Carlos Autorino

Charcot neuroarthropathy in simultaneous kidney–pancreas transplantation: report of two cases

Charcot neuroarthropathy (CN) is considered a major complication in diabetes mellitus (DM), and it is estimated that 1% of diabetic patients may develop this complication. Simultaneous kidney–pancreas transplantation (SKPT) is one of the most effective therapies for patients with type 1 DM and end-stage diabetic nephropathy. Some cases with a Charcot-modified clinical presentation during the postoperative convalescence period after SKPT have been described. The clinical presentation may condition severe destructive lesions, and good practices include systematic follow-up. Based on the cases described, SKPT is one more entity that might lead to CN ‘foot-at-risk’. The aim of this article is to describe two cases of neuropathic arthropathy with rapid progression in the short term after SKPT.

Evaluación de aspectos de la Residencia de Ortopedia y Traumatología por los residentes. [Orthopedic residency survey regarding several aspects of the program.]

Se realizo encuesta a 299 residentes de Ortopedia y Traumatologia en relacion a aspectos del ingreso, actividades y preferencias durante ese periodo formativo de postgrado. Se entrego un formulario durante el Congreso Anual de la especialidad en 2015, a los Residentes de Residencias acreditadas por la Asociacion Argentina de Ortopedia y Traumatologia (AAOT). Las Residencias pertenecian 39.3% a la Provincia de Buenos Aires, 25% a la CABA y 34.88% al resto de las provincias. El 71.4% eran estatales y el 26.9% privadas. El 80.9% de las residencias tenian duracion de 4 anos. El 55% rindio examen una sola vez. Entre los motivos de eleccion figuran que la practica quirurgica era la mas importante para el 70% de los encuestados. El 53% se sentia satisfecho con la Residencia, la poca satisfaccion se presenta por las fallas estructurales en el 58%, la sobrecarga laboral en el 47% y el poco desarrollo academico en 41%. Las residencias se hallaban completas en el 55%; en las incompletas el 56% de los faltantes eran por renuncias y en el 49% no hubo postulantes. El 94% de los programas de residencia tenia el Curso Bianual de la AAOT incorporado. Estos datos nos muestran el estado actual de la residencia en nuestra especialidad, pero son parciales, al no contar con datos de las residencias no acreditadas. En el ano 2016 se realizo una nueva encuesta cuyos resultados estan en proceso de analisis.

Giant cell tumor in adipose package Hoffa

Tumors of adipose Hoffa package are very uncommon, with isolated cases reported in the literature. His presentation in pediatric patients knee is exceptional. The most frequently described tumors are benign including vellonodular synovitis. The extra-articular localized variant there of is known as giant cell tumor of the tendon sheath. It is characterized by locally aggressive nature, and has been described in reports of isolated cases. Objective: A case of giant cell tumor of the tendon sheath in adipose presentation package Hoffa in pediatric patients is presented in this paper. Methods: male patient eleven years with right knee pain after sports practice was evaluated. Physical examination, showed limited extension -30º, joint effusion, stable negative Lachman maneuver without peripheral knee laxity. MRI hyperintense on tumor is observed in T2 and hypointense on T1 homogeneous and defined edges content displayed prior to LCA related to adipose Hoffa package. Results: The tumor specimen was obtained and histopathology is defined as densely cellular tissue accumulation of xantomisados fibrocollagenous with histiocytes and multinucleated giant cells, compatible with giant cell tumor of tendon sheath. Conclusion: The presentation of giant cell tumors of the tendon sheath in Hoffa fat pad is exceptional. However, his suspicion allows adequate preoperative surgical planning, as a whole resection is the only procedure that has been shown to decrease the rate of recurrence of this disease.

