Servicio de Cirugia Ortopedica y Traumatologia

Ávila, Spain

Servicio de Cirugia Ortopedica y Traumatologia

Ávila, Spain

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Sanchez Hernandez N.,Servicio de Cirugia Ortopedica y Traumatologia | Paniagua Tejo S.,Hospital Rio Hortega | Valverde Garcia J.A.,Servicio de Cirugia Ortopedica y Traumatologia | Montero Diaz M.,Servicio de Cirugia Ortopedica y Traumatologia | And 2 more authors.
Revista Espanola de Geriatria y Gerontologia | Year: 2015

Introduction: Hip fracture in the elderly often occurs in patients with high co-morbidity. Effective management requires a comprehensive and multidisciplinary approach. Purpose: To evaluate the effect of a quality improvement intervention in the detection and treatment of complications in elderly patients admitted for hip fracture. Material and methods: A comparative study was conducted between two groups of patients admitted for hip fracture prior to 2010, and after a quality improvement intervention in 2013. The intervention consisted of implementing improved multidisciplinary measures in accordance with recent scientific evidence. The degree of compliance of the implemented measures was quantified. Results: Patients admitted due to hip fracture in 2010 (216 patients) and 2013 (196 patients) were similar in age, sex, Barthel Index, and a reduced Charlson Index, although there were more comorbidities in 2013. After implementation of the protocols, the detection of delirium, malnutrition, anemia, and electrolyte disturbances increased. A larger number of patients in 2013 were precribed intravenous iron (24% more) and osteoporosis treatment (61.3% more).The average stay was reduced by 45.3% and surgical delay by 29.4%, achieving better functional efficiency. Conclusion: The implementation of a clinical pathway in geriatric patients with hip fracture is useful to detect and treat complications at an early stage, and to reduce pre-operative and overall stay, all without a negative clinical or functional impact. © 2014 SEGG.


PubMed | University of Ottawa, CIBER ISCIII, University of Santiago de Compostela, Servicio de Cirugia Ortopedica y Traumatologia and 3 more.
Type: Journal Article | Journal: Molecular therapy : the journal of the American Society of Gene Therapy | Year: 2015

The development of therapeutic strategies for skeletal muscle diseases, such as physical injuries and myopathies, depends on the knowledge of regulatory signals that control the myogenic process. The obestatin/GPR39 system operates as an autocrine signal in the regulation of skeletal myogenesis. Using a mouse model of skeletal muscle regeneration after injury and several cellular strategies, we explored the potential use of obestatin as a therapeutic agent for the treatment of trauma-induced muscle injuries. Our results evidenced that the overexpression of the preproghrelin, and thus obestatin, and GPR39 in skeletal muscle increased regeneration after muscle injury. More importantly, the intramuscular injection of obestatin significantly enhanced muscle regeneration by simulating satellite stem cell expansion as well as myofiber hypertrophy through a kinase hierarchy. Added to the myogenic action, the obestatin administration resulted in an increased expression of vascular endothelial growth factor (VEGF)/vascular endothelial growth factor receptor 2 (VEGFR2) and the consequent microvascularization, with no effect on collagen deposition in skeletal muscle. Furthermore, the potential inhibition of myostatin during obestatin treatment might contribute to its myogenic action improving muscle growth and regeneration. Overall, our data demonstrate successful improvement of muscle regeneration, indicating obestatin is a potential therapeutic agent for skeletal muscle injury and would benefit other myopathies related to muscle regeneration.


Barco R.,Servicio de Cirugia Ortopedica y Traumatologia | Encinas C.,Servicio de Cirugia Ortopedica y Traumatologia | Valencia M.,Servicio de Cirugia Ortopedica y Traumatologia | Carrascal M.T.,Spanish University for Distance Education (UNED) | And 2 more authors.
Revista Espanola de Cirugia Ortopedica y Traumatologia | Year: 2015

Aim: Rotator cuff repairs have shown a high level of re-ruptures. We hypothesized that the use of adipose-derived stem cells (ASC) could improve the biomechanical and histological properties of the repair. Material and methods: Controlled experimental study conducted on 44 BDIX rats with section and repair of the supraspinatus tendon and randomization to one of three groups: group A, no intervention (control); group B, local applications of a fibrin sealant; and group C, application of the fibrin sealant with 2x106 ASC. At 4 and 8 weeks a biomechanical and histological analysis was performed. Results: There were no differences in load-to-failure at 4 and 8 weeks between groups. The load-to-failure did increase between week 4 and week 8. Histologically the tendon-to bone union showed a disorganized fibrovascular tissue. Group C showed a different inflammatory pattern, with less presence of neutrophils and more presence of plasma cells. Conclusion: The use of ASC does not improve the biomechanical or histological properties of the repair site. More studies are needed to improve techniques that enhance the healing site of the repair. © 2014 SECOT.


