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

La osteomielitis crónica recurrente multifocal es un trastorno inflamatorio estéril en las extremidades. Afecta principalmente a niños simulando una osteomielitis infecciosa. Puede estar asociada a trastornos inflamatorios cutáneos y del tracto intestinal. Los niveles de reactantes de fase aguda están normales o levemente altos. Las radiografías muestran lesiones osteolíticas rodeadas por esclerosis, pero pueden ser normales al inicio de la enfermedad. Identificar las características propias de la enfermedad y descartar una etiología infecciosa permiten establecer un diagnóstico oportuno y ofrecer el manejo adecuado. Se presentan tres casos de esta patología. Un hombre de 24 años con síntomas inflamatorios persistentes y recidivantes en el tobillo derecho, de 8 años de evolución. Una niña de 11 años que acude reiterativamente por dolor en hemitórax, clavícula derecha y tobillo izquierdo, y una niña de 12 años con múltiples episodios breves de síntomas inflamatorios en ambos tobillos. Los tres casos, sin leucocitosis, reactantes de fase aguda levemente aumentados o negativos, con criterios mayores y menores de Jasson para diagnóstico de esta patología. Los cuadros mejoraron con antinflamatorios no esteroides. Es importante conocer esta rara entidad como posibilidad diagnóstica, pues un diagnóstico oportuno evita el uso innecesario de antibióticos y la resolución del cuadro se logra con antinflamatorios no esteroides, sin necesidad de procedimientos quirúrgicos que aumentan las comorbilidades.

BackgroundThe purpose of this study is to analyze the long-term clinical and radiological results of a series of patients with early stages of the Kienbock disease treated with radius core decompression.MethodsThis retrospective study included 23 patients with Kienböck’s disease (Lichtman stage II and IIIA) who underwent distal radius metaphyseal core decompression that were followed-up for at least 10 years. At the last follow-up, the patients were evaluated for wrist range of motion and grip strength. The overall results were evaluated by the modified Mayo wrist score and visual analogue scale pain score. We also compared the radiological changes between the preoperative and final follow-up in their Lichtman classification and the modified carpal height ratio. ResultsThe mean follow-up period was 13 years (range 10-18). Based on the modified Mayo Wrist Score, clinical results were excellent in 9 patients, good in 11 patients, fair in 2 and poor in one patient. The mean preoperative pain according to VAS was 7 (range 6-10) and was 1.1 (range 0-6) at the final follow-up. Compared with the opposite side, the average flexion/extension arc was 78% and the grip strength was 81%. Radiographic disease progression according to the Lichtman classification occurred in four wrists.ConclusionThis long-term follow-up study shows that radius core decompression is a valid alternative for the treatment of the early stages of the kienbock disease.

There are several surgical options described for osteochondral defects of the knee. The aim of our study was to analyze a series of patients treated with mosaicplasty with an average of 8 years follow-up.            Sixty-two patients with osteochondral defects of the knee who underwent mosaicplasties between 2001 and 2014 were included in the study with minimum follow-up of 2 years. Patients were evaluated using the Lysholm score, International Knee Documentation Committee Score (IKDC) and Kellgren-Lawrence radiographic scale.            Forty-five were men and seventeen women with an average age of 36 years old. Mosaicplasties were 45 in the medial condyle, 12 lateral condyle, 12 trochlea and 3 combined. Forty-two patients had isolated mosaicplasties and 20 patients presented associated surgical procedures (osteotomy, ACL reconstruction, meniscectomy). The mean results of the Lysholm score were 80.1 and IKDC was 66.7. There were no significant differences among the Lysholm and IKDC scores between these two groups. In 30 patients evaluated with radiography a satisfactory inclusion of the bony block was observed.            We believe that mosaicplasty is a procedure with a high degree of satisfaction with good functional results in patients with focal lesions of articular cartilage that may or may not be associated to other surgical procedures.

Tibiofibular dislocation is uncommon, and it is related to sport injuries as a result of an external rotation trauma with the knee in fully flexed position, and foot pointing inwards and downwards. It causes pain in the anterolateral aspect of the knee, motion is complete but painful. Diagnosis is clinical and radiological. This entity goes unnoticed in the emergency department (60%), with functional and biomechanic consequences if diagnosis is no immediate. The objective is to describe diagnostic experience and orthopedic treatment of an unusual knee condition. We present a 23-year-old patient who fell while skating. He refers a proximal protuberance in the lateral face of the left leg, inflammation, pain, and limitation for knee extension.

Cirugía percutánea del pie: ¿hacia dónde debemos ir?

