Revistas
Revista:
GLOBAL SPINE JOURNAL
ISSN:
2192-5682
Año:
2023
Vol.:
13
N°:
1
Págs.:
156 - 163
Study Design: Animal experimental model. Objective: To study the clinical behavior and histological changes in the spinal cord, nerve roots and perivertebral muscles of the spine after induced leakage of polymethylmethacrylate (PMMA) loaded with antiblastic drugs during vertebroplasty in an animal model of pigs. Methods: We performed vertebroplasty on 25 pigs. The animals were divided into 3 groups: vertebroplasty with PMMA alone (control group), vertebroplasty with PMMA loaded with methotrexate (MTX) and vertebroplasty with PMMA loaded with cisplatin (CYS). At 2 vertebral levels, epidural and prevertebral, massive cement leaks were induced. Animals were evaluated daily. Two weeks later, the pigs were sacrificed, and the tissues that came in contact with the cement were analyzed. Results: The clinical results for each of the groups were reported. The control group had no clinical alterations. In the MTX group, 2 pigs died before 1 week due to pneumonitis. In the CYS group, 4 animals had motor impairment, and 3 of the 4 had paraplegia. The histological results were as follows: the control and MTX groups showed synovial metaplasia, inflammatory reaction, crystal deposits, and giant cell reaction in the dura mater and muscle and all the animals in the CYS group had spinal cord and muscular necrosis. Conclusions: Massive cement leak after vertebroplasty with PMMA loaded with cisplatin is extremely toxic to the spinal cord and muscles around the spine. Therefore, its use cannot be recommended for the treatment of vertebral metastases. Using PMMA loaded with methotrexate seems to be a safe procedure, but further research is needed.
Revista:
ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY
ISSN:
0936-8051
Año:
2022
Vol.:
142
N°:
8
Págs.:
1793 - 1800
Purpose A question still remains as to whether constrictive toe-box shoes (TBS) cause disability only due to pain on pressure points or if they can cause permanent changes in the hallux anatomy. The aim of this study is to compare the hallux morphology in 3 groups classified according to their use of constrictive or open TBS. Methods 424 patients were classified into 3 groups: group A used open TBS daily; group B used constrictive TBS daily; group C used both open and constrictive TBS. Hallux's angles, presence of exostoses and shape of the distal phalanx (DP) were analyzed on dorsoplantar weight-bearing radiographs and compared amongst groups. Results The intermetatarsal (IMA), metatarsophalangeal (MTPA), DASA, PASA, interphalangeal (IPA), obliquity (AP1), asymmetry (AP2) and joint deviation (JDA) angles for group A were 10 degrees, 8 degrees, 5 degrees, 4 degrees, 9 degrees, 3 degrees, 5 degrees, 3 degrees; for group B were 9 degrees, 19 degrees, 5 degrees, 6 degrees, 12 degrees, 2 degrees, 8 degrees, 2 degrees; and for group C were 10 degrees, 10 degrees, 4 degrees, 4 degrees, 12 degrees, 3 degrees, 8 degrees, 1 degrees. Only the differences in the MTPA, IPA and AP2 were statistically significant (p < 0.05). The prevalence of exostoses on the tibial side of the DP was 22, 36, and 29% in groups A, B and C, respectively (p < 0.05). We found similar distributions of the different DP shapes in the three groups. Conclusions Our results suggest that the use of constrictive TBS, even if used only occasionally, could change hallux anatomy from a young age increasing MTPA, IPA and AP2. Moreover, we have found that DP exostoses are present as a "normal variation" in patients who wear an open TBS, but their prevalence is higher in those wearing constrictive toe-box shoes. This could be due to a reactive bone formation secondary to the friction caused by the inner border of the shoe. Level of clinical evidence 3.
Revista:
GERIATRICS
ISSN:
2308-3417
Año:
2022
Vol.:
7
N°:
6
Págs.:
142
Changes in vertebral body height depend on various factors which were analyzed in isolation and not as a whole. The aim of this study is to analyze what factors might influence the restoration of the vertebral body height after vertebral augmentation. We analyzed 48 patients (108 vertebrae) with osteoporotic vertebral fractures who underwent vertebral augmentation when a conservative treatment proved to be unsatisfactory. The analyses were carried out at the time of the fracture, during surgery (pre-cementation and post-cementation), at the first medical check-up (6 weeks post-surgery) and at the last medical check-up. The average vertebral height was measured, and the differences from the preoperative values were calculated at each timepoint. A Pearson correlation coefficient and a linear multivariable regression were carried out at different timepoints. The time since the vertebral fracture was 60.4 +/- 41.7 days. The patients' average age was 73.8 +/- 7 years. The total follow-up period was 1.43 +/- 1 year. After vertebral cementation, there was an increase in the vertebral body height of +0.3 cm (13.6%). During the post-operative follow-up, there was a progressive collapse of the vertebral body, and the pre-surgical height was reached. The factors that most influenced the vertebral height restoration were: a grade III collapse, an intervertebral-vacuum-cleft (IVVC) and the use of a flexible trocar before cement augmentation. The factor that negatively influenced the vertebral body height restoration was the location of the thoracolumbar spine.
