Bifosfonatos e implantes dentales, ¿son incompatibles? Revisión de la literatura / Are bisphosphonates and dental implants compatible? A review of the literature

Introducción. La osteonecrosis de los maxilares ha sido descrita en pacientes que toman bifosfonatos y han sido sometidos a cirugía dentoalveolar. Actualmente, la terapia con bifosfonatos e implantes dentales es un tratamiento muy común en adultos. Objetivos. Evaluar, a través de una revisión de la literatura, si la osteointegración del implante dental podría disminuir en pacientes que toman bifosfonatos orales o intravenosos. Además, se analiza el riesgo que tienen estos pacientes de desarrollar osteonecrosis de los maxilares. Material y métodos. Se realizó una búsqueda a través de la base de datos Medline (PubMed) de los artículos publicados en inglés en los últimos 15 años que incluyeran las palabras clave «bisphosphonates and dental implants», «bisphosphonates and orthopaedic implants» y «osteonecrosis of the jaws and dental implants». Conclusiones. El tratamiento con bifosfonatos no disminuye la osteointegración del implante dental, aunque estos resultados se han obtenido en base a estudios retrospectivos en humanos. Se han descrito casos de osteonecrosis de los maxilares relacionada con bifosfonatos en estos pacientes, sobre todo tras tratamiento prolongado (AU)

Introduction. At present, treatment with bisphosphonates and dental implant therapy are frequently used in adults. Bisphosphonate-related osteonecrosis of the jaws has been described in patients with bisphosphonate medication who underwent dentoalveolar surgery. Objectives. The aim of this study was to evaluate, through a literature review, whether osseointegration of dental implants could decrease in patients on intravenous or oral bisphosphonates. The risk of developing bisphosphonate-related osteonecrosis of the jaws in these patients was also analysed. Material and methods. A search was performed to find the most recent scientific literature (the last 15 years) using PubMed database, with the keywords «bisphosphonates and dental implants», «bisphosphonates and orthopaedic implants» and «osteonecrosis of the jaws and dental implants». Conclusions. Based on the current literature, it is concluded that bisphosphonate treatment does not decrease osseointegration of dental implants. Nevertheless, these results have been obtained in a retrospective in humans. Bisphosphonate-related osteonecrosis of the jaws has been described in patients on prolonged treatment (AU)

Footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in patients with diabetes: a systematic review.

BACKGROUND: Footwear and offloading techniques are commonly used in clinical practice for preventing and healing of foot ulcers in persons with diabetes. The goal of this systematic review is to assess the medical scientific literature on this topic to better inform clinical practice about effective treatment. METHODS: We searched the medical scientific literature indexed in PubMed, EMBASE, CINAHL, and the Cochrane database for original research studies published since 1 May 2006 related to four groups of interventions: (1) casting; (2) footwear; (3) surgical offloading; and (4) other offloading interventions. Primary outcomes were ulcer prevention, ulcer healing, and pressure reduction. We reviewed both controlled and non-controlled studies. Controlled studies were assessed for methodological quality, and extracted key data was presented in evidence and risk of bias tables. Uncontrolled studies were assessed and summarized on a narrative basis. Outcomes are presented and discussed in conjunction with data from our previous systematic review covering the literature from before 1 May 2006. RESULTS: We included two systematic reviews and meta-analyses, 32 randomized controlled trials, 15 other controlled studies, and another 127 non-controlled studies. Several randomized controlled trials with low risk of bias show the efficacy of therapeutic footwear that demonstrates to relief plantar pressure and is worn by the patient, in the prevention of plantar foot ulcer recurrence. Two meta-analyses show non-removable offloading to be more effective than removable offloading for healing plantar neuropathic forefoot ulcers. Due to the limited number of controlled studies, clear evidence on the efficacy of surgical offloading and felted foam is not yet available. Interestingly, surgical offloading seems more effective in preventing than in healing ulcers. A number of controlled and uncontrolled studies show that plantar pressure can be reduced by several conservative and surgical approaches. CONCLUSIONS: Sufficient evidence of good quality supports the use of non-removable offloading to heal plantar neuropathic forefoot ulcers and therapeutic footwear with demonstrated pressure relief that is worn by the patient to prevent plantar foot ulcer recurrence. The evidence base to support the use of other offloading interventions is still limited and of variable quality. The evidence for the use of interventions to prevent a first foot ulcer or heal ischemic, infected, non-plantar, or proximal foot ulcers is practically non-existent. High-quality controlled studies are needed in these areas.

