TRAUMATOLOGY

Author: ROTLLANT SOLA ROSA.
Year: 2002.
University: BARCELONA [More theses of this university] [www.ub.es].
Place of preparation: UNIVERSIDAD DE BARCELONA.

Summary: INTRODUCTION The orthopedic treatment remains key to modify the natural history of idiopathic scoliosis (EI) and corsets plaster EDF influenced to a significant degree. The treatment is complex and requires a lot of dedication from both the optional and the family. This paper is intended to facilitate the entire process. PURPOSE The purpose of this study is to demonstrate that the introduction of fiberglass in the manufacture of corsets EDF, reduces the overall cost without significant loss of correcting the Cobb angle or rotation ápex, both of the curve higher as for the minor. MATERIALS AND METHODS This is a study done in consecutive HU Bellvitge on orthopedic treatment of scoliosis. Look into three sets of patients with IE in a period of growth that has been treated by the method EDF made in the Framework Abbot-Cotrel, with different variations in their realization. The Series A (hospitalization n = 19), all patients prior to EDF have required hospitalization remained in continuous spinal traction, an average of 7.5 days and EDF has been made of plaster bandages. The Series B (Day hospital n = 19), patients have not required after continuous spinal traction, have remained in the hospital 5 hours on average and the EDF has been made of plaster bandages. In the C series (Ambulatory n = 25), patients have not required prior continuous traction, have remained in External Consultation 2.5 hours on average and the EDF has been made of fiberglass bandages. Statistical Method: In all parameters the level of statistical significance was felt that he had to be less than 5% (p less 0.05). It has used the Kruskal-Wallis non - parametric test for analyzing the homogeneity of all three series, finding no significant differences between age of diagnosis, Cobb angle and rotation curves spinal preEDF of major and minor of the three sets. For the test x2 not observe significant differences in correcting the Cobb angle and rotation spinal postEDF between the three sets. Yes there is a significant reduction of expenditure on health in the C series because it is not necessary prior income, thereby decreasing the number of doctor visits, the time and hours of physiotherapy hospital. CONCLUSIONS We believe that the introduction of fiberglass in the orthopedic treatment of escoliasis has meant an improvement of the entire process. They reduce the cost but not the correction.

Author: AL-GHANEM NABHAN RANIA.
Year: 2004.
University: ZARAGOZA [More theses of this university] [www.unizar.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: UNIVERSIDAD DE ZARAGOZA.

Author: GONZALEZ PEDROUZO JOSE EDUARDO.
Year: 2005.
University: ROVIRA I VIRGILI [More theses of this university] [www.urv.cat].
Place of defense: FACULTAT DE MEDICINA I CIENCIES DE LA SALUT.
Place of preparation: FACULTAT DE MEDICINA I CIENCIES DE LA SALUT.