Revista:
GERIATRICS
ISSN:
2308-3417
Año:
2021
Vol.:
6
N°:
1
Págs.:
23
Several studies have shown that double mobility (DM) cups reduce postoperative dislocations. Does the cemented dual mobility cup reduce dislocations in a specific cohort of elder patients with a high dislocation risk? Our hypothesis is that this implant is optimal for elder patients because it reduces early dislocation. We have retrospectively reviewed elder patients who underwent total hip arthroplasty (THA) with cemented double mobility cup between March 2009 and January 2018. The inclusion criteria were patients (>75 years) who were operated on for primary THA (osteoarthritis or necrosis) with a cemented dual mobility cup and a high-risk instability (at least two patient-dependent risk factors for instability). The exclusion criteria were revision surgeries or hip fracture. In all the cases, the same surgical approach was performed with a Watson Jones modified approach in supine position. We have collected demographic data, instability risk factors. Patients were classified using the Devane's score, Merle d'Aubigne score and the patient's likelihood of falling with the Morse Fall Scale. Surgical and follow-up complications were collected from their medical history. Sixty-eight arthroplasties (68 patients) were included in the study. The median age was 81.7 years (SD 6.4), and the American Society of Anesthesiologists (ASA) score showed a distribution: II 27.94%, III 63.24% and IV 8.82%. Devane's score was less than five in all of the cases. At least two patient-dependent risk factors for instability (87% had three or more) were present in each case. The median follow-up time was 49.04 months (SD 22.6). Complications observed were two cases of infection and one case of aseptic loosening at 15 months which required revision surgery. We did not observe any prosthetic dislocation. The cemented dual mobility cup is an excellent surgical option on primary total hip arthroplasties for elder patients with high-risk instability.
Revista:
FOOT AND ANKLE SURGERY
ISSN:
1268-7731
Año:
2021
Vol.:
27
N°:
2
Págs.:
143 - 149
Background: The literature published about osteoid osteoma (OO) in the ankle-foot consists mainly on case reports.
Methods: We performed a retrospective study in which we analyzed demographic parameters, pain characteristics, treatment options and functional outcomes measured using the AOFAS and the SEFAS scales.
Results: We treated 17 patients with OO around the ankle-foot. Eighty-eight percent of patients had night pain that was relieved with NSAIDs. The bones most often affected were the talus and calcaneus. OO was diagnosed 21 months after the onset of symptoms. Mean follow-up was 17.3 years. The surgical techniques most used were curettage and curettage and bone grafting. There was a significant increase in AOFAS and SEFAS scores after surgery.
Conclusions: Suspicion is the base of a prompt and a correct diagnosis of OO. The OO should be especially suspected in patients who present night pain that can be relieved with NSAIDs.
Revista:
REVISTA DE LA ASOCIACION ARGENTINA DE ORTOPEDIA Y TRAUMATOLOGIA
ISSN:
1515-1786
Año:
2021
Vol.:
86
N°:
2
Págs.:
139 - 150
Introducción: Las técnicas para corregir las deformidades del hallux incluyen osteotomías metatarsianas y falángicas. Las osteotomías sobre la falange proximal corrigen el DASA y el ángulo interfalángico. Sin embargo, no se han publicado las indicaciones para la osteotomía de la falange distal. El objetivo de este artículo es comunicar la técnica y las indicaciones de la osteotomía percutánea de la falange distal del hallux, y evaluar los resultados de una serie de casos.
Materiales y Métodos: Se analizaron 14 pies en los que se realizó una osteotomía de la falange distal del hallux para corregir una deformidad. Se midieron el DASA, la oblicuidad interfalángica y el ángulo falange distal-interfalángico en las radiografías. La técnica quirúrgica fue percutánea con control fluoroscópico. Los resultados se evaluaron mediante las escalas analógica visual de dolor y AOFAS. Seguimiento medio: 52 meses.