Enclavado percutáneo de fracturas complejas intraarticulares de la extremidad distal del radio. A propósito de dos casos / Percutaneous pinning in complex intraarthicular fractures of the distal radius. Report of two cases

Objetivo: Señalar el buen resultado con enclavijado percutáneo combinado de estas lesiones y analizar la literatura al respecto. Pacientes y metodología: Presentamos dos casos de fractura compleja e intraarticular de la extremidad distal del radio, tratadas mediante enclavijado percutáneo con agujas de Kirschner. Seguimiento anual. Valoración radiológica y funcional. Resultados: Evolución muy satisfactoria, uno con mínima limitación en la movilidad y ambos con algodistrofia, con total recuperación. Los dos se reintegraron a sus trabajos previos. Conclusión: Con calidad ósea subyacente, este tratamiento es idóneo por sencillez, rapidez y economía, pudiendo realizarse incluso por un único cirujano. Por contra, precisa un exhaustivo seguimiento postoperatorio e inmovilización temporal (AU)

Objective: To note the good results with combined percutaneous pinning of these lesions and to analyze literature related to this topic. Material and method: We present two cases with complex and intra-articular distal radius fractures, treated by percutaneous pinning with Kirschner wires. Anual follow-up. Radiological and functional outcomes. Results: Quite good evolution, one with minimal mobility limitation and both with algodystrophy with total recovery. Both returned to previous works. Conclusion: If the bone has a good quality, this orthopedic fixation device is useful because it is simply, fast and a low-cost method. One surgeon can do it alone. On the other hand, it needs an exhaustive postoperative follow-up and a cast is imperative during a variable period (AU)

Clinical study of a new design multifunction dynamic external fixator system for bone reconstructions.

BACKGROUND: Fractures with related problems including intercalary bone defect, shortening, and malunion are still major problems in orthopedic practice. The Ilizalov's circular external fixator device has several advantages for bone reconstruction but also has certain drawbacks such as its bulkiness and complicated mounting. To maintain the advantages of Ilizalov's original concept and combine with the simplicity of monolateral frame, a new design multifunction dynamic external fixator system was developed to overcome the drawbacks. OBJECTIVE: To evaluate the clinical results and complications of a new design multifunction dynamic external fixator system for bone reconstructions. MATERIAL AND METHOD: Twenty patients requiring reconstructions between 2006 and 2009 participated in this study. The new design multifunction dynamic external fixators were used in 11 tibial and two femoral intercalary defects for bone transportation, three tibial and one femoral lengthening, and three tibial malunion correction (45, 60 and 75 degrees). RESULTS: In bone transportation, new bone formation and union at the docking site were achieved in all patients. The mean new bone formation was 5.8 cm (range 3.5-14) in tibia and 4.3 cm (range 3.5-5) in femur. The mean healing index was 46.3 days/cm (range 42-60) in tibia and 93.9 days/cm (range 85.7-102) in femur. In bone lengthening, new bone formation and union were achieved in all patients. The mean amount of elongation was 3.5 cm (range 3-4) in tibia and 5 cm in femur. The mean healing index was 71.1 days/cm (range 68.6-76) in tibia and 73 days/cm in femur. In malunion correction, the mean correction time was 65 days (range 35-84) and the mean healing time was 187.3 days (range 154-212). CONCLUSION: The new design multifunction dynamic external fixator system was successfully used for bone transportation, bone lengthening, and malunion correction with good results and low complications. It is simple, safe, and easy to use.

New and improved orthopedic hardware for the 21st century: part 1, upper extremity.

OBJECTIVE: The purpose of this article is to provide a survey of new orthopedic products for use in the upper extremity. CONCLUSION: Knowledge of the physiologic purpose, orthopedic trends, imaging findings, and complications is important in assessing new orthopedic devices.

