Primary Joint Arthroplasty Surgery: Is the Risk of Major Bleeding Higher in Elderly Patients? A Retrospective Cohort Study.

BACKGROUND: Increased risk of bleeding after major orthopedic surgery (MOS) has been widely documented in general population. However, this complication has not been studied in elderly patients. The purpose of this study is to determine whether the risk of major bleeding after MOS is higher in elderly patients, compared with those operated at a younger age. METHODS: This retrospective cohort study included total hip and total knee arthroplasty patients operated during 5 consecutive years. The main outcome was the occurrence of major bleeding. Patients with other causes of bleeding were excluded. Relative risks (RRs) and confidence intervals (CIs) were calculated, and a multivariate analysis was performed. RESULTS: A total of 1048 patients were included, 56% of patients were hip arthroplasties. At the time of surgery, 553 (53%) patients were older than 70 years. Patients aged >70 years showed an increased risk of major bleeding (RR: 2.42 [95% CI: 1.54-3.81]). For hip arthroplasty, the RR of bleeding was 2.61 (95%CI: 1.50-4.53) and 2.25 (95% CI: 1.03-4.94) for knee arthroplasty. After multivariate analysis, age was found to be independently associated with higher risk of major bleeding. CONCLUSION: According to European Medicines Agency criteria, patients aged ≥70 years are at a higher risk of major bleeding after MOS, result of a higher frequency of blood transfusions in this group of patients. Standardized protocols for blood transfusion in these patients are still required.

Vascularized Bone Grafting for the Treatment of Capitate Avascular Necrosis.

Avascular necrosis (AVN) of the capitate bone is a rare condition and it can be related to major trauma or idiopathy. Different treatments are available including soft tissue interposition and intercarpal arthrodesis including lunocapitate, scaphocapitate, four corner, and carpometacarpal fusions. Other surgical options are resection of the proximal pole and revascularization procedures. The main purpose of this article is to present two cases of AVN of the capitate treated with a revascularization procedure using the 4th-5th extensor compartment artery (4th-5th ECA). Two female patients with capitate AVN are reported with an average age of 30.5 years. Both cases were classified as type-I according to Milliez classification. The major complaint in each case was wrist pain that increased during activity. In both cases there was no history of trauma, smoking, diabetes, or hematologic diseases. Both patients had a diminished range of motion, grip, and strength. The definitive diagnosis was made with magnetic resonance imaging. Both patients underwent treatment revascularization of the capitate using a vascularized bone graft based on the 4th-5th ECA. At average follow-up of 12 months, each patient had improved with regards to pain and had increased grip strength. The literature does not describe a specific algorithm treatment for capitate AVN. We recommend revascularization of the capitate using the 4th-5th ECA in type-I Milliez classification in young patients without signs of carpal collapse.

Microsurgical Complications after Finger Reimplantation Treated with Negative Pressure Wound Therapy: A Case Report.

Venous congestion is the most critical complication following microsurgical finger replantation and can present within the first postoperative days or even in the immediate postoperative period. This is a case series of three patients who underwent digit replantation. The postoperative complication was venous congestion, and immediately, negative pressure wound therapy (NPWT) was applied to reduce the risk of failure. Three patients with a range of 35 years of age were included. One index finger, one thumb, and one ring finger were the fingers amputated; the surgical technique was described; our anticoagulant protocol was demonstrated; and finally, standardization of the NPWT was established. At the end of the therapy, all fingers survived. We concluded that NPWT is an excellent treatment option following the identification of venous congestion in digit replantation.

Negative Pressure Wound Therapy as a Salvage Procedure in Venous Congestion of Microsurgical Procedures.

Negative pressure wound therapy (NPWT) is widely used in skin defects, active infection, and surgical reconstruction; lately, it is being used after skin graft to improve the adhesion on the receptor area. During the last decade, another indication has been identified: the use of NPTW to avoid complications after free flaps such as venous congestion and the risk of necrosis. NPWT can be used in the initial complication of a free flap, and the venous congestions can be treated with this technique, with very good outcomes. NPWT can be established as a part of a postoperative protocol in microsurgical procedures to avoid major complications.

Avascular necrosis of the lunate secondary to perilunate fracture dislocation: Case report and review of the literature.

This is a 39-year-old male, fell from a bike, left wrist with trans-styloid perilunate fracture dislocation that underwent open reduction internal fixation, 20 months after surgery the patient developed avascular necrosis of the lunate, final wrist fusion was performed secondary to the arthritic changes on the wrist. Anatomic dissection was performed and vascularity of the lunate was identified, its origin is from the volar palmar arch, when dislocated palmarly and more than 90 degrees the vessel is still intact. More than 512 patients with perilunate dislocation and perilunate fracture dislocation are included we identified in the literature transient avascular necrosis of the lunate in nine and seventeen of pure avascular necrosis of the lunate. Concluding that avascular necrosis of the lunate after perilunate dislocation or perilunate fracture dislocation is an infrequent finding especially when the volar ligaments are intact.

