¿Efectividad de la técnica de liberación miofacial en el aumento del rango articular en restricción glenohumeral? Una comparación con la kinesioterapia tradicional / Effectiveness of the myofascial release technique in increasing joint range in glenohumeral restriction? A comparison with traditional kinesiotherapy

OBJETIVO: comparar la kinesioterapia tradicional con la técnica miofacial en pacientes con restricción articular interna glenohumeral. MÉTODO: estudio comparativo de 8 pacientes en un grupo de intervención (GI) y kinésico (GC), durante 8 semanas. Se comparó el pre y post test del ROM interno glenohumeral en ambos grupos mediante t de student. RESULTADOS: el grupo de la técnica miofascial demostró una amento significativo de ROM interno glenohumeral de 15,2º (p < 0,001), mientras que el grupo control no fue significativo (p > 0,05) sólo de de 6,4º. CONCLUSIONES:Un tratamiento de terapia con la Técnicas Liberación Miofascial en pacientes con déficit rotacional interno de hombro es más eficaz para aumentar el rango de movimiento articular de rotación interna glenohumeral que una técnica tradicional y conservadora.

OBJETIVE: to compare traditional kinesiotherapy with myofacial technique in patients with glenohumeral internal joint restriction. METHODS: comparative study of 8 patients in an intervention (IG) and kinesiotherapy (CG) group for 8 weeks. The pre- and post-test of glenohumeral internal ROM in both groups was compared using Student's t-test. RESULTS: the myofascial technique group showed a significant increase in glenohumeral internal ROM of 15.2º (p < 0.001), while the control group was not significant (p > 0.05) only 6.4º. CONCLUSIONS: A therapy treatment with Myofascial Release Techniques in patients with shoulder internal rotational deficit is more effective in increasing glenohumeral internal rotational joint range of motion than a traditional, conservative technique.

Evaluación de resultados del tratamiento aplicado a adultos mayores con entidades del SOMA en Sala de Rehabilitación Integral / Evaluation of the results of the treatment applied to older adults with OMAS entities in the Comprehensive Rehabilitation Room

RESUMEN Introducción: el paciente anciano está expuesto a múltiples problemáticas con el envejecimiento que van a condicionar en gran manera su independencia y que de forma obligatoria hay que conocer y tratar de solucionar. Objetivo: evaluar el resultado del tratamiento aplicado a adultos mayores con entidades del sistema osteomioarticular en sala de rehabilitación integral. Materiales y Métodos: se realizó un estudio observacional, descriptivo, de tipo longitudinal de los todos los pacientes de 60 y más años, que acudieron al Centro de rehabilitación integral, quedando la muestra constituida por 920 pacientes tratados en el período comprendido entre enero y diciembre de 2007 con enfermedades del Soma. Resultados: predominó el sexo femenino (59 %) en el grupo de edades de 60 a 69 años (48%). Las afecciones ortopédicas fueron las más frecuentes con el 64 % y dentro de estas, la periartritis escapulo humeral. La electroterapia fue el tratamiento más utilizado (38,4%) de los casos. Dentro de los síntomas que presentaron estos pacientes el que más frecuente se encontró fue el de alteraciones en las funciones tanto al inicio y como posterior al tratamiento aplicado. El 93% de los pacientes resultaron rehabilitados, siendo el 86 % los evaluados de excelente al final de tratamiento aplicado. Conclusiones: los resultados en la atención al adulto mayor fueron excelentes en la gran mayoría de los casos con la aplicación del tratamiento rehabilitador (AU).

SUMMARY Introduction: the elder patient is exposed to multiple problems with ageing that will greatly condition their independence and that we will necessarily have to know and try to solve, using all the available resources within our reach. Objective: to assess the result of the treatment applied to older adults with entities of the osteomyoarticular system in the comprehensive rehabilitation room. Materials and methods: an observational, descriptive, longitudinal study of all the patients aged 60 years and over who attended the Comprehensive Rehabilitation Center was carried out, intentionally the sample stayed formed by 920 patients treated in the period between January and December 2007 with diseases of the OMAS. Results: female sex predominated (59%) in the age group of 60 to 69 years (48%). Orthopedic conditions were the most frequent with 64% and within these, scapular-humeral periarthritis. Electrotherapy was the most used treatment (38.4% of the cases). Among the symptoms that these patients presented, the most frequently found was alterations in functions both at the beginning and after the treatment applied. 93 % of the patients were rehabilitated, resulting outstanding 86 % of the assessed patients at the end pf the treatment. Conclusions: the results of elder people care was outstanding in most of the cases with the rehabilitative treatment application (AU).

