Cirugía de ortopedia en el anciano / Orthopedic surgery in the elderly

Marzo 24, 2017. No. 2638

El aumento aislado de troponina cardiaca no modifica el pronóstico de pacientes geriátricos con fractura de cadera Isolated cardiac troponin rise does not modify the prognosis in elderly patients with hip fracture. Vallet H1, Breining A, Le Manach Y, Cohen-Bittan J, Mézière A, Raux M, Verny M, Riou B, Khiami F, Boddaert J. Medicine (Baltimore). 2017 Feb;96(7):e6169. doi: 10.1097/MD.0000000000006169. Abstract Perioperative myocardial infarction remains a life-threatening complication in noncardiac surgery and even an isolated troponin rise (ITR) is associated with significant mortality. Our aim was to assess the prognostic value of ITR in elderly patients with hip fracture.... ITR was not associated with a higher risk of new institutionalization or impaired walking ability at 6 months, in contrast to ACS group.In elderly patients with hip fracture, ITR was not associated with a significant increase in death and/or rehospitalization within 6 months. PDF Artroplastía total de cadera. Seguimiento a 5 años de la evolución funcional pacientes independientes viejos y muy viejos Total hip arthroplasty for hip fractures: 5-year follow-up of functional outcomes in the oldest independent old and very old patients. Godoy Monzón D1, Iserson KV2, Jauregui J3, Musso C3, Piccaluga F1, Buttaro M1. Geriatr Orthop Surg Rehabil. 2014 Mar;5(1):3-8. doi: 10.1177/2151458514520700. Abstract INTRODUCTION: This study aimed to determine the dislocation and reoperation rate, functional outcomes, and the survival rate of the unique subset of very old but lucid and independent patients with hip fractures following a total hip arthroplasty (THA) and geriatric team-coordinated perioperative care. METHOD: Between 2000 and 2006, previously independent ambulatory patients ≥80 years old presenting with an intracapsular hip fracture were given THAs under the care of an integrated orthopedic surgery-geriatric service. Their fracture-related complications, ambulation, mental status, and survival were followed for 5 to 11 years postinjury. RESULTS: Five years postinjury, 57 (61.3%) patients of the original study group were living. In all, 3 (3.2%) patients had postoperative hip dislocations (and 2 patients had dislocation twice) and 2 reoperations were needed within the first postoperative month. There were no hip dislocations or reoperations after the first year. Radiographs obtained on 88% of the surviving patients at 5 years postoperatively showed that all remained unchanged from their immediate postoperative images. Nearly half of the patients were still able to ambulate as they did preoperatively and their mixed-model equation was statistically unchanged. CONCLUSION: This study of patients >80 years old with previously good functional status demonstrates that with appropriate surgical (best prosthesis, good operating technique, and regional anesthesia) and geriatric (pre- and postoperative assessments, close follow-up, medication adjustments, and fall-prevention instruction) care, they have few hip dislocations and reoperations, survive postfracture at least as long as their noninjured contemporaries, and continue to function and ambulate as they did prior to their injury. KEYWORDS: geriatrics; hip fractures; orthogeriatric team; perioperative care; total hip arthroplasty PDF Mortalidad postoperatoria después de cirugía para fractura de cadera. Seguimiento a tres años Postoperative Mortality after Hip Fracture Surgery: A 3 Years Follow Up. Kilci O1, Un C1, Sacan O1, Gamli M1, Baskan S1, Baydar M1, Ozkurt B2. PLoS One. 2016 Oct 27;11(10):e0162097. doi: 10.1371/journal.pone.0162097. eCollection 2016. Abstract BACKGROUND AND AIMS: To determine mortality rates and predisposing factors in patients operated for a hip fracture in a 3-year follow-up period. METHODS: The study included patients who underwent primary surgery for a hip fracture.The inclusion criteria were traumatic, non-traumatic, osteoporotic and pathological hip fractures requiring surgery in all age groups and both genders. Patients with periprosthetic fractures or previous contralateral hip fracture surgery and patients who could not be contacted by telephone were excluded. At 36 months after surgery, evaluation was made using a structured telephone interview and a detailed examination of the hospital medical records, especially the documents written during anesthesia by the anesthesiologists and the documents written at the time of follow-up visits by the orthopaedic surgeons. A total of 124 cases were analyzed and 4 patients were excluded due to exclusion criteria. The collected data included demographics, type of fracture, co-morbidities, American Society of Anesthesiologists (ASA) scores, anesthesia techniques, operation type (intramedullary nailing or arthroplasty; cemented-noncemented), peroperative complications, refracture during the follow-up period, survival period and mortality causes. RESULTS: The total 120 patients evaluated comprised 74 females(61.7%) and 46 males(38.3%) with a mean age of 76.9±12.8 years (range 23-95 years). The ASA scores were ASA I (0.8%), ASA II (21.7%), ASA III (53.3%) and ASA IV (24.2%). Mortality was seen in 44 patients (36.7%) and 76 patients (63.3%) survived during the 36-month follow-up period. Of the surviving patients, 59.1% were female and 40.9% were male.The survival period ranged between 1-1190 days. The cumulative mortality rate in the first, second and third years were 29.17%, 33.33% and 36.67% respectively. The factors associated with mortality were determined as increasing age, high ASA score, coronary artery disease, congestive heart failure, Alzheimer's disease, Parkinson's disease, malignancycementation and peroperative complications such as hypotension (p<0.05). Mortality was highest in the first month after fracture. CONCLUSION: The results of this study showed higher mortality rates in patients with high ASA scores due to associated co-morbidities such as congestive heart failure, malignancy and Alzheimer's disease or Parkinson's disease. The use of cemented prosthesis was also seen to significantly increase mortality whereas no effect was seen from the anesthesia technique used. Treatment of these patients with a multidiciplinary approach in an orthogeriatric ward is essential. There is a need for further studies concerning cemented vs. uncemented implant use and identification of the best anesthesia technique to decrease mortality rates in these patients. PDF Curso sobre Anestesia en Trasplantes, Cirugía abdominal, Plástica, Oftalmología y Otorrinolaringología. Committee for European Education in Anaesthesiology (CEEA)  y el Colegio de Anestesiólogos de León A.C. Abril 7-9, 2017, León Guanajuato, México Informes  (477) 716 06 16, kikinhedz@gmail.com Congreso Latinoamericano de Anestesia Regional Asociación Latinoamericana de Anestesia Regional, Capítulo México Ciudad de México, Mayo 24-27, 2017 Informes http://r.enviosgrupolahe.com/2e7l0th0feu87f.html

