[Arthroscopic biceps tenodesis with a «relaxed» technique.Clinical and radiological results of a prospective cohort]

INTRODUCTION

in the treatment the long head of the biceps tendon (LHBT) pathology, the «relaxed tenodesis» is an arthroscopic articular suprapectoral tenodesis that seeks to lower the tension on the LHBT, and therefore, theoretically avoid persistent pain.

OBJECTIVE

to assess clinical and radiological results of «relaxed» tenodesis in a prospective cohort of patient with work related illness.

MATERIAL AND METHODS

prospective cohort, 54 shoulders with «relaxed» tenodesis performed with an intra-articular interference screw by the same surgeon, from October 2014 to 2018, in a level 1 trauma center. Demographic, clinical, functional and radiologic results were analyzed. On 6 months follow-up, a sonographic and clinical assessment was performed.

RESULTS

mean age 49 ± 9, mean follow-up 16 ± 4 months. The main diagnosis was a rotator cuff tear in 79%, primary biceps pathology in 10% and other pathologies in 11%. At the end of follow-up, the cohort showed active anterior elevation 157.7 ± 22.7, external rotation 47 ± 16.6, median internal rotation T12, Constant Score 83 ± 12.05 points, subjective shoulder value 83 ± 12.97% and pain visual analogue scale 1.4 ± 1.7 points. One patient had a biceps tear and two had cosmetic arm asymmetry. On ultrasound 98% had the LHBT in situ and 10% had inflammatory changes on the bicipital groove. There were complications in 21% of the sample.

CONCLUSIONS

«relaxed biceps tenodesis» is a technique that shows good clinical, functional and sonographic results, with low failure rate.

[Comparative analysis of three models of reverse shoulder prosthesis based on the new angles of distalization and lateralization]

PURPOSE

Compare functional and radiological outcomes of three different designs of reverse shoulder arthroplasty according to distalization and lateralization shoulder angle, in heterogenic diagnostics (fracture, cuff arthropathy, fracture sequela and osteoarthritis).

MATERIAL AND METHODS

Prospective cohort of 33 patients of reverse shoulder arthroplasty (RSA) between December 2014 and July 2017 with a minimum one year of follow-up. We defined three groups, G: 10 patients with Grammont (155o, Medialized Glena), B: 9 patients with Bio-RSA (155º, lateralized bone glena) and A: 14 patients with Arrow (135o, lateralized metallic glena). We analyze demographic, clinical, functional and radiological outcomes (lateralization shoulder angle (LSA) and distalization shoulder angle (DSA)). For the statistical analysis, ANOVA, T-tests and linear regression tests were used, with a statistical significance of 5%.

RESULTS

The LSA was significantly higher in group A (98o A, 79o G, 80o B) (p < 0.05). In DSA, group B was significantly higher than A (52o B, 39o A) (p < 0.05) and not significant to G (48o G) (p = 0.06). There was no correlation of LSA and DSA with external rotation (p = 0.51) and active elevation (p = 0.41), respectively. There was no significant clinical (anterior elevation, external rotation, internal rotation) and functional outcomes (adjusted Constant score and subjective shoulder evaluation) differences between the different RSA models (p > 0.05).

CONCLUSIONS

The LSA was higher in the Arrow and the DSA was higher in Bio-RSA. We did not find Clinical - Radiological correlation in this heterogeneous series of patients.

A narrow intercondylar gap favours anterior cruciate ligament (ACL) rupture in patients with an immature skeleton

OBJECTIVE

Anatomical risk factors predisposing to anterior cruciate ligament (ACL) and/or avulsion fractures of tibial spines (AFET) have been reported in paediatric patients with controversial results. Our aim is to compare morphometric parameters in magnetic resonance imaging (MRI) of patients with immature skeleton presenting AFET or ACL rupture versus healthy controls.

METHODS

Observational study of a transverse cohort where all those patients with immature skeleton presenting ACL rupture or AFET were collected consecutively. A control group of patients with open physis and MRI reported without lesions was added. A trained observer measured in each MRI with previously standardized technique: a)the width of the intercondylar femoral notch, and b)the opening angle of the intercondylar femoral notch.

RESULTS

The sample was composed of 11 patients with ACL rupture, 11 patients with TEA and 11 normal controls. The opening angle of the intercondylar femoral notch, measured in axial and coronal sections, was significantly lower in those patients with ACL rupture versus healthy controls (P=.0256 and P=.0097). The rest of the variables studied did not present significant differences between groups.

CONCLUSION

In patients with an immature skeleton, a narrower femoral intercondylar notch is associated with ACL rupture, while those with an ETF do not present a distinctive bone anatomy versus healthy controls. These findings suggest that bone morphometric parameters are associated with a lesional or other pattern in open-knee.

[Tendon transfers around the shoulder for patient with brachial plexus injury sequels]

Brachial plexus lesions can significantly affect patient function. The type of management will depend on the severity of the injury as well as the anatomical location. Tendon transfers around the shoulder have emerged as an effective treatment alternative, and therefore we should consider them when faced with patients who might require it. There are various transfer techniques, within which the most frequently used are upper trapezium, latissimus dorsi and lower trapezium transfers, each with its specific indications and objectives depending on the type of patient. These surgeries aim to decrease the pain resulting from the hypotonia and glenohumeral subluxation as well as improve the range of movement of the shoulder, getting the patient to take his hand to the plane that requires to perform his daily life activities. We will provide a description of some of the most commonly used shoulder tendon transfer techniques associated with a bibliographic review and a description of our experience with these surgeries.

Remote triggering of thermoresponsive PNIPAM by iron oxide nanoparticles

Thermoresponsive PNIPAN can be remotely triggered by embedded iron oxide nanoparticles under an AC field, and the transition temperature can be tuned by changing the ionic concentration.

[Prevalence of E. coli O157:H7 in a pediatric population in Bogotá, D.C. with acute gastroenteritis]

BACKGROUND

The aim of this study was to determine the prevalence of E. coli O157:H7 in pediatric patients with acute gastroenteritis (AGE).

PATIENTS AND METHODS

A prospective epidemiologic study was performed in cases and controls to detect the germ in fecal samples of 300 children with AGE in Bogotá, D.C. The stools of the patients and 85 controls were seeded in MacConkey-sorbitol agar. The sorbitol negative colonies were biotyped and seroagglutinated with a latex test for E. coli O157:H7. Antimicrobial susceptibility was performed after using the Bauer & Kirby method.

RESULTS

Of the 300 diarrhea specimens analyzed, 14 strains corresponded to E. coli O157:H7 with a prevalence rate of 4.7% in children with AGE. The prevalence was 1.14%, the excess of risk of presenting E. coli O157:H7 was 14% in children with AGE. One child developed SUH. In three of the 85 controls E. coli O157:H7 was isolated, with a prevalence rate of 3.53%. The mean age of the 14 patients was 21 months (range: 3 months to 7 years) and the mean length of diarrhea in the children was 2 days. All the isolations of E. coli O157:H7 were sorbitol negative and indol negative with only 2 strains being MUG negative.

DISCUSSION

This epidemiologic study has, for the first time, demonstrated the strong prevalence of E. coli O157:H7 in Colombia. The clinical data do not show a common pattern. Whether the strains isolated in the study are verotoxin producers remains to be demonstrated.