La pròtesi de tija enforrellada

En el cas de les Hemiartroplàsties per fractures en gent gran la tija protetica enforrellada ( Medcomtech i Acumed ) pot ser de utilitat i possiblement un standard en el futur.

    

Medcomtech / te tijes de 8-10-12 mm de diàmetre i molta versatilitat hemi-inversa bilboquet... mentre que 

Acumed te tijes en diametres de 7 a 15 mm i llargada estandard de 130 mm amb opcio llarga de 200 1 230 mm en 8 mm de diàmetre que la fa util en situacions complexes.  

Informes C de la CV

Informes clinics per Op i postop a la CV : Fets

Al final els millors resultats motiu de tract quirurgic de les fractures de clavícula

Open Reduction and Plate Fixation Versus Nonoperative Treatment for Displaced Midshaft Clavicular Fractures: A Multicenter, Randomized, Controlled Trial

C.M. Robinson, et alt.

J Bone Joint Surg Am, 2013 Sep 4;95(17):1576-1584. doi: 10.2106/JBJS.L.00307

Acute proximal humeral fractures. Hemi vs RSA

Functional outcomes of reverse shoulder arthroplasty compared with hemiarthroplasty for acute proximal humeral fractures 

Matthew J. Boyle, MBChB, Department of Orthopaedic Surgery, Auckland City Hospital. NZ

Journal of Shoulder and Elbow Surgery
Volume 22, Issue 1 , Pages 32-37, January 2013

ConclusionsPatients with acute proximal humeral fractures who undergo RSA appear to achieve superior 5-year functional outcomes compared with patients who undergo hemiarthroplasty.

Sembla que tothom ho te força clar la superioritat de la RSA versus hemi en fractures en gent gran o molt gran. Quina es la edat-funció limits per aquest tractament?

Hemiarthroplasty for Humeral Four-part

Hemiarthroplasty for Humeral Four-part Fractures for Patients 65 Years and Older: A Randomized Controlled Trial 
Harm W. Boons MD, 

No differences could be found in Constant and Simple Shoulder Test scores at three and twelve months. Patients who had nonoperative treatment had better abduction strength at three and twelve months and worse pain scores at three months.There was no clear benefit in association with the use of hemiarthroplasty as compared with nonoperative treatment for patients over the age of sixty-five years with four-part proximal humeral fractures.

 

Aixo pot ser nou i cal veure com han dissenyat el treball ( Diuen Level I terapeutic). De tota manera una funcio limitada amb poques molesties es la norma en moltes fractures desplaçades del cap. Calen mes treballs...

Les ruptures evolucionen en un percentatge...

The Natural History of Asymptomatic Rotator Cuff Tears: A Three-Year Follow-up of Fifty Cases

Stefan Moosmayer, MD, PhD¹; Rana Tariq, MD²; Morten Stiris, MD³; Hans-Jørgen Smith, MD, PhD⁴
Conclusions: 
During a relatively short-term follow-up, a substantial percentage of asymptomatic rotator cuff tears became symptomatic and underwent anatomic deterioration. Increase in tear size and decrease of muscle quality were correlated to the development of symptoms. Subjects diagnosed with an asymptomatic rotator cuff tear should be informed about the natural history of the condition and follow-up with repeated imaging may be indicated to monitor tear progression.

Estaba cregut que la evolucio de una ruptura no era tant segura com es preveia ( Gerber).

Sant Cosme i Sant Damià

Sants Cosme i Damià
Els nostres Sants patrons. Aqui un dels seus miracles, la implantacio de la cama de un Etiop que havia mort la nit abans, a un malalt que tenia un procès gangrenòs a la seva.
Sens dubte els hem de tenir tambe com els patrons de la Microcirurgia  especialment de la re-implantacio d'extremitats. Curiós i un xic esfereidor...

Retaule gòtic pintat per en Jaume Huguet al segle XIV.