Diagnóstico y tratamiento de los osteomas osteoides del retropié: un método terapéutico para cada caso / Diagnosis and treatment of hindfoot osteoid osteoma: A therapeutic method for each case

Objetivos: 1) Recordar el diagnóstico de los osteomas osteoides (OO) del pie; y 2)definir las indicaciones de su tratamiento en el retropié. Material y método: Se han revisado un total de 5 osteomas osteoides (3 localizados en el astrágalo y 2 en el calcáneo). El diagnóstico se estableció por datos clínicos y de imagen. En todos los casos se identificó un nidus calcificado en la TC, edema óseo perilesional en la RM y captación focal gammagráfica. Se realizaron 2 termoablaciones con ondas de radiofrecuencia y 3 resecciones: 2 abiertas y una artroscópica. Se evaluaron los resultados clínicos y oncológicos al final del seguimiento. Resultados: No se registró ninguna complicación. El resultado clínico fue excelente en todos los casos. Un paciente fue tratado inicialmente con cirugía abierta y, después, por fracaso del procedimiento, mediante termoablación. No hubo recidivas después de un tiempo medio de seguimiento de 4 años y 6 meses (rango: 1-12 años). Discusión: Los OO del retropié son poco frecuentes y su diagnóstico se basa en la conjunción de datos clínicos con los característicos hallazgos de imagen. El tratamiento depende del asiento del nidus y de las relaciones de este con estructuras anatómicas próximas. Conclusiones: El diagnóstico de un OO del retropié puede asegurarse cuando los datos epidemiológicos, clínicos y de imagen son compatibles con la enfermedad. La termoablación está indicada en casos intracorticales o esponjosos en los que el nidus dista más de 1cm de la piel y de estructuras neurovasculares mayores. En el resto de casos una resección abierta o artroscópica sería de elección

Objectives: 1) to set a reminder of the diagnostic approach to osteoid osteomas (OOs) of the foot; 2) to define the indications of treatment for hindfoot OOs. Material and method: 5 OOs were checked (3 cases located in the talus and two cases in calcaneus). The diagnosis was established by clinical and imaging data. In all cases, a calcified nidus was identified on CT, perilesional bone oedema on MRI and focal scintigraphic uptake. Two cases were treated with radiofrequency ablation (RFA) and 3 cases with surgical resections: two open surgeries and one arthroscopic surgery. Clinical and oncological outcomes were evaluated at the end of the follow-up. Results: No complications were reported. The clinical outcome was excellent in all cases. One patient was initially treated with open surgery and then subsequently with RFA due to failure of the procedure. There were no recurrences after an average follow-up time of 4 years and 8 months (range, 1-12 years). Discussion: Hindfoot OOs are uncommon and their diagnosis is based on clinical data in conjunction with characteristic imaging findings. Their treatment choices depend on the location of the nidus and relationships with nearby anatomical structures. Conclusions: The diagnosis of an OO of the hindfoot can be ensured when the epidemiological, clinical and imaging data are compatible with this pathological entity. RFA is indicated for intracortical or cancellous cases in which the nidus is more than 1cm off the skin and significant neurovascular structures. For all other cases an open surgical resection or arthroscopic resection would be the first choice

Diagnosis and treatment of hindfoot osteoid osteoma: A therapeutic method for each case. / Diagnóstico y tratamiento de los osteomas osteoides del retropié: un método terapéutico para cada caso.

OBJECTIVES: 1) to set a reminder of the diagnostic approach to osteoid osteomas (OOs) of the foot; 2) to define the indications of treatment for hindfoot OOs. MATERIAL AND METHOD: 5 OOs were checked (3 cases located in the talus and two cases in calcaneus). The diagnosis was established by clinical and imaging data. In all cases, a calcified nidus was identified on CT, perilesional bone oedema on MRI and focal scintigraphic uptake. Two cases were treated with radiofrequency ablation (RFA) and 3 cases with surgical resections: two open surgeries and one arthroscopic surgery. Clinical and oncological outcomes were evaluated at the end of the follow-up. RESULTS: No complications were reported. The clinical outcome was excellent in all cases. One patient was initially treated with open surgery and then subsequently with RFA due to failure of the procedure. There were no recurrences after an average follow-up time of 4 years and 8 months (range, 1-12 years). DISCUSSION: Hindfoot OOs are uncommon and their diagnosis is based on clinical data in conjunction with characteristic imaging findings. Their treatment choices depend on the location of the nidus and relationships with nearby anatomical structures. CONCLUSIONS: The diagnosis of an OO of the hindfoot can be ensured when the epidemiological, clinical and imaging data are compatible with this pathological entity. RFA is indicated for intracortical or cancellous cases in which the nidus is more than 1cm off the skin and significant neurovascular structures. For all other cases an open surgical resection or arthroscopic resection would be the first choice.