Randomized trial for the treatment of post-traumatic elbow stiffness: surgical release vs. rehabilitation.

BACKGROUND: There are no previous randomized trials comparing surgical to conservative treatment for post-traumatic elbow stiffness. The aim of our study was to compare elbow range of motion (ROM) and clinical outcomes among patients undergoing surgical treatment or a standardized rehabilitation for post-traumatic elbow stiffness. METHODS: Randomized clinical trial of patients with post-traumatic elbow stiffness for more than 6 months who failed conventional physical therapy for 4 months. Patients were randomized into 2 treatment groups. The conservative group underwent the rehabilitation protocol associated with the use of orthoses (static progressive for extension and dynamic for flexion) and continuous passive motion. The surgical group underwent surgical release by a posterior approach without triceps detachment, followed by a rehabilitation protocol similar to the conservative group. The primary outcome of the study was flexion-extension ROM at 6 months of follow-up. Secondary outcomes included the visual analog scale for pain, the Mayo Elbow Performance Score, the Disabilities of the Arm, Shoulder, and Hand score, absolute and relative increase in flexion-extension ROM, and complication rates. RESULTS: Thirty patients were analyzed in the study, 15 in each group. The mean elbow flexion-extension ROM at the end of 6 months of follow-up was 108° in the surgical group and 88° in the conservative group (P = .002). The mean absolute and the relative increase of elbow flexion-extension at 6 months were, respectively, 17° and 27% in the conservative group and 41° and 59% in the surgical group (P < .001). CONCLUSION: Surgical elbow release associated with the rehabilitation protocol resulted in a greater flexion-extension ROM, as well as a greater absolute and relative increase compared with rehabilitation alone at 6 months of follow-up. The groups did not differ regarding clinical scores and complication rates.

Effects of performing dual tasks on postural sway and postural control complexity in people with haemophilic arthropathy.

INTRODUCTION: People with haemophilic arthropathy (PWHA) have impairments in postural control. However, little is known about the effects of demanding conditions, including the unipedal stance and dual tasks, on postural control in PWHA. AIM: Determine the effects of performing dual tasks while in the one-leg stance on postural sway and postural control complexity in PWHA vs. healthy active (HAG) and non-active (HNAG) groups of individuals. METHODS: Fifteen PWHA and 34 healthy subjects (18 active and 16 non-active) were recruited. Vertical (V), mediolateral (ML) and anteroposterior (AP) centre of mass signals were acquired using a 3-axis accelerometer placed at the L3/L4 vertebrae of subjects as they performed the one-leg stance under single and dual-task conditions. Sway balance and the complexity of postural control were studied via root mean square (RMS) acceleration and sample entropy, respectively. Increased complexity of postural sway was attributed to increased automatism of postural control. RESULTS: RMS values for PWHA were higher than HAG under both conditions for the V and ML axes, and higher than HNAG under the dual-task condition for the ML axis. Sample entropy was lower in PWHA than healthy individuals under the dual-task condition for V and ML axes, and the single-task condition for the ML axis (P < .05). CONCLUSION: PWHA had poorer postural sway and decreased postural control complexity when performing a one-leg stance than healthy people, especially when the dual-task condition was applied. These results may help to design new approaches to assess and improve postural control in PWHA.

Translation, cross-cultural adaptation and validity of the Brazilian version of the Foot and Ankle Ability Measure questionnaire.