Summary: At present the treatment of vertebral fracture type outbreak of the union tóraco-lumbar remains controversial. Within the surgical treatment, the most widely used and accepted is mounting post short transpedicular with or without instrumentation of the fractured vertebra. In the literature found no study comparing two treatment methods. Our working hypothesis is to assess which of the two methods will get the best results radiology. To appreciate this: correction and stability in the previous column, the correction of the deformity and the restoration of alignment in the sagittal plane and the failure rate of spinal assembly. We analyzed retrospectively in two groups of patients who meet the 15 inclusion criteria set forth in the study. Group A are the patients with instrumentation of the fractured vertebra. And the group B are patients without instrumentation of the fractured vertebra. The data and iconography of the 43 medical records are collected and analyzed by a single observer. Of all the patients gather in a Pre-Op, post-operative and to meet the minimum years of evolution, radiographs in simple terms and antero-lateral. All radiographs were digitized by a scanner brand: Epson GT-12000à through the driver Epson Twain Pro-32 (version 1.01) Ã. Using the computer program Micrografx Picture Publisher 8.0Ã, different images are processed to improve quality. It uses the computer program AutoCAD 2000 in castellanoà to determine a number of angles and adimensionales measures, which allow us to perform the measurement of different angles and applying the method of proportions to make different measurements radiological. All data and radiological measurements are stored in a data table designed for the study according to the software Microsoft Access 2000Ã. There will always be a descriptive statistical analysis, and an analysis univariable univariable analysis of repeated measurements (MANOVA). The level of statistical significance was accepted p £ 0.05. We radiological measurements in different radiology simple in the sagittal plane (kyphosis regional type 1, type 2, type 3, type 4, type 5, type 6, spinal kyphosis, index sagittal, angulation regional traumatic, angle of the back wall, percentage compression of the spinal height above, the percentage of vertebral compression height later quotient of the previous vertebral height / posterior vertebral height of the fractured vertebra, ratio of the height of the anterior spinal unit / height of the spinal unit later) and at the antero (spinal angulation side, the percentage of widening interpedicular). All measurements were repeated in each patient by three periods of the study. As most significant findings include: 1) patients with instrumentation of the fractured vertebrae have a better post-operative radiographic outcome than patients without instrumentation of the fractured vertebra in the regional kyphosis: CR2, CR4, CR5, CR6, IS ART and the ratio AUVA / AUVP; 2) patients with instrumentation of the fractured vertebrae have a better result in radiological monitoring than patients without instrumentation of the fractured vertebra in the regional kyphosis: CR1, CR2, CR3, CR4, CR5 , CR6, IS ART, PDB, VC and the quotient AUVA / AUVP; 3) patients with instrumentation of the fractured vertebrae have a better initial correction, lower loss and maintain correction in the evolution of the body height above vertebral better than in patients without instrumentation of the fractured vertebra (depending on the values of CV percentage of the AVA and the quotient AVA / AVP); 4) patients with instrumentation of the fractured vertebrae are 8 best ev d15 olución radiation patients without instrumentation of the fractured vertebra in most radiological measurements analyzed according to the analysis of variance (MANOVA); 5) patients with instrumentation of the fractured vertebrae have a failure rate of spinal mounting virtually zero in compared to patients without instrumentation of the fractured vertebra. The results of the present research in the scientific community by publishing several articles in international journals (European Journal of Spine, Injury, Journal of Bone and Joint Surgery, Journal of Spinal Disorders and Spine), national (Journal of Orthopedics and Traumatology ) and communications conference (GEER, SECOT, SCCOT, SICOT, NASS). The titles of different items will be: 1) Divide outbreak tóraco-lumbar. Radiological study of the comparative short post mounts with and without instrumentation of the fractured vertebra. 2) Implementation of the fractured vertebra. Importance of intermediate screw on the stability of the column earlier in the outbreak fracture. 3) Reduction in the rate of failures mounts short transpediculares by implementing the fractured vertebra. 4) The importance of fixing three points in the fracture outbreak tóraco-lumbar through subsequent stagings short. 5) Measurement of different types of kyphosis regional fracture outbreak. What's the most useful?. 6) Utility of the ratios between the anterior and posterior wall of the vertebral body in the assessment of the results in the fracture outbreak tóraco-lumbar. 7) epidemiological study of the fracture outbreak tóraco-lumbar treated through subsequent stagings short transpediculares. With this work we have begun a line of research in the field of vertebral fracture type outbreak of the union tóraco-lumbar. In the laboratory we are comparing resistance biomechanics of the instrumentation and non-fractured vertebra in subsequent stagings short columns pigs, where there has been an outbreak fracture through a machine designed to produce loads. Using the material of the thesis will make future work: 1) Comparison of accuracy, reproducibility and reliability of the measurements manuals address the digital divide in the outbreak tóraco-lumbar. 2) consistency within and inter-observador of different radiographic measurements analyzed according to a digital method. 3) Correlation of the results with the radiological clinic patients through different scales of functional assessment (SF-36 and Oswestry).