Osteocondromas del extremo proximal del húmero. Manejo diagnóstico y terapéutico / Osteochondromas of the Proximal Humerus. Diagnostic and Therapeutic Management

Objetivo: 1) Recordar la epidemiología y semiología de los osteocondromas del extremo proximal del húmero (EPH); 2) determinar las indicaciones de su tratamiento y 3) hacer recomendaciones relativas al tratamiento quirúrgico en ese asiento. Material y método: Estudio retrospectivo observacional y longitudinal de 20 osteocondromas solitarios y 12 múltiples del EPH. Se analizaron las características epidemiológicas, clínicas y de imagen de los pacientes de la serie, y los resultados del tratamiento, con un tiempo medio de seguimiento de los casos intervenidos de 45 meses. Resultados: Los osteocondromas solitarios correspondieron a 11 hombres (55%) y 9 mujeres (45%), con una edad media de 21 años. Doce (60%) fueron intervenidos a una edad media de 23 años por ser sintomáticos o, en un caso, por sospecharse malignización. Dos casos solitarios no intervenidos pudieron haber involucionado espontáneamente. Las formas múltiples ocurrieron en 11 hombres (92%) y una mujer (8%) y 3 fueron intervenidos. No hubo complicaciones ni recidivas y el resultado funcional fue excelente en todos los pacientes. Discusión: Los osteocondromas del EPH son relativamente frecuentes, aunque la mayoría de las publicaciones son de casos clínicos aislados o de series cortas. Conclusiones: Los osteocondromas del EPH no difieren de los de otra localización. Los casos sintomáticos y en los que se sospecha malignización serían intervenidos, aquellos mejor con el crecimiento finalizado. El tratamiento quirúrgico se resume en la planificación del abordaje mediante TC o RM, resección en bloque extraperióstica y una eventual reconstrucción ósea, idealmente con homoinjerto

Objective: 1) To recall the epidemiology and signs of osteochondromas of the proximal humerus (OPH); 2) determine treatment indications; 3) and make recommendations for surgical treatment. Methods: Retrospective, observational and longitudinal study of 20 solitary and 12 multiple osteochondromas of the proximal humerus. We analyzed the epidemiological, clinical and imaging characteristics and treatment results with an average time of follow-up of the operated cases of 45 months.Results: Eleven (55%) males and 9(45%) females with an average age of 21 years presented solitary osteochondromas. Twelve (60%) cases were operated on at a mean age of 23 years because they were symptomatic or, in one case, malignancy was suspected. Two solitary osteochondromas could have spontaneously regressed. Multiple osteochondromas were found in 11(92%) males and one (8%) female of whom 3required surgery. There were no complications or recurrences. Functional outcome was excellent in all patients. Discussion: Osteochondromas of the proximal humerus are relatively common, although most publications are case reports or short series. Conclusions: Osteochondromas of the proximal humerus do not differ from those in other locations. Symptomatic cases and those in which malignancy is suspected would be operated, the former preferably at the end of growth. The surgical treatment is summarized in planning the approach, using CT and/or MRI, extraperiosteal en bloc resection, and eventual bone reconstruction, ideally with allograft

Osteochondromas of the Proximal Humerus. Diagnostic and Therapeutic Management. / Osteocondromas del extremo proximal del húmero. Manejo diagnóstico y terapéutico.

OBJECTIVE: 1) To recall the epidemiology and signs of osteochondromas of the proximal humerus (OPH); 2) determine treatment indications; 3) and make recommendations for surgical treatment. METHODS: Retrospective, observational and longitudinal study of 20 solitary and 12 multiple osteochondromas of the proximal humerus. We analyzed the epidemiological, clinical and imaging characteristics and treatment results with an average time of follow-up of the operated cases of 45 months. RESULTS: Eleven (55%) males and 9(45%) females with an average age of 21 years presented solitary osteochondromas. Twelve (60%) cases were operated on at a mean age of 23 years because they were symptomatic or, in one case, malignancy was suspected. Two solitary osteochondromas could have spontaneously regressed. Multiple osteochondromas were found in 11(92%) males and one (8%) female of whom 3required surgery. There were no complications or recurrences. Functional outcome was excellent in all patients. DISCUSSION: Osteochondromas of the proximal humerus are relatively common, although most publications are case reports or short series. CONCLUSIONS: Osteochondromas of the proximal humerus do not differ from those in other locations. Symptomatic cases and those in which malignancy is suspected would be operated, the former preferably at the end of growth. The surgical treatment is summarized in planning the approach, using CT and/or MRI, extraperiosteal en bloc resection, and eventual bone reconstruction, ideally with allograft.