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

Lesiones atléticas de la cadera

http://www.lesionesdeportivas.com.mx/academia/lesiones-atleticas-de-la-cadera/

Lesiones atléticas de la cadera » Athletic Hip Injuries

Fuente

Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/28252476

http://journals.lww.com/jaaos/Fulltext/2017/04000/Athletic_Hip_Injuries.3.aspx

De:

Lynch TS1,Bedi A,Larson CM.

J Am Acad Orthop Surg.

2017 Apr;25(4):269-279. doi: 10.5435/JAAOS-D-16-00171.

Todos los derechos reservados para:

© 2017 by American Academy of Orthopaedic Surgeons

Abstract

Historically, athletic hip injuries have garnered little attention; however, these injuries account for approximately 6% of all sports injuries and their prevalence is increasing. At times, the diagnosis and management of hip injuries can be challenging and elusive for the team physician. Hip injuries are seen in high-level athletes who participate in cutting and pivoting sports that require rapid acceleration and deceleration. Described previously as the “sports hip triad,” these injuries consist of adductor strains, osteitis pubis, athletic pubalgia, or core muscle injury, often with underlying range-of-motion limitations secondary to femoroacetabular impingement. These disorders can happen in isolation but frequently occur in combination. To add to the diagnostic challenge, numerous intra-articular disorders and extra-articular soft-tissue restraints about the hip can serve as pain generators, in addition to referred pain from the lumbar spine, bowel, bladder, and reproductive organs. Athletic hip conditions can be debilitating and often require a timely diagnosis to provide appropriate intervention.

