¿Disminuyen las complicaciones cutáneas tras la cirugía de fracturas de tobillo con el uso de Aquacel Extra Ag(R)? / Do surgical site complications after ankle fracture surgery reduce with Aquacel Extra Ag(R)?

Introducción: Las fracturas de tobillo representan un 10% del total de fracturas. La mayor parte requieren tratamiento quirúrgico, que conlleva un importante riesgo de complicaciones de la herida. El objetivo de este estudio ha sido determinar si los apósitos impregnados con plata (Aquacel Ag Extra(R)) reducen la tasa de complicaciones de la herida quirúrgica tras el tratamiento de las fracturas de tobillo en comparación con el uso de gasas estériles. Métodos: De forma prospectiva se han reunido 233 pacientes con fracturas de tobillo subsidiarias de tratamiento quirúrgico. Desde el inicio del estudio en julio de 2017 hasta febrero de 2018, los traumatólogos participantes en el estudio cambiaron el uso de la gasa estéril estándar para cubrir la herida quirúrgica tras su cierre por Aquacel Ag Extra(R), manteniendo el resto del protocolo pre- y posquirúrgico igual. Se comparan la tasa de complicaciones cutáneas en ambos grupos, tras un seguimiento de 3 meses. Resultados: El análisis estadístico no reflejó diferencias significativas entre ambos grupos. Conclusiones: Se necesitan ensayos clínicos aleatorizados para demostrar las ventajas teóricas de los apósitos impregnados con plata y su indicación en Traumatología

Introduction: Ankle fractures account for up to 10% of total fractures. Most of them require surgical fixation, which involves an important risk of wound complications. The aim of this study was to determine whether a silver-impregnated occlusive surgical dressing (Aquacel Ag Extra(R)) was effective in reducing the rates of wound complications after ankle fracture open reduction and internal fixation compared to standard sterile dressing. Methods: We prospectively reviewed 233 patients who underwent ankle fracture open reduction and internal fixation. Surgeons switched from using a standard dressing to an Aquacel Ag Extra(R) from July 2017 to February 2018, without other major changes in perioperative management. We compared skin complications between both groups after 3 months' follow-up. Results: The statistical analysis showed that there is no difference in the prevalence of skin complications between both groups. Conclusions: The theoretical advantages of silver impregnated dressings need further prospective randomized controlled studies to assess the appropriate indications for their use in orthopaedic surgery

Do surgical site complications after ankle fracture surgery reduce with Aquacel Extra Ag®? / ¿Disminuyen las complicaciones cutáneas tras la cirugía de fracturas de tobillo con el uso de Aquacel Extra Ag®?

INTRODUCTION: Ankle fractures account for up to 10% of total fractures. Most of them require surgical fixation, which involves an important risk of wound complications. The aim of this study was to determine whether a silver-impregnated occlusive surgical dressing (Aquacel Ag Extra®) was effective in reducing the rates of wound complications after ankle fracture open reduction and internal fixation compared to standard sterile dressing. METHODS: We prospectively reviewed 233 patients who underwent ankle fracture open reduction and internal fixation. Surgeons switched from using a standard dressing to an Aquacel Ag Extra® from July 2017 to February 2018, without other major changes in perioperative management. We compared skin complications between both groups after 3 months' follow-up. RESULTS: The statistical analysis showed that there is no difference in the prevalence of skin complications between both groups. CONCLUSIONS: The theoretical advantages of silver impregnated dressings need further prospective randomized controlled studies to assess the appropriate indications for their use in orthopaedic surgery.

Characterization of the human ridged and non-ridged skin: a comprehensive histological, histochemical and immunohistochemical analysis.

The structure of the human skin is directly dependent on its location and the mechanical forces to which it is subjected. In the present work, we have performed a comprehensive analysis of the human ridged and non-ridged skin to identify the differences and similarities between both skin types. For this purpose, human skin samples were obtained from dorsal hand skin (DHS), palmar hand skin (PHS), dorsal foot skin (DFS) and plantar foot skin (PFS) from the same cadaveric donors. Histological, histochemical and semiquantitative and quantitative immunohistochemical analyses were carried out to evaluate the epidermis, dermis and basement membrane. Results show that the epithelial layer of ridged skin had larger cell number and size than non-ridged skin for most strata. Melanocytes and Langerhans cells were more abundant in non-ridged skin, whereas Merkel cells were preferentially found in ridged skin. The expression pattern of CK5/6 was slightly differed between non-ridged and ridged skin. Involucrin expression was slightly more intense in non-ridged skin than in ridged skin. Collagen was more abundant in foot skin dermis than in hand skin, and in ridged skin as compared to non-ridged skin. Elastic fibers were more abundant in DHS. Biglycan was more abundant in foot skin than in hand skin. No differences were found for blood and lymphatic vessels. The basement membrane laminin was preferentially found in foot skin. These results revealed important differences at the epithelial, dermal and basement membrane levels that could contribute to a better knowledge of the human skin histology.