In Vitro Comparison between the Pulvertaft Weave and the Modified Core Suture Pulvertaft Weave.

Background: The Pulvertaft weave was described more than 50 years ago and is still used in tendon transfers. The aim of this study was to evaluate the strength of a modified core suture Pulvertaft weave technique and compare it to the original Pulvertaft weave traditionally used in tendon transfer surgery. Methods: 12 extensor pollicis longus tendons and extensor indices proprius tendons were harvested from fresh frozen cadavers. Six Pulvertaft weaves were performed using FiberWire 4.0 and six core suture tendon weave were performed using FiberLoop 4.0. Biomechanical analysis was performed and stifness, first failure load and ultimate failure load were measured for both set of repairs. Results: The stiffness of the core suture tendon repair (9.5 N/mm) was greater than that of the Pulvertaft repair (2.5 N/mm) The first failure load of the core suture tendon repairs (68.9 N) was greater than the Pulvertaft repairs (19.2 N) and the ultimate failure load of the core suture tendon repairs (101.8 N) was greater than the Pulvertaft repairs (21.9 N). All of these differences were statistically significant. Conclusions: The core suture Pulvertaft weave is a modification to the Pulvertaft weave used in tendon transfers. The results of this cadaveric study suggest it is 5 times stronger than the traditional Pulvertaft repair, potentially allowing it to be used with early active motion protocols after tendon transfers.

The medial femoral condyle free flap: An excellent option for difficult cases: case series.

The use of the medial femoral condyle free flap is a versatile option for the treatment of upper extremity non unions and reconstructive procedures associated with bone loss or osteonecrosis. The benefit of this type of flap is the viability of the bone which favors primary ossification and increases bone density. Vascularized free bone flaps are especially useful for the treatment of recalcitrant nonunions, or nonunions that have failed three or more treatments to obtain consolidation. We present a case series of three patients treated with medial femoral condyle free flap for reconstruction of the upper extremity of different etiologies at the level of the distal humerus, distal radius and distal phalanx of the thumb.

Uniform Manifold Approximation and Projection for Clustering Taxa through Vocalizations in a Neotropical Passerine (Rough-Legged Tyrannulet, Phyllomyias burmeisteri).

Vocalizations from birds are a fruitful source of information for the classification of species. However, currently used analyses are ineffective to determine the taxonomic status of some groups. To provide a clearer grouping of taxa for such bird species from the analysis of vocalizations, more sensitive techniques are required. In this study, we have evaluated the sensitivity of the Uniform Manifold Approximation and Projection (UMAP) technique for grouping the vocalizations of individuals of the Rough-legged Tyrannulet Phyllomyias burmeisteri complex. Although the existence of two taxonomic groups has been suggested by some studies, the species has presented taxonomic difficulties in classification in previous studies. UMAP exhibited a clearer separation of groups than previously used dimensionality-reduction techniques (i.e., principal component analysis), as it was able to effectively identify the two taxa groups. The results achieved with UMAP in this study suggest that the technique can be useful in the analysis of species with complex in taxonomy through vocalizations data as a complementary tool including behavioral traits such as acoustic communication.

Revascularización y reimplante digital. Revisión de conceptos actuales / Digital reimplantation adn revascularization. current concets

El reimplante es la obra maestra del cirujano de mano, donde incluye la técnica microquirúrgica para la anastomosis de arteria, vena y reparación del nervio, la osteosíntesis de los huesos y el manejo de tejidos blandos como los tendones y la piel Indicaciones absolutas, amputación del pulgar, el pulgar es quizás el elemento más importante de la mano, dado que le da funcionalidad a la extremidad, sin importar la movilidad final ni la sensibilidad debe reimplantarse el pulgar. No se debe intentar el reimplante en lesiones aplastantes de los dedos, amputación en más de un nivel, presencia de lesiones que amenacen la vida del paciente, enfermedades graves del paciente, isquemia prolongada, amputaciones en paciente con alteraciones psiquiátricas. Clasificación según Tamai es la mas utilizada. Se explica además como se debe transportar la parte amputada. La técnica microquirúrgica es lo mas importante para el desenlace. La rehabilitación física y posibles complicaciones.

Reimplantation is the masterpiece of the hand surgeon, which includes the microsurgical technique for artery anastomosis, vein and nerve repair, osteosynthesis of the bones and the management of soft tissues such as tendons and skin. Absolute indications, Amputation of the thumb: the thumb is perhaps the most important element of the hand because it gives functionality to the limb, regardless of the final mobility or sensitivity it should be reimplanted. Reimplantation should not be attempted in crushing lesions of the fingers. Crush injury of the fingers may have multilevel amputation and microcirculation injury that may not be susceptible of repair. Amputation at more than one level, the presence of life-threatening injuries, serious illnesses of the patient, prolonged ischemia, amputations in a patient with psychiatric disorders. Tamai Classification is the most used. We explain the correct way to transport the amputated part. The microsurgical technique is the most important in order to avoid complications. We also explain the physical therapy and complications.