Gluteal Compartment Syndrome following an Iliac Bone Marrow Aspiration.

The compartment syndrome is a condition characterized by a raised hydraulic pressure within a closed and non expandable anatomical space. It leads to a vascular insufficiency that becomes critical once the vascular flow cannot return the fluids back to the venous system. This causes a potential irreversible damage of the contents of the compartment, especially within the muscle tissues. Gluteal compartment syndrome (GCS) secondary to hematomas is seldom reported. Here we present a case of a 51-year-old patient with history of a non-Hodgkin lymphoma who underwent a bone marrow aspiration from the posterior iliac crest that had excessive bleeding at the puncture zone. The patient complained of increasing pain, tenderness, and buttock swelling. Intraoperative pressure validation of the gluteal compartment was performed, and a GCS was diagnosed. The patient was treated with a gluteal region fasciotomy. The patient recovered from pain and swelling and was discharged shortly after from the hospital. We believe clotting and hematologic disorders are a primary risk factor in patients who require bone marrow aspirations or biopsies. It is important to improve awareness of GCS in order to achieve early diagnosis, avoid complications, and have a better prognosis.

Para leer el resto del artículo, entra a este link:

https://www.ncbi.nlm.nih.gov/pubmed/24392235

Trivalent reconstruction for posterolateral and lateral knee instability.

Chronic posterolateral rotatory and lateral instability of the knee is approached from multiple anatomic and functional points of view. Traditional surgical techniques provide one-directional stabilization using autologous tendon transplantation and the split-tendon biceps procedure. Both of these resolve the lateral opening of the joint but do not secure the rest of the anatomic structures that are very important, such as the arcuate ligament and the capsule. This new approach to solving an old problem acts by tightening the fibular collateral ligament, arcuate ligament, the capsule (partially), and biceps tendon in 1 step by performing an oblique fibular-head osteotomy and pulling down these structures with good results. We report 2 cases in which this technique was used. The first was a 26-year-old man who hit the dashboard in an automobile accident and presented 1 week later with posterolateral instability associated with a tear of the posterior cruciate ligament. The second was a case of pure chronic lateral instability of the knee in a 32-year-old man who sustained a fall that caused a rupture of his lateral collateral ligament. This was repaired using a trivalent reconstruction at 3 months. Both patients successfully achieved good stability after reconstruction.


Para leer el resto del artículo, entra a este link:
https://www.ncbi.nlm.nih.gov/pubmed/11774154

Células madres para el dolor de rodilla

La causa más frecuente de dolor de rodilla es la OSTEOARTRITIS DEGENERATIVA, o sea el desgaste de las articulaciones, que es una situación natural propia del paso de los años y que todos sin excepción, la vamos a padecer en mayor o menor grado. Se han descrito diferentes grados de desgaste en las rodillas y según sea su nivel de intensidad, se realizan tratamientos que van desde analgésicos, antinflamatorios y ejercicios, hasta el reemplazo total de rodilla o prótesis total de rodilla.
Palos los casos que no han llegado todavía a requerir la prótesis total, se ha diseñado el tratamiento con aplicación de CÉLULAS MADRE.
Las células madre se encuentran en la médula ósea y son las precursoras de diferentes tipos de células, por esa razón se aplican directamente en las rodillas con el fin de revitalizar el tejido dañado por el desgaste.
El procedimiento se realiza en el consultorio, no requiere preparación y puede continuar con sus actividades normalmente.
El protocolo de investigación se encuentra en el Comité de Ética de Christus Muguerza del Parque y en Pensiones Civiles del Estado.
El procedimiento se recomienda una o dos veces al año según la evolución de cada caso.

Anatomically-designed shoulder hemiarthroplasty made after 3-D models and implanted in a child with rheumatoid arthritis. A case report

The first known report of shoulder arthroplasty is that by Pean, a French surgeon who replaced a joint destroyed by tuberculosis with a prosthesis made of platinum and plastics. In 1951, and mostly in 1974, Neer became the strongest advocate of this practice by designing his own systems. In the 1990s, knowledge on the kinematics and recognizing the significance of adjacent soft tissues involved in shoulder function, led to technique improvements having a significant impact on the outcome.
Shoulder arthroplasty is unusual at an early age. Diseases such as juvenile rheumatoid arthritis (JRA), however, warrant this treatment modality as shoulder pain and a limited range of motion significantly compromise function. The main problem is that this disease leads to bone loss that usually occurstogether with soft tissue incompetence and muscular atrophy.
The purpose of this paper is to present the case of a patient who underwent shoulder hemiarthroplasty due to JRA sequelae, and to review the literature about it.

