de un recién nacido con ectasia congénita de las arterias coronarias. Se repasan la frecuencia, la etiología, la clínica y la evolución de esta entidad, así como su posible relación con el hiperinsulinismo que también presentaba el paciente (AU)

The case of a newborn with congenital coronary artery ectasia is presented. Frequency, etiology, and clinical evolution of this entity and its possible relationship with hyperinsulinism also presented the patient is reviewed (AU)

Tratamiento del derrame de Morel-Lavallée mediante soporte endoscópico, a propósito de ocho casos clínicos / Utility of endoscopy in the treatment of Morel-Lavallée lesion, about eight clinical cases

Objetivo: El derrame de Morel-Lavallée es una colección linfoserosa-sanguínea y con necrosis grasa, posterior a traumatismos tangenciales, rodeada de pseudocápsula. Nuestro objetivo es revisar su tratamiento endoscópico. Material y método: Estudio observacional, descriptivo y retrospectivo sobre ocho pacientes. Analizamos edad media, sexo, etiología, localización, ecopunciones previas, volumen, tiempo quirúrgico, recidivas, reintervenciones y tipo de alta. Resultados: Edad media: 39,8 ± 8,1 años, 100% de varones. Causa fundamental: contusión directa (25%), fracturas pélvicas (37,5%). Localización: pierna (75%) y espalda (25%). 1,63 ± 0,9 ecopunciones previas, obteniendo 85 ± 46,4 cc. Tiempo quirúrgico: 55,6 ± 18.7 minutos. 2,1 ± 0,3 drenajes. Tiempo de seguimiento con mediana de 12,5 meses. Aparecieron parestesias (57,1%), así como recidiva e infección (14,3%). Tipo de alta: mejoría (87,5%), informe propuesta (12,5%). Conclusión: En nuestra experiencia reservamos el tratamiento endoscópico para casos crónicos (más de tres semanas de evolución), puesto que con un tiempo quirúrgico no excesivamente prolongado permite tratar el derrame, con mínimas incisiones, aunque no está exento de complicaciones (AU)

Objective: Morel-Lavallé's lesion is a linfoserosus and hematic seroma with fat necrosis, that appears after tangential trauma. Our aim is to review its endoscopic treatment. Material and method: Observational, descriptive and retrospective study on eight patients. We analyzed mean age, sex, etiology, location, previous ecopunctions, volume, surgical time, recurrence, reoperation and labour reincorporation. Results: Average age: 39.8 ± 8.1 years, 100% of males. Etiology: direct contusion (25%), pelvic fractures (37.5%). Location: leg (75%) and back (25%). 1.63 ± 0.9 previous ecopunctions, obtaining 85 ± 46.4 cc. Surgical time: 55.6 ± 18.7 minutes. We used 2.1 ± 0.3 drains. Median follow-up time of 12.5 months. There were paresthesias (57.1%), and relapse with infection (14.3%). 87.5% of patients came back to work, but 12.5% did not. Conclusion: In our experience we reserve endoscopic treatment for chronic cases (more than three weeks), because without not too long surgical time it allows to treat the lesion with minimal incisions, although it is not without complications (AU)