Resumen

Históricamente, las lesiones atléticas de la cadera han ganado poca atención; Sin embargo, estas lesiones representan aproximadamente el 6% de todas las lesiones deportivas y su prevalencia está aumentando. A veces, el diagnóstico y el manejo de las lesiones de cadera puede ser difícil y elusivo para el médico del equipo. Las lesiones de cadera se observan en atletas de alto nivel que participan en deportes de corte y pivotantes que requieren una rápida aceleración y desaceleración. Descrita anteriormente como la “tríada de la cadera deportiva”, estas lesiones consisten en cepas de aductores, osteítis púbico, pubalgia atlética o lesión muscular básica, a menudo con limitaciones subyacentes del rango de movimiento secundarias al choque femoroacetabular. Estos trastornos pueden ocurrir en el aislamiento pero ocurren con frecuencia en combinación. Para añadir al reto diagnóstico, numerosos trastornos intra articulares y restricciones extra articulares de tejidos blandos alrededor de la cadera pueden servir como generadores de dolor, además del dolor referido desde la columna lumbar, el intestino, la vejiga y los órganos reproductivos. Las condiciones atléticas de la cadera pueden ser debilitantes ya menudo requieren un diagnóstico oportuno para proporcionar la intervención apropiada.

PMID: 28252476 DOI:

10.5435/JAAOS-D-16-00171

#lesiones deportivas #lesiones de cadera #atletas #cadera

Mejorar la precisión del análisis del líquido sinovial en el diagnóstico de la infección articular protésica con biomarcadores simples y baratos

http://www.artroscopiayreemplazos.com.mx/academia/mejorar-la-precision-del-analisis-del-liquido-sinovial-en-el-diagnostico-de-la-infeccion-articular-protesica-con-biomarcadores-simples-y-baratos/

                                                                                                                           

Improving the accuracy of synovial fluid analysis in the diagnosis of prosthetic joint infection with simple and inexpensive biomarkers

Fuente
Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/28249975

http://www.bjj.boneandjoint.org.uk/content/99-B/3/351.long

De:

Sousa R1,Serrano P1,Gomes Dias J2,Oliveira JC1,Oliveira A1.

Bone Joint J.

2017 Mar;99-B(3):351-357. doi: 10.1302/0301-620X.99B3.BJJ-2016-0684.R1.

Todos los derechos reservados para:

©2017 The British Editorial Society of Bone & Joint Surgery.

Abstract

AIMS:

The aims of this study were to increase the diagnostic accuracy of the analysis of synovial fluid in the differentiation of prosthetic joint infection (PJI) by the addition of inexpensive biomarkers such as the levels of C-reactive protein (CRP), adenosine deaminase (ADA), alpha-2-macrogloblulin (α2M) and procalcitonin.

CONCLUSION:

The total leucocyte count in the synovial fluid offers great negative predictive value in the diagnosis of PJI and the addition of more specific markers such as CRP and ADA improves the positive predictive value. Thus the addition of simple and inexpensive markers to the measurement of the leucocyte count in the synovial fluid may reduce the number of equivocal results which demand more expensive investigation. Cite this article: Bone Joint J 2017;99-B:351-7.

©2017 The British Editorial Society of Bone & Joint Surgery.

KEYWORDS:

Adenosine deaminase; Biomarker; C-reactive protein; Leukocyte count; Prosthetic joint infections; Synovial fluid

Resumen

OBJETIVOS:
Los objetivos de este estudio fueron aumentar la precisión diagnóstica del análisis del líquido sinovial en la diferenciación de la infección protésica articular (PJI) mediante la adición de biomarcadores de bajo costo como los niveles de proteína C reactiva (CRP), adenosina desaminasa (ADA ), Alfa-2-macrogloblulina (α2M) y procalcitonina.

CONCLUSIÓN:
El recuento total de leucocitos en el líquido sinovial ofrece un gran valor predictivo negativo en el diagnóstico de PJI y la adición de marcadores más específicos como CRP y ADA mejora el valor predictivo positivo. Por lo tanto, la adición de marcadores simples y baratos a la medición del recuento de leucocitos en el líquido sinovial puede reducir el número de resultados equívocos que exigen una investigación más costosa.Citar este artículo: Bone Joint J 2017; 99-B: 351-7.

© 2017 Sociedad Editorial Británica de Cirugía de Huesos y Articulaciones.

PALABRAS CLAVE:
Adenosina desaminasa; Biomarcador; Proteína C-reactiva; Recuento de leucocitos;Infecciones protésicas articulares; Líquido sinovial

PMID:   28249975   DOI:  

10.1302/0301-620X.99B3.BJJ-2016-0684.R1

#Adenosina desaminasa#biomarcador#Proteína C-reactiva#Recuento de leucocitos#leucocitos#Infecciones protésicas articulares#liquido sinovial