The association between sleep quality, low back pain and disability: A prospective study in routine practice.

BACKGROUND: The objective of this study was to estimate the association between sleep quality (SQ) and improvements in low back pain (LBP) and disability, among patients treated for LBP in routine practice. METHODS: This prospective cohort study included 461 subacute and chronic LBP patients treated in 11 specialized centres, 14 primary care centres and eight physical therapy practices across 12 Spanish regions. LBP, leg pain, disability, catastrophizing, depression and SQ were assessed through validated questionnaires upon recruitment and 3 months later. Logistic regression models were developed to assess: (1) the association between the baseline score for SQ and improvements in LBP and disability at 3 months, and (2) the association between improvement in SQ and improvements in LBP and disability during the follow-up period. RESULTS: Seventy-three per cent of patients were subacute. Median scores at baseline were four points for both pain and disability, as assessed with a visual analog scale and the Roland-Morris Questionnaire, respectively. Regression models showed (OR [95% CI]) that baseline SQ was not associated with improvements in LBP (0.99 [0.94; 1.06]) or in disability (0.99 [0.93; 1.05]), although associations existed between 'improvement in SQ' and 'improvement in LBP' (4.34 [2.21; 8.51]), and 'improvement in SQ' and 'improvement in disability' (4.60 [2.29; 9.27]). CONCLUSIONS: Improvement in SQ is associated with improvements in LBP and in disability at 3-month follow-up, suggesting that they may reflect or be influenced by common factors. However, baseline SQ does not predict improvements in pain or disability. SIGNIFICANCE: In clinical practice, sleep quality, low back pain and disability are associated. However, sleep quality at baseline does not predict improvement in pain and disability.

Termoablación por radiofrecuencia de osteomas osteoides del extremo proximal del fémur. Utilidad de la ecografía en casos seleccionados / Radiofrequency thermal ablation of osteoid osteomas of the proximal femur. Usefulness of ultrasound guidance in selected cases

Objetivo. Repasar la sintomatología y los hallazgos de imagen de los osteomas osteoides (OO) del extremo proximal del fémur, analizar los resultados de la técnica de la termoablación del nidus con ondas de radiofrecuencia en esa localización y describir la utilidad de la ecografía en la realización de la técnica en casos seleccionados. Material y método. Estudio descriptivo retrospectivo de una serie de 8 pacientes con OO del extremo proximal del fémur tratados mediante termoablación del nidus con ondas de radiofrecuencia desde 1998 hasta 2014. Resultados. El tiempo medio de evolución del dolor hasta la termoablación fue de 11,5 meses (rango: 5-18 meses). No hubo ninguna complicación y todos los pacientes refirieron la desaparición del dolor al día siguiente del procedimiento, con molestias que desaparecieron en la primera semana, salvo en uno, que se prolongaron más de un mes por la dificultad de la técnica. En la actualidad, con un seguimiento medio de 6 años y 2 meses (rango: 6-190 meses), todos los pacientes siguen asintomáticos y realizan una vida rigurosamente normal. Discusión. La termoablación con ondas de radiofrecuencia guiada por TC es un procedimiento seguro, eficaz y eficiente. Conclusiones. La presentación habitual de un OO del extremo proximal del fémur no difiere significativamente de la de un OO de otra localización y el diagnóstico es fácil cuando aquella se conoce. La termoablación del nidus con ondas de radiofrecuencia, que en casos seleccionados podría ayudarse de la ecografía para situar el electrodo en el centro del nidus, nos parece el tratamiento de elección por su eficacia y mínima morbilidad (AU)