Introducción: Presentamos los resultados funcionales y criterios de indicación para artroplastía de rodilla con estabilización superior al estabilizado posterior, en la artroplastia de rodilla primaria (ATR). Materiales y métodos: Análisis retrospectivo de 43 ATR en 40 pacientes, con seguimiento promedio de 6,2 años. 38 casos presentaban genu valgo artrósico y 5 genu varo artrósico. La suficiencia de los ligamentos colaterales se definió como suficiente, atenuado o incompetente. Se desarrollo un sistema de clasificación para los genu valgo que relacionara el tipo de rodilla con el implante elegido.  Resultados Se utilizaron 28 prótesis con estabilización posterior plus en pacientes con un deseje coronal promedio de 15.9°, de los cuales 21 presentaron ligamentos suficientes y 5 atenuados. Se utilizo una prótesis constreñida en 7 pacientes con deseje en valgo promedio de 21.6°, 2 con ligamentos suficientes y 5 con ligamentos atenuados. Se utilizaron 8 prótesis abisagradas rotatorias, 5 en pacientes con un genu valgo promedio de 24.6° (3 de ellas asociadas a recurvatum), 4 con ligamentos incompetentes y una con ligamentos atenuados, y tres con genu varo de 16° promedio.  Conclusiones: Recomendamos utilizar las prótesis estabilizadas plus en desejes < 20°, con ligamentos colaterales suficientes en ausencia de defectos óseos. Las prótesis constreñidas en pacientes con grandes desejes con ligamentos colaterales que presenten algún grado de suficiencia (a lo sumo atenuados). Las prótesis abisagradas rotatorias las reservamos para rodillas con incompetencia ligamentaria colateral o multidireccional, grandes defectos óseos o deformidades severas en artritis reumatoide o de origen neuropático.   Abstract Introduction: The objective of this retrospective study was to show the functional results and indication criteria for prostheses for primary TKA with more constraint than posterior stabilization. Methods: Forty-three TKA were analyzed in 40 patients, with an average follow-up of 6.2 years. Preoperative diagnoses were valgus osteoarthritis (38 cases) and varus osteoarthritis (5 cases). Sufficiency of the collateral ligaments was classified as sufficient, attenuated or incompetent, through physical examination and X-rays with varus-valgus stress. Functional results were evaluated using the KSS. Results: Posterior-stabilized plus implants were used in 28 cases, with an average alignment of 15.9°: 26 were valgus knees, 21 of which presented sufficient and 5 attenuated ligaments. Constrained prostheses were used in 7 patients with an average valgus alignment of 21.6° (2 with sufficient and 5 with attenuated ligaments). Rotating-hinge prostheses were used in 8 patients, 5 with an average valgus alignment of 24.6° (3 of them associated with recurvatum), 4 with incompetent ligaments and one with attenuated ligaments. The average post-operative KSS was 84 (range 73-94) points. Noinstabilities were detected and prosthetic survival was 100% at the end of the follow-up. Conclusions: We recommend using posterior-stabilized plus implants in deformities <20°, with sufficient collateral ligaments and no bone defects; constrained prosthesis in patients with greater deformity (>20°) and collateral ligaments with some degree of sufficiency (attenuated at the most); and rotating-hinge implants in knees with collateral or multidirectional ligament insufficiency, associated with recurvatum, significant bone defects or severe deformities in rheumatoid arthritis or with neuropathic origin.

 Introduction: Treatment of soft tissue lumbosacral defects is based on dead space management and defect coverage. The aim of this study is to describe the surgical technique, results and complications of patients who underwent rectus abdominis flap for lumbosacral defects coverage.Methods: A six-year retrospective review was performed. Demographic characteristics are analyzed. Surgical technique and intra-operative complications are described. Postoperative variables, such as donor site complications, recipient site complications, and flap survival were also reported. Results: Five patients met the inclusion criteria (average age, 50 years). Four patients presented sacral tumor diagnosis and one patient had lumbosacral osteomyelitis. Mean follow-up was 20 months. Flap average size was 8 x 13 cm. Intraoperative complications were one pedicle injury (microsurgical repair) and the death of a patient. Regarding postoperative complications, one wound dehiscence was reported. None of the flaps suffered vascular complications and all remained vital throughout follow-up.Conclusion: Rectus abdominis flap should be considered a valid option in the management of large soft tissue lumbosacral defects. This flap provides sufficient skin volume and muscular tissue. Surgical technique is relatively simple with no need for microsurgical procedure.   

