Fractura del componente femoral el C-vastago cementado, en la cirugía de revisión de cadera mediante impactación de injerto óseo técnica: informe de 9 casos.

http://www.traumayortopediaslaot.org/academia/fractura-del-componente-femoral-el-c-vastago-cementado-en-la-cirugia-de-revision-de-cadera-mediante-impactacion-de-injerto-oseo-tecnica-informe-de-9-casos/

El doctor Buttaro, cuenta con 24 publicaciones en Argentina y 49 en revistas internacionales, aquí les presentamos uno de sus últimos artículos en el Hip International, el profesor Buttaro es otro de nuestros ponentes de excelencia que estará presente en la edición XXIV del Congreso Internacional de la F/SLAOT en Punta Cana del 12-16 de Octubre, acompáñanos!!!

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Fracture of the C-Stem cemented femoral component in revision hip surgery using bone impaction grafting technique: report of 9 cases.

Fuente
Este artículo es originalmente publicado en:

http://www.ncbi.nlm.nih.gov/pubmed/25655735

http://www.hip-int.com/article/fracture-of-the-c-stem-cemented-femoral-component-in-revision-hip-surgery-using-bone-impaction-grafting-technique–report-of-9-cases

De:

Buttaro M¹, Comba F, Zanotti G, Piccaluga F.

Hip Int. 2015 Mar-Apr;25(2):184-7. doi: 10.5301/hipint.5000210. Epub 2015 Feb 3.

Todos los derechos reservados para:

© Wichtig Publishing | ISSN 1120-7000 | eISSN 1724-6067 | VAT 03945040156 | R.T.M. 70 16.02.1991

Resumen

Presentamos una serie de 9 fracturas de un componente femoral C-STEM (6 vástagos largos y 3 vástagos convencional) que habían sido implantados con el uso de injerto óseo impactado (IBG). La longitud del largo fracturado tallos fue de 240 mm en 4 casos y 200 mm de 2. Los pacientes se presentaron tenían un IMC promedio de 26.5 y un promedio de 2.7 cirugías de cadera anteriores (rango 2-5 cirugías) antes de la fractura del vástago. Un total de 5 casos presentados con una fractura de malla de metal, además del vástago fracturado. La flexión de los tallos o defectos madre no se observó en ningún caso. ondas de fractura típicos compatibles con insuficiencia fatiga fueron claramente visibles en todas las superficies de corte, a partir anterolateralmente y que se propagan hacia el lado medial. Aunque la fractura por fatiga de un vástago femoral cementado moderna cónico pulido es un evento raro, el estrés debido a la falta de soporte óseo del fémur proximal podría ser suficiente para poner este vástago en un mayor riesgo de fractura por fatiga en pacientes no obesos.

Abstract

We present a series of 9 fractures of a C-Stem femoral component (6 long stems and 3 conventional stems) that had been implanted with the use of impaction bone grafting (IBG). The length of the long fractured stems was 240 mm in 4 cases and 200 mm in 2. The patients presented had an average BMI of 26.5 and an average of 2.7 previous hip surgeries (range 2-5 surgeries) before the stem fracture. A total of 5 cases presented with a metal mesh fracture in addition to the fractured stem. Bending of the stems or stem defects was not observed in any case. Typical fracture waves consistent with fatigue failure were clearly visible on all the cut surfaces, starting anterolaterally and propagating to the medial side. Although fatigue fracture of a modern cemented tapered polished femoral stem is a rare event, stress due to the absence of proximal femoral bone support could be sufficient to put this stem at a higher risk for fatigue fracture in non-obese patients.

PMID: 25655735 DOI: 10.5301/hipint.5000210

[PubMed – indexed for MEDLINE]

Pláticas que dará el dr Buttaro durante el congreso !!!