PURPOSE: To translate and cross-culturally adapt the Foot and Ankle Ability Measure (FAAM) questionnaire and verify the psychometric properties of the Brazilian-Portuguese version of this instrument. METHODS: Analysis of validity was carried out by applying the Rasch model and evaluating correlations with the Short Form-36 (SF-36) Physical Function (PF) subscale. Test-retest reliability and internal consistency were analyzed with the intraclass correlation coefficient (ICC2,1) and Cronbach's alpha tests, respectively. RESULTS: Ninety subjects with various foot and ankle musculoskeletal disorders (age 37.05 SD 10.49 years) were included. The ICC2,1 was 0.88 and 0.82 with Cronbach's alphas of 0.93 and 0.90 for the "Activities of Daily Living" (ADL) and "Sports" subscales, respectively. Correlations with the SF-36 PF were 0.78 (p < 0.01, CI95: 0.62-0.87) and 0.65 (p < 0.01, CI95: 0.45-0.79) for the ADL and Sports subscales, respectively. Item reliability indices in Rasch analysis were 0.91 (ADL) and 0.84 (Sports). Three items from the ADL subscale (14.2%) did not match the expectations of the model. All items from the Sports subscale fit the model. CONCLUSIONS: There is evidence of validity and reliability of the FAAM-Brazil. Rasch analysis indicated that three items of the ADL subscale did not fit the model in the sample studied. Implications for Rehabilitation Self-report questionnaires are commonly used in both clinical practice and research because of their ability to efficiently collect information. If the instrument is created properly, the information collected can be used to interpret the effect of clinical conditions on physical function. The Foot and Ankle Ability Measure (FAAM) is an evaluative instrument that assesses functional limitations for those with foot- and ankle-related disorders. It was translated into four languages and has evidence of validity, reliability, and responsiveness. Evidence of validity and reliability is provided for the FAAM-Brazil when applied to subjects with a wide range of foot and ankle musculoskeletal disorders.

Uso do plasma rico em plaquetas no tratamento da doença articular degenerativa em cão: relato de caso / Use of platelet-rich plasma in the treatment of degenerative joint disease in dog: case report / Uso de plasma rico en plaquetas en el tratamiento de la enfermedad degenerativa de las articulaciones en perro: relato de caso

No presente trabalho é descrito o uso do plasma rico em plaquetas (PRP) no tratamento de um caso de osteoartrose naturalmente adquirida em um cão. O PRP foi obtido a partir de sangue venoso autólogo coletado em citrato de sódio. A separação do precipitado celular do sobrenadante foi realizada de forma estéril. Após adição de cloreto de cálcio e liberação dos fatores de crescimento, o PRP foi infiltrado no joelho do animal em estudo. Após o tratamento, os parâmetros de apoio, crepitação e dor articular apresentaram melhora, não havendo intolerância do animal à infiltração. Preliminarmente, pode-se dizer que é esta é uma técnica minimamente invasiva e de alta aplicabilidade. O emprego do PRP para infiltração mostrou ser simples, rápido, barato e seguro para o tratamento da osteoartrose no animal em questão. Estudos com maior número de casos em cães são necessários, a fim de validar este procedimento como prática terapêutica na rotina clínica.(AU)

The use of platelet-rich plasma (PRP) in the treatment of a natural case of osteoarthrosis in a dog is reported in the present work. The PRP was obtained through autologous venous blood collected in sodium citrate. The cellular precipitate was separated from the supernatant in a sterile condition. After the addition of calcium chloride and the release of growth factors, the PRP was infiltrated in the knee of the dog under study. After the treatment, weight-bearing, crackle and joint pain parameters presented improvement without intolerance to the infiltration by the animal. Preliminarily, it can be concluded that this is a minimally invasive method with high applicability, as well as being simple, quick, cheap and safe for the treatment of degenerative joint disease to the described animal. The study of a larger number of cases in dogs is necessary in order to validate the procedure for clinical routine.(AU)

En este estudio se ha descrito el uso del plasma rico en plaquetas (PRP) en el tratamiento de un caso de osteoartritis, adquirido naturalmente por un perro. El PRP ha sido obtenido a partir de la sangre venosa autóloga recogido en citrato de sodio. La separación del precipitado celular del sobrenadante se ha realizado de forma estéril. Después de la adición de cloruro de calcio y liberación de los factores de crecimiento, el PRP ha sido infiltrado en la rodilla del animal en estudio. Tras el tratamiento, los parámetros de apoyo, crepitación y dolor articular presentaron mejora, no ocurriendo intolerancia del animal a la infiltración. Preliminarmente, se puede decir que esta es una técnica poco invasiva y de alta aplicabilidad. El empleo del PRP para infiltración ha mostrado ser sencillo, rápido, barato y seguro para el tratamiento de osteoartritis en el animal estudiado. Estudios con mayor número de casos en perros son necesarios, para que se pueda validar este procedimiento como práctica terapéutica en la rutina clínica.(AU)