New and improved orthopedic hardware for the 21st century: part 2, lower extremity and axial skeleton.

OBJECTIVE: The purpose of this article is to provide a survey of new orthopedic products for use in the lower extremity and axial skeleton. CONCLUSION: Knowledge of the physiologic purpose, orthopedic trends, imaging findings, and complications is important in assessing new orthopedic devices.

Deformidad en varo del tobillo del niño: corrección mediante fijación externa / Varus deformity of the ankle in a child: correction using external fixation

Introducción y objetivo. La deformidad en varo del tobillo durante la infancia es una secuela no infrecuente tras una epifisiolisis de tibia distal o una infección de esta zona durante la infancia. Los autores revisan los casos tratados mediante fijación externa. Material y métodos. Se revisaron de forma retrospectiva 14 casos de tobillo varo estudiados clínica y radiológicamente mediante telerradiografía anteroposterior de EEII en bipedestación y tratados mediante fijación externa monolateral. Se analizó la causa de la deformidad, su magnitud, procedimiento empleado, complicaciones y cierre precoz de fisis tras el tratamiento. Resultados. Se revisaron retrospectivamente todos los casos de tobillo varo, siendo las causas más frecuentes de deformidad en varo del tobillo durante la infancia: las epifisiolisis de la porción medial de la tibia distal (lesiones SH II, III o IV), infección de tibia distal y sepsis. Hubo dos casos de epifisiolisis tipo II, tres de tipo III y tres de tipo IV. Los métodos de corrección empleados fueron en cuatro casos la distracción fisaria cuando había fisis abierta o la osteotomía metafisaria distal y callotasis posterior en ocho casos. En dos se realizó la corrección de forma aguda asociando otro método de tratamiento para corregir una discrepancia concomitante. En todas las callotasis se realizó osteotomía del peroné, fijándolo con aguja de Kirschner excepto en tres casos. Las complicaciones más frecuentes fueron infecciones alrededor de los tornillos y desplazamiento ad-latum. Discusión y conclusiones. En esta serie se han obtenido buenos resultados en el tratamiento de la deformidad en varo del tobillo del niño mediante la condrodiastasis, la osteotomía y la callotasis. La distracción fisaria antes de alcanzar la madurez esquelética puede ser el método de elección. Si se realiza precozmente es presumible el cierre precoz del resto de fisis fértil. Si el tratamiento es hemicallotasis es recomendable además de la osteotomía del peroné su fijación intramedular con aguja de Kirschner (AU)

Introduction and objective. Varus deformity of the ankle during infancy is a not uncommon after effect after epiphysiolysis of the distal tibial or an infection in this area during childhood. The authors review the cases treated using external fixation. Material and methods. A retrospective review was made of 14 cases of varus ankle clinically and radiologically studied using lower limb antero-posterior teleradiography in the standing position and treated using monolateral external fixation. The cause of the deformity, its magnitude, procedure employed, complications, and premature physeal closure after treatment. Results. All cases of varus ankle were retrospectively reviewed, with the most frequent cause of the deformity in ankle varus during infancy being epiphysiolysis of the middle portion of the distal tibia (SH II, III or IV lesions), distal tibia infection or sepsis. There were two cases of epiphysiolysis type II, three of type III, and three of type IV. The methods of correction employed were, physeal distraction when the physis was open in four cases, and distal metaphyseal osteotomy and subsequent callus distraction in eight cases. In two cases correction was performed acutely combining another treatment method to correct a concomitant discrepancy. The callotasis was performed on all of them using fibular osteotomy, fixing it with a Kirschner wire, except in three cases. The most frequent complications were infections around the screws and ad-latum displacement. Discussion and conclusions. Good results have been obtained in this series of varus deformity of the ankle in the child by means of physeal distraction, osteotomy and callotasis. Physeal distraction before reaching skeletal maturity may be the method of choice. If it is performed earlier the premature closure of the rest of the fertile physis is likely. If the treatment is hemicallotasis, besides the fibular osteotomy, intramedullary fixation with a Kirschner wire is also recommended (AU)

