Dr Michell Ruiz

Dr Michell Ruiz
Cirugía de hombro y del Manguito rotador

jueves, 27 de marzo de 2014

Isolated Tubercular Osteomyelitis of Scapula – A Report of Two Cases and Review of Literature

Isolated Tubercular Osteomyelitis of Scapula – A Report of Two Cases and Review of Literature

Abstract
Introduction: Isolated tuberculosis of the scapula is rare. The presentation mimics the tumors of scapula. Hence it is important to know the clinical presentation and when to suspect tubercular osteomyelitis of scapula. Few cases have been described before. We have analyzed all reports with isolated scapular tuberculosis so far and described the varied presentations.
Case Report: We report two cases of isolated scapular tuberculosis. One patient underwent aspiration and was started on antituberculous drugs ( ATT ) and the other underwent debridement, drainage of abscess and then was started on  ATT. Both had excellent outcomes at the end of one year follow up. We  reviewed previous published literature of isolated scapular tuberculosis. The most common presentation of scapular tuberculosis is as follows: age less than 30 years and there is no difference with respect to gender. Swelling and pain are the commonest symptoms. Lytic areas with surrounding sclerosis is the commonest radiological finding. Body of the scapula is affected most commonly. Prognosis is excellent with adequate treatment.
Conclusion: To conclude, clinicians should have high index of suspicion for diagnosing this condition as it mimics tumors. Pain and swelling is the most common presentation of scapular tuberculosis. Radiography shows lytic lesion with marginal sclerosis. The prognosis is excellent with appropriate treatment.
Keywords: Tuberculosis, osteomyelitis, scapula.

martes, 25 de marzo de 2014

Alexandria Shoulder Arthroscopy Live Surgery Course

Alexandria University in collaboration with Andalusia Hospitals
Presenting (Alexandria Shoulder Arthroscopy Live Surgery Course)
ASALSC
10th - 11th April 2014
Andalusia Shalalat Hospital
For Info:
012 82 75 75 55
Last announcement for Early registration, very limited available numbers.

sábado, 22 de marzo de 2014

Discusión entre pares / 40 days old comminuted # distal humerus in an elderly male


Ashish Gupta ha añadido fotos al álbum "March 21, 2014".
40 days old comminuted # distal humerus in an elderly male . on opening gross comminution was present in both the columns . so did column shortening & recreated the fossa with high speed burr & bone grafting.

jueves, 20 de marzo de 2014

CONGRESO AMECRA 2014


martes, 18 de marzo de 2014

John W. Sperling, MD, MBA, discusses bone deficiency in shoulder arthroplasty

http://www.healio.com/orthopedics/shoulder-elbow/news/online/%7B112067a0-3d6b-4dcc-b6f2-d1451f59f9ba%7D/john-w-sperling-md-mba-discusses-bone-deficiency-in-shoulder-arthroplasty

lunes, 17 de marzo de 2014

Shoulder Infection, Propionibacterium Acne - Everything You Need To Know - Dr. Nabil Ebraheim

Publicado el 17/03/2014
Educational video describing shoulder infection Propionibacterium Acnes.

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sábado, 15 de marzo de 2014

Michell Ruiz en ORS!!!


Michell Ruiz
AAOS done! Ahora viene a presentar el poster del proyecto que mas he disfrutado y sufrido. Empieza ORS! Gracias a todos los involucrados, desde reclutar pacientes, tomar muestras, y procesarlas — con Ivan Encalada y Fernando Valero en Hyatt Regency New Orleans.


viernes, 14 de marzo de 2014

German Association of Shoulder and Elbow Surgery GASES DVSE

http://dvse-kongress.de/dvse2014/

miércoles, 12 de marzo de 2014

Frequency and size of humeral and glenoid bone defects in shoulder instability


Michell Ruiz ha añadido 2 fotos nuevas — en New Orleans Ernest N. Morial Convention Center.