Uso do plasma rico em plaquetas no tratamento da doença articular degenerativa em cão: relato de caso / Use of platelet-rich plasma in the treatment of degenerative joint disease in dog: case report / Uso de plasma rico en plaquetas en el tratamiento de la enfermedad degenerativa de las articulaciones en perro: relato de caso

No presente trabalho é descrito o uso do plasma rico em plaquetas (PRP) no tratamento de um caso de osteoartrose naturalmente adquirida em um cão. O PRP foi obtido a partir de sangue venoso autólogo coletado em citrato de sódio. A separação do precipitado celular do sobrenadante foi realizada de forma estéril. Após adição de cloreto de cálcio e liberação dos fatores de crescimento, o PRP foi infiltrado no joelho do animal em estudo. Após o tratamento, os parâmetros de apoio, crepitação e dor articular apresentaram melhora, não havendo intolerância do animal à infiltração. Preliminarmente, pode-se dizer que é esta é uma técnica minimamente invasiva e de alta aplicabilidade. O emprego do PRP para infiltração mostrou ser simples, rápido, barato e seguro para o tratamento da osteoartrose no animal em questão. Estudos com maior número de casos em cães são necessários, a fim de validar este procedimento como prática terapêutica na rotina clínica...

The use of platelet-rich plasma (PRP) in the treatment of a natural case of osteoarthrosis in a dog is reported in the present work. The PRP was obtained through autologous venous blood collected in sodium citrate. The cellular precipitate was separated from the supernatant in a sterile condition. After the addition of calcium chloride and the release of growth factors, the PRP was infiltrated in the knee of the dog under study. After the treatment, weight-bearing, crackle and joint pain parameters presented improvement without intolerance to the infiltration by the animal. Preliminarily, it can be concluded that this is a minimally invasive method with high applicability, as well as being simple, quick, cheap and safe for the treatment of degenerative joint disease to the described animal. The study of a larger number of cases in dogs is necessary in order to validate the procedure for clinical routine...

En este estudio se ha descrito el uso del plasma rico en plaquetas (PRP) en el tratamiento de un caso de osteoartritis, adquirido naturalmente por un perro. El PRP ha sido obtenido a partir de la sangre venosa autóloga recogido en citrato de sodio. La separación del precipitado celular del sobrenadante se ha realizado de forma estéril. Después de la adición de cloruro de calcio y liberación de los factores de crecimiento, el PRP ha sido infiltrado en la rodilla del animal en estudio. Tras el tratamiento, los parámetros de apoyo, crepitación y dolor articular presentaron mejora, no ocurriendo intolerancia del animal a la infiltración. Preliminarmente, se puede decir que esta es una técnica poco invasiva y de alta aplicabilidad. El empleo del PRP para infiltración ha mostrado ser sencillo, rápido, barato y seguro para el tratamiento de osteoartritis en el animal estudiado. Estudios con mayor número de casos en perros son necesarios, para que se pueda validar este procedimiento como práctica terapéutica en la rutina clínica...

Exercise interventions for shoulder dysfunction in patients treated for head and neck cancer.