Lo cuantitativo y cualitativo en la investigación. Un apoyo a su enseñanza | Cienfuegos Velasco | RIDE Revista Iberoamericana para la Investigación y el Desarrollo Educativo

Lo cuantitativo y cualitativo en la investigación. Un apoyo a su enseñanza | Cienfuegos Velasco | RIDE Revista Iberoamericana para la Investigación y el Desarrollo Educativo

Anestesia y anticoagulación oral / Oral anticoagulants and anesthesia

Julio 27, 2016. No. 2399

Nuevos anticoagulants orales y anesthesia regional New oral anticoagulants and regional anaesthesia. Benzon HT1, Avram MJ, Green D, Bonow RO. Br J Anaesth. 2013 Dec;111 Suppl 1:i96-113. doi: 10.1093/bja/aet401. Abstract The new oral anticoagulants are approved for a variety of clinical syndromes, including the prevention of stroke in atrial fibrillation, acute coronary syndromes, treatment of venous thromboembolism (VTE), and prevention of venous thrombosis after total joint surgery or hip fracture. Published guidelines have differing recommendations on the safe interval between discontinuation of the anticoagulant and performance of neuraxial procedures and between the interventional procedure and redosing of the drug. While two to three half-life intervals might be acceptable in patients who are at high risk for VTE or stroke, an interval of four to six half-lives between discontinuation of the drug and neuraxial injections is probably safer in most patients at low risk of thrombosis. In those with renal disease, the interval should be based on creatinine clearance. After a neuraxial procedure or removal of an epidural catheter, anticoagulants can be resumed within 24-48 h in most patients, but they can be taken sooner in patients who are at higher risk for VTE or stroke, that is, 24 h minus the time to peak effect of the drug. The new antiplatelet drugs prasugrel and ticagrelor should be stopped 7 or 5 days, respectively, before a neuraxial injection and can be restarted 24 h later. In selected situations, laboratory monitoring of the anticoagulant effect is appropriate, and reversal agents are suggested when there is a need to rapidly restore haemostatic function. KEYWORDS: anaesthesia, regional; blood, anticoagulants; drug, safety PDF Manejo de los anticoagulantes orales de acción directa en el período perioperatorio y técnicas invasivas Management of direct action oral anticoagulants in the peri-operative period and invasive techniques]. Llau JV1, Ferrandis R, Castillo J, de Andrés J, Gomar C, Gómez-Luque A, Hidalgo F, Torres LM; participantes en el Foro de Consenso de la ESRA-España sobre «Fármacos que alteran la hemostasia». Collaborators (28) Rev Esp Anestesiol Reanim. 2012 Jun-Jul;59(6):321-30. doi: 10.1016/j.redar.2012.01.007.Epub 2012 May 23. Abstract The new direct-acting oral anticoagulants (ACOD) in patients on prolonged treatment require the need to balance the risk of haemorrhage by administering them against the risk of thrombosis on withdrawing them. Recommendations for their management are proposed in the present article: A) Thromboprophylaxis and general anaesthesia: the performing of regional anaesthesia if administered with an ACOD as thromboprophylaxis requires some safety intervals based on their pharmacokinetic parameters; B) Management of ACOD in elective surgery: in patients with normal renal function and a low haemorrhage/thrombosis risk, stop the ACOD two days before the surgery; it the haemorrhage/thrombosis risk is high and/or renal function is impaired, therapy with a low molecular weight heparin is proposed from 5 days prior to the surgery, and C) Management of ACOD in urgent surgery and associated haemorrhage: the systematic prophylactic administration of haemostatics is recommended. In the event of acute bleeding that may place the life of the patient at risk (due to volume or location), the administration of concentrated prothrombin complex, fresh plasma, or factor VIIa, must be assessed, together with general control measures of acute haemorrhage. These recommendations should be considered in the context of the use drugs that do have a specific antidote, where their monitoring by the usual coagulation tests is not routine, and with those in which there is limited experience. We believe they need to be reviewed in the future, depending on further studies and clinical experience obtained. PDF Hemodiálisis antes de cirugía urgente en un paciente manejado con dabigatran Haemodialysis before emergency surgery in a patient treated with dabigatran. Esnault P1, Gaillard PE, Cotte J, Cungi PJ, Beaume J, Prunet B. Br J Anaesth. 2013 Nov;111(5):776-7. doi: 10.1093/bja/aet160. Epub 2013 May 5. Abstract Novel oral anticoagulants (NOAs) which directly inhibit thrombin (dabigatran) or factor Xa (rivaroxaban and apixaban) have recently been developed. We report the first case of perioperative management of a patient treated with dabigatran requiring haemodialysis before emergency surgery. A 62-yr-old woman visited the emergency department for a left bi-malleolar ankle fracture; she had a past medical history of severe ischaemic cardiomyopathy, alcoholic cirrhosis Child B, and moderate chronic renal insufficiency. The patient was treated with dabigatran for a left ventricular aneurysm with thrombus. Cutaneous manifestation of a voluminous haematoma required emergency surgery. Blood tests revealed dabigatran anticoagulant activity of 123 ng ml(-1) (therapeutic values: 85-200 ng ml(-1)), activated partial thromboplastin time of 63 s, and a prothrombin ratio of 68%, indicating that dabigatran disturbed coagulation. We decided to perform emergency haemodialysis before surgery. After 2 h, the anticoagulant activity of dabigatran was 11 ng ml(-1), allowing surgery. Surgery proceeded without any problems and the postoperative period was unremarkable. This case highlights the difficulties for the anaesthesiologist regarding emergency perioperative management of patients treated with NOAs and confirms the efficacy of haemodialysis in cases of dabigatran treatment. NOAs should be prescribed with caution, especially for patients with renal or hepatic disease, at least as long as no antagonist is available. In cases of deferred operative urgency in haemodynamically stable patients treated with dabigatran, haemodialysis should be considered to reverse dabigatran's anticoagulant effects. KEYWORDS: dabigatran; haemodialysis; surgery PDF Curso de Especialidad en Algología 2017-2018 Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Universidad Nacional Autónoma de México Información / Information Comité Europeo de Enseñanza en Anestesiología Curso de Actualización en Anestesiología Anestesia por Especialidades y Simposio Anestesia y Cirugía Plástica Seguras Agosto 5-7, 2016. Tijuana BC, México Información Dr. Sergio Granados Tinajero granadosts@gmail.com  Programa 16th World Congress of Anaesthesiologists 28 August - 2 September 2016  Hong Kong Convention and Exhibition Centre World Federation of Societies of Anaesthesiologists http://wca2016.com/