Case Report
Male, 14-year-old patient, with a 6-year history of juvenile rheumatoid arthritis (JRA), who received several therapies beginning with anti-inflammatory agents and followed by multiple infiltrations. Multiple musculoskeletal conditions occurred due to the disease, including bilateral hip and wrist lesions, which had previously undergone arthrodesis. Both shoulders showed severe functional limitation with 15° of abduction, 10° of flexion, 10° of extension, and 15° of external rotation. According to the UCLA classification score, the patient had a score of 7, indicating poor function. The pain visual analog scale (VAS) indicated 9/10 (severe pain). Xrays revealed a severe panarticular destruction pattern and evidenced closure of the physis (Figure 1), which was confirmed by MRI.
The decision was made to place a hemiprosthesis in the left shoulder. The prosthesis was designed after the natural anatomy of the patient under the supervision of the bioengineering department of the orthopedics group in our hospital. A three-dimensional model was used for the surgery planning and optimum prosthesis manufacturing.

Para leer el resto del artículo, entra a este link:

http://www.medigraphic.com/pdfs/ortope/or-2005/ors051k.pdf

Double-Bundle and Double-Tunnel ACL Reconstruction with Looped Proximal Tibial Fixation

Anterior cruciate ligament (ACL) reconstruction has been a challenge for the orthopedic surgeon. Nowadays, we understand the consequences of the anteromedial and rotational instability that follow the absence of a functional ACL. Arthroscopic surgery offered not only a better scope of the anatomy and reconstruction possibilities, but also the best therapeutic tool available for solid biomechanical and anatomical reconstructions.


History has shown many different therapeutic approaches to ACL reconstructions, most of them with good results in anteromedial stability. However, many recent studies have emphasized the role of rotational stability as a major variable in the final success of ACL reconstructions, specifically on the development of meniscal and articular cartilage damage.


The use of autologous graft tissue in ACL reconstructions has been a sound strategy used worldwide with good results. The use of patellar tendon–bone grafts, hamstrings, or other similar tissues has the advantage of good and rapid integration at low cost. However, taking tissues from healthy sites has a toll. Patellofemoral pain in bone-tendon-bone grafts has been well described and decreased knee flexion power with high risk of muscle sprains in hamstring grafts has also been frequently reported in athletes. Donor sites can be painful, and sometimes even more symptomatic than the surgery itself. Other problems may arise such as hematomas or neurovascular injuries. Neuropathic pain is associated equally on the surgical portals and on the donor site in many reports.


The development of tissue banks in the past 2 decades has opened a new window for ligament reconstructions. Taking the autograft off the table is an attractive option that potentially means less time, less morbidity, and faster recovery. Integration of the bank graft is similar to autografts. Biomechanical properties of tendon allografts have shown similar behavior at long follow-ups. Risk of bacterial or viral cross infections is low, but remains a concern. Modern tissue banks must follow strict protocols for harvesting, sterilization, packaging, and delivery. Demand is high and donors are scarce, especially in underdeveloped countries. Bone-tendon-bone and hamstring allografts are commonly used, as they do not require changing the original surgical technique. However, sometimes more demand exists than available tissue, so surgeons have been exploring other tendon allografts suitable for ACL reconstructions.


The anterior tibialis tendon can be considered a good allograft for knee ligament reconstructions. It is a long tough tendon that can easily measure up to 20-cm long and 10-mm wide. It is biomechanically strong enough to take the knee forces, and long enough to play with different anatomical or biomechanical reconstruction techniques in ACL or posterior cruciate ligament reconstructions.


Most of the complications related to ACL reconstructions are related to graft placement than to fixation or tissue choice. At the end of the past century, we saw a research boom on fixation devices, showing different possible advantages, more in terms of easiness than in biomechanical fixation properties. In the past decade, we witnessed the arrival of poor graft placement complications resulting in early meniscus and cartilage damage in many patients. Some studies highlighted the relevance of associated injuries, especially posterolateral instability and residual rotational deficits. The use of anatomical landmarks for better graft placement was followed by the introduction of the double-bundle technique that biomechanically replaces the posterolateral and anteromedial anatomical bands of the native ACL.


We believe a double-bundle graft provides a better anatomical and biomechanical approach to ACL reconstruction. It has been clearly shown that on the tibial and femoral insertions, footprints exist of these 2 bundles. The biomechanical studies of Freddie Fu have shown the function of each bundle on the flexion and extension of the loaded knee joint. They play a crucial role in the rotational degrees of freedom of knee motion and provide better flexion-extension and anteroposterior (AP) gliding moments.


Anatomically and biomechanically speaking, it is logical to use double-bundle reconstruction. However, it involves designing new techniques that will require a learning curve, some complications due to these new techniques may arise, and many surgeons with good experience do not have a clear reason to switch techniques because of the good results of previous methods. All the in-vitro studies favor the double-bundle techniques, whereas the contrasts in clinical follow-ups are not as different. Cost is also an issue; in many of the new techniques, more implants are required for graft fixation.


