Influencia de la artroplastia total de cadera y el consejo médico en la actividad deportiva realizada después de la intervención / Influence of total hip arthroplasty and physicians advices in the sports activity performed after the surgery

ANTECEDENTES Y OBJETIVOS: No hay estudios prospectivos aleatorizados que evalúen la actividad deportiva tras una artroplastia total de cadera (ATC). El objetivo de este estudio es evaluar el nivel y el tipo de actividad deportiva en pacientes intervenidos de ATC y valorar las recomendaciones dadas por los médicos. MATERIALES Y MÉTODOS: Estudio descriptivo que analiza a 46 pacientes (edad media 41 años, rango 37-48) menores de 50 años que fueron intervenidos de ATC (58 caderas) en nuestro centro. El seguimiento medio fue 7,5 (1-11) años. Se evaluó la edad, el sexo, la actividad deportiva según la escala UCLA, las actividades deportivas practicadas antes y después de la intervención, las complicaciones y las recomendaciones dadas por los médicos. RESULTADOS: La media del tiempo para retomar la actividad deportiva tras la intervención fue de 5 (3-10) meses. No hubo diferencias en la escala UCLA antes y después de la intervención (p > 0,05). El deporte más practicado antes de la intervención fue la natación (17%). El 31% de los pacientes no recibió consejos de su médico y el 65,2% fue disuadido de realizar deporte tras la ATC. Los deportes aconsejados fueron la natación (44%) y la bicicleta estática (17,5%), correlacionándose con los deportes más practicados tras la intervención. CONCLUSIÓN: Los pacientes modificaron su actividad deportiva tras ser intervenidos de ATC, siendo la propia intervención y el consejo del médico los que influyeron en la elección de la actividad deportiva realizada tras ser intervenido

BACKGROUND AND OBJECTIVES: There are no randomized prospective studies that evaluate sports activity after total hip arthroplasty (THA). The objective of this study is to assess the level and type of sports activity in patients undergoing THA and to assess the recommendations given by physicians. MATERIALS AND METHODS: We performed a descriptive study that analyzes 46 patients (the average age was 41 years, range 37 - 48) under 50 years of age who underwent THA (58 hips) in our center. The average follow-up was 7.5 (1 - 11) years. Age, sex, sports activity according to the UCLA scale, sports activities practiced before and after the intervention, complications and recommendations given by doctors were evaluated. RESULTS: The average time to resume sport activity after the surgery was 5 (3-10) months. There were no differences in the UCLA scale before and after the operation (P> 0.05). The most practiced sport before the surgery was swimming (17%). The 31% of patients did not receive advice from their physician and the 65.2% were dissuaded from playing sports after ATC. The recommended sports were swimming (44%) and the static bicycle (17.5%), correlating with the most practiced sports after the operation. CONCLUSION: The patients modified their sport activity after having undergone a total hip arthroplasty. The surgery and the physician's advice were the ones that influenced the choice of the sports activity performed after being operated on

Influence of total hip arthroplasty and physicians advices in the sports activity performed after the surgery. / Influencia de la artroplastia total de cadera y el consejo médico en la actividad deportiva realizada después de la intervención.

BACKGROUND AND OBJECTIVES: There are no randomized prospective studies that evaluate sports activity after total hip arthroplasty (THA). The objective of this study is to assess the level and type of sports activity in patients undergoing THA and to assess the recommendations given by physicians. MATERIALS AND METHODS: We performed a descriptive study that analyzes 46 patients (the average age was 41 years, range 37 - 48) under 50 years of age who underwent THA (58 hips) in our center. The average follow-up was 7.5 (1 - 11) years. Age, sex, sports activity according to the UCLA scale, sports activities practiced before and after the intervention, complications and recommendations given by doctors were evaluated. RESULTS: The average time to resume sport activity after the surgery was 5 (3-10) months. There were no differences in the UCLA scale before and after the operation (P> 0.05). The most practiced sport before the surgery was swimming (17%). The 31% of patients did not receive advice from their physician and the 65.2% were dissuaded from playing sports after ATC. The recommended sports were swimming (44%) and the static bicycle (17.5%), correlating with the most practiced sports after the operation. CONCLUSION: The patients modified their sport activity after having undergone a total hip arthroplasty. The surgery and the physician's advice were the ones that influenced the choice of the sports activity performed after being operated on.