BACKGROUND: Shoulder dysfunction is a common problem in patients treated for head and neck cancer. Both neck dissections and radiotherapy can cause morbidity to the shoulder joint. Exercise interventions have been suggested as a treatment option for this population. OBJECTIVES: To evaluate the effectiveness and safety of exercise interventions for the treatment of shoulder dysfunction caused by the treatment of head and neck cancer. SEARCH METHODS: We searched the Cochrane ENT Group Trials Register; CENTRAL; PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ISRCTN and additional sources for published and unpublished trials. The date of the search was 7 July 2011. SELECTION CRITERIA: Randomized controlled trials (RCTs) comparing any type of exercise therapy compared with any other intervention in patients with shoulder dysfunction due to treatment of head and neck cancer. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials, assessed risk of bias and extracted data from studies. We contacted study authors for information not provided in the published articles. MAIN RESULTS: Three trials involving 104 people were included. We classified one study as having low risk of bias; the others had some limitations and we classified them as having high risk of bias.Two studies (one with low risk of bias and the other with high risk of bias) applied progressive resistance training (PRT) combined with range of motion exercises and stretching; the comparison group received standard care. Pooled data demonstrated that PRT can improve shoulder pain (mean difference (MD) -6.26; 95% confidence interval (CI) -12.20 to -0.31) and shoulder disability (MD -8.48; 95% CI -15.07 to -1.88), both measured using the Shoulder Pain and Disability Index (SPADI) (range 0 to 100). Similarly, secondary outcomes were also improved: active range of motion for external rotation (MD 14.51 degrees; 95% CI 7.87 to 21.14), passive range of motion for abduction (MD 7.65 degrees; 95% CI 0.64 to 14.66), forward flexion (MD 6.20 degrees; 95% CI 0.69 to 11.71), external rotation (MD 7.17 degrees; 95% CI 2.20 to 12.14) and horizontal abduction (MD 7.34 degrees; 95% CI 2.86 to 11.83). Strength and resistance of scapular muscles was assessed in one study and the results showed a statistically significant benefit of PRT. The studies did not demonstrate a statistically significant difference in quality of life. Only two non-serious adverse events were described in the PRT group compared with none in the standard care group.One study with high risk of bias used a broad spectrum of techniques including free active exercises, stretching and postural care for a period of three months following surgery. This study did not demonstrate a difference between the exercise group and routine postoperative physiotherapy care in shoulder function and quality of life, but serious methodological limitations could explain this. No serious adverse events were reported. AUTHORS' CONCLUSIONS: Limited evidence from two RCTs demonstrated that PRT is more effective than standard physiotherapy treatment for shoulder dysfunction in patients treated for head and neck cancer, improving pain, disability and range of motion of the shoulder joint, but it does not improve quality of life. However, although statistically significant the measured benefits of the intervention may be small. Other exercise regimes were not shown to be effective compared to routine postoperative physiotherapy. Further studies which apply other exercise interventions in head and neck cancer patients in the early postoperative and radiotherapy period are needed, with long-term follow-up.

Immediate breast reconstruction with transverse latissimus dorsi flap does not affect the short-term recovery of shoulder range of motion after mastectomy.

Immediate breast reconstruction, depending on the surgical strategy, can result in anatomic modifications that may affect the shoulder apparatus. This study compares the recovery of shoulder range of motion (ROM), after mastectomy, in women with and without immediate breast reconstruction with latissimus dorsi flap (LDF). This was a prospective study with 87 women who underwent mastectomy (41 with LDF). Shoulder ROM was assessed with goniometry, with a universal full-circle manual goniometer, prior to surgery, and on a weekly basis during the first 4 weeks postoperatively. Reconstruction with LDF was not associated with a decrease in shoulder ROM (P = 0.84). By the end of the 4-week assessment program, women in both groups still had an average reduction of 30 degrees in their shoulder ROM compared with baseline. Factors significantly associated with a reduction in shoulder ROM during the recovery period were complete dissection of the axilla, current smoking behavior, and presence of painful axillary cords. It is likely that breast reconstruction with LDF has little or no effect on shoulder ROM in the immediate postoperative period. It is also possible that LDF effects (if any) are overridden by the major reduction (over 30% in the immediate postoperative period, subsiding partially during the first weeks postoperatively) in shoulder ROM caused by mastectomy.

Isokinetic assessment of knee flexor/extensor muscular strength in elderly women.