PubMed | Institute Investigacion Sanitaria Fundacion Jimenez Diaz, Spanish University for Distance Education (UNED) and Servicio de Cirugia Ortopedica y Traumatologia
Type: Journal Article | Journal: Revista espanola de cirugia ortopedica y traumatologia | Year: 2015

Rotator cuff repairs have shown a high level of re-ruptures. We hypothesized that the use of adipose-derived stem cells (ASC) could improve the biomechanical and histological properties of the repair.Controlled experimental study conducted on 44 BDIX rats with section and repair of the supraspinatus tendon and randomization to one of three groups: group A, no intervention (control); group B, local applications of a fibrin sealant; and group C, application of the fibrin sealant with 2 x 10(6) ASC. At 4 and 8 weeks a biomechanical and histological analysis was performed.There were no differences in load-to-failure at 4 and 8 weeks between groups. The load-to-failure did increase between week 4 and week 8. Histologically the tendon-to bone union showed a disorganized fibrovascular tissue. Group C showed a different inflammatory pattern, with less presence of neutrophils and more presence of plasma cells.The use of ASC does not improve the biomechanical or histological properties of the repair site. More studies are needed to improve techniques that enhance the healing site of the repair.


Sanchez-Hernandez N.,Servicio de Cirugia Ortopedica y Traumatologia | Saez-Lopez P.,Geriatra Complejo Asistencial de Avila | Paniagua-Tejo S.,Hospital Universitario Rio Hortega | Valverde-Garcia J.A.,Servicio de Cirugia Ortopedica y Traumatologia
Revista Espanola de Cirugia Ortopedica y Traumatologia | Year: 2016

Purpose: To evaluate the efficiency of a clinical pathway in the management of elderly patients with fragility hip fracture in a second level hospital in terms of length of stay time to surgery, morbidity, hospital mortality, and improved functional outcome. Material and methods: A comparative and prospective study was carried out between two groups of patients with hip fracture aged 75 and older prior to 2010 (n = 216), and after a quality improvement intervention in 2013 (n = 196). A clinical pathway based on recent scientific evidence was implemented. The degree of compliance with the implemented measures was quantified. Results: The characteristics of the patients in both groups were similar in age, gender, functional status (Barthel Index) and comorbidity (Charlson Index).Median length of stay was reduced by more than 45% in 2013 (16.61 vs. 9.08 days, p = .000). Also, time to surgery decreased 29.4% in the multidisciplinary intervention group (6.23 vs. 4.4 days, p = .000). Patients assigned to the clinical pathway group showed higher medical complications rate (delirium, malnutrition, anaemia and electrolyte disorders), but a lower hospital mortality (5.10 vs. 2.87%, p > .005). The incidence of surgical wound infection (p = .031) and functional efficiency (p = .001) also improved in 2013. An increased number of patients started treatment for osteoporosis (14.80 vs. 76.09%, p = .001) after implementing the clinical pathway. Conclusion: The implementation of a clinical pathway in the care process of elderly patients with hip fracture reduced length of stay and time to surgery, without a negative impact on associated clinical and functional outcomes. © 2015 SECOT.


PubMed | Hospital Universitario Rio Hortega, Geriatra and Servicio de Cirugia Ortopedica y Traumatologia
Type: Journal Article | Journal: Revista espanola de cirugia ortopedica y traumatologia | Year: 2016

To evaluate the efficiency of a clinical pathway in the management of elderly patients with fragility hip fracture in a second level hospital in terms of length of stay time to surgery, morbidity, hospital mortality, and improved functional outcome.A comparative and prospective study was carried out between two groups of patients with hip fracture aged 75 and older prior to 2010 (n=216), and after a quality improvement intervention in 2013 (n=196). A clinical pathway based on recent scientific evidence was implemented. The degree of compliance with the implemented measures was quantified.The characteristics of the patients in both groups were similar in age, gender, functional status (Barthel Index) and comorbidity (Charlson Index). Median length of stay was reduced by more than 45% in 2013 (16.61 vs. 9.08 days, p=.000). Also, time to surgery decreased 29.4% in the multidisciplinary intervention group (6.23 vs. 4.4 days, p=.000). Patients assigned to the clinical pathway group showed higher medical complications rate (delirium, malnutrition, anaemia and electrolyte disorders), but a lower hospital mortality (5.10 vs. 2.87%, p>.005). The incidence of surgical wound infection (p=.031) and functional efficiency (p=.001) also improved in 2013. An increased number of patients started treatment for osteoporosis (14.80 vs. 76.09%, p=.001) after implementing the clinical pathway.The implementation of a clinical pathway in the care process of elderly patients with hip fracture reduced length of stay and time to surgery, without a negative impact on associated clinical and functional outcomes.