Medial and lateral exostoses of the distal phalanx of the hallux: A potentially painful bunion-like structure. Part 1: Incidence and clinical application.

BACKGROUND: Exostoses at the base of the distal phalanx of the great toe are usually asymptomatic. The literature has not generally considered them as the origin of a possible problem resulting from a pressure conflict between hallux and shoe (medial aspect) or second toe (lateral aspect) nor a potential complication of surgical correction of hallux valgus deformity. No studies, to our knowledge, have evaluated its possible correlation with other foot disorders. When one of these neglected exostoses became painful after surgical correction of hallux valgus, we decided to start a study to determine their possible origin, prevalence in daily practice and histo-pathological morphology. METHODS: Two hundred and fifty-four feet of patients (average age 41.7y.) were enrolled in the study from January 2007 to June 2009. Dorsoplantar weight-bearing radiographs were used to analyze the presence of exostoses and their correlation with the distal phalanx morphology, metatarsal formula (or transverse plane orientation of the metatarsal heads parabola) and hallux valgus angles. Patients were classified according to their age and main symptom for consultation. Four exostoses removed from cadaver feet were also analyzed microscopically. RESULTS: Osseous excrescences arising on the medial or lateral aspect at the proximal part of the terminal phalanx of the hallux were observed in 132 feet (51.9%). Thirty-five feet out of these 132 (13.7%) had exostoses on both sides of the phalanx.A statistically significant positive correlation was found between the presence of a medial exostosis of the phalanx and the severity of HVA. Patients with higher IPH and asymmetry angles have a lower prevalence of medial exostoses (p<0.05). Amongst the different morphologies of the second phalanx, exostoses were most likely found in the standard form. CONCLUSIONS: Prevalence of exostoses at the base of the distal phalanx is high (51.9% of the studied feet). Histological findings would suggest that these exostoses could be considered a mechanical reactive process, produced by a chronic irritation by shoes. We encourage surgeons to be aware of its potential clinical implications. Direct resection is very simple and the most appropriate treatment for symptomatic cases.

Inflammatory biomarkers and intellectual disability in patients with Down syndrome.

BACKGROUND: Intellectual disability (ID) is part of the Down syndrome (DS) phenotypic spectrum, but the exact molecular pathophysiology of ID in individuals with DS is not yet fully understood, with many research hypotheses still unproven. Basing on previous studies (which suggested a possible role of altered inflammatory response in DS-related ID), we assessed the serum levels of a number of inflammatory biomarkers [serum amyloid A (SAA), C-reactive protein (C-RP), high mobility group box-1 (HMGB1)] in a cohort of individuals with DS and healthy controls. METHODS: In total, 24 children diagnosed with DS and 12 healthy controls were enrolled, and all underwent detailed cognitive assessment. Also, serum SAA, C-RP and HMGB1 levels were measured in all recruited subjects and correlated to the severity of ID in the DS group. RESULTS: Serum SAA, C-RP and HMGB1 values were found to be significantly higher in the DS group compared with the healthy subjects (P = 0.001). In addition, serum HMGB1 levels positively correlated with C-RP and SAA in the DS group but not in the healthy controls. Only serum C-RP levels resulted inversely correlated (P < 0.01) with intelligence quotient (IQ); conversely, significant statistical correlations between serum SAA levels and IQ (as well as between HMGB1 and IQ) have been not found (P > 0.05). CONCLUSIONS: The levels of the determined markers were higher in DS individuals compared with (cognitively) healthy subjects, and CRP showed a negative correlation with IQ in children with DS.

Serum interleukin-6 levels are increased in HIV-infected patients that develop autoimmune disease during long-term follow-up.

