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Objective: To evaluate the clinical and radiological results in the surgical treatment of moderate and severe hallux valgus by performing percutaneous double osteotomy. Material and method: A retrospective study was conducted on 45 feet of 42 patients diagnosed with moderate-severe hallux valgus, operated on in a single centre and by the same surgeon from May 2009 to March 2013. Two patients were lost to follow-up. Clinical and radiological results were recorded. Results: An improvement from 48.14. ±. 4.79 points to 91.28. ±. 8.73 points was registered using the American Orthopedic Foot and Ankle Society (AOFAS) scale. A radiological decrease from 16.88. ±. 2.01 to 8.18. ±. 3.23 was observed in the intermetatarsal angle, and from 40.02. ±. 6.50 to 10.51. ±. 6.55 in hallux valgus angle. There was one case of hallux varus, one case of non-union, a regional pain syndrome type I, an infection that resolved with antibiotics, and a case of loosening of the osteosynthesis that required an open surgical refixation. Discussion: Percutaneous distal osteotomy of the first metatarsal when performed as an isolated procedure, show limitations when dealing with cases of moderate and severe hallux valgus. The described technique adds the advantages of minimally invasive surgery by expanding applications to severe deformities. Conclusions: Percutaneous double osteotomy is a reproducible technique for correcting severe deformities, with good clinical and radiological results with a complication rate similar to other techniques with the advantages of shorter surgical times and less soft tissue damage. © 2014 SECOT. Source


Martinez de Albornoz Torrente P.,Servicio de Cirugia Ortopedica y Traumatologia | Forriol F.,University of San Pablo - CEU
Revista Espanola de Cirugia Ortopedica y Traumatologia | Year: 2012

Objective: To analyse the changes in synovial fluid (SF) in the most common knees joint diseases, and to establish a relationship according to its concentration. Material and methods: A total of 62 synovial fluids were analysed from knees with, meniscus disease (32), anterior cruciate ligament (ACL) (17) and isolated chondral injury (13). A quantitative and quality study was performed on each sample, which included cytokines IL-1, IL-2, IL-6, IL-10, TNF-α, and growth factors, IGF-1 and TGF-ß). Results: The SF environment in the ACL injury was mainly anabolic and inflammatory, with increased levels of IL1, IL6, significant levels of TGF-ß (P=.02 and P=.004), IL-10 (P=.046 and P=.047) and significantly decreased levels of TNF-α (P=.02 and P=.004). There was mainly a catabolic environment in chondral and meniscal disease, with a significant increase in TNF-α and a significant decrease in TGF-ß (P=.02 and P=.004). The differences were greater in the case of isolated chondral injury. Conclusion: The changes observed show that, as well as the biomechanical changes, the SF has a negative effect on joint homeostasis, it composition varying depending on the type of pathology. © 2011 SECOT. Source


Maio Buicas J.,Servicio de Cirugia Ortopedica y Traumatologia
DOLOR | Year: 2014

Bone metastasis is the cause of clinical situations with dramatic deterioration in quality of life. Surgical treatment must take into account the stage of the disease, the systemic treatment of primary neoplasia, the possibilities of local radiotherapy treatment, life expectancy, and the response of the disease and bone metastasis to systemic or radiotherapy treatment. Pain is the initial symptom before the physical affectation caused by osteolysis, which has severe conse-quences on quality of life and cannot always be controlled with analgesic medication in wide lesions. Pathological fractures have to be prevented in the follow-up of these patients to implement a preventive treatment with osteosynthesis or prostheses, always preferable over treatment of the established fracture. Medullar compression, with indication of liberation and stabilization, needs to be evaluated before the appearance of neurological affectation. Surgical indications are given, depending on the affected anatomical zone, insisting on the use of less- Aggressive surgical techniques, aiming to guarantee pain palliation and the necessary functionality, taking into account the evolutionary stage of the disease. Source


Cervera-Irimia J.,Servicio de Cirugia Ortopedica y Traumatologia | Tome-Bermejo F.,Hospital Universitario Fundacion Jimenez Diaz
Revista Espanola de Cirugia Ortopedica y Traumatologia | Year: 2013

Objective: There is no consensus on the treatment of chronic low back pain of disc origin in the medical literature. The few prospective, randomized, controlled studies evaluating the effectiveness of caudal epidural steroid injections (CESI) have obtained contradictory results. The aim of this study is to evaluate the efficacy of CEI in reducing pain and improving the associated disability. Material and method: This is a prospective, randomized, case-control study of a group of 46 patients with chronic low back disc pain. Patients were randomly allocated into 2 groups to either receive fluoroscopy guided CESI (CESI-group), or oral non-steroidal anti-inflammatory drugs (NSAID-group). All patients were clinically evaluated at 4, 12, and 24 weeks, and according to the indications of the Spanish Society for Study of Diseases of the Spine (GEER). Results: Lumbar pain, measured by the visual analog scale (VAS) and the Oswestry Low Back Pain Disability Questionnaire (ODQ), did not improve significantly during follow-up in any of the two study groups (P>.05). Younger patients, women, patients with shorter duration of symptoms, low physical job demand, without leg pain, and sport-active, included in CESI-group showed a trend towards better results, but none reached statistical significance (P>.05). Conclusions: The present study has not demonstrated the superiority of CESI over NSAIDs in treating chronic low back pain of disc origin. While CESI could show some improvement in patients with degenerative lumbar disc disease, we consider it should be used with caution, informing patients about realistic expectations on the success of treatment. © 2013 SECOT. Source


Sanchez Lazaro J.A.,Servicio de Cirugia Ortopedica y Traumatologia | Linares Alvarez L.,Gerencia de Atencion Primaria de Leon
Semergen | Year: 2014

Pycnodysostosis is a rare disease caused by a dysfunction of the osteoclasts due to a mutation in the cathepsin K gene. We present a case of a young adult patient with the above mentioned syndrome, who suffered an atypical fracture of the tibia after a low energy fall. Some bone changes that could have predisposed the fracture were observed when examined in the Emergency Department. Not long afterwards he suffered the same type of fracture in another tibia. Due to the conditions typical of the pycnodysostosis, the above mentioned fracture required an unconventional approach for this mid-shaft tibial fracture (osteosynthesis plate), combined with a longer consolidation time. The case was finally resolved satisfactorily. © 2013 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Source

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