Frequency and size of humeral and glenoid bone defects in shoulder instability

lunes, 10 de marzo de 2014

The impact factor of a journal is a poor measure of the clinical relevance of its papers / El factor de impacto de una revista es una mala medida de la relevancia clínica de sus artículos

Fuente original del artículo:
http://www.bjj.boneandjoint.org.uk/content/96-B/3/414.abstract

The impact factor of a journal is a poor measure of the clinical relevance of its papers

El factor de impacto de una revista es una mala medida de la relevancia clínica de sus artículos
  1. B. Ollivere, MD, FRCS, Consultant Trauma and Orthopaedic Surgeon2;
  2. J. Holley, MRCS, Core Surgical Trainee2; and
  3. C. G. Moran, MD, FRCS, Professor of Trauma and Orthopaedics2
+ Author Affiliations
  1. 1Queens Medical Centre, 16 Topliff Road, Chilwell, Nottingham, NG9 5AS, UK.
  2. 2Queens Medical Centre, Derby Road, Nottingham, NG7 2UH, UK.
  1. Correspondence should be sent to Mr P. Kodumuri; e-mail:dr.preetham.k@gmail.com

Abstract

We evaluated the top 13 journals in trauma and orthopaedics by impact factor and looked at the longer-term effect regarding citations of their papers.
All 4951 papers published in these journals during 2007 and 2008 were reviewed and categorised by their type, subspecialty and super-specialty. All citations indexed through Google Scholar were reviewed to establish the rate of citation per paper at two, four and five years post-publication. The top five journals published a total of 1986 papers. Only three (0.15%) were on operative orthopaedic surgery and none were on trauma. Most (n = 1084, 54.5%) were about experimental basic science. Surgical papers had a lower rate of citation (2.18) at two years than basic science or clinical medical papers (4.68). However, by four years the rates were similar (26.57 for surgery, 30.35 for basic science/medical), which suggests that there is a considerable time lag before clinical surgical research has an impact.
We conclude that high impact journals do not address clinical research in surgery and when they do, there is a delay before such papers are cited. We suggest that a rate of citation at five years post-publication might be a more appropriate indicator of importance for papers in our specialty.
Cite this article: Bone Joint J 2014;96-B:414–19.

Resumen

Se evaluaron las 13 principales revistas en traumatología y ortopedia por factor de impacto y miramos el efecto a largo plazo en relación con las citas de sus trabajos .

Todos los 4.951 artículos publicados en estas revistas durante 2007 y 2008 fueron revisados ​​y clasificados por su tipo, subespecialidad y super -especialidad . Todas las citas indexados a través de Google Scholar fueron revisados ​​para determinar la tasa de citación por artículo a los dos, cuatro y cinco años posteriores a su publicación . Los cinco principales revistas publicaron un total de 1.986 documentos . Sólo tres ( 0,15 %) se encontraban en la cirugía ortopédica operativa y ninguno fue el trauma. La mayoría ( n = 1084, 54,5 %) eran de ciencia básica experimental. Trabajos quirúrgicos tuvieron una menor tasa de citación ( 2.18) a los dos años que la ciencia básica o documentos médicos clínicos ( 4,68 ) . Sin embargo , a los cuatro años, las tasas fueron similares ( 26,57 para la cirugía, 30,35 para la ciencia básica / médico) , lo que sugiere que hay un lapso de tiempo considerable antes de que la investigación clínica quirúrgica tiene un impacto.

Llegamos a la conclusión de que las revistas de alto impacto no se ocupan de la investigación clínica en cirugía y cuando lo hacen, hay un retraso antes de que se citan dichos papeles. Sugerimos que una tasa de citación a los cinco años posteriores a su publicación podría ser un indicador más adecuado de la importancia de los papeles en nuestra especialidad.

Footnotes

  • The authors would like to thank Prof. B. E. Scammell for input with the manuscript.
    No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
    This article was primary edited by A. Ross and first proof edited by J. Scott.
  • Received May 1, 2013.
  • Accepted November 13, 2013.

domingo, 9 de marzo de 2014

Not much support for the use of biologics in rotator cuff repair / Rotator Cuff 13 - Full thickness rotator cuff tears - repair

http://shoulderarthritis.blogspot.mx/2014/03/not-much-support-for-use-of-biologics.html
http://shoulderarthritis.blogspot.mx/2011/09/rotator-cuff-13-full-thickness-cuff.html


Sunday, March 2, 2014

Not much support for the use of biologics in rotator cuff repair.

Application of biologics in the treatment of the rotator cuff, meniscus, cartilage, and osteoarthritis.