BACKGROUND: Elevated IL-6 levels have been associated with both autoimmune diseases and treated HIV-seropositive (HIV+) subjects. However, few data on classic and trans-signaling IL-6 in autoimmune thyroid diseases and HIV+ subjects developing autoimmune disorders are currently available. MATERIALS AND METHODS: A total of 102 patients were included in the study. They were subdivided into two groups. Group A consisted in 51 HIV+ patients, who were followed-up for a period of five years in search of possible occurrence of autoimmune diseases. Ten of them, treated with antiretroviral therapy (ART), developed an autoimmune disorder, namely Hashimoto's thyroiditis, and psoriasis. Group B consisted in 51 patients affected by Hashimoto's thyroiditis (HT). Serum levels of the free form of IL-6 were analyzed by ELISA in all patients and for HIV+ patients at the beginning of the follow-up, before initiation of ART. RESULTS: Mean serum levels of IL-6 were similar in Group A and in Group B. In Group B, IL-6 levels showed a 5.8% increase compared with assay minimum detectable dose corresponding to 1% of full serum IL-6 level. However, serum levels of free IL-6 were increased in those HIV+ patients who developed autoimmune disorders (5.8±2.8pg/ml) and in these patients, the highest levels of free IL-6 correlated with age and CD4 cellular counts. CONCLUSIONS: The present study indicates a correlation between serum free IL-6 levels and the occurrence of autoimmune disease in HIV+ population, treated with ART during a long-term follow-up. The increased levels of serum free IL-6 were observed before ART treatment was initiated, indicating that IL-6 measurement in such patients may represent an early predictor of development of autoimmune disease.

Staple Line Reinforcement During Laparoscopic Sleeve Gastrectomy: Absorbable Monofilament, Barbed Suture, Fibrin Glue, or Nothing? Results of a Prospective Randomized Study.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is associated with serious complications, such as staple line (SL) leaks and bleeding. In order to prevent the occurrence of these complications, surgeons have advocated the need to strengthen the staple line. The aim of this randomized controlled study was to compare the efficacy of three different ways of strengthening of the SL in LSG in preventing surgical post-operative complications. METHODS: Between April 2012 and December 2014, 600 patients (pts) scheduled for LSG were prospectively randomized into groups without SL reinforcement (group A) or with SL reinforcement including fibrin glue coverage (group B), or oversewn SL with imbricating absorbable (Monocryl™; group C) or barbed (V lock®) running suture (group D). Primary endpoints were post-operative leaks, bleeding, and stenosis, while secondary outcomes consisted of the time to perform the staple line reinforcement (SLR) and total operative time. RESULTS: Mean SLR operative time was lower for group B (3.4 ± 1.3 min) compared with that for groups C (26.8 ± 8.5 min) and D (21.1 ± 8.4 min) (p < 0.0001). Mean total operative time was 100.7 ± 16.4 min (group A), 104.4 ± 22.1 min (group B), 126.2 ± 18.9 min (group C), and 124.6 ± 22.8 (group D) (p < 0.0001). Post-operative leaks, bleeding, and stenosis were recorded in 14 pts (2.3 %), 5 pts (0.8 %), and 7 pts (1.1 %), respectively, without statistical difference between the groups. CONCLUSION: Our study suggests that SLR during LSG, with an imbricating or non-imbricating running suture or with fibrin glue, is an unrewarding surgical act with the sole effect of prolonging the operative time.

Rivaroxaban is as efficient and safe as bemiparin as thromboprophylaxis in knee arthroscopy.

PURPOSE: The aim of this study is to compare effectiveness and safety profile of rivaroxaban with bemiparin in 3-week extended prophylaxis after knee arthroscopy. METHODS: Four hundred and sixty-seven patients were included in this review divided in two groups. One followed prophylaxis with rivaroxaban and the other one with bemiparin. All patients were interviewed and explored at 1 and 3 months postoperatively, looking for symptomatic signs of deep-vein thrombosis (DVT). In case of suspicion, diagnostic tests were performed. Collected data were age, sex, gender, diagnosis, time with ischemia, body mass index, concomitant diseases, concomitant therapy, DVT signs, treatment satisfaction, minor and major complications, treatment adherence and tolerability. RESULTS: No thromboembolic events were observed in any of the groups. In one case treated with rivaroxaban, the drug had to be withdrawn due to epistaxis. CONCLUSIONS: Our study showed that extended prophylaxis with 10 mg of rivaroxaban once daily for 3 weeks resulted as effective as bemiparin in knee arthroscopy thromboprophylaxis.