Resultados: 13 pies de mujeres y un pie de hombre. Edad promedio: 58 años. Los resultados clínico y estético fueron excelentes, con alivio del dolor. Mejoría de la escala AOFAS: promedio 37 puntos. Análisis comparativo de ángulos preoperatorios y posoperatorios: DASA (p = 0,01), excepto cuando se aisló de la muestra a los pacientes con osteotomía tipo Akin (p = 0,33); ángulos F2-IF y F2-MTF (p <0,00001). Se registraron las complicaciones.
Conclusiones: En la deformidad en valgo de la falange distal del hallux sintomática, se debe considerar una osteotomía correctora sola o asociada a osteotomía de la falange proximal. La osteotomía percutánea de la falange distal es un método eficaz, seguro y rápido.
Nivel de Evidencia: IV
Revista:
FOOT AND ANKLE SURGERY
ISSN:
1268-7731
Año:
2021
Vol.:
27
N°:
5
Págs.:
592
Revista:
INTERNATIONAL ORTHOPAEDICS
ISSN:
0341-2695
Año:
2020
Vol.:
44
N°:
7
Págs.:
1435 - 1439
Background: Although different fixation techniques for the Akin osteotomy have been described in the literature, there are no many studies trying to analyze the differences between the types of fixation available. The aim of this study is to analyze if there are any differences between three types of staple fixation available in the market.
Method: We present a retrospective study of 145 cases in which an Akin osteotomy was performed and fixed with three different kinds of implants staple A (28%), staple B (45%), and staple C (27%). Staple A is made out of stainless steel, and the surgeon mechanically controls the compression applied. Staple B increases the compression when heat is applied to it. Staple C has an intrinsic elastic memory that closes the osteotomy. In all cases, distal articular set angle, interphalangeal joint obliquity angle, and metatarsophalangeal angle were measured pre-operatively and 1.5 months post-operatively on dorsoplantar weight-bearing radiographs. Other details such as post-operative complications, implant migration, osteolysis, or fracture of the lateral cortex during surgery were also recorded.
Results: Clinical and radiological results show no relevant differences between the three types of fixation. The mean angular corrections of DASA, interphalangeal joint obliquity angle, and metatarsophalangeal angle were 5, 12, and 21, respectively, for staple A; 4, 10, and 19, respectively, for staple B; and 7, 10, and 23, respectively, for staple C. The rates of intra-operative and post-operative complications were similar for all groups. There was one case of infection per group. We had five cases of delayed union two with staple A and three with staple C. In four cases, there was a loss of correction, two of them fixed with staple A and two with staple C. Seven cases developed a Südeck's syndrome, four of them fixed with staple A and three with staple C. Fifteen patients suffered an uncontrolled fracture of the lateral cortex of the phalanx when performing the osteotomy (3, 8, and 4 cases fixed with staples A, B, and C, respectively), and 87.5% of the patients that developed a plantar displacement of the osteotomy had an uncontrolled fracture of the lateral cortex (p < 0.05). All three staples achieved a rigid internal fixation and minimal periosteum damage and provided a good bone-bone contact.
Conclusions: According to our results, the radiological differences are minimal, and although the thermal compression staple had less complication, clinical differences were also not statistically significant. This means the choice of implant could be left to the surgeon's preferences or made according to cost.
Revista:
HAEMATOLOGICA
ISSN:
0390-6078
Año:
2020
Vol.:
105
N°:
9
Págs.:
E470 - E473
Revista:
ANALES DEL SISTEMA SANITARIO DE NAVARRA
ISSN:
1137-6627
Año:
2020
Vol.:
43
N°:
3
Págs.:
323 - 331
Background: To describe the feasibility of the posterior arch of C2 accepting two crossing screws in the Spanish population.
Methods: One hundred and fifty patients who underwent a routine neck CT scan for non-cervical pathology were enrolled. Submillimeter slices (thickness 0.7 mm) every 0.4 mm were performed with a 64 multi-detector CT scan, which allows isometric measurements. We measured the length and height of the cortical and cancellous (endomedullar) region of the lamina and the spinous process, inclination, maximal screw length and spinolaminar angle.
Results: The average (standard deviation) measurements of the lamina were: width of the left cortical 7.2 (1.5) mm, right cortical 6.9 (1.3) mm, width of the cancellous part of the left lamina 4.8 (1.5) mm, right side 4.6 (1.4) mm. The mean left cortical height was 13.0 (1.5) mm and 13.1 (1.6) mm for the right. The mean height of the cancellous part was 9.0 mm for both sides. The average measurements of the spinous process were: cortical length 15.7 (3.5) mm, endomedullar length 12.5 (3.9) mm; cortical height 11.9 (2.2) mm, endomedullar height 8.4 (2.1) mm; spinolaminar angle 49º (4); the maximum screw length 3.18 cm, and the inclination angle 143º.