In this article, we introduce anewanatomictechniqueusing a double-bundle ACL allograft fixed by U-shape bone tunnels on the tibia, and 2 interference screws on the femur through transtibial and anteromedial portals. As this is a U-shape tibial fixation using 2 bundles, we named it the double-bundle and double-tunnel ACL reconstruction with looped proximal tibial fixation. This surgical procedure provides an anatomic reconstruction without increasing surgical time and using known arthroscopic portals. No need for different instruments is required and the 2 interference screws are the same as those used in conventional reconstructions, which results in equivalent cost.

Para leer el resto del artículo, entra a este link:

http://www.healio.com/orthopedics/journals/ortho/2011-6-34-6/%7B3b564f89-18b1-4ee9-a2b9-46fd90365e6b%7D/double-bundle-and-double-tunnel-acl-reconstruction-with-looped-proximal-tibial-fixation#

Una historia que vale la pena contarse

El día 12 de octubre del 2002 se realizó el primer trasplante de menisco llevado a cabo en el Hospital Clínica del Parque, este procedimiento fue por cirugía artroscópica. Lo cual representa el primer paso para evitar la artrosis de rodilla. Esta enfermedad se ha denominado como el reto a vencer en el tercer milenio. Este hecho, probablemente no tendría más relevancia que la de haber tenido un éxito quirúrgico a corto plazo como muchas más que se llevan a cabo en nuestro país, en nuestros hospitales. Pero en realidad existe mucho más fondo que esta simple aseveración.
Este procedimiento quirúrgico fue llevado a cabo con la cooperación de un gran número de médicos trabajando en forma conjunta en tres estados de la República Mexicana. Por lo tanto los hechos toman más relevancia. En nuestro país desafortunadamente con frecuencia debido a accidentes viales en su gran mayoría, los pacientes sufren de muerte cerebral, a la familia de ellos, los médicos mexicanos le solicitan la donación de sus órganos para ser utilizados para salvar vidas o en el caso de la ortopedia para reparar lesiones. Uno de estos mexicanos con una de estas lesiones incurables donó sus órganos en Guadalajara Jal., en donde el grupo del Dr. David Chung y el Consejo Estatal de Donación de Órganos y Tejidos del Estado de Jalisco llevaron a cabo la procuración de sus órganos y tejidos. Para el procesamiento adecuado de los tejidos, se le solicitó el soporte al Banco de Hueso de Monterrey N.L. Esta Institución fue fundada por el Dr. Carlos de la Garza y activada por el Dr. Rafael Brizeño. Él acudió para realizar la procuración y el adecuado manejo de estos tejidos, así como el estudio para asegurar que se encontraran libres de toda enfermedad infectocontagiosa y su almacenamiento adecuado.
En la ciudad de Chihuahua, un médico general aficionado a correr el medio maratón fue operado algunos años antes de una meniscectomía y empezaba a presentar datos de artrosis del compartimento lateral, así como dolor a la deambulación. Por lo anterior, los miembros del grupo de ortopedia de la Clínica del Parque le solicitaron al Banco de Hueso y Tejido de Monterrey, se colocara al paciente en lista de espera para recibir la donación de este tejido articular.

La tibia proximal fue trasladada el día 12 de octubre a Chihuahua y se inició el procedimiento quirúrgico trabajando en dos equipos. En uno los Doctores Rafael Brizeño, David Chung y Arturo Aguirre Madrid, llevaron a cabo la disección del menisco, así como la preparación para su colocación por vía artroscópica. En otro equipo el Dr. Edmundo Berumen, Dr. Jorge Vallejo y el Dr. Otto Campbell, prepararon el compartimento lateral para su colocación. El menisco fue colocado en el interior de la rodilla y suturado en su sitio. Este procedimiento que en la actualidad se encuentra en debate sus resultados, pensamos que en el futuro tendrá una mejor indicación como lo han logrado en otros países. Y será una forma estándar de tratamiento para muchas de las lesiones del cartílago articular, que de otra forma serían condenadas a la artrosis de la rodilla.
El mensaje que esta historia nos deja es la importancia del trabajo en equipo y cómo podemos sobrepasar el cuento de los cangrejos y ayudarnos los unos a los otros a mejorar la evolución de nuestros pacientes. Por otro lado y de mayor importancia se debe resaltar la importancia de la donación de órganos y tejidos en nuestro país. Los programas de donación de órganos y tejidos son instituciones que verdaderamente salvan las vidas de muchos mexicanos. Pero con agrado observamos cómo también pueden mejorar la función y evitar el desgaste de las articulaciones. Por todos estos avances dirigidos a una mejor atención médica creemos que esta historia, es una historia que vale la pena contarse.