Cardiac diastolic evaluation in pregnant women with abnormal glucose tolerance: an opportunity to detect the early and subclinical alterations and prevent cardiovascular diseases.

OBJECTIVES: of this study were to assess diastolic function in pregnant women with abnormal glucose tolerance (AGT), compared with normal glucose tolerance (NGT) women, and to evaluate the insulin resistance status and its association with Doppler-echocardiographic indexes. Echocardiograms of 108 consecutive Caucasian women with singleton pregnancies were performed. Insulin resistance status was estimated by the homeostasis model assessment of insulin resistance (HOMA-IR) and the quantitative insulin sensitivity check index (QUICKI). All the studied women showed normal diastolic patterns. Patients with AGT (50.9%), as compared with NGT women, had higher HOMA-IR (1.70 ± 1.30 versus 1.01 ± 0.81, P = 0.003), lower QUICKI (0.36 ± 0.005 versus 0.40 ± 0.06, P = 0.004), higher lateral mitral annulus late diastolic velocity (13.6 ± 4.9 versus 11.9 ± 4.9, P = 0.03), and higher A-wave velocity, the wave responsible for the active atrial contraction component (75.2 ± 14.2 versus 67.7 ± 16.2, P = 0.01). At multivariate regression analysis HOMA-IR was the only parameter associated with A-wave velocity. In conclusion, women with AGT had an increased subclinical diastolic active participation, which is associated with higher levels of insulin resistance. For the increased risk of deterioration of cardiac diastolic function, earlier and more seriously than normal pregnancy, AGT women may have a careful followup to detect the early signs of cardiac alteration and to prevent cardiovascular diseases.

High-grade poorly differentiated retroperitoneal sarcoma. Report of a case and review of the literature.

Retroperitoneal sarcomas (RPS) are uncommon tumors associated with a poor prognosis. This is particularly true in case of high-grade sarcomas of specific histological subtypes, as demonstrated by the largest surveys of the last decade. Up to the present day, unfortunately there are no powerful tools available except for surgery. On the other hand, the resection rate of RPS is significantly increased over the last decades allowing to deliver the best treatment available. This paper reports on the case of a young patient who was incidentally diagnosed with a retroperitoneal mass. The patient underwent surgery in our department and the histological report showed a spindle cell sarcoma of high grade of malignancy with an incomplete muscular phenotype. The patient was discharged on the seventh postoperative day and he is still free of local and distant recurrence.

[The United Nations conventions on the rights of persons with disabilities: which strategies for protection at work?]. / La convenzione O.N.U. sui diritti delle persone con disabilità: quali strategie per la tutela sul lavoro?

More than 15% of the world's population lives with some form of moderate or severe disabilities, a growing percentage due to aging population as well as to the global increase of chronic diseases. The United Nations approved, in December 2006, the "Convention on the Rights of Persons with Disabilities" which dealt with the theme "work and employment". It prohibited discrimination on the grounds of disability with regard to health and safety at work, ensuring safe and healthy working conditions including protection from harassment. The most important expectation for the UN Convention, ratified in Italy by law 18/2009, is the guarantee that disable people in the workplaces are provided with "reasonable accomodation". This term refers to modifications and adaptations which are necessary and appropriate, that do not foresee excessive costs, to be taken, where necessary, to ensure even workers with disabilities the enjoyment and exercise of all their rights.

Physiopathological, clinical and therapeutic aspects of hepatopulmonary syndrome.

