Rotura de aquiles y fractura cerrada de maleolo tibial concomitante / Concommitant achilles tendon rupture and medial malleolus closed fracture

Objetivo: Se presentan dos nuevos casos de rotura de Aquiles y fractura cerrada de maléolo tibial y se realiza una revisión la bibliográfica de dicha lesión. Material y métodos: La asociación de rotura de tendón de Aquiles y fractura del maléolo tibial en un mismo paciente es una entidad muy poco frecuente y con pocas referencias bibliográficas y hasta donde los autores conocen no hay ninguna referencia en Castellano. En muchos de los casos una de las dos lesiones puede pasar desapercibidas inicialmente, produciendo un aumento de morbilidad. Solo se han descrito 9 casos clínicos aislados en revistas de habla inglesa y en 6 casos una de las lesiones paso desapercibida inicialmente. Se presentan 2 casos de rotura de tendón de Aquiles con fractura de maléolo tibial asociado. Resultados: En los dos casos presentados se diagnosticaron inicialmente ambas lesiones, el tendón de Aquiles se trató con sutura abierta, y los maléolos tibiales mediante tratamiento conservador al ser estables bajo radioscopia. Conclusiones: La correcta identificación de ambas lesiones, su correcto tratamiento y la ausencia de complicaciones postoperatorias condujo a un buen resultado final en ambos pacientes.(AU)

Objective: Two new cases of Achilles rupture and closed tibial malleolus fracture are presented and a bibliographic review of that injury is carried out.Material and methods: The association of Achilles tendon rupture and tibial malleolus fracture in the same patient is a rare entity with few bibliographic references and as far as the authors know there are no references in Spanish. In many cases, one of the two lesions may initially go unnoticed, leading to increased morbidity. Only 9 isolated clinical cases have been described in English-language journals and in 6 cases one of the two lesions went unnoticed initially. Two cases of Achilles tendon rupture with associated tibial malleolus fracture are presented. Results: In the two cases presented, both lesions were initially diagnosed, the Achilles tendon was treated with an open suture, and the tibial malleoli fractures by conservative treatment as they were stable under fluoroscopy. Conclusions: The correct identification of both lesions, their correct treatment and the absence of postoperative complications led to a good final result in both patients.(AU)

In-hospital care, complications, and 4-month mortality following a hip or proximal femur fracture: the Spanish registry of osteoporotic femur fractures prospective cohort study.

We have characterised 997 hip fracture patients from a representative 45 Spanish hospitals, and followed them up prospectively for up to 4 months. Despite suboptimal surgical delays (average 59.1 hours), in-hospital mortality was lower than in Northern European cohorts. The secondary fracture prevention gap is unacceptably high at 85%. PURPOSE: To characterise inpatient care, complications, and 4-month mortality following a hip or proximal femur fracture in Spain. METHODS: Design: prospective cohort study. Consecutive sample of patients ≥ 50 years old admitted in a representative 45 hospitals for a hip or proximal femur fragility fracture, from June 2014 to June 2016 and followed up for 4 months post-fracture. Patient characteristics, site of fracture, in-patient care (including secondary fracture prevention) and complications, and 4-month mortality are described. RESULTS: A total of 997 subjects (765 women) of mean (standard deviation) age 83.6 (8.4) years were included. Previous history of fracture/s (36.9%) and falls (43%) were common, and 10-year FRAX-estimated major and hip fracture risks were 15.2% (9.0%) and 8.5% (7.6%) respectively. Inter-trochanteric (44.6%) and displaced intra-capsular (28.0%) were the most common fracture sites, and fixation with short intramedullary nail (38.6%) with spinal anaesthesia (75.5%) the most common procedures. Surgery and rehabilitation were initiated within a mean 59.1 (56.7) and 61.9 (55.1) hours respectively, and average length of stay was 11.5 (9.3) days. Antithrombotic and antibiotic prophylaxis were given to 99.8% and 98.2% respectively, whilst only 12.4% received secondary fracture prevention at discharge. Common complications included delirium (36.1 %) and kidney failure (14.1%), with in-hospital and 4-month mortality of 2.1% and 11% respectively. CONCLUSIONS: Despite suboptimal surgical delay, post-hip fracture mortality is low in Spanish hospitals. The secondary fracture prevention gap is unacceptably high at > 85%, in spite of virtually universal anti-thrombotic and antibiotic prophylaxis.

Tratamiento farmacológico para la Osteoporosis y su influencia en el proceso de consolidación de las fracturas / Pharmacologic treatment for osteoporosis and its influence on fracture healing

Las fracturas por fragilidad o secundarias a la osteoporosis se pueden considerar como un importante problema de Salud Pública por las consecuencias en términos de mortalidad y morbilidad que generan. Y las previsiones para el futuro, teniendo en cuenta el progresivo envejecimiento de la población y el aumento de la esperanza de vida, no son nada optimistas. Suponen y supondrán un importante consumo de recursos. Una de las estrategias que ha demostrado eficacia para su prevención, es el tratamiento farmacológico. Pero este tratamiento puede afectar de una manera u otra al proceso de consolidación, uno de los objetivos primarios fundamentales en su manejo. En este trabajo de revisión queremos establecer, en base a la evidencia actual, cómo afectan todos y cada uno de los fármacos indicados para el tratamiento de la osteoporosis al proceso de consolidación de las fracturas por fragilidad, una cuestión que genera dudas e incertidumbres en el traumatólogo, cuya responsabilidad y papel en el escenario de la prevención, es fundamental

Osteoporotic fragility fractures can be seen as a major public health problem because their consequences in terms of mortality and morbidity. Taking into account the progressive ageing of the population and the increase in life expectancy, the expectative in the next future are not optimistic. They are and will be an important focus of health resources consumption. One of the strategies that have proven be effective for fracture prevention, is the antiosteoporotic pharmacological treatment. This type of treatments can affect bone healing process in one way or another. In this review, based on the current scientific evidence, we want to establish how each one of the drugs prescribed for the osteoporosis treatment affects the bone healing process of fragility fractures, an issue that generates doubts and uncertainties in the orthopaedic surgeon, whom responsibility and role in fracture prevention is essential