dijous, 28 d’agost de 2014

Ferides tractades amb cura de pressio negativa

Negative-Pressure Wound Therapy After Fasciotomy Reduces Muscle-Fiber Regeneration in a Pig Model
; ; ; ; ; ; ; ;
Clinical Relevance: NPWT may be harmful to skeletal muscle after compartment syndrome requiring fasciotomy and local wound care.
Acute compartment syndrome is a limb-threatening condition. As pressure rises inside a muscle fascial compartment, capillary perfusion pressure falls and causes cellular hypoxia. Untreated, the cascade of hypoxia, microvascular dysfunction, and increased capillary permeability results in irreversible ischemic injury. Prompt fasciotomy is the ideal treatment. Many patients who undergo fasciotomy require delayed skin-grafting and have long-term functional impairment1.
Recently, negative-pressure wound therapy (NPWT) has been used on fasciotomy wounds. The results of this practice are variable. Some authors have reported decreased wound size2 and a shorter time to wound closure3, but a recent randomized controlled trial showed a longer time to wound closure and an increased need for skin grafts with NPWT4.
To our knowledge, no one has examined NPWT effects on the underlying skeletal muscle. NPWT increases microvascular circulation around the wound5-8, and this may be beneficial after ischemia. We assessed NPWT effects on skeletal muscle cellular morphology at different time points after compartment syndrome in an animal model and attempted to determine whether regional differences in fiber recovery occurred. The primary outcome that we investigated was the cross-sectional area occupied by normal-appearing muscle fibers and other cellular morphologies. A secondary outcome was the change in muscle weight as a marker of intramuscular fluid accumulation. We hypothesized that NPWT would improve muscle fiber regeneration after an acute compartment syndrome and would decrease muscle weight by enhancing edema clearance.

La bibliografia pot ser  interessant x si heu de presentar algun cas tractat amb aquest tipus de cura oclusiva-aspirativa

Inmobilitzacio en rotacio externa de la luxacio espatlla reduïda

Bueno sembla Dra Boo que no es posen d'acord en la inmob en RExt de l'espatlla...............
Immobilization with an External Rotation Brace Was Similar to an Internal Rotation Sling for Shoulder Dislocation......Conclusion: In patients with a shoulder dislocation, immobilization with use of an external rotation brace did not reduce the rate of recurrent instability or improve quality of life more than use of an internal rotation sling.

Artrosi post meniscectomia

Tots els llibres diuen que la meniscectomia va seguida de una artropatia degenerativa. Aqui un exemple:

Total meniscectomy in adolescents: A 40-YEAR FOLLOW-UP.
pág. 1649-1654
DOI: 10.1302/0301-620X.94B12.30562
Pengas, I. P.; Assiotis, A.; Nash, W.; Hatcher, J.; Banks, J.; McNicholas, M. J.

AB : We continued a prospective longitudinal follow-up study of 53 remaining patients who underwent open total meniscectomy as adolescents and who at that time had no other intra-articular pathology of the knee. Their clinical, radiological and patient-reported outcomes are described at a mean follow-up of 40 years (33 to 50). The cohort of patients who had undergone radiological evaluation previously after 30 years were invited for clinical examination, radiological evaluation and review using two patient-reported outcome measures. A total of seven patients (13.2%) had already undergone total knee replacement at the time of follow-up. A significant difference was observed between the operated and nonoperated knee in terms of range of movement and osteoarthritis of the tibiofemoral joint, indicating a greater than fourfold relative risk of osteoarthritis at 40 years postoperatively. All patients were symptomatic as defined by the Knee Injury and Osteoarthritis Outcome Score. This study represents the longest follow-up to date and it can be concluded that meniscectomy leads to symptomatic osteoarthritis of the knee later in life, with a resultant 132-fold increase in the rate of total knee replacement in comparison to their geographical and age-matched peers. 
(C) 2012 British Editorial Society of Bone and Joint Surgery   

dissabte, 17 de maig de 2014


Qualsevol processador de textes tenen tantes funcions que amb tanta botoneria si vols simplement escriure et distreus. Proveu de buscar Pyroom...torna a ser una pantalla i el texte sol, com als 90's.

Acetabular fractures in patients > 55 years...

Acetabular fractures in patients aged > 55 years: A SYSTEMATIC REVIEW OF THE LITERATURE.
The Bone & Joint Journal 96-B  2014  pág. 157-163
DOI: 10.1302/0301-620X.96B2.32979
Daurka, J. S.; Pastides, P. S.; Lewis, A.; Rickman, M.; Bircher, M. D.