Patients with cirrhosis or portal hypertension may develop hepatopulmonary syndrome (HPS) and portopulmonary hypertension (PPHT). HPS occurs in 25% of the subjects with chronic hepatopathy waiting for a liver transplantation. HPS is characterized by chronic hepatopathy and/or portal hypertension, increased P(A-a)O2 gradient (more than 20 mmHg) with hypoxemia and intrapulmonary vascular dilatations without a primary cardiovascular disease. Hypoxiemia is due to intrapulmonary arteriovenous shunts and to dilatation of microvessels in basal parts of the lung and of pleural vessels. In patients with cirrhosis an impaired cardiovascular function is frequent, often in a subclinical phase of the disease. Left ventricular systolic and diastolic dysfunction may develop a chronic hepatopathy and the relation between right ventricular and liver failure has been studied. During cirrhosis characteristic alterations of systemic hemodynamic can cause the hyperdynamic circulatory syndrome. Contrast enhanced 2D ECHO cardiography is the preferred screening test for intrapulmonary arteriovenous shunts. The aim of HPS therapy is to contrast intrapulmonary vasodilatation, increased portal flux and hyperdynamic syndrome. New therapeutical agents are fosfodiesterase inhibitors, ET-1 receptor antagonists and selective NOS inhibitors. However, medical treatment is not much effective in HPS and liver transplantation is considered the only therapeutical chance.

Diagnosis and treatment of depression in Alzheimer's disease: impact on mood and cognition.

Depression, a common neuropsychiatric syndrome associated with lower quality of life (QOL), higher mortality, and higher caregiver burden, is estimated to occur in 20-50% of Alzheimer's disease (AD) patients. Recent research suggests that depression in AD (dAD) may differ from major depression phenomenologically and etiologically. Treatment options for dAD include behavioral modifications, pharmacotherapy, and electroconvulsive therapy. Successful treatment of dAD has been reported to improve patients' mood and QOL, as well as lower caregiver burden. Further research is needed in therapeutics of dAD to enhance treatment options and effectiveness.

Prótesis total de rodilla tras osteotomía proximal de tibia / Total knee arthroplasty after high tibial osteotomy

Introducción. El resultado de la prótesis total de rodilla (PTR) tras una osteotomía de tibia proximal para el tratamiento de las artrosis unicompartimentales de rodilla es un tema de gran relevancia en la actualidad, especialmente a raíz de la masificación de las prótesis unicompartimentales de rodilla. Hemos realizado un estudio retrospectivo comparativo para determinar si la presencia de una osteotomía previa influye negativamente en el resultado de las PTR. Material y método. Del conjunto de pacientes intervenidos en nuestro centro a los que se implantó una PTR, seleccionamos una serie de 20 casos que presentaban una osteotomía de tibia proximal previa y los comparamos con un grupo de 20 pacientes con PTR primaria utilizada como grupo control. Realizamos una serie de mediciones radiográficas (altura de la rótula, alineación del eje de la rodilla, grosor de corte tibial) y clínicas (movilidad articular, capacidad de marcha y complicaciones) para comparar y establecer diferencias entre ambos grupos. El tiempo medio de seguimiento postoperatorio fue de cinco años. Resultados. No se encontraron diferencias en las mediciones obtenidas respecto a índice varo-valgo ni en el resultado funcional. Sí observamos una discreta disminución en la altura rotuliana, un aumento del tiempo operatorio y en las exigencias técnicas de la cirugía, así como un déficit relativo de stock óseo en los pacientes que habían sido sometidos previamente a osteotomía proximal de tibia. Conclusión. La osteotomía valguizante de tibia sigue siendo un buen tratamiento para la artrosis unicompartimental de rodilla, en la que hay una amplia experiencia sobre su uso y que no interfiere, según nuestros resultados, en la reconversión a una posterior PTR