Purpose. To review symptoms and imaging findings of proximal femoral osteoid osteomas (OO); to analyse the results of a thermal ablation technique for radiofrequency of the nidus in this location; and to describe usefulness of ultrasound guidance in selected cases. Material and method. Descriptive and retrospective study consisting of 8 patients with OO in the proximal epiphysis of the femur, which were treated by thermal ablation of the nidus with radiofrequency waves from 1998 to 2004. Results. The mean pain period until the performance of the thermal ablation was 11.5 months (range 5-18 months). There were no complications, and all patients stated that the pain was gone by the day following the procedure, with some discomfort during the first week, except for one where it lasted more than one month due to technique difficulties. At present, with a mean follow up of 6 years and 2 months (range 6-190 months), all patients remain asymptomatic and live a rigorous normal life. Discussion. Thermal ablation with CT-guided radiofrequency waves is a safe, effective and efficient procedure. Conclusion. Normal appearance of a proximal femoral OO does not differ significantly from other location osteomas and its diagnosis is easier with previous knowledge. Thermal ablation of the nidus with radiofrequency waves, that may be performed using ultrasound guidance, appears to be the elective treatment of choice due to its efficiency and minimum morbidity (AU)

Radiofrequency thermal ablation of osteoid osteomas of the proximal femur. Usefulness of ultrasound guidance in selected cases.

PURPOSE: To review symptoms and imaging findings of proximal femoral osteoid osteomas (OO); to analyse the results of a thermal ablation technique for radiofrequency of the nidus in this location; and to describe usefulness of ultrasound guidance in selected cases. MATERIAL AND METHOD: Descriptive and retrospective study consisting of 8 patients with OO in the proximal epiphysis of the femur, which were treated by thermal ablation of the nidus with radiofrequency waves from 1998 to 2004. RESULTS: The mean pain period until the performance of the thermal ablation was 11.5 months (range 5-18 months). There were no complications, and all patients stated that the pain was gone by the day following the procedure, with some discomfort during the first week, except for one where it lasted more than one month due to technique difficulties. At present, with a mean follow up of 6 years and 2 months (range 6-190 months), all patients remain asymptomatic and live a rigorous normal life. DISCUSSION: Thermal ablation with CT-guided radiofrequency waves is a safe, effective and efficient procedure. CONCLUSION: Normal appearance of a proximal femoral OO does not differ significantly from other location osteomas and its diagnosis is easier with previous knowledge. Thermal ablation of the nidus with radiofrequency waves, that may be performed using ultrasound guidance, appears to be the elective treatment of choice due to its efficiency and minimum morbidity.

Circuito de asistencia a pacientes con sarcomas de partes blandas de las extremidades: un tortuoso y lento camino hasta las unidades de referencia / Health care circuit for patients with soft tissue sarcomas of the extremities. A tortuous and slow road to referral units

Objetivo: Analizar los tiempos de espera transcurridos desde que los sarcomas de partes blandas (SPB) se hacen sintomáticos hasta su tratamiento específico en nuestra Unidad de Tumores Músculo-Esqueléticos (UTME) para proponer estrategias de mejora en los circuitos de derivación. Material y métodos: Estudio observacional, longitudinal y ambispectivo de una cohorte de 61 pacientes con SPB vírgenes obtenidos e identificados de forma continúa del registro de pacientes de la UTME. Se analizó la relación entre diferentes tiempos transcurridos desde que la enfermedad se hizo sintomática hasta la primera consulta en la UTME, y diversas variables ligadas a la persona, tumor y circuito asistencial. Se usó un nivel de significación _ = 0,05. Resultados: El tamaño medio de los sarcomas fue de 11,3 cm. Treinta y seis pacientes (59%) siguieron el circuito habitual del Sistema Nacional de Salud en nuestro país. El tiempo medio transcurrido desde que la enfermedad se hizo sintomática hasta la primera consulta médica fue superior a 9,5 meses; y el que transcurrió desde esta hasta la primera en nuestra UTME fue de casi 8,5 meses. Algunas variables independientes mostraron relación estadísticamente significativa con las variables dependientes analizadas. Discusión: El estudio muestra que la asistencia a los pacientes con SPB de las extremidades en nuestro medio está muy lejos de los tiempos que transcurren en los países de nuestro entorno. Conclusiones: Parece fundamental la necesidad de concienciar a la población sobre la enfermedad y recordarla entre los profesionales sanitarios, al igual que la existencia de un circuito de derivación que es necesario utilizar (AU)