La osteotomía patelar coronal de la faceta externa asociada a liberación del retináculo lateral mejora los resultados clínicos de la liberación lateral aislada en el síndrome de compresión lateral de rótula / Coronal patellar osteotomy of the external facet combined with the release of the lateral retinaculum improves the clinical outcomes of isolated lateral release in lateral knee compartment syndrome

Objetivo. Descripción de una nueva osteotomía coronal de la faceta externa de la rótula y valorar si los resultados del tratamiento del síndrome de compresión lateral de la rótula (SCLR) con nuestra osteotomía junto a la liberación del retináculo lateral externo son mejores que la liberación aislada del retináculo lateral. Material y métodos. Estudio prospectivo con 2 años de seguimiento, donde tratamos 70 pacientes diagnosticados de SCLR y distribuidos en 2 grupos: un primer grupo de 50 pacientes en los que se realizó la liberación del retináculo lateral asociada a osteotomía, y un segundo grupo de 20 pacientes en los que se realizó una liberación aislada del retináculo lateral. Se midió la escala funcional de Werner de forma preoperatoria y a los 3, 12 y 24 meses. Resultados. Existen diferencias significativas en el estado funcional global postoperatorio entre grupos (mejor el grupo de osteotomía en todos los intervalos, p<0,05). La mejoría, que es progresiva hasta los 12 meses, experimenta un ligero retroceso a los 24, aunque los valores siguen siendo mejores que los preoperatorios en ambos grupos. Todas las variables muestran valores mejores en el grupo de la osteotomía. La variable con mayor mejoría es aparición del dolor. Los pacientes con SCLR con signos degenerativos presentaron un beneficio en todos los casos. Conclusión. Los resultados muestran que la técnica de osteotomía rotuliana descrita asociado a la liberación del retináculo lateral mejora de forma significativa el dolor y la escala funcional de pacientes con SCLR a los 2 años de seguimiento, en mayor grado que lo hace la liberación aislada del retináculo lateral, incluso en aquellos en los que existe evidencia de signos degenerativos (AU)

Objective. To describe a novel coronal osteotomy of the external facet of the patella, and to evaluate if the outcomes of the treatment of lateral knee compartment syndrome (LKCS) with this osteotomy, combined with the release of the external lateral retinaculum, are better than the isolated lateral retinacular release. Material and methods. A prospective study with a 2 year follow up that included 70 patients diagnosed with LKCS, distributed into 2 groups. The first group included 50 patients on whom the lateral retinacular release combined with osteotomy was performed, and a second group on whom an isolated retinacular release was performed. Measurements were made using the Werner functional scale before the surgery and at 3, 12, and 24 months follow-up. Results. There were significant differences in the overall functional state between the two groups after the surgery (better in the osteotomy group at all the intervals, P<.05). The improvement, which was progressive up to 12 months, was slightly less at 24 months, although the values were still better than the pre-surgical ones in both groups. Pain was the variable that showed most improvement. The patients with LKCS with degenerative signs showed a benefit in all cases. Conclusion. The results demonstrate that the described patellar osteotomy technique, combined with lateral retinacular release, significantly improves the pain and the functional scale score of patients with LKCS after 2 years of follow-up, to a greater extent than isolated lateral retinacular release, including those in which there was evidence of degenerative signs (AU)

Coronal patellar osteotomy of the external facet combined with the release of the lateral retinaculum improves the clinical outcomes of isolated lateral release in lateral knee compartment syndrome. / La osteotomía patelar coronal de la faceta externa asociada a liberación del retináculo lateral mejora los resultados clínicos de la liberación lateral aislada en el síndrome de compresión lateral de rótula.