Introduction. The result of total knee replacement (TKR) after proximal tibial osteotomy performed to treat unicompartmental knee osteoarthritis is a highly relevant issue given the widespread use made nowadays of unicompartmental knee prostheses. This is a retrospective comparative study carried out to determine whether the presence of a previous osteotomy negative influences the result of TKRs. Materials and methods. Of all the patients subjected to TKR in our hospital, we selected a series of 20 cases that had a prior proximal tibial osteotomy and we compared them with a group of patients with a primary PTR, which we used as control. We performed a series of radiographic (patellar height, alignment of the knee axis and thickness of the tibial section) and clinical (joint mobility, walking capability and complications) measurements, in order to compare both groups and establish differences between them. Mean follow-up was 5 years. Results. No differences were found in the measurements taken with respect to the varus/valgus index or the functional result achieved. We did observe, however, a slight decrease in patellar height as well as an increase in OR time and in the technical complexity of the procedure. We also detected a relative bone stock deficit in patients who had undergone a previous proximal tibial osteotomy. Conclusion. High tibial osteotomy remains a reliable treatment for unicompartmental knee osteoarthritis. It is a procedure surgeons have vast experience of and which does not negatively influence a potential TKR implantation at a later date

Relationship between metabolic syndrome and platelet responsiveness to leptin in overweight and obese patients.

OBJECTIVE: To verify whether platelet responsiveness to leptin is associated with metabolic syndrome risk factors. DESIGN: Cross-sectional study. SUBJECTS: We studied 169 consecutive patients, mean age=43.6+/-9.9 years, with overweight (N=57) or obesity (N=112). MEASUREMENTS: Cluster analysis was used to generate three clusters based on platelet responsiveness to increasing doses of leptin. Profiles of metabolic syndrome risk factors of the three clusters were compared by discriminant analysis. RESULTS: Platelet responsiveness to leptin was absent in cluster 1, whereas cluster 3 had the greatest platelet aggregation response to leptin pre-incubation. Plasma leptin levels significantly decreased from cluster 1 to cluster 3 in both gender. Patients in cluster 2 had an intermediate profile of leptin responsiveness. Highest body mass index (BMI) values were more frequent in non-responders, whereas the prevalence of high waist circumference, as well as hypertriglyceridemia and hypertension, increased with increasing responsiveness to leptin from cluster 1 to cluster 3. Pattern of metabolic syndrome risk factors qualified as group specific in 69.0% of the cluster 1, 54.9% of the cluster 2 and 55.8% of the cluster 3. Circulating leptin, waist circumference, plasma triglycerides and BMI defined distinctive patterns of metabolic syndrome risk factors in the clusters. CONCLUSIONS: In overweight and obese outpatients, metabolic syndrome risk factors parallel to some extent platelet responsiveness to leptin. Such a correlation involves plasma leptin levels, waist circumference, plasma triglycerides and BMI, and may contribute to the excess risk of cardiovascular events in overweight and obese patients.

[Migration, work flexibility and early retirement of nurses in Italy]. / Immigrazione, flessibilità e ritiro precoce nel personale infermieristico in Italia.

Several work organizational changes have been occurring in the health sector in the last years. Workforce is rapidly changing and particularly nurses. In Italy there is a growing shortage of nurses (5,4/1000 inhabitants versus 9,26 in EU25) due mainly to early retirement and insufficient turnover of nurses coming from educational programmes. Work flexibility and facilitation of migration flow of foreigner nurses have been introduced in Italy to face the problem. The present study is aimed at investigating the impact of such a change in the nursing sector in Italy and its possible impact on occupational safety and health. In view of this, the main institutional and category Sources were used. According to IPASVI estimates, the shortage of nurses in Italy is 99,000. Out of a total of 342,000 active professional nurses, 20,000 are foreign, mainly from European countries. Nurses are specially affected by accidents at work, mainly musculoskeletal disorders. The study shows a higher vulnerability of migrated nurses and nurses hired through cooperatives. Therefore urgent measures are needed to promote their integration and assess educational and training needs in the field of health and safety at work.

[Bone transplant]. / Trasplante óseo.