Objective: To analyse the waiting periods elapsed since soft tissue sarcomas become symptomatic until their specific treatment in our unit, and to determine new strategies for the improvement of referral circuits. Material and methods: This is an ambispective observational study of a cohort of 61 patients, with previously untreated soft tissue sarcomas, obtained from our Musculoskeletal Tumors Database. Several variables related to the patient, tumour, and health care circuit were analysed, as well as the different periods between the initial symptoms of the disease and the first consultation in our unit. The significance level was _=0.05. Results: The mean size of the sarcomas was 11.3 cm. Thirty-six patients (59%) followed the usual circuit of the National Health System in Spain. The time elapsed since the disease became symptomatic until the first medical consultation was greater than 9.5 months, and nearly another 8.5 months to the consultation in our specific unit. Statistically significant relationships were found between the independent and dependent variables. Discussion: The study shows that the care of patients with soft tissue sarcomas in our environment is far away from the times of care in our neighbouring countries. Conclusions: It is essential to make the population and health professionals aware of this disease, as well as to remember that there is a referral circuit that must be used (AU)

[Health care circuit for patients with soft tissue sarcomas of the extremities. A tortuous and slow road to referral units]. / Circuito de asistencia a pacientes con sarcomas de partes blandas de las extremidades: un tortuoso y lento camino hasta las unidades de referencia.

OBJECTIVE: To analyse the waiting periods elapsed since soft tissue sarcomas become symptomatic until their specific treatment in our unit, and to determine new strategies for the improvement of referral circuits. MATERIAL AND METHODS: This is an ambispective observational study of a cohort of 61 patients, with previously untreated soft tissue sarcomas, obtained from our Musculoskeletal Tumors Database. Several variables related to the patient, tumour, and health care circuit were analysed, as well as the different periods between the initial symptoms of the disease and the first consultation in our unit. The significance level was α=0.05. RESULTS: The mean size of the sarcomas was 11.3 cm. Thirty-six patients (59%) followed the usual circuit of the National Health System in Spain. The time elapsed since the disease became symptomatic until the first medical consultation was greater than 9.5 months, and nearly another 8.5 months to the consultation in our specific unit. Statistically significant relationships were found between the independent and dependent variables. DISCUSSION: The study shows that the care of patients with soft tissue sarcomas in our environment is far away from the times of care in our neighbouring countries. CONCLUSIONS: It is essential to make the population and health professionals aware of this disease, as well as to remember that there is a referral circuit that must be used.

Lipomas intramusculares: bultos benignos grandes y profundos. Revisión de una serie de 51 casos / Intramuscular lipomas: Large and deep benign lumps not to underestimated. Review of a series of 51 cases

Objetivo. Recordar una enfermedad poco tratada en la literatura científica. Material y métodos. Estudio observacional, longitudinal y ambispectivo de una serie de 51 lipomas intramusculares en 50 pacientes. Se ha calculado la distribución de frecuencias de las variables cualitativas y la mediana y el rango intercuartil (RIC) de las cuantitativas. La relación entre el tamaño de los lipomas (recodificada en 2 valores) y las variables de estudio se ha analizado con el test exacto de Fisher. Resultados. El 62% de los pacientes de la serie fueron varones y la mediana de edad, 61 años, con sobrepeso en el 55% del total. Se describe su localización, sus características de presentación clínica y de imagen, su tratamiento y resultados. Discusión. Los lipomas intramusculares tienen un aspecto característico, aunque a veces la RM no los distingue de liposarcomas bien diferenciados. El tamaño como criterio único de derivación de un paciente con una lesión de partes blandas a un centro de referencia es discutible. Conclusiones. Los pacientes con lipomas intramusculares, aunque estos puedan ser típicos en su presentación, sobre todo cuando sean grandes y muestren signos que los puedan confundir con liposarcomas bien diferenciados de bajo grado, se deberían tratar en centros con experiencia (AU)

Objective: To review a poorly studied pathology in the scientific literature. Material and methods: An observational, longitudinal and ambispective study of a series of 51 intramuscular lipomas in 50 patients. The frequency distribution of qualitative variables, and the median and the interquartile range (IQR) for continuous variables were calculated. The relationship between the size of the lipomas (recoded into two values) and the study variables were analyzed using the Fisher exact test. Results: Men made up 62% of the series, and the median age was 61 years, with 55% of the total being overweight. About half of the patients were diagnosed in the upper limb. More than threequarters (78%) were strictly intramuscular lipomas. Location, clinical and image presentation, treatment and results are described. Discussion: Intramuscular lipomas have their own particular characteristics. Nevertheless, MRI is sometimes unable to distinguish them from well differentiated liposarcomas. Using size as the only criterion for referring a patient with a soft tissue injury to a reference center is still debatable. Conclusions: Patients with intramuscular lipomas, although they may be typical in their presentation, especially when they are large and show findings that can be confused with a well-differentiated low grade liposarcoma, should be treated in experienced centers (AU)

[Intramuscular lipomas: Large and deep benign lumps not to underestimated. Review of a series of 51 cases]. / Lipomas intramusculares: bultos benignos grandes y profundos. Revisión de una serie de 51 casos.