Conclusion: A CT scan with submillimeter slices is necessary in order to avoid malpositioning of the screws. The outer cortical measurements are 2 to 4 mm bigger than the endomedullar ones. Taking into account the dimensions of the spinous process, 24% of the population would not be candidates for this crossing screw technique.
Revista:
THE FOOT
ISSN:
0958-2592
Año:
2019
Vol.:
38
Págs.:
39 - 42
Background: Having had a previous experience of 4 open F2 osteotomies to correct interphalangeal hallux valgus, the aim of this study was to test the efficacy of a percutaneous approach for this correction.
Methods: 3 open and 12 percutaneous F2 osteotomies in 15 cadaver feet were performed. Interphalangeal (IPH), F2 asymmetry (AF2) and joint deviation (JD) angles were measured on radiographs. The operated great toes were anatomically analyzed looking for possible lesions to surrounding tissues.
Results: Mean IPH decreased from 10.7° to 2.9°, AF2 from 7.8° to 1°, and JD from 1.4° to 0.5°. Damage to the hallux extensor tendon was detected in 1 foot and a nail bed lesion was detected in 1 case, both operated percutaneously.
Conclusions: F2 Valgus deformity can be corrected using open or percutaneous osteotomy. The authors consider the open correction worthwhile because percutaneous techniques may damage surrounding tissues and the incision length difference is minor.
Level of clinical evidence: 3.
Revista:
ANALES DEL SISTEMA SANITARIO DE NAVARRA
ISSN:
1137-6627
Año:
2019
Vol.:
42
N°:
2
Págs.:
231 - 234
There are few published data available about simultaneous bilateral hip fractures. We present the case of a 56-year-old man with Down syndrome and Alzheimer-like dementia with simultaneous bilateral hip fracture. A bilateral partial hip cemented arthroplasty was performed on this patient. The aim was to avoid the partial burden that could be caused by ostheosynthesis, due to the patient's lack of cooperation arising from his mental deterioration and his problems realizing everyday activities. He was able to walk unaided with complete autonomy until his death fourth years later. In our experience, one stage surgery for bilateral hip prosthesis is safe and provides good results in patients with severe mental impairment.
Revista:
FOOT AND ANKLE SURGERY
ISSN:
1268-7731
Año:
2019
Vol.:
25
N°:
2
Págs.:
158 - 164
Background: Exostoses at the base of the distal phalanx of the great toe are usually asymptomatic. The literature has not generally considered them as the origin of a possible problem resulting from a pressure conflict between hallux and shoe (medial aspect) or second toe (lateral aspect) nor a potential complication of surgical correction of hallux valgus deformity. No studies, to our knowledge, have evaluated its possible correlation with other foot disorders. When one of these neglected exostoses became painful after surgical correction of hallux valgus, we decided to start a study to determine their possible origin, prevalence in daily practice and histo-pathological morphology. Methods: Two hundred and fifty-four feet of patients (average age 41.7. y.) were enrolled in the study from January 2007 to June 2009. Dorsoplantar weight-bearing radiographs were used to analyze the presence of exostoses and their correlation with the distal phalanx morphology, metatarsal formula (or transverse plane orientation of the metatarsal heads parabola) and hallux valgus angles. Patients were classified according to their age and main symptom for consultation. Four exostoses removed from cadaver feet were also analyzed microscopically. Results: Osseous excrescences arising on the medial or lateral aspect at the proximal part of the terminal phalanx of the hallux were observed in 132 feet (51.9%). Thirty-five feet out of these 132 (13.7%) had exostoses on both sides of the phalanx.A statistically significant positive correlation was found between the presence of a medial exostosis of the phalanx and the severity of HVA. Patients with higher IPH and asymmetry angles have a lower prevalence of medial exostoses (p. <. 0.05). Amongst the different morphologies of the second phalanx, exostoses were most likely found in the standard form. Conclusions: Prevalence of exostoses at the base of the distal phalanx is high (51.9% of the studied feet). Histological findings would suggest that these exostoses could be considered a mechanical reactive process, produced by a chronic irritation by shoes. We encourage surgeons to be aware of its potential clinical implications. Direct resection is very simple and the most appropriate treatment for symptomatic cases.