AB : The increasing prevalence of osteoporosis in an ageing population has contributed to older patients becoming the fastest-growing group presenting with acetabular fractures. We performed a systematic review of the literature involving a number of databases to identify studies that included the treatment outcome of acetabular fractures in patients aged > 55 years. An initial search identified 61 studies; after exclusion by two independent reviewers, 15 studies were considered to meet the inclusion criteria. All were case series. The mean Coleman score for methodological quality assessment was 37 (25 to 49). There were 415 fractures in 414 patients. Pooled analysis revealed a mean age of 71.8 years (55 to 96) and a mean follow-up of 47.3 months (1 to 210). In seven studies the results of open reduction and internal fixation (ORIF) were presented: this was combined with simultaneous hip replacement (THR) in four, and one study had a mixture of these strategies. The results of percutaneous fixation were presented in two studies, and a single study revealed the results of non-operative treatment. With fixation of the fracture, the overall mean rate of conversion to THR was 23.1% (0% to 45.5%). The mean rate of non-fatal complications was 39.8% (0% to 64%), and the mean mortality rate was 19.1% (5% to 50%) at a mean of 64 months (95% confidence interval 59.4 to 68.6; range 12 to 143). Further data dealing with the classification of the fracture, the surgical approach used, operative time, blood loss, functional and radiological outcomes were also analysed. This study highlights that, of the many forms of treatment available for this group of patients, there is a trend to higher complication rates and the need for further surgery compared with the results of the treatment of acetabular fractures in younger patients.

Sempre surt a la sessio de trauma , Tractament funcional de les fractures de olecranon? Mostra molt petita?

Non-surgical functional treatment for displaced olecranon fractures in the elderly.
The Bone & Joint Journal 96-B  2014  pág. 530-534
DOI: 10.1302/0301-620X.96B4.33339
Gallucci, G. L.; Piuzzi, N. S.; Slullitel, P. A. I.; Boretto, J. G.; Alfie, V. A.; Donndorff, A.; De Carli, P.

AB : We retrospectively evaluated the clinical and radiological outcomes of a consecutive cohort of patients aged > 70 years with a displaced fracture of the olecranon, which was treated non-operatively with early mobilisation. We identified 28 such patients (27 women) with a mean age of 82 years (71 to 91). The elbow was initially immobilised in an above elbow cast in 90[degrees] of flexion of the elbow for a mean of five days. The cast was then replaced by a sling. Active mobilisation was encouraged as tolerated. No formal rehabilitation was undertaken. At a mean follow-up of 16 months (12 to 26), the mean ranges of flexion and extension were 140[degrees] and 15[degrees] respectively. On a visual analogue scale of 1 (no pain) to 10, the mean pain score was 1 (0 to 8). Of the original 28 patients 22 developed nonunion, but no patients required surgical treatment.
We conclude that non-operative functional treatment of displaced olecranon fractures in the elderly gives good results and a high rate of satisfaction

Quina via millor en les protesi de Maluc?

Patient-reported outcome is influenced by surgical approach in total hip replacement: A STUDY OF THE SWEDISH HIP ARTHROPLASTY REGISTER INCLUDING 42 233 PATIENTS:
The Bone & Joint Journal 96-B  2014 pág. 590-596 DOI: 10.1302/0301-620X.96B5.32341
Lindgren, J. V.; Wretenberg, P.; Karrholm, J.; Garellick, G.; Rolfson, O.

AB : The effects of surgical approach in total hip replacement on health-related quality of life and long-term pain and satisfaction are unknown. From the Swedish Hip Arthroplasty Register, we extracted data on all patients that had received a total hip replacement for osteoarthritis through either the posterior or the direct lateral approach, with complete pre- and one-year post-operative Patient Reported Outcome Measures (PROMs). A total of 42 233 patients met the inclusion criteria and of these 4962 also had complete six-year PROM data. The posterior approach resulted in an increased mean satisfaction score of 15 (SD 19) vs 18 (SD 22) (p < 0.001) compared with the direct lateral approach. The mean pain score was 13 (SD 17) vs 15 (SD 19) (p < 0.001) and the proportion of patients with no or minimal pain was 78% vs 74% (p < 0.001) favouring the posterior approach. The patients in the posterior approach group reported a superior mean EQ-5D index of 0.79 (SD 0.23) vs 0.77 (SD 0.24) (p < 0.001) and mean EQ score of 76 (SD 20) vs 75 (SD 20) (p < 0.001). All observed differences between the groups persisted after six years follow-up. Although PROMs after THR in general are very good regardless of surgical approach, the results indicate that some patients operated by the direct lateral approach report an inferior outcome compared with the posterior approach. The large number of procedures and the seemingly sustained differences make it likely these findings are clinically relevant.

Al final acces des de casa a les revistes

Hola a tots -es. Us deixo aqui tambe el enllaç a la intranet per accedir tambe a les revistes on-line de la biblioteca 
Pel qui arribeu un cop activat el link  https://extranet.tauli.cat/intracspt/ i identificar-vos amb el nik i pasword del hospital s'obrira directament la intranet i alli es questio d'anar a la botonera esquerra  a 

Recerca, innovació, docència i formació...d'alli a
Biblioteca i despres a ....
Revistes on line: 

INJURY extra
JOURNAL OF BONE & JOINT SURGERY (BRITISH) des de  2013: The Bone & Joint Journal

dimecres, 16 d’abril de 2014


Si no ens equivoquem de foto... la Ona i la Oskia les nostres noves residents de primer