A. Combalia

Use of bone allograft in tibial plateau fractures

Abstract To determine the behaviour of bone allografts in the treatment of tibial plateau fractures, 20 recipients of frozen bone allograft for a depressed tibial plateau fracture were studied. Incorporation of grafts took place in all cases, and no complication secondary to the allograft use has been detected. To avoid donor site morbidity associated with harvesting iliac crest, the use of frozen bone allograft is a good alternative in the treatment of depressed tibial plateau fractures.

Unusual locations of osteoarticular tuberculosis

Tuberculosis continues to occur frequently in some underdeveloped regions. Bone and joint tuberculosis is less common than the pulmonary form. Fourteen cases of bone and joint tuberculosis in unusual locations are presented. Tuberculostatic treatment and surgical approach were associated in all the patients. In 6 cases an arthrodesis of the affected joint was carried out. A surgical debridement was done in 6 patients and a needle biopsy in 2 patients in order to obtain samples for pathology and bacteriology. Twelve of the 14 patients recovered. One patient who was affected by atlanto-axial tuberculosis died within the immediate postoperative period. A second one affected by the acquired inmunodefiency syndrome died 4 months after surgery.

Bone allograft contamination in multiorgan and tissue donors

Abstract Multiorgan and tissue donors offer a large quantity and high quality of bone allograft that cannot be obtained from living donors. The risk of bone contamination must be borne in mind if secondary sterilization is not performed. The bacteriological cultures of 270 bone segments obtained from 53 multiorgan or tissue donors were analysed to study the relationship between previous organ and tissue procurements and bone retrieval contamination. We concluded that no significant differences in bacterial contamination percentage were found for each type of previous organ and tissue procurement, nor in the number of teams per donor.

Compression of the ulnar nerve in Guyon's canal by uremic tumoral calcinosis.

Abstract We describe the case of a 70-year-old woman with chronic renal failure on haemodialysis presenting with an ulnar nerve compression in Guyon’s canal secondary to uremic tumoral calcinosis. Excision of calcium deposits and external neurolysis of the ulnar nerve were successfully performed. Simultaneously, the hyperphosphatemia and hypercalcemia were corrected. The pathogenesis of this condition is different from primary tumoral calcinosis. Clinical and radiological features and therapy are discussed. Uremic tumoral calcinosis is an unusual etiology of ulnar nerve compression in Guyon’s canal not previously reported in dialysis patients.

Importance of selection and duration of antibiotic regimen in prosthetic joint infections treated with debridement and implant retention.

OBJECTIVES Early prosthetic joint infections (PJIs) are managed with debridement, implant retention and antibiotics (DAIR). Our aim was to evaluate risk factors for failure after stopping antibiotic treatment. METHODS From 1999 to 2013, early PJIs managed with DAIR were prospectively collected and retrospectively reviewed. The main variables potentially associated with outcome were gathered, and the minimum follow-up was 2 years. For the present study, only patients who were in remission after one debridement and without long-term antibiotic suppression were included. The primary endpoint was implant removal or the need to reintroduce antibiotic treatment due to failure. RESULTS One-hundred-and-forty-three patients met the inclusion criteria. The failure rate after a median duration of oral antibiotic treatment of 69 days (IQR 45-95 days) was 11.8%. In 92 cases, PJI was due to Gram-positive microorganisms, in 21 cases PJI was due to Gram-negative microorganisms and in 30 cases PJI was due to a polymicrobial infection with both Gram-positive and Gram-negative microorganisms. In Gram-positive infections, rifampicin administered in combination with linezolid, co-trimoxazole or clindamycin was associated with a higher failure rate (27.8%, P = 0.026) than that in patients receiving a combination of rifampicin with levofloxacin, ciprofloxacin or amoxicillin (8.3%) or monotherapy with linezolid or co-trimoxazole (0%). Among patients with a Gram-negative infection, the use of fluoroquinolones was associated with a lower failure rate (7.1% versus 37.5%, P = 0.044). CONCLUSIONS The only factor associated with failure was the oral antibiotic selection, not the duration of treatment. Linezolid, co-trimoxazole and clindamycin, but not levofloxacin, serum concentrations are reduced by rifampicin; a fact that could explain our findings. Further studies monitoring serum concentration could help to improve the efficacy of these antibiotics when administered in combination with rifampicin.