Revista:
ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY
ISSN:
0936-8051
Año:
2019
Vol.:
139
N°:
12
Págs.:
1681 - 1690
Introduction A multitude of procedures has been described in the literature for the treatment of lesser toe deformities and there is currently no general consensus on the optimal method of fixation. The aim of this study is to assess the clinical and radiological outcomes of an intramedullary nitinol implant for the correction of lesser toe deformities, and to determine if the distal interphalangeal (DIP) joint and metatarsophalangeal (MTP) joint are modified during patient follow-up after correction of the PIP joint. Materials and methods A prospective analysis of 36 patients with claw toe or hammertoe who were treated with an intramedullary nitinol implant. Clinical manifestations and angulation of the metatarsophalangeal, proximal and distal interphalangeal (MTP, PIP, DIP) joints were evaluated in radiographic studies preoperatively, at first medical revision post-surgery, and after a minimum of 1 year of follow-up. Complications such as non-union rate, implant rupture, and implant infection were also evaluated during follow-up. Results All patients were women with an average age of 65.5 (range 47-82) years. The average follow-up time was 2.4 (range 1-5.7) years. Fifty intramedullary nitinol implants were used. The MTP joint extension and PIP joint flexion decreased by 15.9 degrees (95% CI - 19.11 to - 12.63) and 49.4 degrees (95% CI - 55.29 to - 43.52), respectively, at the end of follow-up. Moreover, the DIP joint flexion increased progressively during follow-up (13.7 degrees pre-surgery versus 35.6 in last medical check-up, 95% CI 13.24-30.57). There were four (8%) asymptomatic implant ruptures. The rate of fusion was 98%. Conclusion The reduction of the PIP joint using an intramedullary nitinol implant is a good option in lesser toe deformities, with few complications and a high rate of arthrodesis. Moreover, the PIP joint reduction affects both the MTP and DIP joints.
Revista:
JOURNAL OF ORTHOPAEDIC SURGERY AND RESEARCH
ISSN:
1749-799X
Año:
2018
Vol.:
13
Págs.:
72
Background: TGF-beta has been described as a mediator of fibrosis and scarring. Several studies achieved reduction in experimental scarring through the inhibition of TGF-beta. Fibroblasts have been defined as the cell population originating fibrosis, blocking fibroblast invasion may impair epidural fibrosis appearance. For this purpose, biocompatible materials used as mechanical barriers and a TGF-beta inhibitor peptide were evaluated in the reduction of epidural fibrosis. Methods: A L6 laminectomy was performed in 40 New Zealand white rabbits. Divided into four groups, each rabbit was assigned to receive either collagen sponge scaffold (CS group), gelatin-based gel (GCP group), P144 (R) (iTGF beta group), or left untreated (control group). Four weeks after surgery, cell density, collagen content, and new bone formation of the scar area were determined by histomorphometry. Two experienced pathologists scored dura mater adhesion, scar density, and inflammatory infiltrate in a blinded manner. Results: In all groups, laminectomy site was filled with fibrous tissue and the dura mater presented adhesions. Only GCP group presented a significant reduction in collagen content and scar density. Conclusion: GCP treatment reduces epidural fibrosis although did not prevent dura mater adhesion completely.
Revista:
INTERNATIONAL ORTHOPAEDICS
ISSN:
0341-2695
Año:
2017
Vol.:
41
N°:
11
Págs.:
2281 - 2287
Purpose Proximal medial gastrocnemius recession (PMGR) is a surgical procedure performed in patients with gastrocnemius tightness (GT). The purpose of this study is to evaluate the efficacy of pedobarographic analysis on PMGR in patients with GT and metatarsalgia. Methods This prospective study included 52 patients diagnosed with GT treated surgically with PMGR and 49 non-operated upon patients (control group). A total of 55 PMGRs (three bilateral) were performed as an isolated or combined procedure in the treatment group. Passive ankle dorsiflexion with knee flexion and extension was evaluated in all patients. In addition, pedobarographic analysis was performed before and after surgery. Results Median preoperative ankle dorsiflexion was -10.0 degrees (equinus) with extended knee and 10.0 degrees with flexed knee and postoperative differences in median ankle dorsiflexion was 12.5 degrees (extended knee) (p = 0.000) and 5.0 degrees (flexed knee) (p = 0.002). After the PMGR, the median area of the contact surface (-3.0 cm(2)) (p = 0.009), the maximum (-13,239.0 Pa) (p = 0.019) and mean pressure (-2,942.0 Pa) and the forefoot force (-70.0 N) (p = 0.000) decreased. An increase in hindfoot force (20.0 N), hindfoot bearing time (4.0 ms) (p = 0.005), and forefoot bearing time (1.0 ms) was also observed. Conclusions Pedobarographic analysis is an efficient tool to evaluate surgical procedures that assess metatarsal overload. PMGR is an effective surgical procedure to improve passive ankle range of motion and decrease forefoot plantar overload.