Mingo-Robinet J.,Servicio de Cirugia Ortopedica y Traumatologia | Abril Larrainzar J.M.,Hospital Infanta Leonor | Valle Cruz J.A.,Hospital Clinico San Carlos
Revista Espanola de Cirugia Ortopedica y Traumatologia | Year: 2012

Introduction: Ankle fractures involving a posterior malleolar fragment are associated with worse clinical outcomes. The standard indication for its fixation is a displaced fragment that involves more than 25% of the distal articular tibia. The method of reduction and fixation of these fractures has not received much attention. The purpose of this paper is to describe the surgical technique and clinical results. Material and methods: Over a 6 year period 10 patients with an ankle fracture involving more than 25% posterior malleolus were admitted for surgery, which was performed by the first author. Postoperative management and complications were recorded, reduction accuracy evaluated in the first postoperative radiograph, and functional outcomes were measured using the American Orthopaedic Foot and Ankle Society (AOFAS) hind foot-ankle score and the modified Weber protocol. The surgical technique is described. Results: A total of 10 patients were included in the study; and the overall mean age was 53.8 (range: 19-82) years. With regard to complications, none of the 10 patients had any postoperative complication. No cases of reflex sympathetic dystrophy syndrome, superficial infection, iatrogenic lesion of the sural nerve or failure of internal fixation were recorded. One of them had screw and plate removal surgery. Clinical results were good; 9 patients regained their pre-injury activity level, with excellent or good results in both AOFAS and modified Weber protocol. Discussion: Given that posterior malleolus fractures are usually posterolateral, this approach allows perfect visualization of the fracture, articular anatomical reduction, and strong fixation. Clinical results obtained were at least equal to other case series published. © 2011 SECOT.


PubMed | Servicio de Radiodiagnostico and Servicio de Cirugia Ortopedica y Traumatologia
Type: Journal Article | Journal: Revista espanola de cirugia ortopedica y traumatologia | Year: 2014

To analyse the exposure of two Orthopaedic Surgeons to ionizing radiations in their daily work, and to review the main national and international recommendations on this subject.A retrospective study was conducted on the surgical treatments that use fluoroscopy performed by two Orthopaedic Surgeons during a one year period. An evaluation was made of the radiation received, based on measurements of the processes published in the bibliography section. A literature review of international recommendations and regulations is also presented.The radiation received by the two Orthopaedic Surgeons during one year did not exceed the limits of present-day legislation or the new European and international recommendations. The exposure was asymmetrical, with the hands being the most radiated part. The new recommendations reduce the permitted level of radiation on eyes.The evaluation of the radiation received demonstrates the need for radiation protection, paying particular attention to the hands and eyes. Good knowledge of operating a fluoroscope and radiation safety measures are also essential.


PubMed | Hospital Virgen del Mar, Felow Cot Instituto Nacional Of Rehabilitacion and Servicio de Cirugia Ortopedica y Traumatologia
Type: Journal Article | Journal: Revista espanola de cirugia ortopedica y traumatologia | Year: 2016

The purpose of this study is to present a method for treating the serious consequences that result from failure of corrective techniques used for hallux valgus, which produces severe shortening of the first ray, and makes it difficult to perform the third rocker.In this study, conducted in 2 hospitals in Madrid and Barcelona, an assessment was made of the clinical and radiological results of 40 cases, of which 97.5% were female. Technically it involves making a metatarsophalangeal arthrodesis after bone distraction with an external mini-fixation, and then inserting an iliac crest bone graft, stabilising it with a plate or the mini-fixator.The pre-operative shortening was 2.5cm. and elongation obtained was between 1.5 and 3.0cm. Clinical and radiological bone graft integration was achieved at 2-4 months, although full integration occurred after one year. Falliner and Blauth criteria were used to evaluate the results at 6 and 12 months follow-up, and using Visual Analogue Scale (VAS score/pain, scale 1-10), being favourable in 80%, and not changing over time. The failure rate was 7.5%, which included the non-integration of the graft and infection, requiring additional surgery.There are not many publications on the number and type of complication for hallux valgus surgery, or guidelines established, only the treatment by conventional fusion. The problem arises when the patient presents a severe shortening of the ray, and direct fusion would aggravate the insufficiency of the first ray and the transference metatarsalgia. In these cases, these procedures would be indicated.


PubMed | Servicio de Cirugia Ortopedica y Traumatologia
Type: Evaluation Studies | Journal: Revista espanola de cirugia ortopedica y traumatologia | Year: 2013

Ankle fractures involving a posterior malleolar fragment are associated with worse clinical outcomes. The standard indication for its fixation is a displaced fragment that involves more than 25% of the distal articular tibia. The method of reduction and fixation of these fractures has not received much attention. The purpose of this paper is to describe the surgical technique and clinical results.Over a 6 year period 10 patients with an ankle fracture involving more than 25% posterior malleolus were admitted for surgery, which was performed by the first author. Postoperative management and complications were recorded, reduction accuracy evaluated in the first postoperative radiograph, and functional outcomes were measured using the American Orthopaedic Foot and Ankle Society (AOFAS) hind foot-ankle score and the modified Weber protocol. The surgical technique is described.A total of 10 patients were included in the study; and the overall mean age was 53.8 (range: 19-82) years. With regard to complications, none of the 10 patients had any postoperative complication. No cases of reflex sympathetic dystrophy syndrome, superficial infection, iatrogenic lesion of the sural nerve or failure of internal fixation were recorded. One of them had screw and plate removal surgery. Clinical results were good; 9 patients regained their pre-injury activity level, with excellent or good results in both AOFAS and modified Weber protocol.Given that posterior malleolus fractures are usually posterolateral, this approach allows perfect visualization of the fracture, articular anatomical reduction, and strong fixation. Clinical results obtained were at least equal to other case series published.

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