ACL Revision in Synthetic ACL graft failure

The development of synthetic grafts as an alternative to biological grafts for reconstruction of the anterior cruciate ligament dates from 1980. The interest is awakened due to the potential advantages of: The absence of morbidity associated with donor site, and early return to sport. However, this surgical technique has had multiple complications associated with graft: mechanical failures (synthetic graft failure, loss of fixation), synovial foreign body reaction, recurrent stroke, recurrent instability and ultimately, early osteoarthritis. Objectives: We describe the synthetic graft failure LCA, intraoperative findings and details of surgical technique. Methods: Patient 35 years old, with a history of ACL reconstruction four years of evolution in another health center, consultation with the Service knee arthroscopy for acute knee pain left knee during secondary sporting event to a rotation mechanism with fixed foot. On physical examination, presents and positive Lachman maneuver Pivot. Radiografia in a widening of the tibial tunnel is observed. NMR shows a discontinuity of fibers of synthetic graft. Results: First time arthroscopic revision where synthetic plastic LCA identifies with Disruption fiber pattern. Intraoperatively, hypertrophic chronic synovitis localized predominantly in intercóndilo is observed. debridement thereof is performed, and proceeds to the extraction of the synthetic ligament. Then he was made prior cruentado and revival of the edges of the tunnel, filling them with non-irradiated structural bone allograft. At four months as planned and after confirmation by studies incorporating bone graft was performed the second time with the new plastic ACL. It was planned like a primary graft surgery with autologous hamstring prepared in fourfold form, and fixation with modified transtibial technique Biotransfix system proximal and distal screw Biocomposite (arthrex®). A quadruple graft 9 mm was obtained, making good positioning of tunnels and stable fixation. Conclusion: While ACL reconstruction with synthetic graft has favorable medium-term results, the proportion of patients with complications of irreversible nature and high rates of dissatisfaction in the long term we are inclined to dismiss the indication of this technique in primary ACL reconstruction, to despite the potential benefits it offers.

Modified Transtibial versus Anteromedial Portal Technique in Single Bundle ACL Reconstruction: Tomographic Comparision Femoral Tunnel Location

Objectives: The aim of this study is to determine whether it is possible to achieves a similar anatomical placement of the femoral tunnel with a modified transtibial ACL single bundle reconstruction tecnique compared to anteromedial transportal technique. Results were evaluated by tomographic comparisons between patients from both groups. Methods: 36 patients (36 knees) who were candidates for an ACL single bundle reconstruction with patellar bone graft were included in the study. Patients were randomly allocated using a computerized sequence into two groups. 18 patients were assigned each group (modified transtibial vs AM transportal technique). Surgery was performed by the same surgical team in both groups. Femoral tunnel quadrant placement, oblicuity in the coronal and sagittal planes and diameter of the femoral tunnel were assesed tomographically blinded by two observers and statistical comparison between groups was realized. Results: Average distance measured from posterior edge of the condyle to the femoral tunnel ( measured as a proportion respect to the T line) was similar in both groups ( Group I : 32.7 % +- 5.1% ; Group 2: 32.4 % +-4.4% , p = 0.85). Average distance measured from the Blumensaat line to the femoral tunnel (measured as a proportion respect to the H line) was similar in both groups ( Group I: 28.5% 4.49 % Group II , 31.5% of 4.83% p = 0.06). Average angulation values of the femoral tunnel in the coronal plane were lower in Group I than in Group II (Group I = 34.8 ° range 32.7 ° - 38.6 ° and 41.2 ° range Group II 36.7 ° - 43.1 ° P = 0.0016 ). Average angulation values of the femoral tunnel in the sagittal plane were similar in both groups (Group I 40.2 ° range 38.4 ° - 43.4 ° ; Group II 38 1 ° range 36.6 ° - 40.2 ° p = 0.17).. The average diameter of the femoral tunnel was significantly higher in group I than in Group II (Group I 11 mm 0.84 mm and 10.2 mm Group II 0.65mm p = 0.007) . Conclusion: The modified transtibial technique for single bundle ACL reconstruction has proved to be suitable to reproduce the anatomic placement of the femoral tunnel compared to the transportal AM technique.

Low Grade Juvenile Osteochondritis Dissecans of the Knee: Need to be Fixed?

Juvenile osteochondritis dissecans (OCD) of the knee is a nosological entity acquired, idiopathic and potentially reversible. Dissects the subchondral bone tissue plane from the underlying bone, making a partial or complete osteochondral detachment, with a loose body. Consensus to treat none surgically poor symptomatic and stable lesions. If the lesion becomes instable or more symptomatic, surgical treatment will be best the option. Recently histological evidence holds is possible find sources of instability in deep layers sub chondral bone, even in patients with ¨stables lesions¨. This condition might be the reason of unfavorable evolution certain cases previously considered as ¨stable or incipient¨, treated with the classic non operative protocols. Objectives: The purpose of the present study consist in present a series of cases of young patients with symptomatic low grade juvenile OCD (grade I-II), treated surgically with subchondral debridement and fixation ¨in situ¨ describing the clinical and imaging findings. Methods: We evaluated 15 cases of symptomatic juvenile OCD of the knee, stables lesion (grade I/ II) according to Di Paola´s classification, who have not responded to conservative therapy for at least 6 months. Results: All patients were treated surgical consecutively with arthroscopically assisted ¨in situ¨ fixation with pins Smart Nail NR, ConMed-Linvatex and for the same group of surgeons. We evaluated the clinical and imagenologic outcomes with MRI for a minimum follow up of six month to one year. No looseness of fastening material or loose bodies in the submitted sample were recorded. The study by MRI imaging techniques using high definition chondral identification evidence allowed the consolidation of the fragment to the 6th month. Conclusion: All patients evolved asymptomatic and returned to the previous activity, with high level of satisfaction.