Revista:
EUROPEAN SPINE JOURNAL
ISSN:
0940-6719
Año:
2017
Vol.:
26
N°:
12
Págs.:
3216 - 3224
PURPOSE:
To determine the efficacy of cisplatin- or methotrexate-containing acrylic cement for local and systemic antineoplastic drug diffusion. Among the uses of acrylic cement or Polymethylmethacrylate (PMMA), there is the possibility to employ it as vehicle for drug diffusion. This capability is of interest in the treatment of pathological fractures: The curative effects of the cement (cytotoxicity of the monomer and increased temperature) are added to the antineoplastic effect of the drugs.
METHODS:
In the experimental study, two groups of ten pigs underwent vertebroplasty using cement mixed with 500 mg of powder cisplatin or 1000 mg of powder methotrexate. Vertebroplasty was performed in two non-consecutive lumbar vertebrae with bipedicular cement injection. Transpedicular bone biopsy was performed weekly to measure levels of antineoplastic agent in bone tissue and blood plasma. Cisplatin was studied by atomic absorption spectrometry and methotrexate by fluorescence polarization immunoassay. Renal and hepatic function and blood analysis were performed weekly.
RESULTS:
Cisplatin and methotrexate levels were found in bone tissue at more than 5 weeks following surgery. The cisplatin peak occurred at week 3 (mean 1269 ¿g/g bone) and the methotrexate peak at week 1 (mean 862.76 ¿g/g bone). Plasma drug levels were found 72 h after surgery, with a peak at 24 h for cisplatin (mean 0.23 ¿mol/L) and at 30 min for methotrexate (mean 0.92 ¿mol/L). None of the animals died during the study. Animals with intracanal cement leaks showed no neurological involvement. Renal, hepatic and hemogram studies remained within normal limits.
CONCLUSIONS:
There is local diffusion of antineoplastic agents from the cement to bone and plasma. We found methotrexate and cisplatin levels in bone at up to 5 weeks, comparable to previous in vitro reports. At the doses administered, there were no cases of myelosuppression, hepatotoxicity, or nephrotoxicity.
Revista:
JOURNAL OF FOOT AND ANKLE SURGERY
ISSN:
1067-2516
Año:
2016
Vol.:
55
N°:
3
Págs.:
461-4
We used coronal computed tomography to determine the normal sesamoid position in 20 healthy volunteers. The sample involved 40 feet (20 left [50%] and 20 right [50%]) in 20 volunteers, including 11 females (55%) and 9 males (45%). The relationship between the first metatarsal head and the sesamoid complex was categorized as Yildirim grade 0 in every case (100%). The mean width of the foot was 77.7 ± 5.8 mm, and the ratio of the foot width to the distance from the second metatarsal head to the tibial sesamoid was 39.6% ± 2.02%. Based on our findings, we consider Yildirim grade 0 to be the normal sesamoid alignment.
Revista:
ANALES DEL SISTEMA SANITARIO DE NAVARRA
ISSN:
1137-6627
Año:
2015
Vol.:
38
N°:
3
Págs.:
417 - 424
Los resultados obtenidos sugieren que tras la aplicación del protocolo de atenuación del artefacto en equipo de TCMC de 64 coronas el artefacto es reducido a unas dimensiones similares a la dimensión real del tornillo pedicular.