Author: OLIVE VILAS RAMON.
Year: 2005.
University: BARCELONA [More theses of this university] [www.ub.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: INTRODUCTION By joining Taekwondo (Korean martial art) as Olympic discipline demanded control and monitoring sports doctor allowed it noted that some of these athletes had a picture in the chain symptomatic limiting their sporting performance. In the literature there are no international work on this pathology. MATERIALS AND METHODS We have studied a population of 40 athletes (20 women and 20 men) taekwondo practitioners of the national teams from Spain, Mexico and Venezuela, after obtaining informed consent. The only requirement to join the study was to have been a minimum of 6 years in the national team whatsoever. For the athletes are subjected to an examination and clinical examination, radiological Simplex (front and profile project to fake. Dunlap), CT, MRI, study coordinated video platform forces and electromyography. RESULTS Our population of 40 athletes with an average age of 24.68 in 16 (40%) had clinical (pain) at the hip and meet the criteria of the American Academy of Rheumatology to be classified as artrósicos. Only angle VCA Dysplastic was statistically significant as a risk factor. Alterations are also a bone proliferative (steofito and osteocondensación). In soft tissue injuries of upper labrum was the most frequent in the symptomatic hip. The peak vertical projection on the hip support are 2.3 times the body weight during the execution of the techniques of combat, the muscle groups most active: m.oblicuos, m.multífidus and m.cuadrieps and ranges mobility articulate more demanding for the bending can be achieved with the technique Neryo for leg impact and Tuit with support. DISCUSSION osteoartrosis incidence in young people is 100 new casos/100.000 inhabitants years, the prevalence in persons 25-39 a.es of 1.9%. The incidence of coxartrosis in athletes increases at 4.5 times that of the general population. In our population prevalence of arthritis was 40% greater tendency affectation hip support and with a higher incidence in women. CONCLUSIONS The table can categorized as symptomatic osteoarthritis early athlete. The clinic is the most frequent pain. The most frequent bone lesions are proliferating. The angle VCA dysplastic statistical significance. The radiology is a simple test that presumption is tempered by studies of CT and MRI. KEYWORDS Taekwondo, osteoarthritis, radiology, pain, hip, coxartrosis, electromyography, silver form of forces, videography, biomechanics, mmondollio, Bandal, Neryo, Tuit. Dollio.

Author: RODRÍGUEZ FERNÁNDEZ PEDRO JOSE.
Year: 2005.
University: CÓRDOBA [More theses of this university] [www.uco.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: The hip fracture especially in the elderly, re-presents a problem not only important for their doctor high prevalence and morbidity, but also has enormous social implications. It is estimated that 20% of women aged over 80 years suffer a hip fracture. OBJECTIVES Valuing the impact the delay surgery for more than 48 hours at the onset of medical complications during a surgical or postoperative first year in elderly patients who suffer hip fracture in our area hospital. Besides trying to verify whether a surgical intervention during the first 48 hours of hip fractures in the elderly improves functional recovery as the morbidity and mortality associated with this disease in the same time period. MATERIALS AND METHODS To achieve our study we have seen two groups of patients. One of them is you group of patients treated early for the first 24-48 hours after the fracture. The second group includes those patients who had fractures of each era during which as a result of a fire in our hospital decreased activity surgery. Patients were evaluated by clinical history and physical examination. All patients were picked up the following variables as age (years, gender, personal history, provenance (own home or family residence), type of fracture, functional level prior to the fall, after pathology and medication routine. Revisions to patients per month were recorded for the three and six months and a year of the intervention and were conducted in the outpatient or contacted by phone. were also questioned about their patients toxic habits (alcohol and snuff). RESULTS We noticed that early in the surgical treatment does not influence the mortality so early as late in the first year. however, we detected a statistically significant improvement in terms of the emergence of both pressure sores are concerned, thromboembolic disease, pneumonia, gastrointestinal bleeding and other complications clinics. CONCLUSIONS We believe that the earliness of the surgery does not reduce mortality, but are reduced medical complications.

Author: SÁNCHEZ LÁZARO JAIME ANTONIO.
Year: 2006.
University: LEÓN [More theses of this university] [www.unileon.es].
Place of defense: FACULTAD DE BIOLOGÍA.
Place of preparation: FACULTAD DE BIOLOGÍA.