OBJECTIVE: To describe a novel coronal osteotomy of the external facet of the patella, and to evaluate if the outcomes of the treatment of lateral knee compartment syndrome (LKCS) with this osteotomy, combined with the release of the external lateral retinaculum, are better than the isolated lateral retinacular release. MATERIAL AND METHODS: A prospective study with a 2 year follow up that included 70 patients diagnosed with LKCS, distributed into 2 groups. The first group included 50 patients on whom the lateral retinacular release combined with osteotomy was performed, and a second group on whom an isolated retinacular release was performed. Measurements were made using the Werner functional scale before the surgery and at 3, 12, and 24 months follow-up. RESULTS: There were significant differences in the overall functional state between the two groups after the surgery (better in the osteotomy group at all the intervals, P<.05). The improvement, which was progressive up to 12 months, was slightly less at 24 months, although the values were still better than the pre-surgical ones in both groups. Pain was the variable that showed most improvement. The patients with LKCS with degenerative signs showed a benefit in all cases. CONCLUSION: The results demonstrate that the described patellar osteotomy technique, combined with lateral retinacular release, significantly improves the pain and the functional scale score of patients with LKCS after 2 years of follow-up, to a greater extent than isolated lateral retinacular release, including those in which there was evidence of degenerative signs.

Fracturas de cadera intra- y extracapsulares en mayores: ¿dos enfermedades distintas? / Intra- and extra-capsular hip fractures in the elderly: two different pathologies?

Objetivos. Comparar las fracturas de cadera (FC) intra- y extracapsulares (FIC y FEC) en pacientes mayores para determinar si son patologías diferentes. Sujetos/método. Diseño prospectivo longitudinal, observacional, descriptivo y analítico. Muestra no probabilística. Muestreo de colección completa. Seiscientos cuarenta y siete sujetos (ambos sexos), 60 o más años, ingresados con FC desde el Servicio de Ortopedia y Traumatología del Hospital (1 de enero de 2010 al 31 de diciembre de 2012). Seguimiento de un año pos-FC. Se comparan variables sociodemográficas, etiológicas, evolutivas, terapéuticas y pronósticas. Resultados. Es la primera investigación sobre este tema realizada con población latinoamericana. La incidencia de FEC fue superior a FIC, al contrario de lo publicado en población europea/estadounidense. Existen diferencias significativas en las variables etiológicas (χ2 = 6,34, p < 0,042), siendo la etiología traumática en FEC y no traumática en FIC. También hay diferencias en las intervenciones terapéuticas realizadas (osteosíntesis para FEC, artroplastia para FIC); y la decisión de no operar es menor en FIC (ambos p < 0,0000). Las variables asociadas con la decisión de no intervención quirúrgica son edad, diagnósticos causales y mortalidad postoperatoria. Discusión. Los resultados son similares a otros trabajos, añadiendo la asociación FIC y origen no traumático, especialmente la tendencia de asociación FIC y enfermedad no osteoporótica primaria (neoplasias, osteodistrofia renal, osteoporosis secundaria a hiperparatiroidismo primario). Debemos profundizar en las diferencias entre poblaciones latinoamericana y europea/estadounidense en la incidencia de uno u otro tipo de FC. Existen diferencias importantes, etiológicas y terapéuticas, entre FIC y FEC, por lo que sería conveniente considerarlas como entidades nosológicas distintas (AU)

Objectives. To compare intracapsular (IC) and extracapsular (EC) hip fractures (HIF) in elderly patients in order to determine if they are different pathologies. Subjects and methods. Longitudinal, observational, descriptive, analytical prospective design, using a non-probabilistic sample from a full sample collection with 647 subjects (male and female), of 60 or more years old, admitted with HIF to the Department of Orthopedics and Traumatology of the Hospital, between January 1, 2010 and December 31, 2012. Follow-up was for 1 year post HIF. Socio-demographic, etiological, developmental, therapeutic and prognostic variables are compared. Results. This is the first study on this subject with Latin American population. EC HIF incidence was superior to IC, contrary to that published in European/American populations. There are significant differences in etiological variables (χ2 = 6.34, p<0.042), with traumatic etiology in EC and non-traumatic in IC. There are also differences in therapeutic interventions performed (osteosynthesis for EC, arthroplasty for IC), with the decision on not to operate being lower in IC (both p<0.0000). The variables associated with the decision on not to perform surgery are age, etiology and postoperative mortality. Discussion. The results are similar to other studies, adding the IC association with non-traumatic origin, in particular the trend of statistical association between IC and non-primary osteoporotic pathology (neoplasms, renal osteodystrophy, primary hyperparathyroidism). A further analysis was performed on the differences between Latin American and European/American populations in the incidence of either type of HIF. There are important etiological and therapeutic differences between IC and EC HIF; therefore it would be advisable to consider them as distinct disease entities (AU)

Intra- and extra-capsular hip fractures in the elderly: Two different pathologies?