OBJECTIVE: To review a poorly studied pathology in the scientific literature. MATERIAL AND METHODS: An observational, longitudinal and ambispective study of a series of 51 intramuscular lipomas in 50 patients. The frequency distribution of qualitative variables, and the median and the interquartile range (IQR) for continuous variables were calculated. The relationship between the size of the lipomas (recoded into two values) and the study variables were analyzed using the Fisher exact test. RESULTS: Men made up 62% of the series, and the median age was 61 years, with 55% of the total being overweight. About half of the patients were diagnosed in the upper limb. More than three-quarters (78%) were strictly intramuscular lipomas. Location, clinical and image presentation, treatment and results are described. DISCUSSION: Intramuscular lipomas have their own particular characteristics. Nevertheless, MRI is sometimes unable to distinguish them from well differentiated liposarcomas. Using size as the only criterion for referring a patient with a soft tissue injury to a reference center is still debatable. CONCLUSIONS: Patients with intramuscular lipomas, although they may be typical in their presentation, especially when they are large and show findings that can be confused with a well-differentiated low grade liposarcoma, should be treated in experienced centers.

[Solitary proximal end of femur osteochondroma. An indication and result of the en bloc resection without hip luxation]. / Osteocondromas solitarios del extremo proximal del fémur. Indicación y resultados de la resección en bloque sin luxación de la cadera.

OBJECTIVE: To review the indication of surgical treatment of solitary proximal end of femur osteochondromas, and present our experience as regards the approach for a complete and safe resection. MATERIAL AND METHOD: A retrospective study of a series of 6 symptomatic solitary proximal end of femur osteochondromas treated by en bloc resection by means of a single anterior or posterior-lateral approach. The patients were followed up routinely, as well as contacted by telephone to find out their current status. The functional assessment was made using the Musculoskeletal Tumour Society (MSTS) scale. The main limitation of the study was the its low level of recommendation. RESULTS: There were no post-operative complications and, after a mean follow of 8 years (rang:2-21 years), the clinical result was excellent or good in all cases, and there were no recurrences of the tumour. DISCUSSION: Although some authors have proposed femur head subluxation or luxation to expose the whole of the femur neck and head to facilitate the resection of the osteochondroma and the joint exploration, in our experience, this can be avoided in the majority of cases. CONCLUSIONS: Surgical treatment of solitary proximal end of femur osteochondromas is mandatory, as is the detailed pre-operative study of each case. Depending on their implantation and extension, en bloc resection can be performed by a single wide approach without the need for hip luxation.

Osteocondromas solitarios del extremo proximal del fémur. Indicación y resultados de la resección en bloque sin luxación de la cadera / Solitary proximal end of femur osteochondroma. An indication and result of the en bloc resection without hip luxation

Objetivo. Repasar la indicación del tratamiento quirúrgico de los osteocondromas del extremo proximal del fémur y presentar nuestra experiencia con respecto al abordaje para una resección completa y segura. Material y método. Estudio retrospectivo de una serie de 6 osteocondromas solitarios sintomáticos del extremo proximal del fémur, tratados mediante resección en bloque a través de un único abordaje anterior o posterolateral. Los pacientes fueron seguidos rutinariamente, a la vez que contactados telefónicamente para saber de su estado actual. La evaluación funcional fue hecha según la escala de la Sociedad de Tumores Musculoesqueléticos (MSTS). La principal limitación del estudio fue su escaso grado de recomendación. Resultados. No hubo complicaciones postoperatorias y, al cabo de un tiempo medio de seguimiento de 8 años (rango:2-21 años), el resultado clínico fue excelente o bueno en todos los casos. Tampoco hubo recidivas de la tumoración. Discusión. Aunque algunos han propuesto la subluxación o luxación de la cabeza femoral para exponer la totalidad del cuello y la cabeza femoral y facilitar la resección del osteocondroma y la exploración intraarticular, en nuestra experiencia, en la mayoría de los casos puede evitarse. Conclusiones. El tratamiento quirúrgico de los osteocondromas solitarios sintomáticos del extremo proximal del fémur es obligado, como lo es un estudio preoperatorio detallado de cada caso. Según su implantación y extensión, la resección en bloque del tumor puede realizarse a través de un único abordaje amplio sin necesidad de luxar la cadera (AU)

