Sistema Regional de Información
en línea para Revistas Científicas de América Latina,
el Caribe, España y Portugal

Introduction Tibial Plateau Fractures represent 1% of all fractures. The type of treatment for these fractures continues being controversial. The functional result mainly depends on the knee´s range of motion, stability of the joint and the pain suffered by the patient. Only a few cases evaluate the functional result of the knee after a secondary tibial plateau fracture to high energy fractures.  Materials and Methods Number of cases, 51 patients, 34 males and 17 females, average age of 48, follow- up average of 42 months. Range of movement (ROM) was assessed; functional results were evaluated with the KOOS test. Pain was evaluated using the VAS scale and the diagnosis of complications was performed through anamnesis, physical examination and complementary methods.Results 51 patients, 69% due to motorbike accidents and 6% car accidents; 23% falls from heights and 2% from sport activity. 33 left knees and 18 right knees. 25 patients suffered Schatzker type V fractures (two of them were Gustilo exposed fractures, grades IIIa and IIIc) and 26 were type VI (one Gustilo IIIc). Among the Schatzker  type V fractures, the average ROM was 2,4°-120,68°, in Schatzker VI fractures, average 1,5°-118,04°. Regarding pain, considering the VAS scale, Shatzker V and VI classifications showed significant differences (p=0,0403), since in the first one, 50 % of the patients reported no pain, and only 25% reported a VAS pain score higher or equal to 2. In patients with Schatzker VI fractures, the pattern was different since 50% indicated pain score over 2 and 25% higher than 3. 22% of the patients showed complications.Discussion Tibial Plateau Fractures remain being a pathology in which the results can considerably modify life quality in patients. Therefore, patients must be informed about the possible bad functional outcomes in the long run, require multiple surgeries, as well as the possibility of being unable to regain their previous standard of labor or sport activity.

La condrodisplasia de Grebe es un trastorno raro autosómico recesivo que pertenece al grupo de las osteocondrodisplasias. Clínicamente se caracteriza por un severo dismorfismo con una marcada micromelia y deformidad de las extremidades inferiores y superiores. Conocer este tipo de síndrome orienta a dar mejores diagnósticos y permite el diagnóstico diferencial con patologías más comunes, como la acondroplasia. Se presenta una paciente de 35 años con diagnóstico de síndrome de Grebe desde los 10 años. El síndrome de Grebe tiene una muy baja incidencia; por este motivo, es poco conocido por el cuerpo médico en general y aun menos para los ortopedistas, quienes serán los encargados de tratar a estos pacientes. AbstractGrebe syndrome is a rare autosomal recessive disorder that belongs to the group of osteochondrodysplasias. Clinically, it is characterized by severe dysmorphism, marked micromelia and deformities of the lower and upper limbs. Recognition of this syndrome allows to give better diagnoses and to establish a differential diagnosis with more common pathologies, such as achondroplasia. We present a 35-year-old woman with diagnosis of Grebe syndrome at the age of 10. Grebe syndrome has a very low incidence; therefore, it is unknown by general physicians and still less by orthopedic surgeons, who will treat these patients.

A peritalar dislocation involves simultaneous disruption of the talocalcaneal and talonavicular joints. It is relatively uncommon and account for approximately 1% to 1.5% of all traumatic foot injuries. Medial dislocation is the most frequent accounting for approximately 80% of reported cases. Lateral peritalar dislocations are less common (17%), and posterior (2.5%) and anterior dislocations are rare (1%). Approximately 55% of medial and 72% of lateral subtypes are associated with fractures. A thirty-six-year-old woman had suffered an indirect traumatism during kite-surf practice and after falling from the kite-board near the beach trying to avoid an accident because of intense wind. She presented a lateral peritalar dislocation with navicular, calcaneal and fibular fractures associated. After the primary evaluation, a closed reduction was attempted three days from trauma. After six days of the lesion the surgery was perform. The fractures were treated with minimally invasive osteosynthesis and in the postoperative the patient developed a complex regional pain syndrome. We recomend an early diagnosis of peritalar dislocations and a correct recognition of infrequent fractures to avoid usual complications. 

Introducción: La estructura histológica de los ligamentos, incluyendo el LCA, está compuesta por colágeno y elastina envueltos en una matriz de agua y proteoglicanos. El colágeno es el componente principal de los tendones y ligamentos, representa el 65 – 75% de su peso en seco. El objetivo del presente estudio es realizar una evaluación histopatológica de los fragmentos de LCA rotos tomados en el momento del acto quirúrgico por artroscopía.Material y métodos: Estudio prospectivo observacional sobre 50 casos con rotura de LCA. Se tomaron muestras de LCA en procedimiento artroscópico y se evaluó la histopatología del ligamento.Resultados: Se mencionan los resultados en base a resultados de anatomía patológica y evolución post operatoria.Conclusión: No se evidenciaron cambios degenerativos en la histopatología que justifiquen la rotura ligamentaria.   Palabras claves: ligamento cruzado anterior, LCA, Histopatología, anatomía patológica.Nivel de evidencia: IV serie de casos. AbstractIntroduction: Histological structure of ligaments, including the anterior cruciate ligament, is composed of collagen and elastin wrapped in a matrix of water and proteoglycans. Collagen is the main component of tendons and ligaments, accounting for 65-75% of its dry weight. The aim of the present study is to perform a histopathological evaluation of the ruptured anterior cruciate ligament fragments taken at the time of surgical procedure by arthroscopy.Methods: A prospective observational study of 50 cases with anterior cruciate ligament rupture. Anterior cruciate ligament samples were taken in an arthroscopic procedure and histopathology of the ligament was evaluated.Results: Pathology results and post-operative evolution are mentioned.Conclusion: Degenerative changes were observed in the histopathology exam; it cannot be demonstrated if these changes are previous or posterior to ligament rupture. 

El tumor de células gigantes espinal es una neoplasia de estirpe benigna y comportamiento local agresivo, de presentación rara en la población pediátrica. El dolor asociado al compromiso neurológico es la presentación típica en niños. La resección amplia del tumor y la descompresión de los elementos neurales asociada a fusión instrumentada permiten obtener una columna estable, preservar o restaurar la función neural y evitar la recidiva tumoral. Se presentan dos pacientes con tumor de células gigantes espinal en esqueleto inmaduro, sometidos a resección y estabilización mediante artrodesis instrumentada, sin recidiva en el posoperatorio alejado. La presentación clínica, la edad de los pacientes y los resultados quirúrgicos a largo plazo hacen de extremo valor el reporte de estos casos en esqueletos inmaduros.

IntroductionTotal knee replacement is associated with extensive postoperative blood loss.Tranexamic acid is synthetic antifibrinolytic agent that, in the last few years, has been successfully used intravenously to reduce bleeding after total knee replacement. However, topical application of tranexamic acid in total knee replacement remains largely unexplored.MethodsWe conducted a retrospective study of 117 total knee primary replacements, where 63 of them received topical tranexamic acid, and the remaining 54 replacements in whom no tranexamic acid was used. A comparison analysis was made, capturing results of blood transfusion rates, postoperative hemoglobin levels (24 and 48 hs), number of changed bandages, associated comorbidities and complications.ResultsTranexamic acid reduced the blood tranfusion rate by 43.9% when compared with the group without tranexamic. We also found, that  the same group, resulted in a lower decline in postoperative hemoglobin levels (24 hs) by 2,12 gr/dl. There was no complications in both groups.ConclusionsTopically applied  tranexamic acid was effective in reducing the need for blood transfusion following total knee replacement, without additional adverse effects.