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

GESTIÓN EN SALUD PÚBLICA: NGC Update Service: July 25, 2016 || American Academy of Orthopaedic Surgeons

GESTIÓN EN SALUD PÚBLICA: NGC Update Service: July 25, 2016 || American Academy of Orthopaedic Surgeons

• American Academy of Orthopaedic Surgeons clinical practice guideline on management of carpal tunnel syndrome. This updates a previously published guideline summary.

Anticoagulantes orales directos y anestesia regional / Direct oral anticoagulants with regional

Julio 26, 2016. No. 2398

Uso de anticoagulantes orales directos con anestesia regional en pacientes ortopédicos Use of direct oral anticoagulants with regional anesthesia in orthopedic patients. Cappelleri G1, Fanelli A2. J Clin Anesth. 2016 Aug;32:224-35. doi: 10.1016/j.jclinane.2016.02.028. Epub 2016 Apr 22. Abstract The use of direct oral anticoagulants including apixaban, rivaroxaban, and dabigatran, which are approved for several therapeutic indications, can simplify perioperative and postoperative management of anticoagulation. Utilization of regional neuraxial anesthesia in patients receiving anticoagulants carries a relatively small risk of hematoma, the serious complications of which must be acknowledged. Given the extensive use of regional anesthesia in surgery and the increasing number of patients receiving direct oral anticoagulants, it is crucial to understand the current clinical data on the risk of hemorrhagic complications in this setting, particularly for anesthesiologists. We discuss current data, guideline recommendations, and best practice advice on effective management of the direct oral anticoagulants and regional anesthesia, including in specific clinical situations, such as patients undergoing major orthopedic surgery at high risk of a thromboembolic event, or patients with renal impairment at an increased risk of bleeding. PDF Comité Europeo de Enseñanza en Anestesiología Curso de Actualización en Anestesiología Anestesia por Especialidades y Simposio Anestesia y Cirugía Plástica Seguras Agosto 5-7, 2016. Tijuana BC, México Información Dr. Sergio Granados Tinajero granadosts@gmail.com  Programa 16th World Congress of Anaesthesiologists 28 August - 2 September 2016  Hong Kong Convention and Exhibition Centre World Federation of Societies of Anaesthesiologists http://wca2016.com/

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015