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

Pyroom

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.

Review

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: 

ARTHROSCOPY
FOOT & ANKLE INTERNATIONAL
INJURY
INJURY extra
INTERNATIONAL JOURNAL OF SHOULDER SURGERY 
INTERNET JOURNAL OF ORTHOPEDIC SURGERY
JOURNAL OF BONE & JOINT SURGERY (AMERICAN)
JOURNAL OF BONE & JOINT SURGERY (BRITISH) des de  2013: The Bone & Joint Journal
JOURNAL OF FOOT & ANKLE RESEARCH
JOURNAL OF HAND SURGERY (AMERICAN VOLUME)
JOURNAL OF HAND SURGERY (EUROPEAN VOLUME)
JOURNAL OF ORTHOPAEDIC RESEARCH
JOURNAL OF PEDIATRIC ORTHOPAEDICS
JOURNAL OF SHOULDER & ELBOW SURGERY
JOURNAL OF TRAUMA AND ACUTE CARE SURGERY
TECHNIQUES IN HAND & UPPER EXTREMITY SURGERY 
     

BENVINGUDES

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

SIGUEU BENVINGUDES

Curs de Penjolls Dr Masquelet.

Les lambeaux de réparation des parties molles au membre inférieur 

Responsable : Alain Charles Masquelet
(cours de niveau 2)
Experts : Thierry Bégué, Franck Fitoussi, Dominique Le Nen, Sylvain Rigal, Claudia Romana

différé du cours du 29/06/2013

Un curs amb  videos interessantissim . Diseccions sobre cadaver dels penjolls de membre inferior mes freqüents
http://fmcevent.com/sofcot/differe1

Calcificació del supraespinós

La calcificació del espai subacromial es un enigma interessant amb una clinica força constant.

Aqui tenim l'evolució de una de coneguda

.

Smart Sutures That Detect Infections

Surgical sutures are mindless threads no more. Researchers have now coated them with sensors that could monitor wounds and speed up healing.
The electronic sutures, which contain ultrathin silicon sensors integrated on polymer or silk strips, can be threaded through needles, and in animal tests researchers were able to lace them through skin, pull them tight, and knot them without degrading the devices.
The sutures can precisely measure temperature—elevated temperatures indicate infection—and deliver heat to a wound site, which is known to aid healing. And John Rogers, professor of materials science and engineering at the University of Illinois at Urbana-Champaign and inventor of the smart sutures, imagines that they could also be laden with devices that provide electrical stimulation to heal wounds. "Ultimately, the most value would be when you can release drugs from them in a programmed way," he says. The researchers could do that by coating the electronic threads with drug-infused polymers, which would release the chemicals when triggered by heat or an electrical pulse.
The smart sutures, reported online in the journal Small, rely on silicon-based devices that flex and stretch. Rogers and his colleagues make the devices with silicon membranes and gold electrodes and wires that are just a few hundred nanometers thick and patterned in a serpentine shape. The technology, which they have also used in inflatable catheters and medical tattoos (see "Stick-On Electronic Tattoos"), is being commercialized by MC10, a Cambridge, Massachusetts–based startup Rogers cofounded (see "Making Stretchable Electronics").
The researchers first use chemicals to slice off an ultrathin film of silicon from a silicon wafer. With a rubber stamp, they lift off and transfer the nanomembranes to polymer or silk strips. Then they deposit metal electrodes and wires on top and encapsulate the entire device in an epoxy coating.
They have built two types of temperature sensors on the sutures. One is a silicon diode that shifts its current output with temperature; the other, a platinum nanomembrane resistor, changes its resistance with temperature. The micro-heaters, meanwhile, are simply gold filaments that heat up when current passes through them.
All the materials used in the devices are safe for use in the body, and the biggest challenge was to make the sutures flexible, Rogers says. Silicon is brittle, so making the nanomembranes as thin as possible and laying them out in a winding pattern was key for elasticity. Placing the silicon halfway between the top epoxy and bottom polymer surfaces of the suture is also crucial. "When you bend the entire construct, the top surface is in tension and the bottom is in compression, but at midpoint the strains are very small," he says.
The researchers have tested the sutures' mechanical flexibility and toughness on incisions in rat skin, but they haven't tested the temperature sensing and heating capabilities in animals yet. They are also working on making the devices wireless.