OBJECTIVE: To assess knee flexor-extensor muscular strength in elderly women with no previous history of musculoskeletal disorders on the lower limbs using an isokinetic dynamometer, in order to obtain data that could be used as a comparative parameter in the evaluation of elderly women with knee disorders, thus facilitating a better rehabilitation of these patients. METHODS: Twenty-six volunteers aged 75 to 83 years were studied using a Cybex 6000 isokinetic dynamometer. The chosen angular velocity was 60 degrees /s, and concentric exercise was used for either flexion or extension. The studied parameters were: peak torque, angle of peak torque, and flexor-extensor torque rate. RESULTS: There were no differences between dominant (D) and nondominant (ND) knee peak torque values. This was true for both flexor (D = 42.46 +/- 9.09 Nm / ND = 40.65 +/- 9.38 Nm) and extensor (D = 76.92 +/- 13.97 Nm / ND = 77.65 +/- 15.21 Nm) movements. The descriptive statistical analysis of the values obtained for the flexor-extensor peak torque rate and for the angle of occurrence of peak torque was the same for the dominant and nondominant sides. CONCLUSIONS: The values of peak torque for the contralateral side can be used as a reference during rehabilitation of elderly women with acute disease of the knee, and the angular velocity of 60 degrees /s is proper and safe for isokinetic assessment of elderly people.

Capacidad funcional postoperatoria en pacientes jóvenes con artrosplastía total de cadera no cementada, en el Hospital General de México / Post-operative functional ability in young patients who have non-cemented hip prosthesis in the Mexico City General Hospital

Se incluyeron en el presente estudio todos los pacientes que ingresaron al Servicio de Ortopedia del Hospital General de México, con patología de cadera propuestos para artroplastía total de cadera no cementada, en el periodo de enero de 1993 a julio de 1996, con un total de 42 pacientes con 46 artroplastías, con una edad mínima de 17años, máxima de 59 y promedio de 39.4 años. Las prótesis utilizadas fueron PCA (10), isoelásticas (12), Harris Galante (7), Osteonics (13), AML (2), Lima Litto (2). Se valoraron los pacientes a las 2, 6 y 12 semanas de postoperatorio utilizando la escala de Merle D'Aubigné. A las seis semanas marcha, 26 (61.90 por ciento) escala III, 16 (38.09 por ciento) en a escala IV. Dolor: 16 (38.09 por ciento) en la escala V, 26 (61.90 por ciento) en la escala VI. Movilidad: 42 (100 por ciento) en la escala III. A las 12 semanas, marcha: 28 (66.66 por ciento) escala V, 14 (33.33 por ciento) escala VI. Dolor 42 (100 por ciento) escala VI. Movilidad: 42 (100 por ciento) escala de III, y de acuerdo la satisfacción del paciente; regular 2 (4.76 por ciento), buena 21 (50 por ciento) y excelente 19 (45.23 por ciento). Se concluye que hasta la fecha, gran variedad de prótesis no cementadas han demostrado buena respuesta en un principio, mejorando notablemente la capacidad funcional del paciente

Lásers de baja potencia: resultados de su aplicación en la rehabilitación / Low powers lasers: results of their application on rehabilitation

Se analizan los resultados alcanzados con la aplicación de los lásers de helio-neón y galio-arsenio a 204 pacientes en el tratamiento de diversas afecciones, fundamentalmente osteomioarticulares, dermatológicas y trastornos de la cicatrización. Se tomaron como base las propiedades fisiológicas fundamentales del láser: acción antiinflamatoria, antiflogística y efectos espasmolíticos y bioestimulantes. Se consideran prometedores los resultados, por cuanto el 77 por ciento de los pacientes mejoraron notablemente o desaparecieron sus síntomas(AU)

Lásers de baja potencia: resultados de su aplicación en la rehabilitación / Low powers lasers: results of their application on rehabilitation

Se analizan los resultados alcanzados con la aplicación de los lásers de helio-neón y galio-arsenio a 204 pacientes en el tratamiento de diversas afecciones, fundamentalmente osteomioarticulares, dermatológicas y trastornos de la cicatrización. Se tomaron como base las propiedades fisiológicas fundamentales del láser: acción antiinflamatoria, antiflogística y efectos espasmolíticos y bioestimulantes. Se consideran prometedores los resultados, por cuanto el 77 por ciento de los pacientes mejoraron notablemente o desaparecieron sus síntomas

Restauración de la pronosupinación, en diferentes patologías de la muñeca, por la técnica de Sauve-Kapandji / Restoration of the pronation-supination movement in different sequelae of the wrist joint by the Sauve-Kapandji technique

