[Functional assessment in total knee arthroplasty comparing the posterior cruciate ligament preservation versus postero-stabilization]

INTRODUCTION

The two most commonly used types of prostheses are the total knee prosthesis with posterior cruciate ligament preservation and posterior cruciate ligament replacement.

OBJECTIVE

To assess whether there is a difference in functionality between the two procedures.

MATERIAL AND METHODS

Observational, retrospective and cross-sectional study with 134 patients divided into group A (N = 67) with ligament preservation and group B (N = 67) with posterior substituting. Using the American Association Scale for Knee Prosthetics with Insall modification to assess functionality. Statistical analysis: use of 2 with Yates correction.

RESULTS

In group A the results: excellent (31%); good (24%); regular (22%) bad (22%). In group B the results: excellent (34%); good (31%); regular (16%) and bad (19%); without statistical difference between the two groups.

CONCLUSIONS

No statistically significant difference was observed between age, gender, laterality of injury, or between number of patients with excellent results, good regular and bad according to the scale used. The high percentage of poor results in both groups of this series for the knee prosthesis is striking.

[Injury of the anterior branch of the posterior interosseous nerve]

INTRODUCTION

Posterior interosseous nerve syndrome, a branch of the radial nerve at the level of the forearm, is characterized by the motor function loss of some or all of the muscles innervated distally.

CLINICAL CASE

A 26-year-old male with a history of proximal radius fracture associated to radial nerve injury, treated with osteosynthesis 7 years earlier, with full recovery, who currently presented intense pain 4 cm distal to the radial head, accompanied by paralysis of Extensor pollicis longus, Extesnor pollicis brevis and Abductor pollicis longus, with paresis of the Extensor indicis propius, in which a diagnosis of entrapment syndrome of the anterior descending branch of the posterior interosseous nerve (SNIP) was performed.

DISCUSSION

The conservative management of SNIP is indicated during the first 8-12 weeks, if no improvement is found, the indication for surgical exploration is indicated, and the removal of osteosynthesis material is controversial.

[Parathyroid carcinoma: diagnosis by a femur fracture]

BACKGROUND

Carcinoma of the parathyroid gland (PC) described by De Quervain since 1909, it represents the least common neoplasm, with an incidence of 1,25/10,000,000 peoples. It has been reported approximately 1,000 cases of CP in world literature. There are two series in Mexico, one of eight patients and other with four cases. Because CP is functionally active, its early clinical behavior is similar to that of parathyroid benign neoplasms.

CLINICAL CASE

A 66-year-old female with history of thighbone pain and spontaneous femoral fracture, osteolytic lesions, hypercalcemia, elevated levels of alkaline phosphatase and parathyroid hormone detected; the scintigraphy showed a functioning tumor located in upper mediastinum. By hemithyroidectomy in block, the tumor was resected. Histopathological study reported parathyroid carcinoma.

DISCUSSION

PC is the least common neoplasia, in patients with parathyroid hormone levels greater than 1,000 pg/ml and hypercalcemia upper of 14 mg/dl this disease should be suspected.

[Shoulder injuries in the elderly and their functional impact on the DASH scale]

INTRODUCTION

Disabling shoulder problems in the elderly are common.

OBJECTIVE

To quantify the diagnoses found in 100 consecutive shoulders cases in rehabilitation and its functional impact on the DASH scale.

MATERIAL AND METHODS

100 consecutive patients with age 65 years received in the Rehabilitation Department, performing diagnosis and functional assessment in the DASH scale.

RESULTS

Distribution by gender with predominance of the female (67%); the age showed variation from 65 to 98 years with average and SD 78 ± 12. Ten different diagnoses were found: supraspinatus tendon rupture (58%); gleno-humeral osteoarthritis (11%); impingement syndrome (9%); proximal humeral fracture (9%); acromio-clavicular osteoarthritis (7%); long biceps tendon rupture (2%); scapula fracture (1%); humeral head avascular necrosis (1%); neglected gleno-humeral dislocation (1%) and circumflex nerve injury (1%). The distribution corresponded to 52% right, 40% left and 8% bilateral. The DASH scale showed variation from 94 to 52% with mean and SD 71 ± 22.3. Elderly shoulder problems are associated with disability, its relation with DASH is not clear.

[Quadratus femoris muscle tear]

BACKGROUND

Quadratus femoris tear is an uncommon injury that usually cause hip pain, it incidence is unknown. The patient can suffer of posterior gluteal pain or groin pain or both, which makes accurate diagnosis difficult, because the differential diagnosis of hip pain is broad.

CLINICAL CASE

A 65 years old male, with gluteal and groin pain presented during tennis; evaluated by neurologist with lumbosacral magnetic resonance imaging (MRI) (normal) and referred to physical therapy, a pelvic MRI was required, finding an unsuspected quadratus femoris tear.

CONCLUSION

MRI with its superior soft-tissue resolution and multiplanar capability is an excellent adjunct to physical examination because it shows the anatomic location of the abnormality, aiding the clinician to make unsuspected diagnoses.

[Iliacus muscle injury caused by inadequate exercise]

BACKGROUND

Traumatic iliacus muscle injury is rare; it is usually caused by trauma or intense exercise involving the pelvic girdle; it can produce a hematoma with femoral nerve neuropathy. Spontaneous muscle hematomas occur in patients with coagulation disorders.

CLINICAL CASE

A 45-year-old male with 18 days of evolution, with an intense pain in the right buttock, groin and iliac fossa, with an inability for hip flexion and ambulation caused by inadequate exercise (supine double leg lifts). On the physical examination: intense pain with bending and/or internal rotation of the right hip, positive Thomas maneuver, quadriceps rated 3/5; area of paresthesia in the right femoral nerve territory. Pelvic magnetic resonance imaging showed: right iliacus muscle tear with blood between its fibers. Initial treatment was rest and analgesics for eight days and gradual extension of the hip, axillary crutches with partial weight bearing and diathermy on the right abdominal lower quadrant, active hip exercises, bicycle and right quadriceps strengthening. The evolution was satisfactory, with full recovery in six weeks.