Summary: In streamlining the treatment of a knee with no Crossfire Previous Ligament (ACL) is the prediction of primary progressive deterioration of the same. This deterioration is due to the high incidence of laxity previous rotational instability and meniscal injuries associated evolve toward osteoarthritis. Osteoarthritis is a degenerative disease that has a high prevalence in our society, and that moves inexorably towards the destruction of the joint. The aim is to diagnose osteoarthritis emerging that is triggered after the ACL tear, and that until now could only be assessed with radiographic evidence that detect very advanced stages of the disease. Patients in the study were patients with complete ACL injury that might ligamentoplastia, to which were valued preoperatoriamente a form of subjective assessment of the role articulate (IKDC), and measuring the instability of the knee injured in millimeters (KT2000 ). Later samples were obtained synovial fluid and cartilage arthroscopic biopsy in the context of the reconstruction of LCA.Se conducted to quantify apoptosis of chondrocytes through the techniques of apoptosis in situ TUNEL method through and quantify apoptosis through technique citométrica. It quantified the molecular weight and concentration of Hyaluronic Acid synovial fluid. It was determined the Nitric Oxide (NO) through an indirect, one for the quantification of mRNA of the enzyme inducible nitric oxide synthase (iNOS), and another through the quantification of stable NO metabolites, nitrites and nitrates. Of all the diagnostic methods for the direct visualization arthroscopy remains the method par excellence. The results obtained highlight: The greater the displacement of the tibia respect to the femur (KT2000), lowest score IKDC and less concentration of AH. There is a positive correlation pending the KT2000 and between the time evolution of the ACL injury. By increasing the time evolution of the injury decreases the concentration of AH in synovial fluid. In older fewest AH in synovial fluid. The average molecular weight of AH was found in the order of 2x106 Daltons. By reducing the IKDC enhances apoptosis measured by the TUNEL method and citómetro well as increased concentrations of nitrites. The relationship between apoptosis measured by TUNEL and nitrite concentration is not yet positive. There is a strong relationship between apoptosis measured by TUNEL and the age of patients. By increasing the concentration of nitrite reduces the concentration of synovial AH. We found, despite having partial results with the determination iNOS by PCR-RT an important statement of the quantity of mRNA detected with the concentration of nitrite obtained. We did not find any significant differences between the study groups on the basis of sex and the presence of injury or not affiliated. Following this work, we can conclude that: The diagnosis of ACL injury is based on the use of MRI and arthroscopy, but the clinical assessment of the patient with the KT2000 and IKDC us closer to the same cartilage injury. The determination of the molecular weight and concentration of AH give us information about the injury condral especially in the first six months of evolution of the injury. The study citométrico of chondrocytes is a useful tool to determine the status of cartilage associated with the injury. The study of apoptosis in situ has an important 8 limitac 612 ion when the sample is obtained by biopsy. The concentration of stable NO metabolites relates modestly with the cartilage injury. The determination with PCR-RT seems to be a good technique for quantifying indirect NO, but it is a complex technique to be debugged in future studies. The time evolution of the injury is a bad prognostic parameter for the development of the lesion condral. Age is a parameter that alone is not used to predict a worse prognosis of the injury. As a final conclusion after analyzing all the data support the ligamentoplastia ABI as a first and essential step in the prevention and treatment of injury articulate evolving toward osteoarthritis. Further studies should be conducted to assess the association to ligamentoplastia drug condroprotectores

Author: ALDECOA LLAURADO JAVIER.
Year: 2006.
University: ROVIRA I VIRGILI [More theses of this university] [www.urv.cat].
Place of defense: HOSP. UNIVER. JOAN XXIII DE TARRAGONA.
Place of preparation: UNIVERSIDAD AUTONOMA DE BARCELONA.

Summary: Introduction: The surgical decompression of carpal tunnel syndrome (STC) is the more frequently performed by surgeons in the hand. Local changes secondary to that procedure are not yet well known. The high definition ultrasound (EAD) is being increasingly used in the diagnosis of various musculoskeletal diseases. Objective: To study whether EAD through morphological changes in the median nerve, and its timing, after surgical decompression in the STC. Materials and Methods: We performed a prospective observational study of cases and controls. Clinical checks were carried ultrasound and the median nerve, patients suffering from idiopathic STC (n = 44). A linear transducer was used to 11 MHz, the nerve studied at three different levels of the wrist. The studies were conducted preoperatoriamente, a month, three and six months after the surgery. We calculated the areas section, the ratio of edema and ratios flattening of the nerve. The results were correlated with ultrasound clinic, the initial ultrasound and ultrasound scans obtained in two control groups. The first consisted of patients with similar characteristics but no intervention (n = 26) and the second by dolls asymptomatic volunteers (n = 40). Results: We describe the clinical and sonographic evolution of the three study groups. There were significant changes in the morphology of the median nerve in the three groups studied. The evolutionary trend of the nerves uncompressed was not different from the uncompressed. Within six months of their intervention ultrasound parameters were not standardized. Conclusions: Our results suggest that there is no criteria to enable ultrasound to predict a good evolution of the surgical decompression of the median nerve at the STC. Keywords: carpal tunnel syndrome, median nerve, ultrasonography, postoperative.