Se presenta una serie de 18 casos con 19 muñecas, con edad promedio de 40 años, que tenían artrosis de la unión radio-cubital distal, con inestabilidad en 8 casos, incongruencia en 11, artrosis no traumática en 8, artritis traumática en 8, y un caso de polio, de artritis reumatoide juvenil, de deformidad de Madelung y de gota. El tratamiento que se les realizó consistió en sinotosis radio-cubital distal y pseudoartrosis del cúbito, proximal a la sinostosis (Suave-Kapandji). Después de la cirugía la pronación aumentó de 23 a 64 grados en promedio y la supinación aumentó de 29 a 81 grados en promedio. El dolor postoperatorio persistió solamente en 5 casos, de mediana a baja intensidad y de aparición esporádica, ya fuera en la zona de la pseudoartrosis cubital o después de trabajo pesado

Artropatía hemofílica: resultados obtenidos con tratamiento de rehabilitación / Haemophilic artropathy: results obtained with rahabilitation

Estudio retrospectivo, longitudinal, descriptivo y observacional, en el que se describen los resultados obtenidos en pacientes con artropatía hemofílica, con tratamiento de rehabilitación preventivo, curativo y asociado al tratamiento quirúrgico. Los pacientes fueron tratados en el servicio de Medicina de Rehabilitación del INP, captados en un periodo de 18 años. En los resultados se aprecia que la prevención fue eficaz para evitar nuevas hemartrosis, así como mejoría en el daño articular causado por hemartrosis aguda y subaguda con tratamiento de rehabilitación curativa, aun con inicio tardío. Las recidivas de deformidad y disfunción articular son casi siempre por nuevas hemartrosis. Los resultados en pacientes con tratamiento de rehabilitación periquirúrgico no fueron concluyentes

Osteotomías en el tratamiento de la gonartrosis / Tibial or femoral osteotomies for treatment of knee joint arthrosis

Se presenta una serie de 64 pacientes, 18 del sexo masculino y 46 del femenino, que fueron sometidos a osteotomía tibial o femoral para corregir defectos angulares por artrosis unicompartimental primaria de la rodilla; 16 casos tenían artrosis bilateral, lo que dio un total de 80 osteotomías. De un total de 119 pacientes atendidos por el mismo diagnóstico, se ecluyó a los que presentaban artritis traumática, secuelas de cirugía o artritis de otra clase. Hubo 74 tibiales en cuña de cierre correctora de varo, uno en cuña de cierre correctora de valgo, dos supracondíleas femorales correctoras de valgo y tres semicirculares tipo Maquet. Los pacientes se dividieron en dos grupos, el primero con evolución postoperatoria de tres meses a tres años cuyo resultado fue el siguiente: de las osteotomías tibiales correctoras de varo, el resultado fue bueno en 25 de 32 en las que se hizo hipercorrección, regular en siete y malo en uno. En ocho la corrección fue a lo normal, y el resultado fue bueno en siete y regular en uno. La corrección fue insuficiente en cinco rodillas, siendo el resultado bueno en dos y regular en tres. El segundo grupo se valoró de tres a seis años de postoperatorio, fueron 28 osteotomías y el tresultado fue, de nueve con hipocorrección, bueno en seis, regular en dos y malo en uno. En los seis en que se corrigió a lo normal, el resultado fue bueno en seis y regular en dos; finalmente de los 13 que tuvieron hipercorrección el resultado fue bueno en ocho y regular en cinco. De las tres osteotomías de Maquet, dos quedaron hipercorregidas, una con buen resultado y otra con recurrencia de la deformidad. Se concluye que es necesario hipercorregir las osteotomías tibiales correctoras en cuña de cierre para obtener mejores resultados. La técnica de Coventry èrmite resultados más estables que en la de Maquet

La osteosintesis de pseudoartrosis corporales del escafoides carpiano / Ostheosyntesis in scaphoid bone pseudoarthrosis

Se presentan 2 casos de pseudoartrosis corporales del escafoides carpiano, estadio I y se describe la tecnica de osteosintesis empleada en ambos con el tornillo esponjoso AO minifragmento. Se senala que los dos objetivos de la mencionada tecnica son: una fijacion solida y la comprension del foco pseudoartrosico. Finalmente se observa que el tratamiento de esta patologia es dificil como lo insinua la multiplicidad de metodos propuestos.