OBJECTIVES: To compare intracapsular (IC) and extracapsular (EC) hip fractures (HIF) in elderly patients in order to determine if they are different pathologies. SUBJECTS AND METHODS: Longitudinal, observational, descriptive, analytical prospective design, using a non-probabilistic sample from a full sample collection with 647 subjects (male and female), of 60 or more years old, admitted with HIF to the Department of Orthopedics and Traumatology of the Hospital, between January 1, 2010 and December 31, 2012. Follow-up was for 1 year post HIF. Socio-demographic, etiological, developmental, therapeutic and prognostic variables are compared. RESULTS: This is the first study on this subject with Latin American population. EC HIF incidence was superior to IC, contrary to that published in European/American populations. There are significant differences in etiological variables (χ(2)=6.34, p<0.042), with traumatic etiology in EC and non-traumatic in IC. There are also differences in therapeutic interventions performed (osteosynthesis for EC, arthroplasty for IC), with the decision on not to operate being lower in IC (both p<0.0000). The variables associated with the decision on not to perform surgery are age, etiology and postoperative mortality. DISCUSSION: The results are similar to other studies, adding the IC association with non-traumatic origin, in particular the trend of statistical association between IC and non-primary osteoporotic pathology (neoplasms, renal osteodystrophy, primary hyperparathyroidism). A further analysis was performed on the differences between Latin American and European/American populations in the incidence of either type of HIF. There are important etiological and therapeutic differences between IC and EC HIF; therefore it would be advisable to consider them as distinct disease entities.

Variación de los indicadores radiográficos de la patología patelofemoral intrínseca con la rehabilitación / Rehabilitation-related variability in the x-ray indicators of intrinsic paellofemoral pathology

Introducción. La rehabilitación es un método aceptado para el tratamiento inicial de la patología intrínseca de la articulación patelofemoral, obteniendo en muchos casos una importante mejoría de las manifestaciones clínicas.Objetivos. En el presente estudio se intenta comprobar si la terapia rehabilitadora produce alguna variación en los índices radiológicos que definen un síndrome rotuliano doloroso o una inestabilidad femoropatelar.Material y método. Hemos realizado un estudio prospectivo, sobre 50 sujetos, divididos en dos grupos. Un primer grupo se constituyó con 25 individuos afectos de un síndrome rotuliano doloroso, sin signos de inestabilidad, y un segundo grupo con otros 25 que presentaban una inestabilidad femoropatelar. En todos ellos se realizó un estudio radiográfico estandarizado previo y posterior a la aplicación de unprotocolo de rehabilitación.Resultados y conclusiones. La rehabilitación hizo variar el índice fémoro-rotuliano de forma significativa en los individuos con un síndrome rotuliano doloroso, y este índice y el ángulo de congruencia en los pacientes con una inestabilidad femoropatelar

Introduction. Rehabilitation is an accepted method for the initial treatment of pathologies intrinsic to the patellofemoral joint, leading in many cases to an improvement of clinical manifestations.Purpose. The purpose of this study is to determine whether rehabilitating therapy causes any variation in the radiological indices that define a painful patellar syndrome or patellofemoral instability.Materials and methods. This is a prospective study of 50subjects, divided up into 2 groups. The first group comprised 25 individuals afflicted with a painful patellar syndrome without signs of instability; the second group comprised another 25 individuals with patellofemoral instability. All the subjects were subjected to standardized x-ray study bothbefore and after undergoing a rehabilitation protocol.Results and conclusions. Rehabilitation led to significant changes in the patellofemoral index of subjects with a painful patellar syndrome and in both this index and the patellofemoral congruence angle in patients with patellofemoral instability

Analgesia postoperatoria en hallux valgus / No disponible

Objetivo: Evaluar la efectividad de dos formas diferentes de prescribir la analgesia postoperatoria en pacientes sometidos a cirugía del hallux valgus con alta en el día. Material y método: A través de un cuestionario telefónico se evaluó la efectividad, grado de cumplimiento y complicaciones de dos protocolos de analgesia en pacientes ambulatorios intervenidos de hallux valgus. Los dos protocolos sólo se diferenciaron en la forma de prescripción de los mismos. Se recogieron datos de 48 pacientes distribuidos al azar en dos grupos mediante una hoja diseñada para este propósito. Resultados: La intensidad del dolor postoperatorio fue menor, tanto en las primeras 24 horas, como después, cuando se dio al paciente un protocolo de analgesia detallado minuciosamente, mejorando también el grado de cumplimiento. Las complicaciones (náuseas, vómitos, mareos) fueron más frecuentes en el grupo que no recibió una prescripción detallada. Un 34,5% de los pacientes padeció dolor bastante intenso en algún momento, pese a la analgesia. El dolor fue más intenso en las primeras 24 horas, cuando se asoció corrección de otros procesos y en los pacientes más jóvenes. Conclusiones: Comunicar al paciente de una forma muy detallada (por escrito) la pauta analgésica adecuada hace que su postoperatorio sea menos doloroso y reduce la incidencia de complicaciones, así como facilita su cumplimiento (AU)

