Dr Michell Ruiz

Dr Michell Ruiz
Cirugía de hombro y del Manguito rotador

miércoles, 17 de diciembre de 2014

Human Dermal Allograft for Massive Rotator Cuff Tears

Este artículo es publicado originalmente en:
http://www.healio.com/orthopedics/journals/ortho/2014-12-37-12/%7B54b052fa-a239-47e4-9cf2-6ed59640107b%7D/human-dermal-allograft-for-massive-rotator-cuff-tears?ecp=318F9B42-3E81-E311-ADF0-A4BADB296AA8

http://www.ncbi.nlm.nih.gov/pubmed/22215726

http://ajs.sagepub.com/content/40/1/141.full.pdf


PEER REVIEW
   
 

Interpositional
human dermal allograft
Orthopedics — December 2014
Human Dermal Allograft for Massive Rotator Cuff Tears— by Zinon T. Kokkalis, MD; et al
Previously published studies reported variable results using various suture techniques and reconstruction options for massive rotator cuff tears. The authors retrospectively studied shoulders with massive rotator cuff tears treated with a human dermal allograft through a mini-open approach.Read more

martes, 16 de diciembre de 2014

Arthroscopic subscapularis-only repair, greater tuberoplasty showed promise for rotator cuff tears

http://www.healio.com/orthopedics/shoulder-elbow/news/online/%7B605c4b00-806f-4d62-bced-35d8390d6457%7D/arthroscopic-subscapularis-only-repair-greater-tuberoplasty-showed-promise-for-rotator-cuff-tears


IN THE JOURNALS

Arthroscopic subscapularis-only repair, greater tuberoplasty showed promise for rotator cuff tears

Cortical suspensory fixation with interface screw showed low early rate of failure

Este artículo es originalmente publicado en:
http://www.healio.com/orthopedics/shoulder-elbow/news/online/%7B3c827756-9eac-4f94-a568-d415c3a95e9b%7D/cortical-suspensory-fixation-with-interface-screw-showed-low-early-rate-of-failure


IN THE JOURNALS

Cortical suspensory fixation with interface screw showed low early rate of failure

domingo, 14 de diciembre de 2014

Percutaneous pinning of three- or four-part fractures of the proximal humerus in elderly patients in poor general condition: MIROS® versus traditional pinning.

Clavos percutáneos de fracturas de tres o cuatro partes del húmero proximal en pacientes ancianos en mal estado general: MIROS® frente a la fijación tradicional.

Este artículo es publicado originalmente en:

De:
 2012 Jun;36(6):1267-73. doi: 10.1007/s00264-011-1474-5. Epub 2012 Jan 18.

Percutaneous pinning of three- or four-part fractures of the proximal humerus in elderly patients in poor general condition: MIROS® versus traditional pinning.

Abstract

PURPOSE:

Elderly subjects often have fractures of the proximal humerus, which may be difficult to manage in patients in poor general condition. The MIROS is a new percutaneous pinning device allowing correction of angular displacement and stable fixation of fracture fragments. We evaluated the results of percutaneous fixation of three- or four-part fractures of the proximal humerus of patients in the American Society of Anesthesiologists physical status three or four treated either with MIROS or traditional percutaneous pinning (TPP).

METHODS:

A total of 31 patients treated with MIROS and 27 undergoing TPP were enrolled in the study. Pre-operatively anteroposterior and transthoracic or axillary radiographs were obtained in all cases and computed tomography scans in patients with the most complex fractures. Follow-up evaluations were carried out at three, six, 12 and 16 weeks, and six months, one year and two years postoperatively, using the Constant Score (CS) and subjective shoulder value (SSV) methods.

RESULTS:

Of the 58 patients, 52 could be evaluated at all follow-ups. In both three- or four-part fractures there were significantly higher CS and SSV scores in the MIROS compared to the TPP group at all the late follow-ups. Lower rates of deep infection, pin tract infection and pin mobilisation were found in the MIROS group (p < 0.001). In both groups there was a significant association between the final result (CS) and either the type of fracture or complications (p < 0.001).