Anterolateral Ligament Reconstruction: Surgical technique in anterior cruciate ligament reviews

Anterior cruciate ligament (ACL) reconstruction is a common procedure in daily practice with 75 to 97% excellent long-term results. But in certain cases, some patients perceive rotational instability, for this reason the revision rate can be 10 to 15%. Objectives: evaluate functional outcome in revisions of ACL reconstruction associated with ALL. Methods: Between July 2015 and February 2016 (11 knees) Eleven Revision ACL reconstruction were performed with ALL with double incision technique performed by the same surgical team. Inclusion criteria were: ACL reconstruction failures with a grade 2 or 3 Lachman test, a grade 3 pivot-shift without other ligamentary injury lesions associated and complete range of motion. Results: The concept of rotational instability associated with ACL injury has been described more than a decade ago. However, there is no consensus on how to quantify rotational instability in ACL injuries; so when associating an extracapsular technique. Currently there is a lack of high-level evidence comparing isolated ACL repair and associated with the modified reconstruction of ALL that allows us to define therapeutic approaches. The ALL reconstruction associate an ACL reconstruction remains a matter of study. Conclusion: We obtain excellent results in antero – posterior and rotational stability after performing the procedure.

Periprosthetic fungal infection of a hip caused by Trichosporon inkin

An immunocompromised patient with a history of multiple hip implant revisions extended courses of empiric antibiotic treatment, and a retained metallic rod in the femoral medullary canal was transferred for diagnostic studies and treatment. A high suspicion of fungal infection and utilization of extended and specific fungal cultures were the diagnostic keys for infection with Trichosporon inkin. The treatment consisted in a debridement surgery with the use of a functional spacer with cement supplemented with voriconazole and vancomycin plus a 6-month systemic treatment with voriconazole. After 2 years of follow-up, the patient is free of symptoms.

Fracturas intertrocantéricas inestables tratadas con clavos endomedulares cortos intertrocantéricos/subtrocantéricos. Valoración de la calidad de vida y de la recuperación funcional

Introduccion El objetivo del presente estudio consistio en evaluar una serie de pacientes con fracturas intertrocantericas inestables tratados con clavos cortos Intertrocantericos/Subtrocantericos ITST(NR) con especial atencion en la calidad de vida y la recuperacion funcional. Material y metodos Se incluyeron 171 pacientes con fracturas AO 3.1 A2 y A3, con un seguimiento minimo de 14 meses, y una edad promedio de 79 anos. Se evaluo: calidad de vida, utilizando la escala de WOMAC reducida convertida a una escala del 1 al 100, recuperacion funcional en funcion del tiempo en que se logro la bipedestacion, necesidad de ortesis al final del seguimiento, y el regreso a las tareas de la vida diaria utilizando la sub-escala de funcion de la Sociedad Americana de Tumores Musculoesqueleticos. Resultados A los 14 meses el promedio de WOMAC total fue 77. El 73 % de la poblacion camino dentro de las 36 hs de la cirugia. El 48% retorno a las actividades diarias con una restriccion minima, el resto tuvo restricciones recreacionales y parciales. El 71% del grupo que no utilizaba ortesis conservo tal condicion al finalizar el seguimiento. La incidencia de complicaciones intraoperatorias y postoperatoria fue 6,5% y 23%. La fractura distal al clavo y el “cut-out” se produjeron solo en el 1%. Discusion La baja incidencia de “cut-out” y fractura distal al clavo con la posibilidad de insercion temprana a las actividades, conservando una buena calidad de vida y funcion, convierten al ITST en un alternativa de eleccion para el tratamiento de las fracturas intertrocantericas inestables de cadera.