Actualización en el diagnóstico y tratamiento de la Fascitis plantar.

Plantar fasciitis is a very common pathology. Over time, some aspects of this entity have generated controversy, so our objective is to group the latest available scientific evidence. Plantar fasciitis has its origin in a degenerative process resulting from repetitive microtrauma. In addition, multiple risk factors are involved that contribute to its overload the fascia and its collagen degeneration. Its diagnosis is clinical, reserving the performance of complementary tests to perform differential diagnosis with other entities, which may originate in the plantar fascia or adjacent structures, paying special attention to nerve entrapments. There are numerous treatments that have proven effectiveness, obtaining better results by individualizing each patient and with a combination of treatments.

Pseudoartrosis séptica de tibia por pseudomona aeruginosa. Tratamiento mediante transporte óseo.

Septic non union has still been a challenge for orthopedic surgeons. Its resolution is complex and has hight morbility. It needs a multidisciplinary approach. Distal tibia is a common location due its poor vascularity and soft tissues. We present a patient with pseudoarthrosis of the tibia treated with resection and bone transport. Contact was achieved at the docking site at 5 months. Bone grafting and freshening of fracture ends was performed. At 12 months the frame was removed after complete consolidation. As the only complication, the patient suffered two episodes of cellulitis that were resolved with antibiotic therapy.

Quiste óseo esencial: revisión de la literatura a propósito de un caso.

Simple bone cyst is a typical cavitated injury which appears between the ages of 5 and 15 and is usually located in long bones’ metaphysis. It is limited by a membrane and filled with liquid, being considered a pseudocyst. The cyst is diagnosed as a casual finding in radiological tests as well as for causing pain or pathological fractures.Different aetiologies and pathogenies are postulated, of which sine or venous blockage with increased intracameral pressure is considered to be the most probable.The traditional treatment has been surgical curing and bone filling, with new less invasive techniques such as corticosteroid injection and cyst drainage recently appearing with good results. In this article we present a large simple bone cyst at the proximal end of the femur treated by intracavity puncture of corticosteroids.

Shock séptico asociado a gangrena gaseosa - Miositis necrotizante por Clostridium.

Introduction: Gas gangrene, also known as clostridial myonecrosis, is an acute, potentially life-threatening infection of muscular and soft tissues caused by pathogens in the Clostridium genus. Clinical case: We present the case of spontaneous gas gangrene caused by C. Perfringens in a patient with no history of trauma. Discussion: The treatment of gas gangrene consists of prompt surgical debridement combined with antibiotic therapy. Emergency surgical debridement is especially important for patient survival, preserving the limb and preventing complications. If C. Perfringens is confirmed, the antibiotic therapy should consist of penicillin (3-4 million units intravenously every 4h) with clindamycin (900 mg intravenously every 8h) or tetracycline (500 mg intravenously every 6h). Even when we encounter a patient with no history of trauma, gastrointestinal pathology, neutropenia or immunodeficiencies, we should quickly suspect this diagnosis when there is extreme pain in a limb, with or without fever. This suspicion is important due to the need for rapid and aggressive treatment to save the limb and life of the patient and to prevent complications.

Actualización en osteonecrosis y fractura de rótula tras prótesis total de rodilla.

Periprosthetic patella fractures are much more common in knee prostheses in which the patella has been replaced. The aetiology of periprosthetic patella fractures has a traumatic origin in 12% of cases and atraumatic secondary to avascular necrosis in the remaining 88%. Peri-implant fractures, in which the patella has been replaced and the implant is stable with an integral extensor mechanism, resolve with conservative treatment. In cases of stable implant, with a displaced fracture of the upper or lower pole of the patella, the implant is left in situ and the extensor apparatus is repaired according to standard techniques. If there is disruption of the extensor apparatus with an unstable implant, the patellar button should be removed and continuity of the extensor apparatus repaired with a patellectomy. In these cases, internal fixation with wire cerclages is discouraged. In cases where the extensor mechanism is intact and the implant is unstable, the removal of the patellar button is sufficient. The risk of infection after surgery for a periprosthetic patella fracture is high.

Valoración funcional en pacientes intervenidos mediante plastia de LCA con semitendinoso-recto interno y sistema Togglelock.