Objective: To evaluate the effectiveness of two different ways to prescribe the postoperative analgesia subjected patients to surgery intervention of hallux valgus with discharge from hospital in the same day. Material and method: Through a telephone questionnaire we evaluated the effectiveness, fulfilment and complications of two analgesia protocols in ambulatory patients under hallux valgus surgery. Both analgesia protocols were only different in the prescription form. We analyzed the feed back from 48 patient random distributed in two groups. Each group was assigned to different a analgesia protocol prescription. Results: The intensity of the postoperative pain was smaller at the first 24 hours but also after that, when the prescription of analgesia protocol was given to the patient meticulously detailed. It also improved the protocol fulfilment by the patient. The complications (sickness, vomits, dizziness) were also more frequent in the group that did not receive a detailed prescription. A 34.5% of the patients suffered quite intense pain sometime, even when they have already taken the analgesia. The pain was more intense in the first 24 hours, when correction of other processes was associated and in the youngest patients. Conclusions: To communicate to the patient the analgesia protocol in a very and meticulous way (even by written) achieves a less distressful and painful postoperative process. It even reduces the postoperative complications and increases the correct analgesia protocol achievement (AU)

Testicular-epididymal hemodynamics and inguinal hernia.

Testicular-epididymal hemodynamics is studied by ultrasonographic color velocity imaging (CVI) in patients with primary, uncomplicated inguinal hernias. This procedure allows more precision than any other known Doppler system in measuring hemodynamic parameters such as peak systolic and diastolic velocity, resistance index and pulsatility index. The results of the exploration of 480 arteries of various testicular vascular territories are compared with those obtained by other authors in young healthy individuals using color Doppler. This procedure shows that the hernia does not cause significant alterations in the arterial circulation of the testicle and epididymis.

Autoinjerto y aloinjerto en la reconstrucción del ligamento cruzado anterior / Autografts and allografts in reconstruction of the anterior cruciate ligament

Objetivo. Comparar los resultados con las plastias autólogas y homólogas en la reconstrucción del ligamento cruzado anterior (LCA) en dos grupos de pacientes con un seguimiento mínimo de dos años. Material y método. Estudio retrospectivo no aleatorizado. Se realizaron 96 reconstrucciones de forma artroscópica por dos cirujanos entre agosto de 1997 y abril de 2000. Se instauró un protocolo precoz de rehabilitación. Se llamaron telefónicamente para revisión, acudiendo 66 (30 autoinjertos y 36 aloinjertos). Se valoró la sintomatología subjetiva mediante la escala de Lysholm y se objetivaron los signos clínicos y radiológicos mediante las pruebas de Lachman, pívot shift y Lachman activo radiológico, comparando con la rodilla sana. Resultados. No hubo diferencias estadísticamente significativas en los resultados de las pruebas de Lachman, pívot shift, Lachman activo radiológico y escala de Lysholm. Hubo dos casos de artrofibrosis entre los autoinjertos; en el grupo de los aloinjertos se produjeron dos casos de osteólisis tibial. Conclusiones. Observamos una mayor tendencia al deslizamiento en las pruebas de Lachman y pívot shift en los aloinjertos, si bien los pacientes presentan subjetivamente rodillas estables. Creemos que ambas opciones de tratamiento son igualmente adecuadas, ya que los resultados son estadísticamente similares en ambos grupos (AU)

[Prevention of thromboembolic disease and post-transfusional complications using normovolemic hemodilution in arthroplasty surgery of the hip]. / Prévention de la maladie thrombo-embolique et des complications post-transfusionnelles par l'hémodilution normovolémique en chirurgie arthroplastique de la hanche.

A prospective randomized study was conducted to evaluate the effect of moderate normovolemic haemodilution in arthroplastic surgery of the hip, to prevent postoperative deep vein thrombosis and the need for postoperative transfusion. The patients (n = 151) were divided into three groups: 48 patients received Dextran + Acetylsalicylic Acid as a prevention of the thromboembolic complications (Group I). 57 patients received a low dose of Heparin according to the Kakkar protocol (Group II). 52 patients were operated under Haemodilution (Group III). In Group I and II homologous blood transfusions were necessary in 83% of the cases, and in two cases posttransfusional hepatitis were observed. In Group III haemodilution avoided the use of homologous blood. Therefore of the three methods this study showed that haemodilution is the best way to prevent postoperative thrombo-embolism, significantly more effective than Heparin and Dextran, in arthroplastic hip surgery.