CONCLUSIONS:

The MIROS resulted in better clinical results and less complications than TPP in elderly patients. This method, however, may not be indicated for younger patients in good general condition.
Resumen
PROPÓSITO:
Los sujetos ancianos a menudo tienen fracturas del húmero proximal, que puede serdifícil de manejar en pacientes en mal estado general. El MIROS es un nuevo dispositivo de clavos percutáneos permitiendo la corrección de desplazamiento angular y una fijación estable de fragmentos de la fractura. Se evaluaron los resultados de la fijaciónpercutánea de tres o cuatro partes fracturas del húmero proximal de los pacientes en la Sociedad Americana de Anestesiólogos de estado físico tres o cuatro tratados ya sea con MIROS o clavos percutáneos tradicional (TPP).
MÉTODOS:
Un total de 31 pacientes tratados con MIROS y 27 que experimenta TPP se inscribieron en el estudio. Anteroposterior y transtorácica o axilares radiografías antes de la cirugía se obtuvieron en todos los casos y la tomografía computarizada en pacientes con las fracturas más complejas. Las evaluaciones de seguimiento se realizaron a los tres, seis,12 y 16 semanas, y seis meses, un año y dos años más después de la operación,mediante la puntuación de Constant (CS) y el valor del hombro subjetiva (SSV) métodos.
RESULTADOS:
De los 58 pacientes, 52 pudieron ser evaluados en todos los seguimientos. En ambos de tres o cuatro partes fracturas no fueron significativamente más altos puntajes CS y SSVen el MIROS comparación con el grupo TPP en todos los finales de los seguimientos. Se encontraron menores tasas de infección profunda, infección del tracto pin pin y movilización en el grupo MIROS (p <0,001). En ambos grupos hubo una asociación significativa entre el resultado final (CS) y, o bien el tipo de fractura o complicaciones (p<0,001).
CONCLUSIONES:
El MIROS dio lugar a mejores resultados clínicos y menos complicaciones que TPP en pacientes de edad avanzada. Este método, sin embargo, puede no estar indicada para pacientes más jóvenes en buen estado general.
PMID:
 
22252413
 
[PubMed - indexed for MEDLINE] 
PMCID:
 
PMC3353076
 
Free PMC Article

viernes, 12 de diciembre de 2014

Study shows better outcomes with trabecular shoulder prosthesis in proximal humeral fractures

Este artículo es originalmente publicado en:
http://www.healio.com/orthopedics/shoulder-elbow/news/online/%7B53747292-d06c-4248-b04c-f365b83ab6e3%7D/study-shows-better-outcomes-with-trabecular-shoulder-prosthesis-in-proximal-humeral-fractures

IN THE JOURNALS

Study shows better outcomes with trabecular shoulder prosthesis in proximal humeral fractures

Estudio muestra mejores resultados con prótesis de hombro trabecular en las fracturas de húmero proximal

miércoles, 10 de diciembre de 2014

Managing Osteochondritis Dissicans of the Capitellum

Este artículo es originalmente publicado en:
http://icjr.net/article_105_elbow_rgr#.VIhXmTGG-An


Managing Osteochondritis Dissicans of the Capitellum

A young gymnast presents with a history of recurrent elbow pain, swelling, and locking and catching. She has failed conservative treatment. When an unstable OCD lesion of the capitellum is diagnosed, the authors recommend elbow arthroscopy, removal of a loose body, and microfracture of the OCD lesion.
By Edward Chang - December 8, 2014

Authors
Edward S. Chang, MD, and Christopher C. Dodson, MD
Disclosures
The authors have no disclosures relevant to this article.
Background
Osteochondritis dissecans (OCD) of the capitellum is a rare disorder generally seen in the immature athlete. The exact etiology is unclear, however there is an association between this condition and athletes that sustain repetitive trauma to the radiocapitellar joint (ie, overhead athletes, gymnasts).
The typical presentation is in a young athlete with lateral elbow pain and swelling that is worse with activity and improves with rest. A detailed history and physical examination, along with advanced imaging modalities, can lead to early diagnosis.
Treatment of OCD lesions depends on the size, grade, and location:
  • Stable, low-grade lesions can be treated with rest and activity modification, with gradual return to sports.
  • Operative treatment is generally indicated for:
    • Unstable lesions
    • Presence of loose bodies
    • Mechanical symptoms
    • Failure of non-operative treatment
Surgical techniques range from debridement to fragment fixation to osteochondral autograft transplantation surgery (OATS). Clinical outcomes and return to sport vary by surgical technique, and long-term results are still needed to assess its efficacy.

The following case illustrates a classic presentation of a young gymnast with OCD of the capitellum who underwent successful treatment via arthroscopic repair.