Author: Ardura Aragón Francisco.
Year: 2006.
University: VALLADOLID [More theses of this university] [www.uva.es].
Place of defense: Facultad de Medicina.
Place of preparation: FACULTAD DE MEDICINA, UNIVERSIDAD DE VALLADOLID.

Summary: Objective: assessment of the relationship between skeletal fractures purpose of the trauma and temporal dimension. Materials and Methods: studied 57310 patients hospitalized with fractures of the community, from 1999 to 2004. We conducted univariate analysis and logistic regression; study ritmométrico with spectral analysis (Fourier transform) and method cosinor, to investigate the existence of pace, all in the group total fractures, and the anatomical subgroups by region: humerus, wrist, hip, leg, upper limb and lower limb. Results: at work are shown epidemiological data for each subgroup anatomical. Logistic regression showed increased risk for hip fracture with age, sex women, urban and cardiovascular disease, neurological and mental. The analysis of rhythm were obtained following resutlados: spectral analysis: dominant period of 365 days. Analysis cosinor: rhythm significant (acrofase 11 / 8 and batifase 17/12). All subgroups showed pace, and for most subgroups according variables. Traffic and traffic are not similar rhythms. The hip fracture presents a pace different from the rest of fractures, at the expense of women, because men present pace similar to other men with fractures. The information provided in this work are pioneers in the field of traumatology. Introducing regions not previously studied. As for other work, our data are sometimes conflicting, but in most published studies have not been conducted study cronobiológico like ours. The study data cronobiológico can be applied in the clinic, through resource planning with a sense temporary. Keywords: Divide, orthopedic surgery, orthopedics, hospitalization, cronobiología, biorhythms, variability, circanual seasonal.

Author: GARCIA PARRA PABLO.
Year: 2006.
University: VALLADOLID [More theses of this university] [www.uva.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA DE VALLADOLID.

Summary: It explores the scientific productivity fracture generated from the year 1500 to 1925, using as tools of bibliometric indicators and cienciométricos productivity, circulation, impact and consumption. It is concluded that the scientific literature on fractures has increased in a linear fashion until the nineteenth century, by which time there is an exponential growth until today. It analyzes the producing countries, languages, cities printing areas and bibliometric indicators.

Author: Ardura Aragón Francisco.
Year: 2006.
University: VALLADOLID [More theses of this university] [www.uva.es].
Place of defense: Facultad de Medicina.
Place of preparation: FACULTAD DE MEDICINA, UNIVERSIDAD DE VALLADOLID.

Summary: Objective: assessment of the relationship between skeletal fractures purpose of the trauma and temporal dimension. Materials and Methods: studied 57310 patients hospitalized with fractures of the community, from 1999 to 2004. We conducted univariate analysis and logistic regression; study ritmométrico with spectral analysis (Fourier transform) and method cosinor, to investigate the existence of pace, all in the group total fractures, and the anatomical subgroups by region: humerus, wrist, hip, leg, upper limb and lower limb. Results: at work are shown epidemiological data for each subgroup anatomical. Logistic regression showed increased risk for hip fracture with age, sex women, urban and cardiovascular disease, neurological and mental. The analysis of rhythm were obtained following resutlados: spectral analysis: dominant period of 365 days. Analysis cosinor: rhythm significant (acrofase 11 / 8 and batifase 17/12). All subgroups showed pace, and for most subgroups according variables. Traffic and traffic are not similar rhythms. The hip fracture presents a pace different from the rest of fractures, at the expense of women, because men present pace similar to other men with fractures. The information provided in this work are pioneers in the field of traumatology. Introducing regions not previously studied. As for other work, our data are sometimes conflicting, but in most published studies have not been conducted study cronobiológico like ours. The study data cronobiológico can be applied in the clinic, through resource planning with a sense temporary. Keywords: Divide, orthopedic surgery, orthopedics, hospitalization, cronobiología, biorhythms, variability, circanual seasonal.