We describe the methodology of the Bone and Soft Tissue Bank, from extraction and storage until use. Since the year 1986, with the creation of the Bone Bank in the University Clinic of Navarra, more than 3,000 grafts have been used for very different types of surgery. Bone grafts can be classified into cortical and spongy; the former are principally used in surgery to save tumour patients, in large post-traumatic reconstructions and in replacement surgery where there are massive bone defects and a structural support is required. The spongy grafts are the most used due to their numerous indications; they are especially useful in filling cavities that require a significant quantity of graft when the autograft is insufficient, or as a complement. They are also of special help in treating fractures when there is bone loss and in the treatment of delays in consolidation and pseudoarthrosis in little vascularized and atrophic zones. They are also used in prosthetic surgery against the presence of cavity type defects. Allografts of soft tissues are specially recognised in multiple ligament injuries that require reconstructions. Nowadays, the most utilised are those employed in surgery of the anterior cruciate ligament although they can be used for filling any ligament or tendon defect. The principal difficulties of the cortical allografts are in the consolidation of the ends with the bone itself and in tumour surgery, given that these are patients immunodepressed by the treatment, the incidence of infection is increased with respect to spongy grafts and soft tissues, which is irrelevant. In short, the increasingly widespread use of allografts is an essential therapeutic weapon in orthopaedic surgery and traumatology. It must be used by expert hands.

Trasplante óseo / Bone transplant

Describimos la metodología del Banco de Huesos y Tejidos blandos desde su extracción y su almacenamiento hasta su utilización. Desde el año 1986 con la creación del Banco de Huesos en la Clínica Universitaria de Navarra, se han utilizado más de 3.000 injertos para cirugías muy diversas. Los injertos óseos se pueden clasificar en corticales y esponjosos; los primeros se emplean principalmente en cirugía de salvamento en pacientes tumorales, en grandes reconstrucciones postraumáticas y en cirugía de reemplazo en el que los defectos óseos son masivos y requieren un soporte estructural. Los injertos esponjosos son los más utilizados por sus numerosas indicaciones, de especial utilidad en el relleno de cavidades que precisan una cantidad importante de injerto cuando el autoinjerto es insuficiente o como complemento; también son de especial ayuda en el tratamiento de las fracturas cuando existen pérdidas óseas y en el tratamiento de los retrasos de consolidación y seudoartrosis en zonas poco vascularizadas y atróficas. Se usan también en cirugía protésica ante la presencia de defectos de tipo cavitario. Los aloinjertos de tejidos blandos están especialmente reconocidos en lesiones ligamentosas múltiples que requieren reconstrucciones. Hoy en día, los más utilizados son los empleados en la cirugía del ligamento cruzado anterior aunque pueden ser utilizados para reemplazar cualquier defecto ligamentoso o tendinoso. Las principales dificultades de los aloinjertos corticales están en la consolidación de los extremos con el hueso propio y en cirugía tumoral, dado que son enfermos inmunodeprimidos por el tratamiento, la incidencia de infección se encuentra aumentada con respecto a los injertos esponjosos y de tejidos blandos que es irrelevante. En definitiva, el uso de aloinjertos cada vez más extendido es un arma terapéutica imprescindible en cirugía ortopédica y traumatología, que debe ser usada por manos expertas

We describe the methodology of the Bone and Soft Tissue Bank, from extraction and storage until use. Since the year 1986, with the creation of the Bone Bank in the University Clinic of Navarra, more than 3,000 grafts have been used for very different types of surgery. Bone grafts can be classified into cortical and spongy; the former are principally used in surgery to save tumour patients, in large post-traumatic reconstructions and in replacement surgery where there are massive bone defects and a structural support is required. The spongy grafts are the most used due to their numerous indications; they are especially useful in filling cavities that require a significant quantity of graft when the autograft is insufficient, or as a complement. They are also of special help in treating fractures when there is bone loss and in the treatment of delays in consolidation and pseudoarthrosis in little vascularized and atrophic zones. They are also used in prosthetic surgery against the presence of cavity type defects. Allografts of soft tissues are specially recognised in multiple ligament injuries that require reconstructions. Nowadays, the most utilised are those employed in surgery of the anterior cruciate ligament although they can be used for filling any ligament or tendon defect. The principal difficulties of the cortical allografts are in the consolidation of the ends with the bone itself and in tumour surgery, given that these are patients immunodepressed by the treatment, the incidence of infection is increased with respect to spongy grafts and soft tissues, which is irrelevant. In short, the increasingly widespread use of allografts is an essential therapeutic weapon in orthopaedic surgery and traumatology. It must be used by expert hands