Revista:
JOURNAL OF FOOT AND ANKLE SURGERY
ISSN:
1067-2516
Año:
2015
Vol.:
54
N°:
6
Págs.:
1111-1115
Some investigators have emphasized restoring the relationship between the sesamoid complex and the first metatarsal head to reduce the risk of hallux valgus recurring after surgical reconstruction. In a prospective study, we analyzed whether the first metatarsophalangeal joint could be realigned after scarf-Akin bunionectomy without lateral soft tissue release. A total of 25 feet, in 22 patients, were prospectively enrolled and analyzed using anteroposterior radiographs and coronal computed tomography scans obtained before and 3 months after surgery. The Yildirim sesamoid position decreased from a preoperative of 2 (range 1 to 3) to a postoperative position of 0 (range 0 to 1; p < .001), the mean first intermetatarsal angle decreased from 12.6° ± 2.4° to 5.8° ± 2.1° (p < .001), and the mean distance between the second metatarsal and the tibial sesamoid changed from 25.7 ± 4.6 to 25.9 ± 4.6 (p = .59). Our findings suggest that dislocation of the sesamoid complex is actually caused by displacement of the first metatarsal. In conclusion, the scarf-Akin bunionectomy adequately restores the alignment of the first metatarsophalangeal joint, including restoration of the sesamoid apparatus, without direct plantar-lateral soft tissue release
Revista:
MUSCULOSKELETAL SURGERY
ISSN:
2035-5106
Año:
2013
Vol.:
97
N°:
2
Págs.:
159 - 164
Artifact may lead to confusion when evaluating postoperative CT scans of lumbar pedicle screws. The aim of our study was to develop a specific metal artifact reduction image protocol, in order to reduce metal artifact caused by titanium pedicular screw in patients undergoing lumbar pathology by lumbar fusion. Therefore, the reduction in metal artifacts in lumbar pedicle screws allows surgeons to do an accurate diagnosis of the exact placement of inserted pedicle screws, minimizes false reexploration, and maximizes proper and prompt treatment of misplaced screw. In a first step, we performed a retrospective study of 103 titanium alloy pedicle screws in patients undergoing a lumbar instrumented fusion for treatment for degenerative disease. CT scan was performed postoperatively evaluating the possible overdimension caused by artifact. In a second step, a prospective study was performed using a 64-slice multidetector-row computed tomography (MDCT) in 104 titanium alloy pedicle screws in patients undergoing a lumbar instrumented fusion for treatment for degenerative disease. Our results show that on the group of sequential CT scan, mean overdimension (on each side) due to brightness was 1.045 mm (SD 0.45). On the group of 64-slice multichannel CT, mean overdimension (on each side) due to brightness was 0.005 mm at the proximal part of the screw and 0.025 mm at the distal part of the screw. The results observed suggest that beam-hardening artifacts caused by the screw on CT after
Revista:
ASIAN SPINE JOURNAL
ISSN:
1976-1902
Año:
2013
Vol.:
7
N°:
3
Págs.:
159-166
The spinal cord was normal; it is likely that dura mater and cerebrospinal fluid are responsible to isolate neural structures from cement. Dura mater and muscle showed similar histological changes than other publications. Synovial metaplasia was observed in dura mater and muscles that came into contact with cement. The pulsatile rubbing between the tissue and cement could be responsible of this phenomenon.
Revista:
European Spine Journal
ISSN:
0940-6719
Año:
2011
Vol.:
20
N°:
2
Págs.:
338 - 339
Study Design: Prospective, experimental study in animals, approved by the local ethics committee for animal research.
Aims: To evaluate and compare the histological changes in myeloradicular structures and paravertebral tissue induced by contact with acrylic cement with and without methotrexate in vertebroplasty in pigs.
Material and Methods: Ten female pigs of the Large White¿Landrace breed, weighing 30 kg and divided into two groups: control group, containing five pigs that underwent vertebroplasty with acrylic cement, and methotrexate group, with five pigs that underwent vertebroplasty using cement combined with 1 g of methotrexate. A standard fluoroscopy-guide transpedicular vertebroplasty technique was performed with an 11-G trocar. Cement leak to the prevertebral and epidural muscle tissue was induced in two different lumbar vertebrae; 1 cc of cement was injected per vertebra. Animals were sacrificed at 3 weeks. Spines were removed, the section where tissues were in contact with cement was isolated by dissection, the surface in direct contact with cement was marked with India ink, and specimens were processed by fixation and hematoxylin eosin staining for pos-terior microscopic study.
Results: Macroscopic results: In both groups, the cement was distributed in layers surrounding the dural sac. Histological results: In the control group, leakage to the prevertebral musculature with atrophy of muscle fibers, inflammatory infiltrate in areas in contact with cement, epithelial dysplasia, and foreign body reaction in relation to cement particles. In addition, epidural leak with dural thickening and inflammatory reaction only in areas of the dura mater in contact with cement. In the methotrexate group, the same changes as in the control group were observed.
Clinical results: Neurological lesion due to cement leak was not produced any of the ten pigs.
Conclusions:The tube-like laminar distribution of the cement may explain the fact that there was an absence of paraplegia in the study animals. Contact of the muscle and dura with cement seemed to induce an inflammatory reaction, with cell death, and atrophy and thickening of membranes in some cases. Addition of methotrexate to acrylic cement did not seem to increase the local toxicity of cement alone.