Injerto óseo vascularizado y fijación con mini-acutrak (R) en las pseudoartrosis de escafoides con necrosis del polo proximal / Vascularised bone graft with mini-acutrak (R) fixation in scaphoid pseudoarthrosis with proximal pole necrosis

Objetivo. Evaluar los resultados del injerto óseo vascularizado (IOV) de la arteria 1, 2 suprarretinacular intercompartimental (1,2 SRIC) junto con la fijación, en pseudoartrosis de escafoides y necrosis del polo proximal. Material y método. Realizamos un estudio retrospectivo, entre enero de 2006 y diciembre de 2009. Se trata de 10 pacientes con pseudoartrosis de escafoides con necrosis del polo proximal. Todos eran varones con edad media de 27 años (rango: 18-46). El seguimiento medio fue de 18 meses (rango: 12-43). La evaluación clínica incluye el dolor según la escala visual analógica (EVA), el balance articular y la fuerza de prensión. La evaluación radiológica incluye radiografías, TC y RNM. Se midió el ángulo escafolunar y la altura carpiana de acuerdo con el índice de Nattrass et al. La escala utilizada fue la Mayo Wrist Score. Resultados. La consolidación tuvo lugar en todos en un tiempo medio de 15 semanas (rango: 6-25 semanas). La media de EVA preoperatoria fue de 4,5 (2-8) y postoperatoria de 1 (0-2). El índice de la altura carpiana de Nattrass preoperatorio fue de 1,50 y postoperatorio de 1,58. El ángulo escafolunar medio preoperatorio fue de 52° y postoperatorio de 49°. Los valores preoperatorios de la Mayo Wrist Score fueron de 53 y los valores postoperatorios de 92. Conclusiones. La técnica que combina el IOV y la fijación con un tornillo mini-acutrak®, presenta buenos resultados, en el tratamiento de las pseudoartrosis de escafoides con necrosis del polo proximal. Preferimos el uso de la arteria 1,2 SRIC. En el caso de que esta arteria este ausente se pueden utilizar otros pedículos vasculares (AU)

Objectives. We studied the use of vascularized bone graft (VBG) in combination with a fixation with screw in patients with scaphoid nonunion and avascular proximal poles. Materials and methods. Between January 2006 and December 2009, we treated 10 patients with scaphoid nonunion with avascular proximal poles. There were 10 males with nonunion. Their average age was 27years (range: 18-46years). The average follow-up was 18 months (range: 12-43 months). The clinical valuation was the scale of pain (VAS), the range of motion and grip strength. The radiological valuation included radiographies, CT and MRI. We studied the scapholunate angle, the Carpal Height Index by Nattrass et al. and the Mayo Wrist Score. Results. The mean preoperative VAS was 4.5 (2-8) and postoperative VAS 1 (0-2). All patients achieved union in an average time of 15weeks (range: 6-25weeks). X-rays and CT showed a complete osseous union in all patients. Carpal Height Index was a mean of 1.50 preoperative and 1.58 postoperative. The scapholunate angle was a mean of 52° preoperative and 49° postoperative. Mayo Wrist Score was 53 preoperative and 92 postoperative. Conclusions. We have found that the technique which combines VBG with mini acutrak® screw, is successful in treating scaphoid nonunions with avascular poles. We prefer to use the vessel 1, 2 ICSRA. If this vessel is occasionally absent, other pedicles may be used (AU)

Posterior fixation of the upper cervical spine: contemporary techniques.

Instrumentation in the upper cervical spine has changed considerably in the past two decades. Previous stand-alone wiring techniques have been made largely obsolete with the development of occipital segmental plating, transarticular screws, and C1 lateral mass screws, as well as a myriad of C2 fixation options, including pedicle, pars, and translaminar screws. Polyaxial screws and segmental fixation are more user-friendly than stand-alone wiring and provide a stronger construct. Awareness of the risks and benefits associated with the use of modern instrumentation and thorough familiarity with the anatomy of the upper cervical spine are essential to avoid complications and optimize outcomes.

