Andrés Combalia

Comminuted intra-articular fractures of the distal end of the radius treated with the Hoffmann external fixator.

In 1985 we began a prospective study of the use of external fixation in the treatment of intra-articular comminuted fractures of the distal end of the radius. A total of 30 patients have been treated by this method, representing 1.3% of the total number of patients treated in the Emergency Unit for a fracture of the distal epiphysis of the radius. The use of external fixation in instable fractures of the distal end of the radius improves the anatomic results. These correlate closely with the overall functional results obtained, which were excellent or good in 82.1% of cases, according to the rating system of Gartland and Werley. The main indications are fractures with a high degree of comminution, displacement, and articular affectation (unstable fractures) in young patients, corresponding to Frykman grades VII and VIII.

Lithocholic acid downregulates vitamin D effects in human osteoblasts.

Eur J Clin Invest 2010; 40 (1): 25–34

Effects of bilirubin and sera from jaundiced patients on osteoblasts: Contribution to the development of osteoporosis in liver diseases†

Low bone formation is considered to be the main feature in osteoporosis associated with cholestatic and end‐stage liver diseases, although the consequences of retained substances in chronic cholestasis on bone cells have scarcely been studied. Therefore, we analyzed the effects of bilirubin and serum from jaundiced patients on viability, differentiation, mineralization, and gene expression in the cells involved in bone formation. The experiments were performed in human primary osteoblasts and SAOS‐2 human osteosarcoma cells. Unconjugated bilirubin or serum from jaundiced patients resulted in a dose‐dependent decrease in osteoblast viability. Concentrations of bilirubin or jaundiced serum without effects on cell survival significantly diminished osteoblast differentiation. Mineralization was significantly reduced by exposure to 50 μM bilirubin at all time points (from −32% to −55%) and jaundiced sera resulted in a significant decrease on cell mineralization as well. Furthermore, bilirubin down‐regulated RUNX2 (runt‐related transcription factor 2) gene expression, a basic osteogenic factor involved in osteoblast differentiation, and serum from jaundiced patients significantly up‐regulated the RANKL/OPG (receptor activator of nuclear factor‐κB ligand/osteoprotegerin) gene expression ratio, a system closely involved in osteoblast‐induced osteoclastogenesis. Conclusion: Besides decreased cell viability, unconjugated bilirubin and serum from jaundiced patients led to defective consequences on osteoblasts. Moreover, jaundiced serum up‐regulates the system involved in osteoblast‐induced osteoclastogenesis. These results support the deleterious consequences of increased bilirubin in advanced chronic cholestasis and in end‐stage liver diseases, resulting in disturbed bone formation related to osteoblast dysfunction. (HEPATOLOGY 2011)

Ursodeoxycholic acid increases differentiation and mineralization and neutralizes the damaging effects of bilirubin on osteoblastic cells.

Osteoporosis resulting from decreased bone formation is a common complication in patients with chronic cholestasis. Lithocholic acid (LCA) and bilirubin may play a role in osteoporosis given that both substances have detrimental effects on survival of human osteoblasts, the cells involved in bone formation.

How to avoid injuries of the superior gluteal nerve.

BACKGROUND Injuries to the superior gluteal nerve are a common complication in hip replacement surgery. They can be avoided with a good anatomical knowledge of the course of the superior gluteal nerve. METHODS We dissected 29 half pelvises of adult cadavers. The distance and the angle from the entry points of branches of the superior gluteal nerve into the deep surface of the gluteus medium and minimus muscles to the midpoint of the superior border of the greater trochanter were measured. RESULTS The dissections revealed that the nerve divided into 2 branches (86.20%) or 3 branches (13.8%). The more caudal branch was responsible for innervation of the tensor fascia latae. CONCLUSIONS A 2-3-cm safe area above the greater trochanter is appropriate to prevent nerve damage.

The procurement team as a factor of bone allograft contamination.

We studied the effect of the procurement team on the risk of contamination in 270 large bone allografts retrieved from 53 non-living donors under strictly aseptic conditions.The overall contamination rate was 8.1%. When the procurement team was constituted by three or less members the contamination rate was 5.6%, while if there were four or more members the rate was 12.9%; this difference was significant in the statistical analysis.We conclude that a procurement team constituted by three or less trained members is a determinant factor in decreasing the bacterial contamination rate of bone allografts.

Ursodeoxycholic acid decreases bilirubin-induced osteoblast apoptosis.

Low bone turnover osteoporosis is common in cholestatic diseases. Ursodeoxycholic acid (UDCA) counteracts the damaging effects of bilirubin or lithocholic acid (LCA) on osteoblast viability, proliferation and mineralisation. UDCA is anti‐apoptotic in various cell lines, but this effect in bone cells is unknown. Therefore, the consequences of bilirubin and LCA on apoptosis, and whether UDCA has anti‐apoptotic effects have been assessed on osteoblasts.

Pubic osteolysis simulating a malignant lesion: case report.

A case of posttraumatic osteolysis of the pubic bone simulating a malignant lesion in a 55-year-old woman is reported. A review of the literature revealed that all reported cases occurred in post-menopausal women, associated with radiologic evidence of osteoporosis and a history of slight trauma. Biopsy was performed because of the possible malignant nature of the lesion, which should be suspected in all post-menopausal women with a destructive lesion of the pubic bone.

Assessment of Patients with a DePuy ASR Metal-on-Metal Hip Replacement: Results of Applying the Guidelines of the Spanish Society of Hip Surgery in a Tertiary Referral Hospital.

The prognosis associated with the DePuy ASR hip cup is poor and varies according to the series. This implant was withdrawn from use in 2010 and all patients needed to be assessed. We present the results of the assessment of our patients treated with this device, according to the Spanish Society of Hip Surgery (SECCA) algorithm published in 2011. This retrospective study evaluates 83 consecutive ASR cups, followed up at a mean of 2.9 years. Serum levels of chromium and cobalt, as well as the acetabular abduction angle, were determined in order to assess their possible correlation with failure, defined as the need for revision surgery. The mean Harris Hip Score was 83.2 (range 42–97). Eight arthroplasties (13.3%) required revision due to persistent pain and/or elevated serum levels of chromium/cobalt. All the cups had a correct abduction angle, and there was no correlation between elevated serum levels of metal ions and implant failure. Since two previous ASR implants were exchanged previously to the recall, the revision rate for ASR cups in our centre is 18.2% at 2.9 years.

COMPRESSION OF THE ANTERIOR INTEROSSEOUS NERVE AFTER USE OF A ROBERT-JONES TYPE BANDAGE FOR A DISTAL END CLAVICLE FRACTURE: CASE REPORT

There are some controversies in the medical literature about the causes of the anterior interosseous nerve (AIN) compression syndrome. The present case is, to our knowledge, the first reported resulting from an extrinsic compression of the AIN from a Robert-Jones type bandage in a patient with a distal end clavicle fracture.