Introduction: One of the most frequent knee injuries and one that is on the increase, especially in sports, is the anterior cruciate ligament injury. Surgical reconstruction is essential to recover the biomechanics of the knee, provide correct stability and pain-free function, as well as toavoid early degenerative changes. The objective of the present study was to assess the functional recovery of patients undergoing reconstruction of the anterior cruciate ligament by means of ligamentoplasty with semitendinosus- internal rectus tendon and Toggelock system. Material and methods: A retrospective descriptive observational study was designed, which included 29 patients who underwent a ligamentoplasty with internal semitendinosus-rectum and Togglelock system in our Center, during the years 2017-2018. Variables obtained from the clinical history and the Lysholm scale were studied to assess the patients. Results: In total, a sample of 29 patients was obtained, 26 men and 3 women with a mean age of 31.13 years (range 19-53). The most frequently injured knee was the right knee in 17 patients out of 29, with 65% presenting associated injuries. One patient had suffered a tibial fracture operated with an intramedullary nail that altered the final results. The postsurgical score on the Lysholm subjective assessment scale was 86. The mobility of the operated knee showed a minimal reduction in flexion of 6º compared to the non-operated knee that was statistically significant. Conclusion: The results obtained after ACL reconstruction with this technique, using the semitendinosus- internal rectum plasty and the Togglelock system were good-excellent, with a high degree of patient satisfaction, few complications, and notable functional results.

Inestabilidad de la articulación tibio-peronea proximal como causa de dolor en artroplastia total de rodilla primaria.

The isolated instability of the proximal tibiofibular joint (PTFJ) as a cause of pain in a prosthetic knee is a very rare clinical entity, to date we have only found one reference in the bibliography of ATPP instability associated with total knee arthroplasty. We review the bibliography on the different forms of instability and their etiology, as well as the possibilities of conservative and surgical treatment. We present the case of a patient with anterolateral instability PTFJ associated with a primary postero-stabilized (PS) TKA with a mobile tibial polyethylene.

Infección protésica de cadera. Recambio en dos tiempos en una serie de 50 casos.

Chronic infection in hip replacement is an important complication with a complex treatment, that is solved by adequate antibiotic therapy together with single-stage exchange or two-stage exchange. We present a descriptive and retrospective study of a series of 50 consecutive patients operated on in our center with a diagnosis of chronic infection of the hip prosthesis between 2007 and 2018 with a two-stage exchange. At a mean follow-up of 52 months, the overall implant survival was 89%, with a 91% infection cure rate. The most frequent microorganism isolated was Staphylococcus epidermidis. The mean score achieved on the HHS was 82,4 points and 1.67 points on the visual analogue scale. We obtained better functional results (p=0,021) in those patients who had a preformed antibiotic-loaded spacer in the first surgical stage. As complications, we recorded four cases of prosthetic reinfection (8,7%), three cases of dislocation (6,5%), and one case of postsurgical hematoma (4,6%). No case of neurovascular injury or component loosening was recorded. According to the showed results, we consider that two-stage revision procedure, although it is a demanding surgery, is an effective method for the treatment of periprosthetic hip infection, with high implant survival and erradication of the infection.

Estudio de la valoración del dolor articular y del grado de satisfacción, tras infiltración con plasma rico en fibrina en pacientes con artrosis de rodilla.

The definition of platelet rich plasma (PRP) is still controversial, though it can be described in general terms as “a volume of autologous plasma that contains a higher platelet concentration than the physiological basal concentration”. A retrospective observational analytical study was carried out in our hospital in order to assess the results and satisfaction of patients that had undergone PRF injection in knee. Between January and December of 2017, 80 gonoarthrosis patients treated with PRF injection were selected by the Orthopaedic Surgery and Rehabilitation Department, all of whom attended several medical appointments to check their recovery. Those cases that did not follow an appropriate clinical follow-up were dismissed from the study. Pain before treatment was assessed by the Numeric Rating Scale, with a mean of 8.48. A statistically significant decrease was observed after treatment (p<0.001), with a 4.87 mean and a 5.00 post-injection median. Regarding walking perimeter, most patients walked a median of 30 minutes and 55.3 minute mean, and their walking autonomy increased after treatment, doubling the median to 60 minutes, with an average of 93.15 minutes of pain-free walking. This 37.8 minute increase in the walking ability implies a statistically significant improvement (p<0.001). A significant decrease in analgesics intake after treatment was also observed, being 81.3% patients who needed analgesia prior to treatment (n=61), and just 49.3% (n=37) after the procedure. Consequently, there is a significative improvement of pain, walking perimeter and absolute intake of analgesics that cannot be explained by any variable prior to PRF injection.

Osteítis por radiación y fracturas por insuficiencia pélvica en paciente con adenocarcinoma de próstata tratado con radioterapia. Aspectos clínicos y radiográficos de la enfermedad.

Radiation osteitis is an anatomopathological term first coined by Ewing in 1926, refers to a radiation-induced inflammatory response in blood vessels, nerve tissue, and bone cells that can lead to fractures of the trabecular and cortical bone. Pelvic insufficiency fracture is a stress fracture over a weakened bone, seen in patients who have certain risk factors such as osteoporosis, connective tissue disease, use of corticosteroids, and especially in patients who have been treated with pelvic radiation therapy for rectal, anal, urogenital, and prostate tumors. We present the case of a 73-year-old patient with fractures due to pelvic failure treated four years before prostate adenocarcinoma with radiotherapy and hormone therapy. Clinical and radiographic diagnostic aspects are discussed.