Revista:
European Spine Journal
ISSN:
0940-6719
Año:
2011
Vol.:
20
N°:
2
Págs.:
314 - 340
Revista:
Revista española de cirugía ortopédica y traumatología (Ed. impresa)
ISSN:
1888-4415
Año:
2011
Vol.:
55 Espec. Congreso
N°:
CC-81
Págs.:
147
Introducción y objetivos: Los osteocondromas afectan raramente a la columna cervical y la literatura refiere normalmente casos por compresión medular. El diagnóstico es difícil ya que rara vez se sospecha. El caso que presentamos plantea cuestiones en cuanto al diagnóstico, la indicación y el abordaje quirúrgico así como la necesidad de añadir o no una artrodesis.
Material y método: Mujer de 26 años, con dolor occipital/suboccipital izquierdo desde hacía 17 años. Diagnosticada previamente de osteocondroma en arco posterior de C2, se aconsejó esperar y ver por dificultad y riesgo en caso de intervención. El dolor era constante y referido al ¿Punto de Arnold¿ con irradiación a occipital, y aumentaba con los movimientos del cuello. Las radiografías simples no fueron orientativas. En TC se observó una lesión compatible con osteoma osteoide del arco posterior del atlas (en axial) una prominencia ósea que nacía del istmo del axis (cortes coronales y sagitales). Era compatible con un osteocondroma de crecimiento vertical. Los cortes sagitales y coronales mostraban una anquilosis inter-apofisaria de articulación C1C2 izquierda. La gammagrafía mostraba hipercaptación en dicha articulación, sin hipercaptación en la lesión. La intervención quirúrgica (abordaje posterior medio) consistió en resección simple de la lesión mediante osteotomía de su base, siendo fácilmente separable del arco posterior de C1. La raíz C2 izquierda estaba ¿anclada¿ por el osteocondroma en su división, siendo difícil movilizar su ramo posterior.
Resultados: El dolor cedió inmediatamente permaneciendo la paciente asintomática durante todo su seguimiento. La anatomía patológica confirmó el diagnóstico de osteocondroma.
Comentarios y conclusiones: El dolor en el ¿Punto de Arnold¿ área occipital puede ser debido a causas diversas, incluyendo degeneración en C1C2. En este caso, el osteocondroma creció provocando a la paciente dolor durante 17 años y la degeneración observada en la articulación inter-apofisaria adyacente ipsilateral pudo ser reactiva, como en el caso de algunos fenómenos observados en el raquis cervical en torno al osteoma osteoide. Las dudas que planteaba la posible anquilosis C1C2 podrían crear controversia acerca de la indicación de añadir o no artrodesis C1C2 Una vez fue desestimada la fusión C1C2, podría tenerse en cuenta un abordaje posterolateral directo como opción.
Revista:
Revista española de cirugía ortopédica y traumatología (Ed. impresa)
ISSN:
1888-4415
Año:
2011
Vol.:
55 Esp. Congreso
N°:
CC-921
Págs.:
431 - 432
Revista:
European Spine Journal
ISSN:
0940-6719
Año:
2011
Vol.:
20
N°:
11
Págs.:
2067- 2095
Revista:
European Spine Journal
ISSN:
0940-6719
Año:
2011
Vol.:
20
N°:
2
Págs.:
338
Revista:
European Spine Journal
ISSN:
0940-6719
Año:
2011
Vol.:
20
Págs.:
310 - 340
Revista:
Revista española de cirugía ortopédica y traumatología (Ed. impresa)
ISSN:
1888-4415
Año:
2011
Vol.:
55 Esp. Congreso
N°:
CC-669
Págs.:
346 - 347
Revista:
European Spine Journal
ISSN:
0940-6719
Año:
2010
Vol.:
19
N°:
1
Págs.:
179
Revista:
CELL AND TISSUE BANKING
ISSN:
1389-9333
Año:
2010
Vol.:
11
N°:
3
Págs.:
295-298
Infection is one of the most dangerous complications that can be seen when implanting bone or tendon allografts from a deceased donor. The most common germs isolated are found among the cutaneous florae, but sometimes they may be present in the bloodstream as a result of severe injuries suffered before the time of the decease. We present a case of contamination of allografts in a musculoskeletal tissue donor deceased after an accident, whose allografts were contaminated by gastrointestinal microorganisms, probably disseminated through the donor's blood
Revista:
European Spine Journal
ISSN:
0940-6719
Año:
2010
Vol.:
19
N°:
6
Págs.:
1061 -