Objective. To review the indication of surgical treatment of solitary proximal end of femur osteochondromas, and present our experience as regards the approach for a complete and safe resection. Material and method. A retrospective study of a series of 6 symptomatic solitary proximal end of femur osteochondromas treated by en bloc resection by means of a single anterior or posterior-lateral approach. The patients were followed up routinely, as well as contacted by telephone to find out their current status. The functional assessment was made using the Musculoskeletal Tumour Society (MSTS) scale. The main limitation of the study was the its low level of recommendation. Results. There were no post-operative complications and, after a mean follow of 8 years (rang:2-21 years), the clinical result was excellent or good in all cases, and there were no recurrences of the tumour. Discussion. Although some authors have proposed femur head subluxation or luxation to expose the whole of the femur neck and head to facilitate the resection of the osteochondroma and the joint exploration, in our experience, this can be avoided in the majority of cases. Conclusions. Surgical treatment of solitary proximal end of femur osteochondromas is mandatory, as is the detailed pre-operative study of each case. Depending on their implantation and extension, en bloc resection can be performed by a single wide approach without the need for hip luxation (AU)

Fracturas del pilón tibial. Resultados funcionales a largo plazo / Fractures of the tibial pilon. Long-term functional results

Objetivo. Estudio epidemiológico y funcional a largo plazo de las fracturas de pilón tibial ingresadas en nuestro servicio a lo largo de cinco años cuyo objetivo es determinar cuál fue la evolución a largo plazo de las mismas, analizar la posible influencia de la calidad de la reducción obtenida y del estado de las partes blandas en los resultados clínicos, y evaluar la relación existente entre el tipo de fractura, los signos degenerativos radiográficos y los resultados obtenidos.Material y método. Se revisan 91 fracturas de pilón tibial en 87 pacientes (4 bilaterales), de las que 29 fueron mujeres (31,9%) y 62 varones (68,1%). Se realiza un estudio retrospectivo de todas las historias clínicas, citando posteriormente a los pacientes para la encuesta de funcionalidad según la escala de Duquennoy para el tobillo, la valoración objetiva de parámetros y la actualización de las radiografías.Resultados. Los factores más afectados por la fractura, en la escala de valoración de Duquennoy, fueron la capacidad de carrera/salto con una media de 1,6/5 y la deambulación sobre terrenos irregulares (2,6/5); los que menos se vieron influidos por la lesión fueron la necesidad de utilizar bastones (4,3/5) y el perímetro de marcha (8,4/10). Destaca un elevado número de complicaciones iniciales para reducir (27,1%) y/o fijar (12,8%) la fractura; complicaciones precoces comoproblemas en las partes blandas perifractuarias, y destacando entre las tardías la gran incidencia de la rigidez articular (51,4%) y las consolidaciones viciosas (24,3%).Conclusiones. Las fracturas de pilón tibial habitualmente se asocian a una alta tasa de complicaciones que hace muy difícil la predicción de los resultados a largo plazo. Existe una relación directa entre la existencia de signos radiográficosde artrosis y los malos resultados obtenidos con el paso del tiempo. Una excelente reducción articular no asegura unos excelentes resultados a largo plazo, pero sí una mayor probabilidad de que éstos estén presentes (AU)

Purpose. This is a functional and epidemiological long-term study of tibial pilon fractures treated in our hospital over a five-year period. Our aim was to determine the long-term evolution of these fractures, to assess the potential effect of the quality of the reduction obtained and of the condition ofthe soft tissues on the final outcome and to evaluate the relationship between fracture type, radiographical degenerative signs and the results obtained.Materials and methods. Ninety-one tibial pilon fractureswere reviewed in 87 patients (4 bilateral ones), 29 of which were women (31.9%) and 62 men (68.1%). A retrospective study was carried out of all clinical records, further to which patients were called in to be evaluated with respect to the Duquennoy ankle scale and to have their parameters objectively assessed and their radiographs updated.Results. On the Duquennoy scale, the factors most significantly affected by the fracture were the ability to run and to jump, with a mean value of 1.6/5 points and walking on uneven ground (2.6/5). The factors least affected by the injury were the need of a walking-stick (4.3/5) and the gait perimeter (8.4/10). There was a high incidence of initial complications to reduce (27.1%) and/or fixate (12.8%) the fracture. There were also a few early complications such as soft tissue-related problems in the area around the fractureand some late complications such as a high incidence ofjoint stiffness (51.4%) and malunions (24.3%).Conclusions. Tibial pilon fractures are often associated to a high complications rate that makes it very difficult to anticipate long-term results. There is a direct relationship between the presence of radiographic signs of arthritis and poor long-term results. An excellent joint reduction does not guaranteethe attainment of excellent long-term results; but it does lead to a higher probability of success (AU)