Las roturas del extensor propio del hallux son poco frecuentes, más aún aquellas espontáneas o por traumas indirectos. Se pueden producir en cualquier parte del recorrido del tendón, pero las lesiones más frecuentes son las secciones tendinosas por heridas cortantes. No existe una técnica quirúrgica específica descrita para la reinserción distal del tendón. El objetivo de este artículo es presentar a un paciente de 35 años que, por un traumatismo indirecto, sufrió la rotura del extensor propio del hallux a nivel de la inserción distal. Se describen la técnica quirúrgica, la rehabilitación y los resultados según el puntaje de la AOFAS preoperatorio y posoperatorio.

IntroductionThe aim of this study is to assess our clinical-radiographic results with the use of trabecular tantalum cups for the reconstruction of complex acetabulums, both in primary surgeries and revisions, and compare them with other authors’ similar series.Materials and MethodsWe carried out a retrospective revision of a series of 42 surgeries (29 revisions and 13 primary arthroplasties) in 40 patients between March 2010 and March 2016. The series included 20 females and 20 males who averaged 60 years of age (ranging from 27 to 93). The patients’ average follow-up was of 37 months (ranging from 12 to 84). All the patients were treated with the same type of trabecular metal.ResultsAt average 37-month follow-up survival rates in the acetabular component were of 97.6%. One patient was treated with resection arthroplasty due to persistent infection. Global complication rates were of 12% and the average postoperative Harris Hip Score was of 81.54 (63.25-92.75).ConclusionsAlthough a longer follow-up is required, the use of trabecular metal cups gets promising results in the treatment of complex acetabulums.

IntroducciónEl objetivo del trabajo es revisar los aspectos técnicos de la artroplastía de cadera como rescate de una osteosíntesis fallida de un fractura intertrocantérica o subtrocantérica así como evaluar los resultados funcionales y las complicaciones asociadas en una serie consecutiva de 61 casos.Materiales y MétodoRealizamos  61 artroplastías de cadera, en 61 pacientes, como rescate de una osteosíntesis fallida de una fractura intertrocantérica o subtrocantérica. El promedio de edad fue de 76  años (50-93). %). Treinta y cuatro casos (56%) fueron tratados inicialmente con un tornillo deslizante de cadera, 8 (13%) con un DCS, 2 (3%) con clavos de  Ender y  17 (28%) con un clavo de fémur proximal (corto o largo). Cincuenta y cinco 55 (90%) fueron rescatadas con una artroplastía total y 6 (10%) con una hemiartroplastía. En 17 (28%) casos utilizamos tallos no cementados y en 44 (72%) tallos cementados. En 12 casos el largo del tallo fue  estándar y 49 de revisión.ResultadosAl año post-operatorio el HHS (Harris Hip Score) mejoró de  47 (rango de 32 - 54)  en el pre-operatorio a  84 (rango 67-93). Siete pacientes (11.5%) presentaron complicaciones. Tres (4.9%) fueron fracturas femorales periprotésicas. Dos (3.2%) luxaciones. Una (1.6%) infección y un (1.6%) hematoma de la herida.ConclusiónLa artroplastía de cadera se presenta como un método eficaz para el salvataje de las osteosíntesis fallidas de fracturas intertrocantérica y subtrocantéricas. La mayoría de los pacientes logran recuperar una significativa mejoría del dolor y de su capacidad funcional. Sin embargo, es un procedimiento más demandante y con más complicaciones asociadas que el de una artroplastía de cadera primaria. AbstractIntroduction: The aim of this study was to review technical issues of hip arthroplasty after a failed proximal femur fixation, as well as to evaluate results and complications associated with this procedure.Methods: Sixty-one hip arthroplasties after a failed intertrochanteric or subtrochanteric fixation were performed. Average age of patients was 76 years (range 50-93). Thirty-four patients (56%) were originally treated with a dynamic hip screw,  8 (13%) with a DCS, 2 (3%) with Ender nail and 17 (28%) with proximal femoral nail. Fifty-five patients (90%) were treated with total hip arthroplasty and 6 (10%) with hemiarthroplasty. Uncemented stem was used in 17 patients (28%) and a cemented stem in 44 (72%). A standard length stem was used in 12 patients, and a long stem in 49 cases.Results: The HHS improved from 47 (range 32-54) before surgery to 84 (range 67-93) at one-year follow-up. Seven patients (11.5%) had complications: 3 (4.9%) periprosthetic femoral fractures, 2 (3.2%) dislocations, one (1.6%) wound hematoma, and one (1.6%) deep infection.Conclusions: Hip arthroplasty after a failed fixation of an intertrochanteric or subtrochanteric fracture is an effective method. Pain and functional outcomes improve significantly in most patients. However, it is a more technically challenging procedure and causes more complications than primary hip replacement.