Abstract: "Advances in our knowledge of cell signaling and biology have led to the development of products that may guide the healing/regenerative process. Therapies are emerging that involve growth factors, blood-derived products, marrow-derived products, and stem cells. Animal studies suggest that genetic modification of stem cells will be necessary; studies of cartilage and meniscus regeneration indicate that immature cells are effective and that scaffolds are not always necessary. Current preclinical animal and clinical human data and regulatory requirements are important to understand in light of public interest in these products."

With respect to rotator cuff repair, however, the authors conclude that 'synthesis of all the studies illustrates that there is no clear advantage to using PRP (platelet rich plasma) as a surgical adjunct to rotator cuff repair'. A similar statement was made about mesenchymal stem cells.

Comment: While there is no question that platelets, growth factors and stem cells are part of the body's response to injury and healing process, there are many complexities in trying to improve on nature's finely tuned healing response.

As pointed out the Rotator Cuff Tear Book, we consider rotator cuff repair when tendon of good quality can be brought to bone of good quality without undue tension on the repair. We then intentionally create a injury to the bone in the form of trough into which the tendon is secured. By creating this trough, we cause local bleeding and start the response to injury with the natural influx of platelets, growth factors, and stem cells.



Rotator Cuff 13 - Full thickness rotator cuff tears - repair

Full thickness rotator cuff tears are treated by secure reattachment to bone, provided there is sufficient quantity and quality of tendon for a robust attachment with the arm at the side. The goal is to have a smooth distribution of load that is continuous across both the repaired and intact tendon so that disproportionate force concentration on the repair is avoided. Because there is often a loss of tendon substance, repair to bone relatively shortens the tendon. The ability of the muscle to be extended laterally to accommodate for this shortening is limited by (1) the attachment of the capsule to the tendon on one hand and to the glenoid labrum on the other and (2) the attachment of the coracohumeral ligament to the tendon of the supraspinatus and subscapularis laterally and the coracoid medially. Thus, unless the tear is acute, it may be necessary to release the coracohumeral ligament from the coracoid.

 and to release the capsule from its attachment to the glenoid labrum



so that the muscle and tendon can be drawn out further laterally to the insertion. Without such releases the repair may be under undue tension and at risk for failure. After the releases have been performed and after any scar has been dissected from the humeroscapular motion interface, traction sutures are placed in the tendon edge. If good quality tendon can be brought close to its normal insertion site with the arm in adduction, a robust repair can be carried out.



The ideal reattachment technique has the following properties:



(1) yields a smooth upper surface which can articulate congruously with the intact undersurface of the coracoacromal arch 


and avoids knots or tendon edges on the upper aspect of the repaired cuff where they could rub under the coracoacromial arch 





(2) excludes joint fluid from the repair site and accommodates some slippage in the sutures and knots without separation of tendon from bone





(3) creates a secure isometric junction between the tendon and bone spreading the load among numerous sutures 





(4) can accommodate weakened bone at the greater tuberosity





(5) can be accomplished without sacrificing acromion, the acromioclavicular joint, or the deltoid origin 



If there is insufficient quantity and quality of tendon to reach the tuberosity with the arm at the side, consideration can be given to moving the insertion site up to 1 cm medially on the humeral articular surface. If a robust repair cannot be performed, the priority shifts from repair to achieving the smoothest possible upper aspect of the proximal humerus for articulating with the undersurface of the coracoacromial arch. Often the head is translated superiorly because of the loss of the spacer effect of the superior cuff tendon and secondary erosion of the superior glenoid lip


This situation may call for smoothing of the upper aspect of the residual cuff as well as recession of the tuberosities if they are prominent so that the surface presented by the proximal humerus to the coracoacromial arch is smooth – we refer to this as a “smooth and move,” the goal of which is to convert the upper aspect of the proximal humerus into a smooth convexity that articulates congruously with the concave undersurface of the coracoacromial arch. Because the procedure is performed through a deltoid-on approach, no postoperative restrictions are placed so that the patient can move the joint actively immediately after surgery. We have found that when the cuff will not reach to a reasonable insertion site, abducting the shoulder so that repair can be achieved


and then ‘protecting’ the arm in abduction


tends to lead to cuff insertion failure when the arm is brought down to the patient's side.