Eficacia de la hemostasia tras retirada del torniquete en la artroplastia de rodilla / Effectiveness of hemostasis after tourniquet removal in total knee replacement

Objetivo. El objetivo de este trabajo es comprobar si la hemostasia quirúrgica que se realiza tras la retirada del torniquete en las prótesis totales de rodilla es efectiva para reducir las pérdidas sanguíneas. Material y método. Se seleccionaron 30 pacientes, a los que se les realizó hemostasia con electrobisturí una vez retirado el torniquete (grupo A) y otros 30 pacientes a los que se les retiró el torniquete una vez cerrada la herida y aplicado el vendaje compresivo (grupo B). Se midieron las pérdidas sanguíneas recogidas por el drenaje aspirativo, los descensos de hemoglobina y hematocrito a las 24 y 48 horas después de la cirugía comparados con los preoperatorios, tiempos de isquemia e intervención y necesidades transfusionales. Resultados. No se encontraron diferencias estadísticamente significativas en cuanto a las pérdidas sanguíneas (p = 0,836) y requerimientos transfusionales (p= 0,618) entre ambos grupos. Conclusiones. La hemostasia quirúrgica que se realiza una vez retirado el torniquete no es efectiva para reducir las pérdidas sanguíneas en la artroplastia de sustitución de la rodilla

Purpose. The purpose of this study is to determine if surgical hemostasis carried out after tourniquet removal in total knee replacement (TKR) surgery is effective in reducing bleeding. Materials and methods. In 30 selected patients (Group A) undergoing TKR hemostasis was carried out with electrocautery once the tourniquet was deflated intraoperatively; in another 30 selected patients (Group B) the incision was closed and compressive dressing was applied before tourniquet removal. Blood loss was measured by aspiration drainage, and hemoglobin levels and hematocrit were measured at 24 and 48 hours after surgery and compared with preoperative values, ischemic time was also measured and any transfusions required registered. Results. No statistically significant differences were found between both groups regarding blood loss (p=0.836) or transfusions required (p= 0.618). Conclusions. Surgical hemostasis carried out after tourniquet removal is not effective as a way of reducing blood loss in total knee replacement (TKR)

Artroplastia de cadera con vástago femoral recubierto de biovidrio / Hip arthroplasty with a bioactive glass-coated femoral stem

Objetivo. Evaluar el resultado del vástago femoral CRM recubierto de biovidrio (Seipi-Bioimplant, Italia) después de 8 años de seguimiento. Material y método. Se han revisado de forma retrospectiva 67 pacientes a los que se había implantado 70 prótesis totales de cadera con un vástago femoral no cementado y recubierto de biovidrio durante los años 1994 y 1995 con un seguimiento de 8 años. El análisis de supervivencia se realizó por el método actuarial y se calculó también el intervalo de confianza del 95 por ciento (IC 95 por ciento). Se pudo realizar una revisión completa tanto clínica como radiográfica en 59 pacientes con 62 vástagos implantados. Resultados. La valoración clínica se realizó conforme a la escala de Merle D'Aubigné con 19 casos (30 por ciento) excelentes, 17 casos (28 por ciento) muy buenos, 12 casos (20 por ciento) buenos y 14 casos (22 por ciento) entre regulares y malos. Para la valoración radiográfica se utilizaron los criterios de Engh para los vástagos no cementados, apreciando 56 vástagos estables (90,4 por ciento) y un vástago inestable (1,6 por ciento). Se habían realizado 5 recambios (8 por ciento): uno por aflojamiento séptico y 4 por aflojamiento aséptico. La curva de supervivencia a los 8 años es del 91,9 por ciento y el IC 95 por ciento tiene valores de 85,2 por ciento98,7 por ciento. Conclusiones. Teniendo en cuenta que en 1996 ya existían publicaciones sobre vástagos femorales recubiertos de hidroxiapatita (HA) con seguimiento de 7 años y con una curva de supervivencia cercana al 100 por ciento y coincidiendo también con los resultados de la tesis doctoral realizada por uno de nosotros sobre el implante de cilindros de titanio recubiertos de HA y otros recubiertos de biovidrio en fémures de oveja, se desistió de continuar implantando vástagos recubiertos de biovidrio, por considerar que los resultados de supervivencia no son equiparables a los vástagos recubiertos de HA (AU)