Contribución de un programa de calidad asistencial al desarrollo de un Instituto de Gestión Clínica del Aparato Locomotor

Resumen En el ano 1999 se constituye en el Hospital Clinic de Barcelona, el Instituto del Aparato Locomotor (ICAL), agrupacion organizativa de los Servicios de Cirugia Ortopedica y Traumatologia, Reumatologia y Rehabilitacion. Al mismo tiempo, y con el objetivo de asegurar la calidad de este proceso de cambio, se diseno un programa de calidad especifico, en el que se definian objetivos de mejora a conseguir en un ano natural y se monitorizaban una serie de indicadores de calidad, tanto tecnica como percibida. Los resultados de estos ultimos 5 anos nos indican que se ha observado una mejora en la mayoria de indicadores (exceptuando los relativos a las infecciones quirurgicas y las altas voluntarias), contribuyendo a la consolidacion y el reconocimiento de este proyecto innovador en el Instituto de Gestion Asistencial de las Enfermedades del Aparato Locomotor, que situa al enfermo en el epicentro de la organizacion y a los medicos como autenticos gestores del mismo.

Seguridad clínica y reclamaciones por responsabilidad profesional en Cirugía Ortopédica y Traumatología

espanolEl especialista de cirugia ortopedica y traumatologia, como cualquier facultativo, esta sujeto en su ejercicio profesional a la normativa legal vigente y resulta imprescindible su formacion en los aspectos medico-legales de obligado cumplimiento en la asistencia. Las reclamaciones contra los medicos son una realidad y la especialidad de cirugia ortopedica y traumatologia ocupa el primer lugar en frecuencia de reclamaciones segun los datos del Consejo General de Colegios de Medicos de Cataluna. Los profesionales deben conocer los aspectos fundamentales de la responsabilidad profesional medica, asi como de la medicina defensiva y la seguridad clinica en su especialidad. La comprension de estos aspectos medico-legales en la practica clinica habitual puede ayudar a allanar el camino hacia una carrera profesional satisfactoria y segura. Con este trabajo de revision queremos contribuir a esta formacion en beneficio de profesionales y pacientes. EnglishThe specialist in orthopaedic and traumatological surgery, like any other doctor, is subject to the current legal provisions while exercising their profession. Mandatory training in the medical-legal aspects of health care is essential. Claims against doctors are a reality, and orthopaedic and traumatological surgery holds first place in terms of frequency of claims according to the data from the General Council of Official Colleges of Doctors of Catalonia. Professionals must be aware of the fundamental aspects of medical professional liability, as well as specific aspects, such as defensive medicine and clinical safety. The understanding of these medical-legal aspects in the routine clinical practice can help to pave the way towards a satisfactory and safe professional career. The aim of this review is to contribute to this training, for the benefit of professionals and patients.

Leiomyosarcoma of sacrum: imaging and histopathologic findings.

Abstract. A rare case of low-grade primary leiomyosarcoma of the sacrum is described in a young woman who suffered from pain in the right sacroiliac region. A lytic sacral mass was observed on conventional radiology and CT studies. Magnetic resonance imaging clearly showed Gd-DTPA enhancement in the entire mass demonstrating its hypervascularity, which was later confirmed by angiography. Histopathology and immunohistochemical results of biopsy and curettage of the lesion confirmed the diagnosis. We report on the features of a rare tumor entity through imaging and diagnostic methods.

Lung carcinoma with metastasis to biceps muscle: report of a case and review of literature

A case of intramuscular metastasis in biceps muscle due to a squamous cell carcinoma of the lung (Pancoast) is presented. One year after treatment of the lung disease, the patient complained of pain and a sensation of swelling in the anterior aspect of her right arm. The excision of the infiltrated muscles showed proliferation of carcinomatous tissue.RésuméUne métastase intramusuclaire de cancer du poumon localisée au niveau du biceps brachial est rapportée. Douleur et tuméfaction du bras sont apparus un an après le début du traitement du cancer pulmonaire. L’examen histologique de la pièce de résection a confirmé le tissu carcinomateux.

Comparison of bacterial results from conventional cultures of the periprosthetic membrane and the synovial or pseudocapsule during hip revision arthroplasty

IntroductionBacterial identification is essential to diagnose and treat a revision for prosthetic loosening of an infected hip. The purpose of this study was to determine whether conventional cultures from the periprosthetic membrane are superior to synovial/pseudocapsule samples in the diagnosis of infection in hip revision arthroplasty.Materials and methodsWe performed a prospective study including all hip revisions from October 2009 to October of 2011. Once the implants were removed and prior to the administration of the antibiotic prophylaxis, six periprosthetic samples from different sites were sent to the laboratory for culturing: two periprosthetic fluid samples, two solid material (synovial/pseudocapsule) samples and two swabs. Once the six samples were taken, antibiotic prophylaxis was administered and just as the implant was removed, two more solid samples of the periprosthetic membrane were obtained.ResultsOf a total of 86 hip revision surgeries, 22 were considered septic revisions postoperatively, of which 16 resulted in positive cultures. Of these 16 revisions, 14 obtained the same microbiologic diagnostic when considering either the synovial/pseudocapsule culture results or the solid membrane sample.ConclusionsWe conclude that the membrane sample for a conventional culture is not superior to the synovial/pseudocapsule sample in detecting microorganisms.