Fracturas diafisarias del fémur en el niño: actualización en el tratamiento / Diaphyseal femur fractures in children. Treatment update

El tratamiento de las fracturas de la diáfisis del fémur en el niño, está sometido a una gran controversia, debido a que los procedimientos que se emplean en los adultos no son aplicables durante el período de crecimiento. No obstante, parece que existe un cierto consenso en que el método que elijamos debe ir encaminado a acortar el tiempo de estancia hospitalaria, que sea confortable para el paciente, que proporcione una adecuada estabilidad a la fractura y origine en menor número de complicaciones y secuelas. Parece existir cierta unanimidad en que en menores de 5 años los métodos conservadores (arnés de Pavlik, yeso precoz,...) son los métodos de elección salvo en situaciones complejas. Es a partir de los 6 años y hasta los 13 años, el período en el cual la indicación de un método u otro puede estar más en discusión, si bien hoy en día el enclavado intramedular elástico es el método de predilección por parte de la mayoría de los autores, sobre todo para fracturas transversales y que asientan en el tercio medio, excepto en casos de gran inestabilidad. En estas situaciones de fracturas conminutas o con trazos oblícuos, la fijación externa monolateral, los clavos rígidos introducidos desde la región trocantérica y las placas atornilladas percutáneas submuscular pueden ser una buena opción. En la actualidad no existe un método que pueda aplicarse a la totalidad de los diferentes tipos de fractura. La opción terapéutica elegida deberá basarse en la estabilidad clínica del paciente, características de la fractura, diámetro de la cavidad medular y peso del paciente (AU)

The treatment of diaphyseal femur fractures in children is a subject of great controversy due to the procedures employed in adults not being applicable during the growth period. However, there appears to be some consensus in that the method we choose must lead to shortening the hospital stay, is comfortable for the patient, provides suitable stability to the fracture and has less complications and after effects. There is some unanimity in that the methods of choice should be conservative in children less than 5 years-old (Pavlik harness, early cast), except in complex situations. It is from 6 years to 13 years, the period in which one method or the other that should be discussed more. Nowadays, elastic intramedullary nailing is the method preferred by many authors, particularly for transverse fractures and those located in the middle third, except in cases of great instability. In these situations of comminuted or oblique fractures with monolateral external fixation, the rigid nails introduced from the trochanteric region and percutaneous plating can be a good option. There is currently no method that could be applied to all the different types of fracture. The chosen therapeutic option should be based on the clinical stability of the patient, the characteristics of the fracture, diameter of the medullary cavity and weight of the patient (AU)

Experiencia en la utilización de bisturí de ultrasonidos en cirugía ortopédica / Experience in the use of ultrasonic scalpels in orthopaedic surgery

Objetivo. Comparar el efecto de la aplicación del bisturí eléctrico monopolar y el de ultrasonidos sobre el tejido muscular en cirugía oncológica. Material y método. Se recogieron muestras de tejido muscular de 6 pacientes. En cada uno de ellos se obtuvieron 2 muestras: una mediante corte con bisturí eléctrico y otra con bisturí de ultrasonidos que se analizaron en anatomía patológica. Resultados. Observamos una menor profundidad de necrosis y mejor viabilidad tisular en las zonas de corte con bisturí de ultrasonidos, respecto a las zonas en las que se empleó el bisturí eléctrico. Conclusión. El bisturí de ultrasonidos proporciona una capacidad de corte y hemostasia comparable a la del bisturí eléctrico, ocasionando un menor daño a los tejidos sobre los que se aplica (AU)

Objective. To compare the effects using the monopolar electric and ultrasonic scalpel on muscle tissue in oncological surgery. Material and method. Muscle tissue samples were collected from 6 patients. Two samples were obtained from each one of them: one using an electric scalpel and another with an ultrasonic scalpel, which then analysed in histopathology. Results. Less necrosis and better tissue viability was observed in the areas cut with the ultrasonic scalpel compared to the areas where the electric scalpel was used. Conclusion. The ultrasonic scalpel has a cutting capacity and haemostasis comparable to the electric scalpel, causing less damage to the tissue on which it is applied (AU)

Luxación traumática de la articulación trapeciometacarpiana / Traumatic dislocation of the trapeziometacarpal joint

Objetivo: Evaluar los resultados obtenidos al tratar de forma conservadora (mediante reducción cerrada seguida de inmovilización con un yeso antebraquial de escafoides) las luxaciones agudas de la articulación trapeciometacarpiana (ATM). Material y método: Se trató a 7 sujetos (4 varones y 3 mujeres) afectados de luxación aguda traumática de la ATM. Material y método: A todos los sujetos se les realizó reducción cerrada e inmovilización con un yeso antebraquial tipo escafoides por un período de 6 semanas. En 2 casos fue necesario estabilización adicional mediante agujas de Kirschner. El período de seguimiento ha sido de 36 a 79 meses. Resultados: Los resultados fueron satisfactorios en todos los sujetos, ninguno presentaba sintomatología o subluxación residual en los estudios radiográficos en el último control. Todos los sujetos retornaron a su actividad previa al accidente. Discusión: Las luxaciones trapeciometacarpianas son lesiones infrecuentes. La reducción cerrada seguida de inmovilización (combinada con agujas de Kirschner en aquellos casos de inestabilidad residual tras la reducción) ofrece resultados satisfactorios (AU)

Purpose: To assess the results of the use of conservative treatment, consisting of closed reduction followed by scaphoid-type forearm cast immobilization, to treta acute dislocations of the trapeziometacarpal joint. Materials and methods: Seven patients were treated, 4 males and 3 females, who had suffered an acute traumatic dislocation of the trapeziometacarpal joint. Materials and methods: All patients were subjected to closed reduction followed by immobilization with a scaphoid-type forearm cast for a period of 6 weeks. In 2 cases additional stabilization was required by means of K-wires. Mean follow-up was 36–79 months. Results: Results were satisfactory in all patients. At the last follow-up visit none of them presented with symptoms, nor any residual dislocations were observed radiographically. All patients went back to their pre-accident activities. DiscussionTrapeziometacarpal dislocations are an unusual occurrence. Closed reduction followed by immobilization (combined with K-wires in cases of residual instability further to reduction) offers satisfactory results (AU)

Cuidados perioperatorios de Enfermería a paciente sometido a fijación externa / Peri-operative nursing care for the patient undergoing external fixation

La fijación externa es una técnica cada vez más utilizada en nuestros hospitales, dado que se puede emplear como técnica definitiva en la estabilización de fracturas cerradas, o provisional en fracturas abiertas o en las que existen una alteración cutánea. Además su indicación en muy versátil pudiéndose utilizar en el caso de fracturas en las vértebras cervicales, de la mandíbula, en la articulación de la muñeca, de las falanges, del codo, en fracturas de pelvis, de fémur, de la tibia, articulación de la rodilla y tobillo, entre otras. Además proporciona comodidad al paciente, disminuye el dolor, facilita los cuidados de enfermería y el transporte y movilización del mismo. Con todo ello se hace necesaria la realización de un plan de cuidados estandarizado en el perioperatorio de estos pacientes, que facilite el trabajo de las enfermeras, y permita la aplicación y registro de los mismos siguiendo una metodología científica (AU)

El object of this article is to establish the standardized nursing plan in the peri-operative care of patients with external fixation, the purpose of which is to facilitate the work of peri-operative nurses (AU)

[Cement-free hip cups. Current status]. / Zementfreie Hüftpfannen. Aktueller Stand.

Important criteria for stable cup fixation are the type of anchor system and stabilizers,cup form and the material and surface structure. Different fixation systems are manifest in pressfit and threaded cups. Pressfit implants are oversized and lead to equatorial jamming. For additional fixation, and to improve stability, screws, pegs, rings, fins, spikes or hollow cylinders are used. In threaded cups, thread geometry is decisive for the cup's performance during the screw-in process and positioning. The hemispheric shape of the cups requires less bone resection and the position of the implant can be arbitrarily selected. The conical shape guarantees high tilting stability. Most implants are made of pure titanium or a titanium-aluminum alloy. A rough surface area - produced by corundum blasting, titanium-plasma spray, titanium balls, nets or other grid designs - is essential for osseointegration. The results of second generation pressfit and threaded cups with